An Observational Study to Explore the Power and Effect of the Labor Ward Culture on Consent to Intrapartum Procedures

Abstract

AIM:To explore the concept of informed consent to intrapartum procedures within a hospital labor ward.DESIGN:An ethnographic study using participant observation and follow-up semistructured interviews with women and the attending midwives. Data analysis used principles of grounded theory assisted by the computer-assisted qualitative data analysis software (CAQDAS) package, Non-numerical Unstructured Data Indexing, Searching, and Theorizing (NUD*IST). The study was approved by the Local Research Ethics Committee.PARTICIPANTS AND SETTING:100 healthy English-speaking women in spontaneous labor who were to give birth within the labor ward of a large teaching hospital in England and the attending health professionals.FINDINGS:•The fragmented Western technocratic model of childbirth affected gaining informed consent to intrapartum procedures within the labor ward environment.•Midwives and women adopted certain stereotypical roles relating to how information was given and decisions made about intrapartum procedures.•Not all women wanted to be fully informed about intrapartum care and procedures and trusted the midwife or doctor to make decisions, especially concerning the health of their newborn.•Where a birth plan had been completed, women felt valued and enabled by having contributed to decisions made about their care.CONCLUSIONS:The study revealed that true choices to childbearing women were limited andinformedconsent was rarely obtained. Further exploration is required to establish the optimal timing of information disclosure to gain consent to intrapartum practices prior to the onset of labor, because during labor is not ideal. The 2 typologies may be used by midwives to examine how the culture of the birthing environment can affect women’s choice and the obtaining of informed consent to intrapartum procedures, especially where care is fragmented. Until birth is viewed through a holistic birthing model, health professionals will continue to control the birth experience. However, what is provided in practice should be congruent with the needs and expectations of childbearing women.