The UK used to be a leader in maternity care worldwide. We held the gold standard that others aspired to. Unfortunately, that reputation is slipping away rapidly. Every week, maternity care is getting really bad press, whether it’s giving birth in a hospital, at home or freebirthing.
If the NHS maternity journey feels impersonal, full of fear or downright overwhelming, you’re far from alone. Many women step into pregnancy hoping for thoughtful, individualised care, only to feel like they’ve been reduced to yet another number on the conveyor belt of an overstretched system.
So many women enter pregnancy expecting personalised care, only to feel like they’re just another name on a list.
Maybe you’ve already had a tough experience with your first birth.
Maybe you’ve heard stories of women feeling unheard, rushed, or even pressured into decisions they weren’t comfortable with. And now? You’re wondering, How do I make sure that doesn’t happen to me?
Many women tell me their pregnancies felt smooth and uncomplicated, right up until the final few weeks. Suddenly, the tests ramp up, the monitoring intensifies, and the pressure to accept an induction at 40 weeks becomes hard to ignore. Seeds of fear and doubt begin to sprout. You don’t know what you should do , so you follow the advice you’ve been given.
Here’s the truth: You have rights. You have choices. And you have a voice in your birth.
So let’s talk about how to advocate for yourself in the NHS system—so you feel supported, heard, and confident every step of the way.
1. Know Your Birth Rights in the UK
The state of maternity care under the NHS is not what it used to be! Every few weeks, we’re seeing stories in the media about how women are being let down and left physically and/or emotionally harmed when having their babies. You need to know that YOU are the decision-maker when it comes to your body and your baby. Here’s what that means:
Informed Consent
No one can do anything to you without fully explaining the benefits, risks, and alternatives. It is always YOUR decision to make, whether it’s recommended or not.
The Right to Decline Interventions
You can say no to any intervention, test, or procedure, even if it’s recommended. I would suggest that you mirror back what has been offered to you, and let them know that you understand what they’re offering. However, you don’t want that right now.
The Right to Change Your Mind
Just because you agreed or disagreed with something earlier doesn’t mean you can’t reconsider. e.g. you have chosen not to have any vaginal examinations, but as your labour has intensified, you decide you need to know how much progress you have made. It’s truly okay to change your mind at ANY stage.
The Right to Request a Different Midwife or Consultant
If you feel unsupported, you can ask to see someone else. If you have a personality clash, you can request another midwife/consultant. You can even request another midwife when you’re in labour.
The Right to Choose Where You Give Birth
Whether it’s on the delivery suite, in the midwifery-led unit, or in your home – YOU get to decide where you will feel safest. No one can force you to give birth somewhere you don’t want to. For labour to progress well, you need to feel safe, supported, and unobserved. Where is that for you?
Advocacy Tip: If you feel pressured, ask if they can explain the risks and benefits of their suggestion. Are there any alternatives? Do you have time to think it over, or is it an emergency?
2. Build a Birth Plan That Reflects YOUR Wishes
A birth plan isn’t just a ‘nice-to-have’, or something to tick off your to-do list -it’s a powerful tool for making sure your wishes are respected. It is also incredibly helpful in helping you explore options available to you. But the key? It needs to be crystal clear.
What to include in your birth plan
- Your preferred birth environment (dim lighting, minimal monitoring, privacy)
- Your pain relief preferences (or if you want a drug-free birth)
- Your preferences on interventions (e.g. whether you want to avoid continuous monitoring)
- What happens immediately after birth (optimal cord clamping, skin-to-skin, feeding preferences)
- At the top of your birth plan, write (in bold) what your non-negotiables are.
- Have a back up plan and a caesarean section plan too, as birth sometimes deviates from your original plan.
Advocacy Tip: Print several copies of your birth plan and give one to your midwife, birth partner, doula, and have a spare one in your hospital bag. Make sure everyone reads it too!
3. Hire a Doula to Advocate for You
One of the best ways to make sure you feel heard, respected, and fully supported in birth? HIRE A DOULA!
A doula is not just a ‘nice extra’. She will take the time to help you understand how your body is designed for birth, explore how your needs and values can be met, and what to do if there are any diversions along the way. During your labour and birth, she is your advocate, your emotional support, and your voice when you need it most.
- A doula makes sure your birth preferences are respected – so you’re not pressured into decisions you don’t want.
- She helps you navigate NHS policies and procedures, making sure you understand all your options.
- She can step in if you feel dismissed – helping you ask the right questions and stand firm in your choices.
- She’s there for your partner too – so they feel supported and can focus on you instead of worrying about the system.
Many women who hire a doula say they felt more in control, more empowered, and far less stressed during labour, even in hospital settings. Find out the benefits of doulas HERE.
Advocacy Tip: If you’re feeling unsure about your options, book a free chat with a doula – even if you’re not sure you’ll hire one. Most doulas (myself included!) are more than happy to give you clarity and confidence in your choices.
4. Teach Your Birth Partner to Be Your Advocate
In the middle of labour, advocating for yourself can be hard. You’re not (or shouldn’t be) in the thinking part of your brain. Your birth partner should be able to speak up confidently on your behalf. If they don’t have that confidence, see point #3 and seriously consider investing in a birth doula.
They need to know:
- What you do and don’t want (review the birth plan together)
- How to ask for time if you’re feeling pressured (“We need a moment to discuss this.”)
- How to remind staff of your choices (“Her birth plan states she doesn’t want that, can we explore other options?”)
Advocacy Tip: Remember that hospital policy and guidelines are set up for the hospital staff, not for the ‘patients’. You are free to consider all your options available and choose what feels right for you. The midwives and/or consultants then need to support your wishes, not manipulate and coerce you into complying to their guidance.
5. If You Decline Medical Recommendations
You are a beautiful, autonomous individual, and no one knows your body better than you. Yet within the NHS, many staff feel pressured to practise defensively. They encourage you to follow policy not just for safety, but to protect themselves from potential litigation if something goes wrong.
And when you say no to a recommendation, things can quickly shift.
Imagine this: throughout your pregnancy, you’ve been clear that you want to use water for pain relief. In labour, you ask to get into the birth pool. The midwife, following hospital policy, tells you she must perform a vaginal examination first to confirm you’re at least 6cm. You don’t feel comfortable with that and calmly decline.
But instead of your choice being accepted, the midwife, unable to deviate from protocol, insists. When you stand firm, your care is “escalated” to a senior midwife or team leader. Their role often becomes less about supporting your autonomy and more about persuading you to comply. You may face repeated questioning, frightening “what if” scenarios, or warnings that you’re putting yourself or your baby at risk.
After enough pressure, subtle or not, many women end up agreeing. Not because they changed their mind, but because they’re exhausted, overwhelmed, or simply want the confrontation to stop.
This is not informed consent.
Even with good intentions from staff, these interactions can be deeply coercive, leaving long-lasting emotional and psychological impact.
Advocacy Tip: If you’re planning to birth outside guidelines or want to better understand your rights, the Great Birth Rebellion podcast is very helpful. Listen to Melanie from the Great Birth Rebellion. Finding no satisfactory resolution? Get hold of BIRTHRIGHTS UK who will provide legal rights for your maternity care,
Trust your body, baby & instincts
As a woman, your body is designed to give birth. It is a natural event that happens a few times in a woman’s life. Sometimes it is necessary for medical intervention, but not on the scale we are seeing in NHS hospitals.
In a world where we are led by experts, research, and science, it has become difficult to clear the noise and trust our instincts.
Learn to be quiet and sit with your body. Take time each day to sit quietly with yourself and your baby. Breathe and connect. Does everything feel good? Is anything off? Trust that instinct! It’s a God given gift to women.
Advocacy Tip: Before consenting to any medical interventions, drop into your body to feel if this is 100% right for you and your unborn baby. You may want to ask:
- Is this necessary right now?
- What if we wait?
- What are the benefits and risks to my baby and me?
- What other options are there?
YOU are in control of your birth
Since childhood, little girls have been taught not to make a scene, to trust those in authority, and to be nice, good girls. Standing up for yourself is difficult! BUT you will only birth this baby once. No one else will remember this birth as vividly and in as much detail as you. Make it a birth to remember for all the right reasons!
So walk into your birth with confidence. Speak up during your pregnancy. Ask LOTS of questions. And if you need someone to remind you of your power, I’m right here.
If you want to go deeper in preparing for a calm and empowered birth, I offer 1:1 childbirth education, birth support, and birth trauma recovery sessions.
Want to know more?
