Maternity rights and informed decision making

Every woman and birthing person has the right to make their own decisions about their care during pregnancy, birth, and early parenthood, and these decisions will differ for everyone.

Decisions may be based on medical needs, past experiences, personal preferences or values, and changing circumstances. It should never feel necessary to fight for appropriate and personalised care.

A birth partner can play an important role and can help ask questions, explore options, and offer support.

This article discusses how to feel confident about taking an active role in maternity care, making informed decisions, and standing up for your rights or someone else’s. We also cover these topics in our NCT Antenatal courses. 

What is maternity advocacy?

Advocating for yourself or someone else means seeking information or stating individual circumstances, needs, or decisions. This can be done at any time during pregnancy, labour, birth, or after a baby is born.  

In this article, we also use terms like ‘speaking up for yourself or someone else’ or ‘knowing a woman or birthing person’s rights’ or ‘taking an active role in maternity care’. 

Why is maternity advocacy needed?

Safe maternity care is more likely when women, birthing people, and their partners or families are listened to by their care providers and respected (RCM, 2022). Communicating needs and preferences to care providers can have a positive effect on pregnancy and birth experiences and outcomes.

Many women and birthing people say not getting enough information about their care has made their maternity care harder and sometimes changed how their birth went (Care Quality Commission, 2024).  

Read more about how a birth plan can help parents explore options and support conversations with midwives and doctors.

Inequalities in maternity care

Parents who are marginalised or socially excluded often have less positive maternity experiences and outcomes (RCM, 2022). For some, this might be because they are unfamiliar with how UK maternity systems work. They may struggle to communicate effectively because of a lack of translation services. Or they may believe they have to defer to medical authority (Gutiérrez et al, 2025).  

At other times, stereotypes, bias, and a lack of cultural understanding from healthcare providers can make it harder to get equal, personalised care (Care Quality Commission, 2024).  

Midwives and doctors should use clear language so a woman or birthing person knows what is going to happen and can consent to or decline care. Everyone has a right to an independent interpreter if they need one (Care Quality Commission, 2024).

The National Institute for Health and Care Excellence (NICE) provides guidance for all healthcare professionals on how to work with people using health services to make appropriate decisions about care (NICE, 2021).  

What does maternity advocacy look like in practice?

How to speak up for yourself or someone else

While speaking up may sound straightforward, it can be challenging at times because the power may not feel equal between the woman or birthing person and the healthcare provider.  

It can feel exhausting to have to ask for appropriate care (Hinton et al, 2025). Focusing on what is most important, building a relationship with medical staff, and making use of a birth partner or doula can help.  

There are also some simple tools that can help women and birthing people, and their birth partners, speak up, ask questions, and take an active role in their care.  

Most midwives and doctors welcome questions being asked as it helps them to know they are giving the best care.  

1. Ask questions  

It's always okay to ask for more information before making a decision about your care. This will give a better understanding of the benefits, harms, and possible outcomes of any decision (NICE, no date).

Repeating information back to the midwife or doctor in your own words can help ensure you have understood it correctly (NICE, 2021). You can then ask for more information, if needed.

It can also help to ask what the options are. A midwife or doctor should clearly explain each option. They should also tailor the information to your or your birth partner’s personal health and other circumstances (NICE, 2021).

2. Try the traffic lights approach

Some people find a ‘traffic lights’ approach helps them understand their emotional reaction to decisions. For example:

• Green means “Yes that feels good, let’s do it”
• Amber means “I’m not sure / I need more information”
• Red means “Not for me, thank you”  

This can help women and birthing people to discuss their needs and feelings in a simple way, or to start a conversation with midwives and doctors about next steps.

3. Use the B-R-A-I-N decision making tool  

This can help when decisions feel hard or complicated. Ask the midwife or doctor questions which help you to understand (NCT, 2024):  

• Benefits – what is the reason or benefits for what is being suggested?  
• Risks – what are the potential risks or consequences with this option?  
• Alternatives – are there any alternatives to consider?  
• Instincts – what does your gut tell you about the suggestion?  
• Nothing – what would happen if we do nothing right now? Can we revisit this later if I change my mind?  

4. Communicate clearly  

Making notes ahead of time can help you remember your questions. You can also make your own notes of meetings with your care providers. If you want to record meetings it’s helpful to let the healthcare team know that you’re doing that (Birthrights, 2021b).

There are some useful phrases for communicating clearly with midwives and doctors. Remember, you’re all part of a team trying to achieve the best experience and care.

A good way to discuss preferences is by saying: “This is what I / my partner would like. How can we work together to achieve that?”

If not feeling heard, it can be useful to say: “It feels like you’re not hearing what I’m saying”, and if necessary, “Shall I repeat myself?”

If feeling under pressure, it can be useful to say “It feels like you’re pressuring me”. You could also ask the healthcare professional something like, “Am I in immediate danger? Is my baby in immediate danger?” This starts a conversation about what the actual risk is, and how urgently a decision is needed (Birthrights, 2021a).

You can also say “Wait”, “Stop”, or simply move away if possible.  

Asking for a health professional’s NMC (Nursing and Midwifery Council) or GMC (General Medical Council) number and making a note of it will demonstrate that you’re not happy with the situation.

NCT’s simple information sheet has more information on how to advocate during pregnancy, birth, and early parenthood.  

When could maternity advocacy be helpful?

Women and birthing people may need to speak up for themselves during pregnancy, birth, or after their baby is born.  

It is common to feel that midwives and doctors are in charge and that their advice must be followed. However, in the UK, only the woman or birthing person has the legal right to make decisions about their body and to accept or decline care (Birthrights, 2021a).  

Only those with parental responsibility can make decisions about the baby’s or babies’ care (Birthrights, 2021a).

Taking a more active role in maternity care might happen:

• During pregnancy, if there are worries about care, like feeling anxious about symptoms and not being heard.
• Before labour, when talking about birth options and sharing preferences, such as the place or type of birth. This might be particularly relevant if wanting care that is unusual or ‘outside guidance’.
• During labour and birth, when needing extra support, like wanting to move around or manage pain.
• After birth, when needing postnatal care, including help with pain or feeding the baby.
• Giving feedback, if wanting to comment on care or make a complaint

What is ‘care outside guidance’?

Care outside guidance is the term for when someone is declining routine maternity care. For example, this might be around place of birth, kind of birth, or type of pain management. Everyone has the right to decline care.  

In these cases, the maternity team will need to plan how to support a woman or birthing person in a way that respects their decision, while also protecting medical staff from harm. For example, if the woman or birthing person makes a request for care, the team must have the appropriate support, training or equipment to provide that care safely.

Shared decision-making (SDM)

Shared decision making is a reminder to health professionals to allow people to decide how involved they want to be in decisions. Some people prefer not to take an active role in making decisions with their healthcare professionals, while others want more information and control.  

The National Institute for Health and Care Excellence (NICE) states that (NICE, no date; NICE, 2021):

• Care and support should focus on individual needs, preferences, beliefs, and values.
• Midwives and doctors should explain the risks, benefits, and possible outcomes in a way that fits each person’s needs and preference.  
• Visual tools should be used to support discussions.
• Risk should be shared as natural numbers and absolute risks, not vague or scary words or percentages.  
• Risk should be shared as both the chance something might happen, and the chance it will not.
• All information should be personalised to the individual circumstances, so it is relevant.
• There should be an open and ongoing conversation with time to ask questions, think, and discuss options.

Understanding a woman or birthing person’s rights

Informed consent  

Consent means saying yes to care or treatment. It can only be given by the pregnant woman or birthing person. These are the important points to understand (Birthrights, 2021a):

• No one can touch or treat a competent adult without their consent – it is against the law.
• Consent can be given by speaking, nodding, or holding out an arm. It may also be given in writing, for example, a consent form for a caesarean birth.
• To give consent, you must understand what the treatment is and what it involves, the risks, consquences and benefits, what all the other options are and what will happen if you accept treatment and if you don't.
• You do not have to give consent.
• You do not have to explain why you do not give consent. However, it may be helpful for the healthcare provider to understand.
• You can change your mind at any time. This is called ‘withdrawing consent’.
• No one can pressure you into making a decision. Even if a midwife or doctor disagrees, they must respect your decisions.
• If feeling pressured, it is possible to ask for a different caregiver.
• Birth partners can help by asking questions, explaining preferences, and speaking up about concerns, but they cannot give consent.

Additionally, following a UK Supreme Court ruling in 2015 (Birthrights, 2017):

• There must be a conversation between the patient and the health professional about the treatment. This means it cannot be simply a one-way information giving process, such as the health care professional giving the patient an information leaflet.  
• It must address anything that the patient would consider to be important for them as an individual. For example, whether they plan to have more children in the future.
• Healthcare providers cannot rely on a signed consent form as evidence that the patient has understood the risks of a procedure. 

Before treatment or examination

Staff must ask for consent every time before they touch you or do a procedure, even for minor checks (Birthrights, 2021a):

• If care changes, they must explain and ask for consent again.
• If you have given consent in advance, you should still be offered another discussion immediately before the treatment or check.
• Information should be clear, and interpreters must be provided if needed.
• You can decline any procedure, even if it is a routine check.
• Special care must be taken when the woman or birthing person has used opioid pain management.

When consent cannot be given  

Being in labour usually does not stop someone from giving consent. Only in rare situations is treatment allowed without consent (Birthrights, 2021a):

• If unconscious, only life-saving care can be given.
• Rarely, someone may ‘not have mental capacity’, meaning they cannot understand the decision even when explained. This must be legally proven in advance.

Undue influence

No-one can pressure or threaten a woman or birthing person to make a decision. This is called undue influence (Birthrights, 2021a; Birthrights 2021c):

• Threats, including a midwife or doctor saying they will call social services, are not legal.
• Even if healthcare professionals think a woman or birthing person, or baby’s life is at risk, they cannot perform any medical procedure without agreement from the woman or birthing person.
• The baby has no legal rights until born, and even then only those with parental responsibility can make decisions for them.

If feeling pressure from a health professional, any woman or birthing person can ask for a different care provider at any time. With their permission, a birth partner might ask on their behalf if the woman or birthing person feels uncomfortable doing so.

If a pregnant woman or birthing person is under 18 (Birthrights, 2021a)

• People aged 16-17 are legally able to consent to medical treatment.
• People under 16 can consent to treatment if medical staff believe they understand what is involved. Otherwise, someone with parental responsibility can give consent. 

The right to care

Choosing a healthcare provider  

A woman or birthing person can decide to access any maternity service, even if it’s not in their local area. The NHS says a choice will be provided where possible and depending on what services are available. This is not a legal right (Gov.uk, 2024).

If a woman or birthing person feels they have not been offered a choice, they should speak to a senior midwife. If this doesn’t help, they can contact the local Integrated Care Board (ICB) or take the complaint to the independent Parliamentary and Health Service Ombudsman.

See below for how to make a complaint about maternity care.

Requesting a service

Sometimes a woman or birthing person requests a specific service, such as a home birth, water birth, or care from a female or male doctor or midwife.

There is always the right to ask, but the healthcare team is not legally bound to provide that care. This may be because there is (Birthrights, 2021a):

• A medical reason because the option could cause harm.
• A lack of staff or equipment, such as a limited availability of birth pools or midwives able to attend a home or midwife-led unit birth.

Any reason should be explained clearly, and all efforts should be made to ensure that, for example, there are sufficient staff to meet the needs of the woman or birthing person.

Some parents, if they are not confident a service will be provided by the NHS, decide to use an Independent Midwife. 

The right to a second opinion and Martha’s rule  

There has always been a right to get a second medical opinion (The Patients Association, no date a).

Martha’s Rule recognises that people close to a patient may notice early signs that something is getting worse (NHS England, no date). The rule was established in 2024, and encourages patients, families, and carers to speak up if they are worried.

If concerns are not acted on, families or staff can call for a rapid review from another team within the hospital. This helps make sure any problems are checked quickly (NHS England, no date). Ask the staff for the telephone number to call.

The right to access maternity records

Everyone who receives NHS maternity care in the UK has a set of records. A pregnant or birthing person has the right to access these at any time (Birthrights, 2021a). Find out more in our article about maternity notes.  

Who can help?

Most midwives and doctors do their best to support women and birthing people and to ensure they are given safe, personalised, and kind care.  

If a pregnant woman or birthing person is finding it hard to understand their care or to speak up, then a birth partner or doula may be able to help. They can ask to speak to a more senior health professional.

If that is still not helping, there are also people called advocates who can help during pregnancy or after the birth. Advocates are independent of social services and the NHS (NHS, 2022).  

An advocate can help a woman or birthing person to (NHS, 2022):

• Understand the care and support process
• Talk about how they feel about their care
• Make or challenge decisions about their care  
• Stand up for their rights
• Write letters or attend meetings
• Be supported during assessments, care and support planning, and safeguarding and reviews.

Use this NHS page to find an advocate.

Giving feedback or making a complaint

Everyone who uses the NHS has the right to give feedback about the service they receive (Birthrights, 2025). Some people don’t want to make a formal complaint, but do want to give feedback.  

There are three options (Patient’s Association, no date b):

• Raising a concern: This can be done informally with a senior member of the maternity team, the Patient Advice and Liaison Service (PALS), or the local integrated care board (ICB).
• Making a complaint: All healthcare providers have a complaint policy. Ask PALS to see a copy and for details of how to make a complaint.
• Contacting the Ombudsman: If you are not happy with the reply to a formal complaint, contact the Parliamentary Health Service Ombudsman (PHSO). The PHSO is an independent complaint handling service for complaints that have not been resolved by the NHS in England. 

Find out how to make a complaint in Wales, Scotland and Northern Ireland. 

Complaints should usually be made within 12 months, but it can help to make notes of what happened as soon as possible (Birthrights, 2025).

Both these organisations have useful pages on how to give feedback or make a complaint:

• Birthrights   
• The Patient’s Association 

Where to get support

• AIMS Helpline - provides information and support for anyone using maternity services, or supporting someone who is. Email: helpline@aims.org.uk / Telephone: +44 (0) 300 365 0663
• PALS - offers confidential advice, support and information on health-related matters for patients, families, and carers. Find the nearest PALS office online, or ask a GP surgery, hospital or phone NHS 111 for details of the nearest PALS.
• FiveXMore – shares six steps to advocate for yourself  

Need more information?

Every woman and birthing person has the right to feel safe, informed, supported, and confident about their decisions.

For further information, we offer NCT Antenatal courses  which are a great way to prepare for pregnancy, birth, and life with a new baby.  

Our NCT support line also offers practical and emotional support with feeding your baby: 0300 330 0700.