Woman Ordered by State to Submit to Hospital Confinement, Cesarean
Monday, August 3, 2009 at 11:58PM
In March 2009, mother of two Samantha Burton, was suffering pregnancy complications in her twenty-fifth week of pregnancy. At the state’s request, the Leon County Circuit Court ordered that Burton, who allegedly did not comply fully with recommendations regarding bed rest and smoking cessation, be indefinitely confined against her will to Tallahassee Memorial Hospital and submit to any and all medical treatments, bed rest, and other interventions, including cesarean section. In the words of the court, Burton must submit to anything that “the unborn child’s attending physician,” deemed necessary to “preserve the life and health of Samantha Burton’s unborn child.”
Burton requested to change hospitals, but the court denied that request, stating that “such a change is not in the child’s best interest at this time.” In addition, the court approved the state’s complete control over Burton’s liberty and medical care during pregnancy on what the ACLU and the ACLU of Florida, who filed an amicus brief in support of Burton, called the “erroneous” legal premise that the ultimate welfare of the fetus was sufficient to override her constitutional rights to liberty, privacy, and autonomy.
Doctors performed an emergency cesarean on Burton after she had been confined to the hospital for at least three days by the state and found that her fetus had already died in utero. Had Burton’s pregnancy gone to term, the mother of two other children would have been held at Tallahassee Memorial Hospital for fifteen weeks.
The brief filed by the ACLU states that the court erred by placing the best interest of the fetus before the liberty and privacy rights of Burton and by failing to demonstrate the type of compelling interest needed to justify the use of involuntary confinement and forced medical treatment. It also found fault with the use of state’s authority to ensure that children receive medical treatment by forcing Burton to undergo medical treatment for the benefit of her fetus.
The ACLU contends that the state based its decision on a single medical opinion without taking into account the fallibility of that decision and demonstrated in this case that “forced medical interventions cannot guarantee the preservation of fetal life.”
Furthermore, the ACLU noted that Burton “did not agree to comply fully with recommendations regarding bed rest and smoking cessation,” which was not the type of “extraordinary” circumstance that would merit court intervention and the confinement of a person to a hospital against their will. Rather, it stated in the brief that “it is hard to imagine anything more commonplace than the inability of a mother of two to remain on continuous bed rest, or the well-documented difficulty in quitting smoking.”
According to the brief, Burton is currently appealing the Leon County Court’s decision that she was confined to a hospital against her will and submit to medical treatment for the duration of her pregnancy on the grounds that her constitutional right to refuse medical treatment was violated and constituted an “unauthorized intrusion into her fundamental rights of privacy, liberty, and bodily integrity.”
Further reading:
ACLU Asks Florida Court To Protect The Rights Of Pregnant Women To Refuse Medical Care
(Via RH Reality Check)
Reader Comments (34)
Thank You ACLU. Thank You.
This is the secnd instance of forced c section in Tallahassee that I've heard about; the other one was Laura Pemberton, back in the late '90's. I'm certain their stories aren't unique, even though their more widely publicized.
As much as I wish she had stopped smoking and took responsibility over her body and her baby.... it's still not right to force a cesarean on anyone. It's not ok. It's not ok to confine her to the hospital.
I agree, thank you ACLU
We know that stress kills. I wonder if anyone has considered that the stress hormones associated with being confined against the mother's will, contributed to the demise of her baby??
If we are going to hospitalize pregnant women for not being compliant with prenatal recommendations, than we will have to build bigger units. On the flip side, it can be extremely frustrating to care for mom's who don't give two sh*ts about their fetus, who do dangerous things to themselves during pregnancy, and who may be too mentally and emotionally unstable or immature to know what they are doing. It is not pleasant to care for a mom who is a brittle diabetic and refuses to take insulin because she believes it will "hurt the baby," and we end up delivering a 12 pound baby at 34 weeks gestation, who dies 1 day later. It is not pleasant to take care of the same drug addicted mom's who deliver their upteenth drug addicted babies over and over again. It is not pleasant taking care of mom's who refuse all prenatal care because they don't trust doctors, but then run in panicked to the hospital at the last minute, yelling and cursing at the staff, and losing complete control. No, it is not pleasant.
And, as health care workers, we need to deal with it. These women choose this path for themselves and their babies. I would hope all women would want to care for themselves and the babies they plan on bringing to term, but that is a naive view of the world we live in. We can council and beg and plead, but in the end, it is the women's choice, and we will be waiting for them in the hospital with shovels to clean up the mess, but certainly not with handcuffs.
Well I don't support the ACLU and disagree with the term fetus - it's a baby. Regardless, she shouldn't have been confined but I wonder what the other complications were and did they lead to the death of the baby? One still doesn't have to have a section though to deliver a baby who has died, I've know a couple women whose babies died in utereo and they delivered naturally.
I know this isn't the point of the post, but what woman WOULDN'T do everything to save the life of her child? Why would anyone NOT give up smoking as well as their other desires for a short period of time to protect their child? I would. Hands down, I would do anything to protect my kids- even if it meant I had to hang out in bed for a month (or 3) in a hospital bed.
I understand the point that it's wrong to "order" someone to be on bedrest in the hospital, but still... Something just seems wrong with this story to me.
To Morgan: How do we know what the woman did or did not want to do? She had two other children, was she able to go on complete bed rest? Did her husband or family have the time to take off work and care for her and her children? Could their finances handle it? Was everything done to make sure this woman had the option of going on bed rest? And what about smoking? We know it is a serious addiction. Was she offered counselling? Medication? Support? Was everything done to see that she could do the best for her baby? Its completely unfair to assume that this woman just refused to do these things because she was either apathetic or uneducated. I think its more of an example of how we fail to support mothers as a society.
I'm not usually a fan of the ACLU anymore, and I don't think she should have continued smoking, but I find the results horrendous. This stuff is getting so out of hand it'd almost be comical if it weren't a real woman and baby. C-sections are not without risk! What if this woman had died as a result of their court ordered treatments? Two babies at home now would be without a mother. I don't believe in abortion personally, but legally it's allowed basically because the mother's choice/rights trumps that of the baby. So if you intend to carry this baby you're now just a womb pod without a voice because the baby's rights now trump the mother's?
This ruling better get overturned or it can easily be twisted to cover the many women that choose alternative care other than a typical OB and hospital. These rulings getting overturned still don't do enough, in that pregnancy is only finite in length and as long as a doctor or hospital can *get* the court order in the first place, even if it's overturned later, the doctor/hospital still gets enough time to 'treat' as they wish before that happens. This is just horrible.
So...in our society, a woman can actively make a choice to end her baby's life, based on the idea that it's *her* body and the fetus is separate from her...but if she decides to have the baby and passively puts its life in danger, they can force *her* body to submit to whatever someone else decides is best for the fetus. Talk about screwed up! At least be consistent.
I agree completely with ballerina's above comment. Regardless of situation we shouldn't take away a woman's right(or anyone else's for that matter) to decide what she wants to do. What about parents who refuse a life saving blood transfusion for religious purposes?? Can they go to jail for neglect? People enjoy throwing around their authority at whim too much in this country.
Reality Rounds, I am always so glad when you weigh in on stories like this. Every single time you do, I take a minute and reflect on how I am not a strong enough person to be a nurse.
Reality Rounds,
I certainly do appreciate the position that you healthcare professionals find yourselves in, with regards to women who can't or won't take responsibility for themselves and their babies; I really can't even imagine the frustration that must incite. BUT, I wonder if part (obviously not all--or maybe even most) of the blame should be placed on the system of care in our country. It is not a system that encourages personal responsibility. It is not a system that encourages pregnant women to educate themselves and become a vocal, participating member of their care team--so while there will always be women who just don't care, or just can't change, or just don't understand, there may be some who are just casualties of a screwed up system.
In my own personal experience as a Type 1 diabetic, during my first pregnancy, it didn't matter how careful I was, it didn't matter that I checked my sugar twelve times a day and kept it under 100, or that my A1c's were in the low 5s, it didn't matter that my babies were measuring fine and coming up healthy according to all the tests--I was pregnant with diabetes so I DID have a bajillion unnecessary tests and I WAS induced at 38 weeks--and I DID end up with an unnecessary cesarean. He was 7lb 6oz and perfectly healthy.
With my second baby, things started going that way again, so I said, "Screw this" and birthed my perfectly healthy, 9lb 2oz baby at home thirteen days past my due date.
I'm not a doctor, but I'm also not a patient number, or a symptom, or a complication. I am a living, breathing, intelligent woman who is capable of and willing to take responsibility for myself, my health, my baby's health, and the consequences of my own decisions. When doctors start treating women as individuals, and spending more than seven minutes at a prenatal visit with them, and encouraging them to educate themselves and participate in the decisions that need to be made, and stop trying to force a one-size-fits-all approach to care on them, maybe we'll start seeing better outcomes. Maybe we'll stop having so much of this alleged litigation. Maybe we'll see healthier moms, and fewer messes for you guys to clean up. I don't know--but it's worth a shot in my book!
I'm going to be really lazy and copy the comments I left on the Facebook fan page...
The Laura Pemberton (another Tallahassee court-ordered cesarean recipient) video is on the home page of the National Advocates for Pregnant Woman web site here
Court-ordered cesareans are really rare. There are plenty of less dramatic ways to coerce a woman into a cesarean that are used all day, everyday as evidenced by c-section rates of 40, 50, 60 and 70 percent.
However, I get weirded out that this could ever happen in the first place! If laws allow forced bed rest (*especially... Read More* for a woman just 25 weeks pregnant with two kids at home), involuntary confinement in a hospital and an unwanted cesarean, that mindset must be bleeding over into maternity care in general.
I wonder if this woman regrets ever having checked the box on her prenatal forms next to "Do you smoke?"
Jill, thank you for posting these awful stories. We need to keep shining a light on this stuff in order to get the public suitably outraged.
I wonder if the judge (or even the doctors, for that matter) in this case were aware of the fact that there is virtually no evidence of benefits for bedrest, an even smoking cessation during in pregnancy has a modest benefit, and probably no benefit once complications have already arisen. Even if there were studies supporting these interventions, it would still be unethical to hold this woman against her will, but I agree with a previous commenter that the stress from this whole scenario may have been worse for both her and her baby than being on her feet or quitting smoking.
I shudder at the thought that every mother who can't comply with complete bed rest could be held against her will. And since women prescribed bed rest are the ones already at risk of a bad outcome, I'm sure we'll soon be reading about a neglect or fetal homicide case involving a woman who was out of bed because she had to work or take care of her other children.
(Sorry. I wasn't chewing you out. I was waxing passionate. Birth stuff makes me do that. Nurses are amazing, wonderful people, and I can't even IMAGINE who much more screwed up the system would be without you all.)
Ballerina - I agree 100% with what you said. I often think this myself. Just doesn't make sense.
Reading these stories of court ordered cesareans and hospital confinement scares me sometimes. Makes me wonder what's next.
Ballerina, i agree with you 100 percent... the laws of the land should be CLEAR. There is a BABY in there, and our laws must protect that baby, or there isn't and a mother can do WHATEVER she wants untill birth. How can our laws say that abortion is perfectly fine at 25weeks, yet still commit a mother to involentary hospitilazation to protect a "fetus"?? I personally think that a baby is a baby from conception, but untill all of our laws recognize that, a mom has the absolute right to smoke, drink, do drugs or anything elce that's destructive and there is NOTHING that we can or SHOULD do about it. I don't like it, but we can't have it both ways.
I am 100% pro-life and normally despise the ACLU and all of its works.... But this case is disgusting. The state does not have the right to determine how a parent should "best" care for his/her child. This fits in to a lot of other categories in the modern scene - forced vaccination, forced public schooling, etc. If the mother was going to drop her baby off of a 10-story building, then yes, the state should interfere. But when a mother is trying to give her baby life and health, it is up to her to decide how she should do it - cesarean or vaginal, bed rest or non-bed rest, vaccinated or non-vaccinated, public schooled or homeschooled, etc. etc. etc.
Hopefully that wasn't too rambling - I'm tired!! Jill, thanks for your excellent blog and the great issues you present!!
I will now cut a check to ACLU! Thank you ACLU for standing up for every citizen's constitutional given rights!
Bed Rest has not been proven to improve outcomes, and it causes a great financial hardship for most families as we have no National Maternity Leave entitlement so that Bed Rest period is UNPAID. I am a woman of childbearing age, 1 infant son, I work full-time and my husband & I plan to have many more children, and I WILL NOT go on Bed Rest even if ordered to do so. That is MY RIGHT, MY CHOICE.
Pregnant Women have every right to SMOKE CIGARETTES, Drink Alcohol, anything else that is a legal right in this country, and whether or not we agree with it it is HER RIGHT. Should we fine and jail women who run marathons and go cross-country skiiing while 6 or 7mos pregnant? HER BODY, HER RIGHT.