"I didn't feel I could say no": A qualitative study of pregnant women's experiences of consent to vaginal examinations

Objective: A vaginal examination (VE) using digital cervical assessment is routinely offered to women to assess whether labour is established and to monitor its progress. Informed consent is always required but anecdotal evidence suggests these requirements are often ignored. This study investigates women's experiences of being asked for their consent to VE(s). Study Design: Qualitative study using semi-structured face-to-face interviews with 17 women who had recently undergone a VE during labour at an urban inner-city hospital. Data were analysed using thematic analysis. Results: Two overarching, inter-related themes captured women's experiences of the consent process. 1: Perceived absence of choice-women felt they had no option but to undergo VE(s) presented as 'routine' practice; they were not made aware of alternatives including the right to decline. 2: Unsupported decision-making-scant information was provided and women were not informed of the risks or procedural detail. Conclusion: Consent to VE(s) is not fully informed or voluntary and often takes the form of presumed compliance rather than genuine choice-making. There is an urgent need for healthcare professionals to amend their practice to ensure that the legal and professional requirements of a valid consent process are met.