Yes. We want to be sure that we treat every woman in a way which recognises her individual choices and respects her religious and personal beliefs. Before giving anyone a blood transfusion the risks and benefits of having or not having blood or blood products will be discussed. It is up to you to decide if you are willing to accept theses risks.
You may wish to talk to a doctor before you conceive so that you can think about how you will be looked after in pregnancy and how you can become as fit as possible before getting pregnant. Your General Practitioner (GP) can arrange an appointment for you to see a hospital specialist (obstetrician) to discuss this further.
When you think you are pregnant you should make your doctor and midwife aware of your request for no transfusions of blood or blood products to be used as part of your care. At your booking appointment with your midwife (your first main appointment with the midwife) you will be asked about your religious beliefs and if you have any objections to receiving a blood transfusion or blood products, such as the Anti D injection which is given to you following the birth of your baby if your blood group is rhesus negative. If you choose not to receive blood, we would strongly recommend that you have your baby in the consultant-led unit at the hospital rather than a home birth or in the midwifery-led unit.
Your midwife will refer you to a consultant clinic to discuss your pregnancy and make a plan of care with you. Your midwife or consultant will ask you to put your wishes in writing in the form of a letter or note and have this countersigned. A copy will be put in your maternity notes so your wishes are clear to any professional you meet during your pregnancy. If you are one of Jehovah’s Witnesses you may have an ‘Advance Decision to Refuse Specified Medical Treatment’ (sometimes known as a ‘no blood form’) which tells us of your wishes about treatments. Let your midwife and obstetrician see this and give a copy to them. Your local ministers will be able to provide you with this document.
During the antenatal period you will be seen by a consultant obstetrician in the antenatal clinic. Depending on the blood product you do not wish to receive, you may also be invited to talk to an anaesthetist as well.
When you see the doctor they will discuss the following with you:
• Iron and folic acid supplementation (tablets or liquid medicine) throughout the pregnancy
• Regular blood tests to check your haemoglobin (blood count and iron levels) is above 110g/l. If your haemoglobin remains low despite taking supplements and you have low iron store you may be given an infusion of ‘liquid iron’ into a vein.
IV iron has no better efficacy than oral, it is just tolerated better, it might be better to consult with the haematologist for advice if someone is not responding to oral iron.
As with all women, you will have a detailed scan when you are 20 weeks pregnant, which will check the position of the placenta (after birth) to make sure it is not low-lying as this puts you more at risk of heavy bleeding
• Your maternity notes will record that you do not want blood and blood products.
• Your doctor will document the plan for your care in your maternity notes
• You will be asked what treatments and procedures you are willing to accept and these will be written in your maternity notes
• If it is felt that you are at particular risk, for instance if your placenta is low lying, the use of blood salvage techniques (where your own blood is salvaged, cleansed and re-used) will be discussed. This should be discussed with all patients who refuse blood products not just at risk ones as an unforeseen emergency could arise
• We will notify the anaesthetic department that you are pregnant and the expected date your baby is due
• If you are Rhesus negative we will recommend that you have Anti-D injections during your pregnancy and possibly after delivery (if your baby is Rhesus positive). Anti-D is a protein which is obtained from blood plasma. There is no nonblood derived alternative. If you feel you cannot accept this injection for religious reasons you may wish to discuss this with one of your religious advisors. If you do not want to receive this injection for any other reasons the consultant will happily discuss any concerns that you have
• Experienced personnel will be available if you require a caesarean section or if there is heavy bleeding following delivery
When you come to hospital in labour the consultant obstetrician and anaesthetist on call will be notified. You will be looked after normally in labour but we would recommend that you have the drug Syntometrine to help with the delivery of your placenta (active management of the third stage). If there are complications, senior members of the maternity team will be available and your individual care plan will be followed. At all times, even if an emergency arises, we will respect your wishes. You can be confident that you will receive the best possible care and treatment during your time in the maternity unit.
To help us respect your wishes you should:
• have informed us in writing and asked that this is kept on your records
• Carry an ‘Advance Decision’ form and ‘Care Plan’ with you at all times. Before any operation you will be asked to sign a consent form, consenting only to treatment you are willing to accept and which you have discussed with your obstetrician.
If you have questions that are not answered in this leaflet or are worried about any aspects of your pregnancy and delivery, please talk to the midwife or ask to speak to one of the doctors. You can change your mind at any point about the use of blood. You should not feel as though you have to stick rigidly to your original decision.
