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Consent for interventions during childbirth: A national population-based study.

Marianne Jacques1, Anne Alice Chantry1,2, Anne Evrard3

  • 1Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|August 2, 2024
PubMed
Summary

Medical interventions during childbirth, including oxytocin, episiotomy, and emergency cesarean, were frequently performed without obtaining women's informed consent. Improving communication and promoting birth plans are crucial for enhancing patient involvement in childbirth decisions.

Keywords:
deliveryfacility‐based maternity careinformed consent/statistics and numerical datamaternal health servicesobstetrics and gynecologypatient‐centred careshared decision making

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Area of Science:

  • Obstetrics and Gynecology
  • Patient Rights
  • Public Health

Background:

  • Informed consent is a cornerstone of ethical medical practice, particularly during childbirth.
  • Understanding the prevalence and factors influencing the lack of consent for interventions is vital for improving maternal healthcare.
  • Previous research has highlighted concerns regarding patient autonomy in obstetric care.

Purpose of the Study:

  • To determine the population-level frequency of medical interventions performed during childbirth without obtaining women's consent.
  • To identify maternal, obstetric, and organizational factors associated with the failure to obtain consent for interventions such as oxytocin administration, episiotomy, and emergency cesarean section.
  • To provide evidence for improving communication and patient involvement in decision-making during labor and delivery.

Main Methods:

  • A nationwide cross-sectional study, the Enquête Nationale Périnatale 2021, included a representative sample of 7394 women in metropolitan France with 2-month postpartum follow-up.
  • The study calculated rates and confidence intervals for interventions performed without consent (oxytocin, episiotomy, emergency cesarean).
  • Robust variance Poisson regressions, with multiple imputation for missing data and weighting for attrition, were used to assess associations with various characteristics.

Main Results:

  • A significant proportion of women reported lack of consent: 44.7% for oxytocin, 60.2% for episiotomy, and 36.6% for emergency cesarean.
  • Lack of consent for oxytocin was linked to maternal birth abroad, lower education, and advanced cervical dilation; birth plans were associated with higher consent rates.
  • Assistance by an obstetrician increased the likelihood of lack of consent for episiotomy, while cesarean for fetal distress was associated with failure to obtain consent for the procedure.

Conclusions:

  • Perinatal professionals frequently fail to obtain consent for interventions during childbirth, impacting women's autonomy.
  • Reorganization of care, enhanced communication training, and promotion of birth plans are essential to improve women's decision-making involvement.
  • Addressing these issues is critical for upholding patient rights and improving the quality of obstetric care.