Childbirth in hospital after rape/sexual violence, wanting a homebirth

[GoldenCarp22]

Apologies if this is long/triggering for people.

I am a rape survivor posting under a new temporary name. I have searched for threads on the subject of giving birth after surviving rape and sexual violence but found nothing on MN or elsewhere.

I am in a loving relationship and expecting my first baby in a few months with my partner. The rape was almost a decade ago. It was a very violent and sadistic stranger rape. Later the attacker was caught and jailed after I gave evidence in court. This month I heard he was to be released on licence after serving 8 years which has unsettled me.

After the rape happened, I was taken to my local inner city hospital and given some emergency care for my injuries and also subjected to a lot of forensic intimate exams by police doctors who needed to gather evidence. The hours I spent post-rape at the hospital were very traumatic and as a result of all the experiences I went on to develop PTSD. I had lots of counselling and recovered well but there are still some things that can trigger flashbacks, even after all this time. Normally my life is fine and I barely think about the rape. But now I am worried because I am having a baby, I am going to be revisiting certain things I would normally do my best to avoid.

Specifically, I am worried that giving birth in hospital, and the poor post-natal lack of care at my local hospital are very likely to cause a recurrence of the PTSD and depression/panic attacks/flashbacks.

So I am booked in for a home birth. I'm apprehensive about the pain of labour, of course, like any first time mum to be. But I'm much, much more afraid of the hospital environment and what could happen to me there.

I believe - I hope - that I can manage the pain of birth without panicking if I am allowed to 'go into myself': that is how I managed to cope with the rape and have coped with other serious and life threatening experiences I have had ( and giving birth is not like being in a bad accident, or being raped, after all!). I will have a birthpool, gas and air and pethidine and experienced women to help, and my partner there. I want to have the baby at home if I possibly can, and if that means I have to do without hospital drugs, so be it.

The specific triggers I have are:

• internal exams
  
• being 'held down'/wired up/being immobile/legs in stirrups/legs held by other people
  
• men in the room and strangers in the room generally
  
• being on my back, with people looking at my private parts not my face
  
• not being able to communicate
  
• bright lights in my face, being exposed and naked and frightened
  
  This is not to say I think hospital staff at a birth are intending to be frightening or unkind but just that I have a visceral reaction to the above that is to a large extent, beyond my conscious control.
  
  I was feeling happy with my decision to have a home birth, although still worried about what would happen if I had to be rushed to hospital. I did the research, read the stats, I practice the breathing, do the yoga and try not to worry.
  
  But the recent news stories about the dangers of home births have made me feel even more upset: that I am somehow being selfish and endangering my baby by having one. Not to mention all the reports of risks and being rushed to hospital in an emergency after having problems labouring at home.
  
  All I want is to be safe and for my baby to be safe. I honestly think that me having some kind of bad PTSD birth experience in hospital is very likely to be dangerous to me and the baby, not just during the birth but post-natally too. But I can't find any info about giving birth after rape, or giving birth when phobic about hospitals, and everyone seems to make me feel selfish and stupid for not wanting to go to hospital. All I can find is stuff about having your rapist's baby, which isn't what I am looking for.
  
  Can anyone here offer ideas for managing all these fears and trying to minimise the risk of it all feeling like a rerun of the rape experience? I would be very grateful for any help or pointers to sites, articles etc.

[SolidGoldBrass]

Are your MWs and birth partners etc aware of your reasons for wanting to avoid hospital if possible? You don't have to give the HCPs any more detail than you are comfortable with, but if they know that you have a specific (and very strong) reason for not wanting to go into hospital, they will try to make sure that you don't have to and should something go wrong enough that you need an emergency transfer to hospital, (which is not likely if you are healthy and there are no problems with your PG, home births with proper midwife care are pretty safe) there will be someone with you who can explain to the hospital staff that you are a sensitive case and you might react badly but there's a reason for it and you are neither insane nor a troublemaker.

[Poppet45]

My experience was in no league to yours at all - just indecent assault when I was a kid, but by a guy who sadly later went on to murder his next victim in a French youth hostel - but I found the hospital where I had my son so much kinder than I ever, ever thought I would. So if you did have to transfer in from a home birth please try not to let this be another factor for you to worry about. I know not all units are like it, but I was surprised by what a tremendously positive, nurturing space full of incredibly caring women the maternity ward was. The only man I met was my anaesthetist right at the end when my waterbirth ended up in an emergency c-section and by then I was sooo tired I was unphased by everything.
Hoping someone will be able to help you in a bit, but for what it's worth, I don't think you are being at all selfish and stupid for not wanting to go to hospital to have your baby. I think you sound like an amazingly strong and together individual and I wish you all the best.
Can I recommend the book Birth Skills by JuJu Sundin as an amazing resource full of different ways for you to mentally prepare yourself so that you can keep yourself calm and occupied during labour. That book, some loud mooing and a birthing pool helped me get to 7cms with nothing more than cocodamol and paracetamol, which was why the midwife hadn't noticed my son was in an unbirthable position - and actually why I didn't mind at all when my labour went an entirely different route to the one I'd planned.
Good luck

[thisisyesterday]

i don't have experience of rape, or any kind of sexual abuse scenario at all, but i just wanted to say that I think you're heading in the right direction
you KNOW what the problems are, you know exactly what your fears are and you hae figured out ways that you can overcome them
that is really positive

i would definitely agree with talking this through with your midwife (giving as much or as little info as you are comfortable with) so that she is aware of why this is so important to you

making sure your birth partner is well informed and won't make any decisions that could leave you feeling vulnerable will also be important.

you can choose not to have monitoring and not to have any internal exams. HCP's can only advise you on what they think is necessary.

I wonder if you've considered a doula too? sometimes it can help to have an extra person there fighting your corner if necessary. it means that your partner can be looking after you and you have someone else there saying "no, this is what she wants to happen"... obviously again that would be dependent on you finding someone you trust enough to talk it all through with though

one thing you do need to think about is what will happen if you did need to transfer into hospital for any reason, and how you will cope with that. it could be sudden... so it might be wise to write up a plan of what you do and don't want should that occur.

[Flisspaps]

I haven't experienced rape but hope that you don't mind me chipping in with some suggestions. Have you considered a water birth in the hospital? I see you plan on having a pool at home.

It would offer you some privacy as no-one can see you clearly underwater, and it would also put a barrier up between you and anyone else in the room. You wouldn't need to get out of it either all being well.

Write your concerns into your birth plan and show the midwife when/if you get to the hospital.

If you want a HB though, go for it. Things can still go wrong in hospital. And remember the media aren't going to print stories about normal, problem free births, so you might read stories about problems but they're not the be all and end all.

And as for your triggers:
You can refuse internal examinations.

You won't be held down by anyone and even with an epidural/CTG on you still have a degree of movement.

Generally there will be you, birth partner and a MW in the room. Tell the MW that you do not want a man in the room unless it is an emergency

Choose the position that suits you and refuse to move :)

Ask to have the lights dimmed - much nicer for you AND baby!

There wasn't much looking-at-bits going on either, I recall spending most of the labour covered up.

Hope someone more useful than me can advise you more!

[PipPipPip]

Hi there GoldenCarp22, I just want to say that I admire the way you are approaching this and I really wish you all the very best.

[PipPipPip]

PS. What you wrote on this forum is very clear and calm explanation of your feelings and anxieties. It might be worth printing off a copy of this and giving it to your partner or one of your female friends, just to have in case you do end up in hospital. It could help hospital staff know how best to help you.

[preghead]

What about a private birth centre as another option? There is one in London that is in the grounds of a large hospital so you have NICU etc nearby if needed. Good luck, you are right to address these things now before that baby comes and I am sure you will be able to minimise the impact in doing so.

[GoldenCarp22]

Thank you very much for the replies.

I will look into a doula, that is a good idea - not sure how to go about explaining in interviews why i want one, and had the thought it might piss off the home birth midwives to have one there - but will look anyway. The idea about writing this down and putting it into the birth plan - maybe as a stapled letter might be a good idea too. Do hospitals actually look at birth plans much though?

I don't think we could afford a private centre. I also like the idea of being at home, with my safe familiar things.

It's strange, on the one hand, I don't want to have to keep repeating why I have issues about certain things to people, and I don't want the joy and anticipation of the birth day to be tangled up with the crappiness of the rape from years ago - this is a day for me/ my partner and our baby, after all not the bloody rapist - and I am quite resentful that his disgusting attack and the aftermath should even be in my thoughts, when I should be thinking about welcoming the baby into the world and looking after myself at what is obviously going to be a pretty demanding time.

So on the one hand I want to avoid triggers and reminders and flashbacks, and on the other hand, I don't want to think about them happening in case I trigger them!

I can't work out what to do - so far, avoiding thinking about it all has worked fine but now I am thinking about it more and more, so I do have to make some kind of a plan to deal with what might occur because the hospital staff are not telepathic and trying to explain why I am freaking out when I am experiencing some kind of medical crisis sounds impossible!

Anyway I will have a further think in bed. I just wanted to thank everyone for their thoughts and for the reassurance that I am not being unreasonable, that means a lot. I will be back online tomorrow.

Thank you.

[thisisyesterday]

whoever you have at the birth with you, be that your husband/doula/independent midwife/mum..whoever! needs to have a sort of script ready to tell anyone who needs to know about the issues

so, if you have your homebirth but need to transfer, they need to make sure they go with you in the ambulance, speak to the crew if necessary, speak to the midwives when they arrie at hospital and just inform them of everything.
this can be done without you there if you'd rather not hear them all going over it.
ie, if you've just arrived at hosp then your partner could just go slightly ahead and ask to speak to them and let them know the situation, so taht you don't have to

i think if you have a plan you will feel safer and more at ease, you just need to make sure you think of every eventuality and that those with you know what they need to do to keep you feeling safe

[SelinaDoula]

I have supported a couple of women as a Doula after rape/sexual abuse.
I would second looking into having a Doula, somone who is there just to protect and nurture the emotional experience of birth for you and your partner.
I acyually usually ask clients if they have experienced anything like this, as it is sadly quite common, and feelings like you describe can be brought up in pregnancy and when planning birth.
It would probably be useful to discuss birth plans with a senior midwife and have things signed offin your notes, so you dont have to keep explaning yourself or have t worry about triggers in labour.
*(for example not having any vaginal exams, not doing any interventions, however routine or necessary without your express verbal permission etc).
A pool sounds like a good idea too because it is like a lprotective 'zone' around you and encourages others to be hands off.
There is a huge body of evidence to show home birth is safe (barring very rare emergencies) and tat hospital birth tends to end in higher intervention rates for mothers and babies.
In your situation, with specific triggers in a hospital environment, I would say you are being entirely sensible and protecting yourself amd your baby.
Good luck and please do ask any questions about doulas etc and I will answer if I can.
Selina x

[LadyBee]

For my hospital birth every single midwife I dealt with read my birth plan and referred back to it when there were queries/questions, so yes, I think having this or something similar attached to your plan would be worthwhile. I stapled mine to the front of my handheld notes close to term.
I also doubt whether having a doula would be viewed negatively by a midwife, particularly one doing a homebirth. You can get the doula to come to you early on the labour to help get you organised and to advise when to call midwives as well.
I think you are doing extremely well, and in starting to think about it are giving yourself every opportunity to have a birth that you feel reasonably happy about. I do think it's worth exploring the idea that birth is by it's nature an unpredictable event, and that it may be worth thinking through various possible outcomes -- transferring in for more pain relief, transferring in for lack of progress and interventions, water not being what you end up wanting, etc etc just so that you've got a mental picture of those things as well, so that IF they did happen, it didn't feel too out of control and scary simply because you weren't prepared for the possibility.
Oh, and in no way do I think you're being selfish in planning a homebirth, it sounds like the best option for you. Just remember, no choice is set in stone.

[Concordia]

it sounds as if you've thought it all through, especially the triggers.
i haven't had an experience similar to yours but i did have a number of triggers that i put in my birth plan for another reason and i found that it was read and taken on board by midwives, both times. then if you do need to transfer its all there.
btw wrt nakedness i wore a very long floaty skirt (left over from my student days!) and shirt with buttons both times for the whole thing so could remain pretty much dressed throughout. i felt a lot calmer like this. in fact, had my knickers on so late with DD she was nearly born in them, kind of!

[Concordia]

btw, good luck, i'm sure it will be fine as you are so well prepared

[Nemofish]

What a strong woman you are, GoldenCarp, I feel quite moved and inspired. I have huge problems with visiting the dentist (now only done under heavy sedation) and internal exams (which I avoid!) for similar reasons to you.

[beakysmum]

Do you know whether your hospital has a midwife who manages women who have had traumatic births? I had elements of PTSD after first birth and found the support of the specialist midwife invaluable in planning for the second birth. It might be worth you talking to such a midwife, so that she is aware of you and your PTSD triggers if you do end up in hospital.

I hope you get the home birth you want, though, as others have said you sound very together and it sounds like the best thing for you. All the best!

[rimsky]

If you are concerned about home birthing I have found the Natal Hypnotherapy Effective Birht Preparation (Home) cd really useful, helps to combat any fears you have about giving birth at home and helps you to trust in your body.

But as several posters have said acknowledging your thoughts and fears are a huge step to making things easier.

Good luck and I really hope your birth is a lovely experience.

[SilverCod32]

Hi. Also a namechanger (as you can probably tell from the way I've ripped off your name).

I'm really sorry you've had such dreadful experiences.

I also have PTSD, and hospitals are a real trigger. I wanted a HB, but had to transfer to hospital during labour.

And, with apologies for sounding so trite, the beauty of those first precious moments with my baby made every second of it worthwhile.

Going through your triggers.

• internal exams
  

You can refuse them. And you can ALWAYS insist on them being done by a woman. And you can ask to be sedated first. I found the gas and air really helped

• being 'held down'/wired up/being immobile/legs in stirrups/legs held by other people
  

NOBODY will hold you down.
NOBODY will hold your legs for you.
You'll only be put in stirrups or put on continuous monitoring if something goes wrong during the delivery. I was, but I was handled so gently, and always by women.

• men in the room and strangers in the room generally
  

You can ask for there to be only the minimum staff needed. If something does go wrong and there are only male doctor on duty it may be difficult to ensure there are no men there, but if you explain your fears they will always try to help. DS was delivered by a female junior doctor, with the male consultant standing out of my line of vision.

• being on my back, with people looking at my private parts not my face
  

Again, you'll only need to be on your back if something goes wrong.
I found all of the hospital staff very good at looking at my face as well as my private parts. But this is something you can request in your birth plan.

• not being able to communicate
  

A doula or birth partner should be able to help with this.
So should a birth plan.

• bright lights in my face, being exposed and naked and frightened
  

You can ask them to turn the lights down.
You don't need to be naked, as others have said. A long skirt is a really good idea (wish I'd thought of it!)

I guess the other thing I would add is that, during labour, all the hormones really kick in to focus you on the baby. To my surprise, I wasn't getting flashbacks or frightening thoughts because all I could focus on was the labour itself.

Is there anything else I can help with?

[mungogerry]

Hi hun,

I am very sorry for your experience.

I am not a survivor, but hope that I can offer some reassurance on what home water births can be like.

I have had 2 home water births with no internals, no-onw touching me at all other than to hold a doppler to my tummy to listen to baby.

You can do waht you want, wear what you want.

Pain relief is more than managable with a TENS machine then pool, and gas and air if you need a final something.

Birth is a beautiful experience and I hope a vvery cathartic one for you.

I would write a letter and seal it in an envelope to be opened if you need to transfer to hossy.

xxx

[stillbobbysgirl]

Don't have any advice for you - just wanted to wish you the best of luck!

[barkfox]

Hello goldencarp -

I was sexually abused as a child, and developed tokophobia largely as a result (I recently had my 1st DC by elCS) - I know you're in a different position with different experiences, but I just wanted to share a couple of thoughts -

I think floofer's post is very good in that it raises, without being alarmist, the possibility that the best laid plans of mice and men can go awry, and it is worth thinking about the possibility of a transfer to hospital, even if you are aiming for a HB.

It can be hard enough to stand up for yourself/be clear about what you want in a medical environment at the best of times, let alone when you are stressed/exhausted/anxious. You've been admirably clear in your post about what your 'triggers' are, and how you want to avoid them, and be treated appropriately. I think it's a good idea to get other people 'onside' to help you with this. Others have suggested a doula, which I'm sure would be worth investigating - others have suggested seeing if there's a specialist MW you can talk to.

I has support from the perinatal psychiatric team and a senior MW throughout my pregnancy and birth, and it made things SO much easier for me. They were sensitive to the fact that I didn't want to describe or dwell on past traumatic experiences in great detail - but involving them meant that they could flag things up in my notes, and talk to consultants and anaesthetists etc on my behalf, and INSIST for me that I had a certain specific birth plan and care.

It meant I felt protected and looked after, and didn't have to 'fight my corner' at times when I think I would have found it very hard. I dreaded having to deal with anyone to start with, but actually it was incredibly helpful, and much the best route to go down for me. It sounds like planning a HB is ideal for you - but I really would consider flagging up your issues to a senior MW, as clearly as you have done here, so that they can be aware and be sensitive to your needs.

As an aside, I think it's interesting (and sad) there is so little 'out there' about birth after rape or abusive experiences. My suspicion is that there are more women dealing with these issues than seems to be the case. It IS very hard to talk about, and other people's attitudes can be gobsmackingly insensitive. I found other people's insistence that I would 'lose all my dignity' and have 'half the hospital up there' AND that 'I wouldn't care because I was getting a baby at the end of it' etc just awful. Made me feel like an inadequate monster.

However, I had a wonderful birth experience, and now have a beautiful 5 week old DS, and (so far!) no signs of PTSD/flashbacks or PND. I wouldn't have had such a positive experience if I hadn't got other HCP's involved and supporting me, so I really would say, flag it up to them - you won't be the first.

And good luck.

[SilverCod32]

Did you find the perinatal psychiatric team helpful? I was offered a referral but turned it down because I was convinced (probably wrongly) they'd only make things worse. What did they do to support you?

[barkfox]

The perinatal psychiatric team experience -

For me, personally, it consisted of 2 meetings with a psychiatrist, after the senior MW referred me - the psychiatrist was female, v practical and sympathetic. The 1st meeting established my 'problem', which did involve me giving a brief history, but only in a 'factual' summary, and to talk about the best way to go ahead.

(just as an aside, why did you think they would make things worse? I know I was very reluctant to talk about anything traumatic, and rake up the past etc - but I found it wasn't nearly as bad as I'd anticipated, and didn't really involve that sort of thing. They were really concerned about where to go from now, and how not to make things worse! It's not 'therapy' or counselling, although if you wanted that, they could organise it - it's really more of an assessment, and actually a service to MWs and consultants,too, who apparently send refer patients to the perinatal team so a psychiatrist can advise them how best to treat someone. The Senior MW explained that MW's aren't experts in dealing with things like PTSD, so feel happier if they are given specific advice about how best to care for a mother - e.g avoid trigger situations.]

The psychiatrist explained the options for me (which were basically counselling or an ELCS -I was 5 months pregnant when I saw her, so there was a big ticking clock!) - and wrote a letter to the consultant recommending me for an ELCS. At that point I was 'in the system', so every MW and Health Visitor and GP I saw was briefed as to my phobia and associated fears without me having to discuss them. I'm also due a 'follow up' visit to see how I am, which I can't report back on cos it's due next week...

My care up to and icluding my DS's birth was sensitive and protective [bar one totally vile anaesthetist, who at least apologised to me after he upset me]. I recognise most of your trigger situations - mine also included things like people describing what they were doing to me, as they were doing it. Which of course a lot of medical people do because they think they are beng reassuring, not thinking it might press a whole load of wrong buttons. Having 'flags' on my file as to care, and care plans which avoided things like VE's, rooms full of medical students etc, meant I didn't have to try and argue for things myself, at times when either I didn't feel up to it, or people didn't have time to listen to me.

I hope that makes sense. It wasn't what I was expecting from them, but it was actually really useful. I guess I was lucky to get a really good senior MW and psychiatrist, cos these things are a bit of a lottery - but as I say, you wouldn't be the 1st person they saw with your sort of experience and issues... and you can always 'back out' of meetings and referrals, it's up to you.