Must I?

NCT doula, Beverley Hinton, looks at your choices and rights in childbirth.

In a healthy woman, having a baby is a normal function. Mostly women’s (and babies’) bodies can do it on their own. However, over the last 60 years, it has come to be the norm that a woman will travel to hospital to give birth. This shift to giving birth in hospital has caused birth to become medicalised. The hospitals, having to manage larger and larger numbers of birthing women, have had to put in to place procedures and protocols that staff must follow when dealing with a pregnant or labouring woman.

The majority of women believe they are going to have a normal birth, and make birth plans to reflect this desire. When women have contact with the hospital, they are often surprised to find that the birth plans they have created do not fit in with hospital protocol. They believe that they must comply with the routines that are set out by the hospital policies and protocols, and feel that they must do as the hospital staff suggest, even if it goes against their instincts. Women are not always aware that they have the right to make any decision, in regard to their pregnancy and birth, that they feel is best for them, including making choices that go against hospital policy.

A Government Report ‘Changing Childbirth’ (Department of Health, 1993) made it clear that the Government expects the rights of women to be respected:

‘Women must be the focus of maternity care. She should be able to feel that she is in control of what is happening to her and be able to make decisions about her care, based on her needs, having discussed matters fully with the professionals involved’

The European Convention on human rights guarantees every woman the right to physical autonomy and integrity. This includes the right to make decisions about childbirth, or to refuse any medical care at all.

The fact that women have the right to make their own choices about how they manage their pregnancy and birth means that a woman’s consent must always be sought before performing any medical procedure or making any decisions that affect her care. For consent to count, the woman must genuinely agree to receive treatment. She must have been well enough informed about the treatment to make an informed decision, and cannot have been put under undue pressure or bullied into receiving the treatment. If a woman feels that a medical procedure is not what she wants, then she has the right to decline, to refuse consent, or to simply say no.

There are many times during pregnancy and birth when women might feel that they have no choice about what happens to them, and it is important that women feel able (as is their right) to say no, or have time and input from staff, to gain the extra information needed to make an informed decision.

During pregnancy, if a woman decides that she does not feel a medical procedure, or suggested care plan is what she wants, then the first thing she should do is to get in writing what the suggested plan is and why. This can be done by talking to the consultant, or by asking the midwife at an appointment. Once the reasons are in writing, independent research can be done on the subject. Some useful websites (which can be found via google) include:

  • The Association for Improvement in Maternity Services (AIMS),
  • The National Childbirth Trust (NCT),
  • Sara Wickham.

AIMS also produce a range of booklets on the most common issues women face, and have a phone line where you can talk to someone about your situation.

If the woman still feels like the hospital protocol being applied to her goes against her instinct, and feels that avoiding the medical procedure or care option offered will be more beneficial for the way she wants to give birth, then she can book an appointment with a Supervisor of Midwives (SoM). These are a team of senior midwives who have additional training to enable them to help midwives provide the best quality of care. A SoM will be available 24 hours a day, 7 days a week. It can be tricky to get through to one at some hospitals, but persevere!

The SoM will be able to make an appointment for the woman to come in and have a meeting, where she can discuss the issues that have arisen for her. The SoM should offer advice on the options available, and make the woman aware of any concerns she has about the choices. She will help to create a personalised care plan that other midwives will be able to follow.

In some hospitals they have a birth choices midwife or a homebirth/birth centre manager, and a Head of Midwifery. These can also be useful contacts, reachable by phoning the main hospital switchboard.

Once labour has begun, it is often hard to stick with plans that have been made in advance. Having a doula can be a very helpful way of ensuring that you have the time and information available during labour to give informed consent to any procedure suggested, or to decline any procedure you have decided you do not want. Your doula will help you to voice your concerns, and to ask for any additional information or alternatives, and what would be the consequence if you decide to decline. A doula is not medically trained, and will never offer you her opinion, or medical advice, but will make space for you to think, facilitate discussion with the doctors and midwives, and give you the courage to follow your instincts.

As a SoM will always be available 24/7, it is also possible to ask for one to come to you once you are at the hospital, or to speak to you on the phone.

Research shows that having a positive birth experience is not just about having a natural labour. It is about feeling listened to, cared for, and in control of decisions. Knowing your human rights in childbirth, and having someone with you who can make sure you are listened to, and your rights respected will help to ensure your birth experience is a positive one.

Further Reading

Am I Allowed? – AIMS

Why Human Rights in Childbirth Matter