August 9th, 2022

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Informed Consent for Vaginal Delivery: Is It Time to Revisit the Shared Decision-Making Process?
Authors:  Mokerrum F. Malik, M.D., Awoniyi O. Awonuga, M.D., and Cheryl B. Iglesia, M.D.
BACKGROUND: Vaginal delivery as we know it today has evolved, with increasing recognition of trauma to the pelvic floor and perineum. Evolutionary adaptation of the human female pelvis to vaginal deliveries brings with it many benefits, but risks still exist. These benefits and risks should be discussed with patients prior to delivery. Currently, no consensus exists on a standard informed consent process prior to normal vaginal delivery.
OBJECTIVES: To synopsize the current literature regarding the ethics of informed consent in the setting of obstetric and gynecological practice, and to make the case for informed consent for vaginal delivery prior to labor.
DISCUSSION: Vaginal birth is still viewed as the default method of delivery. The reason for this is not unrelated to the direct connection between the uterus that holds the fetus before labor, and the vagina, for which the term birth canal was given even before modern obstetrics. Although there are known benefits for advocating vaginal births, there are also attendant risks.

CONCLUSION: It is incumbent on obstetricians and midwives to discuss those risk and benefits with their patient prior to labor. Verbal discussion without documentation may no longer be appropriate due to medical advancements and the litigious health care climate. For this reason, we argue for and advocate that a consent process be included as an educational measure and as part of our ethical obligation to provide care.
Keywords:  informed consent, obstetric delivery, obstetric surgical procedures, obstetrical surgery, pelvic floor, pelvic floor disorders, urinary incontinence, urogynecology, urology, vaginal delivery.
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