*TW Sexual Assault* - AIBU to ask midwife for ELCS

[sickandsleepy]

Hi all - I don't know if this is the right place and I'm a bit nervous to even ask...

I'm 28 weeks pregnant with my first child and about to have a meeting with a midwife to discuss my birth options. I have come to the realisation (after copious amounts of research about pros and cons of both) that I really don't think it's best for me to deliver vaginally. From aged 15-20 I was subjected to a very brutally sexually abusive relationship (rape almost daily) intertwined with coercive control. I am undergoing specialised sexual assault counselling and take Sertraline for depression and anxiety.

I find the idea of being out of control when my vagina is involved very very triggering with multiple new people touching, handling and looking. I know you can ask to keep exams to a minimum, but emergencies happen and I cannot control that someone won't read my notes etc. Whilst I know it's natural and they are professionals, I just know that if I can sometimes get worked up into a state when DP and I are intimate, then I KNOW I will have huge problems with this.

I don't want to risk my first encounter with my baby being one where I have spiralled and disassociated like I used to have to do during my assaults. I will not be ok. I'm already starting to panic.

I don't know how to bring this up with my midwife. Part of me thinks she is just going to say that I need to deliver normally because I chose to be a mother and what did I expect, I don't want to appear selfish like I'm putting my needs in front of my child but i'm really really really starting to panic.

How do I ask and make sure I'm taken seriously? I'm not very good at standing my ground and still feel a glimpse of shame the assault happened and the feeling I should just get over myself and put my baby first.

Sorry for the long post, I'd really appreciate anyone's advice on this.

You absolutely have the right to ask for an ELCS and your midwife, if a decent midwife (and human) will 100% agree that that is the best option for you. Please speak to them and put your mind at ease. I’m sorry you went through such awful trauma OP.

You have nothing to be ashamed of and should do what is best for you and your baby. And if that is a C section then that is what is right. Just have an open conversation with your midwife and I am sure they will be understanding and helpful.
good luck-and congratulations

So sorry for what you went through, I'd recommend you just tell them what you've told us, surely all of the above should be reason for them to take you seriously. Not sure whether it's something they'd be able to accommodate, but maybe even speaking with them might help.

If your midwife doesn’t allow you to have a section, then go to your consultant and tell them what you want

This was one of the reasons I never wanted children because after childhood abuse I could never face any sort of intimate examination.
I have never had cervical screening for the same reason.
In my day ( yes I am that old!) there was no consideration given to choice in child birth but now in these more enlightened days you should absolutely have the right to have a c section.

You are absolutely entitled to ask for a C- section. I would raise it with the MW- but don’t feel obliged to tell her all the details if that is going to be difficult or triggering. You could say something like ‘I will need to have a C-section because of trauma relating to sexual abuse’. Let her know that you’ve thought deeply about it and done your research and that you have reached a decision that’s right for you. She doesn’t need to know all the details of what you went through.

I’m sorry you went through all that and I wish you all the best for the pregnancy and birth. 💐

That sounds really tough for you. I have had two elective c sections for mental health reasons and you can just ask for it and they will do it. You shouldn't need to go into detail and you could always just say you are scared of giving birth naturally. It is a perfectly valid choice. Sending you lots of love and hope it all goes well for you

The NICE guidelines state that an ELCS must be given when the mother requests one on physical or mental health grounds.

I went to my first appointment with my consultant armed with the guidelines and expected a fight - I told her I'd been traumatised by my first labour and delivery and she immediately agreed that I should have an ELCS and wrote it on my notes. She did check how many kids we wanted (as multiple CS are more complicated and I'd already had one with DD) and advise me that if I went into labour naturally before my CS date and progressed too quickly, they might not be able to do the CS.

I'd advise speaking to your consultant if you have one - midwives won't make this decision anyway.

I also highly recommend ELCS - much, much easier and quicker recovery than an emergency CS. A GP friend of mine had both her boys by ELCS - she likened vaginal delivery to amputation of a limb in the 16th century without anaesthetic. Her exact words were "things have moved on, why would I subject myself and my baby to a vaginal delivery". Not likely to be a popular opinion on her though!

I’m sorry you went through all that. Of course you’re allowed to choose to have a caesarean. Your midwife will probably outline risks of the surgery (she wouldn’t be doing her job if she didn’t) but it sounds like the risk of emotional harm were you to deliver vaginally is far greater than a planned ELCS.

You don’t have to tell her everything. You can say “I want to have ELCS because of past trauma”. There is nothing for you to feel shame over, and speaking up for yourself and your needs IS putting your baby first. You don’t have to subject yourself to more trauma for anyone.

Thank you everyone for your messages - it makes me feel slightly less selfish and that doing something for my emotional wellbeing is actually the most beneficial for my baby too.

I wonder if I should write down a list of things i want to say to make sure i cover everything? - I tend to freeze when I actually have to talk about it and that makes it seem like I'm just saying it on a whim without having thought about it.

Hi. I think you are doing the right thing, and I wish I had done the same. I was significantly traumatised by vaginal childbirth and wish I had never tried it. I had a maternal request C-section for my next child.

I did find the maternal request hard to get. Took having to see 2 different consultants and one was very reluctant. They agreed it but kept trying to persuade me out if it which I found distressing.

They did in the end do my maternal request and it was a significantly better experience then the vaginal. You have every right to have a maternal request on the nhs.my experience though is that you have to push for it.

Firstly so sorry for what you have been through. Yes you can have a C section if you want one. It is not selfish at all. It will be best for you and your baby. Good idea writing things down so you don’t forget any questions if you freeze. If anyone tries to persuade you not to have a C section just close down the conversation and state that is what you require.

Hi. I had an almost identical situation to yours (on paper - I appreciate).

I asked for, and was given, an ELCS with my first and ended up with an ELCS with my second. I’d recommend making a few notes and sharing as much as you are comfortable sharing. You are entitled to ask for an ELCS and to a second referral if required. I admire your strength and wish you the very best experience and future with your new family.

If you freeze when you have to talk about it consider writing it in a letter for the midwife to read that explains what you might find difficult to say. You could give them the letter at the appointment to read, explain you have trauma in your background and you were afraid you'd shut down and not be able to discuss it.

I'd try not have it too long ,as you and the midwife can clarify points afterwards, to male it easier to read.

That way you ensure to get to say what you need to without fear of freezing

How about printing out your post from here and asking your midwife to read that as a starter?

Can you take someone to your appointment with you? For support and to advocate for you if you feel unable to at any point.

Just to confirm that you happy to disclose your SA history to the MW / team looking after you? If so then a short document detailing your request and your main reasons would be very helpful.

Yes, this would be a great start to opening the conversation with midwife. Stats very clearly your reasoning

I'm so sorry that happened to you.

Definitely discuss it with midwives.

Just to play devil's advocate, you might find that you find vaginal birth would help you to kind of reclaim your genitals by using them in a non-sexual way. If you see what I mean. Might be something to discuss with your counsellor. Not letting your abuser take that from you.

If you do go for CS, discuss what if any aspects of care might impact genitals so you're prepared - I had EMCS and seem to remember being on an absorbent sheet thing they had to change, when I still couldn't get out of bed very well. And they'll check the wound which is just where your pubes start. They also need to get a catheter in.

You still bleed in the same way after CS, sometimes pass large clots that they might want to see. Constipation is also v common after any birth including CS, which won't mean anyone wants to see down there but is a generally genital-related event. I got so constipated I got fissures and needed an examination and a ton of creams, suppositories etc.

@Crunchymum Yes, I am happy to disclose my SA history to the midwife or consultant. I think it would actually help my case more than trying to keep it vague. If I keep it too vague I really do fear they'll think I just don't fancy giving birth and am using excuses.

It's so hard being in a position where I already think they won't believe me, but I think that's the abuse talking. I'm definitely going to write a list of things I want to make sure I cover.

I can promise you that your midwife will not say that you choose to be a mother and therefore have no choice over how your baby is born. She may refer you to a specialist midwife who is experienced in dealing with victims of sexual assault and abuse. You can also ask your counsellor to talk this through and to write a letter if your midwife thinks this would appropriate. You can share whatever parts of your story you feel comfortable with, or as little as you need to, in order to have your needs heard. You can ask your partner to be your advocate. You can decline physical examinations. Even if you have a cesarean, you may well benefit from the team knowing that you are a survivor of abuse so that they can be mindful of how they should approach you, that the need to ask for consent before carrying out any procedures and that they explain what they are doing and why - if - having discussed all of this with your midwife and your counsellor, you feel that this would be helpful for you.. or if there are other approaches / adaptations that are important for you. If you want to, you can ask your DP to greet everyone who comes into contact with you during labour, birth and afterwards, to remind to kindly introduce themselves and explain what they are going to do. If you are nervous to ask, you can write it down or send an email beforehand.. If you don't get an appropriate response from the first person you ask, ask to be referred to a senior midwife to carry on the conversation.

Yep - my partner was very helpful in advocating for me when I didn’t feel able to. Or your therapist could write a note. Or just print this post out, as others have suggested. If you make it clear you find it really hard to discuss, they shouldn’t press you for further detail.

Part of me thinks she is just going to say that I need to deliver normally because I chose to be a mother and what did I expect

Might be worth bringing this up with your therapist, because it sounds like that is your own internal feeling of shame talking - no competent midwife would ever say anything like that (and if they did, they would be struck off if reported).

I'm so sorry you went through this and I can totally understand why you want an ELCS.

Don't feel obliged to give any details about trauma if you don't want to. You are entitled to have an ELCS if it is what you wish. If you don't want to divulge why, you just say it's your maternal request and you know you are entitled to one under NICE guidelines. They just have to inform you of the risks associated with an ELCS.

This is how I went about getting my ELCS and all the midwives/drs respected my decision whilst informing me of the risks. I didn't have to give any more information then what I stated above.

I think writing it all down is a good idea. I would even consider passing it to her and saying you find it difficult to talk about but please could she read this now and then discuss it with you.

I'd also include that you understand the risks of C section (and a brief summary of those risks to show this is true) and that you accept these risks as overall this will be best for your MH.

I'd also refer to the NICE guidelines - you will need to check these but I believe that the NHS is supposed to agree to a section for anyone that insists as long as they are informed of the risks.

Good luck

I’m sorry you have been through this. As a former midwife I can say that sadly this isn’t a particularly unusual situation. Your midwife should be very sympathetic but won’t be able to authorise a CS as only the consultant can do this. They almost certainly will do so without any issue. If there is any issue then request a second opinion.

They may request that you see a member of their peri- natal MH team although since you are already receiving therapy that may not be necessary. The doctors are required by law to gain your informed consent by explaining the risks to you.

Wishing you a very happy pregnancy and birth and a safe and happy future.

Sorry I don’t have time to rtft at the moment but I’m sorry that you have had such a traumatic experience and I just wanted to lend my support and encourage you to advocate for your needs. Perhaps you could write some key factual points (or show her your OP) and ask the midwife to read it. YANBU.

Congratulations on your pregnancy btw 💐