60% of Women Who Had an Episiotomy Were Never Asked. This Is Not a One-Off.
By Jen Crawford | Doula Trainer, Doula, Life & Business Coach
A national population-based study of 7,394 women in France found that 60.2% of women who had an episiotomy were never asked for their consent. 44.7% had oxytocin administered without being asked. 36.6% had an emergency caesarean birth without being given the opportunity to give true informed consent.
These are not outliers. This is not one bad hospital or one bad shift. This is a pattern that research is consistently revealing across countries and healthcare systems.
And it matters more than most of us have been willing to say out loud.
This Is Not Just a French Study
A UK survey by the Birth Trauma Association found that 42.4% of women had a procedure performed on them during birth without true informed consent.
The most common unconsented procedures were:
Vaginal examination: 17.9%
Episiotomy: 16.6%
Cervical sweep: 12.5%
Rupture of membranes: 9.8%
(Jacques et al., International Journal of Gynecology and Obstetrics, 2025; Birth Trauma Association Survey, 2024)
These statistics are not about individual bad actors. In my opinion, this is not about individual malice by care providers. It is about a system under enormous pressure, a culture in which clinical judgment has historically taken precedence over patient consent, and a persistent underestimation of what women in labour are capable of engaging with.
Women are capable of consenting. Even in labour. Even in an emergency. The conversation just needs to happen.
What True Informed Consent Actually Means
Informed consent is not a box to tick before a procedure. It is not the absence of a "no". It is not handing someone a form.
True informed consent means:
You were told clearly what was being proposed
You understood the risks and the benefits
You understood what would happen if you declined or asked to wait
You had time — however briefly — to ask a question
You were free to agree or disagree without pressure or coercion
You made the decision yourself
When a procedure is carried out without this process, it is not just poor practice. Under Irish and international law, it is a violation of bodily autonomy.
Ireland's National Consent Policy (HSE, 2022) is explicit: consent must be sought for every procedure, at every stage of care. That policy exists. The question is whether it is being consistently applied in every maternity unit, on every shift, in every room.
Why Does This Keep Happening?
The research points clearly to system factors rather than individual ones.
Time pressure in busy labour wards means that pausing for a consent conversation can feel impossible in the moment. Clinicians trained to act fast in emergencies do not always switch off that mode for routine procedures. There is a cultural assumption in some settings that women in labour cannot or will not engage with decisions — or that the care provider's clinical judgment should simply take precedence.
None of these factors make what happens acceptable.
And in my opinion, the solution is not a new protocol. It is a cultural shift. One that begins with training and extends into every interaction a care provider has with a woman in their care.
If This Happened to You
If something happened to you during your birth without your consent, your experience is valid.
You are not being dramatic. You are not ungrateful. You did not misunderstand what happened.
You have options:
Request a birth debrief: Ask your maternity unit if a debrief service is available. Many hospitals offer this. It allows you to go through your notes, ask questions, and have your experience acknowledged.
Request a full copy of your hospital notes: You are entitled to this. It can help you understand the sequence of events and form the basis of any formal complaint.
Make a formal complaint: You can make a complaint directly to the hospital or to HIQA (Health Information and Quality Authority) in Ireland.
Seek legal advice: If you believe your care fell below the required standard, you are entitled to explore your options with a solicitor specialising in medical law.
And beyond the formal routes — please talk to someone. A counsellor, a doula, a trusted person who will listen without minimising what happened to you.
Before Your Birth: How to Advocate for Yourself
The best time to understand your rights is before you are in labour — not during it.
Here is what I teach every family I work with:
Write your birth preferences. Include your wishes around consent, examinations and procedures. Ask that your care team read them on admission. A good care team will welcome this.
Know these phrases:
"I need a moment to think."
"Can you explain what this involves and what happens if I decline?"
"I do not consent to that right now."
Bring a support person who knows your wishes — a partner, a family member, or a doula. Having a second person in the room who understands what you want and is calm enough to advocate when you cannot is enormously powerful.
You are always allowed to ask. You are always allowed to take a moment. You are always allowed to say no.
For Care Providers
"Is it okay if I...?" takes five seconds.
For the woman in that bed, those five seconds are the difference between feeling cared for and feeling like something is being done to her without her permission.
I teach informed consent and birth rights as a core part of every Doula Training and CPD Day I run. Not because it is a legal requirement — though it is — but because a birth professional who understands this, who makes consent a habit rather than an afterthought, changes the experience of every family they work with.
That change matters. It is evidence based. And it is within all of our reach.
Working with Families on Birth Rights and Preferences
If you are pregnant and want to feel genuinely informed about your rights and your options before your birth, I offer 1:1 Pregnancy and Parenting Coaching.
If you are a birth professional who wants to feel more confident supporting families through these conversations, my 2027 Birth Doula Training and CPD Days are open now.
You can find out more at jen-crawford.com.
Jen Crawford is a Doula Trainer, Doula, and Life & Business Coach based in Ireland. She is the co-founder of DoulaCare Ireland, Ireland's first national doula agency.
@jen_crawford_doula_wisdom | jen-crawford.com
