Women's Experience of the Consent Process to Planned Caesarean Section and Its Surgical Risk: A Qualitative Study

Abstract

Objective

To explore how women appreciated the risks discussed within the consent process for planned caesarean section (CS).

Design

Exploratory qualitative interview study.

Setting

NHS Teaching Hospital in Central London.

Population

Women over the age of 18, English speaking, scheduled for a planned CS.

Methods

Semi-structured interviews were conducted before and after a woman's CS. Eighteen women were recruited and interviewed prior to undergoing CS and 12 of these were interviewed following CS. Interviews were audio-recorded, transcribed and thematically analysed.

Main Outcome Measures

Themes generated from analysis of interviews exploring the experiences of women consenting to CS and specifically their awareness of postpartum haemorrhage (PPH), hysterectomy, organ damage and risk of placental abnormalities in future pregnancies.

Results

Two broad themes and four subthemes were identified (1) Untimely provision of risk information: (a) superficial risk discussions during the antenatal period and full risk disclosure on the day of surgery and (b) incompleteness absent or sparse risk disclosure prior to making the decision to undergo the CS, where women were unaware of specific risks and (2) Emotional overload: (a) fear of risks and (b) fear that a CS will be denied to them—women's cognitive response and notably their emotional response to their situation limited their understanding of risks disclosed.

Conclusion

The consent process for planned CS was found to lack appropriate and full risk disclosure. Risk disclosure was ill-timed or deficient in facilitating women's understanding of risks reflecting a consent process which does not meet legal and professional standards of informed consent.