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Reviewing past and present consent practices in unplanned obstetric interventions: an eye towards the future
  1. Morganne Wilbourne1,
  2. Frances Hand2,
  3. Sophie McAllister3,
  4. Louise Print-Lyons4,
  5. Meena Bhatia3
  1. 1Women's and Reproductive Health, Oxford University, Oxford, UK
  2. 2Faculty of Law, University of Oxford, Oxford, UK
  3. 3Obstetrics and Gynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4Oxfordshire Maternity and Neonatal Voices Partnership, Oxford, UK
  1. Correspondence to Morganne Wilbourne, Women's and Reproductive Health, Oxford University, Oxford OX3 9DU, UK; morganne.wilbourne{at}


Many first-time mothers (primiparous) within UK National Health Service (NHS) settings require an obstetric intervention to deliver their babies safely. While the antepartum period allows time for conversations about consent for planned interventions, such as elective caesarean section, current practice is that, in emergencies, consent is addressed in the moments before the intervention takes place. This paper explores whether there are limitations on the validity of consent offered in time-pressured and emotionally charged circumstances, specifically concerning emergency obstetric interventions. Using the legal framework of the Mental Capacity Act, Montgomery v. Lanarkshire Health Board (2015) and McCulloch v Forth Valley Health Board (2023), we argue that while women have the capacity to consent during labour, their autonomy is best supported by providing more information about instrumental delivery (ID) during the antepartum period. This conclusion is supported by some national guidelines, including those developed by the Royal College of Obstetricians and Gynaecologists, but not all. Further, we examine the extent to which these principles are upheld in modern-day practice. Data suggest there is relatively little antepartum information provision regarding ID within NHS settings, and that primiparous women do not report a thorough understanding of ID before labour. Based on these results, and bearing in mind the pressures under which NHS obstetric services currently operate, we recommend further research into patient and clinician perceptions of the consent process for ID. Pending these results, we discuss possible modes of information delivery in future practice.

  • Coercion
  • Decision Making
  • Ethics- Medical
  • Obstetrics
  • Women

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  • X @FrancesHand_

  • Contributors FH and MW have contributed equally to this project and should be considered to have joint first authorship. They are entitled to reference their own name first on curricula vitae. They have planned the project and drafted the original manuscript. SA, LP-L and MB provided revisions to the original manuscript. LP-L provided data from the Oxfordshire Maternity and Neonatal Voices Partnership. MB and SM provided supervision. MB and SM provided clinical insight and ensured accuracy with respect to current NHS practice in obstetrics. MB is the guarantor and accepts full responsibility for the finished work and the conduct of the study, had access to the data and controlled the decision to publish.

  • 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.