Pregnant women and people frequently need to make decisions about the care they want during their pregnancy, birth and afterwards. This article explains your right to make decisions and suggests approaches which may help with your decision-making.
For information about how to interpret the research which has been used to make recommendations about maternity care see Understanding quantitative research evidence.
Everyone has the right to make decisions about what medical treatments or procedures to accept. This ‘principle of autonomy’ is protected under Article 8 of the European Convention on Human Rights.
This means that doctors and midwives have a legal duty to ensure that a person has given ‘informed consent’ before they carry out any procedure, however routine or minor. They should provide information about the proposed treatment and any possible alternatives, and about any significant risks that there might be with each option. This should include the option of declining any treatment. The information should be objective and research-based. It should also be presented without any attempt to bully, coerce or otherwise unduly influence someone into agreeing to the midwife or doctor’s recommended course of action.
The only exceptions to this are if a person does not have the mental capacity to consent, or in an emergency where they are physically unable to consent, for example if they are unconscious.
For more on the law on the principle of consent see the Birthrights’ factsheet ‘Consenting to treatment.” www.birthrights.org.uk/factsheets/consenting-to-treatment
Although someone has the right to say “No” to a procedure and to have that decision respected, they do not have the right to insist on having a procedure if their midwife or doctor does not agree that it is needed. However, they can request a second opinion from another midwife or doctor, who may take a different view.
Doctors and midwives often talk about something ‘increasing the risk’ without saying by how much the risk is increased (the Relative Risk) or what the chance is of the problem actually occurring (the Absolute Risk). Alternatively, they may state the Relative Risk, saying for example that ‘this situation doubles the chance of a stillbirth’ without pointing out that the Absolute Risk is still low. Double one in 1000 is still only two in 1000.
How people feel about risks is a matter of personal attitudes, values and circumstances. One person might consider a risk of an extra one in 1000 to be too small to worry about, but another might decide a risk of an extra one in 100 is unacceptable.
Midwives and doctors will often focus on one specific risk and ignore other repercussions (risks and other consequences such as the impact on your birth choices) which may be very important to you. It is up to you – and not to your doctor, midwife or anyone else – to decide which risks matter and what level of risk is acceptable.
For any decision, it can be helpful to use the “BRAIN” approach – making sure that you understand the benefits and repercussions of whatever is being recommended, and what the alternatives are (including doing nothing), then asking yourself how you feel about all that.
There will almost always be a trade-off to be made between the benefits and repercussions of each alternative, and how you view this will depend on your own attitudes, needs and priorities. Sometimes one option will carry a very low risk of a serious outcome, whilst other alternatives carry a much higher risk of less serious outcomes, or have other implications for your labour, your recovery or the well-being of you and your baby after the birth.
If both your rational mind and your instinct are pointing you in the same direction, then that’s probably the right decision for you. If not, it can be worth asking yourself why that is. Are you sure that you have all the information that you need, and that it is accurate? Are other people trying to persuade you to go in a direction that doesn’t feel comfortable to you? To help with this, you might try asking yourself about who and what is influencing you.
Even where there is research evidence on a topic, this has usually looked at a group defined by just one or two characteristics (such as their age or whether they have birthed before), so it won’t necessarily apply to you as an individual. Hospital guidelines are generalised and will contain some recommendations which are not evidence based, because there is not sufficient research to show what is best. Your midwives and doctors should give you information that is specific to your individual circumstances, or tell you if no relevant information exists.
Women often say that they wish they had listened to their feelings and not let themselves be persuaded to do something that made them feel uncomfortable.
If you are going to talk to a doctor or midwife you may want to write down a list of questions you want answered. Midwives and doctors have a responsibility to give you the information you need to to make an informed decision, so don’t be put off if they seem to brush your questions aside or give you unsatisfactory answers. It may help to simply keep repeating your question until they answer it to your satisfaction. Other things you may find helpful are:
The sort of questions you might have could include:
Unless you are being told that urgent action is needed, you do not have to decide then and there. You may find it helpful to say something like “Thank you for the information. I will think it over and let you know in a couple of days what I have decided to do.” This can also be a way of politely closing a discussion you are finding unhelpful, for example, if you feel that someone is trying to pressurise you into agreeing to something that you are not sure about.
If you are unsure about a recommendation that is being made to you, you always have the right to a second opinion, which should ideally be from a consultant rather than a less senior doctor, who may take a different view.
Although everyone has the right to decline any form of medical care you do not have the right to insist on something such as an induction or a waterbirth in hospital if your doctor or midwife is unwilling to offer this. Again, you can ask for a second opinion from another doctor or midwife.
Written by: Nadia Higson
Reviewed by: Debbie Chippington Derrick
Review on: 31/05/2020
Next review needed: 31/05/2023
AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email firstname.lastname@example.org or ring 0300 365 0663.
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