OB Guideline 2: Informed Consent

Informed consent is a process employing oral and written communication to convey to the patient the significant and material risks, benefits, and alternatives of medical treatments, including the risk of not pursuing any treatment. The consent form should be considered the documentation of the discussion(s), and both the discussion with the patient and the completed consent forms are necessary to ensure and verify that the patient is informed about their and their baby’s care. Consent forms should be presented to patients in a language they can understand. If this is not feasible, a competent translator should be available to translate the consent form orally into the patient’s primary language.

Prenatally, the clinician will initiate the informed consent process for labor and delivery care, guided by the general written obstetrical consent form. Consistent use of an institutionally approved informed consent form is expected.

Discussions involving specific obstetrical interventions, such as external version or vaginal delivery for second twin (non-vertex), use of tocolytic or uterotonic drugs, or forceps delivery, should be initiated with the patient as early as is feasible.

Informed consent during the course of antenatal care and labor management (when appropriate) should be documented in the medical record.

The person who is actually performing a procedure is responsible for reviewing and confirming the informed consent with the patient and for documenting that conversation in the medical record.

Specific and separate written consent is required for:

• Cesarean delivery (per institutional policy)
• Trial of labor after cesarean delivery¹
• Cesarean delivery on birthing person request¹
• Delivery of twins¹
• Breech vaginal delivery
• External version¹
• Circumcision

If an obstetrical patient refuses to sign the consent form, then more dialogue between the clinician and the patient about the patient's preferences vis-a-vis medical judgment during labor and delivery is indicated. Issues of trust should be addressed. The obstetrical team and hospital administrators should develop a coordinated plan to address those issues and manage the patient’s labor and delivery. This discussion should be documented in the patient’s medical record. Documentation should include the dialogue about the pregnancy and plans for labor and delivery that have occurred and note the proposed obstetrical procedures, activities, risks, and benefits, including unexpected risks and complications. The patient’s oral consent for continuing obstetrical care and refusal to sign a consent form should also be documented. The institution’s printed obstetrical consent form can serve as a reference for the detailed note.

If written consent cannot be obtained in an emergency situation, then an attempt should be made to obtain oral consent. This will be sufficient, and can be documented in the record after the emergency has resolved.

1. Sample consent forms can be found in the Appendix to these Guidelines.