Declining Blood Transfusion or Other Blood Products in Pregnancy and Childbirth

Patient Information Leaflet

Introduction

This leaflet is designed to give you information about your choice to decline blood transfusions or blood products. Your midwife and consultant will discuss this information with you and answer any questions you may have.

What is a blood transfusion?

A blood transfusion involves giving blood or blood components from one person (known as the donor) to another person. A blood transfusion can be a life-saving process. It is usually done to replace blood that has been lost because of severe bleeding, but it is also used for the treatment of severe anaemia.

Why may I need a blood transfusion in an emergency?

If you haemorrhage (bleed very heavily), this is an emergency. Without a transfusion to replace the blood you have lost, you could become seriously ill or even die.

It is often not possible to predict or prevent a life-threatening bleed. Medication and surgical techniques will be used to try to limit the need for a blood transfusion. However, a blood transfusion might be needed to save your life or to prevent serious harm to your health and your baby’s health.

Can anyone refuse a blood transfusion?

Yes. As a Trust, we want to treat every woman in a way that recognises and respects their individual, cultural and religious beliefs.

If you refuse treatment with a blood transfusion and blood products, we want to ensure that you make an informed decision. Your doctor and midwife will discuss the possible risks and benefits of treatment with and without blood products.

If you are a Jehovah’s Witness, you may also wish to discuss this with your ministers.

Who do I need to tell?

If you have chosen to decline any treatment with blood or blood products, then please tell your midwife or doctor as soon as possible in your pregnancy.

It is important that they know your wishes early so that you have the time to discuss the potential implications of declining treatment and options available to you.

What happens in the antenatal clinic?

Your GP or midwife will refer you to a consultant antenatal clinic (ANC). You will have a full discussion with a doctor and midwife to ensure you are making a fully informed choice.

Discussion about your preferences:
Resolutely decline the transfusion of whole blood and primary blood components (red cells, white cells, plasma and platelets).
Accept derivatives of the primary blood components like coagulation factors, wound healing factors.
Accept any procedures involving transfusing your own blood. Blood cell salvage involves safely collecting and cleaning the blood lost from your body at the time of birth and returning it to your circulation through a vein.
You may decide that you accept some treatment but decline others.
If you are a Jehovah’s Witness, you are asked to carry a signed ‘Advance Decision to Refuse Specified Medical Treatment’ form (sometimes known as a ‘No Blood Form’).
Your choices will be recorded onto your maternity records, including the digital records, to ensure staff are aware.
Other treatments and procedures to limit blood loss will also be discussed and it will be documented as part of your plan for care in your maternity record.
We will inform the anaesthetists (specialist doctors in managing pain relief during surgical procedures and critically ill patients) of your wishes. It will be discussed with you if you need to meet them during your pregnancy.

How can the risks be reduced?

Attend all of your antenatal appointments.
We will recommend that you book for consultant care and plan for a hospital birth. There are treatments for a haemorrhage that can be given in hospital that are not available at home.
Your midwife will advise you on a healthy iron-rich diet.
Have regular checks on your blood iron content (Hb level). Your midwife will offer to take your blood regularly to ensure that you are not becoming anaemic (low Hb levels). If you become anaemic, your risk of a haemorrhage will increase.
We will help you to ensure your blood iron content (Hb) is good at the time of your baby’s birth. This will be achieved using oral iron and folic acid supplements. If needed, intravenous iron is available. This is iron given through a cannula (thin, plastic tube) straight into one of your veins.
Attending your scanning appointments will ensure that the midwives and obstetricians (maternity doctors) are aware of the location of your placenta. If the placenta is situated low down in your uterus, you may need to have a caesarean section for your baby’s birth. If this is the case, special arrangements are made to ensure safe delivery.

What happens during labour and after delivery?

When you come into hospital in labour, the consultant obstetrician and consultant anaesthetist will be made aware of your arrival. You will be looked after as normal in labour.

During your labour, the care that you receive will not be affected by your decision to not have a blood transfusion or any blood products.

There is no need for continuous monitoring of your baby’s heartbeat for this reason alone, but there may be other reasons why this is recommended.

We would also recommend a cannula (a small plastic tube) to be inserted into a vein during labour, with your permission, so that if anything were to happen like heavy bleeding, there is no delay in treatment.
If there are any complications, a senior team will be available and your care plan will be followed.
After the birth of your baby, we will advise you to have active management for the delivery of the placenta (afterbirth). This involves an injection of oxytocin (a hormone which is not a blood product) into your leg after your baby’s birth.
This will speed up the separation and delivery of your placenta and make your uterus contract. Research has shown that active management significantly reduces the risk of serious bleeding from the area in your womb where the placenta was attached.
If you need stitches after the birth, the midwife or obstetrician will carry out the repair at the earliest opportunity to minimise your blood loss.
After you have given birth to your baby, you should monitor your blood loss. If you think the amount is more than you expected or you pass clots, you should inform your midwife.

My blood group is RhD negative – is this a problem?

If your blood group is RhD negative, please ask your midwife for the information leaflet. This leaflet explains the reason why anti-D immunoglobulin injections are recommended in pregnancy and after the birth of your baby.

Anti-D is a protein obtained from blood plasma. There is currently no non-blood derived alternative. If you are a Jehovah’s Witness, you may wish to discuss this with your local minister or a member of the Hospital Liaison Committee.

What if I change my mind about having blood products?

If you change your mind about your choice to decline blood transfusions or blood products, please tell us and we can amend your treatment plan accordingly.

You can be confident that, even in an emergency, your wishes will be followed and you will receive the best possible care and treatment during your time on the maternity unit.

Please remember that our aim is to ensure that you and your baby stay healthy and well.

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on (01384) 456111 and ask for the relevant department who issued this leaflet.

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.

Date reviewed December 2023 Next review due December 2026 Version 5.