Find out your legal rights during pregnancy & childbirth - new Mumsnet & Birthrights factsheet(51 Posts)
Judging from countless MN threads over the years, it's clear that many mothers are unsure of what their legal rights are during pregnancy and childbirth, and how they exercise those rights. Questions range from "Can I have a home birth?" and "Can I refuse an antenatal check-up?" to "Can I request an elective caesarean after a vaginal birth?"
We've been working with a new charity, Birthrights, to bring you this Factsheet on your legal rights during pregnancy and childbirth. We hope that you'll find the factsheet useful and, for new mothers especially, empowering.
We also think that, if pregnant women are clearer about their rights, it will make working life easier for hard-pressed midwives and obstetricians. So this is by no means anti-midwives, in fact Birthrights works closely with midwives and doctors as well as with patients to provide them with support and information.
Take a look at the factsheet now or post your thoughts/feedback below.
I think the guidance is helpful and I would add that I think it needs to be expanded and then promoted as available to women at antental appointments though I suspect the potential for lots of informed and more demanding women might be a challenge for the current system.
I wonder if my story so far is helpful to share. I've been advised I should deliver by week 39 (and I accept this advice - i'm healthy but I am just over 40 and there is a risk of still birth post week 39 for us oldies). Here is what has happened to me.
When I started to research birth options it became apparent to me that it is important to understand my rights but also the difference between routine generally applied intervention and life saving medical opinion. Initially I researched hypnobirthing, homebirthing,birthing pool, and pain relief options to support me in spontaneous labour should it happen pre week 39.
I asked at an antental appointment if I could consider a water / home birth with hypnobirthing as my first preference. I was told by a registrar that I would need to deliver in hospital and have continuous monitoring. I felt disappointed but took it and then asked could I deliver in the MLU and was told that that I could not go to the MLU because I am over 40 and considered high risk. I was told that I would likely bleed heavily and my baby or I could die ( and I was told like that). I decided to talk to more senior personnel as I am in good health and only just over 40 and gained agreement that I could go to the MLU and had to arrange this with my consultant and the head of the MLU and get this in writing. I also gained agreement that I would not be bed bound and continuously monitored routinely that I would be listened in to on a regular basis and could wear a cordless monitor if it came to that. I also gained agreement that if I was unable to birth on the MLU for any reason (they were busy or because of my situation) that I would be able to have midwife led care on the consultant led unit meaning that rather than having a trail of DRs doing their rounds and coming in on a regular basis that the people in the delivery room would be kept to a minimum and the midwife would be responsible for updating the DRs outside the delivery room.
Had I not probed and asked more questions I would likely have spent the last months dreading a delivery where I would potentially not be mobile and where I was being continuously monitored.
Next I looked at what would happen if I did not spontaneously labour. After having spoken to many friends, talked to the midwives etc and read lots such as on mumsnet I concluded that for me induction was an option for me BUT only with a 24 hour pessary ( first stage on induction). I decided that if this did not work ( bearing in mind at week 39 my baby might not be planning to come for another 3 weeks) that my preference would be to go straight to C section rather than enter a drawn out labour ultimately involving a syntocinin drip, epidural, forceps and emergency c section. I know I cannot plan the future but this has happened to many people I know and I feel it will be distressing for baby and me and its just not the start I want.
In my NHS trust I found that the 24 hour pessary has to be given on an inpatient basis whereas in many other trusts they let you go home. Again because I am just over 40 I have been told that even if they did let people go home they would not let me go home because of that. Now don't get me wrong. I am really pleased to be looked after but when you are given the pessary procedure is that you are monitored for 30 minutes and again after 12 hours and then 24 hours so I question why I need to remain in hospital if all is OK at each stage. Having questioned this I have been told if I don't stay in they won't give it to me. Had I not asked questions here and been naughty I could have gone in and had the pessary and then discharged myself and gone home anyway and come back for the checks but I felt this was disrespectful to the medical staff who would have to deal with the fall out of me leaving. I have no desire to disrespect medical staff.
So I have decided that if I am going to have the pessary I want to be as confident as I can be that the chances of my body reacting to it are favourable in that my cervix has softened before I have it. If my cervix has not softened pre-pessary the likelihood of a drawn out delivery with further intervention is more probable and I don't want that and therefore my view is to default to c section.
In gaining agreement to this plan which I finally have I had to go through more conversations under the NICE guidelines where I felt pressure to do induction regardless and also to agree to forceps delivery instead of c section should there be an emergency and I am going through a normal birth. However now I feel happier that I have in writing a plan I can refer to that has been agreed by a number of consultants and will avoid pressure in labour to take interventions I disagree to without strong reason arising at the time.
I do put my baby first, that's why I have agreed to 39 weeks, to deliver in hospital and to follow emergency advice but I have also been keen to ensure that I am healthy of mind through the process to have a safe place where I feel I can labour, where I can be unobserved, not pressured when I am in delivery with pre agreed options to hopefully deliver a healthy happy baby.
I feel quite exhausted by this and wonder how the system would cope with more women like me.
Finally I have to say that all of the midwives I have encountered have really been supportive of me, my questions and my plans all along and this has helped me to have the confidence to get to where I am today.
If anyone hasn't seen this, it might be of interest to you.
Birthright.org have issued a response to the CQC consultation on maternity. The short version is here
The more in depth response is here. Its definitely worth a read if you are interesting in this subject as it covers all aspects of maternity and choice/dignity/respect.
I really didn't believe those things happened, and how utterly awfully you could be treated till it happened to me. Even now it still doesn't seem real that they could do that to a person and how badly they violated every single aspect of my life and person with how they acted - and I panic every time someone wants to pop into a quiet room "for a quick chat" - since that's how they described things when they hauled me into that room for what was much more of an interview/interrogation than a chat.
It's awful that they did it to me, and when I had my second - the staff at the (different) hospital were horrified at hearing what had gone on because I was understandably terrified of them all (indeed my birth plan started with "For reasons in the past, I am very scared and distrustful of you and I apologise in advance for this" and it was only when one of the midwives commented that, "You could have them done for assault for doing that without your consent" that I really began to shift mentally from feeling like I'd caused it and the life-shattering guilt I'd carried around that I had done something to put my precious little girl at risk, to realising that what had gone wrong was so fucking wrong it was out the far side of wrongness. I don't think I'll ever feel strong enough to complain directly - the most that has happened is that the specialist midwife who seems to exist to talk traumatised/tokophobic women out of having c-sections was also appalled by what I was saying when discussing it all prior to having DD2 (diff hospital but same NHS trust) and was going to pass the case up to the head midwifery bod as part of her own professional whistleblowing thingees.
Like I say - it's only the reaction of other midwives (it was primarily the doctors behaving appallingly though) that's making me realise more and more how fucked up things were that I went through. Indeed the midwives for DD2's birth encouraged me to assert myself and find my voice to express my wishes - even when it was going to make things so much harder for themselves - and I'm massively grateful to them (and to DD2 for deigning to enter the world in a more cooperative - and more spectacular - fashion than her big sister) for doing so.
Oh god, I am horrified at some of these stories.
Can they actually call social services if a woman refuses to consent to treatment?
It's on the BirthRights website, but I think the complaints procedure should be on the factsheet alongside reassurance that making a complaint won't be on records or affect future care (I know a few women who feared to complain in case it caused them to be treated differently/worse by medical staff in the future).
Also information on when one can and how to change midwives if there is a need. Having the right, supportive, health care professionals is so important and most I know don't even know they may be able to do so.
I hope this is given to the MWs too. I was well aware of my rights but was bullied by MWs into having checks I didn't want during labour. There was no reason to think anything was wrong, everything was progressing well but they wouldn't listen to me. When I eventually found the confidence to make a complaint I was fobbed off because my labour notes were basically a work of fiction. It's put me off having another child.
Thanks for working with Birthrights, MNHQ, hopefully this will help to improve things for mothers in the future.
torn some of us so 'fixated' by our rights in pregnancy, labour and birth because those caring for us so often forget. Many women aren't even aware they have rights. To suggest that women who exercise their rights do so without any regard to the responsibility they personally have to their child is, frankly, a ridiculous notion.
I went to 40+15 in my first pregnancy.
I regret consenting to induction at that point and wish I'd have waited for spontaneous labour - physically I was a mess post-birth (several issues all if which are increased in likelihood through induction) and struggled massively to bond and BF. Looking back, I probably had PND caused by the birth.
I planned a high risk home birth for my second - with a lot of information and help from the MWs - and I'm bloody glad I did.
In both cases I made my choices based on what I believed to be best for me and my babies.
Nailak my birth plan also said the same - I stated that small for dates, or baby under 2.5kg I would not consent to transfer for, unless my baby showed signs of low blood sugar. If otherwise well, I'd be staying at home.
I am perfectly capable of caring for my own baby, far far better than anyone else. I knew how to feed him, when to feed him, and what I was doing. I knew the signs to observe, and would have taken him in if needed.
But yes, as a midwife you would advise to transfer under the Trusts guidelines - but if the mother does not wish to, that is her choice. End of. You just have to ensure you have fulfilled what is required of you in term of discussion with the mother, informing medical colleagues, and documenting the above.
canvas my experience is a lot less dramatic than miaows, and less serious, but it still demonstrates the point that medical advice and guidelines is not based on the individual circumstances of the patient.
to cut a long story short. I had home birth. baby was under 2.5kg. MW said we had to go to hospital, I said no, she phoned neonatal consult who told her to get me to hospital, i said no. My decision was based on the fact that i know i it is normal for me to have small babies, that asian babies are normally smaller and if growth charts were plotted for only asian babies that my dcs would be within normal range, i was a small baby myself and so on,
after wards the midwife confided in me that she thought i had made the right decision, although she had to advise me to go to hospital due to guidelines.
Torn I could not agree less with your post.
Echoing what Miaow said, "The main point about birth is that BOTH the baby and mother come out of it well and safe... that includes the physical AND mental health of the mother."
I am one of these people who has gone against 'advice'. Remember, it is just that. Advice. Research can say whatever the hell you like. I've critiqued enough of it to realise a lot of what is quoted as fact, is not fact at all.
I am so saddened to read attitudes like yours to be honest. When I was making my decisions during my pregnancy, the thing which was at the heart of it was the safety of my baby. It just happens that you may think the things I chose were not for his safety. Not being induced was for his safety - it is well known there are risks to induction. Avoiding the cascade of intervention was for his safety. Not mine.
To be honest. I don't know what to say to you. It would probably be a waste of time. I just feel sickened that anyone would think I did what I did for my benefit. Anything that was for my benefit, also directly impacted on my baby. A mum who is mentally or physically damaged after birth has a HUGE negative impact on her baby.
There is far more to it than you are thinking of.
I just thank god we live in a country where we are free to make choices about our own bodies and use our own intelligence in order to make those choices.
And here we go...
My baby deserved to have a mother not so traumatised and devastated by the experience that she spent the first months of her life sobbing, shaking and having blazing rows with her husband because she simply just couldn't deal with how utterly violated and assaulted she felt. She deserved, she had the right to a sane mother - not one so utterly and totally terrified social services would be back for her child that she was scared to love her, and then so scared of losing the child she loved that she cried herself to sleep every single night for 11 months - either from reliving the birth (I can relive every single moment of it all in crystal clarity) or having nightmares about the social services set on her by the hospital.
ALL I wanted was not to be left at risk of permanent SPD damage - to not be left in a position where I was housebound and barely able to walk with a newborn to care for - I didn't want fancy whale music, I didn't want to trailblaze for birth options beyond the realm of the commonly accepted - I simply didn't want them to shove my legs in stirrups so far apart that my knackered childhood Barbie dolls would wince at the prospect and wreck my pelvis... the forceps thing was secondary to that.
Yet still we get the same "oooh it's all about the baby" brigade wanting to belittle anyone who gets forced into things and just totally reduce women TO that inconvenient piece of meat between the doctors and the baby - which is EXACTLY how I was treated... indeed on the post natal ward several times I was told by staff members, "Well, actually we don't care about the mothers at all - we're only interested in the babies"... these staff members are still working on a post natal ward a year later by the way - pray you don't encounter them when you're dripped, stitched and catheterised up to the eyeballs! In that hospital I know of other women who went through what I did - with social services essentially being used as a patient taming tool - like I said - most don't ever dare speak out and admit it happened because of the stigma.
It absolutely, utterly, totally ruined my life. It still replays now (albeit less now I've had DD2 - that birth chased some of the demons away) and the feeling when we left that hospital, the utter hollow, totally shellshocked feeling, the feeling of being violated, bullied, (and I don't use this as a comparison lightly - I HAVE been there to draw the parallel) almost raped... not at all conducive to mental health or bonding or anything. I stammer fairly badly now (which means I can't go back to my old career if I wanted to) - I only ever used to do that before when under incredible pressure. I get flashbacks at the most silly triggers. I don't trust any child health professionals, I don't trust my own GP, I'm scared of any official letters that come through to the parent or guardian of... I live in constant fear that the closed SS case, that will always remain on file, will come back to bite us in the future - I feel incredibly angry that our family, the family we fought for six years to become, has to carry that stigma around with us... because I didn't want the doctors to cause me permanent mobility issues and got scared.
And yes, it makes me incredibly angry when people just push all of that aside and ignore the woman completely to tell them to basically naff off - you have no rights - you're an incubator on legs now, you will take what we want to do with you and you will do so without protest or quibble. I'd not even gone into things as a "demanding" patient - I had no birth plan written, I was fully prepared to roll with whatever happened - but things were so badly mismanaged, and I was so badly treated by staff that everything just snowballed into what it became - and what it became was SO utterly unacceptable that I've never met ANY member of the medical profession who even BEGINS to try to justify it... the universal reaction is to be appalled by it.
The main point about birth is that BOTH the baby and mother come out of it well and safe... that includes the physical AND mental health of the mother.
I didn't matter at all. I'm so massively grateful for the hospital I had DD2 and the staff there for taking the time to treat ME as a patient and not just a lump of flesh. Incidentally - I needed to have a spinal there as well (placenta got stuck again) and they could not have treated my SPD wrecked legs with more care or respect - even when conducting a relatively tricky furtle up into my uterus to play find the placenta (something the previous hospital had done without explanation, acknowledgement and with extreme brutality) and when not splitting my legs to ridiculous amounts was making it trickier for them - they still respected my body and did their utmost to try to prevent any pelvic damage... it was a difference so marked it was like night and day - things were explained, I was asked how I was coping and feeling - rather than just being dragged into theatre and having a succession of strange men shoving things up there James Herriot style - no wonder I felt violated like I did last time (and a new empathy for the cows on All Creatures Great And Small)!
I have to disagree with you, canvas. And so does the law: it is entirely about the mother's rights. Period. If one starts on the slippery slope of the mothers' rights being subjugated by the babys' rights you invite in all sorts of possibilities....how would you feel if you were sectioned because you disagreed with a Dr.'s opinion and your body violated against your will? There are very few women who would put their baby's safety below their personal birth needs...but those that do have that right and no-one has any right to take that from them because of personal opinion.
Also, not sure where the 42 weeker got her info from...but the info I have actually indicates that the risk of stillbirth is highest at 40 weeks...go figure....
I think this is a good thing but I do think that women are so obsessed and fixated by their rights in birth that they sometimes forget about their responsibilities - so often you hear women banging on about getting the birth THEY want rather than the birth that is safest for their baby. I say that as someone who has had 4 births, good and bad.
The main point about birth is that the baby is born safely. It is very, very, important too that the mother has a good experience, but the baby's safety comes first, and I read so much on mumsnet about women putting their experience before what is safest. Birth is not a lifestyle choice. Yes, pregnant women are adults, but sometimes they don't make the best choices - I've read about women on here who have been advised NOT to have a home birth for example, for good reason, but who have gone ahead and done it anyway because it is their RIGHT. Another one cheerily said that after 42 weeks your risk of stillbirth doubles, but it's still very small so she wasn't going to let the nasty bullying doctors induce her. I have experienced stillbirth and cannot understand how anyone could be so flippant. And another who said that her baby would decide when to be born, so she wouldn't be induced...... Please grow up, honestly. Yet another who refused all scans in pregnancy as she 'just knew' her baby was fine....
Women often seem quite proud of the fact they have gone against advice, despite the fact that luck and luck alone has ensured a happy outcome and they have risked their baby's safety. Why anyone would risk their baby's safety is beyond me. It makes me very angry. And thank God, it usually turns out fine, but the emphasis does seem to be on the mother's experience, not her baby's safety.
Women need to remember this is not their birth. They've had their birth. This is their baby's birth. It's not just about their rights.
Miaow - your post actually made me cry. I haven't read your story before and cannot believe they did that to you - and others by the sounds of it. So glad you had a better experience this time, I'll definitely be more 'stubborn' (or sure of myself) when I have dc2
As a student midwife I'm all for giving women informed choice. I've just finished my first placement (community) and was quite upset at some of the stories of the postnatal women told about their treatment whilst labouring in hospital.
The coercion to submit to intervention was widespread. Obviously in some cases the intervention was medically indicated but it seems very rarely was communication with the women and their partners good. There was a lot of 'you/we need to' as opposed to 'we suggest because'.
Every woman should be aware of their rights and be treated as a capable adult.
Birthrights, would you be interested in partnering with Maternity Liason Committees and providing training sessions to mothers support groups (meetings of the mothers who make up MSLCs) if so get in touch. I have alsi emailes you at your info address.
I know Tower Hamlets MSLC is planning spot checks by volunteer mothers on to post natal wards, to ask mothers how they were treated and support them in any action that needs to be taken.
Knitted - I had contact with SOM's as a pregnant woman.
I was very saddened to find that I was not supported.
I have taken this up with the Trust involved.
What I would like to add, is that there is more than one SOM, so if you are not being supported from one, do not give up. Speak to another SOM.
miaow - congratulations on your second baby and thank goodness you had a much better experience of the second hospital. I hope you are able to finally move on from your terrible first birth.
I am a supervisor of midwives and part of my role is to support women who are having difficulty in obtaining care choices. Every area in the country has a supervisor of midwives who is on call 24 hours a day who can and should support you if you feel that you are being bullied or coerced in any way in to any care choices that you do not wish to have. You can usually contact them through the local hospital switch board, they can be phoned by anyone, partner, yourself or your midwife.
a bit about Supervisors of midwives
I always re-iterate, there is no such thing as allow. We are free women, with free choices. No one can take that away from us.
I often encounter surprise when I tell people my baby was born 20 days after the EDD. 'I didn't think they let you go that far'. I just say 'well, no one can force you to be induced'. It often makes them think, and replies tend to be, well yes, you can't be made to do anything I suppose.
I can see it makes people stop and think, and remember that it is always up to them when it comes to decisions about their own body.
Thank you for sharing that, Miaow. And congrats on the new arrival!!! And I'm so glad you didn't have a repeat experience. I hope, that some time in the future, this new experience and affirmation from other health professionals that you were, indeed, horrifically assaulted, will give you the wind in your sails to make those that treated you in such an inhumane and degrading manner will pay.
MNHQ - this is a great first step - but we're often powerless in the actual situation - there needs to be a change in attitude within the NHS itself - I myself have already encountered the attitude of whether or not the NHS will "allow" me to give birth at home. Allow? This is the attitude pregnant women are often up against; we are infantilised. It is wrong. A HCP isn't \god and should not be allowed to act as God.
I've met at least 2 mumsnetters who have had similar threats mad and even carried out against them during the most vulnerable time of their lives
I'm one of the ones trustissues is referring to - I know I posted the brief story in the childbirth forum at one point (hell I cried when I first got linked to the Guardian article as I honestly thought it was just me it had ever happened to and the weight of carrying the feeling of guilt around that I had somehow done something "wrong" to put my new baby at risk of social services had dragged me down for so long by that point it was insane).
Briefly in my case I'd got scared at the idea of a premature birth, distressed at pain relief being witheld/dithered about for 3 1/2 hours and was being shouted at to have forceps used with no option to refuse - I panicked, was trying to get them to note my safe pain-free gap to prevent SPD damage... and was referred to social services as a "resistant patient" for it. No one should ever have to go through that - I was basically nothing more than a piece of meat and it replayed itself in my mind every single night, in crystal clarity until my second child was born last week - and seriously God bless the hospital who delivered her, who spent endless hours reassuring me they weren't going to call social services if I panicked or didn't want them to do something, and that basically what went on last time was assault and horrifically wrong.
Takes a lot of guts to risk the judgement that you only get reported if there's something you've done to deserve it and admit that it happened - but since I started telling people what happened (although one set of grandparents will never know it did so) I keep finding other people who know others its happened to (one of our local hospitals seems to use it as a patient cooperation insurance policy) - but it's an awful thing to admit to, that feeling you did or said something to cause the child you hadn't even fully given birth to to be put at risk of being taken away and I can understand why people don't want to lay that bare. It destroyed utterly my mental health and I've never recovered - I have an anxiety disorder and for months I had zero quality of life - I just existed back in that bubble of being yelled at by staff, and then that stomach-churning moment they told me they'd rang SS on me.
Agree with Trustissues.
No amount of reading you have done helps you when you are at your most vulnerable and you are especially a trusting first time mother in the hands of HCP who can be embedded in thier thinking against a back drop of an under funded over run NHS hospital.
Sage I work in west lancs we can't be so far away...!
This is a much needed, brilliant organisation. There are some great points in this discussion. I agree the word 'decline' is much better than 'refuse'. Decline refers that there was an option.
As I midwife I have always informed women (and health professionals) that the word 'allowed' isn't allowed! Works well...
Midwives, doctors and women benefit from a gentle reminder that 'guidelines' whether local (hospital) or strategic (NICE) they are GUIDELINES and therefore guidance. They are not policies or protocols (often referred to as such and very different meanings).
Local mothers currently developing a website for families using maternity services in East Lancs, and will certainly be adding a link to Birthrights!
This is great - but what is being done to educate the HCPs about this?
Stories such as this one at the beginning of the article - http://www.guardian.co.uk/lifeandstyle/2012/dec/16/mothers-fighting-against-birth-intervention - are shockingly common.
I've met at least 2 mumsnetters who have had similar threats mad and even carried out against them during the most vulnerable time of their lives. It's all very well educating women - and thank you very much for this fact sheet because it is very useful - but even if you've had access to something like this when you're in a vulnerable position and you're surround by professionals threatening you with the social services and the likes what on earth do you do?!
Join the discussion
Registering is free, easy, and means you can join in the discussion, get discounts, win prizes and lots more.Register now
Already registered with Mumsnet? Log in to leave your comment or alternatively, sign in with Facebook or Google.
Please login first.