• The Fit Midwife

Birth Trauma

As I sit writing this, my background noise is a crying, screaming woman. Now on a Labour Ward, you probably don’t even consider this unusual. Cue One Born Every Minute….. the screams, the noises. Sometimes it is not unusual. The noises women make during labour help them cope. It is painful, so you use every tool at your disposal. It is the same as working out, the grunt, the noises that you make when pushing through something physically tough. Whether that is mooing, screaming abuse at your partner, hypnobirthing, or smiling with your chosen pain relief. I don’t care what noises you make. As long as you are doing so by your own volition.

What I hear right now though. That is not ok. This is from a woman having a vaginal examination. Now are they comfortable? No. Can they even be painful? Yes sometimes. Should they make you scream and cry. HELL NO! We have all had speculums, ultrasounds, STI tests, examinations. It isn’t pleasant but nor is it traumatising.

So why, of late, have I had women telling me how they were reduced to tears after a practitioner enters the room, barely introducing themselves as they snap on their sterile gloves, pushing the woman’s legs open and brutally examining them. I wrote down what they said to me. I told my superiors. These women didn’t have a voice, or the confidence to say what was upsetting them. So yes I am labelled as a trouble maker, but if I am not a voice for my women, then who will be?

“Manhandled… that’s what she did to me.”

“She wouldn’t stop, I feel violated. Why didn’t she stop?"

“Nikki, please please please don’t let her touch me ever again.”

“Her examinations hurt me more than pushing my baby out.”

Just a few of the many statements I have. All of these women were labelled as difficult to examine. Yet when I do it. With 10 sachets of gel and taking my time, talking to my women, knowing them, putting them at ease. An examination is anything but difficult.

I am not sure what it is about the clinical skills of certain practioners that makes them think crying, screaming and fear during an examination is normal. They simply brush off their rough handed ways by claiming “It needed to be done, she is too soft!”. I as a midwife always, always, always try to be the first and only one to examine my women. It is very tricky, in private practice. But as a general rule, Midwives are more gentle doing vaginal examinations. You see, we spend time with you, know your fears, your body language. We empathise. We know the value of taking our time, ensuring you are comfortable. Even in emergency situations, when it is crucial we examine you quickly, there is a way to do it properly, with consent. Time is of the utmost importance, violence is not.

It is important to tell you this is not just Doctors. I am not pigeon holing them. I have had to stop midwives examining women because the patient is so uncomfortable. What I am trying to stress is that birth trauma is a real thing! Birth trauma is a normal reaction to events in labour and birth that you perceive as being scary, out-of-control, helpless, or painful. Birth trauma can result from pregnancy, birth or even during the postnatal period. The response may be one of intense fear, helplessness or horror. Sometimes the events trigger memories of earlier trauma that remain unresolved (BirthTrauma.au).

The internet is rife with stories. I encounter so many women, who have a fear of birth based on their previous experience, or what their friends told them happened to them. But I don’t want you to be scared. That it not my intention. My intention is to arm you with the knowledge that THIS IS NOT OK. It is your body! Do not let anyone treat it as though they have ownership over your body!

If a midwife or obstetrician examines you in any way and you feel that your dignity, fears, comfort or consent were not considered and you feel vulnerable then you absolutely have the right to demand they stop and it is your right to ask for another healthcare professional. Anyone who does any test or examination, no matter how trivial, should ALWAYS ask for consent. This is a non negotiable. Consent is not

“I am going to examine you now” and then before you have a chance to answer their fingers are up by your tonsils and you are contemplating kicking them in the face.

I am going to put a few words here, from a former patient of mine. She emailed me and asked for a debrief. She actually requested a blog post on this. She wants to be heard. I want you to read this, I want you to ensure that you never give anyone the power to make you feel the same way. Use her words to arm yourself, to be in control.

“It was only afterwards, when I spoke to my husband about this feeling that was still here, stopping me from living my life with my new baby boy. During the induction of labour I was examined more times than I felt necessary. My concerns were dismissed. I could feel all the pain and just had to cope with it. It didn’t matter that I coped well, it didn’t matter that the pain was never as bad as I thought it would be. I just felt so violated, so embarrassed! I was being subjected to pain in the most personal parts of my body and I couldn’t do anything but hold on until it was over! The Doctor told me what she was going to do, she never once asked my permission. She assumed it was her right as the Doctor on call to put her hands on me. I begged her to let Nikki examine me. She said she had to do it, she was the Doctor and it was her right."

Like I said, I don’t want to scare you. But I never want to have any woman feeling like this if I can help it. So how do you take control?

  • Do not let anyone touch you without your consent! Ever!

  • If you are having a straight forward pregnancy, you do not need a vaginal examination unless you are in labour or being assessed for Induction of labour…. You CAN decline.

  • If you are not sure about a procedure or examination or course of treatment, ask for thorough explanations before being expected to give consent.

  • Know your birth preferences. Write them down. Give them to every Healthcare Professional who is involved in your care.

  • Have your birth partner as your advocate. If you are in pain or you feel you cannot verbalise your thoughts, make your birth partner your voice.

  • Have a Doula, they can also advocate for you.

  • If at any point during an examination or procedure you want someone to stop, say it and mean it.

  • If you have a preferred midwife or doctor for any physical examinations then it is your right to request them. And it is your right to decline anyone who has ever made you feel vulnerable or uncomfortable.

As a Midwife I will always advocate for my women to the best of my ability. Yes it gets me in trouble occasionally. But you, as my women, are worth it. Midwives are known to be obstinate, bolshy and my favourite “trouble makers”. We have opinions and when we care for you, we make your needs priority. I make no apologies for practicing the way I do. I do what I do for you. And we go in to battle for you sometimes. Especially in private healthcare. But we can only do this if you talk to us, trust us.

So that brings me back round to my main point I guess…. Take control of your body. Know your rights and use them. Prevention is better than the cure. Let’s try and stop the insensitive practices that lead to birth trauma. You as women are the most powerful force when empowered with knowledge and confidence.

If you feel you have experienced any negative feelings and feel traumatised by any aspect of your birth experience please do not hesitate to contact me. You can ask your Doctor for a debrief. If you just want to talk, or want advice on where to connect with other women who have had similar experiences then I will post resources for you.

Nikki xx

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