Informed consent for labour epidurals: what labouring women want to know

Abstract

Purpose: To determine A) what a labouring woman expects to hear about epidural analgesia before consenting, B) if she feels able to understand the risks and thereby assess if we are obtaining informed consent.Methods: Sixty actively labouring women were surveyed immediately after requesting an epidural. Demographic, labour, epidural and consent information were included in the questionnaire. Answers were categorical (yes/no, multiple choice) or scored on a scale from 0 to 10 (visual analogue scale).Results: The majority of parturients wanted all potential epidural complications but not their incidences disclosed in the consent process. However, a discussion of risks would not dissuade women from consenting to an epidural in the majority of cases. Labouring women have a moderate understanding of epidural risks. The ability to understand risks was not affected by labour pain, anxiety, opioid premedication, duration of labour pain, desire for an epidural, previous epidural experience, level of education or age.Conclusion: This prospective survey characterizes what 60 reasonable labouring women wanted to know about labour epidural analgesia. Parturients wanted all risks of epidural analgesia disclosed in the informed consent process. The majority of women did not want the incidences quoted. This study suggests that labouring patients are as able to give informed consent as are other members of our patient population.Objectif: Déterminer ce qu'une parturiente en travail voudrait connaître de l'analgésie épidurale avant de consentir à la recevoir et vérifier si elle croit en comprendre les risques. De là, évaluer si nous obtenons un consentement éclairé.Méthode : On a interrogé 60 femmes en travail obstétrical actif immédiatement après leur demande d'une analgésie épidurale. Le questionnaire comprenait des données personnelles, des informations sur le travail, l'analgésie épidurale et le consentement. Les réponses étaient catégorielles (oui/non, choix multiples) ou cotées sur une échelle visuelle analogique de 1 à 10.Résultats : La majorité des femmes voulait que toutes les complications possibles de l'analgésie épidurale soient révélées dans la formule de consentement, mais non leur incidence. Une discussion sur les risques ne les a pas empêchées d'accepter cette analgésie dans la majorité des cas. Les femmes en travail ont une connaissance moyenne des risques de l'analgésie épidurale. La capacité de comprendre les risques n'a pas été influencée par les douleurs du travail, l'anxiété, la prémédication avec des opioïdes, la durée des douleurs, le désir d'une analgésie épidurale, l'expérience antérieure de cette analgésie, le niveau d'éducation ou l'âge. Conclusion :Cette enquête prospective a précisé ce que 60 parturientes en travail obstétrical veulent connaître sur l'analgésie épidurale. Elles ont demandé que tous les risques de l'analgésie épidurale soient inscrits à la formule du consentement éclairé, mais la majorité ne voulait pas qu'on y ajoute l'incidence. Cette enquête permet d'affirmer que les patientes en t...

Awareness and desirability of labor epidural analgesia: a survey of Nigerian women

“…16 Although there are several publications on the views, knowledge and concerns of health care providers regarding epidural analgesia for childbirth, there are few reports from women about the technique. 17,18 In sub-Saharan Africa, little information has been documented on the views of pregnant women about the use of epidural analgesia in labor. This may hinder widespread use of epidural analgesia should it be introduced by health institutions.…”

Informed consent for epidural analgesia in labour

“…1 Their survey of 60 women in labour concluded that these women, who were able to conduct a 10 min interview while labouring, clearly were also able to consent to the proposed epidural.…”

Obstetric Autonomy and Informed Consent

“…A study of patients in extreme pain, as measured by the Generalized Distress Index, found that there is no relationship between a patient's ability to make decisions and his or her distress index scores (Casarett et al 2003). Specific tests of the relationship between labor pain and ability to understand also found no relationship between physical incapacity and decision-making capacity (Jackson et al 2000). Although childbirth often involves pain and anxiety, there is no reason to think that women in labor should be presumed less competent to consent to interventions, including anesthesia and surgery, than other patients who suffer from stressful or painful conditions (Ladd 1989).…”