Right to a companion during labour and birth

This is the birth bill of rights, and it is broader than its name suggests. Almost everyone arrives looking for a single answer — whether their partner, their mother or their doula can come in with them — and the Act gives it by name, caesarean included. But Article 3 carries twelve rights, not one, and Articles 4 and 5 add those of the newborn and of the parents when the baby is born at risk. What sets this Act apart from other bills of rights is Article 8: it gives the Women’s Advocate the power to receive, handle and investigate complaints, and sets fines of five hundred to ten thousand dollars. It applies equally in a public and a private hospital; Article 1 says so.

Every pregnant woman, during her pregnancy and at the time of labour, birth and postpartum. The Act asks for no age, income, health plan, residence or type of institution: Article 1 makes it applicable to public and private entities where health care services are offered in Puerto Rico. Articles 4 and 5 extend rights of their own to the newborn and to the mother and father of a child born at risk, a category Article 2 expressly defines.

• Be a pregnant woman attended at a public or private health care service entity in Puerto Rico (Article 1).Verified against the official source
• The companion is obliged to comply with the rules the hospital imposes, provided they are consonant with this Act (Article 3(g)).Verified against the official source

• A copy of the Act, which the hospital must have available for you to examine at pre-admission; the institution documents in your record that you have read it via the corresponding form (Article 7).
• Written consent, if you are asked to undergo an examination or intervention for research or teaching purposes (Article 3(f)).

1. 1

   Step 1: Who may accompany you, under the Act

   Article 2(a) defines the companion deliberately broadly: “person or persons the woman in labour freely chooses, to accompany or assist her during the various stages of birth, among whom are: mothers, fathers, relatives, friends, with or without training, or a person trained in comfort measures (monitrice, ‘doula,’ etc.).” The Act names the doula expressly. She need not be a relative or trained: you choose her.

2. 2

   Step 2: How far that right reaches, caesarean included

   Article 3(g) covers labour, the pre-labour rooms, the birth and the postpartum, and mentions the caesarean by name. There is an asymmetry here worth knowing before you reach the hospital: for the ordinary stages the Act speaks of “persons of her trust and choosing,” plural; for the caesarean it says “at least one person of her choosing,” and adds that it is the health professionals who “shall determine in the last instance whether or not they permit the companion’s presence.” It also says, in both cases, that the companion’s presence may not interfere with medical determinations, and that you have the right not to be accompanied if you prefer.

3. 3

   Step 3: The other eleven rights in Article 3

   Do not stop at the companion. Article 3 also gives you: information from a licensed nurse or ob-gyn on the interventions and medication that could induce labour or occur during it, so you can freely consent where there are alternatives; decisions free of coercion and informed, with the benefits and risks of the recommended obstetric processes; respectful, individual and personalised treatment, with privacy and emotional intimacy; natural birth as the first alternative, avoiding invasive practices and medication not justified by your health or the child’s; information on the evolution of the birth and your child’s state; not to be subjected to a research or teaching examination or intervention save with written consent; not to be intimidated about the process; contact with the baby within the first hour and rooming-in if no special care is needed; guidance on breastfeeding and support to breastfeed; advice on the child’s care; and information on nutrition and the effects of tobacco, alcohol and drugs.

4. 4

   Step 4: The prior orientation must include the hospital’s policies

   A detail in Article 3(a) almost nobody uses and the most useful for preparing: the complete orientation you must be given on the most important events of the pregnancy has to include, the Act says, “policies relating to the birth on the provider’s part, as well as the preferences and interests of the pregnant woman for the moment of delivery.” That is, it is a two-way conversation, and the hospital’s rules on companions are part of what you are owed beforehand, not on arrival.

5. 5

   Step 5: If the baby is born at risk

   Article 2(c) defines a “person born at risk” openly: it includes, without limitation, premature birth, congenital anomalies, respiratory conditions, congenital cardiac conditions, prolonged labour, babies born to HIV-positive mothers or mothers with any sexually transmitted disease, and babies of mothers with a controlled-substance addiction where the newborn may show withdrawal symptoms. If that is your case, Article 5 gives the mother and father: comprehensible, sufficient and continued information in an adequate setting on diagnosis, prognosis and treatment; continuous access to the baby while the clinical situation permits and participation in informed decisions; that any research or teaching examination be specified to them so they consent in writing; that breastfeeding be facilitated absent a pressing condition; and advice on the special care.

6. 6

   Step 6: The poster and the copy at pre-admission

   Two concrete obligations you can check with your own eyes. Article 6 orders the Department of Health to make the Act known in every hospital, delivery room and obstetric preparation or recovery room, public and private, and to prepare the material illustrating Articles 3, 4 and 5 as a 17 by 24 inch poster, distribute it or have it available electronically to download or print. Article 7, added by Section 5 of Act 200-2016, makes displaying that poster in a prominent place mandatory, and adds that hospitals shall have a copy of the Act available for you to examine at pre-admission, documenting in your record that you have read it via the corresponding form. If you go to pre-admission, ask for it.

7. 7

   Step 7: If one of these rights is breached

   Article 8 is what makes this Act useful: “The Office of the Women’s Advocate is empowered to receive, handle and dispose of the complaints filed, as well as to investigate any action in violation of the rights established in this Act. Any violation of the provisions of this Act shall carry a fine of no less than five hundred (500) dollars and no more than ten thousand (10,000) dollars.” The complaint goes to the Women’s Advocate, not the hospital. Be clear what that fine is: a sanction, not compensation paid to you.

The rights are exercised where you are attended: any hospital, delivery room or obstetric preparation or recovery room, public or private. The complaint for breach goes to the Office of the Women’s Advocate, which Article 8 empowers to receive it, handle it and investigate. The Act creates no other window and sets no complaint form.

• Believing it applies only in public hospitals: Article 1 makes it applicable to public and private entities alike.
• Thinking the companion has to be a relative: Article 2(a) includes friends and persons trained in comfort measures, and names the doula.
• Assuming the right is the same at a caesarean: there the Act says “at least one person” and leaves the final determination to the health professionals.
• Stopping at the companion: Article 3 carries twelve rights, including natural birth as the first alternative.
• Filing the complaint at the hospital: Article 8 places it with the Office of the Women’s Advocate.
• Expecting to collect the fine: the five hundred to ten thousand dollars is a sanction, not compensation to the patient.
• Not asking for the copy of the Act at pre-admission: Article 7 obliges the hospital to have it available for you to examine.
• Believing the companion may intervene in medical matters: the Act expressly says their presence may not interfere with the professionals’ determinations.
• Forgetting you can say no: the Act equally recognises the right not to be accompanied.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov