Your birth choices don’t disappear because your maternity unit doesn’t recommend them.

There is a sentence I hear ALL the time from pregnant women.

“They said I’m not allowed.”

Not allowed a home birth.

Not allowed in the birth centre.

Not allowed a VBAC.

Not allowed to go past a certain number of weeks.

Not allowed to decline induction.

Not allowed in the pool.

Not allowed to have a vaginal birth because the baby is measuring big.

And whenever I hear it, my first question is normally:

Who actually said you’re not allowed?

Because there is a huge fucking difference between:

“Based on your individual circumstances, we recommend X because we believe it reduces this particular risk…”

and:

“You’re not allowed.”

One gives you information to make a decision.

The other makes it sound like the decision has already been made for you.

And it hasn’t.

A guideline is not a permission slip.

Maternity services have guidelines for a reason.

There will be circumstances where your midwife or obstetrician recommends something because the evidence suggests it may reduce a particular risk to you or your baby, and you absolutely deserve to understand that recommendation properly.

I’m not here to tell women to ignore medical advice.

I’m here to tell women to understand it.

Because recommended does not mean compulsory.

Outside guidance does not automatically mean forbidden.

And we wouldn’t advise it does not magically remove your ability to make a decision about your own body.

Those are very, VERY different things.

Let’s use home birth.

You might be told that because you’ve had a previous caesarean, have a higher BMI, are having your first baby, have reached a particular gestation or have another individual risk factor, the maternity team recommends birth in an obstetric unit.

Okay.

Why?

What is the specific concern in your circumstances?

How likely is it to happen?

What is the absolute risk rather than simply being told the risk is “higher”?

What could happen if it did occur?

What could be done at home?

What couldn’t?

How quickly could you transfer?

Are there ways of reducing or managing some of those risks while still respecting the way you want to give birth?

And what happens if, having understood all of that, you still choose home birth?

THAT is a useful conversation.

“You’re not allowed” isn’t.

NICE guidance actually says women should be given information about the risks and available care so they can make an informed choice about their planned place of birth. It also says healthcare professionals should not disclose personal judgements about a woman’s choice of birth setting.

Funny how different that sounds from “we don’t allow that.”

Then there’s VBAC.

This is where language can get really interesting.

A woman tells me she’s planning a VBAC and somewhere along the way the conversation has shifted from discussing her individual circumstances into a list of conditions she apparently has to satisfy before she’s “allowed” to have one.

Continuous monitoring.

Cannula.

Labour by a certain gestation.

Come in at a particular point.

No birth centre.

No home birth.

Agree to this.

Agree to that.

Now, some of those recommendations may have perfectly legitimate clinical reasoning behind them.

You should hear that reasoning.

You should understand what is being recommended, why it’s being recommended, what risk they’re trying to reduce and what the alternatives are.

Then you make your decision.

Because agreeing to attempt a VBAC doesn’t mean you handed over consent to everything else at the door.

And induction?

This is probably one of the biggest ones.

“They’ve booked my induction.”

Okay.

Do you want an induction?

Because there is a difference between being offered induction and being informed that induction is happening to you.

There may be a really good reason it’s being recommended.

Maybe your waters have been broken for a certain length of time. Maybe there are concerns about your health or your baby’s wellbeing. Maybe you’re approaching or beyond a gestation where the evidence shows particular risks change.

You deserve that information.

All of it.

Not just:

“The risk goes up.”

Up from what?

To what?

What are the benefits of induction in my circumstances?

What are the risks and downsides?

What happens if I wait another 24 hours? Three days? A week?

What monitoring could be offered if I don’t want induction right now?

At what point would your recommendation change?

What would make you concerned enough to recommend something different?

Because induction is an intervention and NICE itself says women should be told that it affects birth options and the experience of birth.

That’s informed decision-making.

Not simply putting your name in an induction diary and waiting for you to turn up.

And this works BOTH ways.

Because birth choice isn’t only about women wanting fewer interventions.

This is really important.

Sometimes a woman wants a caesarean.

She doesn’t want to “just try” vaginal birth first.

She doesn’t want to be persuaded into the birth somebody else thinks she should want.

Maybe she’s had a traumatic previous birth.

Maybe she has severe anxiety around vaginal birth.

Maybe there are deeply personal reasons she doesn’t particularly fancy explaining to six different strangers.

Or maybe, having looked at the benefits and risks, she simply wants a planned caesarean.

Choice still matters when the choice is medical intervention.

Current NICE guidance says that when a woman without a medical indication requests a caesarean, the reasons should be explored, balanced and accurate information provided and options discussed. And if, after that informed discussion, she still requests a caesarean, her choice should be supported and a caesarean offered.

So please don’t mistake birth rights for natural-birth-at-all-costs.

Fuck that.

Birth rights mean your body, your information, your decision whether your decision is home birth with fairy lights and a pool or walking into theatre for the planned caesarean you have actively chosen.

“But you’re not eligible for the birth centre.”

This is another one where I want women to get curious.

Sometimes “not eligible” means the local guideline recommends that women with a particular risk factor birth on the labour ward because certain care isn’t available in the birth centre.

That’s useful information.

But I still want to know:

What specifically makes me ineligible?

Is this national guidance or local policy?

What is the evidence behind it?

What additional risk are you concerned about?

Can I speak to a consultant midwife or attend a birth-options appointment?

What alternatives can we discuss?

Because there’s a difference between understanding why a service has criteria and believing those criteria somehow make you incapable of having a conversation about your individual care.

Ask.

“Outside guidance” doesn’t mean you’ve done something wrong.

This phrase scares the shit out of some women.

Outside guidance.

It sounds dangerous.

Reckless.

Like you’re wandering off into the wilderness while everyone else sensibly follows the path.

Sometimes going outside guidance DOES involve accepting additional risk.

I’m not going to pretend otherwise just because it sounds empowering.

But informed choice isn’t only a choice when you choose the option carrying the lowest clinical risk according to the guideline.

The whole bloody point of informed decision-making is that different people can look at the same information and make different decisions because risk isn’t the only thing that matters to human beings.

Previous trauma matters.

Mental wellbeing matters.

Your previous birth matters.

Your family circumstances matter.

Your values matter.

What you’re frightened of matters.

What you’re willing to accept matters.

And yes, clinical risk absolutely fucking matters too.

Put it all on the table.

Then let the woman think.

You are allowed to change your mind.

This deserves its own section because birth plans sometimes get treated like contracts.

They aren’t.

You can plan a home birth for nine months and decide during labour that you want hospital.

You can plan an epidural and decide you don’t want one.

You can decline something and later accept it.

You can initially consent and then change your mind before or during a procedure where it is still possible to stop.

You can listen to new information and make a different decision.

Changing your mind doesn’t mean your original decision was stupid.

It means you received new information, had a new experience or simply changed your fucking mind.

NICE guidance specifically says women are free to make decisions and change their minds, including during labour and birth.

And THIS is why “just say no” pisses me off.

Because if you don’t understand what you’re being offered, what the alternative is, what the actual risk means or even whether something is optional, how the hell are you supposed to confidently decline it?

Women don’t need me standing on Instagram shouting:

NO IS A FULL SENTENCE.

Sometimes no isn’t the sentence she needs yet.

Sometimes she needs:

“Can you explain why you’re recommending that?”

Or:

“What happens if we wait?”

“What are my other options?”

“Can you explain that risk using actual numbers?”

“Is this a recommendation or is there an immediate emergency?”

“Can I have some time to think about it?”

“I’d like to speak to somebody else before I decide.”

And then, when she understands what is being offered and decides she doesn’t want it?

Her no matters.

I don’t want you fighting your maternity team.

I really fucking don’t.

Despite what people sometimes assume about the work I do, my dream isn’t to march into a maternity unit ready for battle.

Quite the opposite.

I want you surrounded by midwives and doctors who explain things properly, listen when you speak, tell you when they’re worried, give you evidence and recommendations without pretending those recommendations are commandments, and then work WITH you to make whatever you decide as safe as possible.

That’s good maternity care.

Sometimes your maternity team will recommend exactly what you already wanted.

Sometimes they’ll suggest something you hadn’t considered and you’ll think, actually yeah, that makes complete sense.

Sometimes new information will completely change your mind.

And sometimes you will understand their recommendation perfectly…

…and still choose something else.

That’s the bit we need to get more comfortable with.

Because informed consent doesn’t mean giving a woman enough information until she eventually agrees with you.

It means giving her enough information to make her own decision.

Even when it’s different from yours.

So if you’re pregnant and you’ve been told you’re “not allowed”…

Don’t immediately go to war.

Get curious.

Ask what they actually mean.

Ask whether it’s a recommendation, a local guideline, a service limitation or something else.

Ask what they’re worried about.

Ask for the evidence.

Ask for the numbers.

Ask about alternatives.

Ask what support can be put in place if you make a different choice.

And if you need more time?

Take it, where the clinical situation allows.

You don’t need to prove you’re brave.

You don’t need to choose the least medical birth.

You don’t need to choose the most medical birth.

And you certainly don’t get a fucking medal for agreeing with everyone.

You need to understand what is happening, what your realistic options are and what each of those options could mean for you and your baby.

Then you decide.

Because your maternity unit can recommend.

Your midwife can recommend.

Your obstetrician can recommend.

And sometimes their recommendation will be incredibly important information that you need to take seriously.

But your birth choices don’t simply disappear because the option you want isn’t the one they would have chosen for you.

It’s your body.

Your birth.

Your decision.

And that decision deserves to be informed, respected and yours.