Labor and delivery staff: how to explain decisions and ask for consent

Urgency has degrees

When a decision is needed during labor, staff should first assess how much time there really is to explain the situation and hear the woman’s response. An immediate need to act is not the same as the fast pace of a busy unit. Briefly explaining why a decision is needed now helps the patient understand the urgency without presenting every procedure as inevitable. Staff should also identify the options available in the circumstances, rather than offer a choice that cannot be carried out. If time is short, the explanation can be brief, but it should still leave room for her to respond. Assessing urgency does not end the conversation; it helps staff adapt it to the situation rather than skip it altogether.

What respect means

Respect in the delivery room means speaking with the woman in labor, not talking about her over her head. A review of 37 studies on respectful maternity care identifies dignity, consent, and privacy as important areas, but does not confirm the effectiveness of any one approach to asking for consent. In practice, before the next step, staff should address the patient directly, name the proposed procedure, and ask for her consent as the situation allows. Even under time pressure, her questions deserve an answer. Simply stating information at the bedside is not enough if staff give her no opportunity to respond. This approach preserves her role in the decision even when the conversation must be brief.

A message she can understand

Pain can make a long explanation hard to take in. Before a procedure, it is better to start simply: what staff intend to do, why, and what the most important risk is. Then explain how much time there is to decide and how she can respond. If two options are genuinely available, briefly name them and say what will happen next. Staff should not describe a routine procedure as though its being routine takes away the patient’s choice. When circumstances allow, leave a moment for questions. It is also worth checking what she heard and understood rather than assuming the explanation got through despite the pain and rush.

The role of a support person

A support person may help the woman in labor ask questions, but their presence does not determine who answers the staff. First, ask the patient what role she wants that person to have during the conversation and examination. If she can speak for herself, her response should not be replaced by the support person’s, even if they want to help or answer more quickly. Staff should also explain the rules for being present during an examination and protect the patient’s privacy. This keeps support from becoming decision-making on her behalf. Addressing questions directly to the patient matters especially when things are moving quickly: it is easy to shift the conversation unintentionally to someone standing nearby who has more energy to speak.

Research from different settings

A review of 13 studies describes factors associated with respectful maternity care from the perspective of staff in lower-resource countries. It is a useful starting point for examining one’s own practice, but not a basis for applying reported rates of violations to Polish maternity units. Research on childbirth experiences needs to be read in light of its setting, methods, and who was asked. Rather than assume the practices described occur everywhere in the same way, a team can examine when direct conversation, consent, and privacy are harder to maintain in its own facility. This distinction lets the team draw on categories of experience without presenting findings from another setting as a picture of local conditions.

After an urgent decision

After an urgent intervention, staff should return to the woman in labor once the immediate pressure has passed. They can then calmly explain what was done, why the decision was made, and what she can expect next. They should also ask about any concerns: something there was no time to explain during the intervention may still need clarification. This later conversation does not replace asking for consent if there was an opportunity to do so beforehand. Nor should it imply that her earlier lack of response amounted to a choice. The aim is to discuss what happened honestly and address her directly again, not to justify having left her voice out of the decision.

What the team can improve

At a team briefing, staff can practise one short explanation: the reason for the proposed procedure, the choice genuinely available, and a request for a decision addressed to the woman in labor. It is also worth examining shift handovers, when information is passed between staff in the patient’s presence and it is easy to compromise her privacy or start talking about her rather than to her. After a difficult situation, the team can note which parts of the conversation it managed to preserve and where haste deprived the patient of information she needed. The review of 37 studies helps identify the importance of dignity, consent, and privacy, but evidence for the effectiveness of interventions is limited; an erratum was also published. Practising these conversations is therefore a proposed improvement to practice, not a proven guarantee of an outcome.

A rushed delivery may shorten the conversation, but it should not reduce the patient’s decision to a formality. Staff can briefly explain why action is needed, identify the options available, and speak directly to the woman in labor.

Using Empatyzer to prepare for consent conversations during labor

Empatyzer can help staff prepare for a brief conversation before pressure builds in the delivery room. With Em, they can practise a sentence that explains why action is needed, sets out the next step, identifies an available choice, and ends with a question addressed to the woman in labor. It is worth checking that it does not sound like an instruction when the patient can make a decision. The “About Me” section helps staff examine their own tendency to shorten explanations under pressure; the point is to notice a habit, not to replace an assessment of the specific situation. Em can also suggest a simple way to tell the patient what will happen next. A micro-lesson helps reinforce asking for consent and checking what she understood. Even a prepared message must be adapted to the actual urgency, available options, and the patient’s response. The tool is for practising how to communicate, not for making decisions on her behalf or setting formal rules for consent.