Informed consent and birth preparedness/complication readiness: A qualitative study at two tertiary maternity units.

BACKGROUND: Informed consent in obstetrics should involve full disclosure of risks, benefits and alternative interventions. However, we have found no evidence of a formal informed consent process before an attempt at vaginal delivery in published policy or practice. The idea of informed consent in vaginal birth has attracted controversy and has been the subject of some debate. AIM: To explore the perspectives and experiences of informed consent and birth preparedness/complication readiness for birthing women in a high resource setting. MATERIALS AND METHODS: Qualitative study using semi-structured interviews to examine experiences and perspectives of women following birth. RESULTS: Forty telephone interviews were concluded. Eight statement categories were identified: (i) no issues of consent, (ii) absent/inadequate informed consent, (iii) adequate birth preparedness/complication readiness, (iv) inadequate birth preparedness/complication readiness, (v) desire to forfeit decision making to a trusted and accountable health professional, (vi) belief that informed consent is not realistic in birth under some circumstances, (vii) negative feelings related to birth and (viii) poor postnatal follow-up. CONCLUSIONS: When complications arose during birth, 20% of participants felt that informed consent was absent/inadequate, 25% of participants suggested policy change in favour of a formal informed consent process and 55% of participants suggested policy change in favour of increased birth preparedness/complication readiness. Our study suggests that informed consent for vaginal birth and formal birth preparedness/complication readiness should form part of routine antenatal care. Women's preferences for decision-making and informed consent should be established before birth.

'Normal birth': Time to change our tune?

Recent research indicates that atraumatic 'normal vaginal birth' only occurs in 33-40% of women who intend to achieve a vaginal delivery, depending on how the term 'normal birth' is defined. In contrast, the NSW birth policy continues to promote 'normal birth', suggesting that the majority of women will achieve 'normal birth' and that 'normal birth' produces optimal maternal outcomes. Our continued use of the term 'normal birth' may be outdated. This article will consider the term 'normal birth' with regard to history, politics, policy and obstetric practice, and recommend a reconsideration of terminology.

Breast cancer and sexuality.

Breast cancer affects a woman's body image and feelings of sexuality. Little is known about the perceptions of spouses to the sensitive topics of sexuality and body image. A qualitative inquiry was undertaken using in-depth interviews. A diagnosis of breast cancer brought some relationships closer. Mastectomy by disturbing body image did obliterate sexual relationships for a significant period of time. Women often felt (wrongly) that their partner would be repulsed by changes. More support in relation to sexuality and body image could improve relationships by identifying and clarifying perceptions, and therefore the quality of life.