Survey on consent process for the use of instrumentation at childbirth
Research type
Research Study
Full title
A survey on the current practice of consenting to instrumental vaginal delivery and women’s opinions on timing and modality of the consent process at childbirth.
IRAS ID
289693
Contact name
Carolynne Vaizey
Contact email
Sponsor organisation
London North West University Healthcare NHS Trust
Duration of Study in the UK
0 years, 5 months, 30 days
Research summary
Summary of Research
Childbirth is considered a natural process and nowadays it is important to encourage women to look at it as a natural event nevertheless still there can happen some difficult deliveries that need specialist input. That is when senior obstetricians are called in labour room and eventually have to recur to emergency procedures, with the use of instrumentation (forceps and/or ventouse) or caesarean section. During pregnancy women undergo regular checks in antenatal clinics and we believe they should be informed during these meetings about what a normal and difficult delivery mean and what their choices could be. The aim of this project is to highlight what is the level of information provided to pregnant women about the eventual use of instrumentation at childbirth and its risks and benefits.
The use of instrumentation at childbirth is meant to help babies to come out safely nevertheless it is shown in many published articles that this can cause vaginal tears that can extend to the anal verge and cause in the long term inability to retain faeces and gas. We would like to ask women's impressions about their experience at childbirth, before and after birth. This study will provide us with baseline of the current level of information received by mothers about the use of instrumentation at childbirth (before, during and after childbirth), and in what way the consent for the use of instrumentation was taken. The study will take place at Northwick Park Hospital (part of the London North West University Healthcare NHS Trust). This study will be conducted in two groups. Group 1 will be composed of women who had use of instrumentation at birth. Group 2 will be composed of women at least 36 weeks pregnant and willing to proceed for a vaginal birth.Summary of Results
116 pregnant ladies around 36 weeks gestation were included for prospective assessment of the information about labour they received during their pregnancy. 4% were able to describe all stages of labour, 28% could describe some of the stages of labour and 68% were unable to describe any of the stages of labour. 83% were unaware that instrumentation may be used during delivery. 6% were aware they may be used if necessary and 1% were aware of the risk of maternal injury.For the retrospective part of the study which involved ladies who gave birth 6 weeks before with use of instrumentation (forceps and/or ventouse): 59 case notes were reviewed. All had undergone either forceps or ventouse instrumentation. 10% showed no record of informed consent. 71% showed evidence of verbal consent and 18 % had signed consent. The majority of consents were obtained during the second stage of labour. In many cases opioid analgesia had been administered prior to consent.
The current process for obtaining informed consent prior to instrumental delivery is currently substandard with many women being unaware of the consequences of such intervention. There are particular concerns about the methods and timing of the consent process.
REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
20/WM/0303
Date of REC Opinion
18 Dec 2020
REC opinion
Further Information Favourable Opinion