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.

OP, are you going to come back to your thread and talk with us some more ? There are some very supportive and empathic people here.

(As the google image says)

OK so what if the baby has the cord round and round it's neck? How are they supposed to deal with that without looking at your privates

I am very sympathetic towards your situation but for your safety and that of the baby I would suggest having a c section surely this is an example of the best reason to opt for one. looking back to when I had my dd I can't imagine a birth with so many restrictions. obviously it's not a nice thought but if the birth were not to go to plan it puts everyone in a very difficult position and it would be very hard to come to terms with the outcome of that.

I really hope everything goes well for you.

I wonder if this tread should be moved into Childbirth - some of the comments make me uneasy and I don't think AIBU is the right place for something as sensitive as this.

OP - I'd suggest you investigate Sheila Kitzingers Birth Crisis organisation as one source of support, and the Birth Rights organisation others have mentioned. Have you considered using a doula would could work with you and be your advocate during your labour?

I get the feeling that your list of refusals comes from your deeply felt need to be able to maintain control over what happens to your body, and I wonder whether working with a doula or a midwife with experience of supporting the survivors of abuse would be helpful. There may be situations during labour where for the well-being of you or your baby, a midwife may need to see what is going on - there are ways of working with women to ensure that their sense of control and autonomy is not destroyed in the event that touch/looking is required. For example, if a woman has agreed to an examination, she may need to know that the midwife will stop immediately if the woman says so - in order for this to work, the woman needs to have time to get to know the midwife and build a relationship of trust. The midwife may need to maintain eye contact with the woman and use her sense of touch alone - or not mix looking with touching if that makes sense - it can be done, it takes experience and the right attitude.

One thing you might want to consider is asking for an appointment with either a supervisor of midwives or the midwife responsible for safeguarding or with experience of supporting survivors of abuse - there should be one. You need individualised support so this doesn't feel like a battle.

Good luck.

I don't have any useful advice for you I'm afraid, I couldn't even imagine having to make some of the decisions your facing and I'm so sorry for your past experiences.

But I do want to say well done for reaching out for advice and I hope you continue to do this from the NHS too, don't let a few bad members of staff put you off.

Wishing you and your baby lots of luck and good health

OK so what if the baby has the cord round and round it's neck? How are they supposed to deal with that without looking at your privates

^^I would imagine THIS is exactly how births without vaginal examinations end in a 'dead baby'.

Bless you.

I would urge you to speak with your MW to see if it may be possible for you to have an elective section

If the OP doesn't even want someone to look at her then a CS won't help either. They will see things she probably doesn't want them to.

I think the CS is probably the better (and safer) option but I would suggest some serious trauma counselling asap because either way, there isn't a great likelihood of that area remaining unseen and untouched.

I know a couple of people who have had births without any routine vaginal examinations - it's really not that odd a request?

I think you would have to be flexible in emergency situations, but there's not need to accept examinations if unnecessary.

I had a history of sexual abuse. A traumatic labour then emergency section and DS has cerebral palsy. I suffered badly with PTSD for 4 years. At 7 years, discovered I was pregnant again.
I had an ELCS with a spinal. A week before, I had a tour of the maternity unit and spent some time in the theatre, recovery room and was shown my post-natal room (it was felt I would be better on my own). I told the midwives exactly what I wanted them to do with baby and what to say to me whilst they checked her over. I chose the day on which it was carried out.
It went very well. Mostly because I had a great relationship with the consultant, he knew my worries from day 1 and brought in the head of midwifery at an early stage to start arrangements.

Just have a Caesarian

Honestly. It's fine. You will be totally numb and won't really feel the catheter at all. And you can ask fir it to be out as soon as they know your bladder is working. Removal is really quick.

Please don't risk yourself or your baby.

I don't know how it would be possible to guarantee no need to intrude - such as shoulder dystocia (sp?) , requirement of forceps or if you were damaged badly , for that reason I think for both yours and the baby's safety I think an elcs would be the best option - whilst a majority of natural births are fine and could go by without any intrusion enough do require assistance that it is too big a risk if you can not accept such intrusion under any circumstance.

Good luck with whatever you choose and enjoy your baby xxx

I think the hospital are completely right in telling you the absolute risks of the decisions you are making. The brutal facts are that to have fully informed choice you need to be aware that this decision you are making is against medical advice and may lead to complications for both you & your baby. You cannot be upset with the hospital for them wanted to get you to sign a document saying you are going against medical advice.

I had an ELCS for similar reasons OP (although was my first baby). My midwife told me specifically that if anyone touched me without my consent it counted as assault. You have every right to refuse. I felt this was a little drastic as the health professionals were there to help me, but it was something they took very seriously I assume.

FWIW my ELCS was perfect and although I started to panic when the catheter went in (despite having had a spinal) it was over in a flash and removing it was nothing - the midwife didn't have to get close to anywhere private and said I could remove it myself if I'd prefer.

I hope all goes well for you and that you choose what is right for you.

Ps I think no vaginal exam is a completely reasonable request in some patients but it cannot surely ever be 100% guaranteed especially not in a VBAC with a baby who it is known is going to need NICU. Unfortunately nothing about childbirth or neonatal care/ the human body is that predictable.

You have every right to refuse, but as has been said above, a VBAC with those restrictions has a high risk of ending on serious damage to you and the baby.

Why not have a CS? They could do the spinal first, then put the screen up so you wouldn't see or feel the catheter going in.

I wish you all the luck in the world, but are you prepared to take the guilt if the baby is brain damaged because of your decisions? That isn't going to help you psychologically.

Ps whatever you choose consider a doula and relaxation lessons (I would recommend hypnobirthing style relaxation even for a cs - when I was threatened with theatre it helped me stay calm whilst it was all going on - was lucky and didn't need it in the end but being calm helped. Have your birth partner do this with you and train to be your advocate - it might help you feel in control and protected with a doula and a birth partner who is with you all the way. A doula can help post birth too which might be handy if you have a cs.

And I second the trauma counselling - you deserve to come out feeling good with a baby - with a good experience of your child's birth - don't let this haunt you and continue to impact you - you can't change what happened but you can expel some demons

Would they agree to no intrusion and if any doubt is raised as to the success of the birth without intrusion you go straight to emcs ?

Ps I think that in the case of shoulder dystocia or cord round the neck you would need to allow what needed to be done to be done.

In the case of tearing could you go under GA for that?

Second having someone with you like a doula who can help with your wishes, that you get to know and trust. I refused to have any examinations until I'd had a epidural and then only because I wanted to push and the midwife needed to check how dilated I was. I don't respond to anaesthetic so I was still able to walk around the room unaided, it took the edge off the pain that's all.
But if you tear, you need medical help to repair that tear. That's said in the nicest possible way.

"You have every right to refuse, but as has been said above, a VBAC with those restrictions has a high risk of ending on serious damage to you and the baby."

What utter tosh.

None of us here have any idea of how regular vaginal examinations impact on outcomes for birth because there is - as far as I understand - precious little research into this issue.

In fact, I'd go as far as to say that I suspect that routine vaginal exams rarely increase the likelihood of a trouble free birth (because it stands to reason that regularly inserting your hand into the birth canal of any labouring mammal often tends to cause more problems than it solves).

The OP is not declining fetal monitoring, and vaginal exams are not the only clue an experienced midwife will have as to the station and descent of the baby.

I can't see why the hospital can't try to create a care plan for the OP that will satisfy everyone.

Women don't always consent to having tears sutured.

tears

Conclusion of this fairly recent study:

"Women with sutured lacerations report increased analgesic use at the time of hospital discharge compared with women with intact perineums or unsutured lacerations. At 12 weeks postpartum, no differences were noted between groups regarding complaints of urinary or anal incontinence, sexual inactivity, or sexual function."

It isn't utter tosh and the hospital are being quite right to make her understand the seriousness of her decisions. It would be a disgrace if they allowed her to go ahead with a plan that could (not definitely will, but could) have serious implications for her health and that of the baby without informed consent. If she signs something to remove all obligation from the hospital in the event of a tragedy, and takes all risk upon herself, and is happy to take that risk on behalf of herself and the baby then she can go for it.

People have been having natural unassisted births for years, yes, but maternal and foetal mortality was much higher and in the pre hospital days women didn't have scarred uteruses!