Date of Award

Spring 2026

Degree Type

Thesis

Department

Biological Sciences

Director of Thesis

Dr. Curisa Tucker

Second Reader

Dr. Patrick Hickey

Abstract

Informed consent is a fundamental ethical and legal component of preoperative and perinatal care and forms the foundation of trust between patients and healthcare providers. Despite this, current evidence suggests that many childbirth interventions, including episiotomies, are often performed without explicit patient consent. Episiotomy remains one of the most commonly cited interventions associated with non-consented care and obstetric violence. Therefore, this global scoping review aimed to evaluate whether informed consent is obtained for episiotomy procedures during childbirth, understand documented experiences of disrespect and unnecessary procedures, and identify differences between international and U.S. practices. This thesis followed the PRISMA Scoping Review guidelines and included studies include data from 15 countries across Asia, Africa, North America, South America, and Europe.

Findings indicate widespread global deficiencies in obtaining informed consent during childbirth interventions, including episiotomies, with some settings reporting non-consent rates as high as 40-70%. The rate of nonconsent was particularly high among birthing people who are single, of low socioeconomic status, and with lower levels of formal education. Additionally, many countries reported an episiotomy rate significantly higher than the World Health Organization’s recommended threshold of 10%, including Nigeria (62%), Ecuador (35.7%), and Hungary (62%). The deficiencies in consent and high episiotomy rates reflected in these studies indicate high rates of disrespect that lead to birth dissatisfaction, lack of perceived control, and poorer birth outcomes.

First Page

1

Last Page

50

Rights

© 2026, Rachel Gulczinski

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