Explicit consent for episiotomy: recommendations for improving patient communication in prenatal and labor care

Episiotomy is a common surgical procedure during childbirth that involves incising the woman's perineum to facilitate the passage of the fetus. This procedure is used to speed up the delivery, but only in emergencies. It has been reported that explicit consent is unnecessary when the woman in labor is subresponsive or unresponsive. This manuscript analyzes and describes ethical issues regarding the need for explicit consent to use this procedure. The analysis has been made from two perspectives: applying the principlist approach, a system of biomedical ethics that uses the four bioethical principles formulated by Childress and Beauchamp and the principle of vulnerability in its complex relationship with the concepts of dependence and care as articulated in the Barcelona Declaration of 1998. Based on our analysis, we conclude that explicit consent is a fundamental prerequisite in medical practice that should always be sought, even in complex situations such as performing an episiotomy. A table reporting recommendations to enhance communication with the woman throughout the prenatal phase and during labor has also been provided to improve informed consent processes and ensure more effective patient engagement and decision-making.