Maternity Care Informed Consent Practices and Perspectives: A Qualitative Study at a Tertiary Maternity Unit

Aust N Z J Obstet Gynaecol. 2024 Dec 30. doi: 10.1111/ajo.13932. Online ahead of print.

Abstract

Background: Although consent has long been accepted as necessary in maternity care, the concept of informed consent for planned vaginal birth has polarised maternity politics. The publication of the NSW Consent Manual outlines new standards of informed consent, signalling the need for examination of current maternity consent practices.

Aims: To examine informed consent and disclosure of material risks in birth in a prospective qualitative study of midwives and obstetricians.

Materials and methods: Qualitative study using semi-structured interviews to examine practices and perspectives of obstetricians and midwives.

Results: Twenty-two telephone interviews were concluded. Five sub-themes were identified: (1) non-compliance with the NSW Consent Manual, (2) risk communication/informed consent in maternity care, (3) consent practices in instrumental birth, (4) who should deliver risk information and when (5) barriers to change in consent practice (obstetricians only).

Conclusions: One hundred per cent of participants (18 obstetricians, 4 midwives) described risk communication/informed consent practices that were non-complaint with the standards set out in the 2020 NSW Consent Manual. Eighty-three per cent (15/18) of obstetricians reported that current hospital-wide maternity care practices in risk communication/informed consent are inadequate. Sixty-one per cent (11/18) of obstetricians specifically singled out informed consent practices regarding instrumental birth to be inadequate. Ninety-four per cent (17/18) of obstetricians believe that maternity care consent practices need to be improved. The results of this study indicate that material risks of vaginal birth, caesarean section and instrumental birth, are not routinely disclosed during antenatal courses. Urgent resources and structural change are required to uphold women's legal right to bodily autonomy.

Keywords: communication [F01.145.209]; health policy [I01.655.500.608.400]; informed consent [I01.880.604.473.650.718]; natural childbirth [G08.686.784.769.490.249]; prenatal education [I02.233.332.500.500].