*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.

I know you have your own list of questions but I think it would be very important to ask about a urinary catheter. They are routinely inserted in csection to avoid bladder damage. You could ask not to use one. You would probably need a consultant appointment to decide/agree on this. They would have to explain the risks of not using one, is there anything else they could do to reduce the risk? Is there anything they could do to make a catheter more acceptable to you? (A question for you really)

Also I'd advise if you do have a special agreement (eg not using a catheter) asking what the plan would be if you into labour early/or needed delivery in an emergency ie a less planned/controlled scenario. Obvs it should still be your agreement or as close to but how would that happen

One thing to consider is how you'll feel when you can't move your legs. I've had two (emergency sections) and I really struggled with the passivity. I found it really triggering but that may relate to my specific circumstances.

Ask them to put the catheter in after the spinal. I found them talking through what they were doing really helped as well.

I declined midwife help changing pads both times and they were fine with that.

In my experience, the consultants and midwives were all really supportive when I disclosed.

Everyone, you've been so supportive and helpful, I couldn't have asked for more. I'm going to put my OP into a less informal format and hand that to my MW to ask her to read, then she can ask me questions after if she wants to.

I will have to see a consultant but I'm assuming the midwife could write notes on my file that the consultant can see regarding my request so I don't have to start from the very beginning again?

You’re entitled to a birth of your choosing

you don’t need to write anything down

or even have a reason

You can required an ELCS regardless

I put my request in at 10 weeks, my only reason was for love nor money was my daughter coming out of my fanny!

So sorry you’ve been through such a tough time. It’s absolutely reasonable that you should ask for a section. Could your counsellor write you a supporting letter, if indeed you should get some pushback from medical professionals. Hope all goes well 🌷

@sickandsleepy Please do ask for an elective. As awful as it sounds, you won’t be the first woman to have one because of a history of SA, nor will you be the last. Does your midwife know of your history already?
NICE guidelines (which all hospitals should adhere to) state that a woman can’t be refused a caesarean section also, just so you know. Good luck, and congratulations!

I think I would write a little note summarising what youve told us and pass it over to her at your next appointment, if you dont feel like you can verbalise it. Best wishes with everything and I'm so sorry you've been put in this position when you should be enjoying one of the happiest times of your life. Hopefully once this has been sorted for you, you will feel more in control and can start to look forward to meeting your little one xx

@JinxandBinx No, I haven't discussed it with them yet. They know I take medication but don't know why. I have a hard time with the thoughts that there will be plenty probably in a worse situation and that I should just grit my teeth and get on with it. Saying that, I have started to recognise that actually I would be doing more harm than good by doing that.

Hi OP, sounds like a very reasonable request. I will also +1 the idea of writing it down for the midwife to read in case of freezing up or leaving out a key piece detail. Don't forget to mention the use of a catheter, too, and how that might make you feel.

An ELCS sounds like the right way forward for you. Hope it goes well :)

Hey, you're making a great choice in advocating for your mental health as well as your physical health.

When I gave birth in 2018, my history of childhood sexual abuse was made known to my midwife. It was hard to do, but I'm glad I did. I was referred to an obgyn, and between us a care pathway was made. A CS was offered at this point.

It was recorded in my brown notes on hospital IT systems, separate to the blue notes that I took to every appt. I felt very respected and looked after, and although I chose a vaginal birth it meant my midwife respected and understood why I didn't want dilation exams, to be stuck on my back unable to move, and why dignity was important to me.

Letting your midwife know now could be a great shortcut if you need perinatal mental health support as well.

I'm so sorry you experienced this horrific and sustained trauma. You are not selfish. You are not making an issue. You have strong health reasons (mental health is health) reasons for an ELCS and deserve nothing but support.

If you write it down, in the moment if it feels too much to say out loud, you could hand your midwife your note and then discuss it then or at a follow up conversation.

I think being 28 weeks it's good to get this organised soon. Let us know how it goes @sickandsleepy

Will be thinking of you

I think so many good points have been made:

• ELCS must be provided if requested
• NICE guidelines say ELCS must be provided for mental health reasons
• Many midwives, consultants, trusts, will have dealt with previous SA victims

And I know a lot of people have told you that you’re not selfish. But I wanted to point out that what you’re doing is the very OPPOSITE of selfish. Doing the best you can to take care of your mental health, so that you can be the mum you want to be, is what being a mum is all about, from what I’ve seen. It couldn’t be less selfish. If knowing you can have an ELCS will remove some of that panic and fear, so you can enjoy the rest of your pregnancy, and not worry about certain factors during the birth, then it’s absolutely the right choice, and no one has any right to deny you. Good luck, OP.

Off to my appointment now. I have printed some key points and will try to read them myself but if not I can hand it to my midwife. I'll let you all know how it goes! Thanks for all your help.

Maternal request is an indication for elective c section.
It is your midwives job to arrange for you to discuss this with the obstetrician who oversees your care. It is then the obstetricians job to ensure you understand the risks involved with this vs vaginal birth
Dont hesitate to ask your midwife to start this process. I hope you enjoy the birth when it comes

Midwife here- absolutely reasonable to request an elective section. It is any woman's right regardless of history but even more so given your history. I would recommend telling your community midwife if you feel able as a record can be made on your notes and it should be handled very sensitively.
You absolutely should not be judged and please please try not to judge yourself, it certainly isn't something you should just put up with because you want to be a mum.

I am a midwife. This is a very valid reason for an elective section. Don’t hesitate to ask for what you need

Absolutely not unreasonable - you can have an elective section just because you want one, there doesn’t need to be justification but it is good to communicate your reasons to your midwife and consultant so they can understand how to best care for you. I had an elective section due to a heart murmur and did have to have talks about risk but I was firm in my decision making and respected. Good luck with the birth and the rest of pregnancy xx

Maternal choice is sufficient to have a c section. You absolutely do not need any further reason than that. Wanting one is enough. Simply express you've opted for a c section and if anyone pushes back express what you feel comfortable with. But if you don't want to share you don't have to.

Just wanted to say so sorry for what you have been through, and well done for being strong enough to get to this point and to know what is right for you with your pregnancy.

It is definitely a good idea to take a list of things you want to say when you see the midwife. (I did this myself recently at a hospital appointment as I knew I would forget to ask some things otherwise.)

You don’t even need to have a certain type of history to request a C Section. I requested a C Section with my second baby and I had one. It was a simple process and I didn’t have to fight for it at all. Neither was I pressured into having a natural birth. Just tell your midwife that you’d like a C Section and they’ll arrange appointments with the Consultant.

It’s your body, no one can force you to have a natural birth

Speak to your midwife and if she hesistates tell her the NICE guidelines say you can. My friend had similar and as soon as I told her to say this within 24hrs they had scheduled an elective C section.

This comment is odd since it doesn’t reflect the reality of the process to request and get an ELCS within the NHS framework.

Midwives have to refer requests to consultants (either consultants at the hospital that would be performing the surgery or consultant midwives) who then have to book in the section after speaking to the patient and to ensure it’s an informed decision.

So I think you might be telling porkies

Hi all, just got back from my midwife appt and thought I’d update.

I didn’t need my piece of paper in the end because I think writing it all out I felt clearer in my head what I wanted to say and how I wanted to bring it up - she said she completely understands and that she has known of other people who have had general anxiety or tokophobia and have been granted their section.

She said I will need to speak to a consultant as it’s not her choice to ultimately make/ book but has said she will organise that for 32 weeks and assured me that he is very approachable and an all round lovely person (fingers crossed!) but that I should take my paper notes I made just incase I freeze up. She has added into my notes our conversation today.

Just want to say thank you to everyone for making me feel brave and powerful enough and justified in my reasons to advocate for myself. It really made the difference, I don’t think I would have been able to have the conversation without the reassurance that I’m not being selfish, or dramatic (again, I know this isn’t true deep down but the abuse and trauma sometimes tricks me into thinking I am not a victim).

Thank you so much to everyone who took the time to help 💖

So good to read that @sickandsleepy. Well done for starting the conversation. 💐

Really great news. Well done for being able to say how you feel. Hope you’re able to enjoy the rest of your pregnancy without having such uncertainty hanging over you.