Informed consent and obstetric violence: Women's experiences of childbirth

BackgroundObstetric violence is a widespread form of institutional abuse that violates women's sexual and reproductive rights during childbirth. Although informed consent is a fundamental ethical, legal, and human right requiring adequate information and active participation, it is frequently absent or incomplete, even in non-emergency obstetric care.AimTo identify which clinical practices, according to their context (emergency or routine) and the presence or absence of informed consent, are associated with higher perceptions of obstetric violence. Additionally, it is to assess the influence of professional treatment on these perceptions.Research designCross-sectional observational study.Participantsand research context: 2,367 women who gave birth in Spanish public hospitals. Perceptions of obstetric violence and quality of care were measured using the Childbirth Abuse and Respect Evaluation-Maternal Questionnaire (CARE-MQ) and the Quality from the Patient's Perspective-Intrapartal Questionnaire (QPP-I).Ethical ConsiderationsThe study was approved by the Clinical Research Ethics Committee of Reina Sofía University Hospital of Córdoba and by the ethics committees of Ciudad Real University Hospital and Mancha-Centro Hospital.FindingsClinical practices performed without informed consent or adequate information were significantly associated with higher CARE-MQ scores (p < .001). Procedures such as episiotomy and oxytocin administration, when carried out outside emergency situations, had a particularly strong impact on perceptions of abuse. Negative evaluations of professional treatment were also significantly associated with higher CARE-MQ scores (p < .001). Midwives received the highest ratings among healthcare professionals.ConclusionThe absence of informed consent is a key determinant of women's perceptions of obstetric violence, regardless of clinical context. Identifying procedures with low consent rates and highlighting the protective role of respectful professional behavior, particularly midwife-led care, provides actionable targets to improve maternity services. Strengthening communication, ethical training, and midwife-led models is essential to promote respectful maternity care and safeguard women's rights during childbirth.