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

Parvovirus B19 during Pregnancy

Parvovirus B19 is also known as Slapped Cheek, Human parvovirus or Fifth Disease.

What is Parvovirus B19?

Parvovirus B19 is a virus that commonly infects children. It is usually transmitted by coughing and sneezing (respiratory droplets). Hand washing is important in helping to prevent spread. School teachers, childcare workers and mothers of young children are particularly likely to be exposed to this virus as it is commonest amongst younger school age children, but everyone can be exposed to it.

For most healthy people, Parvovirus B19 causes a mild, self-limiting illness which is followed by life-long immunity.
The Human Parvovirus B19 is not the same Parvovirus that vets may be concerned about in pets, especially dogs, and it cannot be passed from humans to animals or vice versa.

Pregnant women are not routinely screened for past parvovirus B19 infection as there is no vaccine or preventative treatment available.

How common is Parvovirus B19?

The exact number of Parvovirus B19 infections in the UK is not known as the virus does not always show symptoms, and the diagnosis can only be confirmed by blood test.

• Parvovirus B19 infection is common in developed countries — about 15% of pre-school children, 50% of adults, and 85% of elderly people show evidence of past infection in their blood.
• Infection with Parvovirus B19 can occur at any age, but is most common in children aged six – ten years.
• One in 512 pregnancies may be affected.
• Seasonal outbreaks of Parvovirus B19 occur every three – four years in the UK, mainly in late winter and early spring. During school outbreaks, ten – 60% of exposed children develop symptoms consistent with Parvovirus B19 infection.

What are the symptoms of Parvovirus B19?

Parvovirus B19 commonly causes:

• High temperature
• Mild cold-like symptoms including feeling under the weather, a sore throat and a runny nose
• Headache
• Mild nausea and /or diarrhoea

The symptoms may happen several days before a rash.

• The rash is the result of your immune system reacting after the infection has passed. The rash is often present on the face in children and looks like a ‘slapped cheek’ appearance. Facial rash is uncommon in adults. The rash may extend down to the chest, arms, stomach and thighs.  It has a lace-like appearance and can sometimes itch. It may take a few weeks for the rash to completely clear and during that time it may seem to worsen until it fades away entirely. Certain stimuli e.g. heat, exercise and anxiety or stress may reactivate the rash until it completely fades. In some cases, especially in adult women or older teenagers, joint swelling or pain may occur.
• Rarer symptoms may include swollen glands, red eyes, sore throat, and a rash that might look like blisters or bruises.

A person with Parvovirus is infectious seven to ten days before the rash (if any) develops, until one day after the rash appears. Exposure to infection with Parvovirus B19 may have occurred earlier than you think.

It is important to note that many people (up to 30%) with Parvovirus B19 have no symptoms at all. Less than 50% have a rash.

Why should parvovirus contact or infection be investigated in pregnancy?

In women who are not immune, infection in the first 20 weeks of pregnancy can lead to serious problems for your baby before it is born. This would usually happen three to five weeks after the onset of maternal infection, but can be later.

Most women who have parvovirus in pregnancy will have healthy babies.

Parvovirus B19 is not known to cause congenital abnormalities. However, the infection can be passed from mother to baby and may cause the baby to become anaemic. The level of anaemia and the length of time the baby might have anaemia will be variable and unpredictable. The health of your baby can be monitored to check for signs of anaemia.

The greatest period of risk to the baby is between four to 20 weeks. Infection during this time can sometimes lead to serious complications such as fetal anaemia and sometimes fetal loss (miscarriage or stillbirth). There is a five – ten per cent risk of fetal loss if women develop this infection in the second trimester.

Infection in the first month of pregnancy is not thought to carry any risk.

After 20 weeks of pregnancy the risk of the baby developing severe anaemia is much lower but investigations are undertaken in all cases.

It is important to remember that most babies will not be infected or affected by the virus.

What happens if I think I may have been in contact with Parvovirus B19?

If you have think you have been in contact with Human Parvovirus B19 infection or if you have a rash you should urgently report this to your midwife or doctor as you will need to have a blood test.

Contact is defined as being in the same room as an infected person for a prolonged period (15 minutes or more) or face-to-face contact with the person.  The main source of infection in pregnancy is from household (rather than occupational) exposure.

Until parvovirus infection has been ruled out you should avoid contact with other pregnant women to reduce the risk of infecting others.

The blood test will tell you if:

1. You have had Human Parvovirus B19 infection before and are now immune and not at risk of infection as you have antibodies to protect you from infection.  *Parvovirus B19 is common and 50-60% of adults have evidence of past infection.
2. You currently have Parvovirus B19 infection.
3. You have not had Parvovirus B19 infection before and are at risk of infection.
4. The blood sample may also be tested for rubella (German measles) in the same way it looks at your parvovirus status if you have no record of previous rubella testing or MMR immunisation.

If I have had a blood test for Parvovirus B19 how soon can I expect my result?

If your midwife or doctor has taken a blood test for Parvovirus B19 infection the result should be available within six working days from sample arriving in the laboratory. Your midwife or doctor should contact you with the result as soon as they receive it.

If you do not hear from your midwife or doctor by seven working days after the test it is strongly advised that you contact them or the surgery, health centre or the Antenatal Clinic of the hospital stated on your maternity yellow book.

If your results show you are Parvovirus B19 antibody negative you are at risk to infection by Parvovirus B19. You will be re-tested one month after the last date of contact to see if you have developed antibodies to the virus. This is to ensure unrecognized (no symptoms) infection is not missed. You should report any rashes that occur in pregnancy or any further contact with known infection as you may need to have another blood test. During this one month you should avoid other pregnant women where possible and inform antenatal services about the contact prior to attending any clinic or ward.

If your initial or follow-up blood test shows you have recently been infected your baby may be at risk of developing the infection. Your doctor and midwife will refer you to a Specialist Fetal Medicine Clinic for further follow-up.

If the results show that you have the infection, you will be referred to a Specialist Fetal Medicine Clinic where you will be offered frequent ultrasound scans to check your baby’s health. An individualised plan for scans is made according to your stage of pregnancy and the findings at each scan. As well as checking the health of your baby, the purpose of the scans is to pick up any signs that your baby is developing symptoms of anaemia.

It is important for you to be aware of the pattern of your baby’s movements and immediately report any changes or concerns to a Health Care Professional.

If the baby shows signs of developing anaemia on scan, an intrauterine blood transfusion may be offered as a treatment for the anaemia. Intrauterine blood transfusion is a process where blood is given to your baby before it is born. This treatment is usually successful in treating anaemia but the procedure itself carries a small chance of miscarriage. If this treatment option is required, the procedure, the benefits, risks and likely outcome will be discussed with you fully by the person carrying out the treatment. The procedure is not undertaken at Southmead Hospital, you will be referred to St. Michael’s Hospital, Fetal Medicine Unit for this.

References & Sources of further information

Fifthdisease.org (2017) What is Fifth Disease
https://www.fifthdisease.org/
[Accessed: 15.11.2017]

NHS (2015) Slapped Cheek Syndrome.
https://www.nhs.uk/conditions/slapped-cheek-syndrome/
[Accessed: 15.11.2017]

NHS (2017) What are the risk of slapped cheek syndrome during pregnancy?
https://www.nhs.uk/chq/pages/1112.aspx?categoryid=54
[Accessed: 15.11.2017]

NICE: National Institute for Health and Care Excellence. Parvovirus B19 infection: Last revised in February 2017
https://cks.nice.org.uk/parvovirus-b19-infection#!scenario:2
[Accessed: 5.12.2017]

https://cks.nice.org.uk/parvovirus-b19-infection#!backgroundsub:1
(Accessed 05/12/2017)

On 28 May 2014, the Brunel building fully opened and is at the centre of the redeveloped Southmead Hospital Bristol site.

The 800-bed Brunel building sees the end of the traditional ward with single en-suite rooms and single-sex four-bed rooms greatly improving privacy and dignity and helping to control the spread of infections.

Care for the most seriously-ill patients has improved. The Emergency Department (ED) has its own entrance - greatly improving access for ambulances. There is a helipad with a link straight into the Emergency Department and there are also 48 dedicated single rooms for High Dependency and Intensive Care patients.

The design and layout of the Brunel building means that patients and visitors find it easy to navigate. There is one main entrance and relevant departments are located next to each other, cutting down on travel times around the site.

The Brunel building was built with sustainability in mind and is bright and airy with outside views.

There are 2,700 parking spaces on site. Public transport links to the hospital have been greatly improved, making it easier for patients, visitors and staff to leave their cars at home.

Key Project Dates

• July 2004 - The Outline Business Case is approved by the Secretary of State
• March 2005 - Southmead confirmed as the preferred site for the new build
• October 2009 - Full planning approval received
• November 2009 – Carillion appointed as preferred bidder
• February 2010 – Contract signed with Carillion to design and build the New Hospital
• 26 March 2014 – Phase 1 Building is handed over to North Bristol NHS Trust
• 28 May 2014 – Brunel building declared fully open
• July 2016 – Phase 2 Building work completed including the Multi Storey Car Park
• 2019 - Phase 3 Final Landscaping to be completed.

We have put together a series of short videos which demonstrate the exercises in the patient information leaflet we will be giving you post-surgery.

Introduction to Physiotherapy after DIEP Surgery

Abdominal exercises Before DIEP Surgery - Beginner Option

Abdominal exercises Before DIEP Surgery – Advanced Option

Breathing exercises after DIEP surgery

How to get out of bed after DIEP surgery

How to Climb Stairs after DIEP surgery

Abdominal exercises eight weeks after DIEP Surgery – Beginner option

Abdominal Exercises eight weeks after DIEP Surgery – Advanced option

Upper Body Exercises eight weeks after DIEP Surgery

Home exercises after DIEP surgery - after the first four weeks

Home exercises after DIEP surgery - after the first four weeks

Home exercises after DIEP surgery - after the first five weeks

On the basis of your answers, you have passed the first stage and you are suitable to be assessed in more detail. We would suggest you read the information leaflet - NHS Blood and Transplant - Could I be a living kidney donor? 

If you are still interested in donating a kidney, then please contact our Living Kidney Donor Coordinators at North Bristol NHS Trust on 0117 4148000. 

If you are not from Bristol you can find your local centre at https://www.organdonation.nhs.uk/become-a-living-donor/ 

The Trust welcomes feedback and members of the public may ask the Board a question on any matter which is within the powers and duties of the Trust. 

Questions may be asked verbally at the beginning of Board meetings, at the discretion of the Chair. The Chair will determine who is best placed to respond and how the response should be provided. 

Questions can also be submitted in writing at least five working days before the Board meeting to the Trust Secretary trust.secretary@nbt.nhs.uk. Each question must give the name and address of the questioner and if the question is being asked on behalf of an organisation then the name of the organisation must be stated. 

No more than three written questions may be submitted per person. If the Chair considers the question appropriate for the Board meeting, the Trust will normally provide a written response, and the question and response will be read out at the meeting. Copies of the questions and the responses will be recorded in the minutes.

Written questions may be rejected and oral questions need not be answered when the Chair considers that they:

• are not on any matter that is within the powers and duties of the Trust;
• are defamatory, frivolous or offensive;
• are substantially the same as a question that has been put to a meeting of the Trust Board and been answered in the past six months; or
• would require the disclosure of confidential or exempt information.

For further information, please email trust.secretary@nbt.nhs.uk