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Commentary
Episiotomies and the ethics of consent during labour and birth: thinking beyond the existing consent framework
  1. Anna Nelson1,
  2. Beverley Clough2
  1. 1 Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Manchester, UK
  2. 2 Manchester Law School, Manchester Metropolitan University, Manchester, UK
  1. Correspondence to Dr Anna Nelson, Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Manchester, UK; anna.nelson{at}manchester.ac.uk

https://doi.org/10.1136/jme-2023-109205

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    We agree with van der Pijl et al that the question of how to ensure consent is obtained for procedures which occur during labour and childbirth is vitally important, and worthy of greater attention.1 However, we argue that the modified opt-out approach to consent outlined in their paper may not do enough to protect the choice and agency of birthing people. Moreover, while their approach reflects a pragmatic attempt to facilitate legal clarity and certainty in this context, this is not necessarily responsive to the messy realities of decision-making during labour (and beyond). We outline some of our concerns with their proposals and demonstrate how these illuminate some broader, longstanding tensions around consent and medical law.

    The universal and the particular

    The authors place significant focus on the particularities of labour, outlining six ways in which maternity care is ‘unlike the usual healthcare setting’ (van der Pijl M et al,1p4). We support the need for attentiveness to these particularities and the problematic nature of consent in this context. Recent scholarly attention on the possible ‘political, ethical and theoretical implications and meanings of birthing embodiment’ (Chadwick R,2p2) has invited more nuanced conversation about consent, agency and decision-making during labour. However, while recognising the embodied particularities of labour, we must also avoid essentialising the differences of labouring bodies and thereby reinforcing exclusionary norms of consent.

    This points to a long-standing tension in feminist theory between the universal and the particular; between recognising and responding to the powerlessness of individuals without …

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    Footnotes

    • Twitter @Anna_Nelson95

    • Contributors Both authors contributed equally to the conception and writing of this work.

    • 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; internally peer reviewed.

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