Further information

The information in this leaflet is from guidelines which midwives and doctors use all the time. They are local and national guidelines and are produced from research. Your midwife or doctor can give you more information should you require it. If you have any questions about blood products and declining these, please speak to your midwife or doctor. More information is also available at www.rcog.org.uk

Feedback
We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone (City Hospital Campus): 0800 052 1195 Freephone (QMC Campus): 0800 183 0204 From a mobile or abroad: 0115 924 9924 ext 65412 or 62301 Minicom: 0800 183 0204 E-mail: pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR www.nuh.nhs.uk

Declining blood products or blood transfusion during pregnancy or childbirth

Information for patients Maternity

This document can be provided in different languages and formats. For more information please contact: Maternity Department City Campus Hucknall Road Nottingham NG5 1PB Tel: 0115 969 1169 ext 55136 (24hours)

The Trust endeavours to ensure that the information given here is accurate and impartial.

Patient Information Group, Maternity Units November 2012. All rights reserved. Nottingham University Hospitals NHS Trust. Review November 2014. Ref: 0756/v3/1112/ JH.

Introduction
This leaflet is designed for pregnant women who wish to decline blood products or a blood transfusion during pregnancy or after childbirth. Blood transfusions are offered only if it is felt to be the most appropriate treatment. However, if you wish to decline blood products, alternative management options will be discussed with you before you go into labour. These include the treatment of anaemia, use of volume expanders, cell salvage and the use of Factor VII. For detailed information about blood transfusion, please refer to the leaflet produced by the National Blood Service Will I need a blood transfusion? For detailed information about Anti-D please refer to the leaflet produced by the Bio Products Laboratory: You, your baby and the RhD factor. You can get a copy of these leaflets from our antenatal clinics or from a community midwife.

To minimise the chance of heavy bleeding during labour you are advised to opt for active management to deliver the placenta (afterbirth). Your midwife or doctor will discuss this with you in more detail.

Having your baby

The care you receive during pregnancy and labour will not be affected by your decision to decline a blood transfusion. You are advised to give birth in hospital, rather than at home to make sure any problems with bleeding are dealt with promptly. Nottingham University Hospitals NHS Trust has developed a plan of care for women in labour who decline a blood transfusion. This plan will guide your care and your midwife or doctor will discuss this with you. Senior staff such as the consultant obstetrician and consultant anaesthetist will be told when you are in labour. If it is thought that you may develop a complication then the consultant haematologist will also be told. If you need an anaesthetic the anaesthetist will discuss this with you; it may be a regional anaesthetic an epidural or spinal or a general anaesthetic. The choice will take account of the importance of minimising the need for a blood transfusion.

Telling your midwife or doctor

You may choose to decline treatment with blood or blood products but it is important that you tell your midwife or doctor as soon as possible, either at booking or during early pregnancy. This will allow enough time to discuss your options with the appropriate medical staff, and to receive advice on staying healthy. After discussion you will be asked to sign a consent form to exclude blood products or transfusion, which will then be kept in your hospital notes. This means the midwives and doctors who care for you are aware of your choices.

If you need a blood transfusion

If you have severe bleeding or anaemia and the senior doctors feel that a blood transfusion is the most appropriate form of treatment they will discuss the reasons with you in detail to allow you to make an informed decision. If the situation gets worse without treatment with blood products your doctor will discuss this with you in detail to make sure you are aware of any possible consequences. Your choices will be respected if you still wish to decline a blood transfusion, even when the outcome may be grave.

Minimising the need for a blood transfusion

You may be able to reduce the need for a blood transfusion by making sure that you are not anaemic (low iron levels) during pregnancy. Eating healthily during pregnancy and afterwards is very important especially eating food which is high in iron content. Your midwife and doctor can advise you on this. You will be offered regular blood tests to check your iron levels and if they are low you will be offered tablets to increase your iron levels.

Changing your mind

You can change your mind at any time and choose to receive a blood transfusion. This choice will also be respected and documented in your notes.