I don’t want to use blood products

What is a blood product?

A blood product is any substance derived from human blood.

Can anyone refuse a blood transfusion?

Yes. We want to be sure that we treat every person in a way which recognises your individual choices, and respects your religious and personal beliefs.

Before giving anyone a blood transfusion, the risks and benefits of having, or not having, blood or blood products will be discussed. It’s then up to you to decide whether you’re willing to accept these risks.

I’m thinking of becoming pregnant

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

I am pregnant

When you think you are pregnant, you should make your doctor and midwife aware of your request for no transfusions of blood or blood products to be used as part of your care.

At your booking appointment with your midwife – your first main appointment you will have with them – we will ask you about your religious beliefs and if you have any objections to receiving a blood transfusion or blood products – such as the Anti D injection which is given to you following the birth of your baby if your blood group is rhesus negative.

If you choose not to receive blood, we would strongly recommend that you have your baby in a consultant-led unit – either at the Diana, Princess of Wales Hospital in Grimsby, or Scunthorpe General Hospital – rather than a home birth or in a birthing unit.

Your midwife or GP will refer you to a consultant clinic to discuss your pregnancy and make a plan of care with you.

Your midwife or consultant will ask you to put your wishes in writing in your maternity notes and to sign it, do your wishes are clear to any professional you meet during your pregnancy journey.

If you are a Jehovah’s Witness, you may have an Advance Decision to Refuse Specified 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. Your local Ministers will be able to provide you with this document.

What plan of care will be put in place for my pregnancy?

During the antenatal period, you will be seen by a consultant obstetrician in the antenatal clinic. Depending on the blood product you do not wish to receive, you may also be invited to talk to anaesthetist as well. When you see the doctor, they will discuss the following with you:

• Iron and folic acid supplementation (tablets or liquid medicine) throughout the pregnancy

• Regular blood tests to check your haemoglobin (blood count and iron levels) is above 110g/L. If your haemoglobin remains low despite taking supplements, and you have low iron, you may be given an infusion of ‘liquid iron’ into vein. IV iron has no better efficacy than oral doses – it is just tolerated better. You may also be referred to a haematologist for advice if you are not responding to oral iron.

• As with all women, you will have a detailed scan at 20 weeks pregnant, which will check the position of the placenta (the afterbirth) to make sure it is not low-lying, as this will put you more at risk of heavy bleeding.

• Your maternity notes will record that you do not want blood and blood products

• The doctor will document the plan for your care in your maternity notes

• You will be asked what treatments and procedures you are willing to accept, and these will be written in your maternity notes

• If it is felt you could be at particular risk during a Caesarean section, the use of blood salvage techniques will be discussed. This should be discussed with all patients who refuse blood products, not just those thought to be at risk, in case an emergency arises

• We will notify the anaesthetic department that you are pregnancy and the expected date your baby is due

• If you are Rhesus Negative, you will be offered Fetal DNA testing – a blood sample obtained at 16 weeks – to accurately predict the Rhesus status of your baby. If your baby is predicted to be Rhesus positive, we will recommend that you have Anti-D injections during pregnancy and after delivery. Anti-D is a protein which is obtained from blood plasma. There is no non-blood derived alternative. If you feel you can’t accept this for religious reasons, you may want to discuss this with one of your religious advisors. If you don’t want to receive this for any other reasons, the consultant will happily discuss any concerns you may have

• Experienced personnel will be available if you require a Caesarean section, or if there is heavy bleeding following delivery

What happens in labour and following the birth?

When you come to hospital in labour the consultant obstetrician and anaesthetist on
call will be notified. You will be looked after normally in labour but we would
recommend that you have the drug Syntometrine to help with the delivery of your
placenta (active management of the third stage).
If there are complications, senior members of the maternity team will be available
and your individual care plan will be followed.
At all times, even if an emergency arises, we will respect your wishes. You can be
confident that you will receive the best possible care and treatment during your time
in the maternity unit

To help us respect your wishes, you should:

• Have informed us in writing, and asked that is kept on your records

• Carry an Advance Decision Document Care Plan with you at all times

Before any operation you will be asked to sign a consent form, consenting only to
treatment you are willing to accept and which you have discussed with your
obstetrician.

What if I have other concerns?

If you have questions that are not answered here, or are worried about any
aspects of your pregnancy and delivery, please talk to one of your community
midwives or ask to speak to one of the doctors.
You can also talk to a transfusion practitioner: 03033 305681