Consent and refusal of procedures during labour and birth: a survey among 11 418 women in the Netherlands.

Autor:	van der Pijl MSG; Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre (UMC), VU University, Amsterdam, The Netherlands m.vanderpijl@amsterdamumc.nl., Klein Essink M; Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre (UMC), VU University, Amsterdam, The Netherlands., van der Linden T; 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., Verweij R; Stichting Geboortebeweging (Birth Movement NL), Amsterdam, The Netherlands.; Tranzo, Tilburg University, Tilburg, The Netherlands., Kingma E; Department of Philosophy, King's College London, London, UK., Hollander MH; Amalia Children's Hospital, Department of Obstetrics, Radboud University Medical Center, Nijmegen, The Netherlands., de Jonge A; Department of Midwifery Science, AVAG, The Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centre (UMC), VU University, Amsterdam, The Netherlands., Verhoeven CJ; 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.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2024 Jul 22; Vol. 33 (8), pp. 511-522. Date of Electronic Publication: 2024 Jul 22.
DOI:	10.1136/bmjqs-2022-015538
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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