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Information for Pelvic Girdle Pain In Pregnancy

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Information for Pelvic Girdle Pain In Pregnancy

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This is a great leaflet for information on Pregnancy related pelvic girdle pain.

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Have you been told you have low-lying Placenta? Placenta praevia?, placenta accreta? or vasa praevia?

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Have you been told you have low-lying Placenta? Placenta praevia?, placenta accreta? or vasa praevia?

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🟣 Low‑Lying Placenta & Placenta Praevia

🟢 What is it?

The placenta is your baby’s lifeline.

Sometimes it sits low in the womb:

📍 Low‑lying placenta = close to cervix

🚫 Placenta praevia = covering the cervix (rcog.org.uk)

👉 This can affect how your baby is born.

🟡 Will it move?

✅ In most pregnancies, the placenta moves upwards as your baby grows
✅ Only a small number stay low later in pregnancy (rcog.org.uk)

🔴 Symptoms – IMPORTANT

⚠️ Go to Maternity Triag immediately if you have:

Vaginal bleeding (often painless)

Contractions or abdominal pain

🚨 Bleeding can be heavy and sudden

🔵 Your care plan

📅 Scans

20‑week scan → placenta position checked

32‑week scan → see if it has moved

36‑week scan → final check if needed

🛑 Safety advice

Avoid sex or vaginal examinations (if advised)

Stay alert to symptoms

Keep hospital contact numbers nearby

✅ These reduce the risk of bleeding

🏥 If bleeding happens

Attend Maternity Triage to be seen immediately.

You and your baby will be Monitored

Admission may be needed if bleeding continues.

🟣 Birth planning

✔️ Placenta moves → A vaginal birth is possible.

❗ Placenta still low/covering →
👉 Planned Caesarean birth

📅 Usually around 36–37 weeks (rcog-irc-bd.org)

⚠️ Why it matters

Risk of heavy bleeding

Possible early birth

May need planned Caesarean (rcog.org.uk)

💬 Key message

💡 Most low‑lying placentas resolve naturally
💡 Always report any bleeding immediately
💡 Your team will plan a safe birth for you and baby.

Placenta accreta is a rare but serious condition when the placenta is stuck to the muscle of your womb and/or to nearby structures such as your bladder. This is more common if you have previously had a caesarean. It may cause heavy bleeding at the time of birth. (RCOG,2018)

Vasa praevia is a very rare condition where blood vessels travelling from your baby to your placenta, unprotected by placental tissue or the umbilical cord, pass near to the cervix. If these blood vessels tear, this can be very dangerous for your baby.(RCOG, 2018)

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Shared Decision Making

If you are asked to make a choice, you may have lots of questions that you want to ask. You may also want to talk over your options with your family or friends. It can help to write a list of the questions you want answered and take it to your appointment.

Ask 3 Questions

To begin with, try to make sure you get the answers to 3 key questions, if you are asked to make a choice about your healthcare:

1. What are my options?

2. What are the pros and cons of each option for me?

3. How do I get support to help me make a decision that is right for me?

*Ask 3 Questions is based on Shepherd et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial. Patient Education and Counselling, 2011;84:379-85 https://www.aquanw.nhs.uk/sdm

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Placenta praevia, placenta accreta and vasa praevia

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This information is for you if you have placenta praevia (a low-lying placenta after 20 weeks of pregnancy) and/or placenta accreta (where the placenta is stuck to the muscle of your womb). It also includes information on vasa praevia. It may also be helpful if you are a partner, relative or friend of someone in this situation.

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Essential information to read about how to protect your new baby from the Respiratory Syncytial Virus (RSV)

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Information, support and guidance for families living in Harlow District

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Search for your closest vitamin dispensary

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Find healthy start vitamins services - NHS

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Find healthy start vitamins services near you on the NHS website.

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MASIC is a charity to support women following an Obstetric Anal Sphincter Injury (OASI), otherwise known as 3rd/4th degree tear.

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Need advice? Please email Birth Injury Support at info@masic.org.uk or call 0808 1640 8333

We are advocates for women and aim to change the lives of those injured during childbirth.

Find out more

Who are MASIC?

MASIC exists to support women, challenge stigma and drive change.

The MASIC Foundation is the only multi-disciplinary UK charity to support women who have suffered severe injuries during childbirth known as OASI (Obstetric Anal Sphincter Injuries).

The charity is run by injured women and healthcare professionals who are committed to better detection and prevention of injury during childbirth.

Find out more

Women's stories

Breaking the silence. Read stories from MASIC advocates who have suffered injuries during childbirth.

Telling women's stories is the most important thing we can do as a charity. When women are brave enough to speak out, change happens. This page is dedicated to telling those stories, and to the women who have been honest and incredibly brave in sharing their experience.

If you have a story to tell we are dedicated to supporting you and making your voice heard.

Please email socialmedia@masic.org.uk and we will help you to tell your story.

Read more stories

Looking for support?

There is support available if you need it, don't suffer in silence and don't be afraid to ask for help and advice.

MASIC can help you over come the physical and emotional trauma you may have experienced during and after child birth. We can support you and guide you to helpful resources, all you need to do is get in touch.

Get Support

Not sure where to start?

Please call the MASIC 24h freephone Birth Injury Support Helpline 0808 1640 8333

My name is Luce. I'm a writer. A partner. A mum. And I had a difficult birth which left me thunderstruck, confused, sad, broken, and well, pretty angry. My reaction to birth trauma was unconventional. I wrote a book - a gory, funny, moving book - about the truth of it for me, what I saw and heard and felt as I gave birth and then coped with injuries, continence issues, depression, and trauma. I needed to speak out because traumatic births are often undiscussed. Recognition is important - we don't talk enough about births that aren't picture-perfect, as if they should be hidden in shame. Like MASIC, I'm here to say it isn't shameful. And don't worry - you have found your people. Like my book this website is a place for all of you - the entertainers, the shell-shocked, new mums and old hands - to share, process, or even just start to think about what is happening, and why googling 'birth trauma' or 'MASIC' late at night is a good thing. You are not alone.

85%

of women with severe birth injury said it impacted on their relationship with their child

78%

were affected by traumatic memories of the birth

52%

stated they were embarrassed by the symptoms of their injury

49%

of women affected said they doubted their ability to mother

45%

suffered postnatal depression as a result of their injury

24%

of women affected regretted having a child because of the injuries sustained

Meet the MASIC team

We are a collection of healthcare professionals & MASIC advocates, existing to give a voice to women's childbirth stories.

The Executive Board

We are led by a small and very experienced Executive team who are dedicated to improving outcomes for women with birth injuries.

Products that will help improve your life

Products that can help make everyday life a bit easier.

After sustaining a birth injury it is so important to know that there are products and services out there that can help make everyday life a little bit easier, and help you to feel a little bit more like YOU again.

We recommend the products here that have been tried and tested by our MASIC advocates - women who understand what it's like to cope with symptoms on a daily basis, and who know what has helped them.

Discover More

MASIC News

Keep up to date with all our latest news and stories

If you would like to be kept informed of MASIC's work and our most recent projects please click on our news items in this section and sign up to our MASIC mailing list.

We would love to hear from you if you are an injured woman or a health professional interested in working with us.

Read more stories

Cookie Policy

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept", you consent to the use of ALL the cookies.

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Home - Aiming to change the lives of women injured during childbirth.

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MASIC supports women who have suffered injuries during childbirth; OASI, Obstetric Anal Sphincter Injuries, or 3rd degree & 4th degree tears.

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Royal College of Gynaecology and Obstetrics information on tears.

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This hub aims to inform about the types of tears that can occur during childbirth, how to minimise your risk of deeper tearing, and what can be done to help your recovery if you do tear.

We also aim to support you to take prompt action if you have any concerns about your recovery, helping you feel better informed when discussing any topics with a healthcare professional.

This information has been developed by the OASI Care Bundle Project Team, the OASI Care Bundle Clinical Champions and perineal specialists.

It is based on the RCOG Green-top Guideline No.29 The Management of Third and Fourth Degree Tears (June 2015) and expert opinion from the above named developers and key stakeholders in line with RCOG due process.

Please give us your feedback

We would like to understand how people are using this resource to help ensure it is relevant and useful. To give us your feedback, please complete our short survey.If you have any questions, please email womensvoices@rcog.org.uk

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Perineal tears and episiotomies in childbirth

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Welcome to our hub for perineal tears and episiotomies in childbirth.

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Information to help you manage the early stage of labour.

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In the short and medium term, vaping poses a small fraction of the risks of smoking. However, vaping is unlikely to be risk-free, particularly for people who have never smoked.

If you are using a vape to help you stay smokefree, it is far safer for you and your baby than continuing to smoke.

Talk to your midwife or self refer to the maternity stop smoking team for more support & information.

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The Best Start in Life parent hub

From pregnancy to childcare right through to starting school, get advice and support for your child’s development.

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D negative blood test to check unborn baby's blood group

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D negative blood test to check unborn baby's blood group

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If your blood group is D negative, this information leaflet covers all you need to know about a blood test to check your unborn baby's blood group

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Leaflet - D Negative Mother's Blood Test to Check Her Unborn Baby's Blood Group

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Healthy eating in pregnancy - Best Start in Life - NHS

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Having a healthy diet is important in pregnancy, find out which foods to include in your pregnancy diet.

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Information if your pregnancy is 37 weeks or over and your water's release before you are in labour.

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Information if your pregnancy is 37 weeks or over and your water's release before you are in labour.

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This information is to support you to make the decisions that are right for you.

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Speak with your midwife if you wish to be referred to the in-house Maternity stop smoking team or contact us directly.

We can offer a wide range of support which includes Nicotine Replacement Therapy, Vapes and behavioural support.

If you have a partner that smokes and needs support to quit we can refer them to our local authority partners who will see them as a priority.

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Exposure

Exposure to carbon monoxide is usually from one of three ways:

Cigarette smoke – this is the most common reason

Faulty or poorly ventilated cooking or heating appliances
(this includes gas, coal, wood and parafin appliances)

Faulty car exhausts

If you or anyone in your home smokes, this is the most likely explanation for the high reading

Reducing your exposure to cigarette smoke is the most important thing you can do for you and your baby’s health.

This may be by quitting smoking yourself or reducing your exposure from others, by asking smokers not to smoke in the home, car or in front of you.

Once you stop, the carbon monoxide clears from your bloodstream and that of your baby, allowing a good flow of oxygen to support their growth and development.

Your midwife can discuss options to help you quit, and will refer you to the maternity stop smoking service.

If you are not usually exposed to cigarette smoke, but you have a reading of 4 or more, you may have been exposed to carbon monoxide through faulty heating or cooking appliances

We strongly recommend that you get expert help from the National Gas Emergency Service Line

0800 111 999

or go to cadentgas.com/emergencies/smell-gas

It is important to check that your heating and cooking appliances are safely installed. You may wish to buy a carbon monoxide alarm that will detect low levels of carbon monoxide in your home.

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You can choose to have a vaginal birth or a caesarean birth.  

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You can choose to have a vaginal birth or a caesarean birth.  

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This website is created by a team based at the University of Liverpool to empower pregnant women and birthing parents to make an informed choice about their birth.

We believe that providing information about vaginal births, caesarean births, and inductions without judgement or agenda will support women and birthing people in preparing for birth and making the decisions right for them.

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Balanced information about vaginal and caesarean birth and induction of labour.

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Welcome to the Neonatal Unit at The Princess Alexandra Hospital

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Information about The Neonatal Unit at Princess Alexandra Hospital can now be translated into various languages using Reach Desk Feature on the Website. 

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Information about The Neonatal Unit at Princess Alexandra Hospital can now be translated into various languages using Reach Desk Feature on the Website. 

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Hospital Information Parking Neonatal Unit- Parking is free for Parents of babies on the neonatal Unit – please ask on the unit for details how to obtain free parking. Ward Information Neonatal Unit- Bliss Baby Charter NICU is located in zone A, lower ground floor, location A28; adjacent to the early pregnancy unit. You will need […]

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Neonatal Unit Parent Information Booklet

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Neonatal Unit Parent Information Booklet

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Everyone is different but here is a list that you might find helpful.

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Feeling your baby move is a sign that they are well

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Feeling your baby move is a sign that they are well

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Immunisations for you, your baby and your family 

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Immunisations for you, your baby and your family 

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Immunisations Informational Infographic (Updated September 25) (1)

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Want to know more about the service, or to complete a referral? Click here!

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The Princess Alexandra Hospital NHS Trust

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Anyone can be affected by pelvic health problems during, or after pregnancy.
This includes accidental bladder or bowel leakage (known as incontinence), painful sexual intercourse and pelvic organ prolapse.

The perinatal pelvic health service (PPHS) offers support to those experiencing pelvic health problems, including early access to physiotherapy if required.

Women and birthing people can self-refer to the service at any point throughout their pregnancy journey, or up to 12 months after their baby is born.

To access the service, please complete the self-referral form via this link.

If you need support to fill out the form, please call 07484079833 and a member of the team (pictured, below) will be able to assist you.

The team are available from Monday-Friday, 9am to 5pm. Once you have submitted your completed form, a member of the team will contact you within five to seven working days.

How do I access support from the PPHS?

Is there a limit to accessing the service?

How can I self-refer to the PPHS?

Types of referrals

Antenatal

Postnatal

What is pelvic floor dysfunction?

How do you treat pelvic floor dysfunction?

What will happen at my first appointment?

If I have my period, should I still come to my appointment?

Can I bring my baby to the appointment?

Can I bring someone with me?

Can I refer myself to the service if it is over 12 months since I had my baby?

I am pregnant but not due to give birth at The Princess Alexandra Hospital, can I refer myself?

Useful resources

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Perinatal pelvic health service - The Princess Alexandra Hospital NHS Trust

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Anyone can be affected by pelvic health problems during, or after pregnancy.This includes accidental bladder or bowel leakage (known as incontinence), painful sexual intercourse and pelvic organ prolapse. The perinatal pelvic health service (PPHS) offers support to those experiencing pelvic health problems, including early access to physiotherapy if required.

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Make sure you have an appointment with your GP when your baby is 6-8 weeks old. This is for your well-being and for your baby too! 

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Make sure you have an appointment with your GP when your baby is 6-8 weeks old. This is for your well-being and for your baby too! 

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Find out about the postnatal check that happens around 6 weeks after the birth, where you can discuss any health issues you may have, including contraception.

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Welcome to the Neonatal Unit - Please find our information here!! Congratulations on having your baby!

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Welcome to the Neonatal Unit - Please find our information here!! Congratulations on having your baby!

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The Princess Alexandra Hospital NHS Trust

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Neonatal Intensive Care Unit (NICU) - The Princess Alexandra Hospital NHS Trust

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Babies can be born early, or your doctor or midwife may decide that your baby needs to be delivered early. In these cases your baby may need to be cared for in our Neonatal Unit, where we provide intensive, high dependency and specialist care for sick newborn babies, depending on their needs. Our staff are […]

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Recognising jaundice on black and brown skin

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Recognising jaundice on black and brown skin

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Choices when pregnancy reaches 41 weeks.

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Choices when pregnancy reaches 41 weeks.

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This information is to help you make an informed decision about what care you would like if your pregnancy reaches 41 weeks.

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Group B Streptococcus (GBS) is one of the many bacteria that normally live in our bodies and which usually cause no harm

Screening for GBS is not routinely offered to all pregnant women in the UK

If you carry GBS, most of the time your baby will be born safely and will not develop an infection. However, it can rarely cause serious infection such as sepsis, pneumonia or meningitis

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Are you feeling low, worried or stressed? We are here to help you - for people who live in Hertfordshire or mid Essex

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Are you feeling low, worried or stressed? We are here to help you - for people who live in Hertfordshire or mid Essex

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Hertfordshire Talking Therapies and Mid Essex Talking Therapies services are part of the NHS Talking Therapies, for anxiety and depression programme, offering free and confidential talking therapy and employment support.

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Hertfordshire Talking Therapies and Mid Essex Talking Therapies services are part of the NHS Talking Therapies, for anxiety and depression programme, offering free and confidential talking therapy and employment support for Hertfordshire and Mid Essex residents.

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The Maternal Mental Health Alliance (MMHA) is a UK charity and network of 130 organisations, dedicated to ensuring women and families affected by perinatal mental health problems have access to high-quality, compassionate care.

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The Maternal Mental Health Alliance (MMHA) is a UK charity and network of 130 organisations, dedicated to ensuring women and families affected by perinatal mental health problems have access to high-quality, compassionate care.

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Support for mums and families | Maternal Mental Health Alliance

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© Maternal Mental Health Alliance 2023. Maternal Mental Health Alliance is a charitable Incorporated Organisation (CIO) registered in England and Wales No. 1178152. Registered address International House, 12 Constance Street, London E16 2DQ.

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Personalised care is centred on you, your baby and your family, based around your needs and your decisions, where you have genuine choice, informed by unbiased information

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Personalised Care and Support Planning in Maternity Services

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Our role as health care professionals is to support you and make sure you have everything you need to make the decisions that are right for you.

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5 Tips for HCPs FXMore X RCOG.pdf for banners

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Six Steps to Advocate for yourself  FiveXMore NOV24

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Choices after a previous caesarean birth

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Choices after a previous caesarean birth

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Published: July 2016

Please note that this information will be reviewed every 3 years after publication.

This information is for you if you have had one caesarean birth and want to know more about your birth options when having another baby.

It may also be helpful if you are a partner, relative or friend of someone who is in this situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information covers:

Choices for birth after having one previous caesarean

The chances of a successful vaginal birth after caesarean (VBAC)

The advantages and disadvantages of VBAC and when it isn't advisable

The advantages and disadvantages of an elective (planned) repeat caesarean (ERCS)

What happens during labour if you're planning a VBAC

What happens if you are planning a VBAC but you don't go into labour

What happens if you have an ERCS planned but you go into labour

Within this information, we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms.

Key points

If you are fit and healthy, both VBAC and ERCS are safe choices with very small risks.

3 out of 4 women who have had one caesarean section and then have a straightforward pregnancy and go into labour naturally give birth vaginally.

9 out of 10 women will have a successful VBAC if they have ever given birth vaginally. Successful VBAC has the fewest complications.

Giving birth vaginally carries small risks for you and your baby but, if you have a successful vaginal birth, future labours are less complicated with fewer risks for you and your baby.

Having a caesarean section makes future births more complicated.

Most women who have a planned caesarean section recover well and have healthy babies, but it takes longer to get back to normal after your baby is born.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Clinical Guideline Birth after Previous Caesarean Birth.

This information was reviewed before publication by women attending clinics in Raigmore Hospital, King's College Hospital, Queen's Hospital, St Mary's Hospital, University Hospital Lewisham and Wrexham Maelor Hospital, by the RCOG Women's Network and by the RCOG Women's Voices Involvement Panel.

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Birth after previous caesarean patient information leaflet

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Pelvic Partnership is a national charity that offer support and information about pelvic pain in pregnancy

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The Pelvic Partnership is a national charity offering support and information about pregnancy-related pelvic girdle pain (PGP).

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Induction of labour guideline at Princess Alexandra 

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Induction of labour guideline at Princess Alexandra 

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Information about care during an induction of labour at Princess Alexandra

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Information about care during an induction of labour at Princess Alexandra

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National guidance on induction of labour

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National guidance on induction of labour

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1.1.1 Discuss preferences about mode of birth with women early on in their pregnancy. Take into account their individual circumstances, and discuss that options for birth can include:

1.1.2 Confirm a woman's preferences for birth at antenatal visits towards the end of pregnancy, as these may have changed since earlier discussions. [2008, amended 2021]

1.1.3 Explain to women that induction of labour is a medical intervention that will affect their birth options and their experience of the birth process. This could include that:

vaginal examinations to assess the cervix are needed before and during induction, to determine the best method of induction and to monitor progress

their choice of place of birth will be limited, as they may be recommended interventions (for example, oxytocin infusion, continuous fetal heart rate monitoring and epidurals) that are not available for home birth or in midwife-led birth units

there may be limitations on the use of a birthing pool

there may be a need for an assisted vaginal birth (using forceps or ventouse), with the associated increased risk of obstetric anal sphincter injury (for example, third- or fourth-degree perineal tears)

pharmacological methods of induction can cause hyperstimulation - this is when the uterus contracts too frequently or contractions last too long, which can lead to changes in fetal heart rate and result in fetal compromise

an induced labour may be more painful than a spontaneous labour

their hospital stay may be longer than with a spontaneous labour. [2021]

1.1.4 Discuss with women being offered induction of labour:

the reasons for induction being offered

when, where and how induction could be carried out

the arrangements for support and pain relief (see also recommendations on pain relief)

the alternative options if the woman chooses not to have induction of labour, or decides at a later stage that she no longer wishes to proceed with the induction process

the risks and benefits of induction of labour in specific circumstances, and the proposed induction methods

that induction may not be successful, and how this would affect the woman's options (see the recommendations on unsuccessful induction). [2008, amended 2021]

1.1.5 When offering induction of labour:

give women time to discuss this information with others (for example, their partners, birthing companion or family) if they wish to do so before making a decision

encourage women to look at other information (for example, by providing written information leaflets or encouraging them to look at information on the NHS website)

ensure women have the opportunity to ask questions, and time to think about their options

recognise that women can decide to proceed with, delay, decline or stop an induction. Respect the woman's decision, even if healthcare professionals disagree with it, and do not allow personal views to influence the care they are given. Record the woman's decision in her notes. [2008, amended 2021]

1.1.6 Provide information on induction of labour in line with the NICE guideline on patient experience in adult NHS services. [2021]

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This guideline covers the circumstances for inducing labour, methods of induction, assessment, monitoring, pain relief and managing complications. It aims to improve advice and care for pregnant women who are thinking about or having induction of labour

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How will I know what decision is right for me? 

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How will I know what decision is right for me? 

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The BRAIN tool can help you ask questions that will help you make the decisions that are right for you.

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This information from Birthrights will help answer questions about informed consent.

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Consent means saying yes. You have the right to make your own decisions about your body, just as you do at any other time.

It is against the law to give you medical treatment unless you agree to it. It is also against the law for treatment to be given to your baby without your consent or the consent of another person with parental responsibility.

Agreeing to treatment is known legally as giving consent. In law, your consent must be genuine. This means you must understand the treatment well enough to make a decision. It also means that no one, including your family or healthcare professionals must put pressure on you or bully you into agreeing to have the treatment.

If you are a surrogate you have the same rights as any other woman or birthing person to make decisions about your body.
You cannot be treated unless you agree
No one can treat or touch you against your will. Even if health professionals don't agree with your decisions about your body, they must respect them. Health professionals must ask if you agree to any medical treatment. For example, they must ask before examining you, before taking your blood pressure, and before giving you pain relief. This is the law.

If you do not agree to treatment, but health professionals still treat you, they may have broken the law.

The only time health professionals do not need your consent to treatment is when you are not able make a decision. It is very rare in law for someone to be unable to make their own decisions.

It could be because it is an emergency and you are unconscious. In this situation healthcare professionals must only give you treatment and care that you need to stay alive and safe.

Very rarely, you may not be able to give consent because you cannot understand the choice you need to make even when it is very clearly explained. This is called not having mental capacity. Our factsheet Mental capacity and maternity careexplains.

If you have particular communication needs or are worried about communicating, talk to your doctors and midwives so you can plan the best way for you to give or not give consent.

A healthcare professional must ask you before they examine you, investigate anything, or give you any care or treatment. You must be asked whether or not you agree to every medical procedure, even if it is as minor as taking your blood pressure. You don't have to speak to show that you agree. You could simply hold your arm out for the blood pressure cuff.

Remember that you do not have to agree. It is not your role to please healthcare professionals. It is their role to look after you in the way that you want. They must ask you every time they carry out a procedure (this includes things like blood tests, monitoring your blood pressure, internal examinations or offering you medication). Even if you consented to this examination or treatment before, they must ask you again. They must be clear about what they are asking.

For example, if your midwife wants to carry out a vaginal examination, they need to tell you in language that makes it clear that they will be putting their fingers inside you. Saying something like, 'Can you just hop up on the bed and we'll have a look and see how you are doing' is not clear. In addition, it is wrong for a healthcare professional to carry out further interventions; for example, I just did a "sweep" while I was there'. They should ask your permission in advance. (A sweep is an internal procedure which is intended to start labour.)

Making a birth plan and having respectful conversations with your healthcare professionals early in your pregnancy can help you think about the treatment and care you may be offered. You can specify in your birth plan any treatment you do not want.
For example, if you do not want vaginal examinations during your care, talk to your midwife about this during your antenatal care. Make sure your choice is written in your notes and birth plan. You do not have to say why you do not want to have vaginal examinations. If you are comfortable explaining why, this can help your midwives suggest care that may work for you.

If y ou do not think your healthcare professionals are listening to you when you refuse consent, you can contact us for advice.

At some point in your pregnancy and labour your healthcare professionals may think your care or treatment should change. If anything changes, they must tell you what is different and ask you again. If the treatment could now bring new risks or new benefits, they must ask your consent again.

You need to know who is giving you maternity care and agree. You must be asked before a medical student can be part of your care.

In some cases you might be asked for consent ahead of time. You can still change your mind afterwards.

If you are going to have an operation such as a planned caesarean section, the doctors should offer you a proper conversation about the risks and benefits ahead of time. They cannot do anything during the operation that you haven't agreed to unless it will save your life or prevent serious harm.

Even if you have discussed your care in advance, you should still be offered another discussion at the time of the procedure in case things have changed or you have changed your mind.
For example, if you have been booked for an induction you can change your mind and decline the induction at any time, including on the day of the procedure.
You do not have to agree to procedures simply because they are standard in this particular hospital or birth centre.

Before you decide about any care or procedure the healthcare professionals must give you information about what will happen.

The information should tell you about any risks that will be important to you. It should tell you if there are other treatments you could have instead and the risks and benefits of those. It should tell you what could happen if you don't have the treatment.

Your doctor should listen to you and find 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 also have a personal discussion with your healthcare professional.

You might want to use the BRAIN framework to help you get the answers you want:

B - What are the B enefits?

A - What are the A lternatives?

I - What does your I ntuition (gut) say about what's right for you?

N - What would happen if I said No or N ot now?

Your healthcare professional must not give you misleading information. The information must be up to date and based on the most recent evidence. They should give you as much information as they can to help you need to make a decision.

They must make it easy for you to ask questions, and they should answer your questions properly. If there is a question that they cannot answer, they should explain why (for example if the information isn't available). They may be able to help you find out information you need if it is available or point you to where that information might be.

If you need an interpreter or support to communicate the Trust should provide this.

You can ask for things to be explained again. It is ok to ask questions about what you were told and why during a previous appointment or during a previous pregnancy.

You have the right to request care but healthcare professionals do not always have to offer care if there is a good reason why they should not.

You should be listened to and taken seriously when you ask for care.
For example, if you ask for pain relief or for your pain relief to be topped up, it should be given unless there are good reasons against providing it. If there is a medical reason for refusing pain relief because it could cause you harm ('a clinical contraindication') then your doctor or midwife should explain this to you and document the discussion.
You can write a birth plan to tell people what care you want during labour and after. Your midwife or doctor should help you to make a birth plan that will be included within your maternity records.

You may also want to think about what is important to you and what you would like to happen in various situations. It can help you think about any boundaries you have, for example if you never want to be naked or be examined internally.

You can give your preferences, for example that you want your baby to be placed skin-to-skin with you after the birth.

Making your birth plan should be a collaboration between you and the health professionals supporting you, sharing information and finding out the best way to care for you and meet your wishes.

Your birth plan has no legal status, but if it has been agreed with your midwives and doctors then this should indicate that they are happy with it and will follow it. Even if you have chosen care that is not what they recommend, they should respect it and try to meet your wishes. A birth plan can be used in court as evidence of your wishes and the informed decisions you had taken at the time it was made.

If you have a disability any reasonable adjustments should be recorded in your notes/ birth plan. This could include, for example, room for your wheelchair in the birthing suite, lighting that lets you see better, a quiet or dark room to help with sensory overwhelm, or time after the birth to recover from fatigue. If you need reasonable adjustments under the Equality Act 2010, the Trust has to provide these.

No matter what you say in your birth plan you can change your mind and consent to different care at any time.

Your birth plan can include the role you want a birth partner or doula to play.

After giving birth, you can challenge the treatment you received. Your birth plan can be evidence of the consent you gave or did not give.

If there are medical reasons not to give you the treatment in your birth plan, your healthcare professionals should explain them.

Healthcare professionals have a duty to prevent suffering that can be avoided. They must not refuse you pain relief or other support simply because of a hospital guideline or policy.

Your healthcare professional's job is to explain the risks of treatment to you. They can recommend one treatment over others and give you their reasons for this. But they must not put pressure on you to choose a particular treatment for yourself or your baby.

If your healthcare professional puts pressure on you to make you choose a particular treatment, this is called undue influence.

Undue influence could mean that your healthcare professional keeps discussing risks even when you have made a decision.
For example, you may have decided that you do not want an induction. You discuss the risks and benefits with the midwife, who is worried about your decision. They call in the senior midwife, who repeats their concerns. Then the consultant obstetrician comes to see you and repeats them again. Unless the risks have changed and your health professionals want to give you new information, this may comprise undue influence.
It may also be undue influence if your health professional threatens to stop caring for you.
For example, if they said, 'Once you are 42 weeks pregnant the home birth team won't be able to come out to you and you will have to give birth in hospital' or 'If you don't agree to giving birth on the labour ward you will have to find another Trust to look after you.'
It may be undue influence if your healthcare professional tells you to make a decision by a certain time even when there is no clear medical need.
For example, they might say, 'You need to decide in the next twenty minutes' without explaining why.
They must not put pressure on people in your family to persuade you to change your mind.
For example, they might say to your partner, 'Try and talk them round. If it were my partner I wouldn't want them to do this. We only want what's best for your baby.'
They must not restrain you physically.

If your healthcare professional threatens to refer you to social services if you do not make the treatment decision they want, this is undue influence. They must never do this. If they do this, you may not legally have given consent. They could be taken to court if they went ahead and treated you.

If you have a disability or long-term illness, you may be worried that social services will take your baby away if you talk about any concerns you have about caring for your baby. They must work with you to find solutions, and you should never feel threatened.

If you are involved in the criminal justice system, you may feel worried that something you say could be used as an excuse to take your baby away. You have the same rights as everyone else and should never be threatened with social services merely because of your circumstances.

If you are in, or may go to prison during your pregnancy, the charity Birth Companions has a guide to pregnancy and early motherhood in prison.

If a woman is being treated for a mental disorder under the Mental Health Act 1983, or the Mental Health (Care and Treatment) (Scotland) Act 2003, that does not necessarily mean that she lacks capacity in relation to decisions about her maternity care. She should be treated in the same way as any other woman unless she has been assessed to lack capacity.

No. You can tell your healthcare professional that you agree to treatment. Or you can agree with a gesture, for example by holding out your arm so they can check your blood pressure.

Usually you will sign a consent form before surgery. Before you sign, you and your healthcare practitioner should talk about the treatment, the risks and the benefits.

It is important that you understand what you are consenting to, and the risks it brings.
For example, if you have a visual impairment and need to read in large print, ask for the form in large print and for plenty of time to read it.
A signed form and medical notes are evidence that you gave consent but not proof. Other evidence may show you did not have enough information or were put under pressure.

Royal College of Obstetricians and Gynaecologists guidance and guidance on consent from the Association of Anaesthetists of Great Britain and Northern Ireland state that special care must be taken when obtaining consent from women who are in labour, particularly if they are under the influence of narcotic analgesics (opiate-derived painkilling drugs).

If you can't give consent in an emergency, for example because you are unconscious, you can be treated to save your life or stop your condition getting much worse. In a situation like this, if there is time, the healthcare team should talk to your next of kin about any decisions.

It is very rare that you would be unable to give consent even if you did need emergency treatment during pregnancy or labour.

Even if healthcare professionals think your baby's life is at risk, they cannot perform procedures, such as assisted birth (forceps or ventouse), without your agreement.

If it feels like an emergency and you feel under pressure to make a decision it can be useful to ask the healthcare professional something like, 'Am I in immediate danger? Is my baby in immediate danger?' This allows you to have a conversation about what the actual risk is, and how urgently you need to make a decision.

Yes. You can refuse treatment even if your doctors or midwives think you are wrong.

If you can make decisions, you can say no to treatment for any reason. Your reason does not have to make sense to other people. You can say no to treatment even where it might lead to your death, or your baby's death.
You can say something like 'I don't want that treatment' or 'I do not consent to this treatment'.

If you need advice on refusing treatment you can contact us.

Yes. Even if you gave consent you can change your mind. This is called withdrawing consent.

You can do this at any time. If your healthcare professional suspects you may no longer want the treatment, they must stop as soon as possible. They should talk to you and only carry on if they are sure you consent.
For example, you can say 'Stop'. If you want some time to process what is happening you can say 'wait a minute, please'. You can move away, if you are able to. If you are in labour, you can ask for the healthcare professional to wait till your contraction has finished before they carry out a vaginal examination. It is always ok to say no.
Mental capacity means that you can understand the choice you need to make about treatment and can make a decision.

In law, everyone has mental capacity unless it can be shown that you do not. It is very rare to not have mental capacity.

The people caring for you cannot say you do not have capacity simply because you do not agree with them.

If you are 16 or 17 then the law presumes that you have the capacity to consent to medical treatment.

If you are 16 or 17 and you wish to decline care, then in rare and serious cases someone with parental responsibility or the Court could override your decision. This should only happen if declining care would be likely to lead to your death or severe permanent injury.

If you are under 16 then you can consent to treatment if your healthcare professionals believe that you fully understand what is involved. This is called having Gillick competence. Otherwise someone with parental responsibility can consent for you.

Labour can be tiring and hard work but it is very unlikely that giving birth will make it hard for you to give consent.

During your pregnancy you should be supported to think about what you might want during labour. You should be given plenty of time and opportunities to discuss decisions that might come up in your case.

If you are in labour your health professionals must take extra care to be sure you have consented to treatment. They must take even more care if you are given painkillers called narcotic analgesics. These are opioid drugs and can make you sleepy.

If you know you will find it hard to communicate during labour, talk to your healthcare professionals early.
For example, this could be because you use British Sign Language and need an interpreter. Or it could be because you are autistic and pain can make it very hard for you to speak or use your assistive technology.
Providing communication support is called a 'reasonable adjustment'. The Trust or Board must make sure that anyone who is disabled has equal access to all of its services. This applies throughout your pregnancy, labour and postnatal care. It includes making sure you can communicate and give informed consent when giving birth. This applies to written as well as spoken communication.

You are the expert in what you need in order to communicate and your healthcare professionals must listen to you.

Only you can give consent to your treatment or care.

You can ask a birth partner, including a doula, to support you during labour. You can ask them to communicate on your behalf to express the preferences you have made in your birth plan.

If something changes in your labour and you need to give consent to something that isn't covered in your birth plan, only you can make that decision.

Your birth partner or doula can support you in this situation. You can ask for some time to discuss the decision alone with them if you want. Or, for example, they can assist you by asking on your behalf for more information about any new risk the midwife raises, how urgent a treatment really is, and how important it is.
Some autistic people can find it very difficult to communicate during labour and to give or refuse consent. It can be hard for autistic people to show that they are in pain, and it can be hard for them to speak when in pain or experiencing sensory overload. If you are autistic, you can ask an advocate to support you from the start of your pregnancy. During labour, if your advocate recognises your personal signs that you are distressed they can ask the health professional to stop by saying, 'Stop', or 'I don't think they want you to continue'.
Yes. Before treating a baby, healthcare professionals must ask consent from a person with 'parental responsibility' for the baby.

In law, the mother always has parental responsibility for her baby. The father has parental responsibility if he meets certain criteria.

A trans man who has given birth will legally be described as the mother under current law. Non-binary birthing people are also described as mother at present.

If parents decline treatment for their baby, healthcare professionals should respect their decision.

No one should threaten parents with a referral to social services to make them consent to treatment for their baby.

A baby should only be referred to social services if health professionals think ('have reasonable belief') that the baby is at risk of significant harm.

In rare and serious cases, including if parents disagree about treatment or doctors feel that the parents' decision is not in their child's best interests, healthcare professionals may ask the High Court to decide. They can ask the High Court to declare that the treatment should be carried out, or not carried out, because it is in your baby's best interests.

Law and guidance

Everyone has the right to make decisions about their body for themselves. This is called the principle of autonomy.

The principle of autonomy is protected under Article 8 of the European Convention on Human Rights and common law of England and Wales, and common law in Scotland. You can read more on our factsheet Human Rights in Maternity Care.

The law says that pregnant women are entitled to make autonomous decisions in the same way as any other person. Even if healthcare professionals disagree with their decisions they must respect them.

The principle of autonomy creates a legal requirement to seek a person's consent whenever they are given any medical treatment.

The only exceptions are rare cases: when a person does not have the capacity to make their own decisions; or in an emergency when a person cannot consent because of their physical condition (for example when they are unconscious).

If a person's consent is not obtained, the medical treatment will be against the law. It will be negligent, and in England and Wales, it will also constitute the crime of battery, and a civil wrong of trespass to the person.

Failure to obtain consent also violates Article 8 of the European Convention. If the harm that occurs as a result is serious, it will breach Article 3 of the European Convention prohibiting inhuman and degrading treatment.
Consent includes knowing who is providing healthcare
In the case of Konovalova v Russia (2015), the European Court of Human Rights held that women's consent must be sought for all medical care provided during labour and this included consent for medical students to be present during a birth. As a result, any person who is providing maternity care should be clear about their status and explain if they are a student, so that the patient can decide whether they wish to receive care from them or to have them present.

The healthcare professional must give the person the information they need before seeking consent. The information should cover any material risks, any alternative treatments that are available, and the risks of doing nothing.

In the Supreme Court case, Montgomery v Lanarkshire Health Board (2015), the court stated that the test for whether a risk is a 'material' one is whether a reasonable patient would attach significance to the risk, or whether the doctor should be aware that the particular patient would attach significance to it. This means that there must be an honest conversation between doctor and patient and the assessment of risk must be sensitive to the individual's characteristics.

When thinking about how significant a risk is for a particular patient, statistics are only one factor. For example, the risk of complications for future pregnancies after a C-section might be statistically small, but it would be more significant for someone who wished to have multiple children than for someone who did not. Every person perceives risk differently.

Hospitals cannot only rely on printed leaflets or online material to provide relevant information; there must always be a personal discussion between the patient and the health professional ( Montgomery v Lanarkshire Health Board (2015)).

Leaflets and online material can form a useful starting point for an informed conversation. Health professionals must make sure that people have time and any support they need to understand the information, to make notes, and to think about the information. When someone finds spoken communication difficult, it is important to give support and to be flexible about their preferred means of communication, for example using a pain scale or assistive technology.

Giving misleading information about someone's medical condition or the proposed treatment, or not giving them relevant information, may mean that consent was not valid. The failure to provide appropriate information may also leave the healthcare professional open to a successful claim of negligence if the person suffers harm as a result of the treatment.

If the patient asks specific questions, a healthcare professional must give full, honest and objective answers. They should take the time that is needed to do this.

General Medical Council guidance on consent sets out how doctors should support people to make decisions about their care, including how consent should be recorded.

The Royal College of Obstetricians and Gynaecologists also provides advice on consent, and on specific procedures and the risks associated with those procedures, including caesarean section, operative vaginal delivery, and participating in research while in labour.

The National Institute for Health and Care Excellence (NICE), which makes guidelines for health and social care, has guidance on improving the experience of care for people using adult NHS services, which includes information about how healthcare professionals should communicate with patients and how to present information about risks and benefits, to enable them to make decisions about their care. NICE guidance is not law, but a hospital has to give good, clear reasons if it does not follow the guidance.

Consent does not need to be recorded in writing. It may be given verbally or with a gesture. Someone might move away from a healthcare professional, shake their head, or simply say, 'No'.

It is usual practice to sign a consent form for surgical procedures, but this does not reduce the need for a fully informed dialogue between the patient and their health professional ( Montgomery v Lanarkshire Health Board (2015)).

A signed consent form and/or medical notes are evidence of consent but do not prove it was obtained: they may be contradicted by other evidence that consent was not well-enough informed or freely given.

The GMC's guidance, Department of Health's reference guide and the Scottish guide on consent contain further information on the form consent should take.

The courts in England and Wales have upheld the rights of patients to make important medical decisions affecting their lives for themselves.

A mentally competent patient has an absolute right to decline medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to his or her own death.

A mentally competent pregnant person may decline treatment during pregnancy or labour even where that might lead to death or serious harm to them or their baby.

Royal College of Obstetricians and Gynaecologists guidance states that special care must be taken when obtaining consent from women who are in labour, particularly if they are under the influence of narcotic analgesics (opiate-derived painkilling drugs).

If someone has difficulty understanding spoken English, NHS England sets out how Trusts should obtain language support. This could include hiring a professional interpreter or translating written material. Everyone needs to be able to communicate fully and understand what consent they are being asked for.

The GMC guidance on consent says that doctors should use an interpreter or translation service.

If someone's illness or disability means that they need support to communicate, this is called reasonable adjustment. The right to reasonable adjustment is set out in the Equality Act 2010.

The principle of reasonable adjustment is that the Trust must make sure that everyone has equal access to all of its services. They must put in place the support that someone needs to understand the treatment they are being offered, and to communicate their consent. This could include large print information materials for someone who needs this, lighting that enables someone to lip read, or an advocate to support understanding and communication.

The NHS has been trialling Reasonable Adjustment Flags, a way for people's needs for extra support to be highlighted to healthcare professionals every time they use the health service.
About Birthrights
Birthrights factsheets give you information about your human rights when you are pregnant and giving birth.

Birthrights champions respectful care during pregnancy and childbirth by protecting human rights. We provide advice and information to women and birthing people, train doctors and midwives, and campaign to change maternity policy and systems.

We are a charity, independent of the government and the NHS.
Disclaimer: Our factsheets provide information about the law in the UK. The information is correct at the time of writing (May 2021). The law in this area may be subject to change. Birthrights cannot be held responsible if changes to the law outdate this publication. Birthrights accepts no responsibility for loss which may arise from reliance on information contained in this factsheet. Birthrights has provided links to third party websites where these may help provide relevant further information. Birthrights takes no responsibility for the contents of linked websites and links should not be taken as an endorsement.
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Consent means saying yes Consent means saying yes. You have the right to make your own decisions about your body, just as you do at any other time. It is against the law to give you medical treatment unless you agree to it. It is also against the law for treatment to be given to ...

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Your choices about where to have your baby

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Your choices about where to have your baby

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Can I choose where to give birth?

Yes. You have the right to choose where you give birth. You can choose to give birth in a hospital, in a birth centre, or at home. A birth centre is a maternity unit that is run by midwives. It can be part of a hospital or completely separate.

Your NHS trust may automatically book you into a hospital or birth centre. You can ask to discuss this and make your own choice.

A healthcare professional may say you 'need' or 'have' to give birth in a hospital. You can ask them why they think this. What medical reasons do they have for this advice? You do not have to agree with them.

In some cases, there may be restrictions on your right to choose a hospital or birth centre. However, no-one can make you give birth away from home if you want to stay at home.

The only time someone else can decide for you about where you give birth, or your treatment, is if you lack mental capacity. This is very rare, but we describe what mental capacity is below.

Yes. You have a right to choose where you give birth. You cannot be made to go to hospital. Healthcare professionals may want to talk to you about your plans and any concerns they have. This should be an opportunity to have an open discussion and to share information. They should always respect your views and choices.

All NHS Trusts are expected to run a home birth service. This is not guaranteed in law, but the law says that your right to choose where to give birth should only be restricted when there is a good reason to do this, and where the decision is 'proportionate'.

This means that a Trust should only pause their home birth service if they have looked at all the options for keeping it going and they are still unable to.

If you are told you cannot give birth at home because of staff shortages, remind the hospital that it must make sure there are enough staff to provide the services it has promised. They should have plans for situations such as staff shortages. This could include providing an independent midwife.

If you feel that your choice to give birth at home is not being respected, you can contact Birthrights for advice using our contact form.

Yes. The Nursing and Midwifery Council's Code says that midwives must put your interests first and make your safety their main concern. This is their professional duty.

Midwives should respect your decision to give birth outside the hospital. They should attend you at home if you ask for this, even if they don't agree with your decision.

If you are in labour and the hospital tells you there is no midwife to attend you, (and that they will send an ambulance), you cannot be made to attend hospital if you do not want to. You or your birth partner can ask to speak to the Head of Midwifery and ask them to provide a midwife.

If a midwife - or any healthcare professional - has breached their duty of care, you can complain. Duty of care means that they must care for you and keep you safe. They can be referred to their regulatory body, which will investigate.

Yes. Only you have the right to decide where you give birth. No one can overturn the decision you have made. This is the law.

The only time that someone else can make decisions about your healthcare is if you lack mental capacity to make those decisions. This is very rare.

Even if healthcare professionals advise you not to give birth at home, no one can make you go to hospital.

Your midwife and hospital consultant (if you have one) should work with you to make a care plan for giving birth at home.

When professionals give you advice and information about where to give birth, it should be based on facts, not personal opinions.

Healthcare professionals must not put pressure on you, or threaten you, when you are deciding where to give birth. They must not threaten to involve social services. If you feel this has happened, you may not have given consent to the treatment you received. This could mean that the healthcare professional can be taken to court for failing to obtain your consent.

Yes. All people in the UK have a right to maternity care in hospital.

Your GP will tell you which hospitals have maternity services in your area, and you can choose which one to use.

You can ask to use a different hospital. If your GP will not refer you to the hospital you choose, you can refer yourself. Look on the hospital's website or ask its maternity team for the self-referral form.

Yes. The government says everyone in the UK should be able to choose between giving birth in hospital, in a birth centre, or at home. You should be offered a full discussion of the risks and benefits of the options you are considering.

If there is no birth centre in your area, or you want to use a different birth centre, you can ask your GP to refer you or you can refer yourself.

Birth centres often have rules, called admissions criteria, that say people with 'high risk' pregnancies cannot use the centre.

These are not legal rules and they cannot be applied in a blanket way. The centre should use them only to guide them when making a decision about who can use the centre.

The birth centre must only refuse to allow you to use the centre if they feel they cannot provide you with safe care. The centre must have a good evidence-based reason that shows you or your baby are at high risk of harm when giving birth without the support of a hospital obstetric ward. The centre must be able to show that it cannot safely manage that risk. They should consider the risk on a case-by-case basis, looking at what the risks are in your personal situation.
For example, a birth centre might say you cannot use the centre if your labour is being induced and where medical advice strongly recommends the monitoring of your contractions.
Or the birth centre's rules might say that you cannot use the centre if your body mass index (BMI) is above a certain level. However, they should look at what the specific risks are in your case and whether they can be safely managed. They need to have evidence for what they say. They need to discuss it with you, and if they think they cannot safely care for you in the birth centre they need to discuss what alternatives they can suggest (for example, offering similar support such as a birth pool on the labour ward).

Both hospitals and birth centres must make 'reasonable adjustments' so that anyone with a long-term health condition or disability has equal access to their services. This is law, under the Equality Act 2010.

These adjustments could be in the way the hospital or birth centre provides care, accessing and navigating the buildings, providing equipment, or providing services such as British Sign Language interpreters or extra support.

The Equality Act 2010 says the midwifery team should talk to you about what adjustments you need. Your midwife can also ask for help from other teams in the hospital, such as Occupational Therapy, if necessary.

They should talk to you from the start of your pregnancy so that together you can work out the best way they can support you throughout your pregnancy, in labour, and during your post-natal care.

Having a long-term health condition, disability or sensory impairment does not take away your right to choose where you give birth.
For example, a woman who uses a wheelchair should be given a room that she can access in her wheelchair as well as a bathroom that she can comfortably access. She should also be provided with appropriate aids such as a shower stool and toilet frame. An autistic person may ask for a familiarisation tour of the ward or have sensory considerations in their birth plan to make the environment accessible.
If you need help to communicate with healthcare professionals, ask as early in your pregnancy as possible so that you can make informed choices from the beginning.

This might be support with British Sign Language interpreters, large print materials or materials in a form that is suitable for your screen reader.

This might be access to an interpreter for your appointments and care.

Yes. A birth plan lets you tell healthcare professionals about the kind of treatment and care you want.

Your midwife or doctor should help you to make a birth plan (this may be called a personalised care and support plan) that will be included within your maternity records (your digital or handheld notes). If you choose care that is 'out of guidelines' then you may find it helpful to make your birth plan with a consultant midwife or doctor. Your plan should be recorded so that any doctors or midwives who care for you can find it. You might also want to print a copy so that you can give it to your doctor or midwife when you are in labour.

This can include where you want to give birth, so thinking about your birth plan will help you to explore the options and decisions you might make.

You may find it useful to think about what is important to you before you make your birth plan. This can help you to think of the questions you want to ask the healthcare professionals who are supporting you. It can help you have a clear and respectful discussion with them about where you want to give birth and what care you want during and after the birth. You can read more about birth plans on our factsheet Consenting to treatment.

Your midwife and doctor should provide you with information and personalised discussions to help you make informed choices about your care.

When you make your decision, your midwife should support you. They should listen to you and respect what you say. They should help you to get the maternity care you choose.

If you are struggling to find this support, contact the Director or Head of Midwifery at your hospital. If you don't know the details for the Head of Midwifery, you can ask your midwife and/or the Patient Advice and Liaison service (PALS) (in England and Wales) to put you in touch. The Trust website will have a page with PALS details on it. If you are worried, you can look these details up in case you need them.

The Nursing and Midwifery Code says that all midwives must treat people as individuals and respect and uphold their rights. Your midwife is your advocate. They should support you even if your decision doesn't fit the hospital or birth centre's guidelines.

You may want to choose a hospital or birth centre in another area, for example to be near family support. Or you may need to change to a Trust if your circumstances change, for example if you move to a new area during your pregnancy.

If you move, you can book with a hospital or birth centre in your new area for care. You can do this directly by looking on the hospital's website or asking its maternity team for the self-referral form. Alternatively, your GP in your new area can help. You should be able to do this even if you are very late in your pregnancy. You can also ask to book with the home birth team, although they may have a limit on numbers of people they can book or how late they can accept bookings, depending on how they are staffed.

If you are having trouble booking for care after a move, you can contact us for support.

If you are told that you cannot choose the hospital or birth centre you want because you do not live in the right area, you can ask for an exception to be made. Ask:

Even if their policy says you cannot use the services you have asked for, you can ask them to look at the reasons why you want this hospital or birth centre. They need to give you a good reason if they say no.

Wherever you give birth, your postnatal care will be provided in your home area.

Many NHS Trusts now offer only online video tours, photographs or leaflets about their maternity wards and birth centres. These can help you familiarise yourself with the maternity unit. You do not have a right to an in-person tour.

However, if you have a disability or health condition that means you may need reasonable adjustments, ask to visit the hospital or birth centre so that you and the healthcare professionals working with you can plan ahead.

You might want to look at physical adjustments that will be needed, such as a hoist. If you have a visual impairment, the position and nature of the lighting could be important. Autistic people often want to visit ahead so that they know what to expect and can ask for changes that will make their birth experience easier. The key is that everyone is different so you need to visit in order that you and the healthcare team can plan your individual care.

You have the right to ask for a water birth. The hospital or birth centre may have rules about who can have a water birth but these are not legal rules. You can ask how many rooms have a pool in the birth centre or hospital.

If your care team has concerns about whether a water birth is safe, they should offer you a respectful discussion on the risks and benefits in your situation so that you can make an informed decision.

The hospital or birth centre should only say that you cannot access a water birth if they have a good reason based on clinical evidence.

Your midwife and doctor should also help you consider other options, such as using water for pain relief in labour but not for the birth itself.

If you choose a water birth at the birth centre or hospital, you may not be able to access a pool if there is not one free when you arrive. If you are unsure whether a pool will be available, some people decide to hire their own pool for use at home and then transfer when they are ready. If you have a home birth, you can buy or hire a pool to use at home.

Mental capacity means that you can understand the choice you need to make about treatment and can make a decision.

In law, everyone has mental capacity unless it can be shown that you do not.

Very rarely, someone may not be able to give consent to treatment because they are unable to make a decision that they need to make, even when it is very clearly explained and they are given lots of support.

It is very rare to not have mental capacity.

The people caring for you cannot say you do not have mental capacity simply because you do not agree with them.

Most people do not have to pay for their care. The NHS provides free care to those who are 'ordinarily resident' in the UK. If you are not 'ordinarily resident' then you may have to pay for your care. If this applies to you, then this includes maternity care in hospital, in the community and at home. Your NHS Trust must tell you if you will be charged for your care.

Even if you have to pay for your care and cannot afford to do so, you must still be given maternity care. You cannot be told that you have to wait until you can pay.

The rules about who has to pay for care, and how charging works are very complicated.
Guidance giving you the choice of where to give birth
The 2016 Better Births report for NHS England set out that women should be able to decide where they want to give birth; whether this is at home, in a midwifery unit or in an obstetric unit. This also applies to birthing people who do not identify as women.

The other nations of the UK have the same expectations of maternity services in their areas. Here is their guidance:
Guidance on home births
The legal position is that you have the right under Article 8 of the Human Rights Act to a private and family life which includes the right to choose where you give birth and who is present.

However, this is a qualified right which means that the rights can be restricted where there is a legitimate aim such as protecting the health of others, and the restriction is 'proportionate'.

This means that the Trust should only suspend their home birth service if they have looked at all the options for keeping it going including using local Independent Midwives or bringing back retired midwives to supplement their team, and looking at alternative ways to transfer into hospital if the ambulance service is under pressure (this last realistically applies only in times of severe crisis such as a pandemic).

The UK's guidance is set out in:

In 2016 the NHS Ombudsman accepted that an NHS Trust that suspended its home birth services and refused to make contingency plans was acting unreasonably. They were told to start providing the service again and to work with other Trusts to provide support for home birth in the meantime.
The Nursing and Midwifery Council Code
The Nursing and Midwifery Council Code sets out professional standards of behaviour for nurses, midwives and nursing associates in the UK. It says that midwives need to put the interests of people using maternity care first.
About Birthrights
Birthrights factsheets give you information about your human rights when you are pregnant and giving birth.

Birthrights champions respectful care during pregnancy and childbirth by protecting human rights. We provide advice and information to women and birthing people, train doctors and midwives, and campaign to change maternity policy and systems.

We are a charity, independent of the government and the NHS.
Disclaimer: Our factsheets provide information about the law in the UK. The information is correct at the time of writing (May 2021). The law in this area may be subject to change. Birthrights cannot be held responsible if changes to the law outdate this publication. Birthrights accepts no responsibility for loss which may arise from reliance on information contained in this factsheet. Birthrights has provided links to third party websites where these may help provide relevant further information. Birthrights takes no responsibility for the contents of linked websites and links should not be taken as an endorsement.
Do you work with pregnant women and birthing people?

Our training equips doctors, midwives and other birth workers with knowledge of the law and human rights principles, an understanding of how to apply it in practice, and the ability to communicate effectively with women and birthing people in a way that upholds their human rights. We offer a 10% discount to multidisciplinary teams.

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Can I choose where to give birth? Yes. You have the right to choose where you give birth. You can choose to give birth in a hospital, in a birth centre, or at home. A birth centre is a maternity unit that is run by midwives.

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This guideline covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and people using services to work together to make decisions about treatment and care. It includes recommendations on training, communicating risks, benefits and consequences, using decision aids, and how to embed shared decision making in organisational culture and practices.

The guideline does not cover unexpected emergencies in which immediate life-saving care is needed. It also does not cover situations when, at the time a decision needs to be made, an adult does not have mental capacity to make a decision about their healthcare. For more information, see the NICE guideline on decision-making and mental capacity.

Recommendations

This guideline includes recommendations on:

Who is it for?

Everybody who delivers healthcare services

Commissioners of health and public health services

Adults (aged 18 and over) using healthcare services, their families, carers and advocates, and the public

It may also be relevant for:

Social care practitioners

Voluntary, community and social enterprise organisations

People who use social care services

Guideline development process
How we develop NICE guidelines
This guideline updates and replaces recommendations on shared decision making in NICE's guideline on patient experience in adult NHS services: improving the experience of care for people using adult NHS services (CG138, February 2012).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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This guideline covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and

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It's your right to be involved in making choices about your care. To make a decision, you need to know what your options are and what might happen if you don't want any treatment or care.

Get information on what to do:

before you see your health or care professional

when you see your health or care professional

when involving other people

when you cannot give consent.

Shared decision making is when health professionals and patients work together. It puts you at the centre of decisions about your own treatment and care.

This means that:

different choices available to the patient are discussed

care or treatment options are explored in full, along with the risks and benefits

patients reach a decision with their health and social care professional.

Our guide contains advice to help you access treatments and care that we've recommended. It includes advice on what to do:

if you are not able to obtain treatments that are suitable for you

to access drugs and medicines recommended by our guidance

if you think that your care is not following NICE's recommendations

to find sources of support.

Find out about:

the licensing of medicines

unlicensed medicines and 'off-label' use

accessing drugs and medicines recommended by a technology appraisal

questions that might be useful to ask about medicines

NICE evidence summaries.

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It's your right to be involved in making choices about your care. To make a decision, you need to know what your options are and what might happen if you don't want any treatment or care.

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Not only do we want to put a stop to the disparity that black women in the U.K. are 5 times more likely to die in pregnancy and childbirth, we also want you to be aware of 6 steps that you can take today that will help put an end to these shocking statistics.

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We can now offer sterile water injections as a method of pain relief in labour.

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Information about GBS

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The information below is for you, a friend or a relative who is expecting a baby, planning to become pregnant or has recently had a baby.
What is group B Strep?

Group B Streptococcus (GBS, group B Strep or Strep B) is a type of bacteria which lives in the intestines, rectum, or vagina of 2 to 4 in every ten women in the UK (20 to 40%). This is often referred to as 'carrying' or being 'colonised with' group B Strep.

Most women carrying GBS will have no symptoms. Carrying GBS is not harmful to you, but there is a small chance it can affect your baby around the time of birth.

GBS can occasionally cause serious infection in young babies and, very rarely, in babies before they are born. Carrying GBS can also sometimes lead to serious infections for pregnant women, though this is also rare.

How is group B Strep spread?

Group B Strep is not a sexually transmitted disease.
Like many bacteria, GBS can be passed from one person to another through direct contact, for example, hand holding, kissing, close physical contact, etc. As GBS is often found in the vagina and rectum, it can also be passed on during sex.

There are no known harmful effects of carrying GBS. The GBS bacteria do not cause genital symptoms or discomfort. GBS carriage is not a sign of ill health or poor hygiene. Around 20 to 40% of women carry GBS.

Because GBS can be passed from one person to another by skin-to-skin contact, everyone (regardless of whether they know they carry GBS) should wash and dry their hands properly before handling a newborn baby.

How is group B Strep found?

Most women carrying GBS have no symptoms, so GBS is often found by chance through a vaginal or rectal swab test or a urine test.
The NHS does not routinely test all pregnant women for group B Strep.
A test designed specifically to identify whether you carry GBS, known as the Enriched Culture Medium (ECM) test, is becoming more available within the NHS and is widely available privately.

Since September 2017, the Royal College of Obstetricians & Gynaecologists (RCOG) has recommended in their guideline on group B Strep that the ECM test should be used when testing for group B Strep. However, many maternity units still use a standard test (known as the high vaginal swab) that misses up to half of the women carrying group B Strep. Ask your health professionals what is available locally.

There are private home ECM testing kits for GBS you can order.

What could group B Strep mean for my baby?

Many babies come into contact with group B Strep during labour or around birth, and the vast majority will not become ill.

However, there is a small chance that your baby will develop a group B Strep infection. In the UK, about 1 in 1,600 of all babies born develops a GBS infection.

This likelihood of infection is higher if you know you carry GBS; about 1 in every 400 babies born to women known to carry GBS develop a GBS infection.

If the GBS infection is not treated, babies can become seriously ill. But with prompt treatment, most babies will make a full recovery. This makes early detection vital.

The infections that group B Strep most commonly causes in newborn babies are sepsis (infection of the blood and other tissues), pneumonia (infection in the lungs), and meningitis (infection of the fluid and lining around the brain).
Although group B Strep infection can make your baby very unwell, with prompt treatment, most babies will make a full recovery.
Group B Strep infections are most common in newborn babies during their first few days after birth. However, babies can still develop group B Strep infections up to three months of age, and in very rare cases, beyond three months.

To reflect this, group B strep infections are often split into two categories: early-onset and late-onset infections:

Early-onset group B Strep infection

Early-onset group B Strep infections are those in babies up to seven days old, and occur in around 1 in every 1,750 babies in the UK and Ireland.

Of the babies who develop an early-onset GBS infection, 1 in 19 (5.2%) will die.

Of those who survive an early-onset GBS infection, 1 in 14 (7.4%) will have a long-term physical or mental disability.

Late-onset group B Strep infection

Late-onset group B Strep infections develop in babies older than seven days, and occur in around 1 in every 2,700 babies in the UK and Ireland.

Of those who develop a late-onset GBS infection, 1 in 13 (7.7%) will die.

Of those who survive a late-onset GBS infection, 1 in 8 (12.4%) will have a long-term physical or mental disability.

Overall chances and outlook for babies

On average, in the UK and the Republic of Ireland, every month:

Around 70,000 live babies are born

66 babies are diagnosed with a group B Strep infection
40 early-onset + 26 late-onset GBS infection

of these, 56 babies make a full recovery
35 early-onset + 21 late-onset GBS infection

4 babies die from their group B Strep infection
2 early-onset + 2 late-onset GBS infection

6 babies survive with long-term physical or mental disabilities
3 early-onset + 3 late-onset GBS infection

Group B Strep and risk of miscarriage or stillbirth

There is evidence that group B Strep can cause late miscarriage (death of the baby between 14 and 24 weeks of pregnancy) and stillbirth (death of the baby after 24 weeks of pregnancy up until the baby is born). We don't understand why group B Strep causes stillbirths or late miscarriages in some babies but not others.

However, thankfully stillbirths are relatively uncommon in the UK, and group B Strep is not a common cause of them, accounting for around 1% of all stillbirths before labour in high-income countries. So, it is rare that someone carrying GBS will have a stillbirth or late miscarriage caused by GBS.

We're not aware of any evidence that group B Strep causes earlier miscarriages (before 14 weeks of pregnancy).

Is my baby at risk of group B Strep infection?

Any baby can develop a group B Strep infection, but early-onset group B Strep infection is more likely if...

your baby is born preterm (before 37 completed weeks of pregnancy) - the earlier your baby is born, the greater the risk;

you have previously had a baby who developed a group B Strep infection;

you have a high temperature (or other signs of infection) during labour;

you have tested positive for group B Strep in this pregnancy;

you haven't gone into labour within 24 hours after your waters have broken.

Developing late-onset group B Strep infection is more likely if...

your baby is born preterm (before 37 weeks of pregnancy);

you have tested positive for group B Strep in this pregnancy.

There are ethnic differences in group B Strep infection rates. The overall rate of GBS infection for Black babies is 1 in 1,000 live births, which is 51% higher than the rate for white babies at 0.67 per 1,000 live births. For Asian babies, the infection rate is 0.85 per 1,000 live births, which is 28% higher than that for white babies. However, there is variation in infection rates within these broad categories; for example, babies from an Indian background have similar GBS infection rate to white babies.

How can the risk to my baby be reduced?

Most early-onset group B Strep infections (before the baby is seven days old) can be prevented with intravenous antibiotics, sometimes known as a 'drip'. These will be given to women during labour if their baby has a higher chance of developing an early-onset GBS infection.

If you opt to have the antibiotics during labour, the risk of your baby developing an early-onset GBS infection drops significantly to around 1 in 4,000.
You will be offered intravenous (IV) antibiotics during labour if...
you developed a urine infection during pregnancy caused by group B Strep (it should also have been treated with antibiotic tablets straight away).

you have tested positive for GBS after a swab from an NHS or other accredited laboratory (see www.gbss.org.uk/test).

you have previously had a baby who was diagnosed with a GBS infection.

you develop any signs of infection during labour (e.g. high temperature), even if you don't know whether you carry GBS. (You will be offered IV antibiotics to treat various infections, including GBS.)

your labour starts before 37 completed weeks of your pregnancy (premature labour), even if you don't know whether you carry GBS.

Other situations:

If you tested positive for GBS during a previous pregnancy and your baby was unaffected, you can be tested when you are 35 to 37 weeks pregnant. If the test result is positive, you will be offered antibiotics in labour. If the test result is negative at this point, the risk of your baby developing early-onset GBS infection is low, and you may choose not to have antibiotics.

If your waters break after 37 completed weeks of your pregnancy and you are known to carry GBS, you will be offered induction of labour straight away. This is to reduce the time that your baby is exposed to GBS before birth. You should also be offered IV antibiotics.

At present, there are no known methods to prevent late-onset GBS infection (those happening after the baby is seven days old). If you carry GBS, your baby will be monitored and receive treatment if they show signs of GBS infection.

Find out how your baby will be monitored after birth for signs of GBS infection.
If you are worried about your baby, you should urgently contact your healthcare professional and mention any history of GBS when you do. Mon-Fri 9am-5pm
0330 120 0796

Or email us at info@gbss.org.uk

Related pages

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Group B Strep and pregnancy - Group B Strep Support

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Group B Streptococcus (GBS, group B Strep or Strep B) are common bacteria that usually cause no harm, but can cause serious infection, most often in young babies.

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Some vaccinations are recommended during pregnancy to protect the health of both the mother and baby. There are currently four vaccinations that are routinely offered to pregnant women, and these are:

Whooping cough vaccine (also called pertussis)

Seasonal flu vaccine

Covid-19 vaccine

Respiratory syncytial virus (RSV) vaccine

These vaccinations may be offered to pregnant women by their GP, maternity serivce or in some cases, such as seasonal flu, a local pharmacist. Pregnant women should contact their GP in the first instance if they have not been offered one or more of these vaccinations to enquire about when and where to access them.

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NHS Herts and West Essex Integrated Care Board

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Advice from midwife Katy Kay about vaccinations during pregnancy (V2)

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LMNS Perineal Tears and Episiotomy Advice FINAL May 23 with QR code

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LMNS Caesarean Birth Advice FINAL May 23 with QR code

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LMNS Postnatal Exercise Advice FINAL May 23 with QR code

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Physical recovery and exercise after birth

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Physical recovery and exercise after birth

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LMNS Postnatal Exercise Advice FINAL May 23 with QR code

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Tiny Happy People can help you develop your child’s language and communication skills, so they get the best start in life.

We’ll show you why and how you can bond with your child, before they’re born and throughout their early lives – it’s never too early to start.

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Tiny Happy People is here to help you develop your child's language skills. Explore our simple activities and play ideas and find out about babies and toddlers' amazing early development.

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Children’s language development and parenting advice - BBC Tiny Happy People

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A chatty child is a happy child, so Tiny Happy People is here to help you develop your child’s communication skills through simple interaction and play.

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Are you feeling low, worried or stressed? We are here to help you - for people who live in Harlow, Uttlesford or Epping Forest.

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Are you feeling low, worried or stressed? We are here to help you - for people who live in Harlow, Uttlesford or Epping Forest.

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Concerned about your mental wellbeing?

We all experience times when we feel like we can’t cope with life, sometimes this can start to affect our everyday lives and prevent us from doing the things we normally do.

If you are experiencing excessive worry, low mood, depression, anxiety or a lack of motivation then NHS Talking Therapies can help. Vita Health Group works in partnership with the NHS to provide talking therapy services in the district of West Essex including Harlow, Uttlesford and Epping Forest known as NHS Talking Therapies or IAPT (Improving Access to Psychological Therapies) and we can provide advice and guidance on the best options for you.

NHS Talking Therapies is a FREE service and you don’t need to visit a GP to get help –  simply click on this post to find out more.

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Free NHS mental health services for residents of West Essex | IAPT | Talking therapies | Self refer | Vita Health Group

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Essex Child and Family Wellbeing Service

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Essex Child and Family Wellbeing Service

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Essex Child and Family Wellbeing Service

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The Family Hub offer we provide and the outcomes we aim to achieve ensures all families within Essex are supported from before children are born up to the age of 19 or 25 for those with Special Educational needs.

We focus on making sure that everyone in Essex has the best possible start in life through having access to Free, high quality and easy access to services in your Community, School, Family Home or within a Family Hub.

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Welcome to your Family Hub - Essex Child and Family Wellbeing Service

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The Family Hub offer we provide and the outcomes we aim to achieve ensures all families within Essex are supported from before children are born up to the age of 19 or 25 for those with Special Educational needs.

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If you’re more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk.

You can also use your card to collect:

Healthy Start vitamins – these support you during pregnancy and breastfeeding

vitamin drops for babies and young children – these are suitable from birth to 4 years old

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What is Healthy Start?

If you're more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk.

If you're eligible, you'll be sent a Healthy Start card with money on it that you can use in some UK shops. We'll add your benefit onto this card every 4 weeks.

You can use your card to buy:

plain liquid cow's milk

fresh, frozen, and tinned fruit and vegetables

fresh, dried, and tinned pulses

infant formula milk based on cow's milk

You can also use your card to collect:

Healthy Start vitamins - these support you during pregnancy and breastfeeding

vitamin drops for babies and young children - these are suitable from birth to 4 years old

If you live in Scotland

You can get help from Best Start Foods (opens in a new tab) instead.

Advice on healthy eating

For more advice on healthy eating, visit:

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If you're more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk. If you're eligible, you'll be sent a Healthy Start card with money on it that you can use in some UK shops.

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How can I support my baby's early development?

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How can I support my baby's early development?

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As parents, you are the most important people in your baby’s early development.

The way you talk and play with your baby can make a real difference to how they develop and learn.

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This is the content area of the home page…

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All the information you need about feeding your baby all in one place.

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These videos have been made by the maternity team at Princess Alexandra to support you in the first few days after the birth of your baby.

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1. Postnatal Ward

2. Postnatal Care

3. Pelvic Health

4. Contraception

5. Baby Care

6. Infant Feeding Intro

Breastfeeding

Bottle feeding

7. Smoking around your baby/babies

8. Birth Reflections

9. Maternity Voices Partnership

10.Once Home

11. Bereavement Services

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1. Postnatal Ward 2. Postnatal Care 3. Pelvic Health 4. Contraception 5. Baby Care 6. Infant Feeding Intro Breastfeeding Bottle feeding 7. Smoking around your baby/babies 8. Birth Reflections 9. Maternity Voices Partnership 10.Once Home 11. Bereavement Services

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Where to give birth - this is my first baby, my choices.

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Where to give birth - this is my first baby, my choices.

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Your midwife will explain to you the different places you can have your baby. You can choose to have your baby at home, in our alongside midwifery-led unit (birth centre) or in our obstetric unit. Your midwife or a doctor may recommend a place after discussing what's important to you and your health and well-being.

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Where to give birth - I've had a baby before, my choices

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Where to give birth - I've had a baby before, my choices

# data[].attributes.body
Your midwife will explain to you the different places you can have your baby. You can have your baby at home, in our alongside midwifery led unit (birth centre) or in our obstetric unit. Your midwife or a doctor may recommend a place after discussing what is important to you and your health and well-being.

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Significant changes to the 15 and 30 hours childcare support are coming from April 2024.

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Starting from April 2024, existing childcare support will be expanded in phases. By September 2025, most working families with children under the age of 5 will be entitled to 30 hours of childcare support.

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Protect yourself and your baby

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Smoking, Nicotine and Pregnancy Study at PAHT

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Smoking, Nicotine and Pregnancy Study at PAHT

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Stopping smoking in pregnancy can be hard. SNAP3 is looking at new ways of supporting pregnant women to use NRT to make it easier for women to try to stop. By taking part in SNAP3 you can help improve stop smoking support for pregnant women

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Bliss offer information and support to parents and families of premature or sick babies. If your baby is sick, or was born prematurely, you can access emotional and practical support here

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For babies born premature or sick | Bliss

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Our vision is that every baby born premature or sick in the UK has the best chance of survival and quality of life.

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Premature labour is labour that happens before the 37th week of pregnancy.

About 8 out of 100 babies will be born prematurely, the information on this page will tell you what happens if your labour starts prematurely.

Call your midwife or maternity unit if you're less than 37 weeks pregnant and you have:

regular contractions or tightenings

period-type pains

a gush or trickle of fluid from your vagina – this could be your waters breaking

backache that's not usual for you

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Find out about premature labour and birth (before 37 weeks of pregnancy), and what you might expect if it happens.

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If you become pregnant and you have diabetes, you should go on to have a healthy baby. But there are some possible complications you should be aware of.

The information on this page is relevant for you if you were diagnosed with type 1 or type 2 diabetes before you got pregnant. We are working towards having a hybrid closed loop pump (HCL) service at Princess Alexandra Hospital which will be in place in 2026. We can currently offer continuous glucose monitoring and support from our diabetes maternity team. If you would prefer to have your care within a service that can support HCL then you can choose to have your maternity care with another hospital if that's right for you.

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If you become pregnant and you have diabetes, you should go on to have a healthy baby. But there are some possible complications you should be aware of.

The information on this page is relevant for you if you were diagnosed with type 1 or type 2 diabetes before you got pregnant.

It does not cover gestational diabetes, which is high blood sugar that develops during pregnancy and usually goes away after the baby is born.

Coronavirus (COVID-19) update

If you're well, it's really important you go to all your appointments and scans for the health of you and your baby.

If you're pregnant, hospitals and clinics are making sure it's safe for you to go to appointments.

If you get symptoms of COVID-19, or you're unwell with something other than COVID-19, speak to your midwife or maternity team. They will advise you what to do.
Find out more about pregnancy and COVID-19

What it means for you

If you have type 1 or type 2 diabetes, you may be at higher risk of having:

People with diabetes (whether they are pregnant or not) are at risk of developing problems with their eyes ( diabetic retinopathy) and kidneys (diabetic nephropathy).

Some people with type 1 diabetes can develop diabetic ketoacidosis, where harmful chemicals called ketones build up in the blood.

Pregnancy can increase your risk of developing these problems or make existing ones worse.

What it means for your baby

If you have type 1 or type 2 diabetes, your baby may be at higher risk of:

having health problems shortly after birth, such as heart and breathing problems, and needing hospital care

developing obesity or diabetes later in life

There's also a slightly higher chance of your baby being born with birth defects, particularly heart and nervous system abnormalities, or being stillborn or dying soon after birth.

But managing your diabetes well, before and during your pregnancy, will help to reduce these risks.

Reducing the risks

The best way to reduce the risks to you and your baby is to ensure your diabetes is well controlled before you become pregnant. So, ideally, a pregnancy should be planned.

Before you start trying for a baby, ask your GP or diabetes specialist (diabetologist) for advice. You should be referred to a diabetic pre-conception clinic for support.
Find diabetes support services near you.
You should be offered a blood test, called an HbA1c test, every month. This measures the level of glucose in your blood.

It's best if the level is no more than 6.5% before you get pregnant. If you cannot get your level below 6.5%, try to get it as close as possible to reduce the risk of complications for you and your baby.

If your blood glucose level is above 10%, your care team should strongly advise you not to try for a baby until it has fallen.

You should continue using contraceptives until you get your blood glucose under control. A GP or diabetes specialist can advise you about how best to do this.

If you have type 1 diabetes, you should be given testing strips and a monitor to test your blood ketone levels, to check for diabetic ketoacidosis. You should use these if your blood glucose levels are high, or if you are being sick or have diarrhoea.

Folic acid

If you have diabetes and are trying to get pregnant, you should take 5 milligrams (mg) of folic acid each day (and until you are 12 weeks pregnant). A doctor will have to prescribe this, because you cannot buy 5mg tablets from a pharmacy or shop without a prescription.

Taking folic acid helps prevent your baby developing birth defects, such as spina bifida.

Your diabetes treatment in pregnancy

Your doctors may recommend changing your treatment regime during pregnancy.

If you usually take tablets to control your diabetes, you'll normally be advised to switch to insulin injections, either with or without a medicine called metformin.

If you already use insulin injections to control your diabetes, you may need to switch to a different type of insulin.

If you take medicines for conditions related to your diabetes, such as high blood pressure, these may have to be changed.

It's very important to attend any appointments made for you so that your care team can monitor your condition and react to any changes that could affect your or your baby's health.

You will need to monitor your blood glucose levels more frequently during pregnancy, especially since nausea and vomiting in pregnancy (known as "morning sickness", although it can happen at any time of the day) can affect them. Your GP or midwife will be able to advise you on this.

Keeping your blood glucose levels low may mean you have more low-blood-sugar (hypoglycaemic) attacks ("hypos"). These are harmless for your baby, but you and your partner need to know how to cope with them. Talk to your doctor or diabetes specialist.

Diabetic eye screening in pregnancy

You will be offered regular diabetic eye screening during your pregnancy. This is to check for signs of diabetic eye disease (diabetic retinopathy).

Screening is very important when you are pregnant because the risk of serious eye problems is greater in pregnancy.

Diabetic retinopathy is treatable, especially if it is caught early.

If you decide not to have regular screening tests, you should tell the clinician looking after your diabetes care during pregnancy.

Read Diabetic eye screening.

Labour and birth

If you have diabetes, it's strongly recommended that you give birth in a hospital with the support of a consultant-led maternity team.

Your doctors may recommend having your labour started early (induced). This is because there may be an increased risk of complications for you or your baby if your pregnancy carries on for too long.

If your baby is larger than expected, your doctors might discuss your options for the delivery and may suggest an elective caesarean section.

Your blood glucose should be measured every hour during labour and birth. You may be given a drip in your arm with insulin and glucose if there are problems.

After the birth

Feed your baby as soon as possible after the birth (within 30 minutes) to help keep their blood glucose at a safe level.

Your baby will have a heel prick blood test (or newborn blood spot test) a few hours after they're born to check if their blood glucose level is too low.

If your baby's blood glucose cannot be kept at a safe level, or they're having problems feeding, they may need extra care. Your baby may need to be fed through a tube or given a drip to increase their blood glucose.

Read more about special care for babies.

After your pregnancy, you should not need as much insulin to control your blood glucose. You should be able to decrease your insulin to your pre-pregnancy dose or return to the tablets you were taking before you became pregnant. Talk to your doctor about this.

You should be offered a test to check your blood glucose levels before you go home and at your 6-week postnatal check. You should also be given advice about diet and exercise.

Community content from HealthUnlocked

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If you become pregnant and you have diabetes, you should go on to have a healthy baby. But there are some possible complications you should be aware of. The information on this page is relevant for you if you were diagnosed with type 1 or type 2 diabetes before you got pregnant.

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West Essex talking therapies can help you.

Please self-refer using the digital assistant on our website: https://www.vitahealthgroup.co.uk/nhs-services/nhs-mental-health/west-essex/

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Talking therapy and emotional support for expectant and new mums

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If you would like to self-refer into our service please use the digital assistant on our website: https://www.vitahealthgroup.co.uk/nhs-services/nhs-mental-health/west-essex/

More information can be found on our perinatal support page here: https://www.vitahealthgroup.co.uk/nhs-services/nhs-mental-health/perinatal-support/

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there are many pain relief choices for use in labour.

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Labour can be painful, so it can help to learn about the pain relief options available to you. The main methods fall into two categories: with medication and without medication. Your anaesthetist will guide you through your options to find the one that works best for you and your baby.

Pain relief methods with medication

Pain relief methods without medication

Compare different pain relief methods

Understanding your pain relief options can be daunting. To help in your decision making, use our comparison table to learn more about the different options available and how they vary from each other.
Pain relief comparisons

Other information related to labour pain relief

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Pain relief and anaesthesia choices during labour

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Labour can be painful, so it can help to learn about the pain relief options available to you. The main methods fall into two categories: with medication and without medication. Your anaesthetist will guide you through your options to find the one that works best for you and your baby.

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This website provides trusted information on lots of medicines and whether they are safe to take in pregnancy

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This website provides trusted information on lots of medicines and whether they are safe to take in pregnancy

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bumps - best use of medicine in pregnancy (medicinesinpregnancy.org)

This information is not intended to replace the individual care and advice of your health care provider. The decision to start, stop, continue or change a medicine before or during pregnancy should be made together with your health care provider. When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause

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We want to share some information

with you about how we will begin to care for you. The information in this section will help you understand what to expect.

Your first midwife appointment lasts

around an hour, we will ask questions to make sure you get  the care that’s right for you.

You will be able to ask lots of questions too!

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Screening tests for you and your baby (STFYAYB)

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It’s really important that you look carefully at this online information before your first

appointment with your midwife. It gives you information on the screening tests you will be offered during your pregnancy and after your baby is born. It explains the different types of test and what the tests are looking for.

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STFYAYB provides information about the screening tests offered during and after pregnancy.

Details

This information is about the screening tests you will be offered during your pregnancy and after your baby is born. It explains the different types of test and what the tests are looking for.

Easy read versions of this leaflet are available. Additional information is also available for parents of babies who are in a special care baby unit, neonatal intensive care unit or paediatric intensive care unit.

We hope this advice will help prepare you for discussions with your midwife or doctor so that you can ask the questions that are important to you.

It is your decision whether or not to have any of the tests described.

In this publication, we use the terms 'woman' and 'women' to refer to anyone able to become pregnant, including trans men. Trans men who are pregnant should be offered the same antenatal and newborn screening tests as other pregnant individuals.

The information is available in 12 other languages: Arabic, Bengali, Chinese, French, Latvian, Lithuanian, Polish, Portuguese, Punjabi, Romanian, Somali and Urdu.

See how to print digital leaflets if you want to print any sections of this guidance.

Free printed copies of this leaflet are also provided for local screening providers to give to women who cannot access the internet. Screening services can view the full PDF of the printed leaflet and order printed copies on the APS online ordering portal (requires login).

Contact the screening helpdesk with any queries about this publication, making sure you include its full title.

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Screening tests for you and your baby (STFYAYB)

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STFYAYB provides information about the screening tests offered during and after pregnancy.

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You will be offered a scan between 10 and 14 weeks of pregnancy to check if you are high or low chance of having a baby with these conditions.

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Sickle cell disease and thalassaemia are blood conditions that may affect your baby.  If one parent is a carrier of the condition, we would recommend the other parent is tested, as the baby may be at risk of having this condition if borth parents are carriers.

Sickle cell disease and thalassaemia are more common for people whose family comes from:
• Africa
• the Caribbean
• the Mediterranean
• India
• Pakistan
• south and south east Asia
• the Middle East
But anyone can be a carrier, so we offer screening to everyone in every pregnancy.

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You will need the blood form that is given to you by your midwife or doctor at your appointment. If you do not have a form please contact our maternity helpline on 01279 827286

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Online Appointment Healthcare Platform | Swiftqueue

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Our #movementsmatter campaign challenges dangerous myths about baby movement during pregnancy, and gives mums-to-be the facts about what to do when they experience reduced fetal movements. Please share our film, it could save a baby's life Find out more: www.tommys.org/movementsmatter

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How to sleep safely during pregnancy - Tommy's

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Peer Support for Parents in the antenatal stage and up to 12 months after birth.

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If you feel that you would like someone to talk to in a non-judgemental space, then please get in touch.

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Share your videos with friends, family, and the world

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Facebook links to the family hubs in your area

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Facebook links to the family hubs in your area

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Hubs in West Essex
Harlow
Epping and Ongar
Uttlesford

Hubs in Hertfordshire
Broxbourne
East Hertfordshire

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Check out our advice & guidance, read women's stories& discover resources to help you become or stay active

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Check out our advice & guidance, read women's stories& discover resources to help you become or stay active

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FREE downloadable resources packed with advice and

top tips to guide you through your pregnancy journey

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Mums & Mums-to-Be

Check out our advice & guidance, read women's stories

& discover resources to help you become or stay active

FREE downloadable resources packed with advice and

top tips to guide you through your pregnancy journey

Join Our Community!

You're not alone

Be active

together!

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Mums & Mums-to-Be Check out our advice & guidance, read women's stories & discover resources to help you become or stay active FREE downloadable resources packed with advice and top tips to guide you through your pregnancy journey Join Our Community! You're not alone Be active together!

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Maintaining activity levels helps you to keep you healthy during pregnancy, this video shows you how exercise when you are pregnant

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Active Pregnancy Foundation - Pregnancy CMO Guidelines

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0:00 / 1:50•Watch full video

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East of England Neonatal, Paediatric Critical Care and Surgery in Children Operational Delivery Network

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East of England Neonatal, Paediatric Critical Care and Surgery in Children Operational Delivery Network

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Parents & Carers

Welcome to the East of England Neonatal, Paediatric Critical Care and Surgery in Children Operational Delivery Network Parents & Carer's page.

This page contains information for parents, carer's & their families in the East of England Network

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Information for Parents and Carers | Support & Guidance | EoE ODN

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Welcome to the East of England Neonatal, Paediatric Critical Care and Surgery in Children Operational Delivery Network Parents & Carer's page.