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  • Writer's picturegrainne35

What are hospital guidelines & policies?

If you are pregnant, no matter where you give birth (including homebirth), you will probably at some point hear a health caregiver say “It’s hospital policy…..” or “The guidelines are….” This a particular popular response when asking "Do I have to be induced if my waters break? Do I have to be induced? Can I vaginally breech birth my baby? Am I allowed to have a homebirth?"

Immediately they can make the birthing person feel disempowered, thinking they have no choice and it does not open a balanced discussion. It can be a lazy way of hiding behind process, not listening to the birthing person and fobbing a person off.

One size fits all

Where do “guidelines” come from?

Guidelines are available for health carers to make decisions, and should be based on the best available evidence. They help provide best practice.

The National Institute for Health and Care Excellence (NICE), which makes guidelines for health and social care, has guidance on improving the experience of care for people using adult NHS services, which includes information about how healthcare professionals should communicate with patients and how to present information about risks and benefits, to enable them to make decisions about their care. Hospitals also refer to Royal College of Obstetricians and Gynaecologists (RCOG) guidelines.

NICE and RCOG guidance is not law, but parameters for safe care. Guidance is constantly being reviewed and updated and so sometimes trusts do not always refer to the latest guidance, as it takes a while to filter through.

What is “hospital policy”?

Hospital policies are made locally. Hospital policies can vary from trust to trust, and covid have highlighted this further. Eg. visiting hours all day in one trust and for 2 hours in another trust, induction after 18 hours of waters breaking in one trust and 24 hours in another trust. They are not based on evidence and have been agreed at trust level. Policies are not legal rules and they should not be applied in a blanket way.

Expert advice

I know it's extremely difficult to press a point or take issue with an “expert”, but it still amazes me how meekly most birthers receive this response. Most of the people I support are professionals, who I am sure would have lots to say in business meetings and not be shy in coming forward to give their opinion. But in a maternity setting they wouldn't dream of coming back with a "Why is that?" They hate the idea of 'making a fuss' or being thought 'difficult'.

Just quoting guidelines/policies does not give anyone the information they need to make an informed decision for them and their baby. The policies and guidelines are based on the majority and not individual care. It is vital to understand, birthers do not have to follow guidelines or policies.

When faced with guidelines/policies being quoted, what can I do?

When faced with quotes of guidelines/policy some things to help you get the information you need to make the right decision for you and your baby are :

  • Anyone can look up NICE/RCOG guidelines and it may help to know them before you discuss your options with your care provider.

  • Open the conversation up with positive language, for example :

    • To make an informed choice and understand my options, please can we talk further about the evidence and risks around that policy/guideline so I can consider what is right for me and my baby?

    • I have read the current RCOG guidelines, but wish to have an individual care plan

    • Thank you for the guidance/policy you have provided, I have looked into this myself and I have made an informed choice and I wish to decline your offer ……..

  • AIMS (Association for Improvements in the Maternity Services) and Birthrights provide great sources of information

  • You might want to use the BRAIN framework to help you get the answers you want:

B – What are the Benefits?

R – What are the Risks?

A – What are the Alternatives?

I – What does your Intuition (gut) say about what’s right for you?

N –What would happen if I said No or Not now?

You only get to birth your baby/babies once, so take control, get informed and own your birth.

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