Find out your legal rights during pregnancy & childbirth - new Mumsnet & Birthrights factsheet

[MylinhMumsnet]

Hello

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.

Thanks
MNHQ

[KangarooKaz]

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.

[RedToothBrush]

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.

[PeaceAndHope]

Oh god, I am horrified at some of these stories.

Can they actually call social services if a woman refuses to consent to treatment?

[RealityQuake]

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.

[EauRouge]

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.

[Flisspaps]

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.

[TheDetective]

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.

[nailak]

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.

[TheDetective]

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.

[flaminhoopsaloolah]

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....

[torncanvas]

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.

[BoyMeetsWorld]

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

[MsIngaFewmarbles]

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.

[nailak]

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.

[TheDetective]

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.

[knittedflower]

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

[TheDetective]

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.

[trustissues75]

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.

[MyDarlingClementine]

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.

[TheDetective]

Sage I work in west lancs :) we can't be so far away...!

[sagefemme55]

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!

[trustissues75]

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 - 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?!