Informed consent in obstetrics – a survey of pregnant women to set a new standard for consent in emergency obstetric interventions

Abstract

Informed consent is necessary for all medical, surgical and obstetric interventions. Whilst informed consent can be obtained for elective procedures, it is much more challenging to obtain for emergency interventions. It can be difficult for women to understand the need for emergency intervention when pregnancy has been low risk. This can lead to problems with psychological trauma from the delivery being foremost in their minds in the postnatal period and in future pregnancies. The Montgomery ruling of 2015 encouraged informing women about risks and benefits of interventions and letting the women take responsibility for their own decision-making. Here, a patient-focused survey collected information on pregnant women’s knowledge and wishes regarding emergency interventions. The responses were analysed in relation to local and Scottish national delivery data. We have initiated a novel programme to ensure all of our pregnant women are empowered to give informed consent for emergency interventions.

IMPACT STATEMENT

• What is already known on this subject? There has been very little published on this subject to date and what has been published has involved focus groups or very small numbers of women.

• What do the results of this study add? This study adds significantly to our understanding of current Scottish and Highland regional delivery statistics to help foster realistic delivery expectations in our pregnant women. This study is the first to report on pregnant women’s understanding of the possibility of requiring emergency intervention in labour and the relevant risks. It also highlights the fact that women prefer to get their information from community midwives, friends and family rather than their obstetricians or GPs. This study is also the first to report women’s actual preferences and comments with regard to information provision, labour and delivery experiences and their wishes for the future.

• What are the implications of these findings for clinical practice and/or further research? The findings from this study have allowed us to develop and implement a novel means of obtaining informed consent in emergency obstetrics and the success of this programme will be reported following future analysis of patient experiences.

Keywords:

• Obstetrics
• consent
• Montgomery
• emergency
• labour

Acknowledgements

This survey would not have been possible without the involvement of our pregnant ladies in NHS Highland and we extend our grateful thanks to those who took time to respond to our survey. With special thanks to Anne Angus, Mary Burnside, all our midwives in Raigmore and our Community Midwives and Maternity Care Support Workers (especially Maria Lapinska, Kelly Carter, Demi Mackenzie) throughout NHS Highland. With thanks also to Dr. Darren Thomas, Dr. Mandy Hunter, Dr. Mostafa Abdalla, Ms. Fiona Mitchell, Ms Norma Shippin, Ms Rachel Hill and Dr. Boyd Peters.

Ethical approval

Ethical approval was not required.

Author contributions

T.E.S. and H.A. conceived the idea and developed the survey questionnaire. T.E.S. disseminated the survey questionnaire to the local and peripheral units. K.M. performed some literature review and contributed to the initial manuscript. T.E.S. collected and analysed the data and wrote the initial manuscript. K.S. contributed to subsequent manuscript. T.E.S. and H.A. reviewed and wrote the final draft.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was not funded by public, not-for-profit or commercial sources.