Clinician Perspectives on Obstetric Anesthesia Informed Consent for Patients With Limited English Proficiency: A...

Informed consent in obstetric anesthesia often takes place under urgent and emotionally intense conditions. For patients with limited English proficiency (LEP), language barriers further compromise the ability to engage in informed, value-aligned decisions. Obstetric anesthesiologists must navigate these challenges while delivering safe and patient-centered care. This study explored clinician perspectives on how language barriers affect the informed consent process in obstetric anesthesia.

We conducted semi-structured interviews with obstetric anesthesia fellowship directors and Center of Excellence leaders across the United States. Participants described their experiences obtaining informed consent from LEP patients, including interpreter use and nonuse, workflow challenges, and communication barriers. Data were analyzed thematically using the Capability, Opportunity, Motivation, Behavior (COM-B) framework.

Thirteen participants from eight states reported substantial barriers to informed consent for LEP patients. Key themes included 1) Capability: lack of training on interpreter use, concerns about interpretation accuracy; 2) Opportunity: workflow constraints, limited antepartum preparation, and challenges accessing interpreters during emergencies; and 3) Motivation: frustration with care inequities and difficulty navigating cultural nuances while aligning care with patient preferences. Clinicians described how language barriers often led to less effective communication, limited analgesia options, and greater reliance on general anesthesia.

From the clinician perspective, language barriers pose serious challenges to informed consent in obstetric anesthesia. Addressing these barriers requires system-level interventions, including formal interpreter training, language-concordant education materials, and earlier engagement during prenatal care.