Patient Perceptions of Informed Consent for Operative Vaginal Birth: A Qualitative Analysis

Operative vaginal birth (OVB) is a potentially life-saving intervention, but as a procedure with potential risks and benefits, it must first be preceded by an informed consent discussion. Informed consent is one aspect of patient involvement in the decision to deliver with the assistance of instruments, such as forceps or vacuum. However, it is unclear whether patients undergoing operative vaginal delivery consider informed consent to be adequate; and whether the adequacy of consent impacts their birth experience.

Using open-ended, semi-structured interviews (n = 20), the purpose of this study was to characterize patient perceptions of the informed consent process for OVB and to evaluate the role pre-procedure communication might play in influencing assisted birth experiences. Patients who had undergone an operative vaginal delivery were invited to share their birth experiences and to provide suggestions for improving the consent process when relevant. Using consensus coding, three investigators independently evaluated the transcribed interviews and identified emergent codes. These codes were then compared, and any disparate ideas were discussed until consensus was reached.

Three primary themes emerged from patient narratives: (1) the difficulty of engaging in the consent process during the second stage of labor; (2) no perceived loss of agency; nonetheless, and (3) acceptance of limited consent discussions because OVB is preferred over a cesarean.

The three key themes identified in the study suggest that patients are satisfied with their birth experience following an OVB, despite significant limitations in informed consent. Findings suggest that patients are accepting a substandard consent process, and that renewed attention should be paid to improving information sharing, even during relatively urgent care encounters. Even though patients expressed satisfaction with the consent process, the adequacy of informed consent is not determined by patient satisfaction. Improving information sharing during urgent care encounters could improve the quality of informed consent for patients undergoing operative vaginal delivery.