Women using maternity services who decline blood and blood products : University College London Hospitals NHS Foundation Trust

This page has been written to provide information to those women who choose to decline a blood transfusion or blood products. It is important for you to know that your decision is respected and that we will care for you during all stages of your pregnancy.

We try to avoid blood transfusion in every woman. Most women will not require a blood transfusion when they give birth, but blood transfusion can be life-saving if there is a major bleeding.

Our primary concern is the safety of you and your baby, and in order for us to ensure this and respect your wishes are followed there are a few things we can do in advance, which are outlined in this information page.

Telling your midwife

If you have made the decision not to accept a blood transfusion or blood products, it is important that you tell your midwife as soon as possible. They will then be able to arrange appointments with a haematologist (doctor that specialises in blood), an obstetrician and an anaesthetist as early as possible in your pregnancy, to allow plenty of time for planning before birth. In these appointments, the team will talk to you about implications, alternative options, what is and isn’t acceptable to you, and to plan your care in an unhurried and calm environment.

Following this discussion where we can find out exactly which products you are and are not happy to accept, the team will ask you to sign a Trust blood transfusion form.

This form will be kept in your medical records on our system, Epic, so that all staff are aware of your exact wishes.

Minimising the need for a blood transfusion

There are things that can be done in every woman to minimise the risk of needing a blood transfusion:

Avoid anaemia (low iron levels) – You can help your iron levels by having a good balanced diet and eating iron rich foods. You will be offered blood tests to monitor your iron levels throughout your pregnancy and if your iron starts to drop, you may be offered iron tablets or sometimes an iron infusion.
Reducing your risk of bleeding after birth – Opting for an injection to be given to help deliver the placenta after your baby is born can help to reduce bleeding. If you require stitches after birth, we will deal with this quickly and efficiently to minimise blood loss.
Place of birth – To ensure that any possible problems are dealt with promptly, it would be advisable for you to give birth to your baby on the labour ward, as opposed to the birth centre.

What happens if a blood transfusion is needed?

If it is recommended that medically the safest treatment for your health would be a blood transfusion, the doctors caring for you will discuss this with you. They will explain the circumstances and the pros and cons of receiving a blood transfusion so that you can make an informed decision.

You are able to change your decision at any time, and if you then decided to proceed with a blood transfusion, your choice would be respected. If you decided that you still would not like a blood transfusion, your decision would be upheld, even if the outcome was that it could contribute to your death. We would do our utmost to ensure your wishes are respected.