An audit of informed consent for cesarean section and instrumental delivery in a tertiary referral center in the United Kingdom

Kate Glennon¹, Clare Tower², Joanna Gillham³, Jenny Myers^2
1St Mary's Hospital, Manchester University, Manchester, UK; ²Maternal and Fetal Health Research Centre, St Mary's Hospital, Manchester, UK; ³St Mary's Hospital, Manchester, UK

Purpose: To audit the process of informed consent for cesarean section (CS) and instrumental delivery (ID) in a tertiary referral center in the UK.
Design: The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines on consent¹ were used as audit standards. A retrospective questionnaire was used to assess patients’ recall and views of the consent process. In total, 116 consent forms were audited (CS = 83, instrumental delivery = 33).
Findings: The consent forms complied with the auditable standards on consent for CS, in relation to documentation of the major risks of surgery. The majority of CS consent forms did not meet the standards in terms of documentation of the risk of laceration to baby or the possibility of hysterectomy. However, most women were questioned on consent between contractions, in accordance with the RCOG guidance on consent (50% CS deliveries and 68% instrumental deliveries). The patients who consented for elective CS, were more likely than emergency CS patients to be able to recall the risks explained.
Action: The findings of this audit indicate that the introduction of a standardized consent proforma would provide a structured approach to preoperative counselling and documentation.

Keywords: informed consent, cesarean section, instrumental delivery, patient recall, documentation