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The ethics of consent during labour and birth: episiotomies
  1. Marit van der Pijl1,2,3,4,
  2. Corine Verhoeven1,2,3,4,5,6,
  3. Martine Hollander7,
  4. Ank de Jonge1,2,4,8,
  5. Elselijn Kingma9
  1. 1 Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
  2. 2 Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands, Amsterdam, The Netherlands
  3. 3 Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
  4. 4 University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, The Netherlands
  5. 5 Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
  6. 6 Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
  7. 7 Amalia Children’s Hospital, Department of Obstetrics, Radboud University Medical Center, Nijmegen, The Netherlands
  8. 8 Amsterdam Reproduction & Development research institute, Amsterdam, The Netherlands
  9. 9 Department of Philosophy, King's College London, London, UK
  1. Correspondence to Marit van der Pijl, Amsterdam UMC Locatie VUmc, Amsterdam, 1081 HV, Netherlands; m.vanderpijl{at}


Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine.

We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures.

  • Ethics
  • Informed Consent
  • Quality of Health Care
  • Personal Autonomy
  • Ethics- Medical

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Data sharing not applicable as no datasets generated and/or analysed for this study.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • Contributors All authors equally contributed to setting up the aim of the paper, the outline of the paper and the arguments raised in the paper. MvdP and EK wrote the manuscript, with the support of all other authors (CV, MH and AdJ). All authors have contributed to and approved the original and revised manuscript. EK is the guarantor of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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