Birth, trust and consent: reasonable mistrust and trauma-informed remedies
In ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al1 respond to the prevalence of unconsented procedures during labour, proposing a set of necessary features for adequate consent to episiotomy. Their model emphasises information sharing, value exploration and trust between a pregnant person and their healthcare provider(s). While focused on consent to episiotomy, van der Pijl et al contend their approach may be applicable to consent for other procedures during labour and beyond pregnancy-related care. One feature of their model for adequate informed consent is trust in the syste...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Lanphier, E., Lomotey-Nakon, L. Tags: Commentary Source Type: research
Extending the ethics of episiotomy to vaginal examination: no place for opt-out consent
van der Pijl et al1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation to VE; and third, the significant risk of perpet...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Brione, R. Tags: Commentary Source Type: research
Safeguards for procedural consent in obstetric care
Van der Pijl et al outline data suggesting an alarmingly high incidence of violation of the bodily integrity of patients in labour, including episiotomies performed without patients’ consent, or over their explicit objection.1 Similar data have been reported from the USA and Canada.2 The authors appropriately conclude that explicit consent is required at the time of all invasive obstetrical procedures, including episiotomy. Commonsense adjustments to the duration and detail of consent under conditions of clinical urgency are appropriate and should be familiar to any clinician involved in perinatal care, as well as no...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Shalowitz, D. I., Ralston, S. J. Tags: Commentary Source Type: research
Informed decision-making in labour: action required
The timely feature article by van der Pijl et al1 highlights not only the widespread frequency with which unconsented episiotomies and other procedures during labour are reported by women but also that there is hardly any discussion in the literature on the ethics of consent for procedures in labour. Those national and international bodies with responsibility for midwifery and obstetric practice need not only to recognise but also act to remedy this unacceptable situation. The studies quoted used the recollection of women in reporting consent or lack of it and, although this is an entirely appropriate measure, it gives no ...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Stirrat, G. M. Tags: Commentary Source Type: research
Consent and episiotomies: do not let the perfect be the enemy of the good
We read commentaries on our feature article ‘The ethics of consent during labour and birth: episiotomies’1 with gratitude and interest. Nearly all commenting authors agree that consent for in-labour procedures is necessary and ideally given at the point of intervening. Both Shalowitz & Ralston and Stirrat note that this is already required by professional statements and guidelines in the USA2 and UK3, respectively, but also note that practice does not yet conform. The Americans authors helpfully emphasise the importance of multilevel institutional measures for closing this gap, including consent policies an...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Kingma, E., van der Pijl, M., Verhoeven, C., Hollander, M., de Jonge, A. Tags: Commentary Source Type: research
Setting a human rights and legal framework around 'the ethics of consent during labour and birth: episiotomies
We commend the authors for their comprehensive discussion on consent and episiotomies.1 They correctly observe that informed consent for all proposed interventions in maternity care is always necessary. The claim that consent for maternity health services does not always have to be fully informed or explicit, however, is erroneous. We are especially concerned with, and surprised by, the endorsement of ‘opt-out consent’. ‘Opt-out consent’ (a.k.a. substitute decision making) is already standard practice in maternity healthcare, with obstetric violence a normalised response to conclusive refusals or re...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Kumar-Hazard, B., Dahlen, H. G. Tags: Commentary Source Type: research
A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives
CONCLUSION: Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption.PMID:37598048 | DOI:10.1016/j.wombi.2023.08.003 (Source: Women Birth)
Source: Women Birth - August 19, 2023 Category: Midwifery Authors: Nigel Lee Jyai Allen Bec Jenkinson Cameron Hurst Yu Gao Sue Kildea Source Type: research
A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives
CONCLUSION: Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption.PMID:37598048 | DOI:10.1016/j.wombi.2023.08.003 (Source: Women Birth)
Source: Women Birth - August 19, 2023 Category: Midwifery Authors: Nigel Lee Jyai Allen Bec Jenkinson Cameron Hurst Yu Gao Sue Kildea Source Type: research
A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives
CONCLUSION: Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption.PMID:37598048 | DOI:10.1016/j.wombi.2023.08.003 (Source: Women Birth)
Source: Women Birth - August 19, 2023 Category: Midwifery Authors: Nigel Lee Jyai Allen Bec Jenkinson Cameron Hurst Yu Gao Sue Kildea Source Type: research
A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives
CONCLUSION: Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption.PMID:37598048 | DOI:10.1016/j.wombi.2023.08.003 (Source: Women Birth)
Source: Women Birth - August 19, 2023 Category: Midwifery Authors: Nigel Lee Jyai Allen Bec Jenkinson Cameron Hurst Yu Gao Sue Kildea Source Type: research
A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives
CONCLUSION: Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption.PMID:37598048 | DOI:10.1016/j.wombi.2023.08.003 (Source: Women Birth)
Source: Women Birth - August 19, 2023 Category: Midwifery Authors: Nigel Lee Jyai Allen Bec Jenkinson Cameron Hurst Yu Gao Sue Kildea Source Type: research
A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives
CONCLUSION: Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption.PMID:37598048 | DOI:10.1016/j.wombi.2023.08.003 (Source: Women Birth)
Source: Women Birth - August 19, 2023 Category: Midwifery Authors: Nigel Lee Jyai Allen Bec Jenkinson Cameron Hurst Yu Gao Sue Kildea Source Type: research
A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives
CONCLUSION: Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption.PMID:37598048 | DOI:10.1016/j.wombi.2023.08.003 (Source: Women Birth)
Source: Women Birth - August 19, 2023 Category: Midwifery Authors: Nigel Lee Jyai Allen Bec Jenkinson Cameron Hurst Yu Gao Sue Kildea Source Type: research
Risk indicators for obstetrical anal sphincter injury in vaginal birth after caesarean section compared to first vaginal delivery
CONCLUSIONS: Women with a VBAC have a higher rate of OASI in comparison with women with a first vaginal delivery, with the exception of women with a vaginal birth after an emergency CS for suspected fetal distress. Factors associated with a significantly lower rate for OASI were MLE, maternal age < 25 and birth weight < 3000 g. A gestational age of 42 weeks, birth weight between 3500 and 4000 g and ≥ 4000 g, operative vaginal delivery and duration of the 2nd stage of delivery longer dan 60 min were associated with a significantly higher rate of OASI.PMID:37572448 | DOI:10.1016/j.ejogrb.2023.07.019 (Source: Reproductive Biology)
Source: Reproductive Biology - August 12, 2023 Category: Reproduction Medicine Authors: J van Bavel A C J Ravelli J P W R Roovers A Abu-Hanna B W Mol J W de Leeuw Source Type: research
Risk indicators for obstetrical anal sphincter injury in vaginal birth after caesarean section compared to first vaginal delivery
CONCLUSIONS: Women with a VBAC have a higher rate of OASI in comparison with women with a first vaginal delivery, with the exception of women with a vaginal birth after an emergency CS for suspected fetal distress. Factors associated with a significantly lower rate for OASI were MLE, maternal age < 25 and birth weight < 3000 g. A gestational age of 42 weeks, birth weight between 3500 and 4000 g and ≥ 4000 g, operative vaginal delivery and duration of the 2nd stage of delivery longer dan 60 min were associated with a significantly higher rate of OASI.PMID:37572448 | DOI:10.1016/j.ejogrb.2023.07.019 (Source: Reproductive Biology)
Source: Reproductive Biology - August 12, 2023 Category: Reproduction Medicine Authors: J van Bavel A C J Ravelli J P W R Roovers A Abu-Hanna B W Mol J W de Leeuw Source Type: research
