Press Call: Forced Cesarean Section Is the Newest Threat to the Personhood of Pregnant Women

RH Reality Check joined Rinat Dray and medical professionals and legal advocates for the rights of pregnant women on a press call on Friday. Listen to a recording of the call above.

Rinat Dray, a 32-year-old mother of two, went to Staten Island University Hospital with the hope of delivering her third child vaginally after two prior cesarean surgeries. Instead, according to Ms. Dray, after several hours of labor, the attending physician told her that he would not examine her unless she agreed to have surgery. When she refused surgery, the hospital made a decision, without consultation with the hospital’s bioethics department and without engaging the hospital’s patient advocate, to deny her the right to medical decision-making and to force her to undergo the surgery. According to records in the case, the surgery was approved by the hospital’s legal department over Ms. Dray’s explicit objection. A physician noted in her medical records: “The woman has decisional capacity. I have decided to override her refusal to have a c-section.” Dray has filed suit against Staten Island University Hospital and two physicians for being forced to undergo a cesarean surgery against her will.

Forced cesarean is one among a growing number of threats to the personhood of pregnant women. While an increasing number of women like Ms. Dray seek to have a vaginal birth after cesarean surgery (VBAC), they are often pressured and sometimes forced by doctors and hospitals to undergo cesarean sections. A 2010 National Institutes of Health Consensus Statement acknowledged that women face significant barriers in finding physicians and hospital-based care that will support VBAC.  Ms. Dray’s desire to have a vaginal birth was based on her understanding of the potential risks of surgery. In fact, according to the complaint filed in the case, her bladder was punctured during the cesarean. Amid national concerns about the overuse of cesareans and increasing reports of doctors threatening their patients with the use of court orders to force surgery, this case involves a hospital’s express decision to override a patient’s medical decision.  The doctors did so without a court order and despite concluding that the patient was mentally competent to make medical decisions for herself.

Ms. Dray was joined in an audio press call by her attorneys as well as medical professionals and legal advocates for the rights of pregnant women including Élan McAllister (Executive Director of Choices in Childbirth), Prof. Mary Faith Marshall, Ph.D., FCCM (Director, Program in Biomedical Ethics, University of Virginia School of Medicine), Fara Diaz-Tello (Staff Attorney and Birth Justice project leader, National Advocates for Pregnant Women) and Dr. Katharine Morrison, MD, FACOG (Director of Buffalo WomenServices).

 

  • MsJack

    What makes me sad about this case is that the only reason it’s made it to court is because (1) it was a cesarean section, (2) the doctors actually documented their decision to override the woman’s wishes, and (3) the woman sustained an injury as a result of the surgery. Had this been an episiotomy without consent or an amniotomy without consent, the plaintiff never would have had a prayer of getting her case into court. And procedures are performed on laboring women without their consent *all the time.* Without their *informed* consent even more often. I hope this becomes a precedent-setting case and things begin to change.

    The question that I have is: what medical reason did the doctors give for wanting to cancel the TOLAC and do a c-section? Given that this hospital is friendly to VBAC and has a low cesarean rate, and it sounds like the woman’s OB-GYN was on board with a TOLAC prior to the onset of labor, why did that suddenly change in labor? Were there non-reassuring fetal heart tracings? The ubiquitous “failure to progress”? Another reason?

    I don’t believe the doctors were justified in doing what they did even if there was a true obstetric emergency like a cord prolapse. But it would be nice to understand more what the doctors might have been thinking in forcing the c-section.

    • JamieHaman

      Looks like the doctor didn’t care to wait through a VBAC, or maybe he just wanted to perform the surgery.
      Either way, it’s a gross violation of her rights, with resultant damage, not only to her bladder.
      I hope she wins, and this is the beginning of a real change in how pregnant women in labor are treated.

    • lady_black

      See, the thing is, I know that a VBAC isn’t guaranteed. When my daughter was born, I wanted to try a VBAC and that got quashed because of her position. Frank breech. I was heartbroken, but I didn’t want to attempt labor with that fetal positioning, and wouldn’t have wanted to do it even without a previous C-section. But I’m curious about the medical reason for the C-section too, because it sounds like the doctor made his mind up before even examining her, and I’m also interested in whether an indwelling catheter was used during surgery, because puncturing someone’s bladder should never happen during a C-section. I’ve seen a few, and they actually sort of pull the uterus out of the way before making a uterine incision. It should be nowhere near her bladder.