Resources: End Coercion in Maternity Care in the UK
We’ve developed some resources for women and birthing people and healthcare professionals who are impacted by coercion in maternity care. These are available to read, download, print and share below.
- Understanding Coercion – “What is coercion in maternity care?”
- Your Right to Make Your Own Decisions in Maternity Care – “What are my legal rights in maternity care?”
1. Understanding Coercion
“What is coercion in maternity care?”
Coercion is when you feel pressured or pushed into making decisions about your care that don’t feel right for you.
It can be obvious or subtle — but it is never acceptable.
“What can coercion look like?”
Coercion can take many forms. You might recognise some of these experiences:
*Particularly common with scans, inductions, sweeps and vaginal examinations
“Just hop up on the bed and we’ll see how you are doing”
“I gave you a sweep whilst I was there to get things moving”
*Particularly common with access to birthplace settings, use of pain relief options, and access to caesarean.
“You’re not allowed on the birth centre if you’ve had a previous caesarean”
“We don’t let you in the birth pool until you’re 5cm dilated”
“We don’t accept maternal request c-section here”
You are made to feel scared or threatened into agreeing.
*Particularly common when asking for something that feels unfamiliar or ‘risky’ to your healthcare provider, and/or is considered “out of guidance”.
This might involve:
- Being threatened with social services involvement, if you do not comply with clinical recommendations
- Being threatened with mental capacity assessment(s) simply for making decisions that are “outside of guidance” or not clinically recommended.
- Being asked to “sign a statement” or “legal letter”, which appears to say that you have waived all your legal rights.
- Being made to feel that your baby’s life is at risk, without personalised discussion of the risks in your individual circumstances
- Being threatened with care being withdrawn
“You have to have antibiotics or else you will be reported to social services and police would step in after birth”
“If you don’t do X, your baby will die”
“If you don’t accept regular monitoring and vaginal exams, we won’t be able to support your homebirth”
Important information is minimised, dismissed, or presented in a biased way.
*Particularly common when you are trying to discuss options for where and how you plan to give birth and what feels important to you.
“We don’t discuss place of birth until you are 36 weeks”
“The benefits of induction are….the risks of waiting for spontaneous labour are…”
(without sharing the risks of induction, the benefits of waiting for spontaneous labour, or alternative options e.g. caesarean birth)
Pressure to choose the option that feels more comfortable for staff, rather than the one that is right for you. It can feel emotional or like it is ‘coming from a good place’ – but still influences your decision.
*Particularly common when your caregivers are facing staffing or resource shortages, or you are asking for something ‘outside of guidance’
“We would all feel quite uncomfortable with that”
“Everyone on the unit is really stretched right now, and if you ask for this it will make things really hard for them”
Your choices are questioned again and again (by the same or multiple staff members) despite your circumstances and reasons not changing.
*Particularly common when making a choice that is considered ‘outside of guidance’ or unusual
“Our consultant would just like to pop in after this to talk to you about your decision to refuse…”
“You’ll have to be referred to our birth choices clinic so that X and Y can speak to you about that further”
You are rushed into making decisions without medical urgency.
“You can’t leave [hospital] until you’ve made a decision on which option you are choosing”;
“As you haven’t decided yet, I’ll just book you in for an induction just in case”
Trying to get your partner or family member on side to guilt or persuade you into something you don’t want.
“Tell your partner she is making a mistake”
“Surely you don’t want this baby to die? You need to convince her to change her mind.”
This can include:
- Being pressured to accept additional tests based on assumptions about your race or ethnicity
- Being automatically labelled as “high risk” or “out of guidance”
- Being told you are “not allowed” to make certain choices because of your race or ethnicity
- Not being told that certain options are available to you e.g. homebirth, maternal request c-section, waiting for spontaneous labour
- Being referred to social services in circumstances which would not trigger a social services referral for white women and birthing people
“You have to be tested for gestational diabetes because you are Asian”
“You have gestational diabetes so you can’t go to the birth centre, and you must be induced.”
“You have a high BMI so can’t have a water birth”
“If you refuse to attend the antenatal appointments we book for you, we’ll have to refer you to social services.”
2. Your Right to Make Your Own Decisions in Maternity Care
“What are my legal rights in maternity care?”
- To receive NHS maternity care, with no upfront charges
- To be treated with dignity and respect
- To ask questions, and make your own decisions about your maternity care
- To say ‘yes’ or ‘no’ to any examination or treatment offered
- To request a different healthcare professional
- To complain
“What decisions might I face during pregnancy and birth?”
During your pregnancy and birth, you will make many decisions relating to your maternity care.
- whether or not to accept any, some or all appointments, scans, examinations or treatments offered during your pregnancy and birth;
- where and how you want to birth your baby;
- what (if any) pain relief you want to use during your birth, and
- who you want to support you at your birth.
- As the pregnant woman or person, you are the decision maker. It is for you, and not your healthcare provider, to decide whether to say “yes” or “no” to any appointment, scan, examination or treatment offered.*
- Your healthcare provider must offer to have a conversation with you before you make your decision, where they explain the important risks and benefits of the option they recommend, and also the important risks and benefits of any reasonable alternative options.
- The information must be relevant for your individual circumstances, and your healthcare provider should give you time to ask questions, and ensure that you understand what they have shared.
- You must not be pressurised or pushed by your healthcare provider to make a particular choice.
If you feel under pressure from your healthcare provider to make a particular choice, this is coercion and it is unlawful. You can read more about what coercion looks like here.
*The only exception to this rule is where someone lacks capacity to make decisions about their care. This is extremely unusual in maternity care. The law says that it must be assumed that you have capacity to make your own decisions unless/until it can be shown that you do not. For more information about this topic, see our factsheet on ‘Mental capacity and maternity care’.
Sometimes, you might make a decision in advance and then later wish to change your mind. That is absolutely ok, and your healthcare provider should respect this.
For example, you might decide before your labour starts that you are happy for midwives to perform routine vaginal exams, but then in labour you might decide that you do not want to be touched at all. That is absolutely ok. You can communicate to your healthcare provider that you have withdrawn your consent. This must be respected.
‘Your Basic Birth Rights’ factsheet & ‘Know Your Rights’ leaflet, both available in 20 different languages.
Our human rights information factsheets on 14 different topics, including our ‘Consenting to Treatment’ factsheet.