Vaginal deliveries - is there a need for documented consent?

Abstract

Historically caesarean section has been seen to be more dangerous than a vaginal delivery. However, with advances in medical care, caesarean sections are far safer today. In addition, the complications of unmonitored labour, especially in the public sector are steadily increasing. Delivery should be discussed during the antenatal period. The consent process for the decision to have a caesarean section is followed by the signing of a consent form. Women who decide to deliver vaginally are not asked to sign a similar form. However, natural birth, a normal physiological process, and modern medical vaginal childbirth are not synonymous and doubtless each intervention in the latter requires consent. Given the current legal climate, the question we therefore ask is 'Does the modern medical vaginal birth process itself require an authorisation form?' In this paper, we present some current scientific opinions on the risks and benefits associated with vaginal and abdominal delivery. We recognise the women’s right to choice in respect of mode of delivery. We argue that even where the health care practitioner anticipates a normal vaginal delivery, s/he is obliged to discuss the alternative, i.e. a caesarean section with the woman. We also explore some other issues that require to be discussed with the woman prior to delivery, and make an argument that the context and environment of the delivery ward are important components of the conversation. The aim of this paper is to stimulate discussion and debate on the current and future status of vaginal deliveries.