This morning a Nobel economist said the goal of his work was to talk to people about why things are being done, not just to use it on them. Replace “governments” with “doctors” and you have informed consent. Here is what that means for many medical interventions including cesarean on request and 39-week induction.
This morning it was announced in Stockholm, Michael Woodford of Columbia University shared the Nobel Prize in Economics with Robert Hall of Stanford. The prize honors work that helps central banks and governments calm the booms and busts of the economy. That sounds far from a labor floor. It is not.
When the Nobel committee reached Woodford by phone, he did not talk about equations.
He talked about people.
He said it matters to have a framework that lets governments talk to the public about what they are doing, and that the goal was “not simply to use it on people, but to also talk to people” about why things are being done. He added that he hoped the work would contribute to “public understanding.”
Now replace “governments” with “doctors.” You have just described informed consent.
For decades, economic policy rested on simple trade-offs between inflation and unemployment. In the 1970s, when prices and joblessness rose together, that formula broke. Hall and Woodford, working separately, built better models based on how households and businesses actually make decisions. A central idea in Woodford’s work is that people act on what they expect to happen next. When a central bank explains its plans clearly, it changes those expectations, and the economy moves. The Nobel committee said exactly this: when governments and central banks communicate their plans, they can help move the economy in the right direction. Explaining the plan is not a courtesy added at the end. It is part of how the policy works.
His newer research goes one step further.
Woodford now studies how people perceive numbers.
Classic economics assumed that people see their options exactly. Woodford argues that they do not. We perceive a number the way we perceive the brightness of a light or the loudness of a sound: with noise.
In laboratory studies, he and his colleagues showed that people’s caution about small gambles can be explained by that noise in how the mind represents the choice. The person is not foolish. The signal is blurry.
Both ideas belong in every obstetric consultation room.
A woman’s expectations about labor, induction or surgery shape what she chooses, how she copes and how she judges the result. When those expectations are built on vague words like “safe,” “small risk” or “reasonable,” she is deciding on a blurry signal.
Informed consent is not a signature on a form.
It is the process in which a doctor gives a woman what she needs to decide: the real options, the real risks of each, in numbers she can understand, and the doctor’s honest recommendation. Woodford’s point is that a policy people do not understand works less well.
The same is true of a clinical plan.
Consider cesarean delivery on maternal request. A woman with no medical indication asks for a planned cesarean. This is not a patient refusing surgery. It is a patient asking for one.
With Frank Chervenak and our colleagues at Northwell, I published a framework for this situation in the American Journal of Obstetrics and Gynecology. Our position is that a cesarean on maternal request can be ethically permissible after thorough counseling, but it should never become routine. Counseling should follow a structured approach that includes trauma-informed care, attention to cognitive bias, and plain language that a woman with any level of health literacy can follow. It should also be free of physician self-interest. A scheduled surgery is convenient for a doctor. Convenience is not a medical reason.
Here is where Woodford’s work on perception matters. The most important risk of a first cesarean is not in this pregnancy. It is in the next ones. In a study of more than 30,000 women having cesarean delivery, placenta accreta occurred in about 2 in 1,000 women having their first cesarean, about 6 in 1,000 at the third, and about 67 in 1,000 at the sixth or more. A woman who plans one child faces a very different decision from a woman who plans four. If we say only “some risk in future pregnancies,” we hand her a blurry signal and call it consent.
Now consider induction of labor at 39 weeks without a medical indication (not “elective” but without medical indication).
The ARRIVE trial was published in August 2018, and that same month ACOG issued a practice advisory saying it is reasonable to offer this induction to low-risk nulliparous women. ARRIVE, funded by the National Institute of Child Health and Human Development, randomized 6,106 nulliparous women at 41 hospitals in a research network. Cesarean delivery occurred in 18.6 percent of women in the induction group and 22.2 percent in the expectant management group.
That is a relative reduction of about 16 percent. In absolute terms, it is about 4 fewer cesareans for every 100 women induced. Put another way, about 28 women would need to be induced to avoid one cesarean. The trial’s main measure of newborn harm was not significantly different between the groups.
Those numbers do not tell a woman what to do. They tell her what she is choosing. A woman who hears “induction lowers your chance of a cesarean” may imagine a large effect. A woman who hears “about 4 in 100” can weigh that against what induction means for her: more time in the hospital, more medications, more interventions, a different experience of birth. She also deserves to know that the result comes from one trial run at research hospitals, and she is entitled to ask whether her own hospital achieves the same results.
Woodford’s research tells us why this step matters. If people perceive numbers with noise, then the format we choose shapes the decision. A relative number makes a benefit sound bigger. A word like “rare” makes a risk sound smaller. Every format choice nudges. Honest consent means choosing formats that make the signal clearer, not formats that push toward the answer we already prefer.
Three practical lessons follow.
First, give absolute numbers with a clear denominator, such as “4 in 100” or “6 in 1,000,” never a percentage change alone.
Second, use the same format for every option, so a woman compares like with like.
Third, explain the reasoning, not only the recommendation. A central bank that explains itself is easier to trust. A doctor who explains herself is too.
This is not about putting autonomy above medical judgment. Respect for a woman’s autonomy is never absolute, and the doctor still has a professional responsibility to recommend what the evidence supports.
A recommendation and a clear explanation are not opposites.
The best doctors give both.
Conclusion
Woodford’s work showed that what people expect, and what they are told, shapes how policy works. On the morning of his Nobel Prize, he chose to talk about public understanding. Medicine has claimed that principle for decades under the name informed consent. Too often, we practice it as a form, a script or a percentage chosen to steer.
For cesarean on maternal request, consent means telling a woman, in numbers, what her first cesarean means for her future pregnancies before she decides. For induction without a medical indication, I believe expectant management should remain the default, and induction should be an intervention that is justified, not assumed. When it is offered, consent means “about 4 fewer cesareans for every 100 women induced,” not “a lower cesarean rate.” Anything less is not consent. It is management.
If an economist can make explaining himself to the public part of his Nobel morning, we can make it part of every prenatal visit.
Share this with a colleague who still counsels in percentages. And if you want evidence without the spin, subscribe to ObGyn Intelligence.
References
1. Grobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett G, et al. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 2018;379(6):513-23. doi:10.1056/NEJMoa1800566. [UNVERIFIED THIS SESSION: from general knowledge; run RefVerify]
2. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-32. [UNVERIFIED THIS SESSION: DOI not supplied; run RefVerify]
3. [AUTHORS TO CONFIRM], Grünebaum A, Chervenak FA. Cesarean delivery on maternal request: the essential role of professional obligations. Am J Obstet Gynecol. [YEAR, VOLUME, PAGES TO CONFIRM]. PMID: 41485817. [Title and PMID confirmed by search; author order and citation fields not verified]
4. American College of Obstetricians and Gynecologists. Clinical guidance for integration of the findings of the ARRIVE trial: labor induction versus expectant management in low-risk nulliparous women. Practice Advisory. Washington (DC): ACOG; 2018 Aug. [UNVERIFIED THIS SESSION: title from general knowledge]
5. Woodford M. Modeling imprecision in perception, valuation, and choice. Annu Rev Econom. 2020;12:579-601. Also NBER Working Paper No. 26258. [Title, journal, volume and NBER number confirmed; page range from general knowledge]
6. Khaw MW, Li Z, Woodford M. Risk aversion as a perceptual bias. NBER Working Paper. 2017. [UNVERIFIED: author list and paper number from general knowledge; title confirmed via Caltech seminar listing]
7. Associated Press. 2 American economists win Nobel for overturning assumptions about how to deal with economic shocks. Philadelphia Inquirer. 2026 Oct 12. Available from: https://www.inquirer.com/business/nobel-prize-economics-robert-hall-michael-woodford-20261012.html
8. Agence France-Presse. Americans Hall and Woodford win economics Nobel for stabilization models. Phys.org. 2026 Oct 12. Available from: https://phys.org/news/2026-10-americans-hall-woodford-economics-nobel.html
9. Ziady H. Americans Robert E. Hall and Michael Woodford awarded the Nobel Prize in economics. CNN. 2026 Oct 12. Available from: https://edition.cnn.com/2026/10/12/business/nobel-prize-economics-intl