Your maternity care rights explained – everything you need to know about giving birth
“Birth is very safe in the UK but there are clear disparities and areas for vast improvement,” says Dr Hannah Rayment-Jones, a midwife and research fellow at King’s College London.
Around 560,000 women in England give birth each year – about one every minute. While women have nine months to prepare, thinking about their birth plan, attending antenatal classes and running questions by their midwife, maternity care on the NHS can let them down.
“There is good evidence that when women receive continuity of care from known and trusted midwives then they are more likely to have a positive birth experience,” Dr Rayment-Jones says. “With current NHS staffing issues this level of care is sadly not routine for many pregnant women.” However, there are fundamental rights that all expectant mothers should be aware of that underpin the care they receive.
Can I choose where I give birth?
Yes, you can choose whether you have your baby in a hospital, a birth centre (a unit run by midwives) or at home. You can choose a specific site within your area or request a hospital or birth centre away from where you live. “It’s only right that people can have the option,” says Andrew Shennan, a professor of obstetrics at King’s College London. “But there are scenarios where you wouldn’t want to be at home, for example if you had a previous caesarean birth or were at high risk.”
Women who don’t get a chance to choose where and how they give birth are more likely to suffer anxiety, postnatal depression and post-traumatic stress disorder, notes Dr Rayment-Jones. “We know that when healthcare professionals facilitate informed choice about where and how women give birth they are more likely to have a better, safer and more memorable experience,” she adds.
Do I have the right to a water bath?
Yes, although a hospital or birth centre may decline access to a water birth if they have medical concerns. There’s also no guarantee that a bath will be available during your labour, for example if they are already occupied. If giving birth at home, you can hire a birthing pool.
What pain relief can I access?
If you ask for pain relief during labour, you should receive it unless there is a medical reason not to. Your options could be limited by timing (for example, pethidine injections aren’t recommended if you’re getting close to the pushing stage of labour) or staff availability (an anaesthetist needs to be free to deliver an epidural).
“Everyone should know the pain relief options they have access to, so they can make a choice,” says Prof Shennan. There are also self-help techniques, such as taking a bath, breathing exercises and changing positions.
“Women have a right to choose if they use pain relief, and if so, which type,” adds Dr Rayment-Jones. “Women are free to make choices, against medical advice, and cannot be forced to accept intervention whether or not it is thought to be in the unborn’s best interests.”
Can I choose to have a C-section?
Pregnant women can ask for a caesarean birth, even if it’s not medically necessary, and should be allowed to have one as long as they have been informed of the benefits and risks of both the procedure and a vaginal birth. This discussion usually takes place with a consultant midwife or obstetrician at a “birth option clinic” run by the local NHS maternity service. “Virtually everywhere now will offer maternal choice,” says Prof Shennan. “There can be cost constraints and issues with service to work around but it seems to be the norm now.”
Can I have more than one birthing partner?
Some hospital and birth centre policies set out that expectant mothers can only have one person in the labour room. You can request to have more than one but this can’t always be guaranteed. “It varies between hospitals, because there are space constraints and ethical issues which mean you can’t have large numbers of people in a clinical area,” he says. “Generally speaking, one person is permitted, and if there are exceptional circumstances, then the service can consider more.”
Will NHS staff follow my birth plan?
Expectant mothers are often asked to detail the care that they want during and after labour, which is then discussed with their maternity team. However, this document has no legal status and, in reality, treatment may vary dramatically if complications arise.
Will I be able to ask for a second opinion?
Women accessing NHS maternity care don’t have the legal right to a second opinion but they are rarely refused one. If somebody is asking for a second opinion, it would be passed on to another senior colleague. “I think that’s perfectly reasonable and a normal expectation in modern care,” says Prof Shennan.
Can I choose the midwife who oversees my pregnancy and childbirth?
There is no legal right to continuity of care (when the same member or team of staff sees you for each appointment and during labour).
Can I change my midwife or doctor?
You can ask your hospital to see a different midwife or doctor, without having to give a reason, and they should accommodate this. “It happens all the time, we change the people who are responsible for you, if you have a poor relationship, or you just want someone else to do it,” says Prof Shennan.
What care can I expect if I have an underlying health condition?
Women who have Type 1 or Type 2 diabetes face a higher risk of complications, so the NHS recommends that they give birth in hospital and that they have their blood sugar levels checked every hour during labour. Doctors could also suggest that these patients have labour induced or undergo an elective C-section.
Meanwhile, women with a disability or long-term health condition, such as epilepsy, have the right to additional support during pregnancy and childbirth. This could include longer appointments and tours of the labour ward where they plan to give birth.
