Your legal rights during pregnancy and childbirth
Many women are unsure what their rights are in relation to antenatal, and postnatal, care. It's unsurprising when there are so many things you haven't had to think about until this point. The charity Birthrights helps answer some commonly asked questions about how to exercise your rights throughout your pregnancy and during childbirth.
- Choosing the birth you want
- Your rights during childbirth
- Your right to refuse antenatal check-ups
- Accessing your notes after birth
How to make a complaint
Things to consider when planning your birth
Can I have an elective caesarean?
If your request for a caesarean section is based on your preference rather than a medical reason then the National Institute for Clinical Excellence (known as NICE) recommends that you are offered a meeting with a mental health specialist who deals specifically with women in your situation to talk about your reasons for wanting a caesarean. If after discussion and being offered support you still want to have a caesarean then this should be arranged for you. Individual obstetricians can refuse to perform the caesarean but they should refer you to someone who is willing to perform the operation.
NICE guidance is not law and does not give you a legal right to a particular treatment, but if a health professional declines to follow the guidance they should provide good and clear reasons for doing so and you can seek a second opinion. See Birthrights' factsheet Right to a c-section for more information.
Can I be refused a repeat c-section and forced to have a VBAC?
If it is medically necessary for you to have a caesarean section for this baby, your care providers must make this available to you in good time. If they don't, this could constitute medical negligence. If you have suffered from psychological trauma as a result of your previous birth, your care providers should consider whether this constitutes a medical reason for a caesarean and if so, you should be offered one.
If your request for a caesarean section is based on your preference rather than a medical reason then NICE recommends that you speak to a mental health specialist about the reasons you would like a caesarean. If you still want to have a caesarean after this meeting then it should be approved. If a health professional declines to perform the caesarean they should provide good and clear reasons for doing so and you can seek a second opinion.
Can I be refused a place at a midwife-led unit birth centre because of pre-eclampsia/other high risks? What if the MLU is in the same building as the hospital – can I still be refused?
All healthcare providers, including midwife-led birthing centres, are entitled to set policies about who they will admit. If a woman who does not fit the criteria asks to be admitted, her individual circumstances should be carefully considered and every effort should be made to respect her choices. Healthcare professionals are obliged by Article 8 of the European Convention to respect women's choices about their births, including the location, unless they can give a proportionate reason for refusing to do so. This means they have to treat you as an individual and consider making exceptions to their policy.
If you are seeking access to particular forms of pain relief available at the birth centre, such as a birth pool, the fact that you are deemed high-risk should not prevent you from having a water birth in a hospital setting so long as you make an informed choice about any risks. If you have any concerns about your care or do not feel you are being listened to at any stage of your maternity journey, please ask to speak to the Head of Midwifery.
Do I have to be a 'low risk' in pregnancy and birth to book a home birth?
Hospitals have policies which midwives and obstetricians take into account when they advise women about their place of birth. Women with more complex pregnancies, such as those planning a vaginal birth after a previous caesarean or with an underlying health condition, may well be advised to plan an in-hospital birth.
In this situation, your care providers should explain in detail the risks and benefits of birthing at home and in hospital in your particular situation, but they must make it clear that the decision is for you to make. You cannot be compelled to attend hospital. If your decision to attend hospital was made in response to undue pressure or threats, such as the involvement of social services, then your care providers could be liable for failing to obtain your consent.
If you have any concerns about your care or do not feel you are being listened to at any stage of your maternity journey, please ask to speak to the Head of Midwifery. Take a look at Birthrights's Choice of place of birth factsheet for more detailed information.
I've been told I might not be able to have a home birth if the unit is short-staffed – is this right?
You have the right to decide where you give birth and you cannot be made to go into hospital. While there is no legal guarantee of a home birth service, it is NHS policy to support homebirths. If a Trust foresees that staffing shortages might prevent them being able to support a homebirth, they should put contingency plans in place (for example, working with another Trust or contracting with an independent provider).
Can I be refused a water birth in my planned home birth (assessed by midwife)? Why aren't all midwives trained in water births? Can I demand an appropriately trained midwife?
You cannot be refused a water birth in your planned, or indeed unplanned, home birth. If you wish to labour and/or birth in a birth pool or bath, you cannot be forced to get out of the water and undue pressure should not be put on you to do so.
If you have planned a home birth and let your midwives know you plan to labour or birth in water then you have a reasonable expectation of being provided with a midwife who is appropriately trained to oversee this form of pain relief. If your midwife is not appropriately trained, you can request that another midwife attends you. A manager is on call 24 hours a day and your birth partner may want to phone the manager on call if this situation arises.
If there is a safety concern about you labouring or giving birth in the water, including lack of training, then any risks should be clearly explained to you. If you wish to continue in your plan to be in the water, then this decision is entirely yours to make.
What are independent midwives?
An independent midwife is a fully qualified midwife who has chosen to work outside the NHS in a self-employed capacity. Most (but not all) of the 80 or so independent midwives in the UK work under the umbrella body Independent Midwives UK (IMUK). In January 2017 the Nursing and Midwifery Council, the body that regulates nurses and midwives, questioned the adequacy of IMUK's insurance cover and stopped independent midwives covered by IMUK's insurance from practicing. This decision is currently being legally challenged by IMUK. You can check the Birthrights website for updates on this.
What are my rights during childbirth?
Can I refuse induction, even beyond 43 weeks?
Yes, you can refuse induction at any point in your pregnancy and for whatever reason, even if midwives and doctors believe this will put you or your baby at risk. All of us have the right to make decisions about our health and our bodies and this right is just as valid when we are pregnant.
If you are offered induction your care providers should explain in detail the process, the risks and benefits of being induced and the risks and benefits of waiting to go into labour on your own.
If you refuse induction, the NICE guidelines on Induction of Labour agree with principles that are clearly set out in our national laws and the European Court of Human Rights. These guidelines advise your care providers to respect your wishes and offer 'expectant management' (regular monitoring of you and your baby) until you go into labour or decide to have an induction.
It does not matter how long you go past your due date, caregivers should treat you in exactly the same way.
If you have any concerns about your care or do not feel you are being listened to at any stage of your maternity journey, please ask to speak to the Head of Midwifery.
Can I be refused an epidural, and how can I demand to receive one?
If you have asked for an epidural, or any of the other forms of pain relief in labour available where you give birth, it should be given to you unless there is a sound medical reason why it is not appropriate for you. If your midwife or doctor believes an epidural is not safe for you at that time, they should explain to you very clearly why this is and offer an appropriate alternative.
Article 3 of the European Convention on Human Rights prohibits inhuman and degrading treatment. So, if your caregivers don't provide you with a requested epidural or other suitable and safe pain relief, then this could amount to inhuman or degrading treatment if you suffer serious distress as a result.
Cost-saving or short-staffing are not sufficient reason for you to be refused an epidural outright, though in practical terms when a labour ward is busy and if your labour progresses quickly, it may not be possible to site an epidural in time. While you are waiting for an epidural, your caregivers should provide you with alternative pain relief if requested and sufficient support if needed to ensure any pain is well managed in the interim.
For more information, see Birthrights' factsheet on Human rights in maternity care.
Can I refuse forceps?
Yes, as with any form of treatment, it is your right to refuse forceps – even if this puts you or your baby's life in danger. Medical professionals should explain clearly to you why they wish to use forceps, what the alternatives are, what the risks and benefits of a forceps delivery are and what the risks and benefits of refusing the treatment are.
If you decline forceps after you have this information, you should be offered an appropriate alternative form of treatment (such as a caesarean section). If there is no appropriate alternative available then the team should respect your wishes and not put undue pressure on you to consent.
The exceptions to this rule are in the very rare event that you have been deemed mentally incapable of making decisions or if it is an emergency and you are unable to communicate your consent – such as if you become unconscious. If you are unable to communicate your consent, and there is time, your next-of-kin should be asked for their consent.
Do I have a right to refuse the oxytocin injection for placental delivery, and in what circumstances can I refuse?
Everyone has the right to make decisions about their body for themselves. This is protected by national laws and also under the European Convention on Human Rights.
A pregnant or labouring woman can refuse any treatment for any reason at any point in her pregnancy, birth or after she has had her baby. She can refuse treatment, such as the injection for placental delivery, even if medical professionals agree that this could lead to her death and/or the death of her baby. She can decline this injection even if she has previously stated she is happy to have it.
The only exceptions to this are if a woman doesn't have the mental capacity to make decisions. There are strict guidelines about how mental capacity is assessed. Having an existing mental disorder does not automatically mean a woman isn't able to make decisions about her maternity care. Making decisions that midwives or doctors feel are irrational and/or potentially harmful should also not be considered adequate reason to say that a woman is mentally incapable of making decisions about her health.
For more in-depth information on refusing treatment and what 'informed consent' means, please see Birthrights' factsheet, Consenting to treatment.
Do I have to have vaginal examinations during labour?
Your midwife or doctor should explain to you why they want to carry out a vaginal examination and seek consent every time they wish to examine you. But with any intervention, examination or treatment, you have the right to decide what happens to your body and it is your right to say no.
Can I refuse or ask for fewer antenatal check-ups?
Yes, you can decline any check-ups or treatment during your pregnancy or birth. Your antenatal care providers will have an obligation to let you know of any risks associated with refusing antenatal check-ups or particular tests, but they are also obliged to respect your decision and not put undue pressure on you to change your mind.
Occasionally, women find that they are threatened with referral to social services if they refuse antenatal care. Birthrights' factsheets on Social services and maternity care, and Consenting to treatment factsheet explain more about this.
Your rights after you've given birth
Do I have the right to access my pregnancy and labour notes? Do I have to pay a copying charge? How do I get hold of them for future pregnancies?
Yes, under the 1998 Data Protection Act you have the right to access your health records, including your pregnancy and labour notes, and the notes relating to your baby.
You can view your records for free at the hospital or GP's surgery if your notes have been added to within the last 40 days (for example if you have had an appointment). If your care ended more than 40 days before you make a request, you may be charged around £10 for viewing the notes. If you want to copy them, a charge of no more than £50 may be made. If you cannot afford this charge and can show that you are on a low income, the hospital should waive this fee.
You can read more about whether you have a right to photograph your notes, on what grounds you could be refused access to your notes and how to have your notes amended in Birthrights's factsheet, Accessing your records.
I wasn't treated respectfully during my birth, how can I make a complaint?
If you would like to make a complaint about your maternity care, you should make a detailed note of what happened as soon as possible and also ask other people who were present to do the same. It is also a good idea to request of a copy of your/your baby's medical notes.
You would generally address your complaint, including as much detail as possible, to the Chief Executive of the NHS Trust who provided your care. Please note that the complaints procedures in Scotland, Wales and Northern Ireland differ from England and you may want to take local advice. Take a look at Birthrights' factsheet on Making a complaint for more detailed information.
Find out more about Mumsnet's campaign for Better Postnatal Care – and how we're aiming to improve care for all new mothers and their babies, with your help.
Birthrights is a charity providing support and advice to women about their human rights in maternity care. It is run by a board of midwives, doctors, lawyers and service users whose aim is to make life easier for both pregnant women and medical professionals by offering them information and support on these issues. If you have a question not covered here or by Birthrights' factsheets, you can ask an expert directly by contacting its free advice service.