"Just Put It in!" Consent for Epidural Analgesia in Labour (Editorial‪)‬

Recently I was called to the delivery unit to attend a severely distressed woman in late labour who was requesting epidural analgesia. I had not met her before, and after introducing myself, her response to my question " I believe you would like an epidural" was "Just put it in!" When I started on a process by which I hoped to obtain her informed consent, she screamed "Stop patronising me, just put it in!" To be told in no uncertain terms (and frequently in language not suitable for the printed page!) to simply "get on with it" is not an uncommon event, and one surely experienced by all of us practising in this field. If we proceed with this invasive procedure, we clearly have consent, but is it informed? Informed consent implies fulfilment of a number of elements: that the anaesthetist has made full disclosure of relevant information (pertinent to what the individual parturient might wish to know, including pros and cons and alternatives); that the parturient understands the nature, effects, implications and risks of the procedure (she must have the capacity or competency to act autonomously); and that the parturient has made an informed decision without coercion (1). When discussing labour analgesia, adequate disclosure can be challenging, lengthy and complex. This is true when dealing with a well informed woman in the antenatal clinic or anaesthetist's rooms, let alone with an exhausted woman at the end of labour, or one in whom competency is in doubt (for example a woman with a mental disability) or with whom understanding cannot be easily confirmed (the non-English speaking parturient using her partner with English as a second language as interpreter at 3 a.m.).