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Barriers to informed consent in obstetric care during childbirth from practitioner's perspective: a qualitative study
Lucile Abiola1,2, Guillaume Legendre2, Aurore Koechlin3
1Paris-Saclay University, Gif-sur-Yvette, France ablucile_sf@yahoo.fr.
Objectives:
To explore healthcare professionals' perspectives and practices regarding informed consent during childbirth, particularly in the context of increased public awareness and discourse surrounding obstetric violence (OV) in France.
Design:
A qualitative study based on semistructured interviews and non-participant observations.
Setting:
Four maternity units in France, representing a diversity of institutional contexts.
Participants:
A purposive sample of 32 participants, including midwives and obstetricians, was recruited across the four sites.
Methods:
Data were collected through 32 semistructured interviews and in situ observations in labour and delivery rooms. A thematic analysis was conducted using a phenomenological approach, supported by NVivo software.
Results:
Four main themes emerged: (1) relational malaise in the caregiver-patient relationship, reinforced by public discourse on OV, further hindered shared decision-making and open communication. (2) Challenges between caring values and systemic constraints (eg, lack of time, staffing shortages and protocol-driven care) limited professionals' ability to engage in meaningful informed consent discussions. (3) Safety paradigm in obstetrics: fetal well-being emerged as a central and non-negotiable argument to justify medical interventions during childbirth. (4) Informed consent as a source of tension, where professionals struggled to balance legal and ethical obligations with clinical urgency, often leading to coercive or merely formal consent processes.
Conclusions:
Informed consent during childbirth remains a critical and unresolved ethical challenge. This study highlights systemic, relational and emotional barriers that hinder shared decision-making and compromise the core ethical principles of autonomy, beneficence and justice. Addressing these issues requires structural changes, improved working conditions to support individualised care, better training in ethics and communication and greater recognition of the moral distress experienced by healthcare professionals.
Registration Number:
Registration number 22-219 from CEEI-IRB INSERM (Research Institutional Review Board INSERM, France) (IRB 00003888, IORG 0003254, FWA 00005831).
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