Counseling, informed consent, and debriefing for cesarean section in sub-Saharan Africa: A scoping review

Abstract

Background: Counseling as part of the informed consent process is a prerequisite for cesarean section (CS). Postnatal debriefing allows women to explore their CS with their healthcare providers (HCPs). Objectives: To describe the practices and experiences of counseling and debriefing, the barriers and facilitators to informed consent for CS; and to document the effectiveness of the interventions used to improve informed consent found in the peer-reviewed literature. Search Strategy: The databases searched were PubMed, EMBASE, PsycINFO, Africa-wide information, African Index Medicus, IMSEAR and LILACS. Selection Criteria: English-language papers focusing on consent for CS, published between 2011 and 2022, and assessed to be of medium to high quality were included. Data Collection and Analysis: A narrative synthesis was conducted using Beauchamp and Childress's elements of informed consent as a framework. Main Results: Among the 21 included studies reporting on consent for CS, 12 papers reported on counseling for CS, while only one reported on debriefing. Barriers were identified at the service, woman, provider, and societal levels. Facilitators all operated at the provider level and interventions operated at the service or provider levels. Conclusions: There is a paucity of research on informed consent, counseling, and debriefing for CS in sub-Saharan Africa.