Pregnant women don’t need husbands’ consent for CS - doctors

Contrary to popular belief in many Nigerian households, senior maternal and reproductive health professionals have stressed that pregnant women do not legally need their husbands' approval to undergo a cesarean section.

They clarified that a woman has complete control over her healthcare choices, including giving her consent for life-saving surgical operations like CS, once she is an adult and mentally capable.

It is ultimately the woman's right to approve any surgery done on her body, the obstetric-gynecologists explained, even though many hospitals and wives include husbands in the decision-making process for emotional and supportive reasons.

Chris Aimakhu, a professor of obstetrics and gynecology at the University of Ibadan in Oyo State, stated that the patient is still in charge of giving consent to CS whether or not there is an emergency.

The don noted, however, that the husband or the present guardian may approve to the treatment if the patient is mentally unwell.

He asserts that medical teams are legally permitted to do surgery even in the absence of family members' agreement in emergency situations where a delay could jeopardize the mother's or the child's life.

He clarified that in certain situations, physicians depend on hospital legal departments to support their actions in the name of preserving lives.

In actuality, the patient is ultimately in charge of providing consent for a cesarean section, even in cases of emergency. The patient offers her consent if she is mentally capable. Otherwise, her guardian may consent on her behalf.

“As far as Nigeria is concerned, patient autonomy is very key. An adult woman can decide for herself once you explain the situation to her. As long as she’s mentally stable, she can make decisions regarding CS herself.

“Before a CS is carried out, some husbands are usually there. When you explain to the woman that she needs to have a CS and the husband is present, she might say, “I’ll give it to my husband to sign.” In that situation, if she wants her husband to sign, fine. But it’s not as if it’s mandatory that, at the time of CS, the husband must come and sign.

“Even in emergencies where CS is urgently needed and there’s not even time for full explanation, the healthcare team will prioritise saving the patient’s life and proceed with the surgery while still attempting to take consent, as practically as possible. After all, the man is not the one dying.”

Aimakhu, the Second Vice President of the Society of Gynaecology and Obstetrics of Nigeria, added, “It’s not a law in Nigeria that, before doing CS or any procedure, the husband must sign. No. In most cases, even in elective procedures, where the women are patient and educated, their husbands are also educated, when it’s time to decide, the woman will just say, “talk to my husband,” because they don’t want to take the responsibility without their husband knowing.

“So, the woman, being an adult and mentally competent, has the legal right to give consent. It’s not a Nigerian thing or something peculiar to Nigerian women. Surgery is done worldwide, and the same principle applies: the patient gives consent. It’s her body. She’s the one carrying the pregnancy.

“So, if it’s to save her life or the baby’s life, it’s still her decision. The only exception is when she is mentally unstable, unconscious, or unable to give consent. In such cases, someone else, like a guardian, can give consent. You know in the African setting, the husband is seen as the head of the house and many women do say ‘My husband is my authority,’ ‘he must know,’ and all that. But that doesn’t mean the husband must take the decision.”

The don, however, explained that in cases where both spouses refused consent, the medical team may be hand-tied.

“Don’t forget, it’s still the woman’s decision unless she has explicitly deferred to someone else. The doctor must obtain consent either written or verbal.

“So, let me be clear, I’m not saying both husband and wife must say yes. I’m saying consent must be obtained from someone legally able to give it. If neither gives it, doctors cannot proceed. That’s how it is,” Aimakhu said.

Corroborating the don’s statement, a Consultant Obstetrician and Gynaecologist at the Lagos State University Teaching Hospital, Ikeja, Dr. Modupe Adedeji, said many Nigerians do not understand how consent for CS works.

According to her, it is not sacrosanct to actually receive consent from the husband, but most of the time, the husbands are the ones available.

“In most cases, the women are of the right age, older than 18, and they can actually give consent by themselves, really.

“But we sometimes engage the husband because, at that time, the patient herself may be emotionally burdened about the whole surgery issue and all that. And because the husband, of course, is allowed to give consent, over time and over the years, people have gone overboard with it, as if it is only the husband that can give consent,” she said.

The consultant noted that most of the spousal refusal hidden under cultural or religious beliefs in Nigeria may be because of surgery costs.

Adedeji said, “You know, religion and cultural beliefs play a big role. Most of it is born out of fear, the fear of the unknown, of what might happen. There’s even the fear of giving consent and then being blamed if something happens. They fear that they may go back to the community and be blamed for giving such consent.

“Another factor that influences cultural and religious decisions is even finances. The Caesarean section is not cheap anymore. That’s where the government comes in. If these things are covered under universal health coverage or through health insurance, then these decisions will be easier to make.

“Because in many cases, the real issue may be financial, but cultural and religious beliefs are used as a cover. So, yes, these beliefs play a major role in delaying surgical intervention for our women in labour or pregnant women generally.”