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:

• 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, thenmore dialogue between the clinician and the patient about thepatient’s preferences vis-a-vis medical judgment during laborand delivery is indicated. Issues of trust should be addressed.The obstetrical team and hospital administrators shoulddevelop a coordinated plan to address those issues and managethe patient’s labor and delivery. This discussion should bedocumented in the patient’s medical record. Documentationshould include the dialogue about the pregnancy and plans forlabor and delivery that have occurred and note the proposedobstetrical procedures, activities, risks, and benefits, includingunexpected risks and complications. The patient’s oral consentfor continuing obstetrical care and refusal to sign a consentform should also be documented. The institution’s printedobstetrical consent form can serve as a reference for the detailednote.

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

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