ONTD Political

Florida Hospital Demands Woman Undergo Forced C-Section

3:42 pm - 07/28/2014


In an action that appears to be increasingly commonplace, a Florida hospital has threatened to force a pregnant patient to undergo cesarean surgery against her will, or to report her to child welfare authorities for attempting to exercise her right to make the medical decisions she deems best for herself and her family.

Jennifer Goodall of Coral Gables was informed in a July 10 letter from the chief financial officer of Bayfront Health Port Charlotte that because she decided to attempt vaginal delivery before agreeing to cesarean surgery in her fourth pregnancy, her prenatal care providers intended to report her to the Department of Children and Family Services, seek a court order to perform surgery, and perform cesarean surgery on her “with or without [her] consent” if she came to the hospital.

A complaint on behalf of Goodall was filed in federal court last week by National Advocates for Pregnant Women (NAPW) and Florida attorney Patricia E. Kahn, seeking a temporary restraining order to prevent the hospital from carrying out its threats. Federal District Judge John E. Steele denied the request, stating in part that Goodall has no “right to compel a physician or medical facility to perform a medical procedure in the manner she wishes against their best medical judgment.”

Goodall is now 41 weeks pregnant and has told her lawyers she is terrified to enter a hospital. Given this and the weight of medical evidence in Goodall’s favor regarding the safety of the delivery she wanted to have, it is unclear whether the hospital or the courts are considering “best medical judgment” and in whose interest they are acting.

Goodall delivered her three other children via c-section and now desires to undergo what is commonly known as vaginal birth after cesarean (VBAC). In decades past, VBAC was a common choice for women who had previously had c-sections, rising from roughly 5 percent of all deliveries after a cesarean in 1985 to roughly 28 percent by 1996. The rate of VBAC deliveries started to fall in the late ’90s, according to the American Congress of Obstetricians and Gynecologists, reaching 8.5 percent in 2006 due in part to “restrictions that some hospitals and insurers placed” on the procedure. In tandem with what some have noted as pressure on women to undergo cesareans, the rate of cesarean delivery overall in the United States simultaneously increased dramatically over the past four decades, from 5 percent to over 31 percent in 2007.

Medical and public health bodies have long criticized the high rate of cesarean sections in the United States. The World Health Organization points out that at the current rate of 30 percent of all deliveries, cesarean sections in the United States far exceed what should normally be between 5 to 10 percent of all deliveries. ACOG agrees. “The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns,” ACOG President Richard N. Waldman said in a statement. “[ACOG's] VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate.”

“The risks associated with a vaginal delivery are lower than the risks associated with a C-section overall, as long as you can deliver the baby at a facility equipped to handle a C-section in case of emergency,” Roger W. Harms, an obstetrician at the Mayo Clinic in Rochester, Minnesota, and medical editor-in-chief of MayoClinic.com, said in a statement. And the recovery time is faster. Undergoing a cesarean surgery for the fourth time carries a 1 in 8 chance of major complications. In short, VBAC deliveries are safer for both the pregnant person and the fetus and lead to fewer complications.

These facts did not escape Goodall, who said in a statement released by NAPW:
My decision to allow labor to proceed before consenting to a surgical intervention is based on years of research, careful consideration of the risks to me and my baby, and my family’s needs. All I want is to be able to go to the hospital when I’m in labor and have my medical decisions respected – and my decision is to proceed with a trial of labor and not have cesarean surgery unless some medical complication arises that makes cesarean surgery necessary for my or my baby’s health. Instead of respecting my wishes like they would for any other patient, my health care providers have made me fear for my safety and custody of my children. The people who are supposed to be caring for me and my baby have put me into an even more dangerous situation. I know I’m not the only one to go through this; I’m speaking out because pregnant women deserve better.

“I would definitely consent to surgery if there were any indication during labor that it is necessary,” Goodall added. “I am trying to make the decision that will be safest for both me and my baby, and give me the greatest chance at being able to heal quickly after my child is born so I can care for my newborn and my three other children.”

NAPW staff attorney Farah Diaz-Tello expressed disappointment in Judge Steele’s ruling. “The process of labor and delivery isn’t a procedure; our client is the one trying to avoid a compelled medical procedure. Deciding whether and when to consent to surgery is a constitutionally protected right,” she said in a statement. Diaz-Tello explained that every appellate court to rule on this issue on a full record has held that pregnant women retain their constitutional rights, including rights to medical decision-making and bodily integrity. “No woman should fear that because she’s pregnant, she can be threatened, coerced, or deprived of her constitutional rights,” she said.

But this is exactly what happened to Rinat Dray in Staten Island and to at least six other women in Florida, according to NAPW. “Florida is particularly bad for people giving birth,” Diaz-Tello told RH Reality Check in an email. “We know of at least a half dozen other women who have had court orders or threats of legal action this against them, but the certainty with which hospitals have made these threats makes us think there are more we don’t know of.”

According to declarations of medical experts filed with the lawsuit, the hospital’s actions violate medical ethics. In a statement to NAPW, Mary Faith Marshall, director of the Center for Biomedical Ethics & Humanities at the University of Virginia School of Medicine, called the hospital’s actions “troubling.”

“Given the clear statements from ACOG’s Committee on Ethics and other professional groups that coerced or court-ordered medical procedures are not ethically justified, it is stunning that a hospital would threaten such an action,” she said.

Diaz-Tello acknowledged the hospital’s concerns about malpractice liability, but noted that there is no legal or ethical authority that supports managing liability concerns by forcibly performing unwanted surgery. “The Florida Supreme Court has said health care providers are protected from liability when they respect and follow the decisions of a competent and informed patient to delay or refuse a proposed treatment, even when there are risks involved,” she said in the NAPW statement. “Ms. Goodall has explicitly and carefully documented her informed decision to proceed with a trial of labor; there is no justification for forcing her, or any person, to have unwanted surgery to protect a hospital’s bottom line.”


Reproductive Health Reality Check
teaoli 28th-Jul-2014 11:31 pm (UTC)
Heaven forbid someone make a decision about what's best for their own body, using years of research to back up their wishes.

I know women who were pressured into having C-sections they didn't want, but I didn't know the pressure could go this far.

Disgusting.
lozbabie 29th-Jul-2014 04:34 am (UTC)
Does this argument not apply to anti-vaxxers?
lady_leia_solo 28th-Jul-2014 11:32 pm (UTC)
Oh my goodness this is terrifying!
bex 28th-Jul-2014 11:53 pm (UTC)
Federal District Judge John E. Steele denied the request, stating in part that Goodall has no “right to compel a physician or medical facility to perform a medical procedure in the manner she wishes against their best medical judgment.”

By this reasoning, nobody has any right to make medical decisions for themselves ever, right? It's basically saying you can never push back against a physician or medical facility's decision about what sort of treatment to administer, according to their "best medical judgment." What an awful precedent.

EDIT: Also, Farah Diaz-Tello and the other NAPW folks are fantastic. I do research on substance use during pregnancy and NAPW writes amazing briefs and comes to the defense of pregnant women who are being railroaded by the court system. I have so much respect for what they do and I'm so grateful that they're there to do it.

Edited at 2014-07-28 11:55 pm (UTC)
lafinjack 29th-Jul-2014 02:49 am (UTC)
Any particular line of research, if I may ask?
sixdemonhag 29th-Jul-2014 06:10 am (UTC)
The anti choice idiots who are all about teh baybeez never think things through. If a pregnant woman's body doesn't belong to her in the interest of another "life" then why should a man with O+ blood be able to decline donating blood? Corpses would stop having more rights than women and mandatory organ donation would become a thing, no matter how one felt about it. This is the slope they have started us down and if this is going to happen, I hope I get to see the bitter tears of the forced birth crowd when it bites them in the ass too.
serendipity_15 28th-Jul-2014 11:59 pm (UTC)
Jennifer had her baby, not at this hospital but a different that would allow her to attempt a VBAC. She ended up having to have a c-section in the end, which she consented to, but was grateful that this hospital respected her decision to allow her to at least attempt labor.

http://www.sheknows.com/parenting/articles/1045199/is-this-america-woman-may-be-forced-to-have-c-section
darsynia 29th-Jul-2014 12:07 am (UTC)
I'm relieved to hear this, thank you! I'm 25 weeks along with my third and as they say, 'there but for the grace of God go I,' as I've been lucky enough that my body responds very well to the interventions that are now par for the course for birthing at a hospital in the US. I 100% would not be pregnant with our third child if it weren't for that fact; every first time mother honestly is so fearful of what's going to happen, and to have to be fearful for the fourth time is so not okay!
asrana 29th-Jul-2014 11:41 am (UTC)
Thank you, really glad to hear this.
alryssa 30th-Jul-2014 04:39 am (UTC)
Oh thank goodness. The fact that this kind of situation required her to do this, however...
blackjedii 29th-Jul-2014 12:03 am (UTC)
silly no once you have a bb in your tummy u are no longer a person

u are like

a box

that will hopefully hold a future white dude

lafinjack 29th-Jul-2014 02:48 am (UTC)
moonshaz 29th-Jul-2014 08:39 am (UTC)
sarahsaturn Nothing makes sense.29th-Jul-2014 12:43 am (UTC)
How can it be legal for a hospital to try to force a pregnant woman to undergo a risky procedure, but nothing can be done when crazed anti-vaxxers refuse to let doctors give their children a dose of vitamin k that can potentially save their lives?

Well, I guess it makes sense from an economic standpoint; hospitals probably make a ton of money on caesarians and god forbid anyone deny them a profit. Vitamin k shots are probably cheap, and if something (on the very off chance) does go wrong, hospitals probably make a ton of money treating the disease the vitamin k could have prevented.
amyura 29th-Jul-2014 01:31 am (UTC)
This is sickening, disgusting, and frightening, but there are a few factual errors in the article.

The WHO used to recommend the C-section rate not exceed 15%. They withdrew that recommendation in 2010, acknowledging that there was no empirical evidence to support such a recommendation. (Source)

VBAC is not the safest method of delivery for the baby. In order, for the baby, the safest methods are, first, scheduled non-emergency cesarean at term, next, uncomplicated vaginal delivery, and last, emergency cesarean. For the mother, flip the first two-- obviously it's best for the mother to have an uncomplicated vaginal delivery. However, it's worth noting that if a mother is going for a VBAC and something goes wrong, she's going to end up with an emergency cesarean, which is more dangerous for both her and the baby than the scheduled cesarean would have been. Cesareans are associated with higher rates of adverse outcomes in newborns, but that's not the same as causing them-- any baby whose safety is compromised in labor is going to stand a higher chance of ultimately being delivered by cesarean, as well as babies who are premature or have been diagnosed in utero with health problems. That's going to skew the numbers to make the cesarean group have worse outcomes.

Full disclosure: I'm pretty earthy-crunchy myself. My first was delivered via VERY unwanted cesarean due to asynclitic presentation, and my second was a VBAC attempt turned emergency cesarean. I used to be very active in a lot of the crunchy LJ-mommy communities when my kids were younger. And there's a lot of misinformation out there, much of it intended to make mothers who don't have uncomplicated home births, vaccinate on schedule, and don't breastfeed exclusively for the first year look like bad, lazy parents.

None of this changes the fact that Goodall's 14th amendment rights are being grossly violated by the hospital. She has the right to make a slightly higher risk choice for herself, especially when that choice, contrary to what Judge Steele wrote, involves NOT undergoing a surgery. She's not forcing anyone to do anything!
lozbabie 29th-Jul-2014 04:40 am (UTC)
Going to be the devils advocate here. Why does a woman with no known medical degree know more than her doctors with medical degrees and years of experience? And 'years of research' is exactly the argument that anti-vaxxers use to not have their children vaccinated. Why is there opinions less valid? The literature from doctors is that VBAC is a risky procedure. The best thing for baby in this situation is c section.

And while I will never argue that a baby's healthy be put above the mothers at this point it's a wanted baby that is viable. This mother was willing to put HER health and her baby's health at risk for what? A brith experience she wanted? I would hope the ultimate birth experience is a healthy baby at the end. Having a c section is not a failure and should never be seen as such.

Having said all the above I don't agree with the hospital. Threatening to take her kids away was an overreaction and Id say to look at legal action but legal action is what's gotten us into this problem ofmovercautious doctors hasn't it?

hikerpoet 29th-Jul-2014 12:25 pm (UTC)
My answer:
To answer your question:
For one, I consider myself pro-vax, but I am also against physically forcing the jab. Repercussions, outreach, brainstorming, various other options, but strapping someone down to force it? I still disagree with from a bodily autonomy point of view. That right there, shows how, for me, how it isn't so different after all.

It can be arguable about what doctors consider riskier. Their hands are often tied more by insurance than their own research and experience based opinions in many cases.

But just to expand, the vax thing is a broad public health issue due to the contagion aspect, and this situation just affects their family if it goes wrong. And also, MAJOR FUCKING SURGERY is a far huger deal than a little poke.
asrana 29th-Jul-2014 12:30 pm (UTC)
It is well documented that once you start on the road of having medical intervention during labour/delivery, you wind up with more and more interventions and higher and higher risks of adverse outcomes.

VBAC is risky but so is caesarean and the recovery time from my caesarean a) was AWFUL and b) took a hell of a lot longer than doctors told me it would. During that time I couldn't cough, sneeze, bend over to pick up my newborn baby, get down in the floor to change his nappy, without feeling like all my stitches were ripping out. I had to have 3 rounds of antibiotics to treat the infection I got in my incision, and I'm left with a thick, rope of scar tissue that STILL, nearly 4 years later, hurts if I pull/twist the wrong way. And that's after just ONE caesarean. *If* I have another child I will definitely be opting for VBAC because if nothing else I don't want the scarring there to get any more worse/painful/restrictive.

You start your second para by saying you wouldn't put the baby's health over the mother's, but in your next sentence you basically do just that by dismissing the mother's birth choice. This woman's been through it 3 times before, she knows what a caesarean's like! She doesn't say "no ceasarean ever", she says she wants to TRY VBAC. In a hospital, under medical supervision, where I bet they'll be doing continuous foetal monitoring (which also reduces mother's ability to have a vaginal delivery, but never mind).

Yes bottom line the ideal outcome to work towards is healthy baby and healthy mother, but caesarean is NOT the best option for the mother AND she still has to be functional to look after her 3 kids plus new baby within a couple of days of the birth. We don't know what ages the other children are but given that most people tend to have children relatively close together you can probably assume at least one of them's relatively young. Doing ANYthing for MONTHS after my caesarean caused me pain (intense pain in the early stages), if there's any way I could have looked after my newborn without having to go through all that I would definitely have chosen it.
lastrega 29th-Jul-2014 11:00 am (UTC)
IIRC the evidence on VBAC pretty clearly shows increased risk for the mother & the fetus and after 3 c-sections, I think she's making a poor choice. But it's her choice to make, and that hospital is so far out of line it's in another hemisphere. You can't go inflicting surgeries on unconsenting patients.
atheistkathleen 29th-Jul-2014 12:00 pm (UTC)
WTF
vampfan30 29th-Jul-2014 01:07 pm (UTC)
another devil's advocate here..

if the other articles I have read stating she has already had 3 previous sections are true, would it not stand to REASON that attempting a vbac is pretty close to insane at this point?
The risk to both mother and child should well outweigh her " I want what I want give it to me now! " attitude. The doctor made a call based on experience and training, which should outweigh a patient's wants when lives are on the line...that's part of a doctor's job.
I totally get the bodily autonomy thing but when you're being stupid and risking lives, too bad. She could have easily killed herself and the baby....and for what?
I sure as hell didn't want a section, but it was in our best interest. It is hell to recover from but we LIVED and isn't that the important part?
hikerpoet 29th-Jul-2014 04:51 pm (UTC)
Not really? Jesus Christ, you make it sound like her body would be apt to immediately explode the second she was allowed to have one contraction. The risks of both are different, greatly lowered with monitoring which it sounds like she was fine with, and can be heightened or lowered based on other factors that we don't know here.

Edited at 2014-07-29 05:17 pm (UTC)
furrygreen 29th-Jul-2014 10:58 pm (UTC)
Why are you assuming that the c-section is in this woman's best interest? Florida is the state with the third most c-sections in the country. It has almost a 40% chance of a c-section in a Florida hospital when it should only be 5% or 10%. I think there's a much higher chance that this is utterly unnecessary and the doctor is lazy.
tabaqui 30th-Jul-2014 02:45 am (UTC)
JESUS FUCK. I have this image of women taking a pregnancy test, and when it says 'positive', alarms sound, lights flash, the Pregnancy Police rush in and tackler her to the ground. She is then chained to a hospital bed for the next 10 months.

Fucking hell, i am *so gods damn sick* of do-gooding *assholes* trying to tell women what they can and cannot do with their bodies.
lafinjack 30th-Jul-2014 06:56 am (UTC)
You jest...
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