Preparing to have a baby after abuse *trigger warning*

[PreparingToBeAMummy]

I hope this is the right place to post. I thought maybe I should post in conception but I'm not worried about the conception, it's the pregnancy and birth that worry me.

I was abused as a child. I've done lots of therapy and am generally doing well - I have a wonderful husband, stable permanent job, our own home etc. We are probably a year or two away now from wanting to start our own family.

I want to be very prepared for this. I know that of course pregnancy and parenting are not things you can ever truly understand before you get there, but I feel like it would be irresponsible for us to begin trying for a baby or even get pregnant without having made the best effort possible to understand the potential trauma triggers for me. I want to be the best mum possible.

I have 4 areas of worry that I would appreciate advice on. If anyone could help with any of these I would be so thankful.

1. Medical professionals. I know that I won't cope with lots of different people, having to explain my needs over and over etc. I am considering paying privately in some way to try and minimise this. Either paying for a private hospital, or a private midwife, or a doula? I would want to give birth in hospital but would need someone by my side throughout with detailed understanding of my needs who could share these with the other HCPs. I don't know which option would be best.

1. Hospitals. I want to give birth in hospital, not at home. But I worry that they would not let my husband stay with me overnight, might make me share a room etc. How can I find out what different hospitals allow? Would I be able to choose? How do I go about finding out the best one for me.

1. Detailed info on examinations, interventions etc. I feel like I need to know EVERYTHING about pregnancy, both what might happen in my body and also what other people might want to do to my body. Scans/checks inside my vagina, blood tests, anything that involves being restrained or touched will be a big trigger so I'm not sure how to best find out this information. Is there a book I could buy, like childbirth for idiots?!

1. I guess sort of linked to above, what my options of consent are throughout pregnancy and labour and what the outcomes would be if I refused checks or interventions. I feel like I need flow chart type information - if this happens, this will be offered, this is the reason why, if I can refuse, and if I refuse, what the risks and outcomes are. How can I find this out? I feel like labour especially happens so quickly that I won't have time to ask in the moment. Also I've just watched a YouTube video where a doctor performed an episiotomy against a woman's explicit request. That terrifies me that someone could do something to me without my consent. I'm worried.

I've asked a few friends who have had babies but it seems that most people seem to accept that labour happens the way it happens. People say things like birth plans are a waste of time. This worries me too.

I'm sorry this is such a long post. I would be grateful for any help.

Hi OP,

Sorry to hear that you were abused in the past But well done for coming so far, having therapy and being in a good place now

Here are my thoughts on some of your questions and concerns:

Firstly, I would recommend getting a doula. I don't think you need to pay for private medical care - it won't necessarily alleviate your concerns anyway - but a doula will be able to support you and advocate for you. You can discuss your past abuse, current concerns and future preferences with her - she will be able to answer your questions and help you to communicate your needs to midwives and doctors.
I didn't have a doula myself but someone in my antenatal class had one - she came to the classes - and said it was definitely worth it.

Secondly, I don't agree with the idea that birth plans are a waste of time. It probably depends what kind of person you are, but I wanted to be informed about the possibilities and options, think about my preferences in advance, and write them down. I think a birth plan is extremely useful if you consider and include different scenarios.

As for books, I recommend "Bump" by Kate Evans. I read a few books about pregnancy and childbirth and that was my favourite. I also bought "Pregnancy for Men" for my DH and we both read and enjoyed it.

If and when you get pregnant, I recommend both pregnancy yoga and hypnobirthing to help you manage your anxieties and feel calm and positive about the birth. And I also suggest that you continue with therapy if you feel it would be helpful.

Best of luck - you can do this!

Also, you might be interested in these Birthrights factsheets, particularly the one about consenting to treatment. It seems that a lot of your concerns are about whether you will have to undergo examinations, interventions and other treatment that you're not comfortable with. The answer is no - medical professionals have to get your consent and you have the right to refuse. Some of them don't respect this (if you were abused by a medical professional I can totally understand your fear of it happening again) but I do think they are in the minority. And certainly if you have a doula it would make it extremely unlikely for it to happen again.

Your post reminded me that a new unit opened in London last year: www.rcm.org.uk/news-views-and-analysis/news/new-maternity-clinic-opens-for-rape-survivors

It sounds as though you may be worth contacting them as they offer support pre-conception as well as during pregnancy and birth

Duggee
That maternity clinic sounds excelllent. The website says:
"Anyone can attend our clinic, as long as they’re a UK citizen. You can visit us from anywhere and health professionals are welcome to refer any UK based patients."
www.mybodybackproject.com/our-maternity-clinics/

Could you get to London, OP?

Name I thought it sounded amazing when I first read about it. It's something that it would also be great to see more widely available as London is a long way for most people in the UK to visit.

From my own experience, I was extremely upfront with my excellent midwife, and said I would not be having any internal examinations (though there aren't generally any unless you're offered a sweep towards the end of pregnancy which, like eveything else, is optional I never had any form of internal examination at all). No one can do anything at all to you without your consent.

There was nothing at all invasive about midwife visits - blood pressure, gave blood a couple of times, doppler etc. When I went overdue, I opted for an ELCS rather than an induction, which was an entirely positive experience (cheeful, professional and consent asked for every tiny mini-procedure.) No restraints, no touching without being asked in advance, everyone respectful and appropriate. You're in control here. It's your body and your baby.

And labour takes absolutely forever in my experience. I would have had time to compose several epic poems, rather than just alter a birth plan. And you have your entire pregnancy to read and take classes and educate yourself.

The only negative part of giving birth was the post-natal ward, which was hot and understaffed -- I was given a private room after a few hours, but DH wasn't allowed to stay over, and that was the grim part, being alone in the early hours with a baby I couldn't pick up or BF.

Duggee's clinic sounds like an excellent idea.

I did find that pregnancy gave my flashbacks to my own abuse, and having a child made me much angrier about it, thirty years after it happened -- you might want to line yourself up some more counselling.

Scans unless you have any complications will be one at approximately 12 weeks and one at 20 weeks, both are external scans though you will be asked to slide your trousers/pants to your pubic hair line at the first one as baby is low. They tend to tuck some paper to cover your clothes but I'm sure you could do this yourself if you requested.

The first internal exam I had was a sweep at full term - these are optional and you can choose not to have them at all.

I'm not sure about the amount of internals exams would normally happen at birth but your options would be explained by midwife

They have to get your consent for everything, blood test, exams, and procedures. And you can ask them to stop at anytime. I was never restrained for anything not sure why anyone would be.

The midwife you get at delivery will probably be unknown to you so I'd make sure that there was a summary of you history (doesn't have to be detailed) at the front of your notes or your partner could say something as you arrive.

Be clear about what you want i.e. Hands off, please don't touch me without asking/explaining first - this could be something as simple as they would come and adjust your pillows to make you feel more comfortable but you'd prefer for your partner to be doing that sort of stuff.

You mayalthough this is an extreme optionwish to consider a scheduled caesarean. I am a survivor of abuse, but I also had other medical conditions that necessitated a caesar. I found it to be a great option, but I am in Australia whereby paying privatelyI was able to get care from a single OB, private room etc. The reason I found a caesar such a great option is that I felt very...not in control of the proceedings, but able to manage them. I was informed all the way through and because it was non-emergent and everything was well managed I didn't have to make any last minute decisions, and nothing was done in a rush or without properly understanding the implications. On the other hand, some survivors find labour and birth empowering, so maybe my advice is rubbish!

Thank you for all your posts and especially for the book review (I've just ordered a copy!) And the info on the place in London. That does sound really helpful so I will contact them.

It's a very good point about choosing ELCS. I did consider that but the catheter puts me off - I KNOW that's such a tiny thing to be worried about but every time I think about an elcs I think about having to have a catheter. I think maybe an ELCS would be easier for me to feel in control of, though, in that I could pretty sure on all the stages in advance.

It's reassuring to hear that people seem to have had very few internals offered and are able to reject them. Reading the internet has scared me with information about internals every 4 hours during labour and all the possible interventions that might have to be done - forceps, being cut etc.

Maybe an ELCS would be better. But would I feel that I had failed by not giving birth vaginally? Would I feel that I had missed out? I don't want to feel that they stole something MORE from me after all they took years ago.

I'd say if feeling in control is key to you it would be worth you exploring a private ELCS. Two friends of mine had them (coincidentally with the same consultant) and the whole process was very different to my NHS vaginal birth. It would tick all your boxes of continuity of care, accommodation for your DH etc.

Good luck OP.

Also - and I mean this gently - if a VB results in birth damage it can be really tough emotionally to recover from. I have no history of abuse but my tear and subsequent medical problems were really distressing.

Thank you Arsey. Do you know approximately the cost for that? We've been saving knowing that obviously any private care will cost money... But I presume a surgery would be significantly more than a private midwife or doula.

That is a very good point about birth damage. I'm sorry to hear you had difficulties. I think any damage down below might be very retraumatising in the aftermath.

You can get an ELCS on the NHS. I dread to think how much a private one would cost

OP, there is a balance to be struck between informing yourself, and freaking yourself by reading or watching videos about things that might never happen to you! I suggest you choose your sources very carefully - good books, good antenatal classes, an experienced doula - and steer clear of the rest. Don't watch One Born Every Minute!!

A word about catheters. I had a vaginal birth and unfortunately had to have a catheter put in afterwards. I'm not going to lie, it was unpleasant. You can ask them to use local anaesthetic when they put it in. I guess if you had an ELCS you would already have anaesthetic so it wouldn't be an issue. Anyway, I just wanted to point out that you might need a catheter however you choose to give birth. So I wouldn't let it stop you choosing an ELCS if that's what you want.

My DC was an EMCS and it was wonderful. I've requested an ELCS for DC2. If it helps, the catheter was placed after the spinal kicked in so I didn't feel anything. It was removed around the time feeling was returning so I still didn't feel it, I was just aware of what they were doing because they told me.

Counselling or advice prior to conception may help you evaluate the potential of each birth type before making a decision.

I found helpful the view that birth is the process where your foetus moves from your womb and into the world - there is no right or wrong method for this to happen

I'm afraid I don't know the cost.

I've just thought though, the consultant who treated me post birth on the NHS also had a specialism in working with women who had a psychological aspect to their care e.g. PTSD from birth, or a history of abuse etc. I wonder whether there is any way of connecting up with someone like that to oversee a pregnancy and birth on the NHS.

I had 3 vaginal deliveries and have only ever had 1 internal examination and that was at my request at the end of labour with my first child.

You might want to consider a waterbirth? I had 3 and it is a very hands off birth as far as the midwives go. They literally have to sit on their hands and just watch you birth your baby. It feels very private because you are under water.
Burth plans are NOT a waste of time. Write one and hace your dh or perhaps a doula ensure all care givers read it.
Good luck with everything. Birth can be so enpowering. I hope everything goes well for you preparingtobeamummy

I wanted to use the birthing pool but couldn't in the end. If you have any risk factors, during pregnancy or labour, they usually want you out of the pool so they can monitor you and/or the baby closely. In my case there was meconium in my waters so they wanted to monitor the baby continuously, which meant a device strapped to my bump and no pool for me!

So the only type of birth you can be sure of getting is an ELCS. All plans for vaginal birth have to be flexible and might end up as an ELCS/EMCS anyway.

I'd also think about a water birth- you are very much in your own space then. All I had was the midwife asking me to check me temp & listen to baby me heartbeat every so often. And I was offered one internal (which personally I decided to accept as I wanted to have an idea of how things were progressing) but there was no pressure to have it.

While I definitely think you should consider an ELCS there can also be an amazing sense of achievement & hormonal high of giving birth vaginally. But if you do plan that then I think it would be good to have a very clear sense of if/when you might like an epidural or would you like to go straight to a CS? I really don't intend to ever slightly pressure you here, but if you have a straightforward pregnancy & are low risk I wouldn't discount it entirely. It's also worth knowing you can change your mind, even late on in pregnancy.

I have also heard of some people finding BF triggering, if so that might be good to discuss with midwife/counsellor/doula.

With an ELCS do you have to have the baby out earlier than expected? Clearly you do i guess otherwise you'd go into labour before you got there. Is that a risk for your baby?

I think I would feel a huge high if I managed to give birth vaginally but if I'm ripped to shreds after it will be hugely traumatizing and ruin all the high from the birth. Water birth also sounds lovely but I don't know whether they'd automatically classify me as high risk because of my background!

Trigger warning for the below...

Sorry for the TMI question, but regarding internals - is it one finger? Two? Whole hand?! Do they use some type of lube like in a smear? And (ugh sorry) is a labouring woman's vagina wider than normal because of the labour... so it's not like if someone tried to put their hand inside me right now? Can you request that it is a woman and not a man?

Also tmi and sorry - would they ever need to put anything inside my bottom?

Hi preparing, I'm an obstetric doctor.

I'll answer the above first. For vaginal examinations it's two fingers, we use a lot of lubricant and can stop at any point you feel uncomfortable or want us to. As for your bottom, with tears we would use one finger in your bottom with your permission and again lots of lubricant to check the muscles around your back passage and sometimes we give a pain killing suppository in your bottom at the end of a caesarean/stitches but you could ask to have this through another route. You can absolutely ask for a female doctor and we would always try to accommodate that but in an emergency there is always a small chance of it not being possible.

My absolute best advice is to get in touch with the Head of Midwifery at your local unit because we could all tell you of our knowledge and experiences but that local knowledge is key. All units should be running sessions for people with previous birth trauma called something like Birth Revisited or Birth Choices and all should have access to psychosexual counselling. Meeting with someone from your unit would allow them to tell you how they can work with you to make sure all of your choices are respected and precious history taken into account. It might feel to you that this is wildly abnormal but I can assure you it unfortunately isn't and we spend a lot of time with women who have survived abuse making sure their experience is as positive and respectful as possible whatever the birth choices and circumstances.

I really hope it all goes well for you.

Something I don't think has been mentioned: Gas and air. I have PTSD from a different type of trauma, but under the influence of entonox (gas and air) I lost awareness of where I was and thought I was back on the scene of that trauma. Gas and air is a common pain reliever during a vaginal birth but there are other options such as water (very helpful), natal hypnotherapy CDs (really calming), and pethidine. It will not always cause flashbacks though - a friend with similar trauma to you found the gas didn't give her problems.

Internals:

• If you have any bleeding between weeks 8 (I think) and 12 they would want do a trans-vaginal scan which involves a (basically penis-shaped) probe in vagina. Unfortunately an abdominal ultrasound is no good when the embryo is so small. You could refuse, though that would mean you might not know if things are ok or not until the 12 week (bump) scan. However, most people don't bleed, and of those that do many go on to have healthy babies, so don't worry too much about this possibility, just wanted you to be aware.
• Then no more vaginal exams usually until you are overdue, when you may be offered a sweep. You can refuse. This is the midwife rubbing her fingers across the cervix to try to trigger labour. I've had 2: One was excruciating and one was uncomfortable. There would be other options in your case - such as an induction or an ELCS.
• I did most of my very long labour at home so no vaginal exams (VE) until I arrived at the ward, where they needed to measure how open the cervix was. Wasn't uncomfortable (but obviously could be triggering for you). Then another 4 VE hours later and gave birth soon after that. You could aim to labour at home (in water - even just a bath) with your doula for as long as possible, which would avoid the VEs until as late as possible (and when your brain is fairly occupied with other things).
• If you tear, and following birth generally you may have midwives/doctors checking you fairly frequently for clots, bleeding, and possibly to stitch you.

As for an ELCS:

• You may still have VE afterwards as they might need to check for bleeding/clots, because you still bleed through your vagina after a CS.
• ELCS are much calmer than a tricky VB and ECS. You'll have time to chat to the anaesthetist and midwives, surgeon etc, calm music in the background. You can also do hypnobirthing for ELCS.

I'd second that recommendation for a doula. Find one you get on really well with and trust. They can do the go-betweening and also support you, and your DP can concentrate on supporting you. I also thoroughly recommend natal hypnotherapy as a way to keep calm and focus your mind. I had a very discreet midwife who was content to let me do my thing in the bath, yoga, hypnotherapy.

There are private midwives I believe, and that might provide the continuity of care (though a good doula as intermediary would help a lot anyway), cheaper than private ELCS.

Private ELCS are incredibly expensive, and only some cities will do them. If you google some of the London clinics and see how much they charge for care, hospital care, the CS itself etc it's wincingly expensive. If you're in London then that specialist unit mentioned above would probably be a better idea for you - and cheaper.

My friend's feedback was that the midwives were supportive and sensitive to her past trauma. Perhaps make sure your DP is at all midwife check-ups (1) in case there is a problem it's always good to have support, and (2) in case there's a different community midwife and you need to explain again. I suspect there may be some discreet symbol they use on the maternity notes you carry everywhere (they have one for women who are subject to domestic violence), so that everyone treating you is aware of the sensitivity.

Sorry that's so long, but information is power. I wish you the best of luck.

If there are risk factors meaning they won't let you use the birthing pool (and typically that would be medical factors including the baby's health or a mother with limited mobility, not your history), then you might still be able to get into a bath. Most rooms/units seem to have baths and IME with mobility issues they were happy to let me wallow in the bath, with underwater monitoring of the baby.

I'm so sorry someone hurt you you are amazing for taking control back and confronting potential triggers head on before you try for a family.

When I had my last son I saw maternity psychologist throughout. I lost my little girl at full term and was so anxious that I needed additional support. It might be something you seek out. I had a sticker on my notes alerting all who picked up my folder to look at my individual care plan put together by my psychologist. In it she listed potential triggers, those which could be avoided and those that could not, but how to support me through them. She was amazing, and although it was tough, with her help I got through it.

The best of luck