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.

I am so sorry. This must be torment.

I would focus on finding a trusted HCP who can be your birth partner, definitely go down the route of an independent midwife or doula. They will be able to advocate for you, do any vital exams, and most importantly, work with you to build up a bond of trust before baby arrives, so that you know if they say something is necessary, it's true. It would be less aggressive and confrontational.

I honestly can't recommend this course of action enough. You need someone to trust.

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.

You need a robust birth plan and for someone to go through this bit by bit. This be a midwife you can trust or a doula to help you stand up for you or both.

Draw up a range of scenarios which you can go through with them; then you can draw up in advance where your boundaries are. If its in writing this makes easier for you when you are in labour as you know you have it as a fall back if you feel pressurised - it may help you to be more confidence and feel like you are in control.

I actually feel for you, as you are in London, as from what I am aware, pressure on services is making it very difficult for women like you to access the support you need. It does sound as if your needs are being dismissed.

Love - you need to change hospital, and if you're going to a London hospital anyway, this should be a realistic option.

A few years ago a woman I knew who'd had an appalling first birth outside of the UK and was experiencing PTSD was referred into Queen Charlottes - I'm hoping to goodness you're not already booked there but if not, have a look.

You need someone who listens and takes your trauma seriously. Not makes you feel that you're being backed into a corner.

OP - I'm sorry about your birth trauma. My 1st birth was horrendous as well, and left me with PTSD which resurfaced during 2nd pregnancy. I had an elCS and it was wonderful.

Like you, I was bedridden for weeks after DD's vaginal birth, but I was fine on day 3 of DS's elCS, fully able to take care of him.

YABU to expect the hospital to agree not to examine you at any point during birth. If you feel that strongly about it, go for elCS.

Sweetie, I had a CS for my second birth. The first was a traumatic vaginal delivery with ventouse (I'd put in my notes that I absolutely refused to allow the doctors to use forceps).

It was because of the distress I'd suffered that my GP recommended a section and the hospital consultant didn't just agree, he was totally supportive of the suggestion.

I had my section on the Monday and was home on Thursday lunchtime. I came home prescribed with paracetamol, took 2 the first day home, 2 the second and needed nothing afterwards (and I am a WIMP! I promise you that I'm very sensitive to pain and squeamish too but honestly I was fine).

A week later I was hoovering my 3 bed house. My then husband was at work from 7am-7pm and totally, abusively unsupportive when when he was at home but I honestly didn't need him. Two weeks later I was almost back to normal, taking it carefully but doing almost everything I'd done before birth.

My section was calm and controlled. I felt in control. My then DH was there but I wouldn't have felt alone if he hadn't been. The theatre team were so kind, calm and reassuring I felt safe and supported.

The delivery of my second DC was wonderful, SO different, so much calmer and less scary and traumatic than the vaginal delivery of my first. I was awake under section. I had a spinal block. I knew everything that was going on, I was kept informed, my baby was handed to me as soon as she came out. I was given the option of going under because it was an elective section but chose to be awake because I'm a control freak! The anaesthatist came to see me the night before to introduce herself and answer any questions and when I went into theatre the doctors and theatre techs all introduced themselves by name and did their utmost to successfully reassure me and answer further questions.

You're NOT a failure for having a section. What's important is that you and your baby are safe, respected and well cared for, not how he or she came into the world. Please believe me, you're not "only half a mummy". Your son won't care that you had a section, only that he's here and that you love him. Trust me, my 2nd child is now nearly an adult and will tell you that!

Please may I suggest that you discuss an elective section under epidural or spinal block with your consultant and GP and find out what that would entail.

And midwives... they can be funny buggers. If you get a good one it's great but some can act above their station. The one I saw at the hospital after my GP had recommended a section told me she'd never heard of such a ridiculous thing and I'd never get it. She was so horrible that I nearly walked out with the intention of going back to my GP to request a termination. It was only my husband who saved my baby and I. He told me to ignore the "silly cow" and wait to see what the consultant said! He was right. The consultant was NOT impressed with her comments! So to quote my ex, don't listen to the monkey, ask the organ grinder.

My section was calm, controlled, safe, peaceful and the recovery a piece of cake in comparison to my vaginal birth. It really is worth considering.

Whatever you decide, good luck, don't be bullied, don't take first responses, get yourself well informed (as you are doing) and fight for what you want. If you feel browbeaten or that your rights are being ignored or overridden contact PALS and have them advocate for you.

Oh heavens, sorry for the long post! I didn't mean to monopolise!

My sympathies OP. I also did not want internals due to childhood abuse. I successfully birthed my daughter with no internals and nothing I didn't specifically consent to. It absolutely can be done.

I'd really recommend a doula, both to talk over your fears and make plans before and be there as your advocate during the birth.

Also read this on alternatives to internal exams: birthwithoutfearblog.com/2013/06/06/alternative-methods-of-checking-dilation-the-purple-line-and-more/

The rest of the site is worth a read too.

Don't listen to anyone who tells you you are putting your baby at risk. There is zero evidence.

Hugs.

Remember the OP wants a vbac for very valid reasons, it's not being forced on her.

She doesn't want to be asleep for the birth of her baby.

Agree with llama :)

The number of posts which show absolute ignorance of the process of birth, but at the same time decide to give the most ridiculous advice about specific medical interventions are just appalling.

A baby with the cord around the neck is NOT detected, nor corrected, by a vaginal examination.

One of the biggest risks of a VBAC (but still very small) is uterine rupture. This would NOT be detected (nor helped at all) by a vaginal examination.

Shoulder dystocia is NOT detected by a vaginal examination either.

The reason midwives and obstetricians do vaginal examinations all the time is not because they are needed, but because they give them information that helps them know the timing of labour. There are lots of labours and births that happen without any vaginal examination (I have seen many and I am only finishing my midwifery studies!).

The great majority of complications during labour and birth are not detected by a vaginal examination.

The reason for most 3rd/4rd degree tears are actually the use of forceps and ventouse. And most uses of forceps and ventouse are unnecessary, and caused by iatrogenic reasons (iatrogenic=caused because of being in hospital, and using technology in an unnecessary manner).

Women (and men) have all the right in the world to opt out of any medical intervention, regardless of what the effect of not having the intervention is. We all increase our risk of death every time we go skiing, or practice any sport. The only difference is that some risk-taking activities are more or less condoned by society, and our society doesn't tolerate "refusing doctors' orders", for some reason.

And finally, the extra risks of a VBAC do not need a vaginal examination to be detected, or acted upon. Continuous fetal monitoring and the attendance of an experience midwife or obstetrician should be more than enough. If a complication arises that would require vaginal examinations, the OP could be given the option of an emergency cesarean at that point.

What the OP needs is a team of maternity care healthworkers meeting together with her to try to adapt to her needs and wishes for her labour and birth, whichever those are. If some of them can't cope with not being able to do what they want, instead of what the OP requires, then they should abstain from being involved in the OP's care.

It is ok to give support and advice to the OP, but please, no medical/obstetric/midwifery advice if you don't have any knowledge of it.

But slithtove, you don't HAVE to be asleep for an elective section. IME you're given the choice (or am I misunderstanding you?).

Sorry, slithytove. I missed the Y in your name.

It has been suggested by other posters though...

I wish there was a like button for auryannes amazing post!

aurynne the OP wasn't just worried about VEs though. She is also concerned about other issues, which mean she would be exposed. For example a HCP looking between her legs.

Please complain to someone high up about the dead baby comment, that's completely unprofessional and unfounded (unless they can provide a research paper proving that the majority of labours without internal exams result in death, which they won't be able to). People shouldn't become midwives if they're happy to lie to women and are unable to exercise any sensitivity to the women's needs or context.

RedToothBrush, those issues can and should be discussed at the meeting with the obstetric/midwifery team in order to find a solution that pleases the OP. It is her baby, her birth and her life. This sounds to me not like a simple phobia of VEs, but an issue of control and the OP needs to be sure she will be the one in control and making the decisions in all cases. In case of an emergency, it is even likely the OP herself will consent to a vaginal examination if she feels she is being respected (or not, if she still chooses not to).

aurynne I am well aware of that. In fact I'm pretty sure I have posted to that effect several times on this thread...

About people looking between her legs... if there are no major complications, the only time anyone really needs to look that way I when the woman is pushing. Even so there are discreet ways of doing it, like using a small mirror on the floor if the woman is standing, kneeling or squatting, or in the water, which happen to also be the best positions to give birth.

The trouble in what you say though is the word 'if'.

The OP clearly did have complications in her first birth which is one of the reasons why she is keen to avoid a repeat and so she feels more in control in those more complex situations.

The OP needs a plan of some description for a text book birth, but also more difficult situations as these are the situations that are causing her the most anxiety and she feels like she is not being given the right to refuse consent. And she needs to feel that those plans are being taken seriously, and that she has the confidence to be able to say no.

That is best achieved with a combination of mental health support, having a trusted HCP(s) who respect what she feels, having some sort of birth advocate, educating herself and finding ways to feel more confident about being assertive about her rights.

How she achieves those goals is really the point here.

I think I probably would also consider changing hospitals as has been already suggested, as I think trust in the HCPs at this hospital has already been lost, and the OP is facing hostility to her needs. I doubt she would be in a worse situation else where as a result.

Completely agree, RedToothBrush. I think we are trying to say the same thing in a different way :)

Most uses of ventouse and forceps are unnecessary? Righty hi then.

OP you need to be very forceful at this point with your midwives and gps etc. you are not ok and you need some proper help/advice. Do not leave your gps office until you are satisfied with their plan for getting you help!

I have no expertise here, but would a doula help you, as your dh can't be with you?