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Safeguards for procedural consent in obstetric care
  1. David I Shalowitz1,
  2. Steven J Ralston2
  1. 1 Gynecologic Oncology, West Michigan Cancer Center, Kalamazoo, Michigan, USA
  2. 2 Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr David I Shalowitz, Gynecologic Oncology, West Michigan Cancer Center, Kalamazoo, Michigan, USA; dshalowitz{at}

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Van der Pijl et al outline data suggesting an alarmingly high incidence of violation of the bodily integrity of patients in labour, including episiotomies performed without patients’ consent, or over their explicit objection.1 Similar data have been reported from the USA and Canada.2 The authors appropriately conclude that explicit consent is required at the time of all invasive obstetrical procedures, including episiotomy. Commonsense adjustments to the duration and detail of consent under conditions of clinical urgency are appropriate and should be familiar to any clinician involved in perinatal care, as well as non-obstetric proceduralists caring for acutely ill patients. However, complete omission of consent for any of these procedures is both disrespectful to patients’ autonomy and strongly associated with morbidity from birth-related psychosocial trauma.3–5

The true incidence of obstetrical procedures performed without patients’ consent is difficult to determine for multiple reasons, including sample selection, recall bias and patients’ reluctance to reengage with traumatic experiences; however, …

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  • Contributors Both authors contributed fully to this commentary.

  • 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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