Documentation of Consent Practices for Assisted Vaginal Births (AVB) at Two Tertiary Care Hospitals: A Retrospective Review of Physician Documentation

Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked

“…Evidence from Canadian hospitals shows that informed consent practices related to operative vaginal deliveries reflect this tendency to under-report the associated risks. 58 59 A study examining consenting practices documented in medical records of women who had operative vaginal deliveries at two tertiary care centres in Ontario, Canada, in 2019, showed that neonatal and maternal risks were not mentioned for 68% of forceps deliveries and 92% of vacuum deliveries. 58 A Canadian survey of patient satisfaction with the informed consent procedure during labour also found that women with operative vaginal delivery had more than fourfold lower satisfaction rates compared with those who had had a caesarean delivery.…”

“…58 59 A study examining consenting practices documented in medical records of women who had operative vaginal deliveries at two tertiary care centres in Ontario, Canada, in 2019, showed that neonatal and maternal risks were not mentioned for 68% of forceps deliveries and 92% of vacuum deliveries. 58 A Canadian survey of patient satisfaction with the informed consent procedure during labour also found that women with operative vaginal delivery had more than fourfold lower satisfaction rates compared with those who had had a caesarean delivery. 59 The benefits and risks associated with all delivery alternatives need to be carefully communicated to pregnant women, ideally in the antenatal period, 60 with current, empirically derived measures that reflect the risks women encounter in routine obstetric practice.…”

The authors reply regarding transparency, balance and perspective on intervention at full dilation

“…Evidence from Canadian hospitals suggests that consent practices for OVD reflect these assumptions. 6,7 One study found a fourfold lower rate of satisfaction with the consent procedure among those who had OVDs compared with those who had cesarean deliveries in labour; 6 another study found 68%-92% of charts at Mt. Sinai and St. Michael's Hospitals lacked documentation regarding neonatal or maternal risks in the consent discussion for OVD in 2019.…”

“…Sinai and St. Michael's Hospitals lacked documentation regarding neonatal or maternal risks in the consent discussion for OVD in 2019. 7 Informed consent must be prioritized to ensure pregnant people can weigh the risks and benefits based on their personal values and priorities.…”