How do we actually advocate for ourselves in pregnancy and during birth?

I encourage people to think about how they might want to ask questions, and ask questions about their care in early pregnancy if you can. The aim is that you feel respected at any maternity contact and that you are able to safely ask any question you want and to feel your health care team provide you with a good response that hears and validates your concerns.

Pregnancy brings with it many choices and decisions and this can feel overwhelming at times so take time to read, think and talk with your partner or trusted supports to ensure you feel you have the information you need for you.

There are lots of excellent books on pregnancy but I really recommend ones such as The Modern Midwife’s Guide to Pregnancy, Birth & Beyond by Marie Louise, Your No Guilt Pregnancy Plan by Rebecca Schiller, Expecting Better by Emily Oster and/or Nobody Tells You by Becca Maberly.

Also look at resources online such as Tommy’s PregnancyHub and find out about your local antenatal classes.

Try to explore until you feel fully informed about what your care options are, this might mean anything from looking at the different NHS maternity services near to you and what they offer such as continuity of midwifery care or home birth teams or a gentle caesarean, thinking about your pain options to thinking about who you want with you in labour and beyond.

Some people find using a doula really helpful as someone to help support and advocate for them but this is often a service that is paid for as an extra resource.

Your local Maternity and Neonatal Voice Partnership can be a great source of information here- they are a NHS working group with a team of women and their families, commissioners and professionals such as midwives and doctors working together to review and contribute to local maternity care and they often publish statistics around their local group.

You can find your local group here: https://nationalmaternityvoices.org.uk

Know you can ask questions during any stage of your pregnancy and some people recommend using the BRAIN tool to help you filter information, this asks:

Benefits - What are the benefits of making this decision?

Risks - What are the risks associated with this decision?

Alternatives - Are there any alternatives?

Intuition - How do I feel? What does my ‘gut’ tell me?

Nothing - What if I decide to do nothing/wait and see? What happens next?

We know from the recent MBRRACE reports that black and brown women have different outcomes through pregnancy and postpartum. I really point here to additional specialist resources such as https://fivexmore.org who suggest six steps women can take to advocate for themselves including speaking up, finding a trusted advocate, seeking a second opinion if you feel you need to, trusting your gut, researching from trusted sources such as NHS.uk and taking your own notes about any treatment or medication you are given or refused and the reason why alongside asking the healthcare professional also to document everything fully and sign it as well in your notes.

Asking for a second opinion is something people often worry to do, please know this is absolutely your right and can be very helpful. As a doctor, please also know I would never take it personally, we want you to feel comfortable and sure of your consultant at all times.

If you have concerns about your care consider sending a written email message to your team with your requests or concerns as this will be saved as a part of your medical record and cannot then be dismissed or be forgotten.

Other sources of great support around advocacy are Birthrights who have lots of excellent free downloadable resources on your rights in pregnancy and consent https://www.birthrights.org.uk and AIMS who have a good resource on making decisions through pregnancy, https://www.aims.org.uk/information/item/making-decisions.

During labour it’s also important to recognise that at times you may not be able to advocate for yourself as well as you would normally do, this is of course natural if you are in pain or exhausted but it can often be a real source of distress for people afterwards. Women and birthing people often blame themselves for not asking questions or making more of a fuss and feel guilty. 

If you feel you are losing your capacity to voice your questions or concerns in pregnancy or during labour this is where a partner can step in if they feel able, or your doula, or if you have a birth preferences list you might ask people to look at that and make sure they do read it. Birth plans can be contentious but in my experience if they are short and focus on the key things you don’t want to have, for example, I don’t want pethidine, or I refuse a forceps birth for example, they can convey wishes clearly at a time when sometimes we cannot.

You can independently also think about the personal things you want to have in your birthing space and task your birth partner to set these up, music, dimming the lights, bringing in LED candles, your own pillow, these things can help make the space feel more like ours.

Sometimes if it’s an acute emergency it may feel rushed and that measured conversations with time for reflection cannot happen, this is rare and afterwards if you feel able I would suggest you ask for the chance to debrief and understand why things happened fully to help you process this.

You can request your medical records after birth if you feel this might help you.

Remember many trusts also offer debriefs post birth if you feel you want to ask more questions about your experience and you can make a complaint via PALS

https://www.nhs.uk/nhs-services/hospitals/what-is-pals-patient-advice-and-liaison-service/​

Finally, good luck with your pregnancy and birth experience. Advocacy can be hard, but I hope some of these resources help you find a way to feel you are being fully heard, seen and respected at all stages through your perinatal journey. For many women this is the case, where this has not been the case and you experienced poor care or feel distressed or traumatised please see lots of support at www.makebirthbetter.org and please know I am always happy to offer any support I can, you can find me best at Instagram @drrebeccamoore via DM.