Re: https://www.hifa.org/dgroups-rss/spotlight-group-b-strep-36-should-there...
Dear Marti and colleagues,
You say: 'I would like to pose the question, “Should there be informed consent before fetal membrane “sweeping” (also known as “stripping”)?'
I was unable to find guidance on the websites of WHO, International Confederation of Midwives or International Federation of Gynecaology and Obstetrics. The ACOG guidelines would seem to align with a Cochrane review on wider aspects of 'Membrane sweeping for induction of labour' https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000451.pub3/...
This review included 'two studies (n = 221) (2/44) (Janakiraman 2011; Netta 2002) examined membrane sweeping in women who were group B streptococcus positive. No additional maternal or fetal risk was noted with membrane sweeping. However, both studies were small and only abstracts were available to assess results'.
The NHS Scotland website notes that sweeping of the membranes can be considered 'with informed consent'. Given that sweeping of the membranes is not entirely risk free, it would seem that verbal informed consent is appropriate in all cases? And, as the ACOG suggest, 'Because of the hypothetical concern of bacterial seeding during the procedure, some practitioners may choose not to sweep the membranes in women colonized with GBS.'
From a wider HIFA perspective this also raises questions about whether and how informed consent is conducted. Informed consent is clearly part of the information that every person needs to protect their own health and the health of others. At one end of the spectrum is the written informed consent that is standard before surgical operations (in most but not all settings). At the other end is verbal informed consent. In both cases (and perhaps especially in verbal informed consent) the 'informed' aspect may be realised, partly realised, or not at all. This would make an interesting theme for a future Spotlight?
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org