O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 2 | 6 O&G Forum 2021; 31: 06 - 09 ORIGINAL RESEARCH Exploring the Adequacy of Obtaining Informed Consent for Caesarean Deliveries - A Patient Perspective Introduction Informed consent is a fairly new concept to the practice of medicine. In ancient medical practice a paternalistic approach was adopted. Paternalism implies that the physician makes decisions based on what he or she deems is in the best interest of the patient despite the fact that the patient is capable of making the decision themselves. is was the practice of medicine in the 19th century. 1 During the 20th century various legal decisions swung the pendulum from a paternalistic approach to a more patient-centered approach. is process includes shared decision-making about treatment options between physician and patient. It is a key component of patient-centered care and is the preferred model for communication in healthcare encounters. 1,2 Autonomy is one of the major ethical principles which govern medicine today. 1,3,4 Autonomy can be broadly de ned as a person’s capacity to freely express his/her own will and freedom for action. 3,4 Patient autonomy is when patients are the decision makers who act intentionally, with understanding and without controlling in uences to determine their decisions. 3 is may be complicated in di cult maternal-fetal situations where for example the fetus may bene t from caesarean section for fetal distress, but the mother has the right of informed refusal. e foundation of informed consent rests on the principle of respect for autonomy and dignity of persons, consent based on information and understanding, and the right of informed refusal. 3,4,5 As informed consent has a legal component it forms part of patients’ rights. Patients’ rights vary in di erent countries and in di erent jurisdictions. Di ering models of the doctor-patient relationship infer the particular rights of patients in each country. 5 Patients’ rights are protected by laws that regulate the type of information that patients must be given so that they can make an informed decision regarding receiving medical care, diagnostic tests or treatment. Some countries have speci c laws about certain medical situations and levels of disclosure to patients. In South Africa self- determination and the rights to bodily and psychological integrity are accepted as fundamental rights of every patient since 1996 when the new Constitution was adopted. 6 e aim of the study was to ascertain the adequacy of the process of informed consent obtained prior to a caesarean delivery in a South African academic healthcare setting. Methods A descriptive study was conducted between April and August 2019 in a major South African center, which comprises three tertiary hospitals. Hospital 1 serves an estimated 2 million people, Hospital 2 is a tertiary Abstract Objectives: The objective of this study was to assess the adequacy of informed consent obtained from patients prior to caesarean delivery. Design: Descriptive study Setting: Tertiary level hospitals in a major South African center in Pretoria, South Africa Subjects: Two-hundred-and-fifty patients who underwent elective and emergency caesarean deliveries Outcome measures: The assessment of the adequacy of the informed consent was assessed via a questionnaire that the participants answered on day 2-3 post caesarean delivery. Results: Average age of participants was 28.8 years (28.75 ± 5.92). Twenty three percent (23.2%) of the participants underwent elective and 76.8% underwent emergency caesarean deliveries. Seventy five percent (75.6%) of the participants knew the name of the procedure, although only 29.2% were aware of the associated risks, and 59.2% of participants knew of their right to refuse the procedure. Conclusion: Adequate communication is essential to all aspects of medicine and this study has highlighted the inadequacy of the informed consent process that takes place at our institution. Information regarding risks and complications was not adequately communicated. A standardized informed consent document that healthcare professionals can use for counseling, starting antenatally, should be considered. Keywords: Caesarean section, Informed consent Correspondence S Adam email: Sumaiya.adam@up.ac.za P. Theletsane 1 , T. Cronje 2 , B.G Lindeque 3 , S. Adam 4 1 Registrar in Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa 2 Senior Research Consultant, Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa 3 Emeritus Professor, Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa 4 Adjunct Professor, Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa