Women’s experiences of consenting to episiotomy: a qualitative interview study

Objective: To explore how women undergoing episiotomy experience and perceive the consent process. Design: Qualitative interview study. Setting: A postnatal ward in a London teaching hospital. Sample 15 women who had recently undergone episiotomy. Methods: Semi-structured, audio-recorded interviews were analysed using thematic analysis. Main outcome measures Themes derived from analysis of interview transcripts. Results: Three themes emerged in relation to women’s experiences of the episiotomy consent process: 1) realities of episiotomy practice, 2) information provision and 3) voluntariness of consent. Practical realities such as time pressure, concern for the baby’s health and women’s state of exhaustion, constrained consent discussions. Minimal information on episiotomy was shared with participants, particularly concerning risks and alternatives. Participants consequently inferred that there was no other choice to episiotomy. Whilst some women were still happy to agree, others perceived the consent process to be illusory and disempowering, and subsequently experienced episiotomy as a distressing event. Conclusions: Consent to episiotomy is not consistently informed and voluntary and more often takes the form of compliance. Information must be provided to women in a timelier fashion in order to fulfil legal requirements, and to facilitate a sense of genuine choice. Funding The study has not received grant funding. The research team are funded by the Higher Education Funding Council for England (HEFCE). Keywords: Episiotomy, consent, women’s experiences, qualitative