Affiliation:
1. Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé) Paris France
2. Midwifery University Department Université Paris Cité Paris France
3. Collectif Interassociatif Autour de la Naissance (CIANE) Paris France
4. Maternité Port Royal, Hôpital Cochin Port Royal, Assistance Publique‐Hôpitaux de Paris Université Paris Cité Paris France
Abstract
AbstractObjectiveTo assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level.MethodsThe 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.ResultsWomen 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).ConclusionWomen 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.