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 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!

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.

This is a slippery slope we are on. There are many people out there bringing children into the world with inadequate prenatal care, dysfunctional family situations, and other issues. Are the courts going to remove the individual rights of all those women during pregnancy? Are they going to then forbid that any woman under 18, with no income and previously diagnosed depression or what have you cannot have control over her body or her baby after its birth? This, and the story about the woman who's child was taken from her because she refused a C-section scare me. Sure, I am also saddened by the 15 year old mothers I see every day in my neighborhood, or the meth addicted mothers, but I still don't agree with someone usurping their bodily and parental autonomy with no proven cause.

(*I am sending telepathic messages to Jill to switch to Word Press so comments can be addressed in a thread)

Kari, I didn't feel like you were chewing me out. Seriously, I have been a nurse for 16 years in inner city hospitals, my skin is made of leather. You by the way are an example of a dream patient. It sucks that you had a C/S for a normal size baby, not sure what your doctor's rationale was. But you obviously go above and beyond for your health and that of your babies. You are not the kind of patient I was talking about.

When a woman is pregnant, her body is her own, like it or not. Even when health care professionals do go above and beyond to help women make healthy choices and treatments, it does not mean they will listen. We are often wasting our breath. It is a symptom of our society, our economy, our priorities, how we view women and how we view children.

I may come from a different perspective from Jill's readers, because I am a neonatal clinical specialist, not a birthing expert. I happen to run many of the state mandated neonatal programs (vaccinations, hearing tests, metabolic screenings) in my hospital. These programs are set up for the health and well being of our infants in our society. I am a firm believer in all of them. Parent's can refuse without (legal) consequence. I council parent's who refuse (sometimes until I am blue in the face), but in the end it is the parent's choice. The infant has no choice either way.

When I started the universal newborn hearing program, I remember bringing a baby in the nursery for the non-invasive test. The baby's mother was a recent immigrant from Iraq (during Saddam's reign), and she came with me and her baby to the nursery. During the test, the mom started to sob. I asked her what was wrong, if she thought I was hurting her newborn. She said no. She explained to me that in her country, children were left to die if they had such minor defects as a cleft lip or palate. Deaf children were not treated, they were ostracized or put in institutions. I cried with her. It is something I will never forget, and I am very proud of the state "mandated" programs set up in this country for newborns.

Why was she confined to bed? What evidence did the doctors present to the court that bed-rest would save the baby, but being at home would not? While smoking raises the risk of infant mortality (I think 4/1000, based on one US vital statistics report), that is an increased risk, not an automatic death sentence. I would very much like to see what evidence the recommended intervention was based on, and how well supported that is by medical literature and studies.

Sheesh! Yet again the gov't thinks they know better than the woman who is trying to bring life into the world.

When will people wake up and realize that the death of a fetus is (almost always) considered tragic by the mother? And that mothers love their babies and want what's best for them, whether inside or outside the womb? The ACOG as much as says so in its own words included in the amicus. Moms want what's best for their babies. Period. Not everyone buys what's being sold by MOST OBs/hospitals in regards to birth or child rearing (heck, not even all doctors do!). That is the mom's right, ESPECIALLY before a viable baby is born. And disagreeing with the doctor on treatment does NOT mean the mom isn't considering her fetus/baby/child's well-being.

When will doctors stop tyring to play God, and realize that they are human? When will people stop criticizing every single decision mothers make in carrying, birthing, and rearing their children, and realize that variety is what made this country great to start with?

And concernig the parens partriae, that is scary stuff. What interest could the state POSSIBLY have in the life of someone's child that the parents themselves don't have (except in EXTREME, and I mean EXTREME beyond a doubt cases of abuse or parental psychosis that might cause homicide)? This mom has 2 living children to care for, and many fetuses die at 25 weeks...it is a normal outcome of pregnancy (rare, but within the range of normal). I suppose the state's interest in this one fetus is more than in the 2 already living and viable children this woman has to care for??

Oh yeah, that's right, the state gets $$ for every child in the foster system and adopted out, not for supporting children in their own families, which helps children more than the foster care system. I suppose if we can claim more women are crazy for not doing everything the doctor says (recommendations that may in fact be harmful), there will be a lot more $$ for the state through cases such as VM and BJ and JGM. I wonder if the child had survived, if CPS would have been called and this woman billed as crazy. Too sad. If the mom had died and the dad couldn't raise the kids himself, or was declared crazy for accepting the mom's paranoia aka folie a deux, maybe the state could have had 2 perfectly healthy viable kids to adopt out to *preferred* parents. (Hopefully you're reading sarcasm into this)

I don't even want to ask what next.

Thanks for posting this Jill.

Hmmm, my pediatrician uncle's wife smoked throughout her entire pregnancy, all three times. She doesn't normally smoke. She did it to keep her weight down so she didn't have to birth big babies. Somehow, they all survived, and none of them smoke or were otherwise damaged. Guess smoking isn't a death sentence for fetuses (although not great for them, sure, but how can we know that the increase in miscarriages to smokers is miscarriages of healthy fetuses that would not have been miscarried anyhow??)

Guess in the 2000's she could've been locked up in a hospital, for doing the same behaviors that I believe were recommended (or at least winked at) by her doctor in the 1970s to prevent *big baby* (don't get me started on *big baby*, either).

Just goes to show how much the medical establishment is a pure science, riiiiiiiiiiiigggghhhhhhhhhttttttttttttt.

Reality Rounds,
I guess what irks me about the system is that women who DO want to be responsible are treated the same as women who don't. When I started "pushing back" during my second pregnancy against automatic induction at 39 weeks, fetal scalp monitoring, amniotomy, birthing in bed, and, of course, vbac, the ob that I was sent to by my first and second choice care providers acted as if I was irresponsibly endangering my baby. Like she was the goddess of all pregnancy and birth-related information and the only way I could have a live baby at the end was to do all these things that ended in my first c-section.

We don't know the circumstances surrounding this woman's specific situation; maybe she just said "To heck with bedrest, rolled onto the floor, and lit up." Maybe she couldn't afford bedrest, and tried as hard as she could to quit smoking. Who knows? I guess it just bugs me that doctors think every woman that doesn't do what they say, and every woman who disagrees with their opinions is irresponsible and selfish (I'm not saying that's YOUR position--I'm making sweeping generalizations here:)). Honestly, I had such a horrible, traumatic hospital experience with my first child, and a horrible start to my second pregnancy (different docs, different hospitals), that I would go unassisted if I couldn't find a midwife, before I would go back to a doctor. Doctors need to trust women, and listen to them, and get to know them, and not just do things because "that's how it's always done with women like you."

And I'll stop ranting now. :)

Oh yeah, and I had a c-section b/c the doc induced me at 37.5 weeks, and turned the pit up too high, too fast. I labored for just four hours before my son's heart tones started showing decels (it was non-reassuring heart tones, not officially distress yet). So he didn't turn off the pit and see what would happen--he just cut me. I'm pretty sure he just did it because he wanted to, though. He'd mentioned sections at a couple earlier visits, like he was trying to prime me for it. And I was too stupid to run away.

I keep reading the materials around this, and they haven't made sense to me yet. NB: I am studying for exams too, so mostly skimming right now; please let me know if I missed something.

What I am seeing here is that a person was stripped of their fundamental rights (liberty, bodily integrity and autonomy, and the ability to make medical decisions for herself) WITHOUT the commission of any crime. In addition, I'm not even seeing that she was deemed incompetent to make decisions for herself.

I would really, really, REALLY like to hear the court's reasoning behind this.

I would also like to know why, if the hospital was the super-duper best place for her and the baby to be, why she was there for three days and then they performed a C-section, during which they discovered the fetus's death? Were they monitoring her before? What went on here?

I am not pleased.

How can this be justified by "for the baby's best interest" but abortion is okay?? Abortion is not for the best interest of the unborn child!! I don't understand how people can make such conflicting decisions. The woman's rights were completely overlooked. Some (not all) doctors and the courts have decided that they're allowed to be God and decide what is best for everyone and try to force them to comply with their thinking... If they can do this, how long will it be before they try to force us to comply with their religion because "it is what is best for us" and we're not smart enough to decide for ourselves what is best for us? We just need to be consistent. Either it is a baby and we should always protect it, or it is a fetus and it is always the woman's decision to decide what to do with it.

Thanks Amy R. and RR for weighing in. It is too bad the comment thread turned into a dumping ground for people to unload anti-abortion rhetoric.

The bottom line is, the woman has bodily autonomy. People who support bodily autonomy support women's rights to refuse treatments, especially unnecessary ones, and those who choose to terminate pregnancies.

25 week abortions are incredibly uncommon, they are illegal in most states, not protected by Roe vs, Wade and make up less than 1% of all pregnancy terminations. These are overwhelming women with wanted pregnancies who have something very wrong with the fetus. And no, it's not a baby yet. If you have to lie to support your opinion, maybe it's time to rethink your opinion.

And, the ACLU recently defended a woman who was pregnant and had HIV and was put in jail, they got her released, got her charitysupport and medical care. The ACLU supports the Bill of Rights and the Constitution. Where do you think our civil liberties come from? Maybe you should check out what they really do before you trash them.

I am late reading this but I also noticed the anti-choice loads and my eyes were rolling.

On another note though, what many don't realize, if you have not been a part of the court system, is that judges often make decisions that are in opposition to our constitutional rights. This mainly happens in the family court system. Judges make and interpret the laws the way they see fit. The appeals court often denies appeals or decides whatever the lower court previously decided. The fox guards the hen house. We live in a sexist society and women do not have the choices they think they have.