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Megregian M, Emeis CL, Tilden E. Antepartum Preparation and Consent for Intrapartum Events: An Ethical Gap. J Midwifery Womens Health 2024. [PMID: 39133163 DOI: 10.1111/jmwh.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/30/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Michele Megregian
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Cathy L Emeis
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Ellen Tilden
- School of Nursing, Oregon Health & Science University, Portland, Oregon
- The Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Jacques M, Chantry AA, Evrard A, Lelong N, Le Ray C. Consent for interventions during childbirth: A national population-based study. Int J Gynaecol Obstet 2024. [PMID: 39092580 DOI: 10.1002/ijgo.15830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/15/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level. METHODS The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition. RESULTS Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96). CONCLUSION Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth.
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Affiliation(s)
- Marianne Jacques
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Anne Alice Chantry
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
- Midwifery University Department, Université Paris Cité, Paris, France
| | - Anne Evrard
- Collectif Interassociatif Autour de la Naissance (CIANE), Paris, France
| | - Nathalie Lelong
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Camille Le Ray
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
- Maternité Port Royal, Hôpital Cochin Port Royal, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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van der Pijl MSG, Klein Essink M, van der Linden T, Verweij R, Kingma E, Hollander MH, de Jonge A, Verhoeven CJ. Consent and refusal of procedures during labour and birth: a survey among 11 418 women in the Netherlands. BMJ Qual Saf 2024; 33:511-522. [PMID: 37217317 PMCID: PMC11287523 DOI: 10.1136/bmjqs-2022-015538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/27/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Informed consent for medical interventions is ethically and legally required; an important aspect of quality and safety in healthcare; and essential to person-centred care. During labour and birth, respecting consent requirements, including respecting refusal, can contribute to a higher sense of choice and control for labouring women. This study examines (1) to what extent and for which procedures during labour and birth women report that consent requirements were not met and/or inadequate information was provided, (2) how frequently women consider consent requirements not being met upsetting and (3) which personal characteristics are associated with the latter. METHODS A national cross-sectional survey was conducted in the Netherlands among women who gave birth up to 5 years previously. Respondents were recruited through social media with the help of influencers and organisations. The survey focused on 10 common procedures during labour and birth, investigating for each procedure if respondents were offered the procedure, if they consented or refused, if the information provision was sufficient and if they underwent unconsented procedures, whether they found this upsetting. RESULTS 13 359 women started the survey and 11 418 met the inclusion and exclusion criteria. Consent not asked was most often reported by respondents who underwent postpartum oxytocin (47.5%) and episiotomy (41.7%). Refusal was most often over-ruled when performing augmentation of labour (2.2%) and episiotomy (1.9%). Information provision was reported inadequate more often when consent requirements were not met compared with when they were met. Multiparous women had decreased odds of reporting unmet consent requirements compared with primiparous (adjusted ORs 0.54-0.85). There was considerable variation across procedures in how frequently not meeting consent requirements was considered upsetting. CONCLUSIONS Consent for performing a procedure is frequently absent in Dutch maternity care. In some instances, procedures were performed in spite of the woman's refusal. More awareness is needed on meeting necessary consent requirements in order to achieve person-centred and high-quality care during labour and birth.
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Affiliation(s)
- Marit Sophia Gerardina van der Pijl
- Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre (UMC), VU University, Amsterdam, The Netherlands
| | - Margot Klein Essink
- Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre (UMC), VU University, Amsterdam, The Netherlands
| | - Tineke van der Linden
- Stichting Geboortebeweging (Birth Movement NL), Amsterdam, The Netherlands
- Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, VU University and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGzE Mental Health Institute, Eindhoven, The Netherlands
| | - Rachel Verweij
- Stichting Geboortebeweging (Birth Movement NL), Amsterdam, The Netherlands
- Tranzo, Tilburg University, Tilburg, The Netherlands
| | | | - Martine H Hollander
- Amalia Children's Hospital, Department of Obstetrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, The Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centre (UMC), VU University, Amsterdam, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre (UMC), VU University, Amsterdam, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
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Ferede WY, Erega BB, Sisay FA, Ayalew AB, Belachew YY, Yimer TS. Consented maternal care and associated factors among mothers who gave birth at public health institutions in South Wollo Zone, Amhara region, Ethiopia 2022. SAGE Open Med 2024; 12:20503121241227083. [PMID: 38347850 PMCID: PMC10860419 DOI: 10.1177/20503121241227083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Informed consent in healthcare services is a legal, ethical, and professional requirement on the part of all treating health providers and providing person-centered care. The methods of requesting consent during childbirth have not been extensively studied. In Ethiopia, there is not at all a single study done. Objective The purpose of this study is to determine associated factors among mothers who gave birth at health institutions in the South Wollo Zone, Amhara region, Ethiopia in 2022. Methods Mothers who gave birth at South Wollo Zone public health institutions, from 01 March to 30 April 2022 participated in a multi-center institutional-based cross-sectional study design. Systematic random sampling was used to select 423 study participants. A validated questionnaire was used for data collection, and the data were collected through face-to-face interviews. Data were entered into Epi-Data version 4.6 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. The level of significance was determined using an adjusted odds ratio with a 95% confidence interval. Result The study had 416 participants in total, with a response rate of 98.3%. Out of the 416 respondents interviewed, 67.1% of the women received consented care. The age group of 30-34, complications during childbirth, intended pregnancy, merchant, and primary and referral hospital were significantly associated with consented care. Conclusion The level of non-consented care during delivery was high compared with other literature reflecting substantial mistreatment. Therefore, stakeholders should strengthen monitoring and assessment systems to prevent abuse, and further study is required to look for practical ways to make improvements. Key elements of consented care have also been included in Basic and Emergency Obstetric Care training sessions and given to health providers.
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Affiliation(s)
- Wassie Yazie Ferede
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Besfat Berihun Erega
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fillorenes Ayalew Sisay
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abeba Belay Ayalew
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yismaw Yimam Belachew
- School of Medicine, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigist Seid Yimer
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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van der Pijl M, Verhoeven C, Hollander M, de Jonge A, Kingma E. The ethics of consent during labour and birth: episiotomies. JOURNAL OF MEDICAL ETHICS 2023; 49:611-617. [PMID: 36717252 PMCID: PMC10511989 DOI: 10.1136/jme-2022-108601] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/26/2022] [Indexed: 06/18/2023]
Abstract
Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine.We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures.
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Affiliation(s)
- Marit van der Pijl
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands
| | - Corine Verhoeven
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Martine Hollander
- Amalia Children's Hospital, Department of Obstetrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ank de Jonge
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands, Amsterdam, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands
- Amsterdam Reproduction & Development research institute, Amsterdam, The Netherlands
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Testoni I, Ronconi L, Lampis F, Iacona E, Zammarrelli J, Pompele S, Valle R, Boscolo G, De Leo D. Alternative Means of Informed Consent in Cardiology: Strategies and Effectiveness in a Group of Italian Patients. Behav Sci (Basel) 2023; 13:bs13050430. [PMID: 37232667 DOI: 10.3390/bs13050430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Informed consent practices in healthcare represent a fundamental element of patient-centred care; however, the traditional use of a written, paper-based description of the medical procedure to obtain informed consent presents many limitations. This research aimed to evaluate the effects of an alternative modality of obtaining informed consent using a brief informative video for patients waiting to undergo a coronary angiography procedure in Italy. The study involved 40 participants-28 males and 12 females (mean age: 68.55, SD = 13.03)-divided equally into two groups: one group received the video-based informed consent and the other received a traditional paper-based form. Each group was asked to fill in two questionnaires; one was created by the researchers to measure the patient's level of understanding of the given information and the perception of usefulness of the informed consent, and the other was the Depression Anxiety Stress Scales-21 (DASS-21), which evaluates levels of anxiety, depression and stress. A comparison of the results of the two groups showed that video-based informed consent allowed participants to better understand the given information, to feel more confident concerning their subjective comprehension of it and to perceive the video-based informed consent as more useful than the traditional one. The video-based informed consent did not lead to higher levels of anxiety, depression or stress among the participants. It can be hypothesized that video-based formats may represent a more useful, understandable and safe alternative to traditional paper-based informed consent in healthcare.
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Lucia Ronconi
- IT and Statistical Services, Multifunctional Centre of Psychology, University of Padova, 35122 Padova, Italy
| | - Francesca Lampis
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy
| | - Erika Iacona
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy
- Human Rights Centre Antonio Papisca, University of Padua, 35137 Padova, Italy
| | | | - Sara Pompele
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy
| | - Roberto Valle
- Department of Cardiology, General Hospital, 30015 Chioggia, Italy
| | - Gabriele Boscolo
- Department of Cardiology, General Hospital, 30015 Chioggia, Italy
| | - Diego De Leo
- De Leo Fund, 35137 Padua, Italy
- Slovene Centre for Suicide Research, Primorska University, 6000 Koper, Slovenia
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD 4122, Australia
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Arendt M, Tasch B, Conway F, Lecomte A, Covi B, Mariani I, Valente EP, Lazzerini M. Quality of maternal and newborn care around the time of childbirth in Luxembourg during the COVID-19 pandemic: Results of the IMAgiNE EURO study. Int J Gynaecol Obstet 2022; 159 Suppl 1:113-125. [PMID: 36530011 PMCID: PMC9877667 DOI: 10.1002/ijgo.14473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the quality of maternal and newborn care (QMNC) during childbirth in Luxembourg from women's perspectives. METHODS Women giving birth in facilities in Luxembourg between March 1, 2020, and July 1, 2021, answered a validated online WHO standards-based questionnaire as part of the multicountry IMAgINE EURO study. Descriptive and multivariate quantile regression analyses were performed. RESULTS A total of 493 women were included, representing 5.2% of women giving birth in the four maternity hospitals in Luxembourg during the study period. Most quality measures suggested high QMNC, although specific gaps were observed: 13.4% (n = 66) of women reported not being treated with dignity, 9.1% (n = 45) experienced abuse, 42.9% (n = 30) were not asked for consent prior to instrumental vaginal birth, 39.3% (n = 118) could not choose their birth position, 27% (n = 133) did not exclusively breastfeed at discharge (without significant differences over time), 20.5% (n = 101) reported an insufficient number of healthcare professionals, 20% (n = 25) did not receive information on the newborn after cesarean, and 41.2% (n = 203) reported lack of information on newborn danger signs before discharge. Multivariate analyses highlighted higher reported QMNC indexes among women born outside Luxembourg and delivering with a gynecologist, and significantly lower QMNC indexes in women with the highest education levels and those delivering in the hospital offering some private services. CONCLUSIONS Despite maternal reports suggesting an overall high QMNC in Luxembourg, improvements are needed in specific aspects of care and communication, mostly related to maternal autonomy, respect, and support, but also number and competencies of the health workforce.
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Affiliation(s)
- Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asblLuxembourgLuxembourg
| | - Barbara Tasch
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asblLuxembourgLuxembourg,Neonatal Intensive Care Unit, KannerKlinik, Centre Hospitalier de LuxembourgLuxembourgLuxembourg
| | - Francesca Conway
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Aline Lecomte
- Luxembourg Institute of Health, Department of Population Health/Public Health ExpertiseLuxembourgLuxembourg
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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