Rights and Risks in Pregnancy and Childbirth
Giving birth and becoming a parent are life changing events, yet, while people spend months and small fortunes preparing for a wedding, often little time or energy is invested in preparing for this most incredible journey. Birth and parenthood preparation helps parents to be understand the emotions and physical changes they are experiencing and how to navigate the maze of information and advice they will face through pregnancy, birth and the key first few weeks of baby’s life.
So what does “being prepared” mean?
Discovering how your body changes through pregnancy, birth and beyond is empowering and reassuring. Beneath the swelling breasts and belly, profound changes are happening to the brain, hormones surge, even the bones of the pelvis change. Understanding these processes can help reassure and guide parents-to- be through the challenges and uncertainties of pregnancy and labour. Learning about the physical and psychological impacts of pregnancy and childbirth is an essential, but in the modern world it’s also important to learn how to navigate the maternity system.
Expectant parents are often unprepared for pressure from the medical profession to accept interventions. Some are essential, but many are not justified by evidence, and rates are rising. For example, in one local hospital rates for induction labour have soared because of changes to guidelines that have little of evidence to support them, are not used in other hospitals and reflect the decisions of consultants in that unit - not national guidelines.
It’s essential to understand that whatever advice is given, whatever tests, interventions or plans of action are recommended it is your decision to accept them. You will always have choices, there is often another way. Informed choice is your right but there's an important caveat - the key word is “informed”.
There’s little evidence to suggest almost half of all pregnant women need to cut short their pregnancy but doctors are often defensive and can present risks in ways that deter questions. Parents may be told “the risk of your baby dying is doubled without an induction”, but they are not told this doubling is from “very slight” to “slight” - the boundaries between relative risks and absolute risks can frequently become blurred.
Occasionally language is used that seems to remove choice, for example, being told “you are not allowed to…” NO-ONE can tell you this. Human rights aren’t left at the hospital door, except in an emergency situation there are choices, it’s rare there is immediate danger, usually there is time to consider and discuss options.
It’s also important to understand medical opinions can differ. One of my hypnobirthing clients was told by a consultant she was ‘not allowed’ to use the midwife led birth unit but a second consultant recommended it - never be afraid of asking for a second opinion.
Another example I encountered recently was a case of a woman who was told she was high risk and needed continuous fetal monitoring throughout her labour and couldn't have water birth. Although the woman was at high risk of post birth complications, there were no risks to her baby - and no reason to deny her birth of choice or to monitor her baby. These decisions are increasingly made as a matter of routine rather than on evidence.
It’s hard to challenge medical opinion, especially once you are in hospital. The BRAINS acronym is a good mnemonic to help you find the right questions. If you are offered intervention ask about:
Benefits: how will this intervention or screening test help me and my baby?
Risks: what is the downside of this intervention?
Alternatives: what other action could be taken?
Information and Intuition: do I have enough information to make a decision - what does “gut instinct” say?
Nothing: what will happen if I wait and do nothing right now.
Smile: health professionals have your interests and safety at heart - it doesn’t have to be a battle.
This is your body, your pregnancy and your baby, how you give birth matters. Getting accurate and up to date evidence will help you make the best decision for you and your baby. Nobody else can do that.
This information does not substitute care from your midwife or doctor and should not be relied upon as personal medical advice.
Molly O Brien is a midwife with over 20 years of experience - she runs a free antenatal class, "moving for an easier birth" classes and hypnobirthing courses at Treat. She is an associate lecturer at the UEA and teaches biomechanics of birth and emergency training to midwives around the world