Supporting your NHS Midwife to support you

Optimally, NHS midwives will practice in an evidence-based manner, offer you informed choice, and support your decisions.

However, hospital policies vary widely from Trust to Trust, and NHS midwives may sometimes be discouraged by their local policies from supporting your choices. The correction of misinformation may empower them to support your hospital birth plan. In one case, an NHS midwife was told by her hospital that she could be labelled as negligent if she turned on birth pool taps for a woman she was caring for, who wished to use the pool during her VBAC, because pool use for a VBAC was not in line with that particular hospital’s policy.

Human rights lawyer Elizabeth Prochaska, founder of Birthrights UK responds:

“The basic position on liability is that midwives/doctors are only liable for negligent practice. That means practice that falls below accepted professional standards.

‘Allowing’ a VBAC woman to use the pool would not, in my view, constitute negligence because it is a practice that is widely adopted in plenty of birth centres and maternity units.

If the maternity unit does not have telemetry monitoring [allowing for wireless/waterproof continuous electronic fetal monitoring] and a woman cannot be monitored in the pool, she should be advised clearly about the risks of lack of monitoring. If she chooses to accept those risks, then the staff cannot be held accountable for adverse outcomes unless they act negligently in another way, e.g. fail to spot other potential signs of distress/scar rupture.

If a woman is refused her choice of pain relief, including water, then the unit ought to be aware that it is restricting her rights under Article 8 of the European Convention on Human Rights. It must clearly justify its restriction and in my view, refusal of water birth would be very difficult to justify in the face of practice at other units”.

The wider implication here is that if your choices are considered unusual by your local maternity unit, but they are normal at some other maternity units, it is reasonable for you to be able to negotiate for what you need locally. To do so may in fact increase the knowledge, skills and confidence of the midwives caring for you, benefiting their Trust and other women they care for in the future. As independent midwives, we can help you negotiate for your hospital birth or NHS supported home birth. Read one client’s story of this kind of support here.