Childbirth Is Not a Medical Emergency: Maternal Right to Informed Consent throughout Labor and Delivery

Stohl, Hindi E.

doi:10.1080/01947648.2018.1482243

Cited by 11 publications

(6 citation statements)

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“…Despite the psychological challenges accompanying pregnancy we were surprised to find that many HCP reported concerns about the decision-making capacities of some women, often, though not exclusively, when women were being asked for consent in the acute Labour ward setting. Similar concerns have been both voiced [ 18 , 19 ] and refuted [ 20 ] in the pre-Montgomery era in but more recently Singh [ 21 ] et al found incapacity in obstetric emergency procedures to be relatively common. Interestingly, a common misapprehension is that the assessment of capacity should be performed by a psychiatrist whereas the MCA [ 22 ] states that it is the clinician responsible for care who is responsible for carrying out an assessment.…”

Section: Discussionmentioning

confidence: 61%

Patient-centred consent in women’s health: does it really work in antenatal and intra-partum care?

Nicholls

David

Iskaros

et al. 2022

BMC Pregnancy Childbirth

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Background Legal and social changes mean that information sharing and consent in antenatal and intrapartum settings is contentious, poorly understood and uncertain for healthcare professionals. This study aimed to investigate healthcare professionals’ views and experiences of the consent process in antenatal and intrapartum care. Methods Qualitative research performed in a large urban teaching hospital in London. Fifteen healthcare professionals (obstetricians and midwives) participated in semi-structured in-depth interviews. Data were collectively analysed to identify themes in the experiences of the consent process. Results Three themes were identified: (1) Shared decision-making and shared responsibility –engaging women in dialogue is often difficult and, even when achieved, women are not always able or do not wish to share responsibility for decisions (2) Second-guessing women – assessing what is important to a woman is inherently difficult so healthcare professionals sometimes feel forced to anticipate a woman’s views (3) Challenging professional contexts – healthcare professionals are disquieted by consent practice in the Labour ward setting which is often at odds with legal and professional guidance. Conclusions Results suggest that there is a mismatch between what is required of healthcare professionals to effect an antenatal or intrapartum consent process concordant with current legal and professional guidance and what can be achieved in practice. If consent, as currently articulated, is to remain the barometer for current practice, healthcare professionals need more support in ways of enabling women to make decisions which healthcare professionals feel confident are autonomous whatever the circumstances of the consultation.

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Section: Discussionmentioning

confidence: 61%

Patient-centred consent in women’s health: does it really work in antenatal and intra-partum care?

Nicholls

David

Iskaros

et al. 2022

BMC Pregnancy Childbirth

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“…This could also apply to interventional trials during childbirth, such as the EVA trial. However, childbirth is not an unexpected event during pregnancy, and some argue that women do not typically lose the ability to make decisions during childbirth [ 23 ], although some women in our study expressed such feelings. A woman giving birth is in a vulnerable position, where she must rely on health care staff but is usually more actively involved in her care than an ill patient.…”

Section: Discussionmentioning

confidence: 88%

Women’s experiences of receiving information about and consenting or declining to participate in a randomized controlled trial involving episiotomy in vacuum-assisted delivery: a qualitative study

Ericson

Anagrius

Rygaard

et al. 2021

Trials

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Background Information about and invitation to participate in a clinical trial involving an intervention during childbirth may cause fear or worry in pregnant women. The aim of this study was to describe nulliparous women’s experiences of receiving an invitation to participate in a randomized controlled trial (RCT) of lateral episiotomy versus no episiotomy in vacuum-assisted delivery (EVA trial). Methods This qualitative study was nested in the ongoing EVA trial. Data were collected through semistructured telephone interviews with 23 women regarding their experiences of the information and invitation to participate in the EVA trial. Interviews were audio-recorded and transcribed verbatim. A qualitative content analysis was used to analyse the interview contents. Results Three main experience categories were identified among the participants. “Timing of trial information and understanding” revealed that women preferred to obtain information about the trial early on during pregnancy. “Reasons to consent to or decline participation in the trial” encompassed a variety of reasons for women to consent, such as goodwill for science or personal benefits, or to decline, such as not wanting to be randomized or fear of increased risk of having a vacuum-assisted delivery. “Thoughts evoked regarding childbirth” were diverse, ranging from not being affected at all to having increased anxiety. Conclusions The women’s experience of receiving an invitation to participate in an RCT of episiotomy in vacuum-assisted delivery varied widely, from immediately giving consent without further worries to increased anxiety or declining participation. Early and personal information with time for reflection was considered most satisfactory. Trial registration ClinicalTrials.govNCT02643108. Registered on December 28, 2015. The Lateral Episiotomy or Not in Vacuum Assisted Delivery in Non-parous Women (EVA) trial was registered at www.clinicaltrials.gov.

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“…Therefore, the exception for informed consent does not usually apply to childbirth. 43 Other studies confirmed that informed consent for episiotomy is not asked for in the second stage of labour. 44 45 Although care providers minimally involve women in the decision-making during the second stage of labour, previous studies reported that women highly value their involvement in decisionmaking during childbirth.…”

Section: Woman-centered Carementioning

confidence: 94%

Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study

Seijmonsbergen-Schermers

Thompson

Jong³

et al. 2021

BMJ Open

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ObjectivesInsight into perspectives and values of care providers on episiotomy can be a first step towards reducing variation in its use. We aimed to gain insight into these perspectives and values.SettingMaternity care in the Netherlands.ParticipantsMidwives, obstetricians and obstetric registrars working in primary, secondary or tertiary care, purposively sampled, based on their perceived episiotomy rate and/or region of work.Primary and secondary outcome measuresPerspectives and values of care providers which were explored using semistructured in-depth interviews.ResultsThe following four themes were identified, using the evidence-based practice-model of Satterfield et al as a framework: ‘Care providers’ vision on childbirth’, ‘Discrepancy between restrictive perspective and daily practice’, ‘Clinical expertise versus literature-based practice’ and ‘Involvement of women in the decision’. Perspectives, values and practices regarding episiotomy were strongly influenced by care providers’ underlying visions on childbirth. Although care providers often emphasised the importance of restrictive episiotomy policy, a discrepancy was found between this vision and the large number of varying indications for episiotomy. Although on one hand care providers cited evidence to support their practice, on the other hand, many based their decision-making to a larger extent on clinical experience. Although most care providers considered women’s autonomy to be important, at the moment of deciding on episiotomy, the involvement of women in the decision was perceived as minimal, and real informed consent generally did not take place, neither during labour, nor prenatally. Many care providers belittled episiotomy in their language.ConclusionsCare providers’ underlying vision on episiotomy and childbirth was an important contributor to the large variations in episiotomy usage. Their clinical expertise was a more important component in decision-making on episiotomy than the literature. Women were minimally involved in the decision for performing episiotomy. More research is required to achieve consensus on indications for episiotomy.

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Childbirth Is Not a Medical Emergency: Maternal Right to Informed Consent throughout Labor and Delivery

Cited by 11 publications

References 0 publications

Patient-centred consent in women’s health: does it really work in antenatal and intra-partum care?

Patient-centred consent in women’s health: does it really work in antenatal and intra-partum care?

Women’s experiences of receiving information about and consenting or declining to participate in a randomized controlled trial involving episiotomy in vacuum-assisted delivery: a qualitative study

Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study

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