Normalising Choice: An Observational Study of Australian Clinicians' Perspectives on Written Informed Consent for Vaginal Birth

TL;DR

Australian clinicians believe women are often not fully informed about vaginal birth risks, suggesting written consent and tools like birth plans could improve this.

Contribution

The study introduces insights into clinician perspectives on informed consent for vaginal birth and highlights gaps in current practices.

Findings

Obstetricians were eight times more likely to believe women are rarely fully informed about vaginal birth.

Only 6.6% of obstetricians and 6% of midwives were aware of written informed consent forms for vaginal birth.

Themes identified include flawed understanding of consent and the need for improved antenatal information.

Abstract

The NSW Birth Trauma Report identified flawed consent processes and poor calibre antenatal information to have harmed birthing women. Written informed consent for vaginal birth may improve carer accountability and is currently applied in limited circumstances, for example, vaginal birth after caesarean section (VBAC).

This study explores how informed women are about birth, as perceived by clinicians, and perspectives on the implications of written informed consent for vaginal birth.

This study uses survey‐based research for quantitative data and inductive content analysis for open‐ended questions. Main outcome measures include carer perceptions on consent to the mode and/or location of birth and arguments against/in favour of written informed consent.

One thousand two hundred and seventy‐one responses were analysed for the final results, with 851 (67%) obstetric (Obs) and 420 (33%) midwifery (MW) respondents. Obs were eight times likelier to believe that women are never/rarely fully informed regarding vaginal birth (p < 0.001). The majority in both cohorts agreed women are frequently/always fully informed about VBAC. However, only 49 (6.6%) Obs and 20 (6%) MW were aware of written informed consent forms in use for vaginal birth. Themes developed include—‘helpless clinicians’ facing impediments to consent, flawed understanding of consent, rejection of consent requirements, juxtaposing consent with normality, disruption to collaboration and antenatal information undermining consent.

Maternity carers in this Australian survey agree women are not fully informed regarding the risks and benefits of birth. Written informed consent alongside adjuncts like birth plans or technology‐based platforms may offer a way ahead for the future.