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This leaflet gives information for women who do not want blood products during pregnancy or birth.
Most women have a normal pregnancy and birth. But it is important to plan for heavy bleeding (called haemorrhage), which can happen during pregnancy or after birth.
Major bleeding is rare, but it can happen suddenly and be very serious. Women who refuse blood transfusion have a higher risk of dying from heavy bleeding. If this happens, you may also need a hysterectomy (surgery to remove the womb) to save your life.
During your pregnancy, we will talk about your wishes and develop a care plan to keep you and your baby safe. Please ask your midwife or doctor if you have any questions.
You may have a higher risk if:
- your BMI is 30 or more
- you have had 4 or more babies
- you are having twins or triplets
- you have anaemia (low iron)
- you have polyhydramnios (excess fluid around the baby)
- your placenta is low
- you had bleeding before or after a previous birth
- you have bleeding in this pregnancy
- your labour is induced
- your labour is long
- you have an assisted birth or Caesarean section
Bleeding can also happen with no risk factors. Please talk to your midwife or doctor about your personal risk.
- Attend all your appointments and scans.
- Your midwife will arrange a hospital visit with an obstetrician to discuss your care.
- You will have regular blood tests for anaemia and may need iron tablets or an iron drip.
- You will see a haematologist (a blood specialist) to talk about your wishes and treatment options.
- You may also meet an anaesthetist to plan pain relief for labour.
We recommend giving birth in hospital on the labour ward so we can treat heavy bleeding quickly if needed.
After your baby is born, we will give you an injection of oxytocin (not a blood product) to help deliver the placenta and reduce bleeding.
If you bleed heavily, we have non-blood treatments we can use. We will make an emergency plan with you and document this in your notes.
After birth, watch your blood loss. If you think it is more than expected or you pass clots, tell your midwife straight away.
If your blood group is Rhesus negative, ask your midwife for the leaflet called:
“D negative mother’s blood test to check her unborn baby’s blood group”
This explains why Anti-D is recommended during pregnancy and after your baby is born.
For more details about blood transfusion, visit the NHS website.
During your pregnancy, you will have an appointment with:
- a consultant obstetrician
- a haematologist (a doctor who specialises in blood problems)
This is to talk about your wishes for blood products and treatment if you bleed.
You will be asked to complete a written Advance Directive saying you do not want blood products. A copy will be kept in your electronic maternity notes. You should also talk about this with your birth partner or family.
A properly completed Advance Directive is legally binding. We will not give you any treatment you have refused. You can change your mind at any time during pregnancy or birth.
Contact us
If you have any queries relating to this information, please contact the Maternity service.
About this information
Service:
Maternity
Reference:
M/042
Approval date:
1 March 2026
Review date:
1 March 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.