Lee Nigel, Kearney Lauren, Shipton Emma, Hawley Glenda, Winters-Chang Peta, Kilgour Catherine, Brady Susannah, Peacock Ann, Anderson Loretta, Humphrey Tracy
Level 3 Chamberlain, Building, School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.
Level 3 Chamberlain, Building, School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Level 6 Ned Hanlon Building, Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Health, Queensland, Australia.
Women Birth. 2023 Nov;36(6):e574-e581. doi: 10.1016/j.wombi.2023.02.005. Epub 2023 Feb 18.
While consent is an integral part of respectful maternity care, how this is obtained during labour and birth presents conflicting understandings between midwives' and women's experiences. Midwifery students are well placed to observe interactions between women and midwives during the consent process.
The purpose of this study was to explore the observations and experiences of final year midwifery students of how midwives obtain consent during labour and birth.
An online survey was distributed via universities and social media to final year midwifery students across Australia. Likert scale questions based on the principles of informed consent (indications, outcomes, risks, alternatives, and voluntariness) were posed for intrapartum care in general and for specific clinical procedures. Students could also record verbal descriptions of their observations via the survey app. Recorded responses were analysed thematically.
225 students responded with 195 completed surveys; 20 students provided audio recorded data. Student's observations suggested that the consent process varied considerably depending on the clinical procedure. Discussions of risks and alternatives during labour were frequently omitted.
The student's accounts suggest that in many instances during labour and birth the principles of informed consent are not being applied consistently. Presenting interventions as routine care subverted choice for women in favour of the midwives' preferences.
Consent during labour and birth is invalidated by a lack of disclosure of risks and alternatives. Health and education institutions should include information in guidelines, theoretical and practice training on minimum consent standards for specific procedures inclusive of risks and alternatives.
虽然同意是尊重孕产妇护理的一个组成部分，但在分娩过程中如何获得同意，在助产士和产妇的经历之间存在相互矛盾的理解。助产专业学生处于观察产妇与助产士在同意过程中的互动的有利位置。
本研究的目的是探讨助产专业最后一年学生对助产士在分娩过程中如何获得同意的观察和体验。
通过大学和社交媒体向澳大利亚各地的助产专业最后一年学生发放在线调查问卷。基于知情同意原则（适应症、结果、风险、替代方案和自愿性），针对一般产时护理和特定临床程序提出了李克特量表问题。学生们还可以通过调查应用程序记录他们观察的文字描述。对记录的回答进行主题分析。
225名学生回复，195份调查问卷填写完整；20名学生提供了录音数据。学生的观察表明，同意过程因临床程序而异。分娩期间对风险和替代方案的讨论经常被省略。
学生的描述表明，在分娩的许多情况下，知情同意原则并未得到一致应用。将干预措施作为常规护理呈现，颠覆了产妇的选择权，而倾向于助产士的偏好。
分娩时的同意因缺乏对风险和替代方案的披露而无效。卫生和教育机构应在指南、理论和实践培训中纳入关于特定程序最低同意标准（包括风险和替代方案）的信息。
