Articles

Key takeaways

• You have human rights that apply to your maternity care.
• You have the right to make decisions about your own body.
• Informed consent means understanding all your options.
• Advocating for yourself helps ensure personalised care.

Why your rights in pregnancy matter

Every human being has human rights. Human rights law means that public organisations, like hospitals, must be aware of your human rights.

They must take actions that protect and uphold them. They can only limit your human rights in certain ways set out in law.

Public organisations and their staff, such as NHS staff, must treat you with dignity and respect. They must consult you about decisions.

They must listen to and respect your choices about your own body. This fundamental freedom is called bodily autonomy.

Your right to make decisions

Human rights laws give you the right to receive maternity care. They also give you the right to make your own choices about your care. Every health professional caring for you must respect your human rights.

You have the right to make your own decisions about your care during pregnancy, birth, and early parenthood. These decisions will be different for everyone. They may be based on medical needs, past experiences, or personal preferences.

You should never feel you need to fight for appropriate and personalised care. Safe maternity care is more likely when you are listened to and respected. Communicating your needs and preferences can positively affect your pregnancy and birth experiences.

Many people say that not getting enough information made their maternity care harder. It sometimes changed how their birth went.

You have a right to say yes or no to any treatment, test, or procedure. This includes examinations.

Your fundamental human rights in maternity care

NHS staff must treat you with dignity and respect. They must consult you about decisions.

They must listen to and respect your choices about your own body. Every health professional must respect your human rights in all the care they give.

You have the right to make your own choices about your maternity care. This includes during pregnancy and even in an emergency situation.

No medical examination or procedure can be carried out without your consent.

Going ahead with a procedure without your consent is a serious issue. It goes against your right to make decisions about your own body and to be treated with dignity. In some cases, touching someone without their clear permission can also be against the law.

Dignity and respect

Your rights prohibit inhuman or degrading treatment. This could include being left without basic dignified care on the postnatal ward.

For example, this can happen if a catheter bag is not changed appropriately. It also applies if soiled sheets are not changed, or you are not supported to use the toilet.

It also means midwives or doctors should not fail to provide care needed to avoid preventable suffering. This includes pain relief.

If you ask for pain relief, it should be given unless there are good reasons against it. For example, there may be a medical reason why a certain pain relief could cause you harm (a clinical contraindication). If so, your team should explain this to you.

Your right to information

Failing to give you sufficient, objective, and unbiased information violates your rights. This includes not providing adequate interpreting services. Your right to make choices about childbirth includes the right to decline all medical care offered to you.

Only you have the legal right to make decisions about your body. You can accept or decline care.

It is common to feel that midwives and doctors are in charge. However, you have the legal right to make decisions about your body.

You may need to speak up for yourself during pregnancy, birth, or after your baby is born. This might be if you are worried about your care or feel anxious about symptoms. It can also happen when discussing birth options or needing extra support during labour.

Everyone has the right to decline care. If you decline care, your maternity team will plan how to support you. This will respect your decision while also protecting medical staff from harm.

The power of informed consent and refusal

Consent means saying yes to care or treatment. In maternity care, only the pregnant person can give consent. It is against the law to touch or treat a competent adult without their consent.

You can give consent by speaking, nodding, or holding out an arm. It may also be given in writing, such as on a consent form for a caesarean birth. Consent can also be implied by an action. For example, if someone comes to take your blood pressure and you hold your arm out.

To give consent, you must understand what the treatment is and what it involves. You need to know the risks, consequences, and benefits. You also need to know all the other options and what will happen if you accept or decline treatment.

You do not have to give consent. You do not have to explain why you do not give consent. However, it may be helpful for the healthcare provider to understand.

You can change your mind at any time. This is called withdrawing consent.

What informed consent means

• Informed – means you know exactly what you are saying yes, no, or not right now to. You are given all the information about the risks and benefits to you personally.
• This includes all your options, and what happens if you do nothing. This information must be given in a way you understand.

You should have a chance to think about what is important to you personally. You can also consider the opinions of others you value.

You should have time to think about your decision. Informed consent should be given voluntarily.

No one can pressure you into making a decision. Even if a midwife or doctor disagrees, they must respect your decisions.

If you feel pressured, you can ask for a different caregiver. Birth partners can help by asking questions, but they cannot give consent.

What to expect during consultations

There must be a conversation between you and the health professional about the treatment. This means it cannot be simply a one-way information-giving process. It must address anything that you would consider important for you as an individual.

Healthcare providers cannot rely on a signed consent form as evidence that you have understood the risks of a procedure.

Ongoing consent

Staff must ask for consent every time before they touch you or do a procedure. This applies even for minor checks.

If care changes, they must explain it and ask for consent again. If you have given consent in advance, you should still be offered another discussion immediately before the treatment or check.

Information should be clear, and interpreters must be provided if needed. You can decline any procedure, even if it is a routine check.

There should be an open and ongoing conversation with time to ask questions, think, and discuss options. Staff must ask you every time they carry out a procedure.

Examples of ongoing consent

This includes blood tests, monitoring your blood pressure, or internal examinations. They must be clear about what they are asking.

For example, if a midwife wants to carry out a vaginal examination, they need to tell you they will be putting their fingers inside you.

It is wrong for a healthcare professional to carry out further interventions without your permission. For example, they should not do a sweep (an internal procedure to start labour) without asking you first.

Using the B.R.A.I.N. framework

You might want to use the B.R.A.I.N. framework to help you get the answers you want:

• B – What are the Benefits?
• R – What are the Risks?
• A – What are the Alternatives?
• I – What does your Intuition (gut) say about what's right for you?
• N – What would happen if I said No or Not now?

Your healthcare professional must not give you misleading information. The information must be up to date and based on the most recent evidence.

They should give you as much information as they can to help you make a decision. They must make it easy for you to ask questions.

They should answer your questions properly. If they cannot answer a question, they should explain why. They may be able to help you find information you need.

How to advocate for yourself and your baby

It is important to communicate your needs and preferences. Speak up if you feel like something is not right.

Make sure you speak to a medical professional and do not stay silent. You know your body better than anyone.

You can find an advocate for yourself. This could be your partner, a family member, or a trusted friend.

They can speak on your behalf if needed. Your midwife is also your advocate and should support you in any decision you make.

You are allowed to ask for a second opinion from another medical professional. Trust your gut feeling and speak up. Your gut feelings are almost always right.

Do your research on pregnancy and labour via trusted sources.

Keeping records

It's important to document everything, so make sure any treatment or medication you are given or refused is written down in your maternity notes. The doctor or midwife should state their name and reason why. It can be helpful to keep your own personal journal and write down all the information for your own cross-reference.

Support at appointments

It can help to have someone with you to support you. This could be your partner or family member.

It could also be a doula or other birth companion. Research shows that having a doula can help improve outcomes for you and your baby. They can also help you feel listened to.

You can bring someone with you to appointments if you want support. It is fine for your partner or a friend to come with you.

You will likely be talking about confidential and private things. It is up to you whether you would feel more comfortable discussing these things with just your midwife.

Using a birth plan

A birth plan is a written record of what you would like to happen during your labour and after the birth. It can also include things you would like to avoid. It is a great way to let your healthcare team know what you do and do not want to happen.

A birth plan can be very useful once you are in active labour and might not feel up to talking. The process of writing a birth plan can help you feel less anxious and more in control.

It helps you convey your hopes and choices for your ideal birth experience. What you include in it is up to you, and you can change your mind at any time.

A birth plan lets you tell healthcare professionals about the kind of treatment and care you want. It helps you explore options and supports conversations with midwives and doctors.

Your birth plan can change before, during or after your birth because of a change in circumstances and needs of you and/or your baby. The reasons for this will be discussed with you and it will still be important for you to make informed decisions.

Saying no

It is always okay to say no. You have a right to say yes or no to any type of treatment, test, or procedure. This includes examinations.

Your right to say no is absolute. This means you can refuse any treatment, even if your healthcare team strongly advises it for your or your baby's health.

If you want some time to process what is happening, you can say, "Wait a minute, please." It can feel difficult to say no to a healthcare professional, but it is your right. Your wellbeing is the priority, and you are in charge of the decisions about your body.