Sarah Holdway was sitting outside her Yorkshire home in July while her baby, Violet, slept. As her four older children picnicked beside her, two strangers approached. “The man said he was from Humberside police,” says Sarah, “and that this was a social worker and that we had been reported for child trafficking.”
Three months earlier, Sarah’s baby had been born in an unassisted birth – also known as a freebirth. After two homebirths attended by medical professionals, she planned for her third and fourth babies to be born without medical help. In England and Wales, there is no legal obligation to have medical care in pregnancy or childbirth, her midwife had been fully supportive of her decision, and both births went well. Pregnant for a fifth time, living in a new area, Sarah, 33, once again gave birth easily at home.
Weeks later, a health visitor (who hadn’t met the family) grew concerned after a clerical error involving Violet’s birth registration alerted her to the family. Sarah believes that a lack of understanding of the law, and suspicion of the family’s alternative lifestyle and the unassisted birth, played a major role in police and social services being informed that lives might be at risk.
The police and social worker were reassured that Violet was indeed Sarah’s baby and, after asking specifically about the unassisted birth, they left. Sarah’s case was eventually closed with no further action taken.
Social services involvement following pregnancy or birth choices is not isolated to Sarah’s case, however. Jean Robinson, president of the Association for Improvements in the Maternity Services, says her organisation has dealt with many hundreds of cases where such choices have prompted referrals to child safeguarding teams.
I first became aware of the issue through my work as chief executive of the human rights in childbirth charity Birthrights. Since 2013, our legal advice service has helped 25 women with problems related to social services.
Laura Moore, 33, from Bedfordshire contacted us earlier this year with a copy of a letter from her obstetrician. It said that if she didn’t change her birth plans, “This may be a safeguarding issue with reference to your unborn child which may have to be addressed further.” Laura says that she felt threatened by the letter. “The safeguarding issue was being used to intimidate me into complying with their care plan.” This was her third pregnancy following two straightforward births.
“I am obese and in both previous pregnancies I had gestational diabetes,” she says. After a range of tests in her first pregnancy, she agreed with her doctor to a more hands-off approach in her second, as long as her blood sugar levels remained under control. All went well and after a happy homebirth she requested the same approach for her third pregnancy, but instead of support she received the uncompromising letter.
Elizabeth Prochaska, a human rights barrister and chair and co-founder of Birthrights, says: “The suggestion of referral should never be used to intimidate, bully or coerce someone into accepting a particular medical intervention.”
Indeed, if a woman has made a decision, she can’t be compelled to change her plans unless she lacks mental capacity. Such referrals are also unhelpful to social workers, as Maris Stratulis of the British Association of Social Workers explains. “If a referral to social services is used as a ‘threat’ by a professional, it does not provide a good foundation for a social worker to build trust and rapport.”
After Birthrights’ involvement in Laura’s case, Bedford hospital wrote to Prochaska confirming that “the woman has the right to what she chooses”. It offered an apology for the remark regarding a referral to social services, adding, “We would have no reason to do this unless we have proven concerns about the parenting, which we did not.”
The obstetrician has been referred for further learning.
The use of social services as a tool for coercion also featured in a 2012 case concerning Southern general hospital in Glasgow. The hospital was forced to apologise after a woman was bullied into taking precautionary antibiotics during labour in hospital. Following her complaint to the Scottish Public Services Ombudsman, the hospital admitted that she had been threatened with having her baby removed from her care in order to gain consent for its planned course of treatment. The ombudsman upheld her complaint, stating that she “did not properly consent to the treatment administered and was wrongly put under extraordinary pressure during labour when she was in a very vulnerable situation”.
Prochaska says the threat of referral to social services “seems to have become a common tool used by health professionals when they are uncomfortable with women’s choices”. And we have also been contacted by women who have found police outside their home or hospital room as a direct result of their birth plans.
A senior obstetrician (who wished to remain anonymous) echoed these concerns, blaming the trend in part on a culture of fear linked to safeguarding in the NHS as a result of high-profile cases where children have not been adequately protected and individual professionals have been publicly vilified. The obstetrician added, “There also isn’t enough understanding of the basic medical ethical principle of the right to autonomy.” Pointing to how prevalent the word “allow” is in maternity care, the obstetrician says there is “clear evidence that women’s right to make their own informed choices is not clearly understood”.
While some people struggle to understand the motivation of those whose choices differ from the norm, Simon Mehigan, deputy director of midwifery at Chelsea and Westminster hospital in London, does not. “Women don’t take decisions around their pregnancy and birth lightly,” he says.
In more than 20 years as a midwife, he has met women whose decisions have been considered inappropriate by other professionals, but he has “yet to meet one whose decision-making process wasn’t rational or sensible, with each having undertaken their own research and weighed up all the advice and guidance they have been given”.
“The skill is to accept that ultimately it is not the health professionals’ decision to own,” says Mehigan.
Yet for women such as Elle Forrest, 30, who is based in Manchester, erroneous social services involvement has even interfered during birth. After an easy pregnancy with her second child, Elle was planning a home birth with local NHS midwives. After not attending an antenatal appointment (because she had not been alerted to it), she received a torrent of calls and notes instructing her to ring the hospital. “It was as though there was an emergency, but it was never made clear what the danger was.”
When Elle went into labour, she informed the hospital, as is routine in a home birth. Two social workers then came to her door instructing her to call the out-of-hours service immediately or “things would escalate”.
Due to the stress, her contractions stopped and she called the number she had been given. “A woman told me that I had a secret plan to give birth without midwives present, that I was not registered with a hospital, that I had not attended any antenatal appointments and that I did not consider the needs of my unborn baby to be paramount,” says Elle.
In shock and through rising panic, Elle offered to put the social workers in touch with her midwife to clear up the misunderstanding, but, she says, “She was not interested in my explanations and accused me of lying when I tried to set her straight.”
Though informed that she was “not allowed to labour at home” and that an ambulance would be sent to collect her, Elle stayed firm. “I was terrified but once my labour resumed, it was fast and furious. My baby could not wait for the midwives or the ambulance we had called. It was never my intention to give birth without medical assistance and when I saw my baby for the first time I thought she was dead. She was completely healthy, but I didn’t know that. The shock of it all remained for a long time.”
For the next few days, social workers would knock loudly at the family’s door. Twice they waited outside and she heard them say, “If you just let us in to see the baby, this will all go away.”
Cases such as Elle, Sarah and Laura’s are not aberrations and, though they represent the extreme end of a complex problem, they are symptomatic of a culture and maternity system that can be unfriendly, even punitive to pregnant women. It is perhaps unsurprising that a society increasingly dictatorial about pregnant women’s behaviour, that fetishises parenting and points the finger of blame all-too-frequently at the mother, is punishing women in this way.
Combined with an overstretched maternity system in which stress and bullying is rife among staff, and where fear of litigation and professional sanctions meets a lack of understanding of women’s rights, it can make for a toxic cocktail that damages new families at an intense and vulnerable time. But awareness is growing. The appetite for much-needed human rights in childbirth training is genuine and the Royal College of Midwives is working closely with Birthrights on education for its members. Professor Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists, says the college “welcomes any opportunity to improve human rights issues relating to childbirth”.
Elle now wishes she had made a formal complaint, but the experience has led her to find out more about her rights, and support other women through pregnancy and birth as a doula. “I have since learned about the law, and I know that, even if the social worker on the phone had been correct about any of the things she accused me of, I was within my rights to make those decisions.
“If I became pregnant again, I would put the onus back on whoever was putting pressure on me, to change their behaviour instead of making myself more accommodating in order to be seen as compliant. How I was treated was unnecessary and cruel.”
• Why Human Rights in Childbirth Matter by Rebecca Schiller is published by Pinter & Martin, £7.99. To order a copy for £6.55, go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min. p&p of £1.99. Join the Birthrights #NewChapter bookclub campaign at Birthrights.org.uk
