Informed consent in episiotomy: Co‐analysis with midwives and distillation of best practice

Abstract

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.

Provision of interpreting support for cross-cultural communication in UK maternity services: A Freedom of Information request

“…Awareness amongst maternity professionals of the impact of professional interpreters on the accuracy and quality of maternity care is essential. Absent or irregular PTIs undermine midwifery care ( Cramer 2017 ), and act as an independent risk factor for poor outcomes ( Karliner et al., 2007 ; Chitongo et al., 2022 ; Divi et al., 2007 ), unconsented procedures (such as episiotomy in labour) ( MacLellan et al., 2023 ) and birth trauma ( Markin and Coleman 2021 ; Birthrights 2020 ), and contribute to disparities in maternal mortality ( Cosstick et al., 2022 ). Evidence suggests higher satisfaction with medically trained interpreters amongst service users, with no particular mode of interpreting (face to face, telephone, video) found to be superior ( Joseph et al., 2018 ).…”