The Problem with Compliance Over Consent: Why Informed Consent Matters in the Maternity System.

It can feel like you're constantly being told what to do when you enter to world of maternity care in the UK, what tests to have, when to come in, what interventions will happen “as standard practice.” Often, this advice is delivered with an air of authority that makes questioning it seem difficult, if not downright irresponsible.

The truth is: being pregnant does not mean giving up your autonomy.

There’s a vital difference between compliance and consent — and mistaking one for the other is where harm can begin.

Compliance vs Consent

Compliance is when you go along with what you're told, often without question, maybe because you trust the system, maybe because you’re afraid not to, or maybe because you weren’t aware you had a choice.

Informed consent, on the other hand, means you’re given clear, accurate and unbiased information about your options which includes the benefits, risks, and alternatives. You make a voluntary decision based on what feels right for you and your baby. That’s not just good practice it's a legal and ethical right.

Unfortunately, in many maternity settings, compliance is rewarded, and consent is often assumed rather than properly obtained. You may hear phrases like:

• “We’re going to do a sweep today.”

• “You’ll be booked in for an induction at 41 weeks.”

• “You have to have continuous monitoring.”

These are presented as decisions that have already been made with no mention that you have a right to decline, ask for more time, or choose differently.

Why Is This Happening?

Most NHS healthcare professionals are working within a high-pressure, under-resourced system. Guidelines are often followed rigidly to manage perceived risks, reduce litigation, or meet institutional targets. But what gets lost in that process is you, your needs, your preferences, and your legal right to bodily autonomy.

Compliance is easier to manage. Consent takes time, nuance, and trust. It also requires the professional to be comfortable with your answer possibly being “no.” And for some, that’s uncomfortable especially if they’ve witnessed and been trained to see protocols as non-negotiable.

But protocols are not law. Guidelines are just that — guidelines. You are not obligated to comply with anything that doesn’t feel right for you.

If your consent isn’t informed, enthusiastic, and voluntary, it’s not consent at all.

Why You Must Do Your Own Research

Too often, I have clients tell me that in a pervious pregnancy, “I wish I’d known I had a choice,””no one told me there was an alternative” or “I didn’t realise I could say no.” By the time they discover that they could have asked for alternatives or declined entirely it’s already happened.

That’s why it’s essential to do your own research. You deserve more than a five-minute summary of “hospital policy.” Learn what the evidence actually says. Seek out balanced resources. Ask questions. Get a second opinion. Speak to a doula, an independent midwife, or a birth rights advocate. Use your B.R.A.I.N. — Benefits, Risks, Alternatives, Intuition, and Nothing to guide your decision-making.

Red Flags: When Compliance is Prioritised

Here are some signs that consent is being pushed aside in favour of compliance:

• You’re told what will happen, rather than being asked what you want.

• You feel pressured, guilted, or scared into agreeing.

• You aren’t given time to think or ask questions.

• Alternatives aren’t mentioned, or are brushed off.

• “Policy” is used to shut down your choices.

If you encounter these red flags, it’s not just frustrating  it’s a warning because if your autonomy isn’t being respected now, how will it be respected in the intensity of labour or birth?

You Have Rights — And They Matter

You are not a passenger in your maternity care. You are the lead decision-maker. The captain of the ship. The NHS must provide care that supports informed choice, not enforced compliance. And while the system may not always make that easy, you have the power to reclaim your voice, your rights, and your birth experience.

Consent matters — not just legally, but because birth is transformative. How you’re treated, and how much control you have over what happens to your body, will stay with you long after your baby is born.

So ask the questions. Seek the truth. Claim your space. And remember: you do not owe anyone your compliance. You are entitled to your consent.