Vaginismus, back into consultant led care and elective c section.....

[SundayLunchHappy]

Hello,

Looking for some helpful advise before seeing the consultant next week. I’ve had a fairly straight forward pregnancy compared to many I’ve spoken with, however at my last midwife appointment my baby had dropped slightly on the centile chart when my bump was measured.

For context I’m 35+4. First baby.

All along we had planned to have a home birth, not just because the experience sounds so ‘magical’ but to try and overcome and win some kind of victory over the condition that has plagued my health and my intimate relationship with my husband for years. Any kind of VE’s are off the menu and whilst we managed to conceive with some degree of difficulty, I have regressed massively and haven’t been able to withstand any penetration for six months. That being said, if baby was well and I was classed as a suitable candidate, I wanted so much to have them at home with the support of my fantastic community midwives who have been brilliant with my case all along.

Now that baby has tapered a little growth wise, we are off to see the consultant to find out if they should be brought into the world ahead of schedule. The thing is, whilst I’m prepared to attempt a vaginal birth at home, I absolutely cannot face that idea in hospital, particularly because an induced labour is physically impossible.

I have been forewarned that an elective section is going to be met with a significant amount of negativity, but I’m also aware that they cannot induce me without consent, nor perform any kind of physical examination.

For what it’s worth, I believe that if baby needs to come early, then 6 weeks of physical recovery with a fabulous support network is much better than potentially years of ptsd from a forced vaginal birth in hospital.

Any ideas or links to useful resources to arm us with info before our appointment would be much appreciated. Sorry it’s rather long!

I'm in a similar situation, but met with a consultant midwife a couple of weeks ago, who was amazing, and really understood the issue. I was expecting a lot of resistance (although mine would have had to be a VBAC, which might have given me more leeway than for a first baby), but she was really supportive and I'm now booked in for an ELCS.
So my first piece of advice would be to say that the hospital staff may be more supportive than you initially thought!
They are also likely to be able to suggest other intermediate options for you - for example, having an epidural before any VEs; having your partner stay overnight with you in a family room; having an ELCS if you go to 40 weeks, to avoid an induction etc. It's not all or nothing.
One thing that's worth checking is how much experience they have of dealing with women with severe vaginismus - in my hospital the incidence is about 1 in 650, so it's not completely uncommon, but some staff I've talked to still have no idea (confused it with vaginosis, tell you just to "relax" etc!!) So you may need to spell out exactly what you can and cannot do. I ended up explaining that the one smear test I'd had took an hour, so I didn't think I could have a VE in between contractions 5 minutes apart... This can help dispel the assumption that you're just being difficult.
I did come across one statistic that said vaginismus increases the risk of an emergency CS a little (1.19 times) (the reference is: Moller et al, Reproduction and mode of delivery in women with vaginismus
BJOG: An International Journal of Obstetrics & Gynaecology May 2014 dx.doi.org/10.1111/1471-0528.12946 )
The other thing is, external measurements of baby bumps are notoriously inaccurate. If it's the sole reason for you to have to go into hospital rather than have a home birth, could you ask for an additional scan to double check? Or pay for it privately if you can?
Good luck - hope it goes well

Thank you so much for taking the time to reply.

To answer some of your questions, I’ve already had a foetal growth scan to confirm the tapering that came up on the bump measurement and am in for another tomorrow with a midwife but not scheduled to see the consultant until next week when I reach 37 weeks.

The issue I see with a vaginal birth in hospital is the fact that with an epidural, the increased likelihood of needing an assisted birth and more repairs for tearing would massively complicate things for me both mentally and physically during recovery. I had initially thought a drip induction with epidural might be a solution, but it’s the “after show” that could then lead us down a road of traumatic recovery.

Thank you for highlighting the issue with medical staff and familiarity with vaginismus, before my appointment tomorrow I plan to insert a document into my hand held notes as my gyne history (all diagnosed by a well respected consultant) isn’t in there for them to see without digging around in my hospital file.

A couple more things I thought of - perineal massage before the birth can help reduce the risk of tearing (this article: tallirosenbaum.com/sites/default/files/j.1743-6109.2012.02811.x.pdf says it's particularly true for women with vaginismus.) - and despite the scary stories, the risk of 3rd or 4th degree tearing is pretty low (6% overall)
The consultant midwife I saw said that vaginal birth can help reduce vaginismus afterwards (though there's no scientific studies of this, just her experience) - so there might be some advantages to trying. There are also risks to the baby for an elective section before 39 weeks (there can be breathing problems), so they're likely to bring this up as an argument not to have an early ELCS.
Are you seeing the actual consultant obstetrician themselves? I had an appointment at the consultant's clinic, but saw a registrar, who didn't have the authority to agree to a CS (only the consultant could) - so they referred me to the Mode of Birth clinic with the consultant midwife to discuss and get the decision - in other words, it may take longer and involve jumping through more hoops than you'd hoped.
Yes, it's a good idea to put your vaginismus info somewhere prominent in your maternity notes - I found staff didn't have much time to read my notes, so it needs to be spelled out really clearly for them.
Hope you get the outcome you want :-)

Hello again,

Not sure but I had assumed it would be the consultant but I can confirm that at the hospital tomorrow.

I’ve been reading the risks associated with babies born before 39 weeks by elective section in the NICE guidlines and it just makes me hopeful even more so that with continued monitoring my baby can make it that far beforehand if my chances of a natural labour and birth are lost.

Here’s hoping they are happy for me to keep cooking for another 3 weeks or they are sufficiently happy that I can be discharged back into the care of my home birth team.