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Birth, trust and consent: reasonable mistrust and trauma-informed remedies
  1. Elizabeth Lanphier1,2,
  2. Leah Lomotey-Nakon3
  1. 1 Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2 Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  3. 3 Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Dr Elizabeth Lanphier, Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati 45229, OH, USA; elizabeth.lanphier{at}

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In ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al 1 respond to the prevalence of unconsented procedures during labour, proposing a set of necessary features for adequate consent to episiotomy. Their model emphasises information sharing, value exploration and trust between a pregnant person and their healthcare provider(s). While focused on consent to episiotomy, van der Pijl et al contend their approach may be applicable to consent for other procedures during labour and beyond pregnancy-related care.

One feature of their model for adequate informed consent is trust in the systems in which prenatal and labour and delivery care are provided. Yet, for some pregnant persons, mistrust in health systems is a reasonable sequela of experiences like racism and epistemic injustice. For a programme in which trust is central to adequate consent, it is important to identify—and counter—forms of mistrust toward pregnant persons within healthcare and acknowledge and rectify reasonable mistrust of pregnant persons toward healthcare.

Like other kinds of healthcare disparities, van der Pijl et al note that ‘the burden of unconsented procedures is not evenly distributed over groups’ and tracks with ‘racial, socioeconomic and other disparities in maternity care’. They are drawing on data from a less diverse context than the one …

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  • Contributors EL proposed and drafted the initial manuscript. LL-N provided additional conceptualisation and edited the manuscript for critical revisions. Both authors reviewed and approved the manuscript.

  • 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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