In the UK, women have more choices about how to give birth than ever before, from a water birth at home to a caesarean delivery in hospital. But choice does not always mean labour unfolds as initially planned.
First-time mothers are more likely to experience medical interventions during labour. The most common include episiotomies, a cut made at the vaginal opening to widen the passage, and assisted vaginal births using forceps or a ventouse, also known as a vacuum device.
While some procedures, such as caesarean deliveries, are widely understood, others are less familiar. In the UK, doctors must obtain a woman’s consent before carrying out any medical intervention during labour. This involves explaining the risks, benefits and alternatives.
But being asked to absorb new information and make decisions during labour, without prior knowledge of these procedures, can make this process very difficult.
Birth trauma
Experiences such as these can leave women with lasting and complicated feelings about childbirth. Even when mother and baby leave hospital without long-term physical injuries, the psychological impacts can be significant – affecting the mother, her attachment with her baby, and also relationships with loved ones.
To explore this further, our team carried out a retrospective service evaluation at a maternity unit in south-east England. We asked women to look back on their experiences of assisted vaginal births.
Many said the intensity of labour and the need to process unfamiliar information meant the time available to make decisions felt too short. Two-thirds reported feeling under-informed about assisted vaginal delivery, and 11.6% said they consented to interventions they did not fully understand.
One way to better support decision-making during labour may be to provide clearer and more consistent information during pregnancy. Research suggests access to this information can be a lottery. Some people receive detailed explanations from midwives or antenatal classes while others do not, even if they would like that support.
Social media is often used to fill this gap, but it can be difficult to separate reliable advice from misinformation. Birth influencers have gained large followings, despite some sharing inaccurate or potentially harmful claims.
Algorithms may also create the impression that only one type of birth is acceptable or “normal”. In reality, one in five first-time mothers have an assisted vaginal birth. Knowing this might help reduce the feelings of failure that some women report after having an intervention.
Access to reliable, evidence-based information is an important step in reducing the likelihood of women feeling “out of control” during birth, which is a risk factor for birth trauma.
Access to information
Access to information should be a right, not an obligation. Some participants in our evaluation said they would not find additional detail helpful. They felt that in-depth discussions about risks and benefits before labour might feel overwhelming unless the intervention became necessary. Women and birthing people who feel this way should be able to decline that information.
What matters most is the ability to access information for those who want it. Our findings suggest that familiarity with the basics of labour interventions before birth could improve decision-making. If consent discussions arise during labour, there is then more time to focus on the individual’s particular situation.
Participants suggested standardising antenatal education, possibly with input from both midwives and obstetricians, or including clearer discussion of labour interventions during routine antenatal appointments.
However, many maternity units are working with limited staff and heavy workloads, and antenatal appointments are often brief. Any additional discussions about labour interventions would need to be realistic about clinicians’ time and capacity. Alongside our audit with women, we also asked clinicians at the same hospital for their views on improving consent for assisted vaginal birth. This work is now being analysed.
Access to antenatal education plays an important role in helping women prepare for childbirth. Our findings suggest that information about assisted vaginal birth is not equally available to everyone.
Women should be able to learn about these procedures at a time and in a way that suits them. This could support more informed consent conversations during labour, and improve experiences of care overall.

