Even the smoothest, most straightforward of births can be overwhelming, so knowing how to advocate for yourself – or having someone who can speak up on your behalf – is important.

In an ideal world, you wouldn’t need to ask for basic items or know your rights when it comes to accessing pain relief, but as the results of the Birth Trauma Inquiry revealed last week, poor care in the UK’s maternity system has “all-too-frequently” come to be tolerated as “normal” over recent years.

Since then, the media has been flooded with stories of women who have experienced traumatic births, and numerous MPs have called for action. In many ways, it feels like this report could be a turning point for maternity care in the UK if it’s taken seriously. But if you’re pregnant now or are thinking about trying for a baby soon, the stories that have emerged over the last week will understandably be anxiety-inducing.  

While you can’t change what’s going on now, there is a sense of control to be found in educating yourself about your rights and knowing what you want from your birthing experience.

We asked 30 women to share their personal advice for this week’s digital magazine cover, but for the essential information you need to know, we asked a range of experts in maternity care to share their advice for speaking up throughout the birthing process. From how to ask for adequate pain relief to the knowledge your birthing partner needs to know, here’s what they had to say.  

First things first, it’s important to know your rights. Not only do you have the basic right to maternity care, but you also have the right to make key decisions about the care you receive, including where you give birth, how you give birth and who you give birth with.

“Healthcare professionals should provide you with the information you need to make these decisions and ask for your consent before providing any treatment or undertaking any procedures, including routine examinations,” explains Janaki Mahadevan, co-chief executive at the UK charity Birthrights.

“All people providing maternity care must treat you with respect and dignity – this includes not leaving you in undue and preventable pain and suffering.”

The doctors, midwives and nurses involved in your care should also not assume what you want or need; they can recommend a certain course of action or explain when things are medically necessary, but they must always consult you first so you feel part of the process. 

Everyone’s feelings towards and experiences with birth are different, and you have the right to request the care which suits you and your situation. Some of these requests can be made in the period leading up to your birth – for example, when it comes to choosing where you want to give birth.

In some cases, the NHS Trust or hospital taking care of you may automatically book you into a hospital or unit to give birth, but you can ask to discuss this and make your own decision.

“In the UK, you have the right to choose your place of birth, be that at home, in a consultant-led labour ward or in a midwife-led birthing unit,” explains Leah Hazard, a midwife, reproductive health care activist and author of three books including Womb: The Inside Story Of Where We All Began.

“You may be advised not to give birth at home or in a lower-risk setting if your pregnancy is more complex, and there may be reasons why it might be safer for you to give birth close to obstetric and/or neonatal care, but ultimately, the choice is yours and the health board is legally required to accommodate you.” 

In cases like the above, it is normal to experience pushback or recommendations from the doctors and nurses taking care of you, but you have the right to ask the medical reasons they have for issuing that advice. Listening to what they have to say is important – they are the experts, after all – but you do not have to agree.

Ultimately, when you make a request of a maternity service, they should try to do what you want. They should only say no if they cannot safely give you the care you want.

However, choosing to give birth at home doesn’t mean the NHS Trust or hospital that’s taking care of you has a legal obligation to send out a midwife to where you live, so it’s important to think carefully about the support you want during birth and choose a location that can meet your needs.

If you feel your requests aren’t being listened to at this stage – or any stage of the birthing process – you can ask to speak to the head of midwifery at your hospital. You can also contact Birthrights for advice at advice@birthrights.org.uk.

Giving birth can be a scary process, and the doctors and nurses involved in your care should do everything they can to accommodate your needs and wishes. This includes how you give birth – including C-sections – and the pain relief you have access to.

“Your rights when it comes to deciding how you give birth mean you can ask for a caesarean birth even if your doctor or midwife doesn’t think that you have a medical need for one,” Mahadevan says. “Your hospital must listen to your reasons for wanting a caesarean birth and have good reasons for saying no; as outlined in the NICE guidelines, the threshold for saying no must be quite high.”

Requesting a caesarean when you have no clinical reasons for needing one is known as a caesarean for ‘maternal request’, so you might see that in your notes.

Alongside a vaginal birth or caesarean section, you can also opt for a water birth or a scheduled induction. If you’re not sure which type of birth is best for you, your consultant or midwife should be able to talk you through the pros and cons of each and share their medical advice. This advice should be tailored to you and your circumstances – not just due to ‘hospital policy’.  

Because you have the basic right not to be left in preventable pain, the hospital or centre where you’re giving birth should provide the pain relief you request where possible.

“You have a right to request whichever pain relief you like, but availability can be affected by the workload within your unit,” Hazard explains. “For example, if the anaesthetist is busy with an emergency in theatre, there may be a delay in reviewing you for an epidural. There may also be clinical reasons why certain forms of pain relief are less advisable for you or your baby; for example, if your baby’s heart tracing is not reassuring in labour, it may not be advisable for you to have morphine until or unless the heart tracing improves.”

If you’re struggling to make decisions about your birth due to pain – for example, if you’re deciding whether to opt for a last-minute caesarean section – you should be offered pain relief so you can have a better conversation. In these cases, it’s worth noting that you may need to wait to have the caesarean if it’s not clinically necessary, as there may be others on the unit who need the procedure urgently. 

Having a birthing partner can make a massive difference to your birth experience. They don’t have to be a romantic partner – family, friends and professional birthing partners like doulas are all great options.

One of the key roles your birthing partner can perform is speaking up when you cannot – for example, when you’re in pain or can’t move from your bed. If you feel as if you’re not being listened to, having someone else speak up can also make it more likely that you’ll be heard.

Your birthing partner should be aware of what you’d like to happen throughout the birthing process.

“It’s great if you and your birthing partner can communicate during pregnancy about your birth preferences, comfort measures you’d like to try and contingency choices in case your labour doesn’t go as planned,” Hazard explains. “Your birth partner can also help to communicate your wishes to your care team if you don’t feel able to do so and can generally provide you with support, love and reassurance.

“Bear in mind that your partner may also feel overwhelmed or confused at times too, and it’s important to talk about what their own boundaries and self-care strategies might be.” 

If you’re worried about experiencing discrimination (be that racism, ableism and/or homophobia), then having a birthing partner who understands these fears and can step in during difficult situations can also be beneficial.

It’s worth noting that you have the right to choose who you want to give birth with, and there are only select occasions when a birthing partner may not be allowed into the room – for example, if they’ve been violent towards staff or their partner.

“However,” Mahadevan adds, “we have heard that policies brought in at the height of the pandemic have set a benchmark, with many Trusts continuing to adopt strict birth partner policies.”

If your hospital or Trust puts restrictions on your birthing partner, Birthrights have an email template you can use to challenge the decision and more information on your rights. 

Your rights should be respected throughout the birthing process, but if you feel you’ve been mistreated or that your health or your baby’s health has been put at risk by the staff in charge of your care, you have the power to complain and speak to a professional about your experience.

First things first, you need to make sure you get the care you deserve. For example, if you suffer a third- or fourth-degree tear, you should be given advice about self-care as well as a follow-up clinic appointment. You should also be able to speak to your GP about any concerns.

If you feel like your care wasn’t as good as it could have been, a good place to start is talking to the hospital who managed your birth. If you feel you’ve been disrespected, then you can talk to hospital staff, request a copy of your maternity notes and/or make a formal complaint.

“It is OK to complain even if you think what happened to you was minor or no serious harm was done,” Mahadevan explains. “Complaints can also be a way of documenting evidence of poor care in the maternity system and contributing to long-term change.” 

In some areas, midwives run a service called ‘Birth Afterthoughts’ or ‘Birth Reflections’, which give women the opportunity to talk through their birth experience – especially if you’ve had a traumatic labour. Your local Patient Advice and Liaison Service (PALS) or maternity unit will be able to tell you if there’s a service like this in your area available for you to access.

When it comes to making an official complaint, in England you have 12 months from the time of treatment. The timescales vary in other areas of the UK, so make sure you check.

Most hospitals have a Maternity Services Liaison Committee to which you can direct your complaint. For more information on making an official complaint, visit the Birthrights website.

You can also speak to a specialist medical negligence solicitor if you feel you’ve suffered an injury as a result of mistakes made in your care. They can help you consider a legal claim for compensation.

“Any medical negligence claim for an adult needs to be brought against the doctor or hospital within three years of the mistakes happening, or their knowledge of the mistakes,” explains Olivia Boschat, associate in the medical negligence team at the law firm Bolt Burdon Kemp.

“It is important for those injured to be aware of this and speak to a solicitor in good time. I would recommend that anyone who thinks they might have a claim make a note of what has happened at the time and keep a timeline of events to prompt their memory later on as it can be difficult to recall events clearly months or years down the line.” 

Speaking to a lawyer about your experience can be scary and potentially traumatising, especially if you’ve not spoken about your birth experience for a while. Many people also fear that their complaint isn’t ‘serious’ enough, but speaking to a lawyer will give you a better idea of where you stand.

Usually, the process would involve speaking to a specialist lawyer to discuss what happened in the first instance, who can explain where the law stands and what you’d need to prove to be successful with a claim. They can help get your medical records in order and investigate the claim, including speaking to any relevant medical experts. If you decide to go ahead, they will also speak to the doctor or hospital to get you the compensation you need to recover from your experience.

“Money won’t undo what has happened, but it can help to provide support and care and reduce the financial burden physical and mental injuries bring,” Boschat adds.

“Every claim is unique and the amount of compensation that is awarded will depend on the individual and their personal circumstances; it is not just about which physical or mental injury has been suffered, but importantly what impact those injuries have had upon the person’s lifestyle, family and ability to work.” 

Alongside NHS-backed services like Birth Afterthoughts, there are plenty of charities across the UK who offer support to new mothers in a range of different areas.

Charities and organisations which could be of help include:

• PANDAS, which offers support for parents dealing with perinatal mental illness
• The MASIC Foundation, which supports women who have suffered injuries during childbirth
• Birth Trauma Association, which is dedicated to helping women and families who have experienced a traumatic birth
• Maternal Mental Health Alliance, which ensures women and their families get the mental health support they need before, during and after birth
• Breastfeeding Network, which offers guidance and information on breastfeeding
• La Leche League, which provides advocacy, education and training surrounding breastfeeding
• The Mummy MOT, a type of postnatal physiotherapy service which screens for post-birth issues 

Images: Getty