Perceptions of Consent for Operative Vaginal Delivery: A Service Evaluation

BACKGROUND: One in five women giving birth for the first time will have an operative vaginal delivery (OVD). Despite this frequency, a considerable number of women and birthing people report feeling unprepared for OVD. This incongruence spurred our decision to further understand our service users' perspectives on the consent process for OVD. In feedback by a local Maternity and Neonatal Voices Partnership, some maternity service users reported that they felt the consent process for OVD was inadequate, leaving them confused and upset after birth. METHODS: As part of a quality improvement project, an anonymous questionnaire was devised and disseminated both within the National Health Service (NHS) Maternity Unit and online. Women and birthing people were asked to fill in the survey if they had experienced OVD in the past two years. Thematic analysis was conducted based on their responses. RESULTS: A total of 88 responses were collected. Two core themes were identified: (1) the majority of women (65.9%) felt under-informed about OVD, and (2) women wanted to know more about OVD in advance of labor. A notable minority (10/86, 11.6%) claim to have consented to procedures that they did not fully understand. CONCLUSION: Our project reflects a growing body of literature interrogating the challenges with discussing consent "in-the-moment," as a one-time decision. Consideration must be given to ways in which we can strengthen understanding and comprehension within this process. Although the current consent model is useful in some medical procedures, the unique circumstances of childbirth may require something more. The consent process could be adapted so women can more fully engage with the conversation.