Before any operation, the surgeon must ensure that her/his patient consents to that procedure by providing information about its benefits, risks and reasonable alternative courses of action. She/he must be satisfied that the patient understands information given and agrees to undergo the operation. These standards apply to instrumental vaginal delivery (IVD) even though there is no specific requirement to obtain written consent.
The authors approached 100 primiparous women who had undergone IVD in their delivery room for non-progressive labour within the previous 48 h. Each was asked to recall all maternal and fetal risks that had been relayed to them before delivery (1) without prompt, then (2) using lists of complications to prompt memory. The authors also asked each woman whether she had discussed IVD before her labour. Finally, the authors examined medical records and listed risks that staff claimed to have discussed with the woman before IVD.
Only 23% of women recalled any maternal risks before being prompted. After prompt, 69% recalled at least one risk being discussed, the commonest being perineal injury. Only 20% recalled any fetal risks before being prompted. After prompt, 61% recalled being told about the risk of facial bruising but recall of any other fetal risk was rare. Written consent for IVD was obtained in no cases, ‘verbal consent’ was recorded in only 27% and risks were specified in the notes in only 19%.
The authors conclude that the process of consent for IVD in the UK is flawed. Standards applied to Caesareans should also apply to IVD.
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