Knowing your legal birth rights in the NHS will help you have a more empowering birth experience.
It’s important that both you and your partner fully understand your birth rights in the NHS so as you can make your own right choices.
The rights that are most important during birth as found in the NHS Constitution 2013, which is supported by UK Legislation under the Health & Social Care Act 2012, I believe are:
[my own notes and suggested implications are in italics]
Access to health services:
- You have the right to access NHS services. You will not be refused access on unreasonable grounds. This means if you would like a homebirth, waterbirth, natural twin birth (without epidural), breech birth, VBAC (vaginal birth after a previous caesarean) and you and your baby are in good health then you have the right to that happening. Getting informed about the latest research and implications of any possible complications you may knowingly have might help you to get the service you want, even if it goes against guidelines
- You have the right not to be unlawfully discriminated against in the provision of NHS services including on grounds of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. Maybe self explanatory… an example of this could be if you have a feeling there is something wrong with you or your baby and the doctors/midwives dismiss your concerns or don’t take appropriate action then they are going against your rights to non-discrimination. Or maybe you would like a homebirth but your doctor doesn’t personally like that option and they persuade you out of it, they would be going against your rights.
- You have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible. Often during pregnancy and birth there isn’t much time to get the services you need. If you’re after a breech birth, for example, and there is no one in the hospital who is adequately trained, then you have the right to go to another hospital where someone is correctly trained… even if that means it’s a private hospital and the NHS has to pay for it. Remember NICE produce guidelines, not rules; you can accept or refuse any care you like.
Quality of care and environment:
- You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality. You can refuse to be treated by a student during labour. You must be asked if you would be happy for a student to be present and be given the option to accept or refuse care by a student. If this is your first birth I would recommend you keep people in the room to the bare minimum… they can practise on someone more confident. Other implications of this right… hands must be washed, vaginal exams must be to your own level of comfort (not painful and to be stopped if you ask them to), the doctor/midwife needs to keep any issues they may have to themselves (showing a feeling of being rushed, annoyed, angry or harassed about something can stay out of your birth room). If a doctor or midwife isn’t confident or comfortable with a particular procedure or service, you can ask for someone else who is to look after you.
Respect, consent and confidentiality:
- You have the right to be treated with dignity and respect, in accordance with your human rights. Your choices, opinions, personal space and feelings are valid as your own experience. No one should make you feel insecure, doubt yourself, bullied, abandoned, feel exposed or invaded at any time. If they do, you can ask them to leave and have a different doctor or midwife look after you.
- You have the right to accept or refuse treatment that is offered to you, and not to be given any physical examination or treatment unless you have given valid consent. If you do not have the capacity to do so, consent must be obtained from a person legally able to act on your behalf, or the treatment must be in your best interests. Vaginal exams during labour are uncomfortable, get you into an unfavourable position and give very little information as to how long your labour will be. You can refuse routine vaginal exams and ask for them at your own request. Sometimes they’re useful in determining baby’s position which may change the way you labour. Sometimes a vaginal exam during a posterior birth, where baby is spine to spine, can mimic the perineal muscle and cause baby to turn, thus relieving back pain and helping baby come down. Vaginal exams have a place but not routinely for every woman according to the clock. Other examples, failure to progress isn’t a good enough reason for a caesarean (the same goes for many other reasons for caesarean such as breech presentation), you don’t have to have an IV line in your hand ‘just in case’, you don’t have to have an epidural in place ‘just in case’ say for a VBAC, breech or twin birth. You have the right to choose everything, every step of the way, and you have the right to be respected in those choices and not be pushed into anything.
The thing to remember here is that it is immoral and illegal for a medical professional to tell you “We won’t let you…”
It’s your birth, your body and your choice
- You have the right to be given information about the test and treatment options available to you, what they involve and their risks and benefits. ‘Informed consent’ or even the NHS heading here ‘consent’ implies that you will accept what they are offering you. I believe it should be ‘informed decision’. Be careful when you ask for the benefits and risks of a procedure that they aren’t giving you information to consent. ALL medical interventions carry risk. Asking about the levels of risk and benefit can be misleading without proof of the research studies quoted. To say you’ve doubled your risk by refusing a procedure is meaningless if you’ve gone from a 0.1% chance of problems to a 0.2% chance of problems. You still have a 99.8% chance of being fine without the procedure. In pregnancy, birth and motherhood always ask what all of the options are and then ask to be given privacy and time to discuss amongst yourselves. If it’s not an emergency you can take all the time you need to feel good about the decision you are making. Always look to other sources to get a broader picture of the issue you are faced with (time permitting). Henci Goer has written many fantastic books on the risks and benefits of procedures in childbirth.
- You have the right of access to your own health records and to have any factual inaccuracies corrected. Make sure that if you’re considered high risk, your health records are accurate and that you understand them. This can help you to negotiate care that may go against guidelines.
- You have the right to privacy and confidentiality and to expect the NHS to keep your confidential information safe and secure. If you don’t want people walking in and out of your birth room, or if you don’t want particular people to be there, you have the right to ask them to leave. You have the right to stop people, unnecessary to your birth, from coming in the room. For example, if people come into the birth room to chat with your midwife or doctor, you can ask them to talk outside.
- You have the right to make choices about the services commissioned by NHS bodies and to information to support these choices. The options available to you will develop over time and depend on your individual needs. Again, you have the right to accept and refuse any care you like and to choose where you receive that care and with whom. There are always options, you may need to keep looking for them.
The NHS also commits:
- To inform you about the healthcare services available to you, locally and nationally (pledge). If you can’t get what you want locally, go national. Your midwife and doctor have a responsibility to you to outline all of your options. You may need to ask them to tell you the options as they may not remember or think to give you the information (often thinking you already know it or you’re not interested). If you ask, they are obliged by law to outline all of the options.
- To offer you easily accessible, reliable and relevant information in a form you can understand, and support to use it. This will enable you to participate fully in your own healthcare decisions and to support you in making choices. This will include information on the range and quality of clinical services where there is robust and accurate information available (pledge). If you don’t understand something, you must ask and get clarification. If they’re unable to explain in a way you understand then ask for someone else to explain it to you. You can make informed, empowering choices that you feel good about when you have understood what it is you are choosing.
Involvement in your healthcare and in the NHS:
- You have the right to be involved in discussions and decisions about your health and care, including your end of life care, and to be given information to enable you to do this. Where appropriate this right includes your family and carers. You are entitled to attend meetings regarding your situation and to make clear your choices, opinions and concerns. If you are considered high risk or you would like to do something not normally done in your situation, you have the right to meet with the head of department, with key members of staff, with people who are likely to be with you at the time of the event and make clear to them all what you want to do. If you have an epidural or a caesarean you are required to sign a legal document at the time allowing them to do the procedure. It’s therefore right that if you want a particular procedure, or not, to have signed copies from the hospital/midwife agreeing to your requests. This way, if they change their mind during your labour and decide to do standard guidelines you can show them again the agreement. I’ve co-written a great birth plan for a VBAC breech birth I attended in 2012. Use this as a template for your own birth.
Complaint and redress:
- You have the right to have any complaint you make about NHS services acknowledged within three working days and to have it properly investigated. If you feel that your health rights have been broken you are entitled to a full investigation. It doesn’t matter when it happened so don’t let time be an issue. Sometimes the longer you leave it the more they take it seriously as it’s obviously effected you. Motherhood is all consuming so finding time and energy to write a formal complaint can be tough and sometimes painful. I do recommend doing it though as it’s a good way for the NHS to make their services better and for you to feel heard.
You have the right to be fully informed
You have the right to be treated with kindness and dignity
You have the right to accept or refuse drugs and procedures
You have the right to be respected in your decision, even if it goes against their recommendation
Samantha Thurlby-Brooks is the creator and director of Mumanu Ltd; specialising in pregnancy massage, postnatal massage and BirthWorks antenatal classes in London, UK. Samantha supports her clients with kindness, understanding, knowledge and a damn good rub! She is also the creator of the award winning Mumanu Pregnancy Pillow
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