Your Body, Your Decisions – This Means You, Moms!

Recently, a mother in South Carolina reached out to the ACLU for help. She was pregnant, and although she had had two prior cesarean surgeries, she wished to attempt a “trial of labor,” that is, to give birth naturally, rather than having a scheduled cesarean surgery. The mother’s wish made sense in light of her medical history, and according to professional standards set by obstetricians.

Nevertheless, the mother’s doctors – publically employed physicians working in a public hospital –forced her to schedule a C-section, called her “stupid” for wanting to do otherwise, and threathened to withhold medical care if she refused the surgery and went into labor naturally. In short, even after having made her wishes known to her physicians, the mother was being coerced into undergoing a serious and invasive medical procedure against her will.

We and our partner organizations wrote to the doctors explaining that a pregnant woman, like any other person, has the right to receive only medical treatment to which she gives informed consent.   This means that a pregnant woman, like all other persons, has the right to refuse any and all medical interventions that she does not want, even if her doctor disagrees. In a case called In Re A.C., brought by the ACLU 25 years ago on behalf of a woman forced by court order to undergo a life-threatening C-section, the judge explained: “[I]n virtually all cases the question of what is to be done is decided by the patient – the pregnant woman – on behalf of herself and her fetus.”

Almost immediately after receiving our letter, the doctors in South Carolina changed their tune. They cancelled the scheduled cesarean surgery and respected the mother’s wish to go into labor spontaneously. The mother avoided the scheduled cesarean, labored naturally and ultimately gave birth to a healthy baby girl.

What is troubling about this story is that it took the intervention of the ACLU to secure for the mother the basic and fundamental right of every human being to decide what medical interventions she or he does or does not want.  Unfortunately, pregnant women are often subjected to pressure or outright coercion to accept unwanted medical interventions.

In a national survey, a quarter of women who underwent cesarean surgery said they had felt pressured to do so. Many more women were simply not given full information about the benefits and risks of cesarean surgery, in other words, their consent, even when given, was not informed. The story is similar with other common labor interventions: seventeen percent of women whose labor had been induced by the administration of drugs said they had felt pressure, and the great majority of mothers who had received an episiotomy (an incision between the vagina and anus) reported that they had had no choice in the matter at all.

Even worse, as we at the ACLU know only too well, what starts as coercion can turn into court-ordered medical intervention. In each case, the woman’s fundamental right to bodily integrity, as expressed through autonomous decision-making in medical matters, is infringed. Considering that about 4 million births occur in the U.S. each year, that amounts to civil liberties infringement on a massive scale.

Every person has a fundamental right to refuse unwanted medical treatments and interventions, which stem from principles of autonomy and self-determination, privacy, liberty and freedom of religion that are so deeply engrained in our society and system of laws. Yet these rights are under attack, with pregnant women as some of the principal targets. It will take courageous people like the South Carolina mother we represented, as well as concerted work by civil libertarians, to ensure a woman does not lose this basic human right simply because she chooses to become or remain pregnant.

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JeninCanada

Hi there,
I'm currently experiencing my 3rd pregnancy (first was a c-section, 2nd was terminated by 11 weeks) and am being told that because of my prior c-section, hospital policy dictates that I must deliver at the hospital since I have a midwife as my primary caregiver. It is my desire to labour & deliver at home after my first hospital experience was a huge disappointment, but I can't do that and keep my midwife. My only other option is an unassisted home delivery which I know my husband isn't supportive of. Can you point me in the direction of any resources in British Columbia, Canada, to help me make my case that I *can* actually labour and deliver at my home?

Thank you, and an excellent article. I'm so glad the ACLU is helping people from all walks of life with all kinds of these problems. Thank you for the great work you do!

Gloria Lemay

Why is this woman considered "courageous" for sticking to her guns and getting the mighty ACLU to intervene on her behalf with lawyers? She's simply smart, assertive and has good friends with money. She might even be called "chicken" for wanting to get away from surgical instruments after having had that nightmare once already.

We had a case in Canada that is now dubbed the "Baby R" case where a poor woman with no friends was coerced into having a c section because her (4th) baby was presenting breech (bum first). She refused the cesarean but the dr got a court order to threaten her. She agreed under duress. Feminist lawyers only got wind of it after the fact but that woman won the right for Canadian women to refuse major abdominal surgery no matter what the drs say. Of course, the drs don't mention that much when they are "convincing" someone to lie on the cutting table.

Thanks for this story. Maybe it will save just one woman from the knife.

Anonymous

Thank you ACLU. Pregnant women have rights. We need health care reform in this country that is clear: coercion is not the same as consent. Maternity care in the US is expensive, lacks flexibility to support women's preferences and needs, is highly technical and is also dangerous. In general, midwives have a greater understanding of the delicate dance that is informing and supporting a woman's choice. So sad that this woman had to call you just the get evidence-based, sane care.

Elizabeth Allemann, MD
Missouri USA

JulieG

Thank you for writing this article. I often receive phone calls from women, (I deal with mostly mothers during pregnancy) who have been "abused and traumatised" by their health care providers, mostly male doctors. First "Do No Harm" should be written in big letters in every doctors surgery/office. Doctors should learn basic human rights, the power of the word (verbal abuse and the harm they often cause), respect and that everyone has a freedom of choice! AND every hospital, clinic should have a patient care centre where patients can be heard, make a compliant and give feedback of mistreatment of any kind. I think this would humble and humanise these people making them accountable for their actions. This happens in other professions.
Well done for this reporting and I do hope someone will take this up on a large scale there are really SO many horror stories of abuse which must be prevented.

DJM

Thank you for this article.
When I had my baby, I had to sign documents and give consent while in labor.
What I had planned to be a drug free, vaginal birth turned into a cesarean in which they completely knocked me out (I never would have agreed to that had I known). Then they kept my baby in the NICU and didn't let me see her for 12 hours.
I'm grateful for the medicine, but angry at how inhumanely we were treated. We had plans to have two children, but after that, I'm not so sure. I feel robbed.

Choose your hos...

In the Tampa Bay Area St. Joseph's Women's Hospital has the highest C-section rate of ANY hospital in the area... They even bullied my daughter's husband into forcing her to sign surgery papers DURING A PERFECTLY NORMAL LABOR. They did it when I went downstairs for coffee because they knew I what advocating for her. They moved so quickly that she was already on her way to sugery when I returned ONLY 22 mins later! We DID win tho, her next child was delivered V-Bac (Vaginal delivery after Cesarian) in a DIFFERENT hospital 2 years later! (With a doula!)

BRex

The problem is that those doctors can face lawsuits if they go along with a mothers wish and something goes wrong. If they go for the C-sec, and pressure too hard they face lawsuits, if they go for a natural delivery at the mothers request and complications occur they can face lawsuits.
Personally I don't know why people still go into medicine.

BRex

The problem is there is this is a no win scenario for doctors. If they do perform the C-section and the mother wasn't convinced they can face a lawsuit. If they don't push hard enough for it and complications arise, they can face a lawsuit.
Personally i dont know why anyone would go into medicine.

Anonymous

I had 2 previous c-sections for the sole reason that my hips were too loose and got mis-aligned. With my third pregnancy, I got a good chiropractor and had no problems. However NONE of the physicians in the state (except in Iowa City, which is a several hour drive) would accept me as a patient unless I concented to have a c-section. I would NOT do this, so I had my third at home with a midwife with no problems at all. There was only one midwife in the state that would take me on as a patient.

I was warned of the possibility that physicians would get a court order to force me to have a c-section. As a Ph.D., teaching medical school for years, I almost hoped that they would try. There was NO reason to force women into an elective surgery except for the convenience of the physician. It is more risky for the mother and child to have a c-section than a natural birth. Therefore physicians in this country are not living up to their oath "Do no harm".

The advent of this policy is due to the fear of uterine rupture. Research indicates that the incidence of uterine rupture post 1 or more c-sections is very similar to those of a mother giving birth for the first time. Physicians have been promoting fear hopefully due to their lack of knowledge on the current research. More dangerously it could also be due to lack of teaching of natural birth in OB/GYN training, fear of litigation, and overall convenience for the physician.

The US has the highest c-section rate in the world by far. This is NOT because they are necessary or good for the patients short-term or long-term health. I am glad to hear this story, not for the pain and trouble that the mother was forced into, but because this is a broken policy within the US that needs to change. Change will only come by publicizing these stories, informing the public with the truth, and getting our society to change the rules.

Anonymous

So by this logic, the woman is in complete control of what happens or does not happen to her body, even while another life resides inside of it. Would anyone be as supportive if she wanted to terminate the pregnancy, but no licensed physicians would perform the abortion? All of these civil rights groups cannot have it both ways. Either the doctors can lawfully intervene to do what's best for the fetus and refuse or require certain forms of treatment over the course of certain pregnancies and abortion is illegal, or women can have the free choice to do what they deem necessary, which could potentially be terminating a pregnancy, no matter the reason for that choice. Why can't everyone just let other people do whatever they want, as long as they are not inflicting suffering or infringing on the rights of others? Women, all women, should have the choice of whether or not to continue a pregnancy, where they have birth, if they want to do it natural or by C-section or use an epidural, it should be at the sole discretion of the woman giving birth, period.

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