Assessment of informed consent process for caesarean section delivery in Mulago Hospital, Uganda

Abstract

Introduction: Caesarean section is not the natural way to deliver a baby. It can be associated with potential complications. Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patients’ authorization or agreement to undergo a specific medical intervention. Many mothers admitted to Mulago Hospital undergo caesarean section delivery. We do not know whether the elements of informed consent process are followed. Objective: To assess completeness of information provided during informed consent process for caesarean section delivery in Mulago Hospital. Methodology: This was a cross sectional descriptive study with both quantitative and qualitative methods carried out at New Mulago on postnatal ward (5B) A total of 424 participants who had undergone caesarean section were recruited by consecutive sampling. Data was collected using a pretested structured questionnaire. It was entered into Epidata 2.1 and then exported to STATA 10 for analysis. In-depth interviews with midwives, junior doctors, senior house officers, anaesthetists, senior gynaecologist/obstetrician were conducted and the collected data was analyzed using framework analysis. Results: Of the participants, 97.8% were not informed about complications of caesarean section while 98% were not informed about the risks of proposed anaesthesia and 97.2% were not informed about risks of blood transfusion. The participants who signed consent form were 92.9%. Informed consent was obtained from about 34% of the participants.

Conclusion: The study suggests that the current informed consent practice in Mulago Hospital for mothers undergoing caesarean section is below standard of international and ethical acceptability. Recommendations: It is recommended that medical doctors be trained on the art of communication in order to enhance the doctor-patient relationship. It also recommends that the Ministry of Health enhance public education and awareness on medical rights and disseminate National guidelines for the process of obtaining informed consent. More work will be required to educate doctors and health care providers to respect the patients’ right to know the information about caesarean section.