El The Supreme Court has marked a turning point In matters of medical liability, the court awarded compensation to a woman who underwent an instrumental delivery without genuine informed consent. Although the judges concluded that the gynecologists' actions were technically correct, the key issue in the case was that the patient was unable to freely decide on an invasive procedure that directly affected her physical integrity.
The ruling, issued by the Civil Chamber on January 13, 2026 (STS 9/2026), analyzes the case of a woman who gave birth in a private hospital in Madrid after a delivery assisted by vacuum extraction and forceps. Although no imminent risk to either her or the baby was identified, the medical team decided to use the instruments without obtaining specific consent, which has ended up having significant legal consequences.
An instrumental delivery without a proven emergency
According to the facts presented in the ruling, the woman —whom the legal proceedings identify with a fictitious name, Veronica— went to the Sanitas La Moraleja Hospital in Madrid when labor began. After about three hours of pushing with epidural anesthesia, the gynecologists attending her opted to intervene with vacuum extraction and forceps to accelerate the expulsion of the baby, even though the four hours that the Spanish Society of Gynecology and Obstetrics (SEGO) establishes as a reference for assessing the use of instruments had not yet been reached.
The woman suffered a tear, an episiotomy, and, over time, a series of persistent physical sequelaeChronic pelvic pain, pelvic floor dysfunction, dyspareunia (painful intercourse), difficulty walking, difficulty sitting, and persistent discomfort that prevented her from leading a normal life. Initially, a pudendal nerve injury was suspected; later, specialists concluded that it was a case of myofascial pain syndrome with chronic pelvic pain.
The judges emphasize that There was no life-threatening emergency. that would justify such an invasive procedure without explanation or consultation with the patient. None of the experts, the ruling states, demonstrated fetal distress, an immediate risk to the mother's health, or a clinical situation that would prevent her from being informed and given her consent. The woman was conscious under epidural anesthesia, fully capable of understanding the information and expressing her wishes.
This point is crucial: the Supreme Court emphasizes that the absence of genuine urgency precludes invoking a supposed need for immediate action. The healthcare center, the court reminds us, is the one that has the authority. burden of proving the existence of that urgencyAnd it is not enough to invoke it generically or preventively to legitimize invasive interventions without express consent.
From the court to the Provincial Court and, finally, to the Supreme Court
The woman decided to initiate legal action after discovering that, three years after giving birth, I continued to suffer pain and limitations which affected her daily life, her relationship with her partner, and her ability to perform basic tasks. Represented by a lawyer specializing in healthcare law and childbirth, she filed a lawsuit seeking compensation for medical malpractice and lack of informed consent.
The Madrid Court of First Instance ruled decisively in her favor. It held that the gynecologists had used vacuum extraction and forceps without a clear clinical indication or danger to the mother or baby, and that there had been no adequate explanation of the risks or possibility of choice. The judge declared the charges proven. bad practice and set compensation exceeding 300.000 euros, directly linking the use of the instruments to the subsequent physical consequences.
The situation changed when the case reached the Provincial Court of Madrid. The appeals court judges overturned the conviction, ruling that the doctors' actions were in accordance with the law. lex arts and that the instrumental delivery was justified. In the opinion of the Court, health regulations permitted the intervention without specific consent in the circumstances of the case, therefore they eliminated the compensation as they did not find liability.
It was then that the patient decided to appeal to the Supreme CourtThe Civil Chamber re-examined the evidence and the reasoning of the Provincial Court and concluded that there had been a “clear error” in the assessment of the facts. Although it agreed that there could not be talk of flagrant technical negligence, it did clearly find a violation of the right to informed consent, an aspect that until now had not always been given prominence in healthcare litigation.
Informed consent and “loss of opportunity”
One of the most noteworthy aspects of the ruling is the way the Supreme Court interprets the signed consent for epidural anesthesiaThe court expressly rejects the notion that this document could be interpreted as implicit authorization for the use of vacuum extraction or forceps. The judges emphasize that these are distinct procedures, each with its own risks and a direct impact on the woman's physical integrity, and therefore require specific, clear, and understandable consent.
The Court explains that informed consent is not a bureaucratic formality, but rather a guarantee that a person can decide on interventions that affect their body. In the case analyzed, the patient was not informed of the available alternatives—such as continuing with a non-instrumental delivery within clinically acceptable timeframes—nor of the possible consequences of using instruments. She was also not given the option of rejecting this approach and waiting, even though, according to SEGO itself, this alternative was reasonable and scientifically supported.
Therefore, the Supreme Court applies the doctrine of the “Loss of opportunity”Instead of compensating for all the physical damage as if malpractice had been proven, the compensation is for the woman's loss of the right to have chosen another option that could potentially have prevented or reduced the injuries. The key question the court is considering is: what would have happened if she had received adequate information and been able to decide?
The judges' response is clear: had she had the necessary information, the woman could have chosen to continue with the delivery without instruments, a realistic decision supported by scientific evidence, not merely a remote hypothesis. By depriving her of that possibility, a legitimate expectation of avoiding harm, or at least of facing it with full knowledge of the facts, is thwarted.
Based on this reasoning, the Court sets compensation at almost 35.000 euros (34.995 euros), a much lower amount than that initially recognized by the court, but which represents a explicit legal recognition that the violation of informed consent, by itself, can generate patrimonial liability even if the medical technique is considered correct.
A wake-up call regarding paternalistic medicine
Beyond the financial amount, the Supreme Court ruling sends a direct message against certain “Paternalistic” behaviors e interventionism during childbirthThe court notes that the evolution of medicine in recent decades has gone precisely in the opposite direction: strengthening patient autonomy and their right to be informed and to decide, especially in such sensitive processes as childbirth.
The Court states that a woman who d a luz It is not “a mere entity without will” that can be freely disposed of. It must be able to participate actively, know the options, the risks and the consequences, and express its preference except in cases where there is a real and serious danger to its life or the life of the baby. In fact, the judges emphasize the Importance of birth plans which many hospitals in Spain already allow to be submitted in writing, where women anticipate their wishes and limits regarding the care they want to receive.
In this specific case, the woman's testimony reflects an experience of depersonalization and a complete loss of control. She herself recounts feeling like a mere spectator during childbirth, with no one explaining what was going to be done or why, nor was her opinion sought. This feeling of disrespect for her decision-making capacity has persisted over time, both due to the physical aftereffects and the perception that her pain was not fully acknowledged.
The Supreme Court's ruling also aligns with other national and international decisions that follow the same line. In Spain, the Constitutional Court upheld in 2023 the forced admission of a woman to a hospital to avoid a home birth only in a context of serious risk to the life of the fetus, emphasizing that outside of these extreme circumstances, the pregnant woman's autonomy must be respected. At the international level, the UN CEDAW Committee Spain had already been condemned for a case of cesarean section performed without real risk or consent in a public hospital.
Impact on healthcare practice and responsibility of centers
From law firms specializing in healthcare law, such as Unive AbogadosIt is worth noting that this ruling provides a relevant criterion in an area where conflicting decisions existed. Until now, it was not always clear whether the lack of informed consent, in the absence of evident malpractice, could give rise to a liability for damages. The Supreme Court answers in the affirmative: when there is no urgency to justify it, the omission of sufficient consent can be a source of liability.
The resolution also makes it clear that it is the hospitals and doctors themselves who must to prove the existence of a real emergency If they act without informing. It is not valid to claim generically that they are acting "for safety" or "out of caution" without a solid clinical basis, nor to assume that signing a general form covers any technique that may be used in childbirth. Each intervention with relevant risks requires, in principle, specific information.
Although the case pertains to obstetrics, the Supreme Court's ruling is easily applicable to other areas of medicine. Invasive procedures, surgeries, diagnostic techniques with significant risks, or treatments with severe side effects. They cannot be carried out without genuine informed consent.unless the urgency and the patient's condition objectively prevent it. And that impossibility must be demonstrable.
In this context, the concept of "loss of opportunity" emerges as a avenue for redress when a patient believes they were unable to make an informed choice. It's not simply a matter of demonstrating that the outcome would have been different, but rather proving that a reasonable alternative existed that could have prevented or minimized the harm, and that this option was never considered due to a lack of information.
In practice, the ruling encourages healthcare facilities to strengthen their information protocols, educate in consent It is important to clearly document the explanations given and the decisions made jointly with patients, and to review procedures where acting "by default" without asking too many questions has become the norm. The doctor-patient relationship is thus shifting towards a more participatory and less hierarchical model.
For the woman affected, the compensation of almost €35.000 represents partial recognition. She herself has expressed that she feels the ruling is a bittersweet victory: it confirms that her right to choose was not respected, but the financial compensation does not cover all the damages. Medical expenses and limitations which she continues to suffer years after giving birth. Despite this, the ruling is now final and the hospital's insurance company will be responsible for paying the agreed amount.
Taken together, this case highlights the idea that, in Spain, giving birth in a hospital—whether public or private—should not mean relinquishing one's own judgment or decision-making power. The Supreme Court makes it clear that, except in situations of serious and urgent risk, Women have the right to have their autonomy respected.to be informed in an understandable way and to choose how they want their childbirth to take place, and that the violation of this right can have a legal and economic cost for the professionals and health institutions involved.
