Your body, Your baby, Your rights: Parents’ rights during pregnancy and birth

The birth of a baby is a very emotionally charged process and parents can feel lost while medical procedures are going on around them, especially if other people are making decisions that affect their wellbeing. In this article, Ina Opperman carefully examines parents’ rights during pregnancy and birth.

Parents experiencing the birthing process will have prepared for the birth, but suddenly doctors are making all the decisions and they may feel like they have no right to speak up and say what they want. “Parents may feel that they have no rights in the delivery room, but fortunately they do have rights they can exercise provided they are properly informed and educated,” says Lynne Bluff, a midwife from Johannesburg.

National Patients’ Rights Charter

Parent rights during the birthing process are based on patient rights as prescribed by the World Health Organization. In South Africa, the Health Professions Council of South Africa has prescribed the National Patients’ Rights Charter to offer ‘Guidelines for good practice in the health care professions’. It gives every patient the right to a healthy and safe environment, participation in decision-making and access to health care services.

In line with patient rights, parents have the right to choose a healthy and safe environment for the birth as part of their right to participate in decision-making. They have the right of access to health care services, health information, a choice of health services, confidentiality and privacy, informed consent, refusal of treatment and a second opinion.

Participation in decision-making

Your birth plan should be informed by your right to make decisions during the birth of your baby. It is therefore important to have all the information you require to be able to make contingency plans and state these in your birth plan too.

While you may be rendered unable to make rational decisions during the birthing process, it is important that your birthing partner knows exactly what you do and do not want according to your birth plan to help you make a rational decision should it be medically necessary.

“It is your baby and your birth, but because you do not have the medical knowledge, medical staff can unfortunately try to make decisions that are right for them and not necessarily for you and your baby. At some stage you have to trust medical professionals and put your life in their hands, but you have the right to question their decisions. However, you can only question their decisions if you are properly educated and informed,” Lynne says.

Available health information

You will need health information to formulate your birth plan. This includes available health services, how healthy you are, medical facts about the birth and the proposed medical procedures, its potential risks and benefits, as well as alternative procedures and the effect of non-treatment. Your doctor must also explain the reason, prognosis and progress of each kind of treatment in clear, plain language with as little unfamiliar technical and medical terminology as possible.

Lynne says you have the right to comprehensive information about the potential direct and indirect effects, risks and hazards to you and your unborn child as a result of using a specific drug or procedure. This includes an explanation of the benefits, risks and alternatives to treatment, the brand and generic names of the drugs used and whether it is medically necessary to use them. You also have the right to know the names and qualifications of all individuals involved in the birth.

“You have to ensure that you base your decisions on the right information and education about the birth, which you will only find in places like childbirth education classes. It is also important to choose the right class based on the qualifications, birth philosophy, birthing choices taught and curriculum offered,” Lynne explains.

Choice of health services

Your choice of a hospital where your baby will be delivered will be determined by your medical aid (if you are a private patient) and will, depending on your scheme, give you some leeway to choose your doctor, the hospital, the midwife and the procedure, says Lynne. Delivery at a state hospital, on the other hand, will happen according to the rules that you have to go to a clinic and give birth at a district hospital near your home if there are no complications.

Confidentiality and privacy

You also have the right to confidentiality and privacy during the birth of your baby. According to Lynne, confidentiality means that all information about your and your baby’s health, condition, diagnosis, prognosis, treatment and any other personal information cannot be shared with anyone else, unless you give written consent for the information to be shared.

She says your right to privacy must also be protected and this includes that only people who are necessary for the birth must be with you, unless you give consent to someone else being there, such as your birthing partner.

Informed consent

According to Lynne, any medical intervention requires informed consent from the patient and therefore it is also the right of the parents to give informed consent for any medical intervention during the birth. If you are unable to give consent, your birthing partner can be asked for permission.

However, if an intervention is urgently needed to save your life and the life or your baby, the medical staff can presume that you have given consent, unless you have indicated beforehand that interventions (such as blood transfusions) are not allowed based on religious grounds. You can also give your birthing partner the right to give consent on your behalf. “If your husband is with you, he can give consent as a spouse if there is a life-threatening situation,” Lynne explains.

Refusal of treatment

You have the right to refuse or stop a medical intervention that is not medically necessary after the doctor has explained the consequences of refusing or stopping it. As a part of your right to refuse treatment, your moral and cultural values and religious and philosophical convictions must also be respected.

You can refuse an induction or c-section if it is not medically necessary. However, the important part of enforcing your right to refuse treatment is to only do so after the consequences of doing so are explained to you and if you are sure that your decision is based on the right facts, says Lynne.

Second opinion

If you are not comfortable with the choices offered, you have the right to ask for a second opinion. Include this option in your birth plan so that you know who to ask.

“Your right to a second opinion also includes receiving a written summary of your diagnosis, treatment and care to give to the second doctor,” Lynne says. She also advises that it is better to ask for a second opinion sooner rather than later and, if possible, before the birth.

Remember:

• You can make informed decisions with the right information.
• You have the right to information to make informed choices.
• The right to choose includes your right to choose your labour position according to medical advice.
• You decide who shares this wonderful experience with you.
• You can decide which drugs and interventions can be used at the birth.
• Make sure that any refusal of treatment is based on facts.
• A second opinion is your choice.