The ethics of consent during labour and birth: episiotomies

van der Pijl, Marit; Verhoeven, Corine; Hollander, Martine; de Jonge, Ank; Kingma, Elselijn

Abstract

Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine. We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures.

• Journal Article Type: Article
• Acceptance Date: Dec 26, 2022
• Online Publication Date: Jan 30, 2023
• Publication Date: 2023-09
• Deposit Date: Mar 22, 2023
• Publicly Available Date: Mar 24, 2023
• Journal: Journal of Medical Ethics
• Print ISSN: 0306-6800
• Electronic ISSN: 1473-4257
• Publisher: BMJ
• Peer Reviewed: Peer Reviewed
• Volume: 49
• Issue: 9
• Pages: 611-617
• DOI: https://doi.org/10.1136/jme-2022-108601
• Keywords: Ethics, Informed Consent, Quality of Health Care, Personal Autonomy, Ethics- Medical
• Public URL: https://nottingham-repository.worktribe.com/output/17374100
• Publisher URL: https://jme.bmj.com/content/49/9/611