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.

Exam action!!! Vaginal examination.

Yes really - personally I'd be too afraid of something happening to the baby eg shoulder dystocia/ forceps needed. I think that would trump my fear of the internal exam but everyone is different and you're right I have not been abused so maybe that makes it different. I just hope the baby is ok if the OP goes down this route. Otherwise it's a whole new level of trauma.

Yes soontobesix that is exactly where I am coming from - glad I'm not the only one saying it will all be ok.

No you don't get examined during an ELCS. But there is the possibility that you may not make it to an ELCS due to complications and/or early labour so the issue of examinations is still relevant and needs to be considered.

Also, during an ELCS you may be exposed for various reasons, as its part of the procedure. Certainly having a catheter, means you will have to be touched between the legs. And because its a medical procedure, which is not emergency, they can refuse to perform an ELCS without a catheter because of the risks involved. A good hospital with understanding of anxiety issues like this, can try and make it a less traumatic experience with some sensitivity applied.

Equally, given attempting a VBAC may end up in an EMCS, you need to consider how this would be handled with regard to intimate inspections etc.

AND what happens if you do tear badly in a VBAC and refuse to be examined. You leave yourself at risk of infections etc. And this may end up with you back in hospital with later complications. Its not something that can just be ignored.

Which is why I really do think the OP needs to think about this, and has to seriously consider individual possible scenarios and dictate her terms should those situations arise, to minimise the effect on her, and leave her feeling in control.

"A vaginal birth without exam action is very very dangerous for your baby."

WTF? This is just nonsense....or a very odd idea of the meaning of very dangerous....

Women can in fact give birth with no medical assistance whatsoever....let alone in a hospital surrounded by medical staff who are skipping just one of a barrage of tests!

You don't understand, Maggie - just count yourself very fortunate then and back out of this thread.

OP - have a look at AIMS 'am I allowed' also. Another organisation, like BirthRights that supports informed decision making in giving birth.

Best of luck with your situation. If you can afford a doula or independent midwife then do consider one - even if you can't then I'd recommend contacting some in your area anyway as many of them offer discounts/payment plans or other help to women who, like you, really need the extra support their services can offer. This is their vocation as well as their livelihood and they will want to help x

I am very sorry to hear you had such a difficult time and I can understand your worries.

Is there any way you can get counseling in time to help you with choosing birth options? Refusing any kind of treatment/intervention is your right and if all goes well then you won't need to be examined/treated, however if something goes a bit wrong would you be willing to risk serious injury or even death to yourself and/or the baby? The doctors have asked you to sign the refusal papers exactly because they want to cover themselves in case you are seriously harmed due to lack of treatment. I hope that is never a reality for you but you need to consider the possibility that all this may happen and whether you are willing to accept the consequences.

Some of you need to remember that the OP is terrified there is absolutely no need to speak to her like that, maggie and also no need for a bun fight on the thread FFS. Show a bit of bloody consideration.

Consent is just that. Call AIMS helpline 03003650663 or email them [email protected]

I don't think it's necessarily the vaginal exam bit that's causing a problem. I'd guess it's the refusing 'any medical staff to touch or look between my legs'. That's an unrealistic expectation of medical staff who are trying to deliver a baby, and certainly would pose a problem if it proved not to be a textbook delivery. Also, refusing to be checked for tearing afterwards is risky; what if there is tearing, it's left untreated and gets infected? That could be very dangerous.

I can totally understand why the hospital would require a waiver to be signed. To be honest, I'm surprised that they're allowing it at all, and I'd see it as an indication that they're trying very hard to help the OP.

Maggie,

I see where you are coming from, but you are seeing it from your perspective and not the OP's.

Imagine your worst fear, spiders for me. Imagine someone saying you have to give birth with spiders crawling all over you, and if you say no then you are being selfish and not thinking of the baby... no matter what the fear is, it's real and just because you don't have that fear doesn't make it any less scary and complex for someone else.

What the OP is saying is that she cannot bear the thought of it, and is trying to make an action plan now.

OK I can see your point roland, but this has been posted in 'am I being unreasonable', known for being a board where frank opinions are sought and given. I don't think the OP is being reasonable to risk her baby's health in this way. That's my final word on the subject.

Wouldn't having a c section be equivalent to not letting any spiders out, if one are using spiders as an example?

Why not have a c section if one has a "vagina-phobia".

I agree with the others, have an ELCS. What if something serious like a cord prolapse is missed? I couldn't live with the guilt .

Oh have a section! Why are you trying for a VBAC if there are so many issues around it? My friend is in a similar position and is having a section.

The hospital will have to get you to sign paperwork to avoid legal action down the line if you end up with a malpresentation/cord prolapse/etc. that could have been picked up and dealt with if examination had occurred. It's just how it is these days.

I hope you're getting some help with your problems

OP The people you have dealt with need a serious update on consent. Some of the elements are that it is freely given and that permitted to with hold it. Actually, if you are prepared to risk your life and that of your baby, you are well within your rights to do so. Not only that, but if they intervene against your wishes and harm results then they will have a legal case to answer.

My feeling is that you are either going to have to:

1. refuse all exams and take the risk of something going wrong (it probably will not do).
2. Agree to certain examinations in certain circumstances, on the understanding that consent is an ongoing process, and can be with held at any stage. Agreeing to one examination does not mean that you agree to another. Maybe a birth partner, in addition to your DP, who can advocate for you, only for you, without taking their own emotions into account. Like a doula, a friend or a trained MW who is not actually delivering your baby (like an IM). Can you use the birth centre within a hospital (my local hospital has this). It means if you need doctor lead management (eg a CS), or the baby does (like yours going to NICU), it can happen just as fast as if you were on a labour ward. I guess it depends on how much monitoring they need to do for your baby. Another thought would be to labour at home for as long as reasonably possible. Having never laboured myself, I'm not sure how feasible that is, but my SIL laboured at home, and was pushing by the time the MW wanted to examine her. She was allowed to get on with it. A friend did similar, and delivered within a couple of hours of getting to hospital, with only one VE.
3. Have a CS. I have had two, and the only intervention involving my vulva was the placement and removal of the catheter. Placement I actually was not aware of, due to the epidural, and removal the MW did not actually touch me. I had rectal pain relief, but was asked first. You could easily decline this.

I'm not really getting this. Say you do tear badly and require stitiches, then you wouldn't want to just bleed and bleed as no one has checked.

Birth is not easy or pleasant and my first birth was awful for various reasons. But I think no one checking "down there" would have made it worse. Failure to progress, forceps and tearing.

I did not consent to forceps for an hour or so and they respected my wishes. In retrospect this was stupid as I was in agony and the baby could not get out so I had to consent in the end. I think I should have taken the doctors advice to have forceps earlier on.

I think that what you are proposing is fine as long as you have a straightforward birth. Have you thought about what you.'ll do if things don't progress, the baby gets distressed or gets stuck?
I'm really sorry this is so hard for you but would urge you to consider what you could cope with in an emergency and whether a C section would be better for you.

I had a vbac last year and I would urge you to have a cs in your case. I'm really sorry about your previous experiences but the hospital staff are being put in an uncomfortable position if something out of the ordinary happens. They can't guarantee to respect your wishes if things don't go to plan

If vaginal examinations can be so freely dispensed with, why do them at all?

Accept the hospital are all over the place with their consent policy, but TBH the health of me and my baby would be more important to me.

I'm inclined to agree with soontobesix, maggiethemagpie and AF.

I had a terrible birth, the delivery could have been directed by Quentin Tarantino. I tore so badly. Foreceps and Ventouse were used, I dont know what would have happened if the professionals had to follow orders to not touch my vag.... I cant understand how this can be safe for either you or baby. If you are that traumatized, why not go for a CS?

Another one who experienced a horrific delivery. Elective CS was perfect for me

erm yes. they can guarrantee to respect your wishes. Like they do with a Jehova's witness aged over 16. They can watch you die while you refuse specific examinations or treatments. Actually, in the OPs case, because the baby needs to go to NICU, they are better off getting her into hospital to deliver, even if she dies, because the baby will get the care it needs. If they refuse to honor the OPs demands and she feels forced to deliver at home, unaccompanied, they will have not only her death, but perhaps the baby's too to contend with.

Like the PPs, I do think that a CS would be the lesser of 2 evils, Less fiddling with the genital region, all of it with the OP numb (or even unconscious if she would prefer and can get a GA), and all in a calm manner, with time to prepare.

I'm voting in favour of C-Section! Safety for mum and baby all the way!!!

and Thank you for posting here terrifiedmummy I'm sure it was not easy but you were brave and we appreciate that :)