Introduction

Informed consent is a cornerstone of ethical and legal medical practice - but in obstetric emergencies, time pressure, maternal stress, and urgent decision-making make it one of the most contested areas in medico-legal cases. This article explores the complexities of consent in high-risk labour scenarios, drawing on clinical insights and real-world case examples.

[Watch the full webinar with Dr Panicos Shangaris here >]

Growth Plate Injuries: Clinical Risks

In obstetrics, the equivalent “growth plate risk” lies in high-stakes conditions like cord prolapse, fetal bradycardia, and sepsis during delayed induction. These scenarios demand urgent intervention, where the mother’s ability to process risk and provide informed consent is significantly impaired.

Key risks include:

• Maternal exhaustion and distress limiting capacity.
• Pressure on clinicians to act within minutes.
• Increased medico-legal exposure if documentation is incomplete.

Medico-Legal Considerations

The Montgomery v Lanarkshire (2015) ruling shifted UK law firmly toward patient-centred disclosure. This means clinicians must outline all reasonable alternatives, not just their preferred course of action.

In obstetric emergencies:

• Verbal consent is acceptable but must be documented.
• Abbreviated consent still requires clarity on key risks.
• Hospitals should build consent foundations before labour, by discussing common emergency scenarios antenatally.
• Documentation is critical: if it isn’t written down, legally it didn’t happen

Case Examples & Outcomes

Cord Prolapse & Emergency Caesarean

A 28-year-old woman presented with cord prolapse. The team had only minutes to deliver via Category 1 caesarean. Verbal consent was obtained, but questions later arose over whether it could be considered “informed” in the context of distress and urgency.

Fetal Bradycardia

In another case, prolonged bradycardia prompted rapid caesarean. Consent was signed, but the woman later questioned whether she had time to properly absorb the information.

Delayed Induction Leading to Sepsis

A 21-year-old woman developed sepsis after delayed induction due to bed shortages. Exhausted, she was asked to sign consent during labour, supported physically by her partner. She later developed PTSD and claimed she lacked capacity at the time.

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Key Takeaways for Solicitors

• Consent in obstetric emergencies is rarely “perfect”; the law recognises context but expects adaptation, not omission.
• Advance preparation during antenatal care reduces litigation risk.
• Even in emergencies, a scribe or support staff should record decisions.
• Emotional context (distress, fatigue, confusion) matters - and can shape claims

“If it’s not written down, it didn’t happen.” - Dr Panicos Shangaris

“Consent must be adapted to context, but never omitted.”

“Advance discussions in antenatal care make emergency conversations much easier.”

[Watch the full webinar here >]