Written By: Dr Ummay Kulsoom

Led by International Cesarean Awareness Network (ICAN), the month of April emphasizes the importance of evidence based care, informed consent, and empowering women to make the best decisions for their health and their babies.
The purpose is to raise awareness about childbirth options, risk of Cesarean sections and to provide support for Vaginal Birth After Cesarean (VBAC).
It aims at educating not only parents, but also healthcare providers about the risk and benefits of Cesarean as well as the importance of reducing unnecessary C-sections. It advocate for support for those who have experienced a C-section whether planned or emergency and encourages for better birth practices. The major goal is to safely reduce the rate of non-medically indicated surgical births and to breakdown the stigma and the misinformation surrounding vaginal birth after Cesarean.
This month also validates the complex physical and emotional recovery journey following a C-section. Sitting on the edge of a table to get a needle pierced through your back into your spine for a spinal block, getting seven layers of tissues cut to get your baby out, trying to breastfeed your baby while you are still getting stitched up, gathering strength and courage to stand and start walking ASAP and giving in all to focus on your baby through the nausea, the pain and the physical recovery ain’t everyone’s cup of tea! It is not at all easy and the mothers who experience birth trauma, unexpected surgical delivery, challenging postpartum healing need to feel seen and supported.

What really is informed consent?

Informed consent means that you have been given a detailed and accurate description of what will happen in a language that is understandable to you, with clear explanation of why this may be helpful or recommended for you, and any risk or complications that could arise as a result. It allows you to freely ask questions following which you are given time to make an intentional and voluntary decision, and it also includes the choice to decline without any further pressure.

So, where is the problem?

Why healthcare providers are in such hurry to get the papers signed? Why is there no proper communication and why every time it seems as if the only expected response from mother is a YES?!
Informed consent during childbirth remains a critical and unresolved ethical as well as practical challenge. As an obstetrician who has worked with institutions and hospitals and as a mother who whole heartedly supports natural unmedicated birth for as many moms as possible, let me discuss a few challenges faced by health care providers in real life.
A 2025 French study comprehensively explains the barriers to informed consent. Systemic constraints, the ethical distress of healthcare providers, and the prevailing safety paradigm often hinder the respect of mother’s autonomy. Studies have shown that women frequently undergo medical interventions during childhood without fully informed and voluntary consent.
Blaming individual healthcare professionals as solely responsible for this failure is unjust. The systemic and organizational factors play a major role to influence consent practices in obstetrics. Emphasis on efficiency, protocol adherence, time constraints and risk minimization may conflict with professionals’ desire to provide compassionate, individualised care and also impact on how informed consent is taken and whether it is genuinely meaningful or not.
In emergency situations, the urgency of decision making often leaves a very little room for patients to consider their options completely. Prioritization of fetal well-being and risk management often results in medical interventions without explicit maternal consent. This can undermine women’s autonomy by drafting consent as secondary to clinical urgency.
Another common practice is selective disclosure where information is sometimes tailored to obtain compliance rather than facilitate autonomous decision-making. Recently, obstetric violence cases and open discussions have created a breach of trust between patients and healthcare providers further complicating the informed consent process. This lack of trust hampers open, honest dialogue and also undermines the ethical principle of autonomy as moms me feel coerced or suspicious of the decisions made by caregivers.
Healthcare providers frequently report a sense of powerlessness when unable to provide care aligned with their ethical principles due to insufficient staffing, excessive workloads or rigid protocols particularly in high-pressure situations were rapid decisions are required.
Another disturbing trend is hierarchical structure within the medical system, which positions the healthcare providers especially doctors as authority figures whose decisions may override the patient preferences. There is a power imbalance that limits the opportunities for shared decision making and respect for autonomy.

Let’s talk about solutions

  1. Building a strong care provider- client relationship is imperative to achieving ethical consent and avoiding both trauma and misunderstanding.
  2. Health professionals must recognize that informed consent should not be subordinated to other priorities. When informed consent is the priority, it creates a foundation of respect and partnership. It builds a greater trust between the client and care provider, increases the overall satisfaction and makes the mother feel empowered and clearheaded, even when complications or unexpected decisions arise.
  3. Health providers should be educated on the psychological consequences associated with lack of informed consent, including the traumatic impact of feeling excluded from decision-making or subjected to non-consensual care.
  4. Trust, equal participation and sincerity ensure a genuine and effective decision-making process. It is essential to create an environment where women feel safe to express their needs, concerns and preferences.
  5. Transparency and honesty in communication is another key component of a meaningful care relationship.
  6. Implementing one to one support models allow for better individualized care, trust building and share decision making. Hiring a Doula for labor and birth can be an effective way to enhance communication and trust.
  7. Encouraging caregivers training, reflection of their practices, debriefings and ethical discussions would help them navigate complex situations with greater awareness and empathy.
  8. Acknowledging and integrating patients’ negative feedback is crucial to improving care practices and rebuilding trust and compassion.
  9. Encouraging and supporting a culture of compromise where professionals and clients engage in a meaningful and equal discussion rather than hierarchical decision making could help mitigate power imbalance and promote a more respectful, patient-centered approach to child birth.
While the care providers and institutions have a greater responsibility to make any consent truly informed and support share decision-making, It’s also the birthing mother’s obligation to be educated about her rights and options, and to ensure that she feels confident and well supported to advocate for her choices and speak for her rights. If used appropriately informed consent is one of the most powerful tools any mother can have. It’s not about being a good obedient patient and courteously agreeing to everything offered. Nobody will give you an award for your politeness. It’s not just signing a form. Every signature of yours comes with a cost. It’s about understanding your options, knowing your rights and making decisions that are aligned with your values and your body. You will live with the consequences of your birth and informed consent ensures that you remain in control, especially in vulnerable moments.

Our AMANI Mothers already know the drill!

  •  Do your own research
  • Always use ‘BRAIN’ questions before you make a choice.
  • Have a birth partner or advocate who knows your preferences, can help ask questions and speak up if you are tired, overwhelmed or in pain.
  • Always always have a birth plan.
  • It’s your right to say NO
  • Choose a care provider who is open to communication. Doctor shopping is crucial and essential.
A wise doula has stated “informed consent is your lifeline to bodily autonomy” and I couldn’t agree more. It transforms your birth from a submissive experience to an empowered partnership. Let the awareness spread as we strive to create a supportive and trusted environment for all birthing mothers where their voice and their choice remains the priority inshaAllah.