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Women’s experiences of consenting to episiotomy: a qualitative interview study

Objective To explore how women undergoing episiotomy experience
and perceive the consent process. Design Qualitative interview
study. Setting A postnatal ward in a London teaching hospital.
Sample 15 women who had recently undergone episiotomy.
Methods Semi-structured, audio-recorded interviews were
analysed using thematic analysis. Main outcome measures Themes
derived from analysis of interview transcripts. Results Three
themes emerged in relation to women’s experiences of the episiotomy
consent process: 1) realities of episiotomy practice, 2) information
provision and 3) voluntariness of consent. Practical realities such as
time pressure, concern for the baby’s health and women’s state of
exhaustion, constrained consent discussions. Minimal information on
episiotomy was shared with participants, particularly concerning risks
and alternatives. Participants consequently inferred that there was no
other choice to episiotomy. Whilst some women were still happy to agree,
others perceived the consent process to be illusory and disempowering,
and subsequently experienced episiotomy as a distressing event.
Conclusions Consent to episiotomy is not consistently informed
and voluntary and more often takes the form of compliance. Information
must be provided to women in a timelier fashion in order to fulfil legal
requirements, and to facilitate a sense of genuine choice.
Funding The study has not received grant funding. The research
team are funded by the Higher Education Funding Council for England
(HEFCE). Keywords Episiotomy, consent, women’s experiences,
qualitative