Women's health

 

 

 

Choice, Consent and Shared Decision Making During Pregnancy and Childbirth

 

 

Introduction

Pregnancy and childbirth are a pivotal time in a woman’s life with access to safe and supported birth a fundamental human right. A positive birth experience is strongly linked to women experiencing a sense of control through choice and involvement in decision making with consent. This leaflet will provide you with information regarding your human rights during childbirth and the importance of consent.

 

Informed Consent

• Consent is a human right and one that should not be diminished during pregnancy or birth.
• During pregnancy and labour you may be asked, by your midwife or doctor, to choose whether to have certain tests or procedures performed.
• Interventions may include prenatal testing, induction of labour, fetal monitoring, vaginal examinations, epidurals, episiotomies, assisted births (forceps or vacuum) and caesarean sections.
• Interventions for your baby may include immediate cord clamping, vitamin K injections after birth, vaccinations, new born screening and other tests.
• Consent includes the right to receive information regarding the benefits and risks of any recommended intervention so you are able to make an informed decision that best suits you and your baby.
• Conversations should allow time for a discussion about the purpose of the tests, and an opportunity to decide not to have some tests performed and a chance for you to ask further questions.
• Discussion should also include the consequences of not performing any treatment or intervention, as well as any reasonable or accepted alternative treatments.

• You may change your mind about having certain tests or treatment once you have been given information and had time to weigh up the pros and cons of having, or not having, what has been offered.

 

Why?

Following a landmark legal case in 2015 (Montgomery vs Lanarkshire Health Board) health care professionals are obliged to give women information which:

• Clearly outlines the potential treatment options, ensuring women are aware of both advantages and disadvantages of each option.
• Give women adequate time to reflect, before making a decision.
• Ensures women have access to high-quality information to aid their decision- making; this might include an information sheet or video clip link.
• Document the above process in the maternity records.
• Documents any changes of mind about the treatment / test by the woman in her maternity record.
• Check women have fully understood their options and implications.

 

• Your partner or next of kin cannot give consent on your behalf, nor can they refuse to allow you to have treatment if you choose to have it, or insist that you have a treatment you have decided not to have, even if they don’t agree with your decision.
• For surgical interventions, such as a caesarean section, your signature will be obtained on a consent form after discussion of all treatment options and risks associated with each option.
• The exception to this is, if emergency procedures are required, verbal consent may be taken at this time.
• Staff will check that women have fully understood their options and the implications and ensure they have an interpreter, if they need language support.

What if I don’t feel listened to or understood?

If you find yourself in this position your named midwife is your number one advocate and will hopefully be a familiar friendly face.

Perhaps contact your named midwife to let her know that you may need a little longer at your next appointment, or need to meet sooner, to talk about things.

Alternatively you can call the Maternity Helpline, contact details are in your handheld notes. The choices about the care you receive during your pregnancy and birth rest with you and your care providers will respect and support your decisions.

 

Handy Links:

Association for Improvements in the Maternity Services: https://www.aims.org.uk/

Birthrights: https://www.birthrights.org.uk/

Maternity care with Human rights: https://humanrightsinchildbirth.org/index.php/2016/11/21/maternity-care-with- human-rights-informed-consent-and-refusal/

 

References

Consenting to treatment - Birthrights.org.uk

WHO recommendations: Intrapartum care for a positive childbirth experience. World Health Organization, Licence: CC BY-NC-SA 3.0 IGO. https://www.rcog.org.uk/globalassets/documents/guidelines/clinical-governance- advice/cga6.pdf

https://www.rcog.org.uk/en/guidelines-research-services/consent/