Making decisions in pregnancy – risks, benefits, consent and your rights

Norgine Pharmaceuticals provided a Grant to support the development of this material. Norgine had no editorial control or scientific input into this material.

On this page:

Making decisions in pregnancy 

What is (and isn’t) informed consent?

Understanding risk

Thinking about your personal situation 

Taking your time 

Asking questions

Finding out more – doing your own research

Talking to your doctor or midwife about your decision

 

Making decisions in pregnancy

Making decisions about your pregnancy and birth can sometimes be difficult. You have to think about different risks and benefits and decide what is best for both you and your baby. There is often no perfect solution or ‘right’ answer.

Sometimes things might not feel like a choice – you might feel like you are being ‘told’ that something will happen, instead of being asked whether you want it to happen. This is wrong. It’s always your choice. You have a right to say ‘yes’ or ‘no’ to any type of treatment, test, examination or procedure.

You might be happy to accept your midwife or doctor’s recommendations, or just go with what most people do.  

You might have questions or worries about whether a choice is right for you and your baby. For example, taking (or stopping) medication in pregnancy, induction of labour and whether, or how, vitamin K is given to your baby after birth.  

Or you might have been recommended something that you know isn’t right for you - and want to try a different approach.

Most healthcare professionals are more than happy to support you and respect your decisions. Sometimes you might have to do your own research and ask more questions. We hope this information will help.

FiveXMore campaigns for better maternal outcomes for Black women and birthing people in the UK. They have more information about your rights in pregnancy and how to speak up for yourself during your pregnancy journey.

Every birth experience is unique, and it's important to have open and fair communication with healthcare providers. Trust your instincts and advocate for the birth experience you wish for. Don’t be afraid or feel shy about anything on your mind during the birthing process 

Shruti  

What is (and isn’t) informed consent?

You have a right to make decisions about your care and say ‘yes’, ‘no’ or ‘not right now’ to any type of treatment, test or examination. Healthcare professionals have a duty to make sure you can do this.  

You can only be treated without your consent in rare situations (for example, if emergency or life-saving treatment is needed but you are unconscious).

Informed means that:

• you know exactly what you are saying ‘yes’, ‘no’ or ‘not right now’ to
• you are given all the information about the risks and benefits - to you personally - of all your options, including what happens if you do nothing, in a way that you understand
• you have a chance to think about what is important to you personally, as well as considering the opinions of other people whose opinions you value
• you have time to think about your decision.

Consent means saying ‘yes’. Sometimes this is written down, for example on a form you sign. Sometimes it is just saying yes, or nodding. Consent can also be ‘implied’ by an action – for example if someone comes in to give you a vaginal examination and you lie down ready, this could be implied consent.

Informed consent should be given voluntarily. This means:

• you are not put under pressure to make a particular decision by threats, for example, referral to social services
• you are not put under pressure in other ways, for example being laughed at or made to feel stupid, being told it is hospital policy, being told you cannot access a service or have someone with you if you don’t agree to something, being made to feel like an inconvenience, being rushed or being judged.

Watch Shivaunne talk about her experiences of consent, and induction of labour.

 

Understanding risk

Everything has risks.  Choosing to do nothing has risks. Deciding what risks you are comfortable with is part of making a decision.  

• Absolute risk is different to relative risk. Relative risk is how likely something is to happen compared to something else. For example, you might hear ‘the risk is doubled’, or something is ‘twice as likely’ to happen.

  Absolute risk is the actual stand-alone risk of something happening (for example 2 in 10,000).  

  2 in 10,000 is double the risk of 1 in 10,000 but both are still very unlikely to happen. You should always be given the absolute risk, when it is known. If you are not given it, ask for it.

   

• There are sometimes long-term risks and benefits to consider as well as short term risks and benefits. For example, a short-term risk of taking medicine for a pre-existing condition in pregnancy might be that some newborn babies have withdrawal symptoms. A long-term risk might be damage to your physical or emotional health in the future, which in turn could affect your baby or child.

   

• Some risks and benefits are easier to measure than others. The ones that are easier to measure often get more attention from the people who make decisions about what care to offer you. For example, it’s easier to measure short term physical risks than it is to measure long term emotional health risks. This means we know more about some risks than others. The ones we have less research or evidence for won't be talked about or thought about as much when writing guidelines.

 

• A risk threshold is when a risk becomes too high for you to be comfortable with. These can be different for different people. For example, someone who has had a stillbirth in the past is likely to want to avoid any risk of that happening again, even if the risk is still very very small. They may be more comfortable choosing an option for giving birth that comes with other risks, if it means the risk of stillbirth is as low as possible.

If something goes badly wrong in pregnancy or birth, the consequences can be huge and life changing. This means the ‘risk threshold’ in guidelines about care in pregnancy and birth are very low. A lot of guidelines and policies are made to be ‘on the safe side’. For many people, this is fine. But if these options do not feel right for you, in your personal situation, it is ok to ask questions and find out more.

Thinking about your personal situation

General vs individual (personal) risk

Most information will give you a good idea of how likely something is to happen to any one person in the population. This page about the benefits and risks of c-sections is a good example. National guidelines are based on these population level risks and benefits.

But guidelines and pregnancy information cannot tell you how likely these things are to happen to you, as an individual, with your personal medical history and situation. It is important to ask healthcare professionals about anything that could make something more or less likely to happen to you. 

‘Just-in-case' recommendations and interventions

Some recommendations are in place ‘just in case’. These can be things like always inducing labour at a certain point in pregnancy and vitamin K injections for newborns.  

These are a bit like the advice to put on a helmet when we ride a bicycle. Most of us won’t fall off anyway. But if we do, we are protected. It’s an easy decision because a helmet is an easy and safe way to protect ourselves.

But if wearing a helmet also had its own risks, we might choose not to wear it anyway, especially if we knew that in our personal situation were very unlikely to hurt ourselves when we fell off (for example, we had stabilisers on and were riding on the grass very slowly).  

You can always ask more questions about anything that is suggested or recommended. For example:

• Is this something that is recommended for everyone? Why?
• What is the problem we are trying to prevent?
• What can be done about the problem if it does happen?
• What would happen if we waited a bit longer?
• What is the risk of this problem for people like me specifically?

Your personal situation

The balance of risks and benefits is different for everyone. For example, if a treatment has a high risk of infertility in the future, this might not be a problem for you if you know you don’t want children, or more children.

Taking your time

You should usually have time to think about what you want to do (unless it is an emergency). If you are feeling under pressure to decide, it’s ok to ask why. You might find questions and phrases like these ones useful.

• Is it an emergency?
• What will happen if I don’t decide right now?
• Why do I have to decide by this date/time?
• Thank you for that information, I will go away and think about it.
• I don’t want to do that right now, but maybe we can revisit this conversation next week.

In some situations, for example when you are in labour, you may have to decide more quickly. It can help if you have thought things through beforehand. Some people make a birth plan but also include their preferences if things do not happen that way – a plan B and C.  

Asking questions

B.R.A.I.N.S is a way of remembering important things to ask yourself and your doctor or midwife when you are making decisions about your care.

B - Benefits. What are the benefits of having this treatment?  

R – Risks. What are the risks (short and long term) to me and my baby? What are the risks of not having it? What risks am I comfortable with?

A – Alternatives. What are the alternatives? Can it be carried out differently if I need it to be?

I – Instinct. What is your instinct telling you? What feels right for you?

N - Nothing. What happens if I do nothing right now? I am not ready to do anything yet/I need more time?

S – Second opinion. Can I get a second opinion from another doctor/ midwife? Who else could I talk to about this? Friends, family or your partner?

Finding out more – doing your own research

Doing your own research can help you feel confident and comfortable with your decision. There are lots of ways you can find out more.

• Read our information pages. We have lots of useful information on pregnancy and birth. These pages are based on the latest research and guidelines and updated regularly.
• Ask our midwives. Our midwives are happy to talk to you about any aspects of pregnancy and loss and help you make decisions about your care. You can call them on 0800 0147 800 or email [email protected].  
• Talk to other people. Partners, family members and friends may all have different and useful opinions. Sometimes just saying things out loud to someone else can help. You might also find it helpful to ask in online pregnancy groups and forums too.
• Get a second opinion. Different doctors and midwives have different education, experience and opinions. You can get a second opinion to make sure you get balanced advice.  
• Ask experts. For example, Epilepsy Action and Diabetes UK have specific pages about pregnancy with these conditions. BUMPS (Best Use of Medicine in Pregnancy) provides reliable, up to date and accurate information about the use of medicines in pregnancy, what we know and what is unclear. Birthrights can offer you information on your rights and support you to have the birth you want.

 

Talking to your doctor or midwife about your decision

Your midwife or doctor has to offer you certain things – because of hospital policy or national guidelines. They should explain why clearly and give you time to ask questions.  

They should still support you if you ask for more information about other options or if you need more time to decide.

‘I had considered all the options, spoken to friends who were doctors, gathered similar     experiences online and done my own research. I wrote a list of all the reasons for my decision to take with me and put in my notes. I went into my consultant appointment ready for a difficult conversation, but she was very supportive and agreed immediately.’  

Rose  

Some people have said that they are told ‘let’s wait and see’ or ‘let's cross that bridge when we come to it’. It’s ok to say that you want to have a conversation now, so you feel prepared.  

Watch Natasha explain why and how she asked for a different midwife.

 

It’s not ok for health professionals to use fear-based tactics. If someone uses blanket statements like ‘if you don’t choose this option, your baby could die’, you can tell them that this isn’t helpful. Ask them for the evidence so you can understand more about how likely this is, compared to all your other options.  

We have more information on talking to your doctor or midwife about induction, with a list of questions that could be changed to use in different situations.

It can help to have someone with you to support you. This could be your partner or family member. It could also be a doula or other birth companion. Research shows that having a doula can help improve outcomes for you and your baby and help you feel listened to.

FiveXMore campaigns for better maternal outcomes for Black women and birthing people in the UK. They have more information about your rights in pregnancy and how to speak up for yourself during your pregnancy journey.