BackgroundPerforming an episiotomy where clinically indicated is a key intervention in the Obstetric Anal Sphincter Injury Care Bundle (OASI‐CB) implemented across England and Wales to reduce the risk and increase the detection of severe perineal trauma after birth. Standards of consent provided to people in maternity care generally and for episiotomy specifically have been reported as suboptimal. Compromising birthing people's personal autonomy or sense of control has been linked to a dissatisfying birth experience, negative psychological sequelae, and litigation.MethodsThis study explored experienced midwives' practice of informed consent for episiotomy during a midwife‐led birth. We sampled 43 midwives across eight NHS Trusts in England and Wales using online focus groups and telephone interviews about their experience of consent in episiotomy. Using qualitative content analysis and art‐based co‐analysis methods with eight midwives from across the research sites, we co‐analyzed and co‐constructed three themes and four practice recommendations from the data.ResultsThree themes were constructed from the data: Assent rather than consent, Change in culture to support best practice, and Standardized information. These themes informed the shaping of four recommendations for best practice in episiotomy informed consent.ConclusionThis study has shown how variations in midwifery practice and culture may impact birthing people's experience of informed consent in episiotomy. Midwives may not have the knowledge or skills to conduct a detailed consent conversation, leading to variation in practice and messages for birthing people. The use of antenatal discussion aids can offer women the opportunity to become informed and fully participate in the decision‐making process.

I think, because we are in a culture that doesn't respect intuition and has a very narrow definition of knowledge, we can get caught into the trap of that narrowness. Intuition is another kind of knowledgedeeply embodied. It's not up there in the stars. It is knowing, just as much as intellectual knowing. It's not fluff, which is what the culture tries to do to it".

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Midwifery has a long oral tradition, where knowledge has been generated via the sharing of stories and experience from practice, rather than via scientific research. Any midwife working in a team in the community, on a labour ward or in a birth centre will be familiar with the rich discussion and reflection on practice that is at the heart of what we do. In recent years, the move towards a more scientific and ‘evidence-based’ approach has undermined the value of this tradition as a form of knowledge. This article explores the nature of midwifery knowledge, proposing that storytelling is a valid method of sharing, reflecting on and developing midwifery knowledge and practice in relation to supporting physiological labour and birth.