(updated 20th April 2021)
If you are pregnant, you may be concerned about how coronavirus or COVID-19 (the illness resulting from coronavirus) will affect your rights to maternity care, if cases increase significantly as expected. The NHS has general information on its website about coronavirus (separate guidance applies to Scotland, Wales and Northern Ireland). The Royal College of Obstetrics and Gynaecology (RCOG) has information for pregnant women and their families on its website, which will continue to be updated. The relevant Royal Colleges (the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives and the Royal College of Paediatrics and Child Health) have also published this information for maternity healthcare professionals.
You can read our March 2020 position statement here.
You still have the right to a safe and positive birth experience. This includes being treated with dignity and respect, having a companion of choice, having access to pain relief, being able to be mobile in labour and give birth in the position of your choice, and being communicated to clearly by staff. On the postnatal ward, your essential needs for food, drink and physical support must be met.
You will still receive maternity care. However your care might be slightly different to what you expected. For example, more appointments may be conducted over the phone, if you don’t need to be seen in person, and you might have fewer appointments than usual (a minimum of six face to face antenatal appointments is advised). If you have, or may have, COVID-19, then routine appointments, including scans, should be delayed until after your isolation period.
Maternity services should still treat you with dignity, and you can always decline any intervention/treatment you are not happy with. However in some cases Trusts/Boards may have to make changes to the services they offer. The law allows them to do this, even if it means restricting choices, if they can show that it is a proportionate response to the challenge of coronavirus.
Yes, if the Trust/Board has enough staff to run this service and women are able to be transferred to hospital if necessary. Nearly all Trusts/Boards are currently running a home birth service.
Official guidance recommends that women who have (or may have) COVID-19 give birth on an obstetric unit. If the Trust/Board is not able to offer a home birth to well women, they should be able to give a good, evidence-based reason why coronavirus has changed their ability to offer a home birth, and to offer alternatives such as birth in a midwifery-led birth centre, where possible. They should also review this decision regularly as the situation changes, for example, if the home service has been partially withdrawn because of staff shortages of over 20%, the expectation is that the service should be reinstated once staff shortages return below 20%. RCM/RCOG have also published guidance on the provision of midwifery settings and home birth during the current pandemic.
The legal position is that you cannot be compelled to go to hospital and giving birth without assistance is not illegal, but should be thought about carefully.
Some women have reported being threatened with social services when mentioning this option. This is completely inappropriate. A referral to social services should only be made on the basis of a risk of “significant harm” to the baby after the baby is born, and should never be made on the basis of birth choices alone.
Yes. If you have , or may have COVID-19, your care team will discuss with you the option of delaying the caesarean. However, if the caesarean cannot be safely delayed it will go ahead. If you have, or may have COVID 19, special precautions, e.g. protecting staff with special masks, will be in place.
If you do not have COVID-19, there may be a need for some re-scheduling of elective caesareans, as services prioritise. If capacity is really stretched induction may be proposed as an alternative.
Yes, unless the Trust can give a good reason why the Trust cannot honour that commitment due to the changed circumstances. Caesareans will be prioritised according to clinical need but Trusts should be doing their best to follow NICE guidance, and to undertake all caesareans on their lists, even if some re-scheduling is required.
Each Trust will have to continue to monitor if it has sufficient staff to offer its usual service, and to make short-term alternative arrangements to see a midwife or doctor even if not your usual one.
The latest guidance from NHS England on visiting restrictions on maternity services was published on the 15th April. It requires Trusts to follow a three step process as a matter of urgency to enable partner to be present at every step in the maternity journey. If you are affected by visitor restrictions, see our template letter to Trusts.
Some Trusts continue to have restrictions on visiting in place although this is changing all the time. A Trust must be able to show that ongoing restrictions are necessary and proportionate, taking into account the need to control the spread of the virus as well as the harm caused by the restrictions themselves. Trusts are required to be innovative in overcoming any obstacles in the way of including partners within maternity services.
Visitors should only be restricted on the postnatal ward if the staff are able to meet all your basic needs for food, drink and physical support. If you need additional support, for example if you have had a caesarean, or you have had twins, or you have a mental health condition, exceptions should be considered on a case by case basis.
If visiting restrictions are still in place and you feel that there are reasons to make an exception for you, do raise this with your care team.
Please note the situation regarding visiting in maternity services differs across the UK. You can find further information here on current visiting restrictions in Scotland, Wales and Northern Ireland.
Many Trusts are facilitating partners dialing into appointments with midwives and doctors. If you are prevented from doing this, you should be given a good, evidence-based reason. Healthcare professionals should bear in mind that the General Medical Council and the British Medical Association have said that patients should be able to record consultations.
We have received legal advice saying that Trusts/Boards should allow partners to be involved in scan appointments remotely unless the Trust/Board can show they have looked at all the evidence and have a good reason to say no. There is currently no national guidance available on this subject (the previous guidance has been archived).
You should still be permitted to have a birth partner with you even if you and/or your partner have COVID. The NHSE guidance says that if your birth partner has COVID you can have an alternative birth partner with you instead. From the 29th March, birth partners are exempt from the self isolation regulations in England. This means that it is no longer against the law for someone with COVID to leave their home to be a birth partner. It will still be up to the Trust to decide if they can manage the risk of that birth partner spreading the virus to staff or other service users. However Trusts should not prevent your partner staying with you for the birth if this is likely to result in you giving birth without someone you know to support you.
A Trust/Board cannot compel people to leave your house. However Trusts/Boards have a duty to keep their staff safe so they can restrict their service and say they won’t attend in certain circumstances, say if someone with a positive COVID test or symptoms is present. By declining to provide the service, the Trust/Board is potentially putting the woman and baby at risk and may be legally liable in the event of an adverse outcome. Therefore Trusts/Boards will need to assure themselves that the restriction is proportionate. For example, requiring other members of the household including other children, to leave the house during the birth, is unlikely to be proportionate.
No. You always have the right to decline any intervention, including vaginal examinations (VEs). If you have given your consent to a vaginal examination under pressure, for example, because you have been told your partner cannot join you until you are in established labour, your consent may not be valid and the healthcare professional could be legally liable if they proceed with the VE.
There are other ways for an experienced midwife to tell if you are in established labour (around 3-4cm dilated) and therefore ready to be admitted to the unit if that is your plan. If you are still in early labour, you should have the option of returning home with your partner. If there is any doubt about whether you are in established labour or not, you should be admitted to the birth centre or labour ward if there is room.
Yes. Trusts should not withhold pain relief including access to water to relief pain in labour, as well as access to an epidural or other drugs without having a rational and evidence based reason to do so.
At present there is no national guidance recommending that individuals cover their faces in labour although partners may be asked to wear a mask. Women who are showing symptoms of COVID are asked to cover their faces until they are in a private room.
In addition, RCOG/RCM advise that babies should not wear face masks due to the risk of suffocation.
There is no official guidance on this but RCOG have told us the following:
“The NHS guidance on wearing face coverings in hospital settings applies to staff, visitors and those attending out-patient appointments, not people admitted to hospital. We do not believe it is appropriate for pregnant women in labour or those having a planned or emergency caesarean birth to be asked to wear a facemask while in labour or when giving birth.“
“Pregnant women admitted to hospital who tested positive for or who are displaying symptoms of COVID-19, would usually be asked to wear a face covering until they are moved into a private room, or while moving from their room to the operating theatre if they are having a caesarean birth.”
Yes you can decline the test and care must not be withdrawn. RCOG’s guidance on testing says that if you decline a test you should be treated as if your test result is pending (ie you should be treated as positive if you have symptoms or have been in close contact with someone who has symptoms or a positive result). RCOG’s guidance can be found here.
The Human Rights Act applies to the whole of the UK and therefore the underlying principles of: individuals having rights which can’t be restricted without good reason, the need to explore all alternative options to ensure restrictions are the minimum necessary to achieve the legitimate aim of protecting the health of others, and the need to review these decisions as the situation changes, apply equally to the devolved nations.
RCOG/RCM guidance also applies UK wide.
The situation regarding visiting in maternity services differs across the UK. You can find further information here on current visiting restrictions in Scotland, Wales and Northern Ireland.
We understand that maternity staff are currently working in very challenging circumstances and are understandably worried about the risk of catching COVID and of passing it on to family members.
Midwives, doctors and other NHS staff have rights as employees, including the right to a safe workplace, and to protective equipment. However NHS Trusts as public bodies also have a duty to protect the human rights of the patients they look after. Trusts must balance the need to protect their staff against the need to protect the rights of their patients. Whilst banning all birth partners, for example, could reduce the risk of infection to staff, it would be a profound restriction on the rights of a woman and her partner. Such a ban would only be proportionate in the most extreme circumstances.
We recognise the dedication and sacrifice of maternity healthcare professionals who are facing increased risks on a daily basis to ensure that women have a safe and positive birth experience.
Frequently Asked Questions
If you feel your rights during birth are at risk, please do email us on email@example.com