Hannah Summers The Guardian, 2 October 2021
Women who turn down advice from health service staff say they are being coerced with threats of referrals to agencies and police.
Pregnant women and new mothers are being referred to social services by midwives for refusing to follow their advice, patient advocacy groups have warned.
Expectant parents who have declined care, including opting out of scans, refusing inductions or failing to attend antenatal appointments, are among those who have faced threats from healthcare professionals amounting to coercion, according to the Association for Improvements in the Maternity Services (Aims).
“Since the pandemic, our helpline has seen an increase in those threatened with or referred to social services for declining some form of medical care during their pregnancy, even though opting out of inductions, tests or scans are perfectly legal and valid choices,” said Maddie McMahon, a helpline volunteer.
While the problem is long-standing, calls to Aims have increased since the Covid-19 crisis, with 5% of inquiries between April 2020 and March 2021 relating to concerns about a referral, either actual or threatened. Aims coordinator Nadia Higson said: “Often the threat of a referral is used to coerce someone into accepting unwanted care.”
She added that since the start of the pandemic there had been an increase in the number of cases where threats had been made to those opting for a freebirth – giving birth without medical staff present through choice – after home services were withdrawn in some areas – rather than agreeing to what they saw as the riskier option of having their baby in a Covid-infected hospital.
The charity Birthrights says it has also seen the number of reports about social service referrals more than double in the last financial year.
Rachel Ree, from Manchester, gave birth at home on 23 December with no complications. But on Christmas Day she received a call saying blood samples taken from the umbilical cord for routine checks had been incorrectly labelled and destroyed, meaning she would have to take her baby into hospital that day for a blood test.
“I told them I would not be taking my newborn into hospital during a pandemic for something that was of no benefit to her – but they said if I refused they would ‘get another agency involved’,” she said. “They even said the police would come and take the baby to hospital.”
Heather Spain wrote an open letter to midwives, claiming she was “held captive” on a postnatal ward in Wales after the birth of her son in February. She had been asked to stay in hospital for a repeat blood test instead of taking her baby home and returning later for the test. The 34-year-old said: “Waiting for the test would have meant another night on the hot, noisy ward, where I was completely exhausted and struggling to sleep and care for my baby without the support of my partner, who was unable to visit because of Covid-19 restrictions.”
I knew they had no legal right to keep me there but I was shocked to find myself feeling so powerless
Yet when she tried to leave, staff refused to unlock doors, called security and threatened to call the police, she alleged. She wrote: “There is not a day that goes by when I don’t wonder…[why] you held me and my then four-day-old newborn captive on the maternity ward, when you initiated the child abduction protocol, resulting in three male security officers physically blocking my path.”
After negotiating with the ward manager, she finally managed to leave but was warned staff would be obliged to report her to social services. “Had I not been alone, I don’t think I would have been treated in that way,” said Spain. “I feel women have been left increasingly vulnerable to such threats during the pandemic because they haven’t had their birth partners around to support them.
“I knew they had no legal right to keep me there but I was shocked to find myself feeling so powerless.”
Spain, who is a diplomat and read extensively around the subject of childbirth after learning she was pregnant, said she felt haunted at the thought of women less able to advocate for themselves.
Shivalee Patel, from west London, had a freebirth after feeling that trust had broken down between her and community midwives. She was reported to children’s social services at 36 weeks pregnant because those assigned to her home birth disagreed with how she intended to manage her labour. “I ended up doing it on my own with my partner, a friend and a birth coach,” she said. “I would have preferred support from a midwife as well but I didn’t feel safe with them because they didn’t listen.”
Maria Booker, programmes director at Birthrights, said: “Referrals to social services are for concerns about how a baby will be cared for after it is born. They are not a tool for coercing women and birthing people into making different birth choices.”
Leah Hazard, a Scotland-based midwife and the author of Hard Pushed: A Midwife’s Story, said that it was important not to vilify midwives. She said: “It’s never OK to threaten women with social services over a difference of opinion. But I think part of the problem is a wider culture of defensive practice, and possibly, for some people, that might push them to make decisions that are not in line with their professional obligations.”
The Royal College of Midwives (RCM) highlighted the midwife’s role in empowering women to make informed choices during pregnancy and birth. It said the ability of midwives to communicate implications for a particular choice was based on developing trust. But it added: “Serious shortages of midwifes are impacting this ability, with little or no time to develop these important relationships. This is a huge concern for the RCM… The reality is pressures on time and resources means communication is sometimes not as clear as it should be and sadly, some women feel their wishes have been ignored.”
The RCM has published guidance for midwives, including on how to support those opting for an unassisted birth. NHS England said it was up to individual trusts to enact their own safeguarding protocols.