The Consent requirement for pregnancy and birth is a convenient one-page guide for maternity care providers in NSW public hospitals.
This document summarises Section 10.2 of the NSW Health Consent to Medical and Healthcare Treatment Manual which sets out the legal requirements to obtain a valid, informed consent prior to providing pregnancy and birth related tests, procedures and interventions.
The consent requirements for pregnancy and birth have not changed, however they have been clarified to support the requirement for valid, informed consent.
Early discussions with women about the range of pregnancy and birth related tests, procedures and interventions will ensure women have adequate information and time to consider their options, ask questions and express preferences. This is critical to a valid, informed consent.
The principles informing these discussions should focus on respecting women's choices and shared decision making. The relative merits, material risks, implications for mother and baby, the timing of these interventions and any potential alternatives to the interventions should be discussed and documented in the Health Record.
For information about consent and refusal of treatment see section 9.14 of the NSW Health Consent to Medical and Healthcare Treatment Manual.
Oral consent (or informed refusal) must be recorded in the Health Record for tests such as: blood tests, Cardiotocographs (CTGs) and ultrasounds.
Spontaneous vaginal birth does not require written consent.
Written consent is required before planned interventions such as elective caesarean section, vaginal birth after caesarean, induction of labour, planned vaginal twin birth, planned vaginal breech, external cephalic version and termination of pregnancy:
Consent must be recorded using the Consent to Medical Treatment /Procedure (Adult with capacity) Form (Appendix 2A of the NSW Health Consent to Medical and Healthcare Treatment Manual). Consent should be confirmed on the day of the procedure and documented in the Health Record.
Written consent should be obtained where practicable in the circumstances and when time permits prior to unplanned interventions performed in the operating theatre such as emergency caesarean section, trial of instrumental birth, repair of severe perineal trauma, manual removal of placenta, insertion of Bakri Balloon or other postpartum haemorrhage procedures.
Consent should be recorded using Consent to Medical Treatment /Procedure (Adult with capacity) Form (Appendix 2A of the NSW Health Consent to Medical and Healthcare Treatment Manual).
Written consent is not required in an emergency to save a life however, a woman's implied or oral consent should be recorded in the health record.
Written consent should be obtained where practicable in the circumstances and when time permits prior to: Instrumental births, epidural block, perineal repairs (third/ fourth degree), manual removal of placenta .
Consent should be recorded using the Consent to Medical Treatment /Procedure (Adult with capacity) Form (Appendix 2A of the NSW Health Consent to Medical and Healthcare Treatment Manual).
Written consent is not required in an emergency to save a life; however, a woman's implied or oral consent should be recorded in the health record.
For perineal repair without external anal sphincter involvement that is performed under local anaesthesia, written consent is not required.
Oral consent is required and must be recorded in the Health Record for episiotomy; perineal repair without external anal sphincter involvement; all vaginal examinations; artificial rupture of membranes; application of fetal scalp electrode; and fetal scalp sampling.