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Maternity & Parenting Center

Another Reason I Love Having Midwives

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My midwives just called me today. When I tested posted for Group B Strep, I asked Angel (the midwife I was seeing) whether I could do oral antibiotics prior to labor instead of IV antibiotics. I told her I knew it was against conventional medical advice, but that I was fairly certain I would be turning down IV antibiotics at labor due to my phobia, and taking the oral antibiotics couldn’t hurt and might be a good compromise. Last time, with Micah, I was on the oral antibiotics (due to the chronic Group B Strep UTIs) and turned down the IV antibiotics. Everything turned out fine. I even had a negative Group B Strep swab just prior to labor, which helped me feel that I was making a safe choice. The risk of transmission is actually fairly low in the absence of a fever, active infection, and labor shorter than 18 hours, so I feel comfortable with my choice. I was in labor with Micah for 6 hours, and we expect this labor will go quickly this time, too. Honestly, with a short labor, they may not even be able to get in an IV and deliver the antibiotics to me at the hospital before the baby is born. They also recommend 2-3 doses prior to the birth of the baby for full effectiveness, and that requires at least 8-10 hours.

Angel said she needed to discuss things with Chris and Sharon, the other midwives who treated me last time. Well, she called back this morning, and they are calling in the antibiotics! I have to sign a form indicating that I have been advised to take IV antibiotics and I am declining, but they are “working with me” in my refusal to take the recommended course of action. This was a wink, wink, nod, nod situation – they have to recommend what the AMA standard is, but they are doing their best to support my decision without endorsing it. I cannot tell you how much I appreciate that!

Naturally, I’ve done my research. There are a number of studies indicating that oral antibiotics, when taken prior to labor and maintained until delivery, are just as effective (and perhaps more so) than IV antibiotics. There are also studies indicating that if the antibiotics are stopped, they are not effective at all. They key is no lapse in the antibiotics allowing time for the Group B Strep to re-grow. There are also studies that indicate IV antibiotics for women with short labors fail to reduce the risk of transmission of the Group B strep because there is insufficient time to for the medicine to work before the baby passes through the birth canal. So, in my opinion, this really is the smartest option for me. That is a HUGE relief for me!! Can I get some credit for being rational in my crazy phobia?

Ouch!!

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Today was my first P17 shot. At our last appointment, I talked to my regular doctor about the other doctor’s recommendation for the shots. He said he was not sure they would help any, but he felt they could not hurt. He suggested we give them a try, at least for a few weeks. I was pretty disappointed, but agreed to do it. I was hoping he would say there was no way they would help, but no such luck! My insurance approved the shots last week, and today the home health nurse came for our first appointment.

The nurse was quite kind and patient, and we started off by filling out a bunch of forms. I talked to her about my phobia, and she seemed quite supportive and understanding. I used numbing cream before she arrived, and she said it would be no problem to inject me in the numb area. After setting everything up, I lay down on the sofa and Elliot held my hands (partially to be supportive, and partially for the safety of the nurse!). She talked me through the steps, wiped off the injection site, and then started sticking me. The numbing cream did its job – I really could not feel the needle going in at all. She gave me regular updates about how much longer the needle needed to be in (1/4 finished, 1/2 way there…). She stayed calm and steady, and that definitely helped. Poor Elliot – I might have broken a few of his fingers with all of my squeezing! I did okay – I did not yell or cry out, but I did start doing this panicky shallow breathing that got faster and louder as the shot continued. I think it made the nurse nervous and she sped up the rate of the injection. Towards the end, the shot started to sting a bit.

I’m now sitting here on a heating pad, with my rear stinging and sore. I cannot believe I have to do this for weeks on end :(. Thankfully, the nurse did not seem afraid to return next week. I hope this at least makes a difference.

Phobias

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I’ve been getting a lot of comments/feedback from many people about my needle phobia, and most people seem to think I’ll just “get over it” when the pain hits. While I appreciate all of the insight, I am definitely frustrated by all the comments because I think most people do not understand the nature of a phobia. For me, I do not just have a fear of needles; I have an honest-to-goodness extreme phobia. I know everyone is trying to be sympathetic and supportive, but many of the comments about my phobia have been upsetting me because I know that no one really understands.

While some of you are lauding my efforts about hanging tough for this baby through the contractions, I also should confess that my phobia is also playing a significant role in the decision-making process. While I do have a genuine desire to put my baby’s interests first, I also have a genuine desire to avoid needles and a c-section at all costs.

Instead of getting offended by some of the “you’ll forget about the needle when you are in labor” comments, or the “you can’t see the needle so it won’t bother you,” statements, I decided to take this opportunity to blog a little bit about phobias. I’m sure that my phobia won’t make sense to most of you, and I can honestly say it defies my own logic as well. My phobia is actually overwhelming to me right now, and I wish it was not part of my reality. I understand that it is totally irrational and yet . . . it still controls me. That is particularly difficult for me because I like to believe I am a fully rational being with control over myself and my decisions.

A phobia is defined as an irrational, intense fear of an object or situation that poses little or no actual danger. Like a needle. At first glance, a phobia may seem similar to a normal fear, however “fear” is the normal response to a genuine danger. With phobias, the fear is either irrational or excessive – it is an abnormally fearful response to a danger that is either imagined or irrationally exaggerated. This is my problem – and no amount of “logic” seems to help the brain comprehend that the perceived danger is either nonexistent or irrationally exaggerated in the moment.

It is the degree to which a person is affected that determines whether that fear has become a phobia. Phobias are emotional and physical reactions to feared objects or situations. Each person’s symptoms are a little bit different, but may include the following:

  • Dizziness, rapid heartbeat, trembling, or other uncontrollable physical response

  • Sensation of terror, dread, horror or panic

  • Reactions that are automatic and uncontrollable, practically taking over the person’s thoughts
  • Preoccupation of thoughts; inability to change focus from the feared situation

  • Fight or flight response – need to defend against the perceived danger and/or an intense desire to flee the situation
  • Recognition that the fear goes beyond normal boundaries and the actual threat of danger
  • Extreme measures taken to avoid the feared object or situation

I pretty much have all of those symptoms. My phobia manifests in an actual uncontrollable physical response in addition to the terror/panic. I shake, I have difficulty breathing and can give myself an asthma attack from the panic, and my heart rate skyrockets. I am currently preoccupied with the possible needle encounters that an induction could bring, and I can’t really seem to let it go. I go to extreme measures (and will even let myself suffer to a great extent) in order to avoid needles. My desire when exposed to a needle is either to run, or if I feel trapped, my instinct is to fight. And fight I do – it is like I leave my head and I am fighting as if my life depends on it. I hit, scream, kick, and generally wreak physical panic on anyone who is unlucky enough to be in my path. It is embarassing because I do not really know that I am doing it and I seem to be powerless to stop myself from behaving that way.

It is generally accepted that phobias arise from a combination of external events and internal predispositions. Many specific phobias can be traced back to a specific triggering event, usually a traumatic experience at an early age. That is actually my problem – I had two traumatic needle encounters as a very young child, and as a result, I have created this ridiculous, overexaggerated belief in the danger of needles that, despite all logic, I cannot seem to release.

Phobias are more often than not linked to the amygdala, an area of the brain located behind the pituitary gland. The amygdala secretes hormones that control fear and aggression. When the fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an “alert” state, in which they are ready to move, run, fight, etc. This defensive “alert” state and response is generally referred to in psychology as the Fight-or-Flight response. Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer only relatively mild anxiety over that fear. Others suffer fully-fledged panic attacks with all the associated disabling symptoms. I fall into this latter category. To the extent I can avoid needle encounters, my phobia presents no problems in my daily life. I do not have issues with seeing needles, or medical procedures performed on others, or even seeing a needle injected into someone else – my fear is solely focused on an actual needle touching ME.

Most individuals understand that they are suffering from an irrational fear, but are powerless to override their initial panic reaction. This is how I feel – I know my fear is irrational, and I start each encounter with the best of intentions to have my logic govern my responses, but somehow, the panic reaction always sets in, and there is nothing I can seem to do to stop the panic once it starts.

Over the years, I have come a long way. I can usually have blood drawn, but I’ve created a lot of “rules” for the phlebotomists that help me avoid my initial panic response. For example, I can only have blood drawn with a butterfly needle. Why? Somehow, I believe that the smaller needles cause less danger. They also have to be able to draw blood with one stick, and not move the needle around once it is inserted. Somehow, I believe that they are more competent or I am in less danger if the stick is done once and the needle isn’t moved around. Speed is also important to me – the stick needs to be done quickly, the blood needs to be drawn immediately, and they need to get the needle out fast before wasting time labeling the vials or separating the vials from the tube. If the phlebotomist fails somehow to draw blood this way, the panic still sets in, and I turn into a holy terror.

Shots are another issue for me. I still haven’t figured out how to get a shot in my arm. I have not had any vaccinations since I was 15 years old. I won’t get a tetanus shot and I won’t get the flu shot. I have refused allergy testing and allergy shots, choosing instead to suffer. I’ve been able to justify my fear with issues of scheduling and time commitments, but the bottom line is I’m too afraid of the shots to even seriously entertain the idea. I have recently discovered that I can handle some subcutaneous shots if I have to . . . as long as I can use numbing cream first. Ridiculous, right? It isn’t like the shots actually hurt, but somehow I need to not feel anything in order to distance myself from the panic response.

IVs are a whole other level of panic for me – for some reason, much worse than a blood draw or a subcutaneous shot. Yes, I have a hierarchy of danger for needles. My second traumatic experience with needles related to the placement of an IV, so I have a particular fear of IVs. I have yet to figure out how to get beyond that one. I had surgery earlier this year, and they were unable to get an IV in me while I was awake – ultimately, laughing gas was required. So, while I’d like to say that for the good of myself and my baby, I can “get through” the uncomfortable placement of an IV, I think the greater likelihood is I am going to panic out of some ridiculous and exaggerated belief that the IV is a threat to my safety.

For those of you that are still here, you probably now think I should be checked into the closest psych ward somewhere. I can understand that – I don’t understand phobias that other people have, but I do know that phobias are real, and right now, my phobia is making my life quite challenging. So, I guess I would ask that before you tell me about how I won’t even see or feel the needle, or I’ll get over it in the moment, or it is no big deal, try and remember that I am dealing with an irrational, overriding fear. Just know that in my head, it IS a big deal. Your support is welcome and much appreciated, but the reassurances actually create more anxiety for me. I do not find ANYTHING reassuring about not being able to see the needle – inability to see somehow makes me believe that the needle poses an increased danger to me – probably a control thing. Even hearing it didn’t really hurt, or it was over quickly, or it only hurts for a minute also does not reassure me – it isn’t really the pain I fear – it is the process itself.

Thanks for listening!

Hypnosis Dropout

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Yes, it is true. . . I am officially a hypnosis dropout. I am a bit torn right now – I keep vacillating between thinking I’m a quitter and the certainty that I did the right thing. I think I made the right decision. I just felt that this “doctor” was a total quack, and the process wasn’t working for me. I tried very hard to be open-minded, but her techniques just weren’t working for me. She spent a lot of time having me repeat phrases that basically boiled down to “I’m good enough, I’m smart enough, and gosh darn it, people like me.” In case you haven’t noticed – I don’t have a self-confidence problem. Even more than that – I honestly don’t care if someone doesn’t like me. I generally see that as their personality failure.

She spent the first 35 minutes of the session today lecturing me about the conscious mind v. the subconscious mind, and she must have thrown about 50 bad analogies at me. I spent the whole time thinking “let’s get on with it.” I understood her point – fears are rooted in the subconscious. We build perceptions (sometimes false) based on our experiences, and then we develop subconscious behaviors/emotional reactions in response to the perceptions we create. I think that point did not warrant 35 minutes of lecture, but then again, perhaps her other patients are a bit dim-witted. My response was . . . fine – how do you change the emotional reactions? What steps would we be taking to accomplish that goal. She then started to give me another analogy, and then told me it was like making a pee-pee or a poo-poo on the potty – you just have to let it go. Yup, she said that to me. Did she think I am two years old?

So, after asking her to speak to me like an adult and to drop the potty training analogies, I stayed on for ANOTHER 20 minutes trying to do the session. We got nowhere. She did not try to talk to me about my responses to a needle situation, or how to let it go, or give me coping techniques, or anything like that. She suggested that I repeat phrases like “it is okay to be afraid” and she suggested I hit my emotions out in a pillow to release my spirit. I know it is okay to be afraid – however, I can’t seem to figure out how to get beyond the fear and passively let a medical professional stick an IV in my arm when I need it. Hitting a pillow isn’t going to change that. I have an irrational fear, I know the root cause, and none of that seems to change the panicky feeling I get when in a needle situation, and no one has yet told me what I can do to stop or control that response, or to create a new response.

I finally had enough of the crap, and when she told me I needed to be willing to make a poo-poo on the potty, I thanked her for her time and left. Besides . . . I had some errands to run so I can make and decorate a cake for my niece’s birthday this weekend!

I have no idea what is next for me. I am certain I will probably slug any phlebotomist that tries to put an IV in me when I go into labor. The odds of me slugging him/her will go down if we can use a topical anesthetic to numb it first. It will completely disappear if they dose me with laughing gas. So . . . I’m going to request the laughing gas – I think it is safer for all involved.

Feel free to suggest other options . . . because I’m thinking that my next best bet is to explore other options beyond IV antibiotics.

First Hypnosis Session

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Today was my first hypnosis session . . . and I’m not quite sure what I think. Some of it was a little crunchy for me, and I’m not convinced that I really buy in to the whole concept yet, but I am committed to giving this my best try to see where it takes me. The good news is that she did not expect me to fall into some kind of a trance. She spent most of the time trying to have me focus on the events that triggered my phobia, and try to relive and discuss those feelings several times. I definitely expressed my emotions about the trigger events, but I can’t say I feel like I made any progress. I guess I am not welling up with tears when I merely think about needing an IV, so we’ll see. She believes that much of the root of phobias is unreleased anxiety that we spend years trying to suppress, and by letting us feel, experience and process our original emotions about the trigger event, we can release some of the fear and allow our rational mind to cope with the situation. She uses a lot of self-affirmations (and it is a good thing my eyes were closed because there were times I am sure I would have rolled my eyes). I’m going to go back for another session next week – supposedly we will focus this next session on the future – why I dread/fear/feel anxious about future needle interactions.

Big Step Today

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At my last appointment, the midwife “yelled” at us for not enrolling in a birthing class yet. For as ready as I am to be a mommy and to meet this little guy, I guess I am completely avoiding thinking about the birth part of this process. We haven’t even picked out furniture, or decided on a name, or chosen the bedding, or started a registry, how can it possibly be time to think about birthing!?! I keep thinking there is so much time for everything later.

For me, I guess the biggest part of thinking about the birthing process is my anxiety over needles. Okay – I’ll be honest – it isn’t just a general anxiety about needles. Yes, I’ll admit it – my name is Jessica, and I have a doctor-certified phobia of needles. My doctors had given me a referral to a psychiatrist months ago to deal with this . . . and I’ve been sitting on the referral.

At our last appointment, we discussed birthing classes. I am planning to try a natural child birth (prompted in large part by my overwhelming phobia of needles – I’d rather feel every contraction and rip than have a needle stuck in my back ANY day). I’m guessing that if I have to have a c-section, they will likely have to knock me unconscious, because I can’t imagine how they will get a needle in my back to keep me lucid during a c-section. After our discussion, the midwife recommended that we try a hypnobirthing class. Yes, I agree – it does sound a tad bit “new-age” and crazy to me. I think that is why I’ve been delaying the process of signing up. The midwife thought it would give me techniques for coping and self-relaxation that would allow me more control over my emotions and my response to any needles that will be used during child birth. The concept of control is appealing to me . . . but part of me thinks I’m too practical and logical for something as “silly” as hypnosis to ever work.

Elliot and I had a long discussion the other night and decided that this is the right choice for us, and we are now committed and trying to get excited about hypnobirthing. Now, if I could just stop chuckling every time I say “hypnobirthing” that would be a vast improvement! I contacted 2 locations, and we have to decide which place we will be taking our class. I plan to sign us up this week.

After tackling the birthing class issue, I realized that part of my aversion to picking a class had a lot to do with my needle phobia. I have been informed (although I am currently choosing not to believe) that I will have to be on IV antibiotics during labor because I am a Strep B carrier. This Strep B issue has thrown a kink in my needle-free birth plan, and has me incredibly anxious. Let’s just say I cannot imagine how any anesthesiologist is going to get a needle in me to give me antibiotics I don’t particularly want without getting a black eye and possibly losing a few teeth. And that is the best case scenario – I’ve been known to take out a room full of nurses and doctors who coming bearing needles.

Once this obvious connection dawned on me, I decided to take charge of my phobia and call the doctor. Naturally, the doctor was not in, and I left a message. About one hour later, the office manager returned my call. It only took about 3 minutes on the phone with her before I was filled with anxiety and practically in tears. I asked about phobia treatments, and after hearing the long spiel about the costs for treatment, they don’t participate with insurance, we have to pay out of pocket, blah blah blah . . . she informs me they plan to treat my needle phobia by bringing me into the office and repeatedly stabbing me with needles until I get over it. Okay, perhaps I am over-simplifying the process a bit, but that was the gist of it. I informed the office manager that I did not think that approach would work for me, and I politely thanked her for her time and hung up the phone.

At this point, my anxiety hit a new peak as the realization dawned on me that I will be going into labor and needing an IV with this phobia looming over me, and no coping mechanisms to help improve the experience for me. About one hour later, the doctor from the phobia center called back to try and convince me that the needle stabbing process would, in fact, benefit me. I just know that nothing she said offered me any comfort. Her philosophy was basically that exposure to the needles would make me see I’m being ridiculous, and I would magically get over my fears when I realize the needles won’t kill me. I would not say this doctor conveyed a warm fuzzy feeling. In fact, her thick German accent created visions of a masculine-looking German frau dressed in Nazi garb strapping me to a table and repeatedly (and sadistically) stabbing me with needles and hooking me up to IVs as her wicked and maniacal laughter reverberates around the darkened room. Not that I have a vivid imagination.

While I sat here hyperventilating, I went back and looked at one of the hypnobirthing web sites . . . and realized that one of the locations is a full hypnosis center! I put in a call and left a message about hypnosis and phobias. About one hour ago, the doctor called me back to discuss treatment of phobias. I explained my situation . . . and she seemed sympathetic. She did not laugh, nor did she tell me she would stab me with needles until I got over it. She asked if I knew the root of the problem, and I shared my story with her (short version – bad allergic reaction to an immunization as a child, followed up 6 years later with a bad IV that damaged a nerve in my hand). She talked a lot about emotional energy, and how negative emotions can sometimes override the body’s internal logic and control functions. She made me feel that it was possible to take control of my emotions, and release them in a way that would let my logical brain dominate over my fear. I am still not sure if I believe in hypnosis, but on Friday I am going in for my first session to give it a try! I think even if it gives me the confidence to face this, or a few coping techniques, it will be well worth the money and effort.