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.

So sorry about your previous trauma, Preparing. You've already had loads of good advice so I'll just answer what I can from your last post.

An ELCS is usually scheduled for between 39-40 weeks, to minimise the risk to your baby of early delivery. If you were to go into labour beforehand, you could still have a CS though depending on how you're getting on/other cases needing theatre you may have to wait some time.

Water births do sound lovely - I wanted one - but a LOT of first timers aren't able to have one for a huge variety of reasons (I was hyperstimulated by my induction pessary) so I wouldn't fix on that as an idea too much.

A vaginal examination is (I think) two fingers, and yes they do use lube. They aren't pleasant, but you don't have to consent to them if you don't want to - it will mean you and the midwives have less idea of how you are progressing in labour, but I'm afraid I don't know if that makes the delivery more risky or not. The vast majority of midwives are female, but obstetricians are more mixed. You can decline to be examined by a man, and they will try to accommodate you as far as possible, but in an emergency in the middle of the night, the only obstetrician available may be male. In those circumstances you may be able to ask if the midwife could examine you instead?

There are pain relief capsules which are sometimes given into your bottom after the delivery (CS or vaginal) but you can refuse those. If you have a vaginal birth and tear, the midwife/doctor MAY want to examine your back passage (1 finger) to check if the sphincter muscles are damaged as this would affect the type of repair needed. If you had a CS then this would not be necessary.

I hope this has answered those questions without being too much information for you. Good luck with whatever you decide!

Thank you for all your help and information. It's really helpful

It's posts like this that terrify me
www.mumsnet.com/Talk/childbirth/922547-What-shocked-you-during-your-birth-full-hand-examinations?pg=2&order=

I don't understand how these things can happen and be a shock. Surely it's not right that women aren't told that it might be a possibility someone shoves their whole hand inside your womb? Or being stitched up without any anaesthetic? It's these sort of things that I know would have me sectioned straight after the birth and ruin any chance of being a good mum :(

I've only glanced at that thread, OP (it's horrifying reading for me for the same reasons I suspect it is for you), but all I can say is that this wasn't my experience at all, at a big-standard GP surgery midwife practice in a grubby bit of north London, and a big East End maternity unit. I felt consulted and in control. No one so much as took my pulse without my consent.

That's exactly what I meant when I said choose your sources carefully - don't read threads like that!

If it's true I want to know that in advance because I would rather die than have a stranger fist me. That's what I think all my friends have been doing when I've asked - not telling me the worst bits because they know it's rough, but then I know if I get there and things happen that I wasn't expecting then I will be in a really really bad place. I feel like I need to know all the possible bad stuff that can happen then I can try to control it a bit.

They don't seriously put their whole hand inside you. Surely? How do they get this 'clip' I keep reading about on baby's head?

I haven't read the thread, but are you talking about a fetal scalp electrode? That's attached to the baby's head. But only if the midwife/doctor feels it's necessary and they would get your consent. During my DS's birth they attached one but I was barely aware of them doing it, I was in pain from contractions and completely out of it on gas and air!

Honestly? Just get an ELCS, OP, otherwise you're going to drive yourself mad reading about all the things that can go wrong with a vaginal birth.

If you can afford it I'd hire a private midwife for continuity of care. Explain to her your history and let her explain to the hospital staff when you arrive. You can also meet with the hospital staff before hand.

I would also labour with the private midwife at home until you are well into established labour (called a domino birth). Then you will reduced the risk of unnecessary intervention. You can try the gas an air etc at home where you feel comfortable and if it's not for you, you can decline it at hospital.

The unfortunate reality is that you can't be sure how a birth will go. Some women have wonderful, calm births with no physical complications (during or after) which completely fulfilled their expectations. For others, things go awry and they feel a whole gamut of negative emotions and/or face physical complications which continue after the birth. If only we knew which one we were going to get in advance, I think a lot of us would feel a lot better about the whole thing

From all you've written here, and also projecting some of my own birth experiences, I would give very serious consideration to an ELCS. It has it's own risks and there's no getting away from it being major surgery, but my feeling of control during an EMCS was so much more comforting and positive than the lack of control I felt during my failed induction.

Take your time, talk to your DH and the professionals and go with the plan which you feel most confident and comfortable with.

Hey PreparingToBeAMummy, I don't have much to add as the advice here is already pretty good. Just wanted to let you know you're not alone in this- I'm also a child abuse survivor and I'm planning to have my first child at the moment.
I agree with PP about getting a doula if you can. If can try and get in contact with local doulas now to see how you can trust them. Luckily I already knew my doula but having that support right from the start has been amazing and such a help.

I found the midwives and other HCPs were incredibly supportive and understanding throughout my pregnancy. However, if you wanted or found you needed extra support, an independent midwife can act as an advocate and doula alongside NHS care and at a hospital birth.

I had 1-2-1 cognitive hypnotherapy during my pregnancy, both for the PTSD and for hypnotherapy during labour and birth, and breastfeeding. With hindsight I didn't find therapy for the PTSD as helpful while staring down a delivery date as it might have been had I started earlier - though it still helped. (The hypnobirthing was really useful.) I know you've had therapy already and are well, which is great but maybe a few sessions now before you're pregnant to focus on your anxieties about triggers during childbirth would be helpful.

I wrote a letter which i took to my first antenatal appointment explaining my history and worries, so I didn't have to find the words face to face. After that I didn't have to explain my history to anyone else. I gave my community mw permission to share the salient details as necessary but my letter didn't have to be placed on record and was never out of my sight. The community mw made sure I always saw her at antenatal appointments, and arranged for me to see the consultant mw at the hospital to discuss how best to manage the birth.

My choice, after advice, was an ELCS. It was very calm and they arranged for an all female theatre team. The catheter wasn't great but the hypnobirthing techniques helped get past the difficult moments. You can choose to insert the painkilling suppository yourself afterwards in recovery if you ask - it delays it slightly but it will still kick in in plenty of time.

My DH was with me throughout and we had a private room on the postnatal ward so he could be there overnight if i had flashbacks. Breastfeeding was a struggle, and is difficult to teach hands off. I gave up on day 2 and gave formula, though i was able to express using a hand pump for a couple of months which assuaged my guilt a bit. I didn't feel regrets about the ELCS, but I struggled with the fact that the bastards from years ago came between me and breastfeeding my baby. With hindsight now, I see it all as just the help and the tools I needed, at the stage my recovery had reached, to stay well. For someone else, a vaginal birth could be very healing, as could breastfeeding. For this reason I'd suggest keeping an open mind, explaining your likely triggers to HCPs when discussing your birth plan and asking their advice on how best to manage them. You know you and they know childbirth so by open and frank discussion you'll be able to make the best plans.

A really good book to read which i cannot recommend highly enough is Penny Simkin's "When Survivors Give Birth". For a standard pregnancy book, Lesley Regan's "Your Pregnancy Week by Week" is informative but accessible. "Stand and Deliver" is filled with empowering, you-can-do--this birth stories.

Good luck. And don't ever let the bastards cheat you of being a mum.

I had the monitoring clip on my baby's head, and to be honest I can't remember how it was attached, but it's tiny, so I think she only used a couple of fingers. I was on the gas & air at the time so barely noticed.
Again, you can decline it if you want.

I can't think why anyone would do any stitching without local anaesthetic. Strongly suggest you stop reading threads like that! Some people will try to scare you with exaggerated horror stories, some people will play down the bad bits, it's impossible to tell who's doing what, or whether any of it will be relevant to you in your birth.

I had an ELCS last week at 39 weeks which is the standard time and not considered risky. It was calm and the staff were all very respectful. For example it took several attempts to get the spinal in, I was asked to say when it was ok to try again and could have asked for a break if I wanted. The catheter was put in when I had no feeling. Its removal was done by a midwife later on and wasn't painful or particularly uncomfortable.

How supportive/good an advocate is your partner? If not great, is there a friend that can undertake this role?

I'm sorry I haven't read the thread yet. Just wanted to say what I did regarding your points:

1. it's really important hear that you give full disclosure about your past at your first midwife appointment - your booking in. This might be very difficult for you, you could consider writing things down so you don't have to discuss in person. They will ask you if you are ok with putting it in your notes (because you carry your notes around and they live in your home, some people can't put information down because husband, family etc don't know). Personally I chose I have 'history of abuse' emphasised as much as possible in my notes and also wrote it as my first line in the 'birth plan' section which is for the mother to complete. If you discuss it all at booking in, it gets put in your handwritten notes AND on the computer. It's also worth requesting a perinatal mental health team referral. Even if you decide you don't need their support, having the referral in your notes is another indication to staff to treat you sensitively, IYSWIM.

2. Hospital. Mental health needs can be a reason for being put in a private room in hospital, and often if you have a private room your DH is allowed to stay on the quiet, as long as he stays in the room and isn't difficult with staff. This is another reason for requesting a perinatal health team referral. I was told the care priority for a private room - life threatening complications first, then a couple of other conditions I can't remember, so you aren't guaranteed. BUT, again blazon it across your notes (I put it in my birth plan section) that you are mentally vulnerable and at risk and so require a private room. I got one. I offered to pay but was told no need.

3. find an antenatal class run by a trained midwife if you can. Will probably require a lot of asking around and internet searching but well well worth it. I did hypnobirthing, my friend did aquanatal! The class doesn't really matter just get in a position where you are paying for a trained midwife to talk you through it all. I say the class doesn't matter but actually I found the hypnobirthing book great for accessible information about the biology of birth, so a hypnobirthing class is worth doing if you can find one run by someone down to earth.

4. best reason to hire a doula. They will be in a position to observe whether consent has been sought and advocate for you. Consent must always be sought! But again, just to make sure, I wrote that in my birth plan too.

I know people are recommending ELCS but I would say this is not something that requires a decision yet. I felt quite strongly once pregnant that I wanted to attempt VBs. I did, and I found it mentally healing. I also found the tears weren't upsetting at all. I was damaged in a positive way not a negative one. I suspect some people will say that's nonsense but it's how I felt. I think I would have felt more damaged by surgery, but then, I haven't experienced CS so I wouldn't know. I wouldn't discount a VB just yet. Wait until you've researched pregnancy and birth a little more, and perhaps wait and see how you feel once pregnant.

I had a pain relief suppository, but inserted when numb, so I didn't mind. I could have declined if I'd wanted.

Oh and I can just say I avoided NCT because I heard it's run on philosophy rather than the realities of birth. Don't know how true that is. But you won't regret time spent talking to real midwives and obs doctors, if you can find a way to attend a private class / pay for their time somehow.

Really brilliant advice here. Thanks guys. I think my next step will be to read some books, perhaps post it note any key worries to discuss with my gp and then after that, make opportunities to talk to all the people you've recommended. Then actually try for a baby!!!

It's really reassuring to hear that other people have had a baby after abuse and coped. It does feel very daunting so it is calming to hear it is possible.

Can I just add to the voices saying I found pregnancy hugely traumatic. Birth not so much. Birth is all emotion and hormones. Pregnancy is a long lonely slog of devoting your body to someone else's survival.

Pregnancy I felt constantly invaded and violated. I really lost all sense of control over my body at one point in my first pregnancy and spiralled into very bad AND. Birth helped me cope with that.

I don't have much advice for coping with pregnancy. Second time around it wasn't so bad and now third time (3rd trimester, almost over!) I'm ok with it - not on any anti-depressants at all! The therapy I was offered was pretty crap tbh so I guess decent therapy might have helped. Little things also helped like my husband not initiating sex at all, asking permission to hug/touch me etc - very much reinforcing that he respected my boundaries, even if the foetus didn't!

That's a really good point Batteries. I do wonder how I will cope with being invaded in that way, even though it is something I know we want. Especially if being pregnant makes me feel really awfully ill.

Thankfully I still have two private therapists I see and would continue to see throughout and they're brilliant so I hope they would continue to be. I do think I've got a lot of talking to do before we even start to try though.

It's shit, isn't it. It is so unfair.

I would say for me, it helped going into it knowing we had both discussed if I felt the need to terminate we were ok with that. I very nearly did.

Knowing what I know now about my finding it easier in subsequent pregnancies I wonder if I would have been better off having a termination with that first pregnancy and then attempting it all again a year later. Who knows! It would have been difficult either way.

I also tried to avoid all talk of 'the baby makes it worth it' fuck that. The very issue I had was the concept of my body being subservient and controlled. Effectively saying 'the baby is more important' is bullshit.

Allow you and your health to be front and centre.

Thanks, batteries.

Can I ask why you chose a doula over a private midwife? I can't seem to really find the difference between them.

I was raped a few years ago. So i need to be fully in control of anything invasive.

I told my MW (first time round) and it was on my file. She wrote a note (i don't know exactly what it said) but it was constantly with my pregnancy notes.

I have to say i was treated really well over the whole thing. I saw a lot of different midwives etc and they never brought it up but i knew they knew. They were very sensitive. For example, they wanted to induce me at one point and were thinking about a sweep but they put the ball completely in my court. I said no, and felt able to say no and that was that.

I felt like they always took in to consideration the benefit of anything maybe preceived as invasive and didn't subject me to anything that may have upset me.

I was examined to see how my cm dilated i was but she was so very kind. And i felt very in control.

I don't think they would have ever considered putting a male with me.

I had a very smooth experience considering. And i never had to mention it (which obviously can be upsetting), because of the notes.

I don't know if i make much sense! But i just hope this can be a little bit reassuring whatever you choose. That in my experience people were very understanding and i never once felt out of control.

A few reasons. There aren't many private midwives around here, the ones there are are older so retired from NHS midwifery and I was worried they might be a little old fashioned in approach. Also a practising private midwife takes her clinical responsibilities to you seriously, you can't just opt in to birth care, you need a number of appointments. They need to satisfy themselves you are low risk and not in need of a delivery on the delivery ward of a hospital. The ones here don't do high risk pregnancies - for those you really need the support of a whole NHS team plus hospital.

Also a midwife might be wonderful, supportive, etc etc but her first concern and primary training is in your physical safety and that of the baby.

A doula is more of an interested amateur regarding the physiological side of birth. A good one can explain common interventions for you, and observe what medical staff are doing and report back to you on exactly what happened - but they don't make clinical decisions. Their only concern / expertise is in mental/emotional support.

Since doulas don't have the same pressure to ensure you won't die (to put it bluntly) they can be more flexible regarding the time you spend with them and how involved they are. This also makes them cheaper.

I trust NHS staff to be clinically competent. I felt no need to try and replicate or replace them in that respect. Where I find they are often lacking is in emotional support, often due to understaffing. A doula provides that constant mental support without interfering with the clinical role of a midwife.

Hope that makes sense.

Also can I just clear up a point you made earlier - mental health history does NOT make you a high risk birth for things like water birth. High risk refers purely to physical risk levels. If you end up under a specialist mental health consultant as I did that should not affect your birth options. Although of course if you want to birth on delivery suite or have a CS, your consultant can advocate for that.

You may find it worth reading The Positive Birth Book by Milli Hill. It addresses lots of ways to get the birth you want (or to the best birth possible) and not accepting things just because that's "normal". I was surprised by all the things you can ask for and expect with both a vaginal birth and a c-section.

OP I have a similar (not same) background that led to almost identical concerns. I was petrified and also needed to know EVERYTHING.

I want to let you know that my first birth was amazing. On paper it wasn't, there were complications, but the way I was treated made me feel incredible. One thing I'd never considered (and i thought I'd looked at Every. Single. Option!) was that (possible TMI) me getting a baby out of my vagina afterwards felt like I'd taken back control of it. It was mine. I did that! Nobody did it to me. I kind of felt reborn.

So what made it good for me was having one-to-one care for the duration of the pregnancy and labour. I was abroad, but the equivalent care in the U.K. would be a home birth with a midwife you trust. A doula there too would be good.

I'd highly recommend speaking to some doulas - you want someone who makes you feel comfortable (like a good therapist does). There are also doulas who will work in hospitals and the advantage of that is she's with you the entire birth and she knows you and knows what you want and don't want. This also takes pressure off your birthing partner.

And I definitely agree about giving ALL info about triggers etc to midwife and getting any perinatal mental health care listed on your notes. You basically can't have too much down there!

I wrote a birth plan in bullets with red, bold capitals about the things not to do. And what to not do (touch me) if I started having flashbacks.

And I'd also recommend Ina May Gaskin's Spiritual Midwifery or Guide to Childbirth because if you want to arm yourself with all the options and have all the info, then you need to know what can cause things like a "cascade of interventions", which I detect is something you don't want (nobody does).

Penny Simpkin's When Survivors Give Birth is excellent too, but it's more intended for practitioners (which you may like!).

But, I have to admit, I was so stressed by it that I didn't read a single book while I was pregnant! I read parenting books instead!

And if you aren't doing it then I'd highly recommend EMDR for triggers that may get provoked during pregnancy/labour/birth. I did EMDR later and in hindsight wish I'd known about it before. There are many things that can impact a birth and stress is one of them. Removing any stress possible is something I'd definitely recommend.

And if ELCS is for you then go for that. I'm not suggesting you shouldn't, more that there can be something very positive that is never shown in the horror stories about birth. They happen and they're horrific (whatever type of birth), but there are also some very good experiences that are rarely spoken about and never shown on TV because they're not dramatic.

Private rooms - I think you'd have a fairly good case for having a private room (though some life-threatening complications/infectious conditions could trump you). I had a private room for medical reasons and though fathers were only allowed to stay 1 night elsewhere, the staff turned a blind eye to him staying with me 24/7 for about 4 days.