Expecting a baby and preparing for the birth is a thrilling yet sometimes daunting experience. One of the critical aspects of this journey is navigating conversations with our healthcare providers, which includes understanding how these healthcare providers communicate risks and options during pregnancy and birth.
We can take inspiration here from the landmark case of Montgomery vs. Lanarkshire which has significantly influenced the way informed consent is approached in maternity care, and it aligns closely with the principles outlined in the UK's Human Rights Act 1998. This blog aims to help you understand these legal frameworks and how a little understanding of them can help you advocate for your care by ensuring your healthcare providers communicate effectively about what matters to you, as an individual.
Understanding the Montgomery vs. Lanarkshire Case
In 2015, the Montgomery vs. Lanarkshire case highlighted the importance of informed consent in medical practice. The court ruled that healthcare providers must ensure patients are fully informed about the risks associated with treatments, emphasising the need to consider what is significant to the woman giving birth, rather than merely what the provider deems important. This shift established the "materiality test," which focuses on providing information based on what the pregnant person wants to know, rather than the previous "Bolam test," which centered on what peers might consider acceptable.
Connecting the Case to the Human Rights Act 1998
The UK's Human Rights Act 1998 reinforces the rights of individuals to receive appropriate and respectful healthcare. Article 8 of the Act protects the right to respect for private and family life, which includes making informed decisions about one’s health and treatment. The principles established by the Montgomery case complement this by ensuring that patients are not only informed about their medical options but are also not active participants, but are encouraged to take the lead in their care decisions.
What Does This Mean for You?
As a pregnant woman or person, it’s essential that your healthcare providers engage with you in a way that respects your rights and values. The Montgomery case and the Human Rights Act empower you to ask questions and seek clarity on what matters most to you, creating a more personalised and respectful approach to care.
A Step-by-Step Guide to Navigating Your Care
Here’s how you can have meaningful conversations with your healthcare providers and encourage them to adopt a materiality test approach, informed by the principles of the Human Rights Act:
### Step 1: Educate Yourself
Familiarise yourself with common risks and options related to your pregnancy and childbirth. Use reputable sources such as healthcare websites, books, or local antenatal teachers and Doulas to gather information. Understanding your choices will help you feel more confident during discussions with your care team.
### Step 2: Prepare Your Questions
Before your appointments, write down any questions and concerns that matter to you. Think about what risks you find significant and any specific preferences you have regarding your care. Here are some examples of questions to consider:
- What are the potential risks and benefits of this procedure or intervention?
- How might these risks impact my specific situation?
- What alternatives are available, and what risks do they involve?
And if you ever find yourself stumped on what to ask, the toddler method can be quite effective. Simply ask 'why' to each response that you get until you have gleaned all of the information your need.
### Step 3: Initiate the Conversation
When you meet with your healthcare provider, take the initiative to discuss your concerns, don't wait for them to give you the opportunity as they may not. You might start the conversation like this:
"I’ve been reading about the risks involved in my pregnancy, and I want to ensure we discuss the aspects that are most important to me, as an individual. Can we go through the risks and benefits together from my perspective?”
### Step 4: Advocate for Your Needs
If you feel that your provider is not addressing your concerns adequately, don’t hesitate to speak up. You can express your desire for a more personalised conversation. And if possible always take someone with you to appointments. Use phrases like:
“I appreciate your guidance, but I want to ensure we’re discussing the risks that matter to me personally. Can we talk about how these risks might specifically affect my specific situation?” Lots of NHS trusts employ a Consultant Midwife or a Professional Midwifery advocate. If you are finding this overwhelming or you are not getting what you need from conversations with your midwife or consultant then you can request to speak to someone in one of these roles. Though these two roles are different, they are essentially both there to help facilitate communication between you and your healthcare team.
### Step 5: Encourage Shared Decision-Making
Remember, you have the right to make ALL decisions on the care that is provided to you. Your health care providers have their own guidelines and regulations to follow THEMSELVES, you have absolutely no obligation to follow them yourself. Encourage your provider to involve you in the decision-making process. Say something like:
“It is important to me to maintain control of the decisions when it comes to my care plan. Can we discuss the options and what might work best for me?”
### Step 6: Follow Up
After your appointment, if you still have questions or feel uncertain, don’t hesitate to reach out again. It’s essential to feel confident and informed about your care. If you are not getting the information or support that you need from your NHS care providers I would suggest reaching outside of the system for support. You can contact organisations like BirthRights or your local MNVP for free or if you have the budget you could contact a local doula or independent midwife with knowledge of how to achieve what you need with your hospital trust.
A baby's human rights after birth
It’s also important to recognise that your human rights are applicable to both you and baby whilst they are inside of you and you maintain mental capacity to make decisions. Once a baby is born, they immediately have their own human rights, including the fundamental right to life. This means that healthcare providers may need to make decisions that prioritise the well-being of the newborn, especially in critical situations. While parents should still play a vital role in decision-making, the healthcare team may sometimes have to take actions that they believe are necessary to protect the child's health and safety. Understanding this balance can help parents navigate the complexities of care during and after childbirth, ensuring that both their rights and those of their newborn are respected.
Conclusion
The Montgomery vs. Lanarkshire case, along with the UK’s Human Rights Act 1998, has paved the way for empowered patient-provider relationships in maternity care. By taking the initiative to discuss your concerns and preferences, you can help ensure that your healthcare provider offers you the information that truly matters to you. Remember, your voice is vital in this journey, and advocating for your needs can lead to a more positive and fulfilling experience of pregnancy and birth. ❤️
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