Midwives’ knowledge and practice of informed consent for vaginal examinations in intrapartum hospital care in Germany: A cross-sectional survey

BACKGROUND: Informed consent is a fundamental right and ethical principle in maternity care, promoting decision-making. Although legally mandated in many countries, evidence indicates inconsistencies in its application during intrapartum care. This study aimed to explore midwives' knowledge and practices of informed consent in the context of vaginal examinations during hospital intrapartum care. METHODS: This cross-sectional survey was conducted among midwives providing intrapartum care in German hospitals. A self-completion online questionnaire recorded socio-demographic, educational and professional characteristics, the practice of obtaining informed consent for vaginal examinations in different labour and birth situations, as well as midwives' level of knowledge of informed consent. Ethical approval was granted. The data were analysed descriptively using SPSS statistical software. FINDINGS: A total of 629 midwives participated in the survey, with 84.1% (n = 476) reporting that they obtained informed consent for vaginal examinations. Some discrepancies were found regarding alternatives and negative aspects for vaginal examinations, with considerable variability in time-critical situations. Merely 28.2% (n = 160/568) of midwives reported informing women mostly about the negative aspects of vaginal examination, while information on alternatives was less consistently provided, with 27.2% (n = 154/567) doing so occasionally and 26.5% (n = 150/567) never. Midwives gave correct answers in over 80% regarding general knowledge of informed consent during intrapartum care. CONCLUSIONS: The study provides novel insights into midwives' practices of obtaining informed consent for vaginal examinations during intrapartum care in the German hospital setting. Findings reveal some discrepancies with legal requirements and highlighting the need to strengthen midwives' communication skills for consistent practice in intrapartum care.