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Table 3 Pre-eminence of Clinical Risk

From: Consent in pregnancy - an observational study of ante-natal care in the context of Montgomery: all about risk?

  Excerpt 1: Field note from Labour Ward. Consent for External Cephalic Version
This is C’s second pregnancy. She found out through a telephone call from clinic midwife a couple of days earlier (Friday afternoon) but the call was brief and they ‘just said they could try to turn baby to make birth easier’. Since then she has been ‘stressed all weekend’ and ‘Googling madly’ and is very worried.
C sitting on bed is quite apprehensive and says she doesn’t really know the score – Dr. pops in says someone will be back.
Waiting for 20 min or so – people popping in – seems busy and C very tense, fidgety
HCP enters room with junior Dr. + medical student + midwife – asks C if she understands what they want to try to do – friendly but hurried – all 3 standing looking at C on bed
C ‘sort of’ ‘not had very much information’ – explains phone call – nothing else
HCP standing - explains purpose of ECV and how procedure done – pressure for 15 mins – might hurt
C listens intently - looks terrified – HCP appears not to notice
HCP have risks been explained?
C ‘no, looked at Google’ very confused
HCP doesn’t seem to realise how ill-prepared C is. Explains that there are very few risks – mainly that it won’t work no other risks mentioned (? Why not) (should there be discussion of Cesarean Section?)
Asks C if she has any questions
C wants to know how likely it’ll work – not really answered. Very rushed
HCP asks C to sign consent form – form signed
leaves says they’ll be back as soon as they can
C to researcher says she hopes she’s doing the right thing – I get the sense she feels a bit trapped by coming to the Labour Ward as though she can’t change her mind
Impression C needs more chance to discuss – this does not really constitute proper consent in any way – it’s been very fast (Labour ward is busy) and there’s been no discussion of pros and cons
  Excerpt 2: Field note from Labour Ward/Ante-natal clinic. Consent for Cesarean Section
T is a primiparous womanwith an IVF pregnancy. She is being seen in ante-natal clinic but admitted to Labour ward for monitoring (due to raised glucose readings) and potentially a CS in a few days
HCP explains CS procedure – details of practicalities of anaesthesia – T seems very relaxed
Explains risks of CS very thoroughly & clearly – infection/antibiotics; deep vein thrombosis/TED Stockings; bleeding; bladder injury; damage to other structures/repair – very reassuring – checks T seems comfortable physically sitting.
HCP goes slowly and asks T if any questions several times – is that clear? does that make sense? - seems to be trying to make sure T is really engaged without alarming her or making her feel pressured into asking questions
T looks attentive but not sure if she’s really taking it in – seems to be saying yes to everything! Lots of laughter
very excited by birth – seems very relaxed about risks