Futuristic Childbirth and Court-Ordered Cesareans
Sunday, September 6, 2009 at 1:30PM
Birth as an American Rite of Passage
THE TECHNOCRATIC MODEL OF BIRTH:
FUTURISTIC EXTREMES
In “Childbirth 2000,” Gena Corea (1979) presents a frightening view of the possibilities inherent in such a hegemony. She tells the imaginary story of a pregnant woman living in a remote rural area, who decides on home birth with a midwife for her first pregnancy. Unbeknownst to the woman, on her one and only visit to the obstetrician at the nearest regional health care facility, an electronic “homing device” was implanted in her uterus. As soon as she goes into labor, this homing device emits a signal picked up by the computers at this regional hospital. A short time later, a helicopter descends down out of the skies and whisks the bewildered and terrified woman and her husband off to the hospital. Labor “fails to progress,” fetal distress is diagnosed, and an emergency Cesarean is performed.
Could such an eventuality come to pass? A 1986 national survey of heads of maternal-fetal medicine teaching programs reported twenty-one attempts to obtain court orders to force obstetrical interventions on pregnant mothers, fifteen of which were for Cesarean sections (Kolder, Gallagher, and Parsons 1987). According to Beth Shearer (1989), four more court-ordered Cesareans have been ordered since then. For example:
In a 1981 Georgia case, doctors told the court there was a 99% chance of fetal death and 50% chance of maternal death unless a scheduled Cesarean section was performed, since two ultrasounds indicated a complete placenta praevia [a potential life-threatening situation in which the placenta lies under the baby, blocking the entrance to the birth canal]. The mother steadfastly believed in her ability to give birth safely. After the court order was granted, a third ultrasound showed no praevia at all. (Shearer 1989:7)
In Denver, in 1982, a judge and an attorney were actually summoned to the hospital room where an obese woman was in labor and was adamantly refusing a Cesarean. The baby still in her womb was declared a ward of the state until birth, the woman was anesthetized, and a Cesarean was performed. The doctor had insisted there was fetal distress, but the baby was born perfectly healthy. This incident, analyzed by Jordan and Irwin (1989) along with eight other similar cases, was reported to me in 1983 by one of the obstetricians whom I interviewed in Centertown. He said that the obstetrician who performed the Cesarean had been bragging about it at a recent obstetrical convention. Even more alarming, the Centertown obstetrician whom I interviewed did not personally see anything wrong with such an approach.
On January 13, 1996, two decades after Corea’s essay was written, Laura Pemberton of Florida experienced what might be the closest to the fictitious futuristic scenario in U.S. history. According to the National Advocates for Pregnant Women site, a lawyer was appointed to her soon-to-be born at home child and a cesarean ordered by the court. She was forcibly and violently removed from her home and taken to the hospital for unwanted, unnecessary surgery. [Emphasis mine]
Laura Pemberton scoured Tallahassee and the surrounding areas for an obstetrician who would attend her in a vaginal birth for her fourth child after a prior caesarean delivery. She was rebuffed by every doctor she contacted; the risk of catastrophic uterine rupture was too high, they told her. Believing in her body’s ability to give birth vaginally, Mrs. Pemberton decided to deliver at home rather than agree to what she viewed as unnecessary surgery. More than a day into her labor with no sign of complications, she nevertheless worried that she was becoming dehydrated. She reasoned that the best way to safely manage her labor would be to go to a hospital for intravenous fluids, and then return home. Mrs. Pemberton entered the hospital expecting to receive care and assuming that she, like other patients, had a right to informed medical decision-making, including the right to consent to or to decline recommended medical procedures. When she arrived, she was placed on a fetal monitor that showed that her baby’s heartbeat was strong, and that her labor was progressing, albeit slowly. However, when the obstetrician on call realized that she was attempting a VBAC, she refused to give the IV that Mrs. Pemberton needed—unless she consented to a caesarean. Mrs. Pemberton was alerted by a nurse that obstetricians were about to seek a court-ordered caesarean section. Without receiving the fluids and while still in active labor, she fled the hospital out of the back steps in her bare feet.
Mrs. Pemberton made it home to continue her labor, her confidence bolstered by the baby’s strong heart tones. Her progressing labor was interrupted by a knock at the door: it was a sheriff and the State Attorney. They entered her home and even her bedroom, following her throughout her house to make sure she did not flee again. They told her that she had to return to the hospital, because a court order forcing her to undergo a caesarean section had been granted. Neighbors looked on as she was removed from her home, still in active labor, with her legs strapped together on a stretcher. Once at the hospital, she was allowed a “hearing” in her hospital room, with an armed sheriff, the State Attorney, and obstetricians crowding her room. Although a lawyer was appointed to represent the fetus, no lawyer was appointed for her.She spoke between contractions, without the benefit of counsel, telling the judge about the extensive research that she had done to support her decisions. Despite the fact that she could already feel her baby’s head in the birth canal and neither she nor the baby showed any signs of danger, the obstetricians were convinced that she exposed her fetus to too much risk by continuing to deliver vaginally: the judge agreed. Laura Pemberton was sedated, and her baby removed via caesarean section.
Mrs. Pemberton left the state and went on to deliver four more children, including a set of twins, vaginally.
On the new(ish) blog, Dou-la-la, author Anne wondered in her post, The Mickey, whether or not a woman could really be anesthetized without her consent in labor so her baby could be removed by cesarean. The story Anne presented was dismissed on another forum as highly unlikely, but it sounds very similar to the case in Denver mentioned in the Birth as an American Rite of Passage excerpt, in which a woman was adamantly refusing a cesarean and her unborn child was declared a ward of the state until birth. The woman was anesthetized, a cesarean was performed and although the doctor had insisted there was fetal distress, the baby was born perfectly healthy.
In both of these cases, the women had their rights trumped by those of the unborn baby inside them. By making a fetus a ward of the state, the state conferred legal rights upon the future citizen that were equal to—and ultimately greater than— those of his or her mother.
Related reading:
Woman Ordered by State to Submit to Hospital Confinement, Cesarean
ACLU Files Amicus Brief in Support of Woman Hospitalized Against Will
Complaint Filed Against Obstetrician, Hospital for Unauthorized Sterilization During Cesarean
New Jersey Cesarean Refusal Case: The “System” is Schizophrenic
New Jersey VM Case - A Victory of Sorts (National Advocates for Pregnant Women)
Does a Laboring Woman Have Any Rights? (Birth Activist)
Refusal of Unnecesarean Leads to Loss of Custody: V’s Story
Superior Court of New Jersey Terminates Cesarean-Refusing Mom’s Parental Rights
When Unborn Rights Trump Maternal Rights
Reader Comments (19)
The Pemberton story makes me break out in cold chills and choke up every time I hear it. :(
A recent judgement concerning the right to informed refusal of medical treatment was upheld in NSW Australia recently, but carries the following: "An exception could be made if a pregnant woman’s refusal of treatment would result in the death of her unborn child." This is is the wake of the momentum created by the efforts of families fighting for their right to birth at home without interference from the obstetric system.
HELLO!!! Women and babies are not state property! I think it's nuts that these politicians are selling out their own future family members. What will they tell themselves when someone they love is shackled and forced into the hospital under the guise of "protecting the fetus"? Oh yes, the ever popular and condescending, "At least you have a healthy baby." Crimeny.
Isn't it funny that the rights of the mother are fought for tooth and nail for the right to terminate a baby, but when a mother wants to have a natural birth (the way it was intended) the baby comes first? We are so backwards in this country.
I don't understand how a fetus gets the rights here, but they have none when the Mother wants an abortion, which WILL end in the death of the fetus knowingly.What a screwed up system.
I was also threatened with a forced cesarean when I wanted a VBAC2.
I think next time I won't even tell anyone I'm pregnant.Just going to trust in the Higher Power.
Given the occasional cases of dangerous abandonment of newborn infants or even infanticide, there must exist some mothers who do not have the capacity to make reasonable decisions about birth, either. I understand that the cases mentioned here may very well be unnecessary coercion by the state and the medical establishment - but how would you propose determining whether a mother is competent to make these decisions when the deck is stacked culturally and legally against those who would protest a cesarean?
It's amazing how we as a society still see nothing wrong with rape. And forced surgery in childbirth is rape, let's not kid ourselves. It's a sign that in our society, the mother is really not important. Mothers who abort for whatever reason are assumed to be selfish, slutty, and worthless - even if the abortion was for medical reasons. In birth, we say "nothing matters except a healthy baby; mothers who put a happy birth experience over medical safety are selfish," even when evidence shows that there is no conflict here, that happy mothers generally have less labour problems and easier births. After the baby is born, the mother is left completely on her own, unless she is fortunate enough to have made private arrangements with nearby relatives who she trusts or has paid help. If she flounders from postpartum depression, that's shameful and we don't talk about it. As the baby matures, then come the milestones and the playground mommy wars. Who walked first? Who slept through the night? Who had better "success" weaning? Mommy wants to focus on her own life? SELFISH. Mommy's having problems coping and needs a little help so she can get time off? SELFISH. Mommy just applied for food stamps because she left her abusive husband and can't afford to live on her own without a little help? SELFISH - because everybody knows welfare mothers shouldn't have got themselves pregnant in the first place, that burdens the taxpayer... Selfish, selfish, selfish. We say the hand that rocks the cradle rules the world, that motherhood is the most important job of all, but do we really mean it? I don't think so. If motherhood were that important, we would treat mothers as if they were important.
P.S. My first child was born via the Great American C-Section, after a medically micromanaged labour. (And to think I'd just switched to a CNM from an obstetric group practice to avoid unnecessary interventions! Gotta love hospital politics.)
My second child was born in a hospital maternity ward, a VBAC that felt like being raped. Having been date raped, I think I can speak with some authority. Nurses were holding me down on my back, were holding my legs open as if they were stirrups (this was supposed to be supportive), the doctor was yelling at me for forcing him to attend a VBAC, and the premature birth was my fault somehow and I held out my arms for my baby and wasn't allowed to touch her, and I still can't forgive myself for not fighting harder. I hadn't even planned that to be in the hospital, but I'd had gastroenteritis so bad that it must have been what triggered my labour, and when the ambulance came to take me to the hospital I was okay with that because I thought I was dying of dysentery or something. If I'd known it was labour I'd have stayed home and then had the hospital transport me and my baby.
My third child was born at home, into my husband's hands. I was crouching in the bathtub. It went so fast that the baby arrived before the midwife and doula. Oops. That was a good birth. I wish the other two had gone that way.
Dear Sarah -- I hope you will find a way to forgive yourself. You had just been raped, and I'm sure you must have been tired after pushing out your baby in such a brutal environment and stupid birthing position that they wrenched you into. I am so sorry you and your baby and your husband had to endure that! It was not your fault. They had temporarily broken you, and fighting harder probably would not have changed a whole lot, anyway, right? I hope you fill be able to somehow find peace about it someday.
This scares me deeply. I had a birth center birth and suffered hemorrhage after the placenta was delivered. I have had two OB doctors tell me that I had placenta previa based on my symptoms and that I should have been told to have a cesarean. However, I was tractioned by my midwife (which I still believe to have been unnecessary intervention) and had a second degree tear that my midwives did not notice. I am ashamed of the fact that I had sought midwives to avoid intervention and ended up suffering intervention consequences. I digress, the OB that actually performed the d&c for the fragments left told me that my placenta was very high in the wall. I am very glad I never had a planned csection for previa that I did not have. Even though I did suffer birth trauma and did have to get 28 stiches and 3 pints of blood. I would gladly do it all over again and still avoid the cesarean. I got to experience every last artificial drug free moment from the first contraction to the last. I got do deliver standing up because that is what I felt like doing at the moment of pushing. I got to eat whatever I wanted whenever I wanted during labor. I labored outside, inside, in a tub, on a bed, walking, sitting, standing. I had my own birth and my own personal experience. Some women would use my experience of an example of what you can avoid with a planned cesarean (trauma) but I view the potential cesarean as far more trauma than what I experienced. I can't imagine being court ordered to miss the most beautiful moment of my life because someone thought I wasn't capable of making my own decisions about the way I birth. That's the worst right to deny a woman that I can imagine and it breaks my heart to hear of these tragedies.
Oh Sarah, your first post makes me want to go picket in the streets and your second post makes me want to hug you and bawl my fool head off. It's so unfair what women and mothers go through in this country. SO UNFAIR.
I cannot believe this. Well, I can, which is even worse. Broke out in tears at the story of Mrs. Pemberton. This is sickening.
Now a days almost everyone are opting for caesarean section. Some years ago, it has been said that ‘Once a caesarean, always a caesarean’. Later on it was found that Vaginal Birth After Caesarean was proven to be safe and effective. Also all post-caesarean pregnancies do not need repeat CS and most of them could have unfussy vaginal delivery.
Mrs. Pemberton's story made my heart pound. What a horrendous, disgusting, criminal breach of patient trust. What mystifies me is that the men who made those decisions aren't in jail. They deserve to be.
Oh, and someone needs to send this link to Dr. Masterson. O.B.s don't push interventions on women, huh, Lisa?
Thank you for all of the great comments. I left this comment over on the Facebook fan page:
Court-ordered cesarans remain VERY rare and I'm not sure exactly why some hospitals take it to that level when a woman refuses a cesarean. I suspect they're so rare because a) it's not common to refuse a cesarean and b) most doctors and hospital administrators have way too much common sense for this. However, they seem to collectively be doing a ... Read Morefantastic job of scaring women and their partners into unnecessary primary and repeat cesareans.
The reason I post stories like this isn't to scare the crap out of readers (sorry) but because I'm so blown away that things could ever get to this level in the first place. If they felt that way about Laura Pemberton's body that they could strap her down in labor, how do they feel about all of the other women in their "care?" It's that mentality I am exploring.
Rosemary said: "Given the occasional cases of dangerous abandonment of newborn infants or even infanticide, there must exist some mothers who do not have the capacity to make reasonable decisions about birth, either. I understand that the cases mentioned here may very well be unnecessary coercion by the state and the medical establishment - but how would you propose determining whether a mother is competent to make these decisions when the deck is stacked culturally and legally against those who would protest a cesarean?"
Honestly... not sure. To me, that is the most difficult ethical dilemma about court-ordered cesareans. What about the rare cases in which a woman really, truly is incompetent? Is there ever justification for commandeering her body and removing the baby surgically against her will, even if the law says there is not? I'll think about it and do some research.
Ha! That's my avatar! Guess I need to go update it with the homing device...
I was held immobile by my husband (who was told if he did not make me co-operate he would be responsible if I or our baby died) and a member of the theatre staff for a spinal anaesthetic. All the way through I was screaming at them to stop, but no-one listened. My baby was delivered with an Apgar score of 9 then 10 and no signs of the distress presented as the reason for performing a caesarean in advanced labour. There was no need for a court order, brute force and male strength over a woman in labour was enough, although I was so resistant it did take two people to hold me still...
This was in the UK in 2005, I still suffer nightmares from the trauma and physical pain from the scar. I also am suffering secondary infertility as a result of the caesarean.
One of the biggest killers of mothers is still suicide, even amongst those with no history of mental illness. I wonder what drives them to such desperation, treatment in labour and a devaluing of motherhood perhaps?
Vicki, that is barbaric treatment. I'm so sorry for you and for your family. I've heard other stories of husbands being intimidated into holding their wives down for the good of the baby and it's horrific.
All of that and your baby had nearly perfect Apgars. Unbelievable. Thanks for sharing and I hope you've been able to find support from friends, family and community.
Jill
What a chilling and menacingly prescient tale Corea told. Who'd have thought it would sound so downright PLAUSIBLE today? I mean, put the current political climate surrounding birth, using not only the examples in the original post but stories like your commenters have shared, together with fancy new innovations like the Birth Track . . . Yeesh. I really need to read the Robbie Davis-Floyd book - it's been on my reading list for ages!
Regarding "The Mickey", I do think the Denver case sounds quite a lot like it. As I said before, I definitely don't think we got the whole picture, and there's no way of finding out more, but I DO think there were elements of truth to it - and it was the L&D nurse's attitude about the whole thing that was the most disturbing of all. And I remember reading Ms. Pemberton's story in "Pushed". Tears me up to this day.