Elizabeth Newnham1, Lois McKellar2, Jan Pincombe3. 1. University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia. Electronic address: newnhame@tcd.ie. 2. University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia. Electronic address: lois.mckellar@unisa.edu.au. 3. University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia. Electronic address: jan.pincombe@unisa.edu.au.
Abstract
OBJECTIVE: to investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth. DESIGN: ethnography. SETTING: tertiary hospital in Australian city. PARTICIPANTS: sequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork. FINDINGS: women were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence. KEY CONCLUSIONS: informed consent is an oft-cited human right in health care, yet in maternity care the micro-politics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices. IMPLICATIONS FOR PRACTICE: as primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned.
OBJECTIVE: to investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth. DESIGN: ethnography. SETTING: tertiary hospital in Australian city. PARTICIPANTS: sequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork. FINDINGS:women were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence. KEY CONCLUSIONS: informed consent is an oft-cited human right in health care, yet in maternity care the micro-politics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices. IMPLICATIONS FOR PRACTICE: as primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned.
Authors: Sarah Milosevic; Sue Channon; Billie Hunter; Mary Nolan; Jacqueline Hughes; Christian Barlow; Rebecca Milton; Julia Sanders Journal: Midwifery Date: 2019-10-05 Impact factor: 2.372
Authors: Sarah Lawrence; Dave Namusanya; Andrew Hamuza; Cornelius Huwa; Dennis Chasweka; Maureen Kelley; Sassy Molyneux; Wieger Voskuijl; Donna M Denno; Nicola Desmond Journal: PLoS One Date: 2021-02-04 Impact factor: 3.240