You Try Saying No to a C-Section


Last year Idaho passed a law making it
a crime to coerce a woman into having an abortion. This year, legislators in twelve states, including Missouri, have passed or are considering bills
that they claim would enhance informed consent measures for pregnant
women seeking abortions and ensure that women are not coerced into having
unwanted abortions. Although it is hard to disagree with legislation
that purports to ensure free and informed medical decision-making, I
have to wonder why legislators who profess to care so much about pregnant
women are only willing to protect some pregnant women – the ones who
plan to end their pregnancies – but not the ones who intend to go
to term.

While approximately 800,000 women end
their pregnancies each year, a far greater number of women, 4.3 million,
go to term. By focusing exclusively on abortion, this kind of law also dangerously
implies that pregnant women who are going to term are fully and adequately
informed and that their medical decisions are never pressured or coerced.  

Instances of poor communications, failure
to fully inform, and coercion in hospital delivery rooms, however, are
increasingly being documented in popular books, films
and collections
of first-hand accounts
. Allegations
of abuse have prompted one organization to provide a guide for filing complaints.  Rigorous
peer-reviewed research
, moreover,
has found that pregnant women are routinely subjected to interventions
during labor and childbirth that have been proven ineffective, or are
appropriate only in limited circumstances.  Pregnant and laboring
women are often deprived of information about and access to a range
of good practices that have been shown to work.    

For example, an increasing number of
women in the United State now give birth by cesarean surgery. According
to the World Health Organization the rate of births by cesarean surgery,
based on actual medical need, should not be more than 15% of all deliveries.
Yet, today approximately 30% of all US births are cesarean surgeries.
Some providers and hospitals have even higher rates (40-50% of all births).
This rise in cesarean surgery rates has not been accompanied by overall
improvements in maternal or child health and creates risks to pregnant
women and babies that do not exist with vaginal births.  

According to Listening
to Mothers II
, the largest
survey of women’s experiences during pregnancy, childbirth, and the
postpartum period, one quarter of the survey participants who had cesareans
reported that they had experienced pressure from a health professional
to have cesarean surgery, and 73% of women who experienced episiotomy,
or vaginal cutting, during delivery, reported that they had no choice
at all in the matter. 

Supporters of so called abortion coercion laws claim that they will
protect pregnant women and ensure that their decisions are made
freely.  Many commentators and organizations
however have raised questions about these legislators’ opposition to
coercion pointing to the fact that the same legislators often support
policies that have the effect of coercing some women to go to term and
others to end their pregnancies. Certainly, though, if protecting
pregnant women and the “unborn” were really the goal, the legislation
would not focus on abortion exclusively, but rather would make it
illegal to pressure or coerce a pregnant woman to have any medical
intervention. This would include policies that force pregnant women who
have had previous cesarean surgery to have repeat surgery whether they
need it or not.

The best available evidence supports
vaginal birth after cesarean surgery (VBAC) for most women who have
had this surgery.  Nevertheless, the International
Caesarean Awareness Network

has documented over 800 hospitals with explicit policies that require
women
to undergo a planned repeat surgery. These women are deprived
of both the right to give or withhold informed consent, and they are
coerced into having repeat major surgery if they want to deliver in
any of these hospitals.  

The Missouri bill requires that women
be provided with  "medically accurate information that describes
the proposed abortion method, medical risks, alternatives to the abortion,
and follow-up care information."  While such information is routinely
provided in the context of abortion, there is significant evidence that
critical information is not provided to women regarding childbirth delivery
methods.  Indeed, only two states in the whole country, New York
and Massachusetts, have Maternal Information Acts that require health
care providers to give expectant parents information about their cesarean
surgery rates and rates of births using medical interventions such as
labor induction and episiotomies. These laws give families the information
they need to avoid providers who are not willing to or who are not trained
to support vaginal birth.  

Each year, state legislators introduce
hundreds of bills that focus on abortion while ignoring serious health
and consent issues affecting the millions of women who become pregnant
and go to term. Legislators who are truly concerned with protecting
pregnant women would ensure that all
of them, not just those seeking abortions are guaranteed informed consent
and freedom from coercion.  

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To schedule an interview with Lynn Paltrow please contact Communications Director Rachel Perrone at rachel@rhrealitycheck.org.

  • http://www.unnecesarean.com invalid-0

    If you replace the word “abortion” with the words “cesarean section” or “induction” in the Missouri House of Reps bill, parts of it are very interesting.

    The physician performing or inducing the (cesarean section or induction) or a qualified professional must:

    (3) Explain that coercing a pregnant woman to get (a cesarean section or induction) is illegal and she is free to withhold or withdraw her consent to the (cesarean section or induction) anytime without fear of losing treatment and assistance benefits

    Women are coerced into unnecessary cesareans and inductions everyday by physicians and hospital midwives who downplay the risks of the procedures and grossly exaggerate the risks of vaginal birth and vaginal birth after a previous cesarean.

    Abortions and cesareans are not the same obviously. While there are spontaneous abortions, there are no spontaneous cesareans. Yet both are medical procedures that will end a pregnancy—one with a dead fetus and one with a live baby. Vaginal birth is not a medical procedure, however. It is a spontaneously occurring event. Maybe it should be illegal to misinform pregnant women of the risks of vaginal birth, thereby coercing them into unnecessary procedures.

    These new abortion laws want to show women how alive their fetus is and that they are about to kill it by consenting to treatment. When pushing unnecessary cesareans and inductions, doctors shower women with tales of how they are about to kill or maim their baby by giving birth vaginally unless they consent to treatment.

    When are these procedures unnecessary and when are they not? Well, if doctors would stop crying wolf and performing so many cesareans and inductions for which they know (or should know) there is no justifying evidence, maybe we would know.

    If it weren’t for Lynn Paltrow, I probably wouldn’t think of these things. Ever.

  • jodi-jacobson

    ensuring women are not coerced into procedures during pregnancy and childbirth that are neither desired nor necessary.

     

    No woman should be coerced in any way in regard to her reproductive and sexual choices, whether that be to coerce her to never be able to have a healthy sexual life through denying the means of pregnancy prevention, or to coerce her into a specific form of medical procedure.

    However, the issue of lack of informed consent and pressure to undergo a cesarean section or other procedure during labor and delivery is profoundly different than the intention of the bills focused on delaying abortion procedures cited by Lynn in her piece and the juxtaposition of these in this way legitimizes the ulterior motives of legislators pushing for laws that seek to undermine women’s choices and in effect coerce them to carry a pregnancy to term.

    The focus of the legislation requiring women to undergo ultrasounds and other procedures prior to abortion in itself is a form of coercion. When a woman enters a clinic intending to terminate a pregnancy, she has made a decision. The intent of the laws cited above is to use every means available to delay, obstruct and otherwise coerce her to change her decision.

    Pairing these two issues without making that distinction is in my opinion an unfortunate weakness of this argument,which otherwise focuses on the critical issue of women’s choices in labor and delivery.

    With best wishes, Jodi Jacobson

  • invalid-0

    Jodi, an ultrasound is required if you want to terminate a pregnancy so that the gestation of the fetus can be determined. Depending on the gestation, the termination with either be medically or surgically managed.

    Ultrasound is currently the only way to INDEPENDENTLY date a pregnancy.

    Unfortunately, women are not always positive of their dates (most are, but some aren’t, especially if they weren’t intending to get pregnant), so we need a dating scan before we proceed with the termination.

    It is not about being obstructive.

  • invalid-0

    It’s true that ultrasounds are important for determining the approparite medical plan for women choosing to abort. However, legislation that requires women to look at the ultrasound, listen to a heartbeat or receive a copy of the ultrasound are indeed coercive and inappropriate. Let’s be honest, the intent of legislators who want to require ultrasounds is not to ensure that best medical practices are employed. The intent is more along the lines of punishing a woman for either choosing not to continue a pregnancy or for being unable to do so.

  • invalid-0

    Speaking as a woman who had a cesarean against stated her will, I am all for the requirement of full informed consent.

    That to which one cannot refuse, one may not truly consent.

  • jodi-jacobson

    My point, not clearly made, was articulated by Frances.

     

    First, I understand ultrasound as it is used to determine gestational age. And we recently had an excellent piece describing this issue by Debbie Billings, writing about ultrasound laws in South Carolina and the use of these to delay or obstruct access to abortion services.

     

    The bottom line is this: You have a medical procedure already in place for good medical practice and to protect doctors from malpractice suits. I understand that.
    It is the intent of legislation mandating ultrasounds, additional counseling, waiting periods and other obstacles to services as Frances underscored to which I object.

    I go to the dentist and have x-rays for good dental care as per good dental practice and certainly the best way for a dentist to draw conclusions about the health of my teeth and gums below the surface is to review those x-rays. I don’t see anyone calling for legislation to mandate dental x-rays, require I review them and then take 24 hours to read up on the possible implications and/or complications of fillings, root canals, periodontal diseases, etc, before I go forward with dental work, though in certain circumstances dental work and dental surgery also pose potential and unforeseen risks to my health.

     

    The point really is that informed consent is being twisted to preclude women from receiving some services they seek out, and the lack of informed consent results in direct or indirect coercion in others. We need to address the real problems rather than putting in place obstacles to women’s decision-making, which is what the ultrasound bills regarding abortion seek to do in my opinion. If it is standard medical practice and has been for quite some time, why do we need to legislate it if not to create additional barriers?

     

    Thanks very much for writing and helping me clarify my intention.
    Jodi

  • invalid-0

    When I had my son, I really didn’t want to have a c-section, but if I did need one, hoped that I didn’t go through hours and hours of labor and then go on the table.

    I ended up having a c-section due to preeclampsia. As much as I truly empathize with women who have had surgery forced upon them, I am grateful that my son and I are both alive due to the skill of my OB and the medical staff of the hospital. (At the time, I was irritated that everyone addressed me as “Mom,” rather than my name. Several years later, I’m a little more relaxed about that sort of thing, since I’ve come to realize it’s both an honorific and a job title, i.e. “Nurse, please hand me a number 10 blade. Mom, try not to throw up on anything sterile.”)

    The unexpected benefit of having a c-section was that I was able to spend an additional two weeks home on short term disability before returning to work. Something is very wrong with our system for maternity leave when I was happy to have had major surgery, because it meant I was able to stay home for a full two months (plus several weeks vacation) after childbirth.

    • invalid-0

      Hello everyone, I appreciate being able to talk about this subject. I am pregnant with number 5, I had my first three naturally, but due to “failure to progress” I had an unexpected C-Section with my fourth child. That was 3 years ago. I assumed since I am healthy and am having another normal pregnancy, that I would be a good candidate for a VBAC. However, I have since been informed that the hospital and doctors no longer allow ANY woman to atempt to give birth naturaly after a C-Section anymore. And its not because the risks of VBAC are too high. It’s because they are now required to have an operating room ready and available during the whole labor just incase of an insision rupture, therefore, it is much more convenient ( and profitable) for them to have me go thru a dangerous and painful abdominal surgery than to put them out for a couple of hours while I give birth! I usually think of myself as being pretty tough, and not given to emotional breakdowns but I have to tell you the thought of them cutting another baby out of me has me completly freaked out! I felt like they completely treated me like an object with no human feelings when I had a C-Section. I was laying there mostly naked while the male and female doctors cutting on me were actually flirting with each other!! The nurse just walked off with my baby after she was born and didn’t even let me see her!!! I didn’t see her for 2 hours. It was awful and left me with a bitter taste in my mouth. My sister-in-law has had two C-Sections and then gave birth to two children naturally as many thousands of other women have. Its time doctors and hospitals to actually do whats in the best interests of their patients.

  • invalid-0

    Attacking a person’s character or motives instead of their actual claims is not an argument, but a substitute for an argument called the ad hominem fallacy. So goes one of the first lessons learned of informal logic. Yet as Lynn Paltrow aptly demonstrates, it is also one of the first forgotten.

    The core statement of this piece reminds me of the old canard about how pro-lifers don’t “care” about born children. Even if we suspend disbelief and affirm this statement for the sake of argument, it does nothing to invalidate the merits of pro-life legislation or the claim that abortion involves the unjust killing of the unborn (before you are born, you are unborn, so I’ll thank the author to remove the quotes). ;-)

    There are a number of possible reasons for this legislation excluding any mention of coercion in the delivery room. Such reasons are, at best, left to speculation. Perhaps these pro-life policy-makers are hypocrites who would love to stop abortion but see laboring women suffer under a physician’s scalpel. And perhaps, in a more likely scenario, they are simply ignorant about the scope of the widespread problem in this country of evidence-free and all-too-often coercive obstetric practices. Regardless of the underlying motive, their exclusion of any mention of forced cesarean or other medical procedures has nothing to do with the merits of protecting women from being coerced into abortions that they do not actually want.

    Moreover, this article presents unjust admonishing against pro-lifers. I’m left to wonder exactly how all-inclusive would this legislation have to be if we followed Paltrow’s line of thinking. Should we also include clauses against absolutely any and every form of medical coercion? Should we mention compulsory Hep B vaccinations for infants? Blood transfusions? Doctors scaring patients into knee replacements or triple bypass surgery “just in case?” Or does Paltrow not “care” about these issues? Giving her the benefit of the doubt, I’ll assume that in one way or another, she does. But the chastisement would hardly be fair, would it?

    So follows that it also would hardly be fair to state (as all too many abortion rights advocates do)that just because pro-lifers advocate for compassionate and non-violent alternatives to abortion, they don’t “care” about other issues. Rather, they must use their already-scarce resources to shoulder the burden for every other social injustice—poverty, HIV/AIDS, war, torture, child abuse, inadequate health care coverage…and now, as this article poses, unethical obstetric practices. Of course these issues are important. But to paraphrase a famous pro-lifer, it would be equally unfair to tell staff members at the Susan G. Komen Foundation that they are “hypocrites” and have no right to search for a cure for breast cancer unless they are willing to cure all other forms of cancer, as well.

    There is a much easier way to dissemble the crux of this article, however. I would ask Paltrow the following: IF a clause were included that banned coerced cesareans, including VBAC denials, while keeping the anti-coercion part about abortion, would you support this legislation? Perhaps it is presumptuous on my part to make assumptions, but I’m thinking that she’ll still tow the abortion rights party line and oppose the protection of pregnant women from getting coerced into abortions. In the end, opposition to Idaho’s legislation will have nothing to do with the exclusion of cesarean coercion and everything to do with the inclusion of abortion coercion. Paltrow has a right to her personal feelings about abortion, and I certainly do not hear anybody contesting that right. But let’s be up front about those feelings, dissolve all smokescreens, and construct arguments based on the actual content of this legislation.

    As one who works in the trenches of both the pro-life and the childbirth reform movements, I oppose Paltrow’s efforts to use the abortion issue drive a divisive wedge between women united in a common struggle for ethical and evidence-based maternity care. It is outrageous to imply that pro-life women must give up their most deeply held ethical convictions in order to have a voice in improving maternity care. At the same time, I applaud Paltrow for her stand on coerced medical procedures in maternity care. Ideally, we could legislate doctors out of all of the abhorrent, anti-evidence labor and delivery practices, including routine electronic fetal monitoring, convenience inductions, and VBAC denials.

    But why exercise the sort of unfair chastisement against pro-lifers that this piece proposes? Why place the burden entirely on us? If it is truly necessary to take this route, perhaps we should redirect some responsibility. Perhaps all of this time spent in online diatribe against pro-lifers could be more productively spent. Given her extensive background in advocacy work, nothing should be stopping Paltrow from lobbying for the introduction of anti-coercion legislation pertaining to women’s choices in labor and delivery. Or about a Maternity Information Act in all 50 states? I cannot speak for every pro-lifer, but she would certainly my full support.

  • invalid-0

    My take on this article is that it is attacking the fact that some are actively trying to coerce women into/out of medical procedures period.

    In maternity settings, women usually look forward to their ultrasounds if they aren’t told about the possible fetal damage, false positives, and heartbreaking decisions that can come along with having a scan. In maternity, the very same bonding that some would like the woman to be forced into, is voluntarily. Mothers’ love is used as a weapon to coerce families into unnecessary procedures which have been found to be harmful and even deadly for the baby and the mom, but financially and socially beneficial for the institution and it’s associates-and, as EternalSkeptic has pointed out, although there are laws which require valid consent for procedures, the Maternity Information Act is not in place in all 50 states, and it is not being upheld in the states which have embraced it.

    Are abortion rights linked to maternity rights? I can see that as soon as a fetus is given rights as a person, then individuals and institutions will more readily override maternal autonomy in the name of protecting that person. This is more commonly called maternal-fetal conflict, or, in other words, the mother does not agree with the doctor as to which course of action is appropriate for her pregnancy and birth. But when a baby dies or is injured because of a doctor’s management decisions, we call it an act of god and not an illegal term abortion or an assault? And when it dies because the mother declined treatment it’s called murder or negligence?

    So what are the priorities here? Are we protecting the unborn first? Then we must forget maternal autonomy. Are we protecting the mother first? Then we must accept that babies die sometimes and that it’s an act of god. Are we protecting a woman’s right to choose abortion? Then we are protecting women’s rights to have (usually) unnecessary procedures. Are we trying to restrict women from having an abortion? Then we are dictating to women and making them less important that the baby they’re carrying, which in turn influences maternity and birth care. A vicious cycle.

    There is a connection between birthing rights and abortion rights and the connection is the concept of maternal autonomy. Take away autonomy at any stage and we reduce all women to imbeciles who don’t know what’s best for them and who are a danger to their baby.

    I certainly don’t agree with abortion in practice, and it is very sad that people sometimes choose to end a healthy, viable pregnancy, especially late term, but neither do I agree with the concept and practice of restricting women’s rights in the form of anti-abortion restrictions.

  • invalid-0

    That still irritates me. It may be a job title, but unless the doctor’s your own child, it’s not applicable. I used to see this all the time when I was doing my ob/gyn and pediatrics rotations in med school. I decided that if it happened to me, I’d respond by calling the person who said it “Junior.”

  • invalid-0

    To imply that allowing a mother-to-be 24 hours or how ever long, to view the ultrasound, hear heartbeat, etc… is *punishment* is blindly ignorant. The old adage, “Ignorance is Bliss” does not apply here. Have you ever made a decision that you were completely confident making in the moment only to have it come full circle in a month, or a year or 10 years later to haunt your soul? When a woman chooses to have an abortion it is more often during a highly stressful time in her life. Allowing her (or even requiring a waiting period) is more like extending a hand of grace or a shoulder to lean on. It is during that time that she can really think through and learn and read and become informed about the risks of abortion. There are risks to any intervention in pregnancy.

  • invalid-0

    Allowing her (or even requiring a waiting period) is more like extending a hand of grace or a shoulder to lean on. It is during that time that she can really think through and learn and read and become informed about the risks of abortion.

    That’s probably the most paternalistic and fundamentally dishonest bit of spin I’ve read this week. No matter how much lipstick you try to put on this pig, it’s coercive bullying and it’s punitive.

    • sayna

      Thank you, Anonymous, for pointing that out. The condescension and dishonesty in that post are just unbelieveable. It assumes that women are mental and emotional children who put no thought whatsoever into their reproductive decisions. Yet again, it’s the "if only women knew they were having abortions when they had abortions!" logic. Please. We’re not stupid. We don’t go through these things thoughtlessly.

       

      The dishonesty, while not overt, is pretty disturbing too. I’ve seen posters here more than once insist that women need to get the facts before they have an abortion or use BC. Do people on this site seriously not understand that informed consent is legally required for all medical procedures? Had they bothered to look at Planned Parenthood’s website they would see that the page on abortion explains the procedure and its possible side effects. And unless I’m mistaken, doesn’t it take more than one visit to assess the pregnancy and perform an abortion? Don’t women already have to wait for their scheduled appointment? I really doubt that these women just walked in off the street and got an abortion.

       

      And notice… they’re never concerned about the possibility that someone might be trying to force or pressure women out of having abortions. Nobody ever mandates a waiting period for women who want to carry to term or give a baby up for adoption. Not only is that a more profound and life-altering decision, it’s also more medically risky! (Before anyone comes in and spins my words: No, I don’t suggest that a woman be pressured or coerced either way. I merely use this as an example of how arrogant and insulting it is to butt into a woman’s life and tell her she’s uninformed and has to wait.)

  • invalid-0

    Bravo on seeing maternal autonomy as the link between these issues.
    The midwifery model of care empowers women and makes birth safe and fulfilling.

  • invalid-0

    To Sanya-
    No waiting period for people who want to place their child for adoption? You are obviously extremely uninformed.

  • invalid-0

    You are obviously extremely uninformed.

    OK, if we’re so uninformed please name one state that requires a mandatory waiting period before some browbeaten teenager foolish enough to have ventured into a CPC is allowed to sign away her parental rights.

  • http://reparecredit.info invalid-0

    Yes, I agree with you, that the bills coming out have little care of women’s rights and interests, but concern commonly the moral aspects of society. Our legislators should not be so one-legged and think more not only about abortions but also about health care for women who are going to go to term.

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  • invalid-0

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