Your Maternal Care Rights: How to Advocate for Yourself During Pregnancy and Childbirth
Key takeaways:
Maternal care is very important. But it doesn’t follow a “one-size-fits-all” pattern. Creating a birth plan helps document your maternal care preferences along your pregnancy and delivery.
It’s important that you understand your maternal care options to help you make the best decisions for your pregnancy. This includes knowing what’s required and optional.
You have the right to advocate for yourself and your newborn if your rights are being violated. Speaking up and working with a patient advocate are good places to start.
Table of contents
Pregnancy can be one of the most exciting and memorable times of your life. But it can also be overwhelming — requiring many decisions, appointments, and procedures. At times, you may even feel like you have no say in your pregnancy. But you should understand that you have rights every step along the way.
Taking control of your maternal care helps set you up for the best possible outcomes with your pregnancy. Knowing what’s required — and optional — can help you feel comfortable throughout the process. Keep reading to learn more about your maternal care options and rights.
The importance of maternal care
Maternal care is care that you receive before, during, and after childbirth. It’s not just important for you, but your baby as well.
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Maternal care includes:
Prenatal provider appointments: Prenatal appointments give you the chance to see your baby through an ultrasound. More importantly, your healthcare provider may catch potential health risks that could affect you or your baby.
A safe place to deliver your baby: If you have a vaginal delivery, you can choose to deliver at a birthing center, at home, or in a hospital. If your healthcare provider recommends a cesarean (C-section) delivery, you’ll have to go to the hospital.
Postpartum maternal care: A visit by 12 weeks postpartum allows you to get physically, mentally, and emotionally checked. You can also bring up any questions or concerns about your health, feeding your baby, birth control, and more.
Adequate newborn care: Newborn screening, for example, is necessary to make sure your baby is healthy. It includes hearing, metabolic, genetic, and other types of tests.
These measures also help lower the likelihood of preventable outcomes, such as maternal mortality — death while pregnant or within 42 days after the pregnancy ends. Compared to other developed countries, the U.S. has the highest maternal mortality rate. And within the U.S., the rate is highest among Black mothers.
About 1 in 3 maternal deaths in the U.S. happen during pregnancy. And over half occur after giving birth. Pregnancy complications, like bleeding and high blood pressure, are often the cause. But these problems can be detected with regular checkups as part of your maternal care.
Making informed decisions about your maternal care
While maternal care is important, know that you have options. Learning what they are can help you make informed decisions during your pregnancy.
A great place to start is with your healthcare provider. Ask them questions or voice concerns that you have about your pregnancy. For example, if you want the birth to be as natural as possible, let them know. You can learn more about what options are available that would align best with your preferences.
One way to stay on track with your decisions is to have a birth plan. A birth plan is a written outline of every step of your pregnancy and delivery. This should be shared with your healthcare provider so you both can coordinate care.
Refusing prenatal care
There are certain aspects of prenatal care that are very important and shouldn’t be skipped. This includes checking your blood pressure, taking blood tests, and hearing your baby's heartbeat. All of these things make sure you and your baby are as healthy as possible.
But there are certain things that you can choose to opt out of:
Cervical exams: These exams can be used to see how much your cervix has been dilated. However, they can be uncomfortable and may not be completely necessary during the final weeks of pregnancy.
Ultrasound: This test is used to estimate the size of your baby and your delivery date. During your second trimester, it’s also used to check how your baby’s organs have formed.
Glucose screenings: Glucose screenings are also optional, but they’re highly recommended. They’re used to see if you’re at risk for gestational diabetes. Gestational diabetes — diabetes that develops during pregnancy — can cause health problems for you and your baby. The good news is that gestational diabetes can be managed.
RhoGAM: If you have Rh-negative blood, you may be advised to get a RhoGAM shot. This shot stops your body from making antibodies that attack your baby’s red blood cells. Discuss the risks and benefits of RhoGAM with your healthcare provider while deciding if it’s right for you.
Below are a few other tests your healthcare provider may discuss with you. These tests aren’t routinely done. But they may be recommended in specific situations if there’s a significant health issue with your baby.
Chorionic villus sampling (CVS): This test involves taking a tissue sample from the placenta. It’s done to check for any chromosome abnormalities in your baby (like Down’s Syndrome). But there’s a small chance that it could lead to a miscarriage.
Amniocentesis: This test involves inserting a needle to extract fluid from your amniotic sac. It’s also used to check for chromosome abnormalities. But it tends to be less risky than CVS.
Maternal care rights in the delivery room
Deciding the details about where and how to have your baby may seem overwhelming, especially if you’re a new mother. And it can be difficult navigating through your healthcare provider’s suggestions.
To start, it’s important to know your rights when making these decisions. Here are some things you have rights to:
Choosing who is allowed in the birthing room with you: You have the right to decide which friends and family members you want — and don’t want — in the birthing room with you. For example, you may want to share this moment with only your partner.
Birth support: You’re allowed to have at least one person with you while giving birth to be there for you through the process. Many people choose their partner, a close friend or family member, or a doula.
Leaving the facility for any reason: Whether you’re at the hospital or birthing center, you can leave for any reason, even if it's against medical advice. But it’s important to understand the risks of leaving the facility during labor.
Asking to switch healthcare providers for any reason: If a healthcare provider is making you uncomfortable, or you feel like you’re being gaslighted, you can ask to switch to a different healthcare provider.
Informed consent: Your healthcare provider is required to thoroughly inform you about certain medical procedures, like a C-section, induction, and augmentation of labor. They must tell you about any risks and why it’s necessary. It’s important to ask questions if you don’t fully understand this information.
Insurance coverage for you and your baby: The Newborns' and Mothers' Health Protection Act (NMHPA) ensures you and your newborn are covered by your insurance for a period of time after delivery. Be sure to confirm details of this coverage with your insurance plan.
Refusing interventions before and during labor
Before and during labor, it can be difficult to decide between what you need and what you can go without. Similar to prenatal visits, blood pressure and heart rate measurements are necessary to prevent negative outcomes. However, other interventions are not as necessary.
Examples of these include:
Induction: Your healthcare provider may recommend labor induction. Sometimes there’s a medical reason to induce. Other times, you may decide to induce based on your preferences. If that’s the case, it’s important to understand the risks.
C-section: A C-section isn’t necessary unless you’re facing complications or have had a failed vaginal delivery. Some healthcare providers also recommend a C-section if you’ve had one before. There are certain situations where a repeat C-section is required, but you shouldn’t automatically assume this is the case for you. Discuss your specific situation with your healthcare provider to understand why it may or may not be necessary.
Epidural: An epidural is given to help you with pain during delivery. It involves using a small tube to inject pain medication into the area around your spinal cord. But you can opt out of any pain management interventions your healthcare provider suggests.
Episiotomies: This is when an incision is made to help widen the vaginal opening and make delivery easier. It’s only done if necessary. Unless it’s an emergency and needs to be done immediately for your safety or the baby’s, your healthcare provider will ask for your consent first. You can refuse an episiotomy but that can result in longer recovery time after giving birth.
How and when to advocate for yourself
Having your rights violated can be a frustrating and traumatic experience. So, it’s important to advocate for yourself and your baby if you think this is happening to you. Doing so can help lower the likelihood of experiencing trauma or another serious event.
If you feel your rights have been violated, there are steps you can take to advocate for yourself and/or your newborn. You can apply these steps at any point during your care. Some examples include:
Documentation: Take pictures and videos and/or write down what’s happening. This can help provide additional evidence for your claims.
Voice your concerns: Speak to your healthcare provider to make them aware of the situation. If you’re unable to make progress, remember that you can ask to switch healthcare providers at any time.
Contact a patient advocate: Most hospitals have a patient advocacy team in-house. But there are also advocacy groups for mothers and newborns that you can contact.
File a complaint: Having your rights violated can lead to serious consequences. If you aren’t properly treated, you may be able to seek legal support if you’ve been harmed or injured.
The bottom line
Maternal care is the care you receive before, during, and after childbirth. Some procedures and interventions are necessary to help prevent complications. But others are optional. Knowing the difference can help you feel more comfortable with the decisions you make during your pregnancy.
Remember: You have many rights regarding your maternal care. This includes having every right to say “no” and speaking up when you feel your rights are being violated.
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References
American Association of Birth Centers. (n.d.). What is a birth center?
American College of Obstetricians and Gynecologists. (2020). Prenatal genetic diagnostic tests.
American College of Obstetricians and Gynecologists. (2021). Levels of maternal care.
American Pregnancy Association. (n.d.). Creating your birth plan.
Birth Rights Bar Association. (2020). Birth rights: A resource for every day people to defend human rights during labor and birth.
Centers for Medicare & Medicaid Services. (n.d.). Newborns' and Mothers' Health Protection Act (NMHPA).
Health Net Federal Services. (n.d.). Hospital patient advocates are there to help you.
HealthyPeople.gov. (2022). Maternal, infant, and child health.
Lothian, J. A., et al. (n.d.). Navigating prenatal appointments. Lamaze International.
McNally, S., et al. (2022). When you do (and don’t) need a cervical check. The Well by Northwell.
MedlinePlus. (2020). Ultrasound pregnancy.
National Women’s Health Network. (2015). What to reject when you're expecting.
Reed, R., et al. (2017). Women's descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy and Childbirth.
Tikkanen, R., et al. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund.
