Coercive Medicine

Wow. What an astounding article (and not necessarily in a good way).

Brief synopsis — pregnant women court-ordered to undergo C-sections many of which were not necessary (several women mentioned all left the hospital and gave birth vaginally, without either themselves or their babies dying).

It also mentioned a woman who was court-ordered to undergo a C-section. The woman had cancer, and was 25 weeks along. There aren’t really any details about it, but some questions that popped into my mind were the following: 1) why did they want her to have a C-section — was she at death’s door, and they thought the baby would die if she died? If so, 2) why didn’t they have a court order to keep her in the hospital (where she likely would be anyway, if she were dying of cancer), and if it became apparent that her life was fading, do a C-section then before the baby died along with the mother. 3) Could they not have waited to do the surgery until the baby was a bit bigger, so would have more of a chance at life with fewer disabilities? As it was, both she and the baby died. The C-section was listed as a contributing factor in her death; and the baby died within two hours, so prematurity was obviously a factor.

Honestly, I’m in the middle here. I know that C-sections are too common, and many times unnecessary. I know that doctors use scare tactics to get women to submit to C-sections. Women have the right to informed consent and refusal, and it sounds as if these women were of sound mind and were therefore within their rights to refuse the procedure. However, I also believe that fetuses have a right to live, and if it is patently clear that the baby will die without medical intervention, then medical intervention is warranted. Few mothers, however, will refuse medical intervention when they believe the life of their baby is at risk.

The article (written in 2004) opened with the story of a woman arrested for murder, because she refused a C-section and one of her twins died in utero. Her case is discussed in ACOG’s Green Journal, and you can also search for the story, which is quite interesting (there are too many links with too many opinions to do them justice, so I’m not going to link to all of them here). Obviously, some people come down more on the “rights of the baby” side, while others come down more on the “rights of the mother” side. (I will point out that this woman is not exactly a “Mother of the Year” — the surviving twin had cocaine in her system; and also there was possibly some degree of mental illness, which may have played into the decision.) The murder charges were eventually dropped, and she pled guilty to child endangerment, for using drugs while pregnant.

Some of the “he said – she said” part of the story, is that she said she wasn’t told that the babies were in serious danger when she refused the C-section; the doctors assert that they told her in no uncertain terms the babies were in danger. The babies were born by C-section after she refused the C-section, which was performed because the baby boy had already died and the baby girl seemed to be in distress. Many of the news reports said that she refused a C-section because of vanity — the scar; while others are quick to point out that weighing some 300+ pounds rather overshadows the scar; and at least one story I read said that she had previously given birth by C-section, so therefore already had a scar.

Was she afraid of the surgery? (Perhaps justifiably so, if she had a horrible surgery and/or recovery after a previous C-section.) Was she just selfish? Did she not truly understand the lives of her babies were at risk? Did her doctors try to talk to her as if she were a reasonable person, or did they get in her face and brow-beat her, so that she felt justified in walking out and refusing to hear them? Were there other options — other things that could have been done to stabilize the babies in utero? What if she had had both babies, but one or both died because they were too premature? So many questions; so few answers.

But I can’t quite come down on the side of “murder,” in this case. I might think that if I knew the reason given by the doctors for C-section, and the accuracy of the diagnosis in general. (I’ve read about too many “unnecessarians” in which women were told that their babies would die without the surgery, only to find out later that it was not the case.) The “M.D.” after the doctor’s name does not stand for “Minor Deity” — he cannot predict the future with 100% reliability. Stillbirths happen for a variety of reasons — and many stillbirths are for entirely unknown reasons. I don’t really know what to do about women who take illicit drugs while pregnant. Yes, it’s child endangerment, but is prison the best or only answer for that? It may be punishment, and it may even be just, but does it help the situation? If doctors know or suspect that a pregnant woman is using drugs, is there some way to reach the women and help them (and their babies) apart from the criminal system? Smoking and drinking while pregnant also raise the risk of stillbirth and a host of other fetal and neonatal problems. But no one is suggesting that mothers of babies who are stillborn or born with nicotine in their systems should be charged with murder.

In reading more of these articles and comments (I was trying to find out how far along this woman was, when she refused the C-section initially), I found that this woman went to a few different hospitals over the course of a few weeks, before finally having the babies by C-section. My question is, if they can charge her with murder for refusing a C-section (even if the charge was ultimately dropped), what could they have done to prevent it? If there was enough evidence of problems with the babies, why didn’t they try to get a court order for a C-section? Did any of the doctors or medical staff find out about her life and her history — you know, talk to her like a real person? Did they suspect drug abuse? Why didn’t they alert the authorities before the baby died, instead of after? If there isn’t a law to prevent the woman from doing what she did, how could she be breaking the law for doing what she did?

And the final question: could she have charged the doctors with murder, had her babies died after being born premature?

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