Declining a Blood Transfusion

This page gives you information about your right to decline blood transfusion or blood products during your pregnancy. If you are a Jehovah’s Witness, you may have heard ‘blood products’ described as ‘fractions.’

Can anyone decline a blood transfusion?

Yes. North Bristol NHS Trust wants to be sure that we treat every woman in a way that recognises and respects their individual, cultural and religious beliefs. As a Trust, we have a programme to conserve blood and minimise the number of transfusions given to all patients. If you decline treatment with blood products we want to ensure that you make an informed decision; your doctor or midwife will discuss the possible risks and benefits of treatment with and without blood products. It is your decision whether or not you are willing to accept the risks of declining blood transfusion and blood products. If you are a Jehovah’s Witness you may wish to discuss this with your ministers. 

What if I am thinking of becoming pregnant? 

You may wish to talk to a doctor before you conceive, so that you can find out more about how you will be cared for during your pregnancy and how to become as fit as possible prior to conception. Your General Practitioner (GP) can arrange for you to see a hospital specialist to discuss your options further.

What if I am already pregnant?

Once you are pregnant you should inform your GP and midwife as soon as possible that you do not wish to receive a blood transfusion or blood products. Please make your wishes clear in writing and ensure that they are included in your handheld maternity notes and your medical notes. 

If you are a Jehovah’s Witness you may already carry an ‘Advance Decision to Refuse Specified Medical Treatment’ (sometimes known as a ‘No Blood Form’) or a ‘Treatment Checklist’. Please show these documents to your obstetrician and midwife so that they can make copies and include them in your notes.

We also strongly recommend that you choose to have your baby in a consultant-led unit, rather than a home birth or birth centre delivery. Your GP or midwife will refer you to a consultant antenatal clinic where they will discuss your options and how you will be cared for during your pregnancy.

Specific things that will be covered at this appointment are:

• Iron and folic acid supplements throughout your pregnancy.
• Regular blood tests will be taken to ensure that your haemoglobin (blood count) is above 130g/L, if your haemoglobin remains low despite supplements, and you have low iron stores, we may recommend an infusion of ‘liquid iron’ into a vein.
• As for all pregnant women you have a detailed scan to check the position of the placenta (afterbirth), a low-lying placenta can increase your risk of bleeding during pregnancy.
• You will be able to discuss the risks and benefits of blood transfusion and blood products. If, following this discussion, you confirm that you do not wish to receive blood and specified blood products this will be clearly documented in both your medical notes and your handheld maternity notes.
• Other treatments and procedures to limit blood loss will also be discussed and it will be documented as part of your plan for care in your maternity notes.
• If you are at particular risk of bleeding, we will discuss the use of blood salvage techniques.
• The Anaesthetic Department will be notified that you are pregnant and when your baby is due.
• If your blood group is Rh D Negative and your baby’s group is Rh D Positive we will recommend that you have Anti-D injections during your pregnancy and after delivery. Anti-D is a protein obtained from blood plasma, there is currently no non-blood derived alternative. If you are a Jehovah’s Witness you may wish to discuss this with your local minister or a member of the Hospital Liaison Committee.

What happens during labour and after delivery?

When you come into hospital in labour, the consultant obstetrician and consultant anaesthetist will be made aware of your arrival. You will be looked after as normal in labour, however we recommend that you have an injection following delivery of your baby, to help with delivery of the placenta (active management of the third stage of labour).

If there are risk factors for bleeding we recommend insertion of an intravenous drip so that urgent drugs may be given without delay. If there are any complications a senior team will be available and your care plan will be followed.

You can be confident that even in an emergency your wishes will be followed and you will receive the best possible care and treatment during your time on the maternity unit.

To help us respect your wishes

Inform us in writing that you do not wish to receive blood transfusion or blood products. This can be done by completing the Trust ‘Checklist for Jehovah’s Witnesses and Other Patients who Decline Blood Transfusion’.

Carry an ‘Advance Decision Form’ with you at all times, so that if you are found unwell and cannot communicate, your wishes will be respected. You may wish to wear a ‘No Blood’ wristband.

Before an operation you will sign a standard consent form, clearly indicating that you consent to the planned procedure but that you do not consent to blood transfusion/products.

I have further questions

If you have any further questions or concerns that are not covered by this leaflet, please discuss them with a member of your medical team. If they are unable to answer your questions, they will find someone who can.

Further help for Jehovah’s Witnesses

Further help is available from:

• Your local minister.
• The Bristol Hospital Liaison Committee for Jehovah’s Witnesses. Contact details can be provided by a member of your medical team, or alternatively you can make contact by email: info@bristol-hlc.org.uk

Contact Maternity Services | North Bristol NHS Trust (nbt.nhs.uk)

© North Bristol NHS Trust. This edition published April 2023. Review due April 2026. NBT003189. 

Read about blood transfusion on NHS.uk