Download Declining Blood Products or a Blood Transfusion in Pregnancy and

form where the risks and benefits will again
be explained to you by an obstetrician and
advice given if you require blood or blood
products.
If your doctor feels that you need a blood
transfusion to treat severe bleeding or
anaemia they will discuss the reasons with
you in detail to allow you to make an
informed decision.
Should the situation worsen without
treatment with blood products your doctor
will discuss this with you and your family in
detail to ensure that you are aware of any
possible consequence. Your choice will be
respected if you still wish to decline a blood
transfusion.
Changing your mind
You can change your mind at any time; this
choice will also be respected and
documented in your maternity notes.
Further Information
Please feel free to talk to your midwife or
doctor if you have any questions.
Author J Seymour (v3)
Reference: DVH Blood Transfusion policy
Reviewed June 2016, review date: June 2018
Information accurate at time of going to print.
Women and Children’s
Directorate
Declining Blood Products
or a Blood Transfusion in
Pregnancy or after
Childbirth
Darent Valley Hospital
Darenth Wood Road
Dartford
Kent
DA2 8DA
Antenatal Clinic: 01322 428190
Maternity Assessment Unit:
01322 428278 / 428280
Community Midwives Office:
01322 428753
www.dvh.nhs.uk
Introduction
This leaflet has been written for
pregnant women who know that they
will want to decline a blood transfusion
or blood products in childbirth.
We aim to treat every woman in a way
which recognises and respects their
individual choices and all religious,
cultural and personal beliefs. Should
you be offered a blood transfusion or
blood products the risks and benefits of
accepting and declining them will be
discussed fully with you.
Telling your midwife or doctor
At your booking appointment a midwife
will review and assess your medical,
obstetric,
social
and
religious
background.
Inform your midwife of your preference
not to receive any blood or blood
products. This will allow enough time to
discuss potential implications in a
relaxed and unhurried environment.
Following discussion with your midwife,
you will be referred to see a Consultant
Obstetrician and anaesthetist so that a
plan of your care can be made with
you for your pregnancy and birth.
If you are a Jehovah’s Witness you will
have been given the form ‘Advance
Decision to Refuse Specific Medical
Treatment’ which tells us of your
wishes about treatment. Please sign
the form in the presence of a witness
and keep it with your pregnancy notes.
Plan of care in your pregnancy
The Royal College of Obstetricians and
Gynaecologists have developed a care
plan for women in labour declining a
blood transfusion. Your doctor will be
guided by this, and will make a plan of
care in your notes.
If you choose not to receive blood or
blood products we recommend that
you book to have your baby within the
Delivery Suite setting. Your wishes will
be documented in your notes after a
detailed discussion on the risks and
benefits, which you will asked to
counter-sign.
You can reduce the risk of needing a
blood transfusion by ensuring that you
are not anaemic (low iron levels)
during pregnancy. You will be offered
regular blood tests to check your iron
levels and if they are low you will be
offered iron therapy.
To minimise the chance of heavy
bleeding after the birth of your baby,
you are advised to opt for ‘active
management’ to deliver your placenta
(afterbirth). Your midwife or doctor will
discuss this in more detail with you.
If your blood group is Rh D negative,
we recommend that you receive an
anti D injection (a separate leaflet if
available regarding this) at 28 weeks of
your pregnancy and following delivery
if your baby is Rh D positive. If you
decline this, it will be clearly
documented in your medical notes and
handheld notes.
Having your baby
The care you receive during labour will
not be altered by your decision to
decline a blood transfusion. To ensure
that any problems with bleeding are
dealt with promptly, you are advised to
deliver in the consultant-led Delivery
Suite rather than the midwifery-led unit
or at home.
A consultant obstetrician will be
notified of your admission, and a
midwife will care for you in labour as
with all other labouring women.
If you require a Caesarean section
(planned or emergency) there is the
facility for cell salvage to be used if you
agree. This allows for your own blood
to be filtered and transfused back to
you. It cannot be used if you bleed
after a normal delivery, as the blood
cannot be kept sterile.
If you need a blood transfusion
If an emergency arises we will respect your
wishes. You will be asked to sign a consent