Consent to Treatment – useful information, including rights around freebirth

There are many myths surrounding the issues of informed consent, declining treatment or attendance.  I hope this helps you to find the information you need.

The legal question about ‘home birth’ needs to be clarified and reframed.  The question isn’t, ‘Do women have a right to home birth?’  The question is: ‘Do women have a legal obligation to give birth in the hospital?’

Hermine Hayes-Klein

The Professional Position:

 NMC Statement on supporting Freebirth (2012)

http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/Regulation-in-Practice-Topics/Free-birthing1/
There is also a printable pdf here: NMC Freebirth Statement 2012

NMC Statement on Consent (2012)

www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Consent/

 RCM Practice guidelines (2008) 

www.rcm.org.uk/college/policy-practice/guidelines/practice-guidelines/

 GMC Consent Guidance (2008)

www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_index.asp

www.gmc-uk.org/static/documents/content/Consent_0510.pdf

 RCOG Clinical Governance Advice No. 6 – Obtaining Valid Consent (2008)

www.rcog.org.uk/files/rcog-corp/CGA6-15072010.pdf

NMC Guidance on Confidentiality

www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Confidentiality/

 RCN Statement on Dignity

www.rcn.org.uk/__data/assets/pdf_file/0003/191730/003298.pdf

 

The Government’s Position:

DoH statement on Consent (2009) 

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_103643

NHS statement on consent (2012)

www.nhs.uk/Conditions/Consent-to-treatment/Pages/Introduction.aspx

NHS lawyers and insurers (NHS Litigation Authority (2012))

www.nhsla.com/NR/rdonlyres/6CBDEB8A-9F39-4A44-B04C-2865FD89C683/0/NHSLARiskManagementStandards201213.pdf

NICE Caesarean Section Pathway (2011) 

www.pathways.nice.org.uk/pathways/caesarean-section#content=view-node%3Anodes-information-and-consent

 

The Law:

Article 8 of the Human Rights Act (last updated 2012)

www.yourrights.org.uk/yourrights/the-human-rights-act/the-convention-rights/article-8-right-to-respect-for-private-and-family-life.html

Freebirth is not illegal.  There is some misunderstanding around this issue.  It is illegal to impersonate or practice as a doctor, nurse, midwife or other medical professional if you do not have a current registration to do so (and that goes for those with lapsed or revoked registrations as well as those who have never qualified).  To practice in the case of birth means things like performing clinical examinations, giving medical advice, drugs or procedures or otherwise giving the impression that you are qualified to do so.  It does not mean that those who are with you can’t give you emotional or practical support, nor does it mean that they can’t give first aid, either under the direction of someone else, such as an ambulance crew or labour ward midwife on the telephone, or the same as anyone passing by might.  If your family and friends support you to birth, as long as they are not tracking your progress, reporting on the well-being of your baby, performing internal examinations and the like, they are supporters and not medical attendants, and they are there perfectly legally.  If you are told that you or your supporters could be charged for being present at a freebirth in the UK it is untrue.

There have been situations where concerned health professionals have referred (or at least threatened to refer) women to Social Services for planning a freebirth or intentionally birthing without medical attendance, using ‘Child Protection’ guidance as a means of persuading parents to comply.  However, unless a health professional has other reason to assume that there is neglect or abuse happening, then the referral is not appropriate, and is, in fact, against their professional code of conduct, regardless of what hospital policy might be.  Social Services expect all referrals to be made in full consultation with parents unless there is a substantial belief that doing so would increase the danger, and they are not there to enforce compliance with medical advice.  If you experience bullying of this nature, AIMS can provide help and support.

You can also have a look at this article from AIMS for more resources and sample letters.

Just for your amusement, here is a definition for all my birth and women’s rights campaigning friends:
Gynaetician – A politician who thinks he has more right to decide what is right for a woman than she does herself.

If you wish to file your own birth notification to generate an NHS number, you can download a template here birth_notification_form_blank, fill in your details, delete the instructions from the bottom, and send it to your local Children’s Services department.

If you want to know more about freebirth, there are some more resources here.