This month we are exploring the theme of ‘Am I allowed?’ in relation to maternity care. Over our years of midwifery practice, in various settings, women and birthing people have asked us the question ‘am I allowed…?’. With that question in mind, this blog is focussing on the commonly offered screening tests and interventions during pregnancy and birth and if you’re ‘allowed’ to decline them.

The short answer to this question is yes. Yes, you’re allowed to decline any screening test or intervention offered to you, but let’s dive a little deeper. 

What Tests and Interventions Are Commonly Offered During Pregnancy and Birth?

Below are some commonly offered screening tests and interventions during pregnancy and birth:

• Blood pressure & urine checks
• Weight / BMI check
• Carbon monoxide testing
• Antenatal blood tests
• Antenatal aspirin
• Antenatal blood thinning injections
• Dating ultrasound scan
• Fetal heart rate checks
• Glucose tolerance test
• Anomaly ultrasound scan
• Anti-D prophylactic injection
• Symphysis-fundal height measurements
• Routine 36-week growth scan
• Membrane sweeps
• Vaginal swabs
• Continuous electronic fetal monitoring (CTG)
• Fetal scalp electrode
• Induction of labour
• Routine vaginal examinations
• Having your waters broken artificially
• Having syntocinon
• Antibiotics in labour
• Pain relief
• Perineal guarding (including the OASI care bundle)
• Episiotomy
• Forceps
• Ventouse
• Caesarean section
• Injection for birthing your placenta

Can You Say No to Screening Tests and Interventions in Maternity Care?

Firstly, let’s start with a disclaimer: you have the right to accept OR decline any of the screening tests and interventions mentioned above. Secondly, nothing on the list above is good OR bad per se and shouldn’t be labelled as such. 

What is important to know is that you have the right to choose. You’re allowed to say yes please, or no thank you, to any of these things. You have the right to take some time to make your decision. You even have the right in the UK to not have any maternity care throughout your pregnancy, birth and postpartum journey (although there is a legal requirement to notify the birth of a baby within 36 hours, which alerts the local health authority). Birthrights has a wealth of information about your rights during pregnancy.

Do You Have to Accept Every Intervention Offered During Labour?

Another important thing to note is that you may wish to accept every single test or intervention offered, decline them all, or accept some but decline others. Your care can be as individual and nuanced as you are.

How to Make Informed Decisions About Your Maternity Care

What’s important is having evidence-based, balanced information to be able to make the decision that is right for you. Perhaps you would like to have your bump measured at your midwife appointments, but don’t want to have a 36-week growth scan? Or perhaps you would accept a caesarean section but not an instrumental assisted birth? Perhaps you have given your consent to have a vaginal examination, but do not want a membrane sweep? These are just examples and there are many options.

Only you can make these decisions about your care – only you can decide what’s right for you. In an ideal world you would be provided with balanced, evidence-based information that was tailored to your unique circumstances, so that you could make an informed decision. In reality, mainstream antenatal appointments are too short for a midwife or obstetrician to go into great detail about each test or intervention and often it seems women and birthing people are presented with a rather one-sided view.

Understanding the Cascade of Interventions in Childbirth

Some tests, particularly during pregnancy, are so routine and embedded in practice that you may not even feel you were given the opportunity to decline them. Furthermore, interventions often lead to more interventions – something which has been termed, ‘the cascade of interventions’. This is worth thinking about when accepting or declining an intervention.

It is absolutely fine to accept every test and/or intervention recommended to you during pregnancy, if that feels right for you. It is also absolutely fine to decline them, if that feels right for you. No one has the right to make you do anything during your pregnancy or birth that you do not want to do.

Resources to Help You Understand Your Rights in Pregnancy

We’ve listed some fantastic resources below if you would like to learn more about your options during pregnancy.

Read…

Plus Size Pregnancy – Sara Wickham 

What’s Right For Me? – Sara Wickham

In Your Own Time – Sara Wickham 

(Can you tell we like Sara Wickham?! These are just a few of her books, head over to her website for info on all sorts of things from anti-D to homebirth)

Your rights in pregnancy and birth – AIMS

Explore the web…

Making decisions about your care – AIMS

Listen…

The herstory of modern birth practices – The Midwives’ Cauldron Podcast

The Great Birth Rebellion Podcast

Have a go…

Try out using the BRAIN tool to support your decision making