How well do women understand and remember information in labour versus in late pregnancy? A pilot randomised study

Abstract

Medical informed consent is the process by which a ‘competent’, non-coerced individual receives sufficient information including risks of a medical procedure and gives permission for it to occur. The capacity to give an informed consent might be impaired during labour. This study aimed to examine women’s abilities to understand and remember during labour. Women were prospectively recruited at 36 weeks of gestation and randomised to undertake questionnaires which assessed their ability to understand and remember information. They were randomised to: (1) information given in labour only, written format (2) information in labour, verbal (3) information at 36 weeks plus labour, written (4) information at 36 weeks plus labour, verbal. Immediate comprehension and retention was assessed at 36 weeks, in labour, and 24–72 hours after birth. Forty-nine women completed the questionnaires regarding understanding and retention of information at 36 weeks, six intrapartum, and five postpartum (90% attrition). Women receiving information at 36 weeks and in labour versus in labour had a higher comprehension of pregnancy-related information, its retention, and total score. Women receiving information in late pregnancy and labour may comprehend and retain it better than women only receiving information during labour. Given small sample size, further research is needed to support these preliminary findings.

Impact statement

• What is already known on this subject? The evidence regarding the capacity of labouring women to give informed consent is largely based on women’s self-reported experiences or expert opinions and has mixed findings. Existing guidelines recommend that an informed consent should be given antenatally for both clinical practice and research. Studies show that obtaining an informed consent antenatally is neither feasible nor widely implemented.

• What do the results of this study add? A novel approach to providing empirical evidence regarding women’s capacity to comprehend and retain information during labour. Our study confirms the difficulty with antenatal recruitment for intrapartum research.

• What are the implications of these findings for clinical practice and/further research? This raises ethical concerns regarding the current intrapartum research in which consent is largely sought at the time of the study. Emphasises the need to explore the question ‘Do labouring women have the capacity to consent to research?’ in order to ensure that women are protected during labour.

Keywords:

• General obstetrics
• intrapartum care
• ethics

Acknowledgements

Dr Maryam Sana for drafting of the initial study protocol and ethical assistance. Dr Nadine Kasparian is the recipient of a Career Development Fellowship from the National Health and Medical Research Council of Australia (NHMRC 1049238).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by an unrestricted grant from the Royal Hospital for Women Foundation and this assistance is gratefully acknowledged.