The right to autonomy means that a women’s consent must always be sought before performing any medical procedure. Carrying out a procedure without your consent violates your right to physical autonomy and integrity under Article 8. It may also violate your right not to be subject to inhumane and degrading treatment under Article 3.
You have the right to make your own decisions about your body. It is against the law to give you medical treatment unless you agree to it. It is important that you understand the treatment or treatment options well enough to make a decision about what treatment you want to have. Failure to give you sufficient, subjective, and unbiased information to enable you to make an informed choice will violate Article 8. It also means that no-one, including your family or healthcare professionals, must put pressure on you to agree to have treatment.
Making a birth plan and having respectful conversations with your doctors or midwives early in your pregnancy gives you a good opportunity to think about the treatment and care you may be offered, and that which you may not want. You can specify in your birth plan any treatment you do not want.
However, at some stage during your pregnancy or labour, the doctors or midwives caring for you may think that your treatment should change. If anything changes, they must tell you what is different, and any changes to risks and benefits of treatment being offered, so that you can consent again.
You also need to know who is giving you maternity care, and agree to them giving you that care. You must be asked before a medical student or a student midwife can be part of your care (though it’s important to note that involvement in your care provides a major part of students’ learning and they will work under the direct supervision of an obstetrician or a midwife).
There are some situations where patients are asked to give consent in advance. For example, if you are going to have a planned caesarean section, then the obstetrician should offer you a proper conversation about the risks and benefits ahead of time. A formal consent form is completed on the day of the surgery following further discussion of the risks and to discuss any concerns you may have. It is your right to change your mind. They cannot then do anything further during the operation that you haven’t agreed to, unless it is required in order to save your life or prevent serious harm.
Likewise, if you have been booked for an induction of labour, you can change your mind and decline the induction at any time, including on the day of the procedure. It is required of the midwife or the obstetrician to provide you with all the information you require to make an informed choice about your care.
Before you decide about any care or procedure, the obstetrician or midwife should tell you about the risks and benefits that will be important to you, so you can be fully involved in the decision-making process. You should be told if there are other treatments you could have instead and the risks and benefits of those. You should be made aware of what could happen if you don’t have the treatment.
It is also extremely important that your doctor/obstetrician listens to you and finds out what matters to you. For example, if a treatment or procedure might make future pregnancies complicated, they need to talk to you about how important it is to you to have more children, so that you have the information you need to make a decision. It is not enough just to give you a leaflet or a link to a website. You should have a personal discussion with your doctor or midwife, to go through what is really important for you.
You have the right to request certain care, but your doctor or midwife do not always have to offer care if there is a good reason why they should not. This should be explained to you fully and documented within your records.
As a birth injury solicitor, I often speak to mothers who have had concerns about information given to them regarding the best way to deliver their baby, and whether they were made aware of all of the relevant risks in order to make the right choice for them. There are some situations where it may be more appropriate for a mother to have an early induction of labour or an elective caesarean section. In this scenario then, it is important that a mother is made aware of all options available to her and the risks associated with each option, so that she can make the right choice for her and her baby. Often expectant mothers will want to know whether they can choose to have a caesarean birth, even if the doctor or midwife doesn’t think there is a medical reason for one. This is called a maternal request caesarean birth. If you are otherwise low risk and your preference is for a caesarean section, the midwife will refer you to the obstetrician for a full discussion of the reasons, risks and benefits. When this situation arises, your doctor or midwife must listen to your reasons for wanting a caesarean birth and have good reasons for saying no.
If you request a caesarean birth during labour, your midwife should listen and take you seriously and refer you to the obstetrician You should be offered other support, such as pain relief, if you feel this would help you to be able to have a better conversation about caesarean birth or other alternative options. On occasion, you may have to wait to have a caesarean section if there are other individuals in the unit who need a caesarean more urgently. There are guidelines available from the national guidance for the National Institute of Health and Care Excellence (NICE), which recommend that if you ask for a caesarean birth, the hospital should support this if they are satisfied you are making an informed choice. The obstetrician should discuss with you why you want a caesarean birth, and the risks and benefits of caesarean and vaginal birth.
If you are requesting a caesarean section due to anxiety about childbirth, the hospital should refer you to a healthcare professional who is an expert in perinatal mental health. However, you do not have to accept this offer of support if you do not want to. The guidance says that if you still want a caesarean birth after you and the hospital have talked about it, and you have been offered support, the hospital should offer you a caesarean.
If you choose a caesarean birth but your hospital refuses to carry it out, you can ask to speak to the director/head of midwifery or the clinical director.
Article 8 also gives you the right to choose your place of birth and choice of birth companion. You can therefore choose to give birth in a hospital, in a midwifery led birth centre, or at home. It is important that you understand the risks and benefits of each option. For example, many women do not understand that a midwifery led unit does not have immediate access to the obstetric team and pain relief does not include the option of an epidural. It is also important to understand that a home birth may encounter complications which could be life-threatening due to delays in transferring to the hospital in the event of an emergency. There are some situations such as a breech or a twin birth or any underlying health conditions where a doctor or midwife may recommend birth on the labour ward in which case it would be important to have a detailed discussion about the risks and benefits associated with this. However, no-one can make you give birth away from home if you want to stay at home and you are fully aware of the limitations of fetal monitoring, pain relief options and the availability of basic resuscitation.
In order to discuss your maternity options with you, Article 8 also means there is a requirement to provide adequate interpreting services necessary to enable you to fully understand the options available to you and be able to make the right decisions.