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"Am I Allowed?" Making decisions about your care during pregnancy & birth

Welcome to my first blog post – yay! ♡

This is something I have wanted to start for a while but have been putting off, mostly due to procrastination and good old Imposter Syndrome! However, when chatting to the women I meet at my Aquanatal class, my Hypnobirthing clients and those I am supporting as their midwife in labour – they have all expressed how grateful they have been for my advice and how invaluable it has been as it has allowed them to go on to make informed decisions. This is my most favourite thing to hear - birthing people taking charge of their care and making decisions that meet their wishes and needs!! On reflection, I have realised that the “advice” they are referring to, hasn’t always been advice as such. But instead, I have been ensuring the women, birthing people and their partners are aware of their options. Aware that they have a say in their care and that their say trumps anyone else’s.

So I’m starting my wonderful blog off with discussing the topic of Autonomy in Pregnancy. I often get asked by pregnant women "Am I allowed to..?" "Do I need to...?" This can be anything from "Do I need to get my bloods taken?" to "Am I allowed to say no to vaginal examinations?"

Being honest, this post could have been very short and sweet as the answer to the above questions will always be: you don't NEED to do anything. You don't have to accept any form of antenatal care, scans, blood tests. Legally, you can refuse anything and everything. The only legal requirement of you during your whole pregnancy and birth is to register your baby's birth. Everything else is an option. No matter how it is worded. E.g. "You'll need to be referred to the consultant because of..." "You'll need to be induced at ... weeks." This is not true and should never be worded in this way. You do not NEED to do anything. Healthcare professionals can only ever advise. Even in an emergency situation, where your own or you baby's life is at risk - if you decline treatment; no one can treat you against your will. As with any other medical test or procedure - you have the right to say no. You should never have to say it more than once. Coerced consent is not valid consent.

However, many are not aware of this or feel they are obliged to do as they're "told" especially in their first pregnancy. I often hear women saying "you (referring to me as a midwife) and the doctors know best." This is disheartening to hear as pregnant people should feel empowered to take control of their care and make the best decisions for themselves and their family. Healthcare professionals can give very valuable and necessary advice to aid your decision making. However, you and your baby will be the ones to live with the results of these important decisions. If you have been coerced into agreeing to an intervention that you were not happy with, this can be very difficult to live with. Coerced consent is not consent. Coerced decisions are not informed decisions.

Midwives and doctors, especially within the NHS, are very busy and don't often meet those who decline tests and interventions, therefore assume consent has or will be given. The role of healthcare professionals in maternity care is to offer and provide care, not insist or coerce you into agreeing or consenting. The reason healthcare providers want you to have a certain test or procedure might not be based on your individual needs, but rather based on a hospital guideline or protocol.

Guidelines and protocols are written with the aim of providing safe care for the majority of those using the service. However, these are not always based on research and should not be viewed as one size fits all. It is not uncommon for pregnant people to never actually see these guidelines and protocols. You have a right to see the protocol which relates to your care. You also have a right not to follow it.

A fit and healthy person having a baby is a normal function and exciting life event. Our bodies are designed to conceive, grow and birth a baby and most can do so on their own. Some birthing people will benefit from additional help and input which can be life-saving. However, this will not be every birthing person. Healthcare professionals can use various tests to pick up on those who might be developing problems. Unfortunately, due to increased pressures and maternity services - maternity care is becoming increasingly routine and medicalised e.g. routine blood tests, routine scans, routine induction of labour etc. Current obstetric care focuses on identifying possible problems. Some of these problems can be very serious, however many are very rare. Tests and interventions often lead to further tests and interventions. No screening or diagnostic test is 100% accurate. It's also important to remember the possibility of false positives (an indication there is problem but there actually is not) or false negatives (an indication that there is no problem but there actually is. I strongly recommend finding out as much as you can about all treatments, tests or interventions being offered. Ask to see guidelines, protocols and recent evidence-based research!

Healthcare professionals working in maternity care can treat those under their care in a more controlling style than what they would treat another service user or patient who is ill. This can be because they believe that they have the best interests of the baby at heart. But tell me this, who will make a better decision about the well-being of a baby, than the parent of that baby?

So how can you ensure you make the best decision for you and your baby? Use your B.R.A.I.N.S ! I teach The Little Birth Company's Hypnobirthing Course and always recommend my clients use B.R.A.I.N.S. to aid their decision-making.

B - What are the Benefits of...

R - What are the Risks of...

A - What Alternatives are there...

I - What does my Instinct tell me...

N - What if we do Nothing...

Do what feels right for you. You've got this! ♡

Joanna x

Further Reading & Useful Sites

Birthrights Website

"Am I Allowed?" by Beverley A Lawrence Beech

"Why Human Rights in Childbirth Matter" by Rebecca Schiller

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