Informed consent in obstetrics: a survey of pregnant women to set a new standard in informed consent for emergency obstetric interventions [POSTER]

Informed consent in obstetrics: a survey of pregnant women to set a new standard in informed consent for emergency obstetric interventions [POSTER]
Tracey Sturgeon, Huma Ayaz, Kirsty McCrorie, Kate Stewart
BMJ Leader, 3 November 2019; 3(A9)
Open Access
Abstract
Respect for autonomy supports the rights of women to make their own decisions about care as laid out by the Supreme Court ruling on Montgomery (2015). Consent for emergency procedures in obstetrics presents a significant challenge. Consent obtained when a woman is exhausted, influenced by endogenous or exogenous chemicals or in fear of her unborn child’s safety cannot be considered to be informed. An opportunistic survey of pregnant women in Highland region was conducted over 6 weeks in community and secondary care antenatal clinics. Primary objective-determine women’s current understanding of emergency obstetric interventions in labour to guide our work in achieving informed consent. Secondary objective-compare regional and Scottish national delivery data to allow realistic counseling of women regarding possibility of such interventions. Results were analysed and comments qualitatively explored. Labour and delivery expectations of survey participants were compared to regional and Scottish national delivery data (2018). We found that many women were uncertain regarding possibility of intervention. Both prim and parous women requested more information; some specifically asked for up-to-date statistics. Regional and Scottish national delivery intervention rates were comparable. Current intervention rates (by regional and Scottish national data) are significantly higher than expected. Our data is in keeping with Scottish data so this is likely an issue in other regions too. Our survey showed pregnant women may not have realistic expectations of delivery outcomes. Pregnant women need information based on regional and national data to foster realistic expectations of labour or delivery; empowering decision-making and ensuring peri-partum emergency consent is still informed consent. A multi-disciplinary approach to a novel means of obtaining informed consent will allow NHS Highland to lead the way in implementing change to improve the care of our pregnant women.

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