Ethical and medico-legal aspects of obstetric anaesthesia

In obstetric practice, ethical and medico-legal problems centre on the ability of a labouring woman to give truly informed consent. Conflicts can also arise between the best health interests of the fetus and those of the mother. Consent to a procedure can be given by a competent patient who has been properly informed and has shown understanding of the risks, benefits and alternatives. Authority must be given voluntarily. The authors explore these elements with relevance to the pregnant and labouring woman. Is the patient competent in labour? Can she truly be informed and decide on a treatment plan in advance of labour without knowledge of the level of pain to be experienced? The Obstetric Anaesthesia Association recommends that information about procedures such as epidural analgesia should be given antenatally, with an explanation also being given and consent obtained in labour. There is a large disparity between individual patients about the level of risk at which they wish to be informed of a particular complication. The authors discuss areas of ethical difficulty in which the mother's health is put at higher risk for the benefit of the fetus (e.g. emergency caesarean section under general anaesthesia). Common medico-legal problems include pain during caesarean section under regional blockade and the neurological sequelae of regional block. Good documentation, honest communication with patients and fellow staff, early advice from senior colleagues and apologies where necessary may avert potential problems. © 2005 Elsevier Ltd. All rights reserved.