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.
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.
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. I fixed my mind on a homebirth, with me in a pool with as few examinations as possible and extremely limited contact whatsoever with any medical professionals.
I had told my community midwife that I had been raped, and had opted to have this recorded in my notes and put it in my birth plan so that I knew that medical staff could be aware of this and deal sensitively with me. There was no support offered, no mental health support, nobody to talk through expectations of birth. Nothing.
In the early weeks of my pregnancy I was acutely ill with a vomiting bug and because of back pain was sent 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 Healthcare 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. But I was then so frightened of the staff and felt so shamed by being treated like a naughty child that had not followed the rules, that I would have struggled to consent even if I had known it was in my best interest. The trust in the medical staff had gone. 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.
Throughout my pregnancy I was having regular panic attacks, I was terrified of induction, terrified of C-Section, 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. I knew I would have to tell her because I wanted her to be one of my birth partners. I wanted someone who felt at home with birth to be able to be there and help advocate for me.
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. She was utterly unconcerned by my trauma, how terrified I was, especially given that I knew I was not in active labour and that I knew that with Spontaneous Rupture of Membranes before labout limiting examinations is key to reducing infection risk. This was the first thing I was pressured 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 and I was utterly terrified.
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 that “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.) But statistics are about judging probability and being able to understand how many risk factors I had would have allowed me to make a decision. Instead I was made to feel that if I didn’t do what they wanted and opt for an induction at that point I would kill my baby and it would be my FAULT.
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 trauma being written plainly in my notes I was treated 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.
After many hours in a bay where I was told off for frightening other women with my distress we were moved to a side room. No midwife was introduced to me, nobody came to check on me. I began vomiting with every contraction, so they put me on a monitor, and I was not allowed to move as they couldn’t keep a good trace, my mum or husband kept having to go and get more bowls until 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 and asked if there was anything we could do to make things more manageable as they were not letting me move, so I couldn’t use any active techniques to manage the contractions, but their only suggestion was paracetamol, which seemed pointless as I was vomiting every 4 minutes.
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 that in an induction I was pressured into because of infection risk, their suggestion was to reinsert a pessary that had been in a bath full of vomit. I refused to consent to this, and complained that I was not being offered anything to help, but they said that there was nothing else they could do unless I was actually in labour and I clearly wasn’t.
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 they could not move me to anywhere that had other pain options unless I fulfilled the criteria for active labour which 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. From this point 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.
The change in atmosphere to the labour ward was huge. At that point having a dedicated midwife focused solely on my care meant that they were able to take note of the vomiting properly, realise I was extremely dehydrated and weak, and set up a rehydration drip and some anti emetics. These things I remember. I don’t remember how many internal examinations were performed. I remember nothing about them at all, I remember nothing except that soon they were concerned that progress was slowing, and that I needed to be put on a syntocinon drip to speed things up. There was not an option to do this without first giving me an epidural. Amongst other tings 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. 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 of nothing really being me I was aware that this midwife was treating me as a person and was trying to keep me as close to the goal of a vaginal birth, rather than a caesarean, which was really the only birth preference left that they might possibly be able to fulfill.
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.
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.
A crash team was called. 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. Shift changed.
I was being stitched up, and I assume the placenta delivered. I do not remember. Once that was done 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 if my baby had died. She said she would go and find out. Nothing. Nothing. Nothing. Andy went to call some of his family to say that the baby was born, we didn’t know if he was alive and could they please pray because there was nothing we could do and 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.
I don’t remember the person coming to tell us he was alive and we could go to see him. I remember being wheeled along corridors and into the NICU. I remember seeing him there, head moulded, tubes sticking out of him. He was breathing on his own, and had apparently only been ventilated for 15 minutes (so why they couldn’t then tell us he was breathing and alive I will never know, I assume nobody in NICU thought to, and that everyone who went to find out from Labour ward actually got hijacked onto something more important.) After a visit I was wheeled away to postnatal ward, to a bay, despite it having been agreed that I would not end up in a bay because I felt so unsafe having strangers surrounding me, and Andy and my mum were sent home. I was taken to see him again the next morning, but whilst I was being taken down to see him, he was being taken to the Transitional Care Unit.
The amazing midwife from the previous day saw my mum, who had been refused entry to the postnatal ward as I was not allowed visitors other than my husband. The midwife asked how we were. My mum broke down and sobbed in the corridor. Mum told the midwife that I was in a bay and nobody was paying any attention to requests to move me, that she wasn’t being 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 for 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 of learning to feel a sense of ownership over my child, and to get over the blame I loaded onto myself, the trauma on top of trauma, the fear and mistrust of all medical professionals I was left with.
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) woman, I refused to let my experience of birth put me off having subsequent children, and Jacob was amazing. We knew we wanted another child. I considered briefly how I’d cope with giving birth again, but when I got pregnant with Reu the ante-natal 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 knew I needed help. I asked a friend with the capacity to refer to the Perinatal Mental Health Team to refer me, and there 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.
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. I based the possibility of me surviving birth 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, so 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.
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, but that I would be making the decisions regardless of the opinions of medical professionals. I felt adversarial. I wasn’t trusting people to help me get the birth I needed, I was going to do it despite them.
I also began to search out empowering birth professionals on social media, independent midwives, obstetricians who focus on women-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. So, I tried everything. I knew I was happy to go to 42 weeks and possibly beyond. I had reflexology, and acupuncture. 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 that were used to attempt to persuade me, and I signed any paperwork I was asked to that said that I was intending to decline induction and 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.
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. 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. Because both babies had been back to back I was discouraged from pushing and 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.
I felt exhausted. I felt empowered. I felt triumphant. I felt proud. I felt a renewed confidence. All of a sudden I believed in all of those affirmations. 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.
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 I believe there will be another. Going into my third pregnancy I believe I’ll 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 woman-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 women 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 an article I am writing on considerations for 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.