Consent in pregnancy: A qualitative study of the views and experiences of women and their healthcare professionals

Abstract

Objective: Consent in antenatal settings is contentious, poorly understood and recognised as problematic for pregnant women. This study aimed to investigate participants' views and experiences of the consent process. Design: Qualitative research performed in a large urban teaching hospital in London. Sixteen pregnant women and fifteen healthcare professionals (obstetricians and midwives) participated. Consent consultations were observed and in-depth interviews carried out with healthcare professionals and pregnant women using semi-structured interview guides. Data were collectively analysed to identify themes in the experiences of the consent process. Results: Four themes were identified: 1) Choice and shared decision-making. Pregnant women do not always experience consent in a choice-making way and often do not understand information provided to them. 2) Contextualising information disclosure. What is important to women is not only the information but the relational context in which consent is obtained. 3) Quality of HCP-woman relationship. Trust in their healthcare professional sometimes makes women seek less information and conversely. Individualised information is desired by women but professionals found it difficult to ensure that women receive this in practice. 4) Law and professional practice. Doctors are more aware of legal developments in consent related to the Montgomery case than their midwifery colleagues, but they are not always certain of the implications. Conclusion: Results suggest that an effective antenatal consent process which empowers pregnant women requires their understanding of provided information to be elicited. There is a delicate balance to be struck between the trust of a patient in their professional and information-based consent, rather than a simple focus on improving information provision. Whilst recognising women's desire for bespoke consent professionals acknowledged the difficulty of ensuring this in practice. If consent is to remain the legal yardstick of autonomous choice-making, women's understanding and that shared with their healthcare professional needs to be more explicitly addressed.

Women’s Views and Preferences for Mode of Birth in Public Hospitals in Argentina: a Mixed-methods Study

“…In line with studies in other settings, a signi cant nding of our study is that six out of ten women wanted to be asked on the birth preference (11,28,29), which reinforces the need to tailor the design and content of interventions targeting women and con rms women's desire for communication and an informed dialogue with healthcare providers (30).…”

Women's Views on Mode of Birth in Public Hospitals in Argentina: Inputs From a Formative Research to Optimize the Use of Caesarean Section

“…In line with studies in other settings, the significant finding of our study is that six out of ten women would have wanted to be asked about birth preference (27)(28)(29). The message reinforces the need to tailor interventions targeting women so as to include them as an active participant in health care decisions and confirms women's expectations for communication and informed dialogue with healthcare providers (30).…”

Biopsychosocial Factors during the Perinatal Period: Risks, Preventative Factors, and Implications for Healthcare Professionals

“…Again, patient-provider communication was listed as an important variable in mitigating healthcare disparities. Building on communication, Nicholls et al [28] utilized an interpretive qualitative methodology and found women in their perinatal periods could benefit from an empowering approach, where they feel like they are able to make choices about their bodies and their pregnancies. Further, a woman-first healthcare initiative could be advantageous, as opposed to the usual compliance culture within healthcare settings [28].…”