forced consent to vaginal examinations

[terrifiedmummy]

Hello,

This is my first post and I'm posting as I really need help.

I'm going to have my second baby soon. My first labour was horrific, abusive and traumatising. Before that I had a history of sexual abuse. I've also subsequently had a traumatic botched coil fitting which ended up requiring hospital treatment.

As a result this time I'm refusing:

• all vaginal examinations
  
• any medical staff to touch or look between my legs
  
• assisted third stage of labour (I'm want the physiological option)
  
• post labour examination for tearing.
  

I've been seeing a midwife councellor and I have a consultant because this birth will be a VBAC. All staff at the hospital are adamant that my consent will be sought before any proceduce and that they will make it as comfortable as possible but that I am not permitted to not consent. Does that make sense? In effect I have to do it! Finally today, after much harrasment from me and from the staff they have agreed to my wishes but say I must come in to hospital and sign a document saying all negative outcomes (ranging from maternal and/or fetal death to tearing) are a direct result of my choices. I've also had one midwife tell me that labours without vaginal examinations usually result in dead babies.

I've provided the hospital with NICE, WHO, Lancet and Cochrane Report papers to support the safety of my decision and provide information on how to make things safer but they won't read them.

I'm glad they've finally agreed not to force me (this happened with my first labour) but I stilll need support to help find alteratives to make things actually safer and make me feel safer, calmer and less under seige. My baby will need NICU observations after birth so I'm keen to give birth in the hospital with the NICU. My babies consultant says her complications won't effect the actual birth.

Please help. Does anyone have similar experiences or information.

[Greengrow]

One reason I hired an independent midwife, the nicest birth at all (and at home). You can also free birth without anyone around although as you know the baby is going to need some intervention in your case hospital seems the only way. Have your lawyer on speed dial.

[Crazeeladee]

eatscake thanks, I hadn't realised they had finally got it, thanks for the correction :-)

[maggiethemagpie]

Glad to see that the OP has recognised that she is risking two lives not one and accepted that she will bend her rules for medical treatment during the actual labour, for the sake of her daughter if not herself. I'd hate for her to come back on here after the birth and tell us that something went wrong with the labour or that there was an adverse outcome.

Whilst it is probable that all will be well, she is right to make plans considering the worst case scenario and I'd advise her to confirm these in advance so that if the worst should happen she knows where there is room for movement.


OP you haven't mentioned your partner much at all, how does he feel about your plans, and do you feel he is supportive of you at all?

[frumpet]

I think terrifiedmummy you have to remember that the health professionals are terrified of you , seriously pooing their pants , because if the shit hits the fan , they are trying to work out who takes the blame for any 'bad' outcome .
Does your husband agree with your stance , not that that should matter , just that if anything happened to you , he could still take the people involved to court .
I really hope you have a lovely birth experience this time round , i know lots of people who had horrific first births , who had wonderful second ones

[terrifiedmummy]

I feel like I have friends here. Thank you,. I will let you know how things go.

[StarlightMcKenzie]

Hi OP,

I have so far only read your first post so have no idea how the thread has developed but I would strongly recommend that you find a doula to support you in this.

I have heard many people, many times suggest that NCT classes should consist of meeting on the first day, being advised to get a doula, then all down the pub for the rest of the classes...........

Sadly (for me) I understand your strength of feeling about your situation. I understand that the absolute base and bottom line has to be that no-one touches you, ever!

From there, if you are completely relaxed and have built up the trust of your caregivers, you may, on concern for your baby, request assistance if you are advised you might benefit from it, but you might choose not to, and that must be respected.

If you truly can't afford a doula, they are top people and will take payment in kind often, or charge minimal if they are training. They are usually strong believers in women having empowered births and the usually resulting from consequence a safe and calm birth for the baby.

For the record, after a horrible first birth, I had I very clear in my birth plan that no-one was to touch me, and that I would not consent to internals. The difference for me was that, eventually, my caregivers were supportive which resulted in births so relaxed I only ever had contact with them at the last minute and delivered both of my last two babies myself.

Neither needed NICU however, but depending on the reason for that, it wouldn't have changed how I did things.

[PacificDogwood]

It all comes down to ignorance though and an institutionalised resistance to change.

I don't agree with the 'ignorance' bit, but very much with resistance to change - hear, hear!

you have to remember that the health professionals are terrified of you , seriously pooing their pants , because if the shit hits the fan , they are trying to work out who takes the blame for any 'bad' outcome

And that. Big Time.
terrifiedmummy, you are up against your fears and previous experiences AND a terrified team of HCP who find you as threatening as you find them (well, maybe not quite ). It's one the consequences of defensive medicine i.e. doing everything to avoid any possibility of being sued. This does NOT ensure best practice or everybody trying extra hard. Fear very rarely leads to good decisions or equal relationships.

Get an experienced birth partner (doula).
Get a different team/hospital if that is at all possible.
Or find a way to really talk to your existing team, at the highest level, Supervisor of Midwifery and/or consultant.

I am so rooting for you .

[StarlightMcKenzie]

And incidentally, I also had written in my birth plan that I did not give consent for the McRoberts Manoeuvre.

Shoulder Dystocia is not an automatic 'hands-on' emergency, though still and emergency.

[Iffy2014]

Out of interest, Starlight, why did you not wish to consent to the McRoberts?

[StarlightMcKenzie]

Because my first baby was delivered by non-consensual fundal pressure after being repeatedly held down when my body and instinct was telling me I should stand.

[Crazeeladee]

Mcroberts isnt a manoeuvre, it's hands off. You lie on your back, with your knees as wide apart and far back as possible.

[StarlightMcKenzie]

I understood that you'd be 'assisted' with keeping your knees back (I'd have to be anyway as I don't have the stamina for even a couple of seconds of that) and then someone might feel obligated to apply pressure to the abdomen, with no time for specific consent for that particular hands-on action.

[Booboostoo]

Like others on this thread I think you need more control over the decision making process and then it may be easier to find solutions that are less risky and still acceptable to you. Can you afford to hire a souls that will come with you to all appointments to help reinforce your wishes? Or possibly is this a role your partner could play?

[Crazeeladee]

starlight the only pressure that should be applied wouldn't be to your legs or abdomen, fundal pressure would only impact the shoulder more behind the pelvic bone, making it worse. You would normally hold your own legs, and if that didn't work, which often does, then some pressure over your public bone to release the shoulder, either rocking or straight down is the next step.

[StarlightMcKenzie]

I am fairly certain that no midwife would do the McRoberts without touching me, unless I had made it extremely clear beforehand and even then they'd probably forget in the moment.

This is what I understand a usual method to be: www.5minuteconsult.com/ViewImage/7050461

[Crazeeladee]

That's only if it's still not working. We touch the bed to lie it flat, as you can usually suspect there might be an issue as the head is crowning, and ask you to grab your legs and pull them as far back as you can. I never actually touch the woman, sometimes, they put a foot onto my hip to help them, but that's them choosing to do that.

[Crazeeladee]

<a class="break-all" href="http://www.google.co.uk/imgres?imgurl=intranet.tdmu.edu.ua/data/kafedra/internal/distance/classes_stud/English/2%252520course/Elective%252520course%252520(Reproductive%252520health)/06_Obstetric%252520operations.files/image014.gif&imgrefurl=intranet.tdmu.edu.ua/data/kafedra/internal/distance/classes_stud/English/2%2520course/Elective%2520course%2520(Reproductive%2520health)/06_Obstetric%2520operations.htm&h=677&w=646&tbnid=4rMEonLG5jpz7M:&zoom=1&docid=RevxcEGhrWdZXM&hl=en-gb&ei=ebIEVOniJ8XcaJvDgrAK&tbm=isch&client=safari&ved=0CEIQMygaMBo" rel="nofollow noindex" target="_blank">www.google.co.uk/imgres?imgurl=intranet.tdmu.edu.ua/data/kafedra/internal/distance/classes_stud/English/2%252520course/Elective%252520course%252520(Reproductive%252520health)/06_Obstetric%252520operations.files/image014.gif&imgrefurl=intranet.tdmu.edu.ua/data/kafedra/internal/distance/classes_stud/English/2%2520course/Elective%2520course%2520(Reproductive%2520health)/06_Obstetric%2520operations.htm&h=677&w=646&tbnid=4rMEonLG5jpz7M:&zoom=1&docid=RevxcEGhrWdZXM&hl=en-gb&ei=ebIEVOniJ8XcaJvDgrAK&tbm=isch&client=safari&ved=0CEIQMygaMBo like this (if the link works!)

[StarlightMcKenzie]

I think there is a motivation to 'DO Something' when things appear to be going wrong, instead of asking the woman gently if their body is telling them to do something.

Of course I understand that drugs can impair a woman's ability to judge that (though some women, including me say that drugs neither impair their mind, reduce their mobilisation or do a thing for the pain (though never tried epidural)), so to be certain I could play an active part in subsequent births confidently I abstained.

In fact even though I'd had it very clearly written in my birthplan that no-one was to touch me, with my second, the midwife couldn't help herself pushing me down as the baby crowned as she thought I was about to stand up in the water. This resulted in me being unable to follow my instinct to change into a position that would allow the superman arm out without shredding my insides.

[StarlightMcKenzie]

But it is no more effective than other less awkward or arm-aching ways of dislodging the baby, and contractions in that position are bloody awful.

[Gruntfuttock]

Sorry, I've only skim-read the later posts but are all these things do-able without a HCP looking between the OP's legs at any point, because the OP insists that never happens as well as any touching and VE?

[StarlightMcKenzie]

Plenty is doable without looking between a woman's legs. I was in the water for my last two and no-one ever looked between my legs - ever. I had the heart listened to with the first of those a couple of times.

With my second I did my own internal examinations and reported back to the midwives. I also had a problem with the membranes being tangled up inside me and difficult to remove so I asked for help and was guided through the removal, but it was still me that removed them. Being in the pool like, forever and way past the first feed ensures that no-one can get anywhere near your anyway.

[StarlightMcKenzie]

The thing is though, if you have a good birth (By good I don't mean painfree or straightforward necessarily), and you are in control, and you trust the people attending, and they stay away from you unless asked or offer their advice or recommendations without touching you, if and when they eventually ask politely if they can 'have a quick look, if you don't mind' for the third time, having backed off the first two when you've replied no, well then, there is every possibility you'll not only consent but also not even mind consenting.

[MsAnthropic]

OP, I haven't read the whole thread but I have a lot of sympathy for you having had a traumatic experience in hospital having my son that I am still traumatised and feel violated by 7 years later (he was absolutely fine, btw, agpars of 9 and 10 and perfect blood gases afterwards so nothing that happened was to 'save' him). I had an internal after saying no, then screaming no, no, no by someone who did not introduce themselves and invited in and stood chatting to a random stranger (presumably another doctor) in the end stages of labour.

One thing I would strongly advise is to get everything you are told documented. That midwife who made the comment about "dead babies" or consent? If something like that happens, insist they write exactly what they said in your notes, and if they refused then YOU write them in your maternity notes, in amongst theirs. I did this throughout and it formed a very interesting record but you must do it at the time so your memory can't be questioned.

As for the person who suggested a c-section under GA? Have you had one? Do you have any idea how traumatic it is to be unconscious when your child is born? Obviously, I am sure that some people might say it's not, but it was horrific for me (c-section with failed epidural, spinal failed during surgery and rapid conversion to GA half way through)

[PacificDogwood]

StarlightMcKenzie, I may remember only bits and bobs of your making/having babies history and what you wrote here, so apologies if I get things wrong.
I think you (and women like you and maybe me and many others) come from a somewhat different direction that what terrifiedmummy sounds like (again, I could be totally off the mark, so apologies there too).
You come across as v well informed, not backwards in coming forwards and prepared to 'fight' your corner: politely and calmly or more stridently is required.
I had heavily medicalised labours and births (induction and emCS) and 2 rather nicer, calmer VBACs (never made it in the water as things moved to quickly). I v frequently remember ALL of these births with fondness and awe as to what the human, female body is capable was. I feel strongly that the fact that I have good memories even from the more traumatic moments is that I at every point knew what was going on and why, had not just signed a consent form but had in my head consented to what was going on AND felt that my wishes would have been heard if I'd had any particular needs at any point.

I realise that this is too often not the case.

MsAnthropic, sorry to read that you had such a bad experience. I hope you have fully recovered; in every repeat.
I have no idea what a CS under GA might be like (particulary if it is a 'crash' CS), but I do know of people who have not had psychological aftermaths from that kind of situation.
As far as terrifiedmummy's situation goes, I think it is important to think about the worst case scenario NOW and then hope it never happens. Plans for the worst, hope for the best - trite I know.

[StarlightMcKenzie]

'You come across as v well informed, not backwards in coming forwards grin and prepared to 'fight' your corner: politely and calmly or more stridently is required.'

That sounds wonderful, - thanks.
And perhaps it is true to an extent, - now, though any confidence in this area grew out of terror.

I was a completely different person going into my first birth. I was vulnerable, scared and a part of the psychological trauma suffered was from looking back and blaming myself for the things that happened to me and for not having the strength of character to stop it or assert myself.

My second birth had to be completely on my terms so I found the resources and information to ensure that happened, whilst trying to be realistic about potential scenarios. I researched how to increase the chances of avoiding potential scenarios too, but if they happened, I had a clear plan, - and a doula to support me in ensuring it was followed.

Those are not the actions of a confident woman but a scared one.

I was not scared for my 3rd birth, though the terms were even more 'radical' and I had suspected gestational diabetes (I didn't suspect it myself and found a way to demonstrate this) but the antenatal care was more of a dialogue and discussion than the insistence surrounding my second.