Thursday, July 30, 2009
Friday, July 24, 2009
Is a Woman in Labor a "Person"? New Assaults on Pregnant Women's Civil Rights in a NJ Case
http://www.huffingtonpost.com/louise-marie-roth/is-a-woman-in-labor-a-per_b_242307.html
Louise Marie Roth
Posted: July 21, 2009 05:35 PM
Yet another ruling is providing legal support for the false belief that obstetricians are infallible and stripping pregnant women of basic civil rights that are then accorded to other individuals. In the case, New Jersey Division of Youth and Family Services v. V.M. and B.G., the New Jersey appellate court found that V.M. and B.G. had abused and neglected their child, based on the fact that the mother, V.M., refused to consent to a cesarean section and behaved erratically while in labor. The mother gave birth vaginally without incident, and the baby was "in good medical condition." Then she was never returned to her parents, and the judge in the case approved a plan to terminate their parental rights and give custody of the child to foster parents. What, beyond the obvious, is wrong with this picture?
First, from a legal perspective, individuals have a right to informed consent and bodily integrity. In obstetrics, informed consent is a blurry concept since many hospitals perform obstetric procedures on laboring women without informing them of the evidence concerning those procedures or their risks. Perhaps this legal case illustrates how paternalistic hospitals can be with respect to pregnant women -- assuming that the hospital staff know best and that informed consent is unnecessary. Never mind that hospitals tend to be run with organizational efficiency, rather than patient interests, in mind. In this specific case, one obstetrician who tried to convince the mother to consent to a c-section concluded that she was not psychotic and had the capacity for informed consent with regard to the c-section. It is clear within the law there is no informed consent without informed refusal, so this obstetrician's conclusion should have made V.M.'s refusal to consent to the c-section her decision alone. If this mother is not legally permitted to refuse major abdominal surgery, then she is clearly stripped of her civil rights to informed consent.
In fact, individuals are not legally required to consent to invasive procedures even to save other individuals, including fetuses that lack full legal status. But in this case the district and appellate courts subverted a pregnant woman's informed medical decision-making in the name of fetal rights, arguing that her refusal was a form of abuse and neglect of the child that had not yet been born. This is another dangerous precedent, along with other court-ordered cesarean cases, that will allow all pregnant women to lose their rights to bodily integrity and informed consent. It may be understandable, if not excusable, that the courts don't understand medicine or recognize that medical judgment is fallible, but it is hard to understand how they could so fundamentally misinterpret the law, in which performing surgery on an individual without that person's permission can constitute criminal "battery" under common law.
The court's opinion also suggests that lawmakers have no concept of what it is like to be in labor. Women in labor tend to find themselves on a different mental plane, where they have to focus inward and work with their bodies to give birth. As midwives know, some women become belligerent. Some seek privacy and seclusion. Most women in labor are likely to find the routine and usually unnecessary procedures of hospitals to be invasive and unwelcome. Yet the courts that decided this case didn't seem to be aware that women are unlikely to behave the same way when they are in labor as when they aren't. The decision cites hospital records that describe the mother, V.M., as "combative," "uncooperative," "erratic," "noncompliant," "irrational" and "inappropriate." Also, her husband indicated that the way she was acting was not her "normal manner and that she is not as 'tranquil.'" Why would anyone expect a woman in labor to be compliant, tranquil, or rational? What kinds of expectations does our society have for women undergoing a powerful physiological process, often with an absurd amount of poking, prodding and general interference? This mother was uncooperative with hospital staff, but clearly her uncooperativeness had nothing to do with the well-being of her baby. There is no reason to believe that she did not have the well-being her baby as her top priority, even though she was not a model patient. There is also no reason to believe that everything the hospital staff wanted to do was essential or even beneficial for the well-being of either mother or baby. In fact, typical obstetric care engages in many procedures that are unnecessary and often harmful, more out of habit and for the convenience of hospital staff than in the best interest of patients.
While the court opinion also focuses on the parents' psychiatric diagnoses (which are fallible medical judgments) and their history of care in determining their fitness as parents and abrogating their parental rights, their psychiatric state would never have been questioned if the mother had not refused invasive abdominal surgery -- which was entirely within her rights. The tragic consequence for this family was separation from their infant daughter from the moment of her otherwise uneventful vaginal birth. That kind of injustice can't have been good for the psyche.
Louise Marie Roth
Posted: July 21, 2009 05:35 PM
Yet another ruling is providing legal support for the false belief that obstetricians are infallible and stripping pregnant women of basic civil rights that are then accorded to other individuals. In the case, New Jersey Division of Youth and Family Services v. V.M. and B.G., the New Jersey appellate court found that V.M. and B.G. had abused and neglected their child, based on the fact that the mother, V.M., refused to consent to a cesarean section and behaved erratically while in labor. The mother gave birth vaginally without incident, and the baby was "in good medical condition." Then she was never returned to her parents, and the judge in the case approved a plan to terminate their parental rights and give custody of the child to foster parents. What, beyond the obvious, is wrong with this picture?
First, from a legal perspective, individuals have a right to informed consent and bodily integrity. In obstetrics, informed consent is a blurry concept since many hospitals perform obstetric procedures on laboring women without informing them of the evidence concerning those procedures or their risks. Perhaps this legal case illustrates how paternalistic hospitals can be with respect to pregnant women -- assuming that the hospital staff know best and that informed consent is unnecessary. Never mind that hospitals tend to be run with organizational efficiency, rather than patient interests, in mind. In this specific case, one obstetrician who tried to convince the mother to consent to a c-section concluded that she was not psychotic and had the capacity for informed consent with regard to the c-section. It is clear within the law there is no informed consent without informed refusal, so this obstetrician's conclusion should have made V.M.'s refusal to consent to the c-section her decision alone. If this mother is not legally permitted to refuse major abdominal surgery, then she is clearly stripped of her civil rights to informed consent.
In fact, individuals are not legally required to consent to invasive procedures even to save other individuals, including fetuses that lack full legal status. But in this case the district and appellate courts subverted a pregnant woman's informed medical decision-making in the name of fetal rights, arguing that her refusal was a form of abuse and neglect of the child that had not yet been born. This is another dangerous precedent, along with other court-ordered cesarean cases, that will allow all pregnant women to lose their rights to bodily integrity and informed consent. It may be understandable, if not excusable, that the courts don't understand medicine or recognize that medical judgment is fallible, but it is hard to understand how they could so fundamentally misinterpret the law, in which performing surgery on an individual without that person's permission can constitute criminal "battery" under common law.
The court's opinion also suggests that lawmakers have no concept of what it is like to be in labor. Women in labor tend to find themselves on a different mental plane, where they have to focus inward and work with their bodies to give birth. As midwives know, some women become belligerent. Some seek privacy and seclusion. Most women in labor are likely to find the routine and usually unnecessary procedures of hospitals to be invasive and unwelcome. Yet the courts that decided this case didn't seem to be aware that women are unlikely to behave the same way when they are in labor as when they aren't. The decision cites hospital records that describe the mother, V.M., as "combative," "uncooperative," "erratic," "noncompliant," "irrational" and "inappropriate." Also, her husband indicated that the way she was acting was not her "normal manner and that she is not as 'tranquil.'" Why would anyone expect a woman in labor to be compliant, tranquil, or rational? What kinds of expectations does our society have for women undergoing a powerful physiological process, often with an absurd amount of poking, prodding and general interference? This mother was uncooperative with hospital staff, but clearly her uncooperativeness had nothing to do with the well-being of her baby. There is no reason to believe that she did not have the well-being her baby as her top priority, even though she was not a model patient. There is also no reason to believe that everything the hospital staff wanted to do was essential or even beneficial for the well-being of either mother or baby. In fact, typical obstetric care engages in many procedures that are unnecessary and often harmful, more out of habit and for the convenience of hospital staff than in the best interest of patients.
While the court opinion also focuses on the parents' psychiatric diagnoses (which are fallible medical judgments) and their history of care in determining their fitness as parents and abrogating their parental rights, their psychiatric state would never have been questioned if the mother had not refused invasive abdominal surgery -- which was entirely within her rights. The tragic consequence for this family was separation from their infant daughter from the moment of her otherwise uneventful vaginal birth. That kind of injustice can't have been good for the psyche.
Monday, July 20, 2009
A day in the birth world
I had the honor of starting my day out with the faces of my girls smiling at me, then off to help support a needy momma in labor, as she struggled through a long, slow labor. I only was able to stay a few hours, but I hope I was able to be of help to her. As I type this, she is in full active labor, with a great doula by her side.
Later in the day,I had a phone conversation, a mom looking for a doula. She told me her story, about her Cesarean. How it left her hurt, betrayed, angry, and left her knowing there was better for her and her baby. This time, she has done her homework. But she's still angry, and knows the battle ahead for her to achieve the VBAC she desires.
I can't help but feel so sad for all the women out there, who want a great birth, especially those VBAC ladies, who are having their rights taken away from them. Where else in society, to we FORCE someone into surgery? Unlike an illness, or cancer, the person has the right refuse treatment, or seek other options. Sure the mother to be can refuse surgery, but at what cost? Many women choose homebirth for this reason. But too many women don't feel that its the best choice for them to birth at home, and are left with no other choice but to go through a major surgery, all because of rules and protocols not even backed by science.
If a woman has given truly informed consent, then the Dr should support her. Not tell her she will kill her baby, or sabotage the birth with words of doubt and fear.
I ended my day by attending a Tampa Bay Birth Network meeting. We had a speaker tonight, Dr. Charles Mahan, MD, Professor Emeritus at University of South Florida.
We discussed informed consent, the status of the Cesarean trend and that we are practically the worst in the country, how we rank poorly with the March of Dimes an "F" ranking in fact, and much of what is driving these rates.
He did empower us though, with information on how to best tackles the problem, at a grassroots level, and the steps currently being taken around the country, to make real changes.
As someone who is passionate about educating families, so they can give TRUE informed consent or true informed decline of consent, I was thrilled to see the sample of a document being worked up that a mom signs, while pregnant, while their is time to really weight out her choices, giving all the facts.
So this has been a day of birth related highs, it has left my inspired and fire up to make changes for our community, for the birth community my daughters will once be in. What will their options be?
Later in the day,I had a phone conversation, a mom looking for a doula. She told me her story, about her Cesarean. How it left her hurt, betrayed, angry, and left her knowing there was better for her and her baby. This time, she has done her homework. But she's still angry, and knows the battle ahead for her to achieve the VBAC she desires.
I can't help but feel so sad for all the women out there, who want a great birth, especially those VBAC ladies, who are having their rights taken away from them. Where else in society, to we FORCE someone into surgery? Unlike an illness, or cancer, the person has the right refuse treatment, or seek other options. Sure the mother to be can refuse surgery, but at what cost? Many women choose homebirth for this reason. But too many women don't feel that its the best choice for them to birth at home, and are left with no other choice but to go through a major surgery, all because of rules and protocols not even backed by science.
If a woman has given truly informed consent, then the Dr should support her. Not tell her she will kill her baby, or sabotage the birth with words of doubt and fear.
I ended my day by attending a Tampa Bay Birth Network meeting. We had a speaker tonight, Dr. Charles Mahan, MD, Professor Emeritus at University of South Florida.
We discussed informed consent, the status of the Cesarean trend and that we are practically the worst in the country, how we rank poorly with the March of Dimes an "F" ranking in fact, and much of what is driving these rates.
He did empower us though, with information on how to best tackles the problem, at a grassroots level, and the steps currently being taken around the country, to make real changes.
As someone who is passionate about educating families, so they can give TRUE informed consent or true informed decline of consent, I was thrilled to see the sample of a document being worked up that a mom signs, while pregnant, while their is time to really weight out her choices, giving all the facts.
So this has been a day of birth related highs, it has left my inspired and fire up to make changes for our community, for the birth community my daughters will once be in. What will their options be?
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