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Table 4 Woman-centred narrative

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

  Excerpt 1: Field note from ante-natal clinic for breech presentation
This is S’s second pregnancy. She is accompanied by her husband. Discussion of elective Cesarean section or trial of labour.
HCP welcomes and explains need to decide whether S wants to opt for a Cesarean section or ‘risk’ a trial of labour. ‘you need to think about the risks and benefits of both decisions and decide what’s best for you’
S says she thinks a Cesarean would be less risky and wants to feel she has a plan this time
HCP ‘well having a CS would be the safest route’
S nods – seems to be happier
HCP Asks if S has thought about whether she wants more children
S looks uncomfortable – ‘possibly’
HCP explains that once she’s had two CS then next birth would need to be CS but she needs to be aware that the risks increase with each subsequent pregnancy
Extensive discussion of risks
Husband sits forward on to edge of chair seems a bit upset – says natural birth is ‘usually better’ and thinks ‘we’ would be better with that; quite dominant and almost aggressive – avoids eye contact
S avoids eye contact and doesn’t say anything – marked ‘tension’ in room; very subdued looks upset
HCP says she can sign the consent form now but can change her mind at any point
S says she’ll do it now; husband looks very cross
HCP asks S and husband if either have any more questions
S No further questions; thanks HCP. Husband is silent – doesn’t say goodbye
Impression HCP – very kind, factual – initially good rapport between the three of them but very different at end. HCP doesn’t seem aware of this. Subsequently, despite having signed the consent form, the woman confided to the researcher that she was very stressed didn’t know what to do ‘I think I should have it (CS) but if I do he’ll say I’m making a decision on the size of our family’
  Excerpt 2: Field note from ante-natal clinic for breech presentation
Relaxed friendly consultation with extensive discussion of risks – L seemed very contented and elective Cesarean Section agreed on. Towards the end of the consultation the following discussion occurred:
HCP one practical thing to think about is that we can’t tell you where you’ll have it. explained to L that her consent was for the CS but not the site – might not be at XXX as about 6 people a week sent to YYY hospital because of bed space
L looked a bit shocked by this – didn’t say very much but seems deflated – get the impression this might be a game-changer for her?
HCP doesn’t seem to have logged L’s reaction
L thanks HCP – takes consent form (which she had signed earlier in the consultation) and outwardly still positive but looks dejected
L to researcher Subsequently confirms to researcher that she will not have an elective Cesarean section but would rather ‘take her chance’ at XXX hospital and ‘would never’ go to YYY