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Wednesday, 21 November 2012

Fearing childbirth in the Netherlands and elsewhere: choices, and options

I have written about giving birth in the Netherlands, among others with Lynn on Nomad Parents, and the topic seems to wear me down so much that I didn’t want to write about it again, ever. But now, a very difficult topic seems to be all over the Internet, and it concerns so many women: tokophobia, the fear of giving birth.

How to deal with this? How to help these women? Maybe the way to start is to ask what exactly they are afraid of? For some it would be pain, or the fear of them or their baby dying. For others, it would be fear of medical interventions or ending up with a C section they don’t want. Or the fear that they won’t be able to push their baby out. For some women, the fear of childbirth is so strong that they’d rather not have any children. For all these women, finding a good care provider is crucial.

But what does it mean, exactly? Who is a good care provider? And, how can this apply to the Netherlands? For me, a good care provider is someone who not only takes care of taking all the tests necessary during pregnancy, but also listens to the woman’s concerns and her fears. It is also someone who provides balanced information about pregnancy and birth. And for me, here it gets tricky.

In countries where doctors are primary care providers, many women feel that they are not supported when they desire a natural birth, when their pregnancies are considered risky- like when they have twins, or a breech baby, or have had a previous C section. Many doctors would encourage or sometimes even push these women into inductions, C sections, or instrumental deliveries they don’t want.

In the Netherlands, where midwives care for pregnant women, the opposite might happen: women may feel pushed into having a natural birth even though they feel that a planned C section would be much better for them due to having what they feel is a riskier pregnancy. Or they are being denied effective pain relief. Also, there are women who feel that even without a medical reason, they want a C section, maybe because they don’t want to go through labour and birth, or are afraid of tearing and having problems in the future. These are real concerns and they need to be addressed!

In both cases, the care providers don’t listen to the women’s concerns. In both cases, the women are not satisfied with what their care providers can offer. But what if the system works against them? What if they’re really afraid of having a C section but can’t find a provider who would offer a natural birth (we’re talking about cases where mom and baby would not necessarily die but the doctors are just being careful)? What about the women who are afraid of natural births but are being denied a C section?

Here’s the thing: nobody should fight for their right to give birth in a certain way if that choice is a legitimate one. Is a natural birth after a C section, or with a breech baby, or twins, a legitimate option? It is. Is a maternal request C section without a medical reason a legitimate option? It is.

Both types of births have their risks, and it’s weighting one against the other. A planned C section is not necessarily more risky than a natural birth, and scheduling one might do a lot to help a women feel in control of her body. The same goes for the woman who wants a natural birth but is considered too risky for that.

Me? I am scared I will be in labour for much too long. I am scared that something will happen to my baby. Personally, I would much rather have  a C section than an induction or a hard, long labour. I would prefer to have a C section than to give birth to a breech baby, or a big baby. I guess I must have a serious talk with my midwife, and my doula, and to consider the best course of action in this situation.

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