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Birth after sexual violence (and birth trauma): my birth stories

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Birth after sexual violence (and birth trauma): my birth stories

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Warning: please read

The first half of this story is a tale of actual medical mismanagement, and negligence. I have had numerous birth professionals request that I make formal complaints about the care that I received, which I have never done, because I have never had the mental energy to do it. This is not a birth story to read if you are expecting your first baby and want to know what to expect. This is a tale of birth trauma loaded on top of rape related trauma. It isn’t the story of “normal births”.

The second part of the story, my second birth, is a story about learning to start to heal, it is a story about beginning to feel empowered, whilst also being frightened and defensive. It is a story about making informed choices and being prepared to shout loud if anyone tried to override those choices. I am writing this to accompany the sister blog on preparing for birth as a survivor of sexual violence because there is so little support available. I needed to write my story in a different place to be able to separate it from the article on points to consider.

Having a baby!

When deciding to have a baby the images of us as a family with our baby were foremost in our mind. Pregnancy and birth weren’t the primary focus, they were just something that you went through to get to the end goal. At that time they didn’t seem hugely significant.

That was until I got pregnant. Once I was pregnant birth took on a much bigger aspect. In fact it became the only thing I could think about a lot of the time. It was something that was going to happen to me and there was going to be nothing I could do about it.

Fears of birth; memories of rape

This was hugely triggering. As a survivor of rape, the idea that things happen to my body that I have no control over is extremely difficult to deal with. The idea that medical personnel would routinely put their hand inside my vagina whilst I was in labour was literally more than I could cope with. I began reading everything I could about labour, about types of birth, about ensuring that labour started naturally and on time. My decision was to have a homebirth, with me in a pool with as few examinations as possible and extremely limited contact whatsoever with any medical professionals.

I told my community midwife that I had been raped. At my request she recorded this in my notes, and put it in my birth plan. This meant I knew that medical staff would be aware of my trauma and deal sensitively with me. I received no mental health support nor any opportunity to discuss expectations of birth. Nothing.

During the early weeks of my pregnancy I was acutely ill with Norovirus. I had back pain and went for a scan to ensure that it was not an undiagnosed ectopic pregnancy. During this check I was asked for a blood sample. I wasn’t willing to give a blood sample as I was unaccompanied and have a needle phobia. Two Health Care Assistants held me down whilst a nurse attempted to take blood. Me struggling and crying was not enough to make them stop. I shouted “I do not consent.”

Only at that point did they stop and ask me to sign forms to say I had gone against medical advice and declined the recommended treatment.

I was confident that I did not need the blood test. However, I was so frightened of the staff and felt so shamed at being treated like a naughty child that disobeyed the rules, that I couldn’t consent. Even if I believed it was in my best interest. The trust in the medical staff had gone.

Undermining trust

If they had been friendly, understanding, acknowledged my phobia and checked that I was happy to have blood taken, checked I understood why it could help, I would have consented. If they if had talked to me and taken things slowly, so I felt listened to and in control I would have let them take the blood sample. I have had all routine blood tests in pregnancy and opted to have additional voluntary blood tests to allow me to become a breastmilk donor. I would have given my informed consent.

Their attempt to use force to take blood, my need to shout “I do not consent” for them to realise that what was taking place was an assault, had horrific parallels for me.  As a survivor of sexual violence this was all too familiar, and this was not even in the highly vulnerable context of giving birth. It seriously undermined my trust in the medical profession and the idea of informed consent in any medical treatment. Presumed consent and pressure to conform to the wishes of the medical profession became a massive concern.

Constant fear

Throughout my pregnancy I was having regular panic attacks. I was terrified of induction, terrified of C-Section. I was terrified of feeling pressured into agreeing to things during birth that would leave me even more mentally scarred than the pregnant shell that was barely held together as it was.

My Mum, a retired midwife and midwifery lecturer knew I was anxious, I was talking to her about studies and techniques and birth choices almost everyday, but she could not understand the level of fear I was showing. I was about 6 months pregnant when I told her I had been raped. My mum was one of my chosen birth partner, so I knew I would have to tell her. I wanted someone who felt at home with birth to be able to be there and help advocate for me.

Spontaneous rupture of membranes

Mum arrived a few weeks before I was due, as I kept having whole evenings of Braxton Hicks. It wasn’t until the evening of my due date, when my waters started leaking with no other signs of labour that anything really looked like it might happen. I reported it to the midwives, who agreed to send someone out to talk to me because I was not at all keen to go to hospital.

The midwife they sent out was utterly insistent that I had to have an internal examination. My trauma and visible fear was of no concern to her. I knew I was not in active labour. I knew that with Spontaneous Rupture of Membranes limiting examinations is key to reducing infection risk. This was the first thing my carers pressured me into.

Having read all the guidelines, I agreed to monitor myself for any signs of infection, and to go to the hospital for monitoring 24 hours after rupture of membranes if I had not gone into labour.

I spent an incredibly anxious night leaking fluids and not going into labour. I felt everything was rushing away from me. Any picture of a birth that I could control was gone. I was utterly terrified.

Informed consent or coercion?

The next morning we went into hospital. My mum repeatedly reassured me that I did not have to agree to anything I was uncomfortable with and that I was within the guidelines to wait for up to 72 hours to allow my body to go into labour if there were no signs of infection or distress. So we went in, me telling myself, without any belief, that it was just a check.

That was when the repeated threats of dead babies began. There was no, here are the risks, here are the statistics, this is what you need to make an informed decision. I was told; “I don’t give statistics because it doesn’t matter what the statistics say, if it happens to you, it happens 100% to you.”

Whilst this is true, it is also true that a traumatic and disempowering birth resulting from unnecessary medical interventions happens 100% to you if that is the outcome of your birth. Statistics are about judging probability. Being able to understand my risk factors would have allowed me to make a decision. Instead I was made to feel that I had to do as they wanted and opt for an induction at that point. Otherwise, I would kill my baby and it would be my FAULT.

Awaiting induction

So there we were on the antenatal ward, in a bay waiting for this induction that terrified me, in at atmosphere that terrified me, with staff who I felt gave my feelings and fears no consideration at all. Despite, or perhaps because of, the record of trauma written plainly in my notes they treated me as hysterical. Their attitude seemed to me to be ‘this one isn’t going to play ball so we are going to have to get her to do what we want by whatever means possible’. When I said no to something, they pushed harder.

Left alone

After many hours in a bay, during which staff told me off for frightening other people with my distress, we were moved to a side room. No midwife introduced themself to me. Nobody came to check on me. I began vomiting with every contraction. Their response was to put me on a monitor. I was not allowed to move as they struggled to keep a good trace. My mum or husband kept having to go and get more sick bowls. Eventually they just gave us a stack of bowls so we could stop bothering them.

They said they I wasn’t experiencing what they would call contractions because they weren’t showing as regular on the monitor. At that point my mum introduced herself as a recently retired midwifery lecturer who suggested that actually observing me was necessary for them to make such judgments. My Mum asked if there was anything we could do to make things more manageable. Since they were not letting me move, I couldn’t use any active techniques to manage the contractions. However, their only suggestion was paracetamol, which seemed pointless as I was vomiting every 4 minutes.

“Clearly not in labour”

We decided that we would try a bath. That helped for a few minutes until the pessary came out with a contraction and I vomited in the bath. Concerned about infection risk I got out of the bath and we went to find a midwife to let them know that the pessary had come out. They suggested they just put it back in.

I got incredibly angry. I was pressured into this induction. Their justification was based on infection risk. Yet their suggestion was to reinsert a pessary that had been in a bath full of vomit. I refused to consent to this.

I complained that they were not offering anything to help. They said that there was nothing else they could do unless I was actually in labour and I clearly wasn’t.

“Oh, you are in labour”

So they went to get a more senior midwife This midwife was the first person who really seemed to look at me. She insisted that I couldn’t go anywhere with other pain options unless I fulfilled the criteria for active labour. This was defined solely as having reached a cervical dilation of 4cm. However, if I would consent to an internal examination to check my dilation they would permit me gas and air for the duration of the check.

At that point anything that might help seemed like a good thing, so I agreed pretty willingly. From this point onward I have no memories of my labour and birth with a view from my perspective. I remember everything happening to me as I watch from outside my body. From this point onwards I pretty much dissociated for the entirety of the next 30 hours.

On checking my cervix they discovered I was at 4cm, to the astonishment of the midwife that had never once looked at me rather than the monitor, and they agreed that they would find me a room on the labour ward. I had had a pessary inserted for 12 hours, and had been vomiting for around 8 of those hours. They agreed I could keep the gas and air until I was moved.

On the labour ward

The change in atmosphere to the labour ward was huge. At that point I received a dedicated midwife focused solely on my care. Finally someone noticed the extent of the vomiting. They released that I was extremely dehydrated and weak. They started a rehydration drip and some antiemetics. These things I remember.

I don’t remember how many internal examinations were performed. I remember nothing about them at all. Soon they were concerned that progress was slowing. They felt that I needed a syntocinon drip to speed things up. There was not an option to do this without first giving me an epidural.

Amongst other things I am highly needle phobic. That I was already coping with a cannula was a huge thing for me, and an epidural, a tube inserted into my spine is something that I, when in my own mind, would massively struggle with. I was a bit anxious, but I had effectively shut down, I had gone into a mental standby mode in which my mind was not truly able to interact with anything that was happening to my body . So I actually managed it rather well.

A truly supportive midwife

The midwife at this point was genuinely wonderful, she supported my mum and husband, she talked to them about how I was doing and about my preferences when I was unable to engage. Even through the dissociative haze I was aware that this midwife was treating me as a person. She was trying to keep me as close as possible to my goal of a vaginal birth, rather than a caesarean. This my only remaining birth preference left. All the others had already gone out the window.

Once the epidural was in, I slept. Removing the physical sensations from my body as well as my mental presence just allowed me to completely let go.

Time for some coached pushing

The next thing I remember was the obstetrician who had threatened me with dead babies coming on his round and deciding that things had gone on far enough and that I needed to be pushing, so the coached pushing began. After a time, which I have no memory of at all they decided that this was not working and that now the baby was in distress and they needed to deliver the baby using ventouse cup. The obstetrician asked if they could do an episiotomy, I said I really didn’t want one.

The obstetrician told me my baby might die in that case, so I agreed.

Enter crash team. There were so many people in the room, I have no idea how many, who they were, or what they were doing. They removed my baby from me, dumped him on my chest and instantly removed him. He wasn’t breathing. They worked on him in the corner, so many people I couldn’t see anything, before they took him away. Andy was not allowed to go with our baby.

They told us nothing.

He was not breathing.

Alive or dead?

Shift changed.

I was stitched up. I assume the placenta was delivered, but I do not remember. Once the finished the obstetrician left. His shift was up too.

The only thing I remember is a new midwife coming in and repeatedly offering me toast. I didn’t want fucking toast. I wanted to know whether my baby was alive. She said she would go and find out.

Nothing.

We heard nothing.

Nothing. Andy went to call some of his family to say that the baby was born, but we didn’t know if he was alive. He asked them to pray because there was nothing we could do. He said we would let them know when we knew anything.

I got dressed. We still didn’t know. We hoped that we were right to assume that they would have told us by now if he was dead. The midwife said “yes, they probably would have”, the probably took away all the hope that that was true.

Meeting our baby

I don’t remember the person coming to tell us he was alive and we could go to see him. I do remember being wheeled along corridors and into the NICU. Finally we saw him; head moulded, tubes sticking out of him. He was breathing on his own. Apparently he was only ventilated for 15 minutes. (Why they couldn’t then tell us he was breathing and alive I will never know. I assume nobody in NICU thought to tell us. Presumably everyone who went to find out was distracted by something more important.)

After a visit I was wheeled away to postnatal ward. I was in a bay. I had prior agreement that I would not end up in a bay because I felt so unsafe having strangers surrounding me. Andy and my mum were sent home. I was still catheterised and couldn’t walk. Nobody took me to see him until the next morning. I was wheeled down to NICU, but he wasn’t there. He was moved to the transitional care unit. Nobody was quite sure what to do with me. The other people in the bay were still pregnant, awaiting C-sections.

Return of the truly supportive midwife

The amazing midwife from the previous day saw my mum in a corridor. My Mum was refused entry to the postnatal ward because she was not ‘the father’. The midwife asked how we were. My mum broke down and sobbed in the corridor. She told the midwife that I was in a bay; nobody listened to requests to move me; that she wasn’t allowed to see me; and that nobody was listening to us. The midwife sorted it out. We got a family room. My mum and husband were to be treated as one person for every purpose except the maximum of 2 people at a time cot side in transitional care

I’m going to end this story here. The 66 hour recorded length birth was over. This was the beginning of something new. This was the beginning of a story. I needed to learn that my baby was my child and that I didn’t need permission to parent. I needed to overcome the self-blame and recover from trauma. My birth left me with and residual mistrust of all medical professionals.

Preparing to birth again

When your first birth is traumatic, preparing to do it all over again can be pretty daunting. And by daunting I mean terrifying. Birth Trauma is a very real experience. It can lead to, or contribute to, ongoing mental health issues including PTSD.

My Mum had never attended a birth like Jacob’s birth. She is still traumatised by it. Many of the feelings of trauma came primarily during my second pregnancy. As a stubborn (strong) and bloody-minded (determined) pindividual, I refused to let my experience of birth put me off having subsequent children, and Jacob was amazing. We knew we wanted another child.

Antenatal anxiety: return of the fear

I considered briefly how I’d cope with giving birth again, but not in great detail. When I became pregnant with Reu the antenatal anxiety resurfaced again, with a vengeance! 

I became entirely mistrusting of all birth professionals except my community midwife. I believed I’d die if I gave birth in hospital. Simultaneously I had lost all faith in my body’s ability to birth a baby on its own. Initially my decision to homebirth was based primarily on the not so rational decision that I’d rather die in my own home than in hospital.  

I sought support

I knew I needed help. A friend of mine worked in infant feeding support. She had the capacity to refer to the Perinatal Mental Health Team. I asked her to refer me. I was diagnosed with rape related PTSD compounded by Birth Trauma, contributing to severe antenatal anxiety. They provided crucial and consistent help until after my baby was born.

Hypnobirthing

I also watched closely as two of my friends who had previously had traumatic hospital births had peaceful homebirths that were totally different to their first births. I remember being totally on edge in the last month of their pregnancies. In my mind I judged the possibility of me surviving birth based on how their births went. And it worked. So I did what they had done, booked the birth pool (our babies were all born in the same pool!), and booked a private hypnobirthing course.  

The first time round I had avoided hypnobirthing because, to me, the idea of mentally going to a safe place felt too similar to dissociating and I had wanted to avoid dissociating during my birth. However, as it happened I had dissociated through so much of my first birth, that I decide it might be worth trying it. I wanted to see if there were techniques I could use to help me stay relaxed in my body, without dissociating because of trauma.

I was worried, but I booked a private hypnobirthing course in my own house. That meant I didn’t have to find childcare, and I didn’t have to discuss my concerns in front of anyone else. It was all about my birth. Doing this felt decadent, if not potentially flagrant. So much money for a birth. And then I thought about the impact of my first birth and it felt totally worth it.

Me vs the medics: not exactly care professionals

I began to work on changing my mindset. I was open about my mistrust of medical professionals, I explained that I understood the risks before making decisions. However, I was firm that I would be making the decisions regardless of the opinions of medical professionals. I felt adversarial trusting nobody to help me get the birth I needed. I planned to do it despite them.

Seeking empowerment

I also began to search out empowering birth professionals on social media, independent midwives, obstetricians who focus on person-centred care, not simply ensuring that there were two(+) living beings at the end of delivery, doulas, the Positive Birth Movement. I repeated affirmations that I didn’t believe at all to myself until by sheer force of will I managed to believe that my body was capable of birthing a baby, that it did not have to be an experience that felt “life and death”, that it could be a powerful yet normal experience, and that the evidence supported that the best place for me to birth was at home, with as hands-off a care set-up as possible.

The hypnobirthing course was utterly life-changing. The power of relaxation in a time when you aren’t in control of your body is hugely powerful. To some extent I was able to mentally buy into “my body is birthing my baby”, but to some extent I simply taught myself to relax, in the belief that I was as safe as I could be, still unsure my body would perform, but knowing it gave me the best chance. I practised daily. I was still anxious. I’d regained faith in my ability to birth a baby IF I went into labour, but as that hadn’t happened naturally with Jacob, that was the bit I really wasn’t sure about.

Would I ever go into labour?

So, I tried everything. I knew I was happy to go to 42 weeks and possibly beyond. I had reflexology, and acupuncture, and I declined induction, and daily monitoring. This time I threw statistics back at every mention of dead babies. I questioned the validity of the figures they used to attempt to persuade me. I signed all paperwork I necessary to the effect that I declined induction. My intention was to birth at home, even up to, and potentially past, 42 weeks.

I agreed I’d talk to someone on the phone at 42 weeks. At 40+13 (41+6) I lay in bed and decided that I would agree to induction at 43 weeks, sure I wouldn’t go into labour before then, but giving my body the best chance to prepare, so the induction would have the best chance of success. And knowing that I could opt for a Caesarean section, and had paperwork from the psychologist supporting even opting to have a Caesarean under General Anaesthetic.

I relaxed

At that point I gave in. A decision was made. I could stop trying to force my body into labour by sheer force of will. Finally, I relaxed for about the first time in 8 months. I went to sleep. And I woke up in labour.  

All it had needed was me to let go a bit. The hormones got busy, did their job, and I DID IT! I gave birth to Reuben, using a TENS machine, hypnobirthing, a birth pool, and a little gas and air. No midwife touched me in my pool. I got in before the midwives arrived, and I did not get out until after he was born.

Both babies were back to back so I spent hours trying to focus on not pushing. I remember telling the midwives that the baby’s head was out, and they said, “we don’t think it is”, but the head between my legs spoke for itself, and with the next contraction he was born.

My baby was handed up to me by Andy, and he was ALIVE. I realised then that I’d almost given up on the possibility of a living baby. So many professionals had talked about dead babies, even though I knew the statistics they referenced did not suggest this. 

Triumphant

I felt exhausted, but empowered. I felt triumphant and proud! All of a sudden I believed in all of those affirmations. I felt a renewed confidence. I felt hugely healed. The support of Andy and my Mum had been utterly essential, but, doing it all in the pool with no checks and no hands on care from the midwives meant there was nobody else I could credit the birth to. I did not feel violated, I did not feel that the birth belonged to someone else.

The contrast makes the trauma of my first birth seem starker, because I now have something peaceful to compare it to. I can also see “where I went wrong” the first-time round. I can see better what was going on, and why things happened, but now I know I have other choices that are holistically safer. Just like I wanted to control my body, medical teams want to control outcomes. Both people alive, even if it meant hugely diverging from birth plans, is their aim.

The thing is, they’ve seen the times when mum or baby didn’t make it, and those really small statistics create the fear and desire to jump in and prevent that outcome. More inductions and caesareans may be justified by fewer deaths? I get that, because it was the same fear reasoning leading me to try everything to get into labour so I could stay away from the place where I had been so physically and mentally harmed by accepting the interventions the first time around.

A different outlook

My second birth was incredibly positive. My second pregnancy was not. It had been so controlled by the fear that whilst it led to a better outcome, in itself, it was a really hard time of my life. I have two kids now, and one day perhaps there will be another. Going into a third pregnancy I believe I’d have a very different outlook. I’ll be empowered and informed. I won’t see medical teams as the enemy, but I’ll make damn sure they know I’m in charge of all decisions.

If I choose to free birth in the woods (unlikely, but maybe) it will be out of choice, and not out of fear. Reuben’s birth was my mum’s first homebirth, and whilst for her that has not healed the trauma of Jacob’s birth, my only regret is that as she has retired she cannot still be part of the system promoting person-centred care in birth. I know now that there are so many people in the profession who are working to achieve that end. And I will speak out about “normal” birth, about pregnant people making the right choice for them, whatever that looks like, about birth trauma, and I will listen to your stories and let everyone know they are not alone, and that it isn’t always that way. 

This blog was written to accompany my article on Birth preparation for survivors of rape and sexual assault. My experiences mean that I strongly feel that it is necessary to be able to advocate for yourself.

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