Contemplating what ethical care during pregnancy looks like leads to considerations of how, when and what information is provided. The provision of information is not a new concept medically or legally: it is well established that healthcare providers must ensure that patients are informed about the medical treatments available to them, and consent to any invasive procedures.

One might, therefore, expect that healthcare providers would take care to ensure that women expecting to give birth are made aware of the birthing options available to them, and the harm/benefit profiles of those options, so that they can reflect upon which risks they prefer to expose themselves to during childbirth. This would ensure women’s preferences around childbirth were appropriately informed, and that any consent given for interventions is valid. However, the rise in birth trauma awareness, anecdotal evidence and posts in birth trauma forums, often with women describing events which they felt unprepared for or were completely outside of their control, suggests otherwise.

Instead, vaginal delivery is treated as a ‘default’ option, that women are expected to pursue unless there are clear reasons to do otherwise. As a result, it is not presented as one option amongst a number to be considered, but as the automatic, ‘natural’ completion of pregnancy, barring exceptional circumstances. Disclosure and consent are all too often sought only once an intervention (be it an episiotomy, assisted delivery, or emergency caesarean) becomes imminently (perhaps urgently) recommended. This provides little time for the reflection and weighing of information. Worse, all too often, it seems consent for interventions during delivery is not sought at all: in this journal, van der Pijl and colleagues have described how numerous women report undergoing episiotomies and other procedures without providing prior consent. It seems that healthcare professionals in obstetric settings often do not think that informed consent is needed.

Yet women can and will reasonably have different preferences regarding what risks they expose themselves to: they have their own values, priorities and fears. The risks to mother and child of vaginal versus caesarean delivery are comparable: the UK NICE guidelines – which recommend providing caesarean sections when women request them, even in the absence of a clear medical indication – reflect this fact. An attempt at vaginal delivery will fairly often end up with an ‘emergency’ caesarean section being performed, meaning that women may experience the downsides of both these forms of delivery. Surprisingly, even the costs of planned vaginal delivery versus planned caesarean section are more similar than is typically assumed: planned caesareans are estimated to cost about £84 extra per delivery in the UK when the downstream costs of incontinence are factored in.

The fulsome provision of information regarding the risks of birthing interventions ahead of time enables individual decision making and agency, and ought to be expected in ethical medical care.

Authors: Kelly Irvine[1]Rebecca CH Brown. [2]Julian Savulescu [3,4,5]

[1] University of Melbourne VCCC, Parkville, Victoria, Australia

[2] Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK

[3] Faculty of Philosophy, University of Oxford, Oxford,

[4] UK Murdoch Children’s Research Institute, Parkville, Victoria, Australia

[5] Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Competing interests: None declared