To think midwife is fobbing me off? *TW* mention of rape.

[Worriedandabitscared]

Good morning,

Sorry about the grim post so close to Christmas but I wanted to post in here as people tend to be more up front and honest than they are in pregnancy and I'm not sure if I need a reality check.

I'm currently 34 weeks pregnant and 6 weeks ago at my midwife appointment she asked me if I had any concerns about birth etc and I said I would like to speak to someone about the pros and cons of birth vs c section as when I was 14-18 (28 now) I was in a very abusive relationship where I was constantly raped (I don't know why I didn't leave, I was young and stupid) and whilst I know childbirth is different to being raped (obviously!) I'm worried about the psychological trauma that being in that much pain around my private parts and having multiple people around looking and touching my vagina would cause and I wouldn't want it affecting my bond with my baby, the reason I even mentioned it to her was because I had an internal the week before which hurt a lot as I had an infection and it made me feel weird and made me think about the previous relationship so she just said "okay" and that was that and I'm too shy to speak up.

At my next appointment I brought it up again as my husband said I needed to be brave and see if I could have the conversation and all the midwife said was "they don't do c sections routinely, vaginal birth is safer for baby and you don't want him to get hurt, do you?" Which obviously made me feel a bit shit, of course I don't want my baby to get hurt but I also want to protect my MH and I hadn't said I definitely want a c section as I know there's risks involved and it certainly isn't the easy way out but I wanted to discuss it with a professional.

The perinatal team came round on Monday and I mentioned it to them and they said they'd email my midwife who I saw on Tuesday and it was the same thing, she just reiterated that vaginal birth is better so it leads me to think I am being unreasonable but it's really stressing me out.

Please can someone give me a little reassurance that I should be okay? It's just so stressful, as if birth wasn't hard enough I need to worry about it triggering things I thought I was over, it's annoying too as I don't want to give my abuser any head space but it's so hard not to

I would say - whilst she should be openly discussing pros and cons with you of both options, that it would be a 2 way discussion where she also listens to your issues. This should then go on to formulate the best way forward, given the circumstances. Maybe give you time to mull it over and work out what you think is best or even set you up to talk to someone else more appropriate. But she shouldn't just be dismissing it or brushing it off. That's outrageous.

Definitely ask for a different Midwife and push to discuss this with a Consultant. The Midwife shouldn’t be putting a vaginal birth ahead of everything. It is certainly not the best, safest option for everyone.

I have issues around my son’s birth that I still struggle with where I felt I couldn’t speak up because of anxiety. If you think you will have trouble asking for what you want or airing concerns during childbirth or while discussing birth options beforehand can you ask your partner to advocate for you? It is all very well him saying you need to be brave, but I felt When I was in labour I really wanted my partner to say ‘actually this isn’t right’ when I felt powerless. If you tell him you feel incapable of speaking up now will he be the more forceful one in insisting you speak to somebody about a caesarean?

Good luck

She is being awful and neglecting your needs. Switch midwives, escalate and make a complaint if you need to.

If you do decide to try for a vaginal birth, have multiple copies of a printed birth plan to hand with a very clear header stating your history and exactly what you require to feel safe – I was assaulted shortly before going into labour and put a bold, italicised header at the top of my birth plan about it and it was totally respected and adhered to, all internals were done with chaperones and plenty of conversation and checking in with me before during and after. (I actually ended up with an emergency c-section anyway.) With my permission the birth plan and assault were shared with the community midwife team too so once home and getting the day 3, day 5, day 7 visits, the midwives arrived knowing what I needed and that I was antsy.

It’s your birth, your choice, and your midwife shouldn’t be pressuring you. You have every right to the c-section and every right to change midwife and hospital if you want and need.

What everyone else has said, but I will add that my birth experience was very positive, and I didn't have midwives constantly prodding and poking me. They basically just checked me for dilation. I had no internal checks as far as I can remember.

I'm so sorry for what you have been through

@Worriedandabitscared please speak up, I know it's very scary .

Having been in an almost identical situation to you, I didn't speak up with my first (didn't know a CS could be an option) and I was severely affected by the birth, and it really affected my relationship with DD1 in the first few months. I did bond with her eventually and the trauma did fade, just mentioning that as I don't want to make you feel even worse!

With DD2, I had an absolutely amazing midwife who let me call the shots from day 1, and was actually present with me (on her day off!) during my CS for DD2, and that was a completely different experience. I do love both DDs the same, but I regret 'losing' the first few month with DD1 whilst I overcame the flashbacks etc.

I wish you well whatever you decide

It really is a big event, and you have significant and valid concerns. If I were in your shoes I'd escalate it beyond the unhelpful midwife.

For what it is worth, I was raped as a teenager (stranger). Obviously this had a lasting impact. However, luckily for me it did not result in any issues for birth of DS many years later. I received good care from the staff.

I am so sorry that midwives such as this exist. She is being unprofessional and appears to be misinformed. My understanding is that a caesarean is slightly safer for the baby and poses a slightly higher risk to the mother. If your midwife is saying things such as "you don't want him to get hurt do you" it's emotional blackmail and is not backed up by evidence based research.

Please speak to the Director of midwives to:

a) draw this poor practice to her attention although the midwife will undoubtedly deny saying it but if enough women report a pattern will form;

b) to request a different midwife, hopefully one with a better understanding of both the evidence based research and the impact of abuse on pregnant women (all women really); and

c) to request a referral to the peri-natal MH team.

Write yourself a script if it helps.

I am sorry you were abused and that the spectre of the past has been raised not just during your pregnancy but has been made worse by someone who is unprofessional and hasn't properly dealt with information you have shared.

Your midwife's approach is all too common and deserves to be challenged because it is unacceptable. It is essential women start challenging rather than feeling anxious and undermined. Only then will maternity services improve.

If you want a caesarean and understand the respective risks of a vaginal birth compared to a caesarean to are entitled to have one.

Good luck.

@HikeForward

Sorry you’re suffering.

But I don’t think the NHS will do an elective section based on psychological trauma, unless you’ve had a previously traumatic birth or an assault that’s left you with lasting physical injuries as well. You could go private for a c-section.

In most hospitals they try to keep the theatres free for emergency c-sections, eg if a baby gets stuck or a mother in labour suddenly deteriorates and they need baby out quickly. Same with aftercare, a c-section means staying in hospital for a few days while with a natural birth you can usually go home after a few hours.

I know lots of women who’ve had planned c-sections but always for medical reasons eg baby was breach or mother had physical injuries from a previous birth, or high blood pressure etc.

C-sections come with their own set of complications and risks. And if it’s your first baby they’re even more reluctant as it makes a c-section or VBAC more risky if you decide to have another.

You could ask for an epidural so you’re numb below the waist?

The NHS absolutely will do elective c-sections for mental health or trauma reasons. A mother’s mental health is just as important as her physical health. Also NICE guidelines are now very clear:

“For women requesting a caesarean section, if after discussion and offer of support… a vaginal birth is still not an acceptable option (Trusts should) offer a planned cesarean section.’

www.nice.org.uk/guidance/cg132

The Trust is required to engage in a supportive exploration of the birth options and if a woman still wants an elective Caesarian to offer one. Some Trusts are still struggling with this and it can be harder than it should be to obtain that support but they are REQUIRED to provide it.

I'm sorry this happened to you I've no advice only I really hope you get the birth you want

"they don't do c sections routinely, vaginal birth is safer for baby and you don't want him to get hurt, do you?"

You are not asking for a "routine" section.

You need to speak to a different midwife. As a child victim of traumatic sexual abuse you will have specific needs which she seems unable to address.

A better midwife may not recommend a c-section but they should at least talk it through with you and help you work through the issues and talk about the practicalities of how the birth could be managed for you if you don't have a section.

I know lots of women who’ve had planned c-sections but always for medical reasons

Mental health is a medical reason.

I'm so sorry.

Lots of Midwives just hate sections in principle. I think that they are indoctrinated, frankly. Of course there are risks and everyone knows that if you have multiple babies it is better to have vaginal births if you can, but they are not an unsafe risky fringe option that will destroy you or baby for life and should not be presented as such.

An elective section is actually at least as safe for the baby (most baby deaths or serious birth injuries caused by oxygen deprivation result from horrendous natural births, or any distress resulting in emergency sections - these are still rare however and should not be used to scare a mother away from an option either), it is the mother who has a slightly elevated risk from a section (which increases each birth), so your midwife is actually lying to encourage you away from a section.

You do have a right to a section, if you have shown you understand the risks and have had adequate consultation, so ask to change midwives. You also do not have to consent to vaginal examinations (though with a first birth it is a bit harder, just because they are a bit lengthier usually).

Please do make a complaint to PALs and see the birth choices clinic. There really is no excuse for this misogynistic shite.

I am pretty sure that the risk with c sections is to the mother (because it is major surgery for her) and isn't any riskier to the baby. The other reasons it is not encouraged unless necessary is cost to the NHS and recovery time for the mother. I think you need to speak to someone who knows what they are talking about to go through the pros and cons.

Good luck with your pregnancy.

Cross-posted with vaccinationstation about risks!

Just agreeing with everyone else that you have every right to ask to discuss a c section and choose that option. I had an ELC for mental health reasons and once I actually got to see the consultant he was very understanding, explained the risks and also that it was my decision. Getting to see the consultant I had to be a bit pushy which you shouldn’t really have to when you’re feeling vulnerable.

Your DH is your ally here. I couldn't have expressed how I felt at 34 weeks. Too tearful and vulnerable and afraid. I was booked for a home birth which they tried to cancel late on and I was too weak emotionally to oppose it. But DH stepped up and calmly asserted what we needed. I got my home birth. This baby is both of yours and he sounds like a good sort. If he were to ring the midwife and articulate your needs (which, after all, are his too because you are a partnership ) you might see some progress.

I think you need more support or to talk to someone else. My mum is now retired but worked in obstetrics and said some of the more traditional midwives were very anti any kind of intervention even with women who had had traumatic first birth experiences and were absolutely terrified. She used to have to insist on their behalf that the women got to discuss other options. Fortunately she said this attitude was now changing. I would push to at least have a discussion with someone else about your options. Obviuosly ideally you'll have a non traumatic natural birth but if it turns out that a c-section is necessary for emotional or medical reasons that's absolutely fine. Your mental and physical health is important too.

YANBU

Please complain about this midwife. That's the only way she will learn how unacceptable her 'care' has been.

Right this isn't about a c-section v vb.

This is about your mental health concerns not being even considered here. And thats how you need to frame things. Kick up a stink on these grounds rather than your method of birth.

And yes you are being fobbed off.

I know it isn’t the main topic of the threads, so sorry if I am derailing, but I just wanted to say that not leaving an abusive relationship doesn’t make you stupid. This is a very normal reaction, especially at such a young age when you don’t have much experience with how relationships should be. None of it is your fault.

You can ask to change your midwife. Its common (ish) that there is just not a gel between mum and MF and they change the MF. It looks like this is your case.

Just to add my mum mentioned that for lots of women being listened to and knowing that other options were available and they would be able to choose what happened gave them a sense of control and often they didn't even need the interventions when it came down to it.

You need better support than this midwife.
Even if it turns out a c-section isn't a viable option with the NHS you need a midwife who you trust and who is understanding of you concerns and can help you prepare for whatever birth you do end up having.
There are lots of options to help reduce stress around birth, you deserve a midwife who takes you seriously and can recommend ways to help you, even if she can't actually offer you a c-section.
I had a traumatic first birth, currently 34 weeks as well - have been finding hyphnobirthing incredibly helpful to shift my mindset around labour to a more positive one. Sounds a bit wu-wu, but honestly really working for me.
I know therapy isn't a financial option for everyone, but CBT may be very helpful for you with this issue.
My midwife has been so supportive the whole way through - listening to all concerns and telling me how they'd tackle every problem I can think of that may come up. You deserve better care.

It’s just crap that AFTER speaking out about past trauma, something many will find extremely difficult to do, you’re still having to fight to be listened to.

The amount of women who are traumatised after birth, the amount who have a history of trauma but find it too hard to speak up and then this is the way someone who does disclose their past abuse is treated? Has it completely brushed off and un-acknowledged. Just shocking.