Shizzle You Need To Know.

Shizzle you should know!!!

Every christmas the amazing Chilled Mama (@Chilledmamacathy) creates the Birth Rights advent calendar and this amazing calendar has so much Shizzle on it that is simply amazing. I have created this recap below in case you missed it so that you have all the info to hand. 

The 24 days of advent is created every year, and is used to help raise money for 2 amazing charities Birth Rights and AIMS. If you enjoy reading this, learnt something and want to help donate the link to do so is – 

https://uk.virginmoneygiving.com/fundraiser-display/showROFundraiserPage?userUrl=birthrightsadventcalendar&pageUrl=2

You have legal autonomy over your body, including your unborn baby.

This is the bottom line. All the other rights stem from this. Body autonomy.

Women have legal autonomy over what happens to their body. Here in the UK, and in many other places, that includes her unborn baby/babies. 

Women have to give consent to anything that happens to their bodies. 

Only if a court of law considers her mentally incapacitated can anything be done to her body without her permission. It is up to a judge to decide that.

If anything is done to a woman’s body without that consent it is assault.
NHS England website:

“If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.

This is still the case even if refusing treatment would result in their death,
or the death of their unborn baby.”

https://www.nhs.uk/conditions/consent-to-treatment

My body. My baby. My decision.

You have ‘parental responsibility’ for all decisions relating to your baby/babies.

A woman, or the person who has given birth, has legal jurisdiction over their baby/babies, known as ‘parental responsibility’.

Men, and other partners, also have parental responsibility if they are married to the mother and/or are named on the birth certificate or have sought it separately. In the early days, before the registration of the birth, the presence of the partner in supporting the mother/birthing person and infant is an indication of parental responsibility.

Parental responsibility means the parents have to agree, give consent, to every investigation, treatment, and intervention. This includes giving antibiotics or infant formula; stay in special care; transfer from home to hospital/discharge from hospital.  

The baby is a separate patient in her or his own right, but the parents give the permission for treatment, which means they can say no. If the doctor or midwife disagrees with the parent they cannot disregard this and go ahead anyway. They need to go to a court of law. There are a few exceptions, such as immediate threat to life. 

The baby might be the hospital’s patient; but s/he is your child, and you have a right to be involved in the decisions around treatment, and as their parent you have the final say. 

If anything is done to your baby without that consent it is assault.

This means there is no ‘have to’, ‘should’ or ‘allowed’.  

This is what the government has to say on legal parental responsiblity.
https://www.gov.uk/parental-rights-responsibilities

This is what the NHS says on parental consent to treatment etc.
https://www.nhs.uk/conditions/consent-to-treatment/children

Just a reminder: consent should be voluntary and informed. So no emotional blackmail, no dismissing your questions. 

Professionals please use language that acknowledges parents’ rights.

The only legal requirement relating to pregnancy and birth is to inform officials of the birth.
Everything else is your choice.

Yup, that’s it. That’s the only thing you ‘have’ to do.

Everything else is the your choice, as the person growing the baby. You don’t have to go to any appointments. You don’t have to tell your GP that you’re pregnant, you can contact a midwife directly. You don’t even have to contact a midwife. It’s your choice. 

You don’t have to see a doctor or a midwife for your entire pregnancy if you don’t want to. You are having a baby. You choose what would be helpful to you. Maternity care is a service that is offered to you. There are benefits to signing up to maternity care early in pregnancy, but you don’t legally have to. 

You do not legally have to have a midwife or a doctor with you when you give birth. You do not have to give birth alone, you can have your partner, friend, doula with you. They cannot be prosecuted unless they pretend they have skills of a midwife and/or act on this. 

So from that starting point you can choose to engage with it as much as fits with you and your situation. And women do. Some women do not ever see a midwife or doctor. Some have some antenatal care but give birth without a midwife (free birth). Some have little or no antenatal care but have a midwife on hand for the birth. Some pick and choose which appointments, tests, treatments, and interventions would help them in growing and birthing their baby. 

To go straight to a midwife when you find out you are pregnant, just call the local maternity unit, or look on their website. This is encouraged by the NHS. There is no need to see your GP first.

So all scans, blood tests, fundal height measurements, wee samples, monitoring, glucose tolerance tests, listening in to baby, giving your weight, midwife appointments, doctor appointments, consultant appointments, caesarean, where you give birth, any help needed at the birth, and all the stuff postnatally, all of it. is your choice.  

You can decide to accept it all. You can decide to accept some, or none. And you can change or mind. 

Your midwife or doctor should give you the pros and cons of every test/screening/intervention, plus the pros and cons of the alternatives, and of doing nothing.

If there are aspects of the offered maternity care that you would like to decline, or would like more info about, talk to your midwife/doctor in the first instance. Just say that you ‘politely decline’. If that doesn’t work out then write to the Head of Midwifery, X Hospital, Y Town.

If you would like more support with your choices you can contact @AIMS or @Birthrights UK. 

You do not have to be a ‘good girl’. You are a mum. You do not need to prove to anybody that you are good. Channel your inner mama bear and decide what is right for you, your baby, and your family. 

I love this article by Aviva Romm, an American doctor, about why Being a good girl can be hazardous for your health.
https://avivaromm.com/good-girl-health-hazard/

Just a reminder: consent should be voluntary and informed. So no emotional blackmail, no dismissing your questions. 

My body. My baby. My choice.

Women do the allowing.
Mary Cronk, midwife

As the woman who is pregnant, who is carrying the baby, who is giving birth to the baby from your own body, you, and only you, have the authority to allow or not allow something to happen.

So many times women hear that midwives/doctors/midwives do or don’t allow something. ‘We’ll only allow you to go to 41 weeks because you are old/fat/had a previous caesarean/having a big baby.’ ‘We don’t allow you to eat in labour if you are high risk.’ ‘We will allow you to go home once baby is feeding well.’

It is your body. It is your baby. It is your choice. 

Most of the time it is just that health professionals have just got used to doing things a certain way. It’s their daily job and they get into routines and use phrases without thinking sometimes. But as pregnant women, or their partner, you are influenced by the language. 

Sometimes midwives and doctors can get caught up thinking about their work practices and following the hospital policies they forget that women have the right to accept or decline, and feel under pressure to get you to comply. Sometimes the ‘only allow’ is because it fits better with the running of the hospital. 

Doesn’t matter why the word ‘allow’ is used though, it is still your choice. This means there is no ‘should’ or ‘allowed’.  

Mary Cronk was one of the UK’s most respected and renown midwives. Sadly she died during advent last year. I was lucky enough to hear her talk at several conferences put on by Chichester Home Birth Group. 

Her words live on. Just this week a midwife shared a story about Mary. Mary had accompanied a client transferring in from a home birth, and was doing a hand over to the hospital midwife. A doctor came in and asked who was in charge. Without missing a beat, Mary replied “I think you’ll find my client is in charge.”
(Imagine this being said in Mary’s Glaswegian accent.)

Mary would say that women should start using the word ‘allow’. ‘I will allow you to do this blood test.’ ‘I won’t allow anyone to do a vaginal examination on arrival at the midwife led unit.’ 

Mary is an amazing, wonderful and wise midwife. She has some great phrases about consent to treatment which she recommends women and their partners learning off by hear. Click on the link to read them. 
http://www.homebirth.org.uk/marycronkphrases.htm

You can watch Mary talking about her phrases, her training and her midwifery experiences. Click on these links.
https://youtu.be/ycutSsGIAkA

You can also read about the first time iron entered her soul here. I tell my clients about her and share her story. Most of them go on to have their own Mary Cronk moment. 
http://wisewomanwayofbirth.com/the-first-time-that-the-iron-entered-my-soul-by-mary-cronk-mbe/

So remember, women do the allowing! Think about channelling your inner Mary Cronk. 

Just a reminder: consent should be voluntary and informed. So no emotional blackmail, no dismissing your questions. 
https://www.nhs.uk/conditions/consent-to-treatment/#defining-consent

You can read Mary Cronk’s guidance on vbac scar monitoring, vaginal twin birth and vaginal breech birth.
http://www.caesarean.org.uk/articles/VBACScarMonitoring.html
http://www.homebirth.org.uk/marycronk/marytwins.htm
https://www.aims.org.uk/journal/item/hands-off-that-breech

You can read this special obituary by Mary’s friend and fellow independent midwife Joy Horner.
https://www.all4maternity.com/mrs-mary-cronk-mbe/

‘Shared decision making’ is a current buzz phrase and a bit of a misnomer. It describes the process, of open discussions with patients at the core, but it does not describe the authority. It is your your body, your baby, so your decision.

Shared decision making was coined to bring birth professionals out from their ingrained practise of making decisions for their patients. “What we’ll do with you is …” “Here’s the date for your scan/consultant appointment/induction/caesarean.” 

It came from the NHS’s ‘No decision about me without me’ move.

“No decision about me, without me. This can only be realised by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone. Shared Decision Making is a process in which patients, when they reach a decision crossroads in their health care, can review all the treatment options available to them and participate actively with their healthcare professional in making that decision.” NHS England

However, some behaviours are hard to change and some women find that ‘shared decision making’ is the process of their midwife or doctor describing what will happen and why and then expecting agreement. Not actually listening to the woman, answering her questions truthfully, sharing the research, and supporting her choices. Giving the positives of their preferred course of action, and the negatives of not complying. And not recognising that it is she who makes the final decision.

It’s a bit like having a ‘Birth Choices Clinic’ but not actually giving women any choices. (Yes, I’ve been there.)

I know there is a repeated theme in these Birth Rights Advent Calendar posts, but it needs to be hammered home. It is your body, your baby, your choice.  

I’m not saying you shouldn’t listen to your midwife or doctor. Knowing your rights isn’t about saying ‘no’ to everything, it’s just knowing that you are the one who decides ‘yes’ or ‘no’.

It is UK law, and international human rights law that women have autonomy over their body, and parents have parental responsibility for their new babies. 

Every appointment, screening, and treatment is offered. It is up to you to accept or decline.

You are having a baby. This is something you have chosen to do with your body. It is a private thing. It is your baby. 

Maternity care is offered to you to support you in that. Research has shown that certain things, on a population level, improve outcomes. So these are offered. Somethings there is little or no research on but they seem to work so they are offered. Research has shown that somethings don’t help, but sometimes these things are still offered because that’s the way we’ve been doing it.

In order to make this work there is a maternity care system, with guidelines and policies. None of it is obligatory. You may decide to accept every appointment, test and intervention, or may decide to decline all or some. It is up to you.

It is worth thinking or asking about the following:

Why is this being offered?
What is it for? What will it do?
What are the Benefits to my baby and me of this? 
What are the downsides to this? (Risks)
What might happen as a result?
What Alternatives are there?
How do I feel about this? What do my Instincts say?
What if I don’t? What if we do Nothing for now? What then?
You might find it useful to remain it as using your B R A I N.

So, for example, scans: do you know why each one is offered? What are they looking for? What would be the benefit of finding out? What if something is shown? Do you want to know? What might be the consequences? What is the research around the safety of scans? How do I feel about scans?

You can accept or decline each scan, and elements within a scan. For example you might decide to accept a dating scan but do not want the sonographer to look for markers of Down’s Syndrome. Or you could decide you only want them to look at the markers and not at the dates. If you don’t want to know about Down’s Syndrome markers and know your dates (or don’t want to risk them being changed by the scan because it might cause problems if you go past your ‘due date’) then you might like to decline it completely. (There are other things checked for in a dating scan, and other reasons for and against having them, I’m just trying to simplify!)

For a thorough and balanced look at the different choices about appointments, tests and interventions I thoroughly recommend Milli Hill’s book The Positive Birth Book.

You can politely decline midwife appointments, consultant appointments, consultant led care, blood tests, wee samples, glucose tolerance test, sweeps, induction, caesarean, forceps, continual monitoring, intermittent monitoring, etc etc etc. I’m not saying that I think you should decline, just that you can.

Knowing your birth rights isn’t about saying ‘no’ to everything,
but knowing you are the one who gets to say ‘yes’ or ‘no’.

You might think that there is one agreed, proven, best way of doing things, but there isn’t. We are all individuals. Different doctors and different midwives have differences of opinion on the whole range of maternity care. You can see one doctor who recommends induction at x weeks, and another who looks at the situation and recommends a different path. Just like us, doctors and midwives do not just make decisions based on the facts and figures, but bring in their experiences, values, and individual viewpoints. There isn’t always the solid, conclusive, gold standard research to go on anyway. 

A review, in 2014, by obstetricians, of the guidance documents from the Royal College of Obstetricians and Gynaecologists, found that just 9-12% of recommendations were based on top quality research, and that 66% of obstetric recommendations/guidelines were only expert opinion or best practise, based on the experience of those on the panel, with no research behind them at all. Read more in my blog about Why bother knowing your birth rights?
https://www.chilledmama.co.uk/post/2017-11-30-why-bother-knowing-your-rights-in-pregnancy

As was said in a previous post: the only legal requirement relating to pregnancy and birth is to inform the officials of the birth. EVERYTHING ELSE IS YOUR CHOICE. You can accept or decline.

If you would like to decline something or opt for alternatives start by talking to your midwife or obstetrician. In my experience the vast majority of times they will bend over backwards to accommodate you. Knowing your birth rights gives you confidence to say, ‘I politely decline’, or to ask for something off the usual routine, and in nine out of ten times it will be met by an ‘oh, of course, let me sort that for you.

If this is not your experience then try the following:

🤰🏾Phone or write to the head of midwifery/consultant midwife if your trust has one and ask for your decisions to be supported.
🤰🏾Contact PALS (patient advocacy and liaison service) at your local hospital.
🤰🏾Seek peer support from your local Positive Birth Movement group.
🤰🏾Seek support from a local doula or antenatal teacher. There may be a charge for this.
🤰🏾Employ a doula.
🤰🏾Contact AIMS and/or Birthrights for more information and support. They both have fab helplines/email help.
🤰🏾Download my leaflet ‘Negotiating your care’ for ways to talk to health professionals about your care in pregnancy or in labour. (Link is in the article above.)

Going ahead if you have said ‘no’ is assault. Consent must be ‘voluntary’ and ‘informed’. So no emotional blackmail and no evading your questions.

My body. My baby. My choice.

I am a doula and antenatal teacher who knows that when birth rights are respected women, their babies and their partners have better care, better outcomes and are less traumatised. 

No professional has a greater stake in the well-being of the baby than the parents.
The consequences are theirs so the decisions are theirs.

“I’m just thinking about what’s best for the baby.” “It’s not about an experience. At the end of the day it’s about a healthy baby.” “The baby is my patient and I am just doing what is best for them.” “You wouldn’t want to put the baby at extra risk, would you?” “Unfortunately in this country we don’t have rights for unborn babies.”

These are all phrases I have heard, or women have told me were said to them, by professionals, when they questioned the suggested care option, or asked for a different course of action.  

I find it highly offensive for any professional to assert they have greater concern for the baby then the parents. It is the number one thought and worry for women and partners, for nine months (and a lifetime after that too). The vast majority of women will always put their baby’s well-being above their own.

Of course most of the time the professional is expressing their genuine opinion, based on their assessment of the situation, which has a number of factors, not just the safety of the baby, but also the ease for the hospital system and staff. Though sometimes the use of the ‘dead baby card’ is purely manipulation to get woman to comply, from a paternalistic stand point. 

To come out with phrases like these is emotional blackmail. It not only stops informed consent, but also breaks down the trust between parents and professionals. 

If you are a health professional, your job isn’t to get women/birthing people to comply, it is to give them the information, answer their questions, and then support their decision, whether you agree or not. Here is an ethical guide on informed consent and refusal in obstetrics.  
https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12281
And this is a guide to human rights in maternity care in the UK for midwives.
https://www.bihr.org.uk/midwiferyhumanrights

Situations are rarely black and white. Whilst guidelines often distil an issue down to one thing (e.g. with vbac, detecting and dealing with scar rupture), women are balancing different factors. One client was having a tear stitched after a vbac when her consultant walked in and said, ‘I bet you wish you’d had that caesarean now.’ ‘No, tomorrow I will be able to pick up my toddler”, she replied.

We all make different decisions, even in the same situation. Not all doctors and midwives think the same either. And sometimes the research isn’t clear anyway. It is very patronising for a professional to say that they have weighed up the risks on your behalf.  

Whatever the risks of one thing or another. It is your risk to take.  

Of course a healthy baby is the most important thing. Nobody knows that more than the parents. We can be trusted to make decisions, we are adults, parents; we are about to make decisions for our child for the next eighteen years. And it is rarely either/or. (More on this in the coming days.)

Research is backing up individualised decision making. The huge national maternity review report, Better Births, concluded “It is increasingly evident that personalised care means safer care and better outcomes.” 

And a healthy baby is not all that matters. (Here is a great article which talks about this.) You are not merely a vessel to grow baby in. You are a dyad, you and your baby. Your baby cannot have maximum health if you are recovering from a traumatic birth where your wishes and your body autonomy were damaged. What’s good for mum is good for baby, and that’s good for dad/other mum too.

My body. My baby. My choice.

Informed consent: the obligation is on the health care provider to give you unbiased information. You do not need to prove your decision is informed.


I meet a lot of women who feel the need to win their health provider over to their point of view, or at least show their midwife or doctor that they know their stuff. They want to show they are reasonable women, making an informed decision. 

The law of the land is that it is your decision, whether it is informed or not, whether the midwife or doctor agrees with you, or they don’t.

NHS England “For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.”

informed – the person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead

You want enough options to make your decisions, to be informed. The midwives and doctors have a responsibility to give you sufficient information to do so, and to give both pros and cons of each option, including the option to do nothing. For example, if considering birth options after a previous caesarean, it is not okay to give you the risk of vaginal birth and not the risks of a repeat caesarean, or visa versa. They should also explain where the research is weak or lacking. (The RCOG Green Top Guidelines specifies that women should be told there is not sufficient good quality research to say whether it is better to have another caesarean or a vaginal birth.)

Informed consent is much more than just giving consent to a test or intervention. It is also making informed decisions, and being given the all the options. Rather than accepting or declining an option from a preapproved menu, informed decision making means being given all the options, including a planned casearean, or giving birth at a midwife led unit/birth centre.

Following the landmark Montgomery ruling in the Supreme Court, clinicians cannot rely solely on printed information. 

“This means that there must be a genuine dialogue between doctor and patient and the assessment of risk must be sensitive to the individual’s characteristics. Statistics alone will not determine whether a risk is significant for a particular patient. For example, the risk of complications for future pregnancies after a c-section might be statistically small, but it would be more significant for a woman who wished to have multiple children than for a woman who did not.”
Birthrights Consenting to treatment fact sheet

Turn the relationship around in your head. The appointments are not there for you to give information to the midwife or doctor about how informed you are, but for you to use their expertise to help you with your decision making. Midwives and doctors are highly skilled and knowledgeable. Use this. Ask them lots of questions. Ask them for the research or websites you could look at. Ask several different people if necessary. They are there to help you make your decision. You don’t have to get them to like you. They are professionals. 

At the end of the day it is your decision. You do not need to get into an argument about it. If they feel unable to support you, you can request to see someone else. You can also say, ‘Thank you for your opinion, we will consider it, but at the moment we still want xyz. Please put it in our notes that we have had this discussion and we have made this decision.’

Whatever the risks of one thing or another. It is your risk to take.  

Oh, and you can change your mind and withdraw consent at anytime. For instance, during a vaginal examination you can ask the clinician to stop, even if they haven’t finished. And they must stop. 

Research is backing up individualised decision making. The huge national maternity review report, Better Births, concluded “It is increasingly evident that personalised care means safer care and better outcomes.” 

My body. My baby. My choice.

“The freedom of a country can be measured by the freedom of birth.”
Agnes Gereb, obstetrician turned midwife


Agnes Gereb is a Hungarian obstetrician who did home births. Threatened with being struck off, because obstetricians don’t do home births, she re-registered as a midwife. Authorities then jumped on the fact that a baby died, even though it wasn’t a home birth, the woman had turned up in premature labour at Agnes’ clinic, and Agnes had sent her straight to hospital. Agnes was found guilty of malpractice and spent months in jail before being released under house arrest.

Agnes Gereb’s story is featured in the documentary Freedom of Birth, made by One World Birth. You can watch these videos of Agnes and others talking about her case, and about the implications for birth around the world.  
December 9th
“The freedom of a country can be measured by the freedom of birth.”
Agnes Gereb, obstetrician turned midwife


Agnes Gereb is a Hungarian obstetrician who did home births. Threatened with being struck off, because obstetricians don’t do home births, she re-registered as a midwife. Authorities then jumped on the fact that a baby died, even though it wasn’t a home birth, the woman had turned up in premature labour at Agnes’ clinic, and Agnes had sent her straight to hospital. Agnes was found guilty of malpractice and spent months in jail before being released under house arrest.

Agnes Gereb’s story is featured in the documentary Freedom of Birth, made by One World Birth. You can watch these videos of Agnes and others talking about her case, and about the implications for birth around the world. One of Agnes’ clients, unable to have a home birth now due to the clamp down after Agnes’ arrest, took the Hungarian government to the European Court of Human Rights , and won. The landmark trial concluded,

“the right to private life includes a right for women to make choices about the circumstances in which they give birth, including whether to give birth at home.”
(taken from Birthrights leaflet on human rights in childbirth)

The good news is that since last year’s Birth Rights Advent Calendar, Agnes Gereb has been granted clemency by the President of Hungary. This means she does not have to serve any remaining sentence, but it still means that she isn’t free to practise midwifery. 

But it is not just Agnes. Even in the UK it happens. Becky Reed, midwife for the Albany Midwifery Practise and the author of Birth in Focus, was under disciplinary for three years before being exonerated. The Albany Practise was closed down even though it had an exemplary record of low intervention and high rates of breastfeeding, even though they worked in an area of high deprivation. What’s more, 70% of women gave birth without even gas and air. Knowing and trusting your midwife makes birth less painful. 

Last year research was published which examined the Albany midwives records, showing the incredible outcomes for the women under their care. This is now held up as a prime example of the impact of continuity of carer.  

Around the world women and midwives are facing challenges to their power. In Spain, in Italy, in India, in the USA, in Ireland. In the US it is illegal to be a midwife in almost half the states. There are restrictions on practise, on place of birth, forced caesareans and denied caesareans.

The UK has seen a huge change in who is in charge of birth, way above any ‘increased risk levels’. In 1989/90 midwives were the primary professional at 75% of births in England. Year by year this has declined. Last year, 2017/18 midwives were the primary professional at only 51% of births in England, and the past year it has dropped to just over 50%. (NHS Maternity Statistics, England 2018/19) This demonstrates the incremental medicalisation of maternity care, and the marginalisation of midwifery. 

We need to reclaim birth. Women and midwives. Freedom of birth depends on midwives. 

There is good news, great news: across the UK every maternity unit is working towards a target for the number of women experiencing continuity of carer by 2020. Continuity of carer is a key element of the Better Births initiative being rolled out across the country.  

We need to add our voices so that we hold on to our power, our freedom of birth.

Ask your midwife about continuity of carer in your area.
Write to the head of midwifery, and the chief exec of the health care trust for your hospital, and ask them what progress is being made.
Contact your local Maternity Voices Partnership and get them to raise continuity of carer. Tell them how important it is to you. Or even better, join your local one. 
Email your local Healthwatch and tell them how important continuity of carer is to you.

My body. My baby. My choice.
One of Agnes’ clients, unable to have a home birth now due to the clamp down after Agnes’ arrest, took the Hungarian government to the European Court of Human Rights , and won. The landmark trial concluded,

“the right to private life includes a right for women to make choices about the circumstances in which they give birth, including whether to give birth at home.”
(taken from Birthrights leaflet on human rights in childbirth)

The good news is that since last year’s Birth Rights Advent Calendar, Agnes Gereb has been granted clemency by the President of Hungary. This means she does not have to serve any remaining sentence, but it still means that she isn’t free to practise midwifery. 

But it is not just Agnes. Even in the UK it happens. Becky Reed, midwife for the Albany Midwifery Practise and the author of Birth in Focus, was under disciplinary for three years before being exonerated. The Albany Practise was closed down even though it had an exemplary record of low intervention and high rates of breastfeeding, even though they worked in an area of high deprivation. What’s more, 70% of women gave birth without even gas and air. Knowing and trusting your midwife makes birth less painful. 

Last year research was published which examined the Albany midwives records, showing the incredible outcomes for the women under their care. This is now held up as a prime example of the impact of continuity of carer.  

Around the world women and midwives are facing challenges to their power. In Spain, in Italy, in India, in the USA, in Ireland. In the US it is illegal to be a midwife in almost half the states. There are restrictions on practise, on place of birth, forced caesareans and denied caesareans.

The UK has seen a huge change in who is in charge of birth, way above any ‘increased risk levels’. In 1989/90 midwives were the primary professional at 75% of births in England. Year by year this has declined. Last year, 2017/18 midwives were the primary professional at only 51% of births in England, and the past year it has dropped to just over 50%. (NHS Maternity Statistics, England 2018/19) This demonstrates the incremental medicalisation of maternity care, and the marginalisation of midwifery. 

We need to reclaim birth. Women and midwives. Freedom of birth depends on midwives. 

There is good news, great news: across the UK every maternity unit is working towards a target for the number of women experiencing continuity of carer by 2020. Continuity of carer is a key element of the Better Births initiative being rolled out across the country.  

We need to add our voices so that we hold on to our power, our freedom of birth.

Ask your midwife about continuity of carer in your area.
Write to the head of midwifery, and the chief exec of the health care trust for your hospital, and ask them what progress is being made.
Contact your local Maternity Voices Partnership and get them to raise continuity of carer. Tell them how important it is to you. Or even better, join your local one. 
Email your local Healthwatch and tell them how important continuity of carer is to you.

My body. My baby. My choice.

All women are entitled to respectful maternity care that protects their fundamental rights to dignity, autonomy, privacy, and equality.
Birthrights UK

Today is International Human Rights Day. Birth rights are human rights.

As the UK human rights in childbirth organisation Birthrights say in their leaflet on human rights in maternity care:
“Human rights require public bodies to treat you with dignity and respect, consult you about decisions and respect your choices.

Human rights law gives pregnant women the right to receive maternity care, to make their own choices about their care and to be given standards of care that respect their dignity.”

They go on to say
“Failure to provide adequate maternity care, lack of respect for women’s dignity, invasions of privacy, procedures carried out without consent, failure to provide adequate pain relief without medical contraindication, giving pain relief where it is not requested, unnecessary or unexplained medical interventions, and lack of respect for women’s choices about where and how a birth takes place, may all violate human rights and can lead to women feeling degraded and dehumanised.”

Birthrights, together with the BIHR – The British Institute of Human Rights , have a really useful booklet for midwives which goes through a number of cases. There are other examples on their website. https://www.bihr.org.uk/midwiferyhumanrights

Birthrights have a helpline so if you are wondering about your rights or what you should do as a midwife, then give them a call.

Find out more about Birthrights, read about their campaigns, download their leaflets. They also need volunteers and trainers. birthrights.org.uk

Hospital policy is just that: the hospital’s policy. Not yours. You are under no obligation to follow it.


Hospital policies give guidance to practitioners, which is really useful for big organisations. They ensure that the care is safe, and updated when new evidence comes along. Policies ensure that all are receiving equitable care. Midwives and doctors are obliged to adhere to their setting’s policies, but you are not.

Policies are often based on population level outcomes, i.e. on average x happens. You want to make decisions on a individual basis.

Hospital policies have weighed up the pros and cons and made a decision on that population level.
You will want to weigh up the pros and cons on an individual basis; you may well give different weighting to the factors than those drawing up the guidelines. You will have additional factors to consider that the guideline committee didn’t; such as looking after a toddler; living on a high rise; partner off on tour of duty. Hospital policies will also have taken some things into consideration which will not be relevant to you, such as ease of carrying something out, buildings, staff time. 

An example is Glucose Tolerance Test. The research into the best way of ascertaining if someone has gestational diabetes is not conclusive. GTT are ‘offered’ as they are easy to administer and have high levels of ‘compliance’. You get everyone in one room and get it done. However you may prefer to do finger prick testing at home, to being sat in a room for two hours and having to arrange childcare/time off work. Or not to do either.

There is an assumption that guidelines are based on the best research. 
They probably are based on the best research possible, but actually often there isn’t research, or it is not good quality. A review by obstetricians found that only 9-12% of guidelines by the Royal College of Obstetricians and Gynaecologists were based on top quality guidelines, and that 66% of all obstetric guidelines were no more than the experience/good practise of the guideline committee (all obstetricians).  https://www.tandfonline.com/doi/full/10.3109/01443615.2014.920794

Sometimes the research is there but it contradicts the way doctors were trained.
For example, there is no evidence that continual electronic fetal monitoring in labour improves outcomes; there is good evidence that it is no better than intermittent auscultation (listening in intermittently with a dopler or pinard), and plenty of evidence that it dramatically increases the chance of a caesarean. Yet it is still used. The RCOG green top guidelines are good because they do give the levels of evidence clearly which can help you with your decision making.  

Conversely some guidelines are not adhered to at all. 
NICE guideline on caesarean section states that all women should be informed that having another woman with them in labour reduces their chance of having a caesarean. Were you told that? I have yet to meet a woman who has been told this by her midwife or doctor. Yet this is recommendation has top level evidence to back it.

Midwives and doctors sometimes feel under pressure to get ‘compliance’ to policies. But that doesn’t mean you have to comply. If their policy does not have provision for your wishes it is breaking human rights law, consent law, and NHS guidelines. Your individual midwife may feel she has to stick to the policy but usually a letter or email to the head of midwifery or consultant midwife is usually enough. Contact AIMS and/or Birthrights for any more assistance.

The Better Births report found that individualised care, rather than blanket policies, led to better outcomes for women and babies.

Have you thought about writing your own policy? In fact, that’s what a birth plan is.
Again, the The Positive Birth Book is a brilliant resource for looking at all your options. There are even downloadable visual birth plan icons from the publisher Pinter & Martin. And just out this week Positive Birth Book Visual Birth Plan Cards to help you discuss the issues with your partner, your midwife, your clients. 
https://www.pinterandmartin.com/vbp
https://www.pinterandmartin.com/visual-birth-plan-cards

My body. My baby. My choice.

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

You do not need to jump through hoops, or compromise. To withhold birth options unless you comply, such as have vaginal exam, or scan, or continual monitoring, is coercion, not consent.


Pressure put on you to accept these things is coercion. Consent has to be voluntary. If you feel you ‘have’ to accept something in order to get something else, then you are being coerced, and not giving consent. The professional is therefore breaking UK laws on consent, and NHS guidelines. 

I hear all sorts of stories from women. They are told they can’t have a home birth unless they have a scan to check the position of the placenta, or meeting with the consultant, or home visit from senior midwife. That they have to have a vaginal examination on arrival at the birth centre/hospital, or before they are ‘allowed’ into the birth pool. That they have to have continual monitoring (with wireless telemetry) to use the birth pool if induced/having vbac. They are told they can’t go home after unless they have had a ‘good feed’, or done a poo. Now you may decide that you want these things, that’s your choice, but you do not ‘have’ to do. 

All sorts of hoops can be presented to women. You can start feeling unco-operative or as if you are being difficult.

Sometimes women think if they compromise on something they will be seen as being more rational, more reasonable, and the doctor/midwife will be more likely to agree with their other wishes. However, there can be knock on consequences that you don’t want if you agree to something you don’t actually want. For example, you agree to a scan because you are past your dates but declining induction, and want to show you are reasonable; the scan then shows you have high/low levels of amniotic fluid. And now you are under more pressure to accept induction or caesarean, when if you hadn’t had the scan you wouldn’t have known. You do not need to get them to like you. You don’t have to be a good girl. You are a mum. A mama bear. Look back to Day 1-4. 

Again, I am not saying that I think you should decline these things. The whole point is that it is your choice. Knowing your birth rights isn’t about saying ‘no’ to everything, but knowing that you are the one who gets to say ‘yes’ or ‘no’. You do not ‘have’ to do these things. If you would find them useful to your decision making or to how your body works then do them. But don’t feel that you have to. Women do the allowing.

Around this time in the Birth Rights Advent Calendar people start commenting that the posts are anti midwife and doctor. I am not saying that midwives and doctors are draconian. The over-worked midwife is just following policy; the caring and knowledgeable doctor only sees the births where there are problems. Either way they have forgotten: Women do the allowing.

If you are a health care professional and find yourself using coercion to gain consent STOP now. You are breaking UK law on consent, international human rights law and your own professional guidelines. You are also breaking the relationship with the family. Don’t take my word for it. There are senior midwives and obstetricians around the world saying the same.  

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies.”
Marsden Wagner, obstetrician and neonatologist, and former Director of Women’s and Children’s Health at the World Health Organisation for fifteen years.

Marsden Wagner was a campaigner for midwifery and for taking birth away from hospitals and doctors. He was an obstetrician who had a epiphany after witnessing a home birth. He realised he had never actually seen a physiological birth. He sadly died a couple of years ago. Here is Marsden Wagner talking about why midwives and doctors have different views of birth, and more. (The first four minutes are very insightful.) https://www.youtube.com/watch?v=Cm8ErQxTFyo

He has a serious point. So much of maternity care is focused on the baby, which is of course the most important thing, but it is not the only thing that matters. A focus purely on a healthy baby and nothing else can result in women feeling that their thoughts, and decisions don’t matter. 
https://www.positivebirthmovement.org/eregrgrtg/

Safety is sometime discussed as if it is diametrically opposite to a positive experience but it is not. As Professor Soo Downe says, it is

“Both/And, NOT Either/Or  
Both safety AND personalisation
Both good outcome AND a good experience,
Both the woman AND her baby,
Both the present AND the future,
Both medical care AND support for physiology,
Both honesty AND recognition of complexity.”

You might find it interesting to watch to her presentation on What women want from maternity care.
https://www.youtube.com/watch?v=dZmR23_XxNg

What is good for baby is good for the woman, and vice versa. They are a dyad. Intrinsically linked. A woman with good mental health, who is happy and confident who has been boosted by her birth will be able to cope with motherhood and meet her baby’s needs easier than a traumatised, damaged woman. 

Women are not selfish for wanting a good experience. Because actually what they are wanting is the least intervention possible, which is good for the baby. Women will always put their baby first. When women want to go for vbac, that is because they think it is better for baby. When they want to go for home birth, that is good for baby. When they want a calm, planned caesarean, they are doing that because balancing out the pros and cons that is better for them and their baby.  

This is your baby. You are the parent. You chose to grow this baby, to make your family. Family is a very private thing. In all likelihood it was very private when you created this baby. We do not live in a ‘Handmaiden’s Tale’ world where procreation is mandated by the state. 

Remember only 9-12% of obstetric guidelines are based on the best quality evidence, and 66% are based on the best practise/opinion of the guideline committee. Obstetrics has only been in charge of birth for the last 40-50 years. And good quality research for less time than that. In the last couple of years there have a number of research articles proving what women and midwives have known all along. For example, immediate cord clamping (brought in in the 1950s) damages babies; babies do better skin to skin than in an incubator; women who are able to move about in labour are less likely to end up in a caesarean. I think I will do an annual award for ‘obstetrics catching up with the bleeding obvious.’

The vast majority of obstetricians I have met are wonderful caring people, but their knowledge has limits. They are great surgeons, caesareans save lives, and caesareans have never been safer. Huge steps have been made in survival of premature babies. And there are women with complex and complicating medical history. But most doctors knowledge of physiological birth is very limited. Unfortunately, medicine doesn’t have a good record of admitting this. It doesn’t have a good record when it comes to caring for women and babies either, as Marsden Warner explains in this clip from Business of Being Born https://www.youtube.com/watch?v=DKZAoEPjHbY

We have a better chance of personalised care if we have a midwife who we know and trust, who looks after us in pregnancy, is there for the birth, and supports us postnatally. This often known as caseloading. There is a big campaign for continuity of carer, following the Better Births initiative. 

The Better Births report on a national review of maternity services found that personalised care led to better outcomes for mothers and babies. 

For help with your rights in pregnancy, birth and postnatally have a look at the websites of AIMSand/or Birthrights. There have helplines/email help.

Your body. Your baby. Your choice. 

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

You can chose a caesarean birth.

It is your body. You have the right to choose what happens to it. Choosing the type and place of birth is central to body autonomy, which is a human right. 


You have the right to choose a caesarean birth. The doctor has the right to decide not to perform the surgery. However the national guidance is that should a doctor disagree with your decision they should refer you to another obstetrician who will support you. 


Birthrights have an information sheet about right to caesarean. It says
“There has never been a legal case on women’s entitlement to maternal request c-sections, but you have a right to make decisions about the circumstances of your birth under Article 8 of the European Convention on Human Rights. This includes the manner in which you give birth.”
www.birthrights.org.uk/factsheets/right-to-a-c-section/

Women do not choose a caesarean birth lightly. It is one of the greatest sacrifices a mother can make, to willingly submit herself to the surgeon’s knife in order to give birth to her baby. 

There are a number of reasons women want an elective caesarean birth, including overwhelming fear of birth, physical and emotional birth trauma, and previous sexual abuse.

A woman should never be put in a a position where she feels forced to speak about her abuse in order to get treatment; she may not even have told her partner. The right to family life means women, and trans men, should be supported to have children but should not be forced into vaginal birth.

NICE guidelines say if you request a caesarean you should be offered CBT (cognitive behavioural therapy). You do not need to accept in order to get your caesarean. Research shows that it does help with fear of birth and 80% of women who do this therapy go on to opt for a vaginal birth.

If a woman’s decision to have a caesarean birth is not respected, if she does not feel listened to, how can she trust that her decisions about the rest of her maternity care will be respected? How can she trust that she will be listened to? This is likely to reinforce her decision to have a caesarean birth. However, if a woman is listened to, if her doctor has said she can have a caesarean birth, then she can consider a vaginal birth, and be more open to the option, knowing and trusting that she will be listened to and that at any time she can turn back to the option of a caesarean birth. A woman I knew just needed that reasurance.

Women can request a caesarean at any time, including during labour, and this should be listened to and respected. Sometimes women know something is just not right. Sometimes a woman would prefer to go for a caesarean birth rather than have interventions such as forceps. 

Let’s remember that women are ‘offered’ caesareans for all sorts of reasons, sometimes feeling forced into them. I was with a woman who was offered a caesarean because her waters had gone before labour, if she wanted to avoid a long induction; she went on to have just a 10 hour labour and gave birth to bouncy 8lb baby with no help needed. 

It is not logical for an obstetrician who tells a woman that she ‘has’ to have a caesarean because she has had two or three previous caesareans, which is against the profession’s own guidelines, but then to withhold a caesarean from a woman requesting one for psychological reasons. This is hugely paternalistic. 

It is not respectful care. It is not compassionate, especially when women are not denied other interventions that may not be ‘clinically appropriate’; for example, women can request to labour on a consultant led labour ward even if they are not high risk, and it will increase the chances of them ending up with interventions including caesarean. 

I would also like to point out that it is wrong to record a caesarean as elective or ‘maternal choice’ when a women feels she has no other choice but to agree to one. 

I really recommend Why caesarean matters by Clare Goggin. https://www.pinterandmartin.com/why-caesarean-matters

There will be more on caesarean birth, and the choices women can make when having one, in an upcoming advent calendar post. 

My body. My baby. My choice.

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

If you decline an appointment or intervention, it cannot be withheld if you later change your mind.


Women can feel worried about declining a test or intervention, fearing that should they change their mind it would not be available, but it can’t be. 

Equally, should you agree to something, you are perfectly okay to change your mind and decline it later. 

You can change your mind backwards and forwards as your circumstances and decision making process changes. For example, you may accept an appointment with a consultant but then decline because you don’t feel it would be useful to you, and then later request one because you want to ask them about something. 

It is your baby. It is you that is going through this. The health services are there to support you in your decision making and your birth. Structures and systems help organise large institutions but you can personalise your care. 

Sometimes it is easier to decline something and then opt in later. For example, you don’t actually need to decide where you are giving birth until you are about to push your baby out. (Some places in the UK actually have this set up.) But it generally is easier to plan for home birth and then change your mind and go into to hospital in labour, than the other way round, especially if you are already in hospital. But it is not impossible. I have known one woman who went into to hospital and decided she would rather be back home. Fortunately she had a case loading midwife (same midwife throughout pregnancy and labour) who sorted it all out for her, and she went home to have her baby.

Here’s my article on the benefits of planning a home birth even if you intend to give birth in hospital. 
https://www.chilledmama.co.uk/single-post/2016/08/15/5-reasons-for-booking-a-home-birth—even-if-you-plan-to-go-to-hospital
My body. My baby. My choice.

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

You can discharge yourself anytime. The length of your stay in hospital, your engagement with the service, is entirely at your discretion. 


Whether it is antenatally, during labour, or postnatally.

You have as many rights postnatally as during birth. Any care plan for you and your baby has to have your agreement.

As was said on the 2nd Dec the baby is a separate patient in her or his own right, but the parents give the permission for treatment, which means they can say no. If the doctor or midwife disagrees with the parent they cannot disregard this and go ahead anyway. They would need to go to a court of law. There are a few exceptions, such as immediate threat to life. 

You do not need to jump through hoops to go home, such as ‘a good feed’ or bowel movement. You may agree with the recommendation to stay or you may feel the balance of pros and cons weighs in the favour of going home. It is your decision.

It happens more often that you would probably think. You will be asked to sign a form but it is a standard thing. 
‘I have decided I want to discharge myself and my baby. I am happy to sign the appropriate form.’ 

Or maybe you are in hospital waiting to be induced and there are delays in starting the process. You can discharge yourself to go home and have a night in your own bed and then come back in the morning. 

You can also ‘discharge’ yourself from consultant led care to midwife led care, or decline aspects of your care. 
You can also change hospital or go to an independent midwife, or private obstetrician at any time.
For info on independent midwives check out IMUK imuk.org.uk
Personalisation is what it is all about. 

You can support and information from both AIMSand Birthrights
aims.org.uk
birthrights.org.uk

It is all My body. My baby. My choice.

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. 

Black women and babies have equal rights to life, and to safe care

Black women and babies are more likely to die in pregnancy, birth and postnatally, irrespective of income, in the UK, and in other affluent countries such as the US.

The MMBRACE-UK Saving lives, improving mothers’ care report (Dec 2019) shows that black women are five times more likely to die that white women, and Asian women are almost twice as likely to die. (white women 7/100000; Asian women 13/100000; black women 38/100000)
https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202019%20-%20Lay%20Summary%20v1.0.pdf

Their report into Infant Mortality (Perinatal Mortality Surveillance Report 2016) showed that not only did black babies have a higher mortality rate, they were they only ethnic group to see an increase in their still birth rate. 
https://www.npeu.ox.ac.uk/mbrrace-uk/reports

Watch these videos by BBC and Channel 4. 
https://www.facebook.com/watch/?v=816536792136495
https://www.youtube.com/watch?v=twBQtqoPKvQ

Institutional and cultural racism is usually covert, except to the recipients. Black and ethnic minority women report staff making assumptions; they may not feel listened to or believed. Midwives and doctors may make assumptions based on what they think of other cultures (such as tolerance to pain); or policies may make assumptions that all women’s labours are like the white European women obstetrics has based its model of care on. Across the world women’s pelvis shape differs. Women from different cultures may labour differently, due to culture or physiology.

Black women can also be inappropriately blamed for the poorer outcomes. The Royal College of Obstetricians and Gynaecologists Green Top Guideline on Birth after Caesarean gives ethnicity as a factor in having a vbac (vaginal birth after caesarean). It states that women “of white ethnicity experienced the highest success rate, in contrast to women of black ethnicity who experienced a lower success rate.” This is in a section about advising women their likely chance of successful vbac to help them make a decision about whether to go for a caesarean or vbac. There is no commentary, or recommendation, to staff to give better care to black women. The implication is that black women should be informed they are less likely to get their vbac, that it is their fault for being black. No suggestion to say to women that this is the result of the racism inherent in the system. Sorry about that. 

It’s not just subtle attitudes and treatment by individual staff but societal and undo systemic biases and privileges, as obstetrician Amali Lokugamage points out. We all need to challenge assumptions and prejudice in our settings. Avoid patronising behaviour. Consider barriers. Consult with users.
https://blogs.bmj.com/bmj/2019/04/08/amali-lokugamage-maternal-mortality-undoing-systemic-biases-and-privileges/

Black birth workers are raising their voices, but white birth workers need to make room for their voices, and we ALL need to raise the issue with our local services, and challenge our own privilege. 

Equality is a key aspect of human rights in maternity care. 

The human rights in childbirth guide for midwives by Birthrights and the British Human Rights Assoc states: 
https://www.bihr.org.uk/midwiferyhumanrights

“Discrimination may involve

* treating someone less favourably in the same situation because of a characteristic or status;
* failing to treat someone differently when they are in a significantly different situation to others, for example when they are pregnant; and,
* applying blanket policies that have a disproportionately adverse effect on a person and other persons who share a particular status.”
Black women, young women, disabled women, immigrant women, poor women, LGBTQ+ women and men, have the same rights to autonomy, dignity, and privacy in their maternity care as white middle class women.  

Birthrights recently published research, with Bournemouth Uni, on the experience of disabled women when accessing maternity care. 
https://www.birthrights.org.uk/campaigns-research/disability/

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

You do not need to get permission to give birth vaginally. It is a normal bodily function. It is the default position. 


It really happens. Some women are actually told they are ‘not allowed’ to give birth, or they ‘have’ to have a caesarean. This is said by people who have been to medical school, so presumably know how babies are born. 

Vaginal birth is an involuntary bodily function. Your body doesn’t need permission from anyone, anymore than you need permission to breathe or throw up. You have to give permission for anything else.

What the doctor or midwife means, of course, is that they don’t advise it. But that is a different thing to ‘not allowed’. There are a few situations in which it is highly unlikely that the baby is able to come out of your vagina. For example if the placenta is covering the cervix, or if the baby is sideways (transverse). There are also some situations where vaginal birth would be difficult or risky for the woman or her baby. However, this covers the whole spectrum of risk. It is still your decision to make. You can also decide to wait until you go into labour and then have your caesarean. There are some short and long term benefits to the baby of in labour elective caesareans. https://birthfit.com/blog/2015/04/30/michel-odent-talks-in-labor-pre-emergency-cesarean-birth/

If your baby is breech, or you are expecting twins or triplets, or if you have had one, two or more previous caesareans you do not have to give birth by caesarean. You can have a vaginal birth. Or you may chose a caesarean birth. It is your choice.

When a doctor or midwife says you are ‘not allowed’ or you ‘have’ to have a caesarean, what they mean is that they have weighed up the pros and cons and made the decision on your behalf. Now you may agree with their conclusions but it is still your decision to make. You can still ask the questions so you feel you are making the decision from an informed place, which is your right. Professionals are under obligation to provide you unbiased information on the benefits and risks of all the options, without coercion. Making decisions on behalf of someone else is paternalistic. No decision about me without me.

Here’s a great article about informed consent and refusal in obstetrics which looks at different perspectives of risk.
https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12281

It is worth asking for other perspectives. Doctors often have very little experience of natural physiological birth. Your midwife may not have met a woman who wants to give birth to twins in the water before. Sometimes people say something is impossible because they have not come across it. Women give birth to breech babies, twins, and give birth vaginally after 2, 3 or even 4 caesareans. Your local The Positive Birth Movement group or doula will be able to give you information, and Tellmeagoodbirthstoryhas a buddy system and can put you in touch with someone who has been in a similar situation.

If you want support for your birth options contact the head of midwifery. You can get further support from AIMS and Birthrights.
aims.org.uk
birthrights.org.uk

Your body. Your baby. Your choice. 

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

Any treatment, observation, intervention without your consent is assault.

*Trigger warning for assualt/rape*

Sometimes you can feel that all this stuff about birth rights, about women having say over their body, is a lot of fuss, when everybody is working towards the same outcome. But let me tell you, body autonomy is so serious that if you don’t give consent then any doctor or midwife who does something to your body is committing assault. 

Today is my daughter’s 24th birthday. It was a straightforward birth but I was given a sweep against my wishes during a vaginal exam, was put on a monitor for no reason when I had asked not to be, a midwife put her hand on my tummy without asking, which made my contraction disappear instantly, and I was physically pushed down from kneeling upright, which also took away my contractions. All these things were done by well-meaning staff trying to be helpful but they invaded my body, disturbed my birth, and took away my power. 

My story is a mild one. Any treatment, observation, or intervention with without your consent is assault. Any hand or instrument in your vagina without your consent is rape. 

Birth rape is real. It happens. Imagine being naked, strapped to a bed, with your legs held up and open. People are talking about you, but you can’t hear what is being said. You might ask what is going on, but no one responds. You are frighten your baby’s life, or your life, might be in danger. Someone you don’t know, who might not even have spoken to you, goes up to your bottom and puts their hand in your vagina. Maybe several people. Someone cuts your genitals. They insert something, or several things, into your vagina. Sounds like rape to me. Feels like rape to the women who told me stories like this one. 

When women feel supported and listened to, where they are treated respectfully, and involved in every decision, they experience the birth as positive, even if they receive every intervention under the sun. But when woman are ignored, demeaned, denied, shouted out, and/or physically assaulted they are damaged by a traumatic life experience and are likely to suffer post traumatic stress disorder. 

We are seeing a rise in PTSD in women, and their birth partners, following birth. This is not necessary. It needs to stop.  

Whatever I wear, wherever I go, yes means yes and no means no.

#metoo
#metoointhebirthroom

What can you do?

* Talk to someone. You can tell me your story, or find a counsellor. I’m sure any doula or antenatal teacher will listen to you. There are also birth trauma helplines.
* Seek therapeutic help. Ask your GP for a referral for CBT, or for EMDR, which is a treatment on the NICE pathway for treating PTSD. Or find a local practitioner of the Rewind therapy. Some midwives are trained in this.
https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/treatment/
https://www.nice.org.uk/guidance/cg26

* Get a copy of your notes. Most hospital trusts have a section on their website for getting a copy of your records. AIMS helpline is useful for this too.This factsheet from Birthrights explains what to do.
https://www.birthrights.org.uk/factsheets/making-a-complaint/
* Go through your notes with an independent midwife, or a sufficiently experienced doula.
* Make a complaint. AIMS can give you moral support too, and help with letter writing. Every hospital has a PALS service (patient advocacy and liaison service) who can support you through the process too. https://www.birthrights.org.uk/factsheets/making-a-complaint/
* Get more info and support from Birthrights. They will be able to advise making a complaint and on legal action.
* Let your local trust know about your experience. Write a letter to the head of midwifery, the head of women’s services, and the chief exec. 
* Join AIMS and Birthrights or otherwise financially support their work so that they can continue to campaign for birth assault and rape to end.

Some people might suggest a ‘birth afterthoughts service’ where you talk through your birth with a senior midwife. Be warned, there is some research that shows that these can be harmful for people suffering trauma as you are reliving the experience in a setting that is not a therapeutic one, with people who might be defensive of the treatment you received. As mentioned above, the NICE guidelines on PTSD recommend referral to EMDR or CBT, and to avoid debriefing sessions outside a therapeutic setting.

Your body. Your baby. Your choice. 

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

You can decline induction.

I’m not saying that you should, only that you can. 

As previous advent calendar posts have covered, any intervention can only be offered. It is up to you to accept or decline. 

Today I’m having a focus on induction because now 30% of women in the UK have their labours induced, and many say they didn’t realise they could have declined. Some are presented with it as a fait accomplis, ‘Here’s the date for your induction’. 

There are a number of reasons that induction is offered and this post isn’t going to go into the pros and cons. 
You can ask your doctor and midwife to go through the pros and cons of induction and of waiting. You can also research yourself. You can have time to weigh up your options. Consent must be informed and voluntary. Knowing your rights in pregnancy and birth isn’t about saying no to everything; it’s knowing you are the one who gets to say ‘yes’ or ‘no’.

Units will have blanket policies about induction. You can use these to inform you decision but as each person and situation is different, your individual situation should be taken into account, and your individual informed decision should be supported, even if it does not go along with the hospital’s policy. It is a very individual decision.

There is a useful Induction of labour facebook group where you can explore the information and your options, and here are 10 things about induction that most women don’t realise.  
https://www.facebook.com/groups/inductionoflabour
https://www.sarawickham.com/articles-2/ten-things-i-wish-every-woman-knew-about-induction-of-labour-the-article/

Many women don’t realise that induction can take days to work, and even if it you are having contractions for a couple of days it may not be enough and then it would be a caesarean. Renowned midwife Mary Cronk used to say that if labour is like a synchronised swimming team, with the different elements such as hormones, muscles, mother and baby, working together, then induction is like throwing one of them in and hoping the rest follow.

Midwife and researcher, Rachel Reed MidwifeThinking says
1. Intervention rates are influenced by organisational approaches to risk management. 
2. The threshold for intervening to reduce a particular risk is very low if the impact of the possible outcome is considered very significant and immediate.
3. Induction is often presented as a requirement rather than an option. As women we are socialised to follow medical advice rather than question it, or choose an alternative option.
https://www.positivebirthmovement.org/why-induction-matters-an-interview-with-rachel-reed/

Here are some of the most common reasons for induction being offered:

Long pregnancy: Most babies are born between 37-42 weeks. NICE guidelines say induction should be offered after 41 weeks. It varies from hospital to hospital whether that is 40+10 or 40+12. NICE guidelines say that should women decline induction then they should be offered at least twice weekly monitoring after 42 weeks. So it is expected that some women will decline. Some women have their babies at 44 weeks. This is not a choice many women will make but it is an option that some want. There are a number of factors that affect pregnancy length. You can decline the routine 41 week consultant appointment.  

Women over 40 years old: women over 40 are usually ‘offered’ induction at 40 weeks, sometimes when they have only turned 40 a few days/weeks back. Stillbirth rates are higher for ‘older mothers’ (At 39-40 weeks it is 2:1000 or 0.2%, compared to 1:1000 or 0.1% for younger women) though it is not understood why. It is your decision, to weigh up the pros and cons. This is a useful document from the Royal College of Obstetricians and Gynaecologists. 
https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_34.pdf

Big baby: Although I am hearing more and more women being ‘offered’ induction for a suspected big baby, the national NICE guidelines say that a suspected large baby is NOT a reason to offer induction.

Some women chose induction. Their partner could be going on a tour of duty with the armed forces, or they could have had a previous stillbirth. Induction on maternal request should be discussed on an individual basis.
https://www.nice.org.uk/donotdo/induction-of-labour-should-not-routinely-be-offered-on-maternal-request-alone-however-under-exceptional-circumstances-for-example-if-the-woman8217s-partner-is-soon-to-be-posted-abroad-with-the-armed

Here are two great books on induction of labour that cover the different situations. 
Induction of labour by midwife and researcher sarawickham.com
Why induction matters by midwife and researcher Dr Rachel Reed, published by Pinter & Martin.

Your body. Your baby. Your choice. 

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

Having a caesarean does not mean giving up your rights. You have choices. You give consent to each aspect. It is your baby. It is your body. You are giving birth. 


Having a medicalised birth, especially a caesarean, can feel like you have to hand everything over. But there are still choices and control you can exercise, from the music to getting skin to skin and delayed cord clamping or even helping your baby out yourself. To find out more search for natural caesarean, gentle caesarean and UK Obstetrician Dr Fisk, and mother assisted caesarean.
https://www.positivebirthmovement.org/natural-caesarean-a-decade-on/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/

Here’s Clare Goggin talking about caesarean birth options. https://www.facebook.com/RCObsGyn/videos/2316705531938084/?t=88
You can read her book Why caesarean matters by Pinter & Martin

Here are some positive caesarean birth stories from The Postive Birth Movement and do read Milli Hill’s ‘The Positive Birth Book’. You can even download a visual birth plan with icons to use.
https://www.positivebirthmovement.org/?s=caesarean

The NCT has a useful caesarean birth plan template as do caesarean.org.uk .
https://www.nct.org.uk/sites/default/files/BirthPlan-PlannedCaesarean.pdf
http://caesarean.org.uk/caesareanBirthPlan.html

Even if you are hoping for a straighforward birth it can be useful to have a caesarean birth plan, as doula Sophie Messenger explains.
https://sophiemessager.com/always-plan-c-caesarean-birth-preferences/

Oh, and ‘once a caesarean, always a caesarean’ is a load of baloney, women have had vaginal births after 2, 3 and even 4 caesareans.

Your body. Your baby. Your choice. 

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

You can choose where to give birth, even a stable. Home birth is your choice. It is the default. You have to decide to leave your home. 


At a conference organised by Chichester Home Birth Group, a lovely obstetrician started his talk by asking why is there a need for a home birth support group? We don’t have support groups for men wanting to stand up and pee, he said. Giving birth is not a medical event, even if it may need medical support in a small number of cases. Giving birth is a normal, involuntary, bodily function. 

You always have the right to a home birth. Full stop. And it doesn’t have to be ‘home’. You can give birth at your mum’s house, a tent in a field, or in a stable. Though actually Jesus was born in a cave, and that’s a good option too!
https://www.chilledmama.co.uk/post/2018-12-20-was-jesus-born-in-a-cave-and-why-thats-a-good-idea-for-you-too

It doesn’t matter how many weeks you are, you can give birth at home before 37 weeks, and after 42 weeks. You can give birth at home if it is your first baby. You can give birth at home if you have high BMI, gestational diabetes, a scar on your uterus, or anything else that makes you ‘high risk’. In these situations some women will choose hospital birth and some will choose home birth. 

Home birth is always the default option. No one can force you to have a hospital birth. And midwives are obliged to support your choice to have a home birth. It is up to you to weigh up the pros and cons of the chances of things happening with a home birth and with a hospital birth, and there are some increased iatrogenic risks associated with hospital birth. You can compare the outcomes from the UK birth place study. (see note about first timers at the bottom of this email.) https://www.nhs.uk/Conditions/pregnancy-and-baby/Documents/Birth_place_decision_support_Generic_2_.pdf

More info on home birth including the stats on transfer, and info on home birth after caesarean here.
www.chilledmama.co.uk/home-birth-info

You do not need anybody’s permission to give birth at home. You do not need to jump through any hoops, such as be ‘signed off for home birth’ by a consultant or senior midwife, or scan, etc. You might find that useful to you, but you don’t have to attend to get your home birth. Midwives often do a home visit, but this is largely for their own safeguarding, checking that you don’t have a crack den next door and where the parking is.

Midwives cannot refuse to attend your home birth because they disagree with your choices. The unit is obliged to send you appropriate care. However, if the unit has a staff shortage they may send an ambulance. You may be told, if there aren’t enough midwives you will ‘have’ to go in. This is not true. You don’t have to. My experience is that though they may ask you to go in to hospital, if you say no they will work really hard to find a midwife to send to you. ‘I am not prepared to put my baby through the added risks of a hospital birth, particularly in a unit that is short staffed.’ 
https://www.birthrights.org.uk/factsheets/choice-of-place-of-birth/

If this has been said to you then I strongly suggest writing to the chief executive of the trust, in advance, and asking about their strategic planning. They should have plans in place for shortages, that protect your human right to give birth at home. What’s more they should be planning to increase the number of home births as a strategic priority, in order to improve outcomes for women and babies, increase midwife retention, reduce staff sickness and save money. 

Sometimes midwives will run through a ‘home birth checklist’ of scenarios which might lead to transfer, which can feel like a risk list. However no one ever does this with women planning a hospital birth to make sure they understand the added risks they are taking by going in to hospital. 

You do not need to sign any disclaimers. Ask anyone who presents one if they also get women planning hospital births to sign a disclaimer. They, or you, can simply write in the notes, that it is your informed decision to have a home birth.

The decision to have a home birth can be made anytime, even in labour. If you find you are coping well at home then stay. It helps the midwives though if they know in advance, which is why it is a good idea to plan a home birth, even if you think you’ll probably want to give birth in hospital. You can also decide early on that you want a home birth and you can write this on your notes.
https://www.chilledmama.co.uk/post/2016-08-15-5-reasons-for-booking-a-home-birth-even-if-you-plan-to-go-to-hospital

Of course not all home births end up as home births, but planning a home birth puts you in the best place for all to go well. All births, that start spontaneously, are home births, just some have planned transfers. 

If you are having any issues about home birth there is info on the home birth reference site www.homebirth.org.uk and AIMS website www.aims.og.uk . You can
1. Write to the head of midwifery, x hospital, y town setting out your plans and your expectation of support.
2. Get local support: local home birth group, @ [313159915458878:274:The Positive Birth Movement] group, doula www.doula.org.uk , antenatal teacher.
3. Get support from @ [150536138348642:274:AIMS] and/or Birthrights, and local PALS (patient advocacy and liaison service). 
4. Write to the Chief Exec, x hospital, y town.

I run a home birth group in Bedfordshire and you are all welcome to join our facebook group. www.facebook.com/groups/lutondunstablehomebirth

Your body. Your baby. Your choice. 

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

A quick note about having your first baby at home: Just to point out that though the Birth Place Study showed there was an increase in poor outcomes for low risk first timers planning home birth, this wasn’t because of the lack of equipment or distance to hospital, as standalone birth centres, which have no better equipment, and are away from hospitals, had the best outcomes. There was no difference between home and hospital in terms of babies dying or needing admittance to special care, which has been the standard measure of poor outcomes in all other studies. It was only when other, not necessarily life threatening, outcomes were included, such as broken clavicle and meconium aspiration syndrome that the difference became statistically significant. And the chance of these things happening is still less than one percent. It is up to you to balance this out against the almost double chance of having a caesarean. (Chance of emergency cs with first baby: home 9% vs hospital 16%.)

Personalised care is safe care. That includes access to midwifery led units.


You are not selfish for wanting personalised care. Personalised care rather than blanket policies results in better outcomes. You have the momentum of change behind you.

In 2015 Baroness Cumberlege conducted a huge review of maternity services in the UK, and produced the Better Births report. All maternity services are now expected to make changes to their services as part of the Better Births Initiative.

One of the conclusions states
“We know that women are more likely to report a positive experience of childbirth, regardless of the outcome, if their care is personalised, if they are treated with respect and if they are involved in decision making. However personalised care and choice are not just about a woman’s experience. It is increasingly evident that personalised care means safer care and better outcomes. We also know that when staff work in well led, positive environments and are supported to take pride in their work and to deliver high quality care, outcomes for women and their babies improve.”

This means personalised care based on an individual’s situation and preferences, rather than blanket policies based on population level outcomes and organisational expediency.

Many women find the choice to give birth in a midwife led unit or birth centre is denied to them because hey don’t meet the criteria. Access to midwifery led units, or birth centres, can be extremely confusing and frustrating for women, especially when they would be supported if they chose a home birth, or, if they were on the consultant led labour ward, they could chose to decline the additional aspects of the care they would have on the labour ward, such as continual monitoring/canula. 

Some women who are ‘high risk’ want to give birth in a midwife led unit, especially one near the consultant led labour ward because they want to be nearby in case intervention is needed, but they want to give themselves the best chance of not needing those interventions, which is good for their baby. Or they may have had a difficult or traumatic birth on the labour ward and wish to avoid the stress and a repeat experience. These seem perfectly sensible and rational assessments of the various risk factors.  

Denying access to a midwife led unit because a woman is ‘high risk’ and therefore the midwife led unit is not ‘appropriate care’ ignores individual circumstances and is highly paternalistic. It is essentially saying that the hospital has decided what is best for you. This contradicts the NHS principle is ‘no decision about me without me’. The evidence base for the recommendations is often low. Remember only 9-12% of RCOG’s maternity care guidelines are based on top quality evidence. 

From Birthrights
“These criteria are not legal rules and should only be used to guide the decision about who can access birth centre services. Any decision to refuse a woman admission to a birth centre must be backed-up by evidence which supports the decision. For example, if a woman is refused admission because of a particular risk factor in her pregnancy, there must be clear clinical evidence that additional risks may arise during the birth that cannot be safely managed in a birth centre.”
https://www.birthrights.org.uk/factsheets/choice-of-place-of-birth/#birthcentre

Birthrights, the Royal College of Midwives and the British Institute of Human Rights have published a Human rights in childbirth guide for midwives. It gives an example of a woman wanting a vbac in a midwife led unit, and explains how in refusing that the unit may be breaking British law. It also says, 

“Some maternity units may operate policies that discriminate against women on the basis of age or other personal characteristics, such as Body Mass Index. There may be clinical reasons that justify these policies. However, whenever a policy is applied to a woman, her personal circumstances must be taken into account and if she requests and exception to the policy it should be considered on an individual basis.”
https://www.bihr.org.uk/midwiferyhumanrights

Quick note about the term ‘high risk’: often ‘high risk’ doesn’t actually mean high risk, it means ‘increased risk’, or ‘greater chance of needing intervention’. If I told you there was a high risk of snow tomorrow you would probably think that meant at least 75% chance of snow, not 0.2%. Yet this is the situation for many women in the ‘high risk’ category. 0.2% chance of something happening is low. It is higher than 0.1%, but not ‘high risk’. We need new words.

If you have been denied birth at a midwife led unit there are various sources of support, both specific to your situations, such as high BMI www.bigbirthas.co.uk or vbac https://www.facebook.com/groups/149800885093152//; and generic such as The Positive Birth Movement groups. You local home birth group will be very supportive and may know of people in your situation locally and what they did. You might like to hire a doula, even just antenatally. 

Steps to take:
1. Ask your community midwife. She may arrange a meeting with the head of the birth centre/midwife led unit. 
2. Ask your community midwife to arrange a meeting for you with the Professional Midwifery Advocate. They have a duty to advocate for you. “The PMA should support midwives to advocate for women who chose birth options that are outside the providers’ policies and guidelines.” 
3. Write to the head of midwifery and copy in the chief exec of the hospital trust, and Debbie Chippington Derek, chair of AIMS. Ask for your situation to be considered on an individual basis, rather than blanket policy, and suggest that they may be in contravention of the British Human Rights Act if they do not. 
4. Get support and advice from AIMS and/or Birthrights.
5. Get moral support from your local doulas, home birth group, positive birth group.


Your body. Your baby. Your choice. 

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

Definitions:
Midwife led units (mlu) and birth centres are the same thing: units where there are no obstetricians, the midwives oversee all of the care. 
Alongside mlu/birth centre: on the same site as the main labour ward (obstetric led unit).
Freestanding or standalone mlu/birth centre: on a different site.

You can change your midwife, doctor, hospital
Antenatally, in labour, and postnatally. 

(Two posts today.)
Antenatally if you are not feeling supported by your midwife, or if she is unprofessional, perhaps there are things that she says or does, or things that she doesn’t do that she should, then simply contact the head of midwifery and request a different midwife. You can’t ask for a specific midwife. The head of midwifery will be really please to hear from you. It could be that that midwife needs some extra support or training. You don’t need to know the head of midwifery’s name; address your letter ‘Head of midwifery, x hospital, y town, postcode if you know it.’ I did. 

When I had my last ten years ago I wrote to the head of midwifery when I was first pregnant. I had helped a couple of women make complaints about our local community midwife for her unprofessional manner. I also specified I would not accept any care from her at any time, including labour and postnatally. I didn’t even have a booking visit with her. I was assigned a lovely midwife, who is now our community midwife.

You can opt for an independent midwife. In most cases you have to pay, but some places there are local arrangements. www.imuk.org.uk 

In labour if you are not happy with the care from your midwife, or you just feel that her presence is hindering your labour, you can request another midwife. You can simply say ‘We would like to have a change of midwife.’ If you feel unable to say this to her, then: if in hospital, your partner can go to the nurses station and ask for the senior midwife; at home, call the labour ward and again ask to talk to a senior midwife. This happens a lot so don’t worry about it. They will know what to do. 

You can decline to see a specific obstetrician, or to see an obstetrician at all. Just tell your midwife that you decline any further appointments with them. Your midwife will sort it out. It is worth asking for the persons name and writing it down at the beginning of any appointment so you have a record of it, and their title. When you have an obstetrician antenatal appointment you may not get to see the doctor named on the letter. Often it is called the consultant obstetrician’s clinic, but then you are just seen in order by which ever of them is free next, and that could be a trainee obstetrician, a consultant obstetrician, or a senior consultant. 

Again, in labour you can ask to see a different obstetrician if you are not happy with the care. Again, just ask your midwife to arrange, or ask to speak to a senior midwife, or PMA (Professional midwifery advocate – midwife with specific responsibility to support midwives in advocating for women).

You can chose your hospital, especially if having a hospital or birth centre birth. Your community midwife will arrange this, or you can contact the hospital you want to go to and they will arrange it. If you are having a home birth then the midwives will usually come from a particular hospital. If you have strong objections to being attended by midwives from that hospital then you can get a midwife from a different area, but it is a long process to get this. There is some information on this in the Birthrights’ factsheet on place of birth. 
https://www.birthrights.org.uk/factsheets/choice-of-place-of-birth/

If you are at a home birth or standalone birth centre and are transferring to hospital in labour you can decline to be transferred to your local hospital if you have a strong objection (e.g. you had bad care there before, not because you don’t want your child to have Luton on their birth certificate. (I have nothing against Luton, I live there, using this as a real example I have come across.) The midwives and the ambulance crew will sort that you for you.

We are almost at the end of this Birth Rights Advent Calendar. If you have enjoyed it and learnt from it please make a donation to sponsor me. It will be shared between AIMS and Birthrights, the two leading organisations that support women all year around in their childbirth rights.
https://uk.virginmoneygiving.com/birthrightsadventcalendar

My body. My baby. My choice.

Birth rights are human rights. Autonomy. Dignity. Equality. Privacy. Respect.

“Fundamental human rights underpin a safe and positive experience of birth.”
Rebecca Schiller, in ‘Why Human Rights in Childbirth Matter’

I am very pleased to be ending this Birth Rights Advent Calendar with this wonderful quote, as I think this sums up the calendar. 

Birth rights are fundamental to us and our babies; fundamental to health, both physical and mental; fundamental to our families. Safe birth and a positive experience is intertwined, mutually inclusive, not exclusive. Both/And NOT Either/Or.

Rebecca Schiller is a doula and founding member of Birthrights charity. Her book Why Human Rights in Childbirth Matter is available from www.pinterandmartin.com Pinter & Martin

Peace on earth begins at birth

Thank you for following my Birth Rights Advent Calendar. I have been thrilled how far around the world it has travelled and seeing it shared my doulas, midwives, obstetricians, and in birth support groups. It has been shared in South America, US, Canada, several European countries, Australia, and New Zealand. I have loved seeing the yellow squares pop up in comment threads on facebook groups as women share this newly gained knowledge and confidence.

Annie, a UK doula, emailed me to say
“These emails are just incredible, I am blown away and so inspired by how empowering and supportive they are. Thank you so much for the amazing difference and immense contribution you are making.”

Millicent commented “Thank you for giving me permission to call my experience assault, I needed that.”

In response to 4th December ‘Women do the allowing’ Maria commented,
“This one (from last year) gave me the courage to decline induction and intervention and go on to have a mentally healing vaginal delivery.”

Top posts on my facebook page
You can discharge yourself 22k reach, 2.5k engagement and 107 shares
You can decline induction 21k reach 2.3k engagement and 135 shares
‘The only legal requirement …’ 18k likes, 2k engagement and 154 shares
‘You do not need to get permission to give birth vaginally.’ 16k likes, 1.4 engagement, 97 shares
‘Women do the allowing’ 15k reach, 1.5k engagements and 148 shares
‘Any treatment etc without your permission is assault’ 15k reach, 1.2k engagement, 114 shares

I have tried to be quite clear that this is not about having a battle but raising questions, asking for things and ‘politely declining’. My experience is that midwives and doctors can just get caught up in the usual way of doing things and talking about things. When a woman says she wants something different often they will bend over backwards to meet those needs. I always had an expectation of support. No need for arguments or debate. Midwives and doctors know, or should know, the stats and the law of consent. Here’s an article I wrote about Why bother knowing your rights in pregnancy?

I hope that this calendar has also helped women to be bolshy when needed. No more ‘good girl’. If everyone who reads these calendar posts starts asking for things to be done differently then maternity care will change. 

You can download my guide to Making decisions and negotiating your care.
https://docs.wixstatic.com/ugd/3814ad_002fe4b302334959a10b89efef07da61.pdf

I hope to do a webinar in the New Year. More details after the holidays.

I would love to hear your thoughts on this Birth Rights Advent Calendar, the conversations you have had or seen, and especially if it has helped you in any way.  

This year’s fundraising has also surpassed last years. If you haven’t made a donation, or would like to make another here is the link to donate to AIMS and Birthrights, the two UK charities who support women throughout the year in their rights in childbirth. 
https://uk.virginmoneygiving.com/birthrightsadventcalendar

Knowing your birth rights isn’t about saying ‘no’ to everything, but knowing it is you that gets to say ‘yes’ or ‘no’. 

Do follow and support these wonderful organisations:
Www.birthrights.org.uk Birthrights
Www.humanrightsinchildbirth.org Human Rights in Childbirth 
Www.aims.org.uk AIMS

Much love for a wonderful holiday time, 
Cathy

Your body. Your baby. Your choice.