For most women, pregnancy and motherhood are exciting, natural steps on the ladder of life. But for Dubai-based Indian expat Vanessa Joseph, it was the opposite. “This was not because I was a success-hungry, career-oriented corporate executive who resented a baby for hampering my chances of moving up the pecking order,” says Vanessa. “But because I was so afraid; I was intrinsically mortified by even the idea of being pregnant.”
The terror was so great that it subsumed the fact that she would have liked to become a mother. “The fear was just too real,” she says. “It didn’t help that I got married in 2014 in my early 30s, by which time I’d had several friends who were already mums regale me with their emotionally charged, pain-stricken experiences of pregnancy and delivery.
“Looking back I think every story I heard strengthened my fears, although they were often sugar-coated with the cliché that ‘at the end it was all worth it.’”
But there was another layer of pain that further heightened Vanessa’s worries. Having got married in India, she and her husband moved to the UK a year later. She went on to have two miscarriages in England: one in 2015 after six weeks, and the second in 2016 after nine weeks.
She blamed these tragedies on her own negative mental state and fear of pregnancy: “I was so confused, especially since I had left home in India and moved not just countries but continents too, to join my husband in England. It was physically and emotionally tough and I was feeling a lot of confusion, fear, sickness and negativity. No joy at all. I don't think I feared anything as much as being pregnant at that time. Everything else I was able to always boldly face in life. But it seemed like being pregnant was my nemesis.”
Debunking fear-inducing pregnancy myths
When Vanessa eventually fell pregnant for the third time in early 2017, it was a huge milestone. After her second miscarriage she says she shifted her mind-set. “For someone who had lost two pregnancies simply because mentally I couldn't cope with it, the loss of the second pregnancy taught me something. I wanted to ensure that if I did fall pregnant the third time, I must take it to full term.”
Added to Vanessa’s existing fears were certain pressures and myths that surround pregnancy and childbirth, whether during a pandemic or not. “Several misinformed ‘facts’ plague pregnant women, COVID or no COVID,” explains Vanessa. “Advice like ‘stay indoors as much as possible, don’t exercise, avoid eating out, be wary of doing new things, avoid carrying anything heavy, eat for two people, etc’.”
Although she was receiving this sort of cautionary advice from family and friends, this time around she could not really put any of it into practice. Her husband had moved to the UAE with work from her second trimester, so she was alone in the UK.
This phase of enforced independence - working and looking out for herself while pregnant in a foreign country - taught her a lot. “Something a friend told me really stood out: ‘Pregnancy is not a disease; it is an experience to be relished and enjoyed at every moment.’”
Pregnancy is not a disease: it is an experience to be relished and enjoyed at every moment
This was a revelation to Vanessa, who was so used to the traditional rhetoric about pregnancy, which can sometimes portray pregnant women almost as invalids. “It gave me the freedom to step out and do everything I wanted,” she says. “I charted out a new fitness regime for myself to walk 7km every day, I delivered several first-of-kind assignments at work, and somehow I seemed to reconfigure my emotional wiring to feel positive towards myself and the new life growing within me.”
From panic to a pain-free birth
During the middle of her third trimester, Vanessa left the UK and moved to the UAE. “I assumed it would be hard to move at such a crucial stage in my pregnancy and felt like my past fears would haunt me again.”
Her biggest concern was finding a good doctor whom she could trust at this late stage of her pregnancy. “After an initial hurdle I landed up with a great doctor who seemed to allay all my fears. But then I learnt she would not be available for the actual delivery date.”
The prospect of putting her own and her baby’s life in the hands of a totally new OB-GYN - however experienced they might be - set Vanessa’s anxieties off again.
“As D-day approached, my fears spiked. I could do nothing but put myself in the hands of God - and I was not disappointed.”
Astonishingly, Vanessa says that she experienced a totally painless and smooth delivery. “I was not administered any pain-numbing drugs, yet I felt no pain during labour or at delivery. For all my imaginations of a horrific delivery experience I was astounded by what had actually transpired: a brand new baby boy had entered our world, totally pain-free.”
Because of the lack of pain, Vanessa did not even realise that she was in labour. “I went to the hospital in Dubai to be induced and the nurse who checked me said I was in labour just a few hours afterwards. I didn’t know what a contraction would feel like as it was my first time, but I never really found out, as all I felt was a strange feeling of a muscle-pull in my abdomen area.”
The agony that Vanessa had so dreaded never came to pass at all, despite the fact that she delivered naturally and without any pain relief. “I never felt labour. The midwife in the labour room told me that my contractions were at their highest and I must try to push the baby out with all the force I had. I did just that.”
Unlike her friends, Vanessa didn’t have to say “at the end it was all worth it”: “Looking back I feel every moment was to be cherished, every feeling of anxiety and fear, experience of joy, loneliness or pain - everything was worth it, as through them all I became what I would never have imagined myself to be: a Mum.”
“We have seen pregnant women who come to the emergency room in the second stage of labour, only feeling some pressure. Or sometimes they just come because their waters broke, although they didn't feel any pain, and during the examination we discover that the lady is in the second stage of labour or about to give birth already.”
In order to increase your chance of having a naturally pain-free labour, look at taking a Hypnobirthing course, or prenatal yoga to help learn breathing techniques that could help with labour. Additionally, keeping active throughout your pregnancy can help strengthen your body for labour, while perineal massage can help prepare your body for birth.
Reaching out to others who fear pregnancy
One of the hardest things about Vanessa’s terror of pregnancy and childbirth was that she felt so alone. “I believed that I was probably the only one in the world who had this issue, because everywhere I looked I saw women getting pregnant and the stories were so positive and happy. You never get to hear of anyone who talks about their fear of getting pregnant or childbirth. It's always the act of becoming a mother that is glorified - no one talks about the pain, sacrifices and struggles it entails.”
For those who are struggling, Vanessa says there is a sense that they should simply endure it: “There is very little help out there as many women are told to accept it as part of life and think positively, for everything will be worthwhile in the end.”
Although she was tempted to opt for an elective C-section in order to avoid the pain she so feared from childbirth, Vanessa eventually decided to choose a vaginal birth. “I was clear in my mind I would go for a normal delivery as it was nature's way of bringing a new life into the world, and I did everything to ensure mine stayed normal with regular walks, house-hold chores and pre-natal exercise sessions at my hospital.
“Having said that I do feel the pain many women have when they elect to have a C-section but as for me I felt strengthened in my spirit to give normal a try.”
Vanessa’s son Daniel is now almost three years old, and her wholly positive experience of childbirth has cured her of her pregnancy fears. She says she would no longer be worried about falling pregnant again: “I am positive and open, which I wasn't before, and that's a great transformation.”
To anyone else experiencing a fear of pregnancy and childbirth, Vanessa has this advice: “Don’t let your fears dominate you. It’s better to understand that fears are unnecessary baggage we carry, and we are the best in position to help ourselves. Be open to being influenced positively and do everything that you need to let that happen.
“If I could do it, so can you. Let nothing rob you of the joy of being a parent!”
AVOID INFORMATION OVERLOAD: “I never researched anything that much except simple things like understanding the various growth stages of my baby and what I should be eating and doing at each stage.”
DON’T FEED YOUR FEARS: Try to avoid Googling every symptom. “You might feel like you are back in the pre-internet era with no news or information on your fingertips, but that is the best way to move ahead instead of indulging your fears with unnecessary information.”
SEEK OUT POSITIVE STORIES: “Speaking to those who can share positive stories and encouragement is very important. Surround yourself with positive and encouraging news and people.”
AVOID NEGATIVE BIRTH STORIES: Try to avoid any stories that might be triggering for you. If someone seems about to tell you a traumatic story, you can politely stop them and say you’re trying to focus on positive stories at the moment. “Don’t even eavesdrop on any conversation about negative pregnancies while awaiting your turn at the clinics,” says Vanessa.
FIND A MENTOR: “I also went for prenatal exercise sessions at my hospital with a trained physio who herself had delivered three children! Those sessions also encouraged me physically and emotionally.”
Can fear really cause miscarriage?
Although Vanessa blamed her miscarriages on her fear of pregnancy, there is no definitive evidence that stress results in miscarriage – although it isn’t good for your overall health.
About 10-20% of pregnancies end in miscarriage (defined as the loss of the baby prior to 20 weeks of pregnancy), although many more may occur before the woman is aware she is pregnant. “Most often, early miscarriage is caused by a chromosomal abnormality that interferes with the normal development of the embryo,” Dr Yvonne Butler Tobah told Mayo Clinic.
A 2018 study in the journal Human Reproduction found no link between maternal stress and early pregnancy loss, while other studies have found that maternal distress does not impact the flow of blood in the uterus or umbilical cord, meaning that is has no effect on the baby’s access to nutrients.
The National Health Service in the UK states that it is a common misconception about miscarriage that a mother's emotional state during pregnancy, such as being stressed or depressed.
However, although it does not directly cause miscarriage, stress could potentially heighten other risk factors that cause miscarriage. If you are experiencing stress or fear of pregnancy and childbirth, talk to your health care provider about management techniques.
Tokophobia is where women have an extreme fear of pregnancy that can lead to them avoiding childbirth altogether. The fear becomes paralysing and terrifying, and can become physically and emotionally disabling.
About 20% to 78% of pregnant women report fears associated with the pregnancy and childbirth (Bhatia and Jhanjee, 2012). Yet only 13% of women report a fear that’s overwhelming enough to make them postpone or avoid getting pregnant altogether.
Symptoms of tokophobia can include sleep disturbances, panic attacks, nightmares, and avoidance behaviors. Women may sometimes avoid any sexual activity out of fear of becoming pregnant.
CAUSES OF TOKOPHOBIA
Some reasons that people can suffer from tokophobia are:
• Hormonal changes that make anxiety harder to manage.
• Hearing stories from other women close to them who have been through traumatic births.
• Fears related to medical care like ineffective pain control, fear of loss of control or death, or lack of confidence in the team providing care.
• Psychosocial factors like being a young parent or at a social disadvantage.
• Psychological factors like low self-esteem, revival of traumatic memories of childhood or psychiatric disorders like depression or anxiety.
TREATMENT FOR TOKOPHOBIA
Tokophobia can be a lot less debilitating if you have a strong support system, including partners, mothers, sisters or friends and colleagues. One study reported a 50% reduction in caesarean birth rates when women received psychological and prenatal support.
Some other forms of treatment include cognitive behaviour therapy, psychotherapy and taking medication to help tackle your feelings. You could also try hypnobirthing techniques to see if that helps ease the anxiety.
Source: The National Childbirth Trust (www.nct.org.uk)
WHAT CAN PREGNANT WOMEN DO AND NOT DO?
The advice from Vanessa's family stressed her out, but how much of it was fact and how much was fiction? We spoke to Dr Fathima Safa, Obstetrics and Gynaecology specialist at Aster Hospital, Al Qusais, for her advice:
First of all everybody should understand that pregnancy is a physiological change not a disease
Take it positive and stay positive.
Gastritis nausea and vomiting are commonly seen in first three months of pregnancy.
1.Take small frequent feeds so that it subsides.
2.Drink plenty of fluids
3.Avoid junk food
4.Maintain healthy diet
5.Avoid alcohol ,caffeine and smoking
Heavy lifting, standing for long periods of time, or bending a lot during pregnancy could increase your chances of miscarriage, preterm birth, or injury during pregnancy.
Also, Avoid raw fish and fish that may contain high levels of mercury
If you are healthy and your pregnancy is normal, it is safe to continue or start regular physical activity.
Physical activity as such do not increase your risk of miscarriage, low birth weight, or early delivery.
High risk pregnant patients should do according to their doctors advice