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.

[minifingers]

"It isn't utter tosh and the hospital are being quite right to make her understand the seriousness of her decisions"

It absolutely IS utter tosh to say that a VBAC without vaginal examinations 'has a high risk of ending on serious damage to you and the baby'.

You have NO idea how this might impact on the safety of a birth.

Neither do hospitals.

There is no research showing how routine vaginal examinations impact on outcomes.

You are guessing.

And on the basis of the fact that you are guessing and making wild assumptions, I'd say it's a bit off to tell the OP she is putting herself and her baby at significant risk.

[minifingers]

"People have been having natural unassisted births for years, yes, but maternal and foetal mortality was much higher"

Please don't start comparing the outcomes for women who have no antenatal care, no midwifery care in labour and no monitoring with what the OP is planning for her birth.

She is planning to have midwifery care, not give birth alone in a field.

[minifingers]

And just out of interest, I've done a quick look for evidence - and there IS a Cochrane review:

here

It concludes that this is a non-evidence based intervention in labour:
"We found no randomised controlled trial evidence to support or reject the routine use of vaginal examinations during labour."

[maddening]

But mini fingers - it is not being suggested that she is increasing the risk of complications but that should complications arise they may need access which she is also not consenting to - totally with the no internal examinations but if the baby is stuck there may be either a choice of internal interventions or a ill or worse baby and / or a v ill mother or both so with a not inconsiderable chance of the need for further assistance if anything were to occur and access to assist the baby denied there is a risk that what is a minor risk where access is allowed can become a huge risk when not. The consequence of the need for further assistance becomes far graver - when you consider risk you consider the propensity for the situation to arise and couple that with the gravity of the consequence of the situation arising - what could be a simple checking the cord is round the neck and getting it loose could become an oxygen starved baby, shoulder dystocia can be delivered successfully but has to be done within a certain time frame and with very invasive procedures but absolutely no chance of no intervention.

How exactly do you venteuse without internal intervention?

[maddening]

Oh and death in childbirth of both mother and baby was v high back in the good old days of unassisted birth.

I did hypnobirthing - v into trying to birth as naturally as possible but totally open to all options and v aware of what complications could arise and the need for medical intervention - consider myself v lucky.

But I haven't been abused or had a traumatic birth so I totally back your right to no examinations but think that there is a massive disconnect between your needs emotionally regarding your body and the potential issue of complications arising so just think you need to plan cs either as elcs or in the case of complications as your first go to point at any sign of problems.

[MrsMook]

I think a VBAC changes the goal posts significantly. Medical staff are very twitchy about the risks of scar rupture, and that makes the risk of intervention higher as they are less inclined to be patient.

With Ds2, they picked up signs of distress. Because of the paranoia about scar rupture they burst the waters to check with internal monitoring. DS had reached the point where he was either going to be born by a difficult Cs, or a difficult forceps birth which resulted in a 3rd degree tear. Maybe he would have been Ok to have been patient and let nature continue. Maybe he and/or I wouldn't. How would I deal with a preventable damage or loss of a baby? How would my family deal with the consequences to me? That would because huge emotional burden on top of the existing trauma. I'm sorry if I'm being blunt. As much as we'd all love a simple birth without intervention, it can't be guaranteed, and some starting points negatively affect those odds.

I think for your concerns, an elcs. would be easier to mentally prepare for. The medical risks are easier to manage, and there is more time to calmly and sensitively work with the patient rather than a panic situation in a Vb, or emcs.

If you still feel a Vb is necessary, I hope some of the other advice helps you prepare. I benefited from a visit to labour ward, and a long discussion with a specialist MW about my baggage from the first birth.

[minifingers]

Midwives don't usually need to check for a cord.

Shoulder dystocia can often be resolved with a change of position of the mother (the Gaskin manouvre).

If in the end the baby is stuck half way out the birth canal and the mother isn't consenting to having anyone do anything and it's too late for a c/s - well, that's a pretty awful situation, but I suspect that the OP would give consent to someone helping deliver the baby in that situation - whatever it took. Vaginal examinations won't show if a nuchal cord is causing problems - if it's holding back the birth at the moment of crowning or after delivery of the head, well that's a bit late for a VE isn't it? If it's causing really significant problems early on it'll be picked up by monitoring.

[parallax80]

Only 2 observations Mini

a) your reference to Leeman et al is only relevant to 2nd degree tears (which IME frequently do go unsutured through women's choice). 2nd degree tears are far less likely to cause ongoing problems with continence etc than 3rd or 4th degree tears in any case, so the study population cannot be extrapolated to all women declining or having no opportunity for perineal repair.

b) yes, there is evidence that routine VEs are of questionable value, but declining routine VEs is a different kettle of fish to declining anyone to touch or look between legs, which is what is mentioned in the OP. This would include emergency VEs, intervention for shoulder dystopia, management of post-partum haemorrhage, perineal support to prevent tearing etc etc etc.

[ICanSeeTheSun]

MW know what they are doing, perhaps I may be to trusting but they don't do vaginal checks willy nilly. They must know there is a problem.

I think it's very risky to go through labour without any checks.

[slithytove]

Vaginal checks are done willy nilly to check for dilation. Unnecessarily too.

Far better to keep them for emergency use.

[terrifiedmummy]

Hello,

Thank you for all of your support and thank you for the legal site, I'll look them up. In answer to some of your questions. A CS isn't really an option because:

• I have to be able to look after my son. It took me months to recover from his birth and I don't have that luxury this time round.
  
• My midwives and consultant are adamant that VBAC is always the best option to try for second time round.
  
• I feel like such a failure for having a CS. I was about to start pushing so I nearly did it. Now I've missed out on an experience I was desperate for and I feel ashamed and only a half mummy.
  
• I had difficulty bonding with my son because of the CS. I never knew he'd been taken out of me so I was never sure he was mine (silly I know, why would they hide babies in theatre to swap them round).
  

To help ensure safety I've agreed to continuous fetal heart rate monitoring. At times I almost think I'll let them examine me during labour for the babies safety but then they are so agressive and confrontational it just frightens me and pushes me further away from them and any intervention.

I don't have a birth partner as my husband can't be there.

With my last labour if I wasn't examined and if I hadn'd had a CS my son and I would have died. This should make me more inclined to be favorable to both but I'm just too traumatised by what's happened. I've begged (quite literally) for help from my community midwife, the triage midwives and my midwife councellor and explained that I've felt suicidal and considered DIY abortions. However the result is always the same, I'm told I have to do this. I've asked for specific guidance on how to make specific treatments bearable but I'm just told I may be allowed gas and air.

I've made an appointment with my GP two weeks ago to discuss my psycological problems and ask for councelling but I stilll have a week before the appointment because I'm not urgent (very busy London practice).

I just want help to sort this mess out and make it all okay. So any advice on where to turn would be good.

[OneLittleToddleTerror]

The OP isn't just refusing vaginal examination. She is refusing any medical personal to look or touch between her legs. People need to retread the OP more carefully.

I didn't get any vaginal examinations to check for dilation. That's specially now in my new birth notes from a consultant that I could request an internal. Multiple MWs missed all the signs I was in active labour the last time. I was in for 3 days so there were quite a few of them. So I can say it's not every hospital that will do it willy nilly. Mine obviously is on the don't touch side.

But I still have medical staff looking between my legs because I got a ventouse and episiotomy. Baby was stuck. Simple as.

[terrifiedmummy]

Sorry, third paragraph should say baby's safety. There is only one in there.

[Fairylea]

I think you need to copy and paste what you've said here into a letter for your head of midwives at your hospital and ask for an appointment to talk through your concerns.

I also think you really need to find yourself a birth partner. Is there anyone you could ask? Failing that a doula or independent midwife would be good. You are less likely to feel so bullied if you have a good birth partner that you know is on your side.

I think you may need counselling about your feelings about your c section. The fact your little one came out through the sun roof doesn't make you any less of a parent. How you give birth is a very small part of being a parent in the grand c scheme of things.

Having an emergency c section is totally different in terms of recovery and positivity than having an elective section. Just something to bear in mind.

[ATruthUniversallyAcknowledged]

How about a doula or independent midwife? Would you consent to someone you knew and had built up a relationship with doing the examinations?

[OneLittleToddleTerror]

terrifiedmummy I just missed your response. Did you have an EMCS last time? I hear from many that it is easier to recover from a ELCS. So don't rule it out yet. I'm not medical so I'm not sure why the consultant believe it is better for you to try a vbac. As it's very common to opt for a ELCS following a previous cs. But he must have his reason. We here can't understand the medical history and background. Is he aware of your emotional well being when he made that decision? Is there counselling you can access in the hospital so you can work through what's the best way forward for you?

[eagle2010]

terrifiedmummy, I really feel for you.

I felt the same after my EMCS - felt that I hadn't properly given birth (I was under a GA as well) and I found it hard to come to terms with the fact that I'd had a section.

A lot of my friends had long labours without ending in a section and there was a good deal of feeling from them that if I'd just "held on" a bit, I'd have had a VB. The reality was that DS was stuck face up in my pelvis and any pushing would almost certainly have harmed him and me.

I hope that you can talk to whomever you need to about your feelings and come to a solution that's right for you and your baby.

Good luck.

[PenguinsIsSleepDeprived]

OP,

Are you really sure that a C-section isn't an option? Your team's views on VBAC aren't in line with current NICE guidelines I don't think. I am sure you could get advice from many knowledgeable posters on here if you wanted help pushing for one. The other things can all be overcome and are reasons for more support, not against a section.

In all honesty, I think if you are feeling suicidal you need to call your GP practice back and tell them it is an emergency and you need an emergency appointment. You need proper support. The good news if you are in London is that you are near many good teaching hospitals with expertise in supporting women in your position.

[ATruthUniversallyAcknowledged]

Alternatively, an ELCS and arrange some support to help with DS1 for the first few weeks?

I had DS2 by ELCS a week ago and managed DS1's bath time tonight. I could already do most other things with him. I've found recovery from the ELCS much easier than recovery from the labour and EMCS last time.

[RaspberryRuffle]

OP sorry about what has happened to you.
I've just seen your update and maybe you could get counselling around the CS option because even with your update I think it could work.
Women tend to recover more quickly from an ELCS than EMCS. With a VBAC there's a chance of a CS anyway, but if it gets to that point you may be exhausted.
Method of giving birth does not make anyone a good/bad mother.
With your fears in mind plans can be made to minimise contact with your vaginal area.
Maybe the screen caqn be lowered so you see the baby come out of you, or the baby can be passed to you before cord id cut, they are undeniably "yours".
If Dh can't be there do think about who you can bring, a good friend, your mum, an aunt, a doula, someone who will make you fell safer.

Good luck

[treaclesoda]

How long have you got until the baby is due?

[treaclesoda]

Someone might already have posted this link, but there might be information on this site that can help with your feelings regarding your previous birth experience.
www.birthtraumaassociation.org.uk

[bakingtins]

I have requested no routine VEs for my three labours and consented at the time to a single one to assess progress in labours 1 and 3. The MW's were pretty good at staying 'hands off'. In every case they observed and 'caught' as baby was born, checked for tears, few stitches after labour 1. In labour 2 I had a dramatic PPH after attempting physiological delivery of placenta which involved a whole world of interventions with no time to do anything about consent other than explaining to barely conscious self what they were doing. It's not predictable. I think what OP is requesting is in a different league to requesting no routine exams and quite unrealistic, particularly for a VBAC. I can't see how the MW can assist in delivering a baby vaginally without at least observing at the business end. Something went wrong in OPs first labour resulting in decision to EMCS, presumably because of concerns about baby, and this baby is already known to have some issues meaning it will need NICU care, plus traumatised mother attempting VBAC and refusing assistance. I'm v sorry for whatever you have suffered that has caused your trauma, op , but I'm with the majority that say an ELCS sounds like a much better option.

[bakingtins]

sorry, cross posted with your update. as well as pursuing the counselling as a matter of urgency ( can't MW or consultant refer you?) you need someone supportive to be your birth partner and to help you post-natally. Why can't your husband be there? Will he be around after the birth? Is paying for a doula an option? It would make so much difference to have someone there you trust to support you and if necessary fight your corner. When you are giving birth you are probably not in a position to be assertive.

[AnotherStitchInTime]

Talk to some of the ladies on the yahoo vbac forum here there are some very knowledgeable midwives, doulas and mothers on there who can help you.

I had a vbac attempt where I basically stayed at home until the last minute and was fully dilated on arrival. They didn't need an internal to tell them that. I was only monitored after I consented because I refused on my notes and I also refused cannulation until we got to theatre for EMCS,not a problem. The only internal I had was because I consented to a ventouse attempt in order to avoid another c section,but you can refuse ventouse/forceps and go straight to c section.