Women often given an episiotomy during childbirth without explicit consent: Report

Over 40 percent of women who got an episiotomy during childbirth did not give explicit consent for the procedure. A small proportion was asked by their healthcare provider whether they consented to the cut, but their refusal was ignored, according to a study by health scientist Marit van der Pijl of Amsterdam UMC and gynecologist Martine Hollander of Radboud UMC, the Volkskrant reports.

By law, healthcare providers must get explicit consent from a patient for major medical procedures. In birth care, these include a vaginal examination, a caesarian section, or an episiotomy - making a cut to speed up the delivery because the child is in danger. The healthcare provider must explain the treatment options and their consequences, and the patient must give verbal or written permission. A patient can always refuse treatment.

But that refusal is not always respected, Van der Pijl and Hollander found after questioning 11,000 women on whether they underwent one or more common medical procedures during childbirth. And if so, whether their doctor asked for their permission.

Almost all women underwent a vaginal examination during childbirth. Over 90 percent said their doctor asked for permission.

But, of the 2,308 women who received an episiotomy, 962 (41.7 percent) said their healthcare provider did not ask for their consent. 26.5 percent of them, 255 women, felt that was a problem. Another 43 women refused the episiotomy, but the healthcare provider did it anyway.

Healthcare providers also often administer an injection with the hormone oxytocin - to deliver the placenta and prevent blood loss - without permission. Of the 4,788 women who got the injection, 2,274 said the doctor didn’t ask beforehand. And 41 got the injection after they refused it.

“The tricky thing about maternity care is that the healthcare provider feels responsible for both the mother and the child,” said Hollander. “If the mother does not want treatment, it also has consequences for the child. That is different from someone with breast cancer who does not want chemotherapy after receiving information.”