The Charter of Rights for Hospital Patients assumes that no medical procedure is carried out without the prior written consent of the patient. "You may request the presence of a person or persons of your choosing during the procedure for granting consent. The consent form you are asked to sign should clearly state the nature of the procedure to be undertaken," it says.
The National Maternity Hospital does not seek written consent for amniotomy or oxytocin, according to Dr Declan Keane, its master; nor does it have guidelines for midwives on seeking informed consent. "Women are told in the antenatal classes that hospital policy is to break the waters," he says. "In labour, they are told: 'you are now in labour. Our policy is to break the waters. We wish to rupture the membranes.' If they don't want it, we don't do it."
Keane says it's the same with oxytocin. "Not a lot of patients exercise their right to refuse. They are told in the antenatal classes that if their labour is not going along at an acceptable rate - that's one centimetre per hour - then our policy is to give them oxytocin. If they don't want it, we don't do it." A lot of birth plans, he says, specify no early amniotomy and no oxytocin. "It's not being rammed down their throats."
At the Coombe Women's Hospital in Dublin, a woman signs a general consent form on admission to the labour ward. "You're supposed to seek consent," says Dr Sean Daly, the master. "Tell them what you're doing and ask their permission to do it." As at the National Maternity Hospital, the Coombe does not seek written consent for routine labour procedures, nor has guidelines on consent for midwives.
Dr Peter McKenna, the master of the Rotunda, also says his hospital has no such guidelines. Women's consent to procedures such as amniotomy "would be covered in the general consent". He declined to explain how "the general consent" operated at the Rotunda.