Refusal of a Blood Transfusion

We want to be sure that we treat every woman in a way which recognises her individual choices or religious beliefs. North Bristol NHS Trust has an active programme to reduce blood loss and reduce the number of blood transfusions given to all women.

Before giving anyone a blood transfusion the risks and benefits of having or not having blood or blood products will be discussed with you. It is up to you to decide if you are willing to accept these risks.

What if I am thinking of becoming pregnant?

You may wish to talk to a doctor before you conceive to think about how you will be looked after in pregnancy and how you can become as fit as possible before becoming pregnant. Your GP can arrange an appointment for you to see a hospital specialist (obstetrician) to discuss this further.

What if I am pregnant?

When you think you are pregnant you should make your GP and midwife aware of your request for no transfusions of blood or blood products. Please do this in writing and ask for it to be included in your maternity hand held notes and medical notes. If you choose not to receive blood, we would strongly recommend that you have your baby on the Central Delivery Suite at Southmead Hospital, rather than at home or in a birth suite. Your midwife or GP will refer you to a consultant antenatal clinic in the early stage of your pregnancy care.

You may have an ‘Advance Decision to Refuse Specialist Medical Treatment’ (sometimes known as a ‘no blood form’) which tells us of your wishes about treatments. Let your midwife and obstetrician see this
and give a copy to them.

Plan of care for your pregnancy

You will be seen in a consultant antenatal clinic where the following will be covered:

  • Iron and folic acid supplementation throughout your pregnancy
  • Regular blood tests to check your haemoglobin (blood count) is above 12g/dl. If your haemoglobin remains low despite taking supplements and you also have low iron stores you may be given an infusion(s) of ‘liquid iron’ into a vein.
  • As with all women, you will have a detailed scan which will check the position of the afterbirth (placenta) to make sure it is not low-lying
  • Your maternity hand held notes and medical notes will record that you do not want blood and blood products and you will be asked to sign a consent form
  • A copy of your Care Plan ”Management of women who decline blood or blood products in Obstetrics” will be filed in your maternity hand held notes and medical notes
  • You will be asked what treatments and procedures you are willing to accept and these will be recorded on the ”Checklist for Blood /Blood Product Acceptance” in your maternity hand held notes and medical notes
  • If it is felt that you are at particular risk, for instance, if your placenta is low-lying the use of blood salvage techniques will be discussed
  • If your blood group is Rhesus negative we will recommend that you have Anti-D injections during your pregnancy and after delivery if needed (if your baby’s blood group was Rhesus positive). Anti-D is a protein which is obtained from blood plasma. There is no non-blood derived alternative.

What happens in labour and follwing birth?

When you come into hospital in labour the consultant obstetrician and anaesthetist on call will be notified.

We would recommend that you have an injection to help with the delivery of your placenta (active management of the 3rd stage). If there are any extra risk factors we would suggest that you have an intravenous infusion (‘drip’) or a cannula inserted into a vein so a ‘drip’ can be started or drugs administered quickly if necessary.

You may choose to bring with you and wear a “No Blood” wristband.

If there are any complications your care plan will be followed. At all times, even if an emergency a rises, we will respect your wishes. You can be confident that you will receive the best possible care and treatment during your stay in the maternity unit.

To help us respect your wishes you should:

  • Have informed us in writing and asked that this is kept in your maternity hand held and medical notes
  • Carry an ‘Advance Decision form’ and ‘Care Plan’ with you at all times (in case you are unconscious and we cannot identify you)
  • Before any operation you will be asked to sign an additional consent form. You will be consenting only to treatment you are willing to accept and which you have discussed with your obstetrician.
  • If a consent form for refusal of blood or blood products has not already been signed and is in your notes, you will be asked to sign this when you come into the maternity unit.

If you have any questions or are worried about any aspects of your pregnancy and the birth of your baby, please talk to your midwife or doctor.