Why the autonomy of pregnant women really matters: the alternative could be incarceration


In case you thought yesterday’s discussion of maternal autonomy vs. “the best interests of the child” was just an arcane academic discussion, today comes word of a pregnant woman forced into a drug treatment program (even though she was not taking drugs) because her doctor thought it would be in the best interests of the child.

The New York Times reports reports on the case of Alicia Beltran, a case that practically defies belief:

Alicia Beltran cried with fear and disbelief when county sheriffs surrounded her home on July 18 and took her in handcuffs to a holding cell.

She was 14 weeks pregnant and thought she had done the right thing when, at a prenatal checkup, she described a pill addiction the previous year and said she had ended it on her own — something later verified by a urine test. But now an apparently skeptical doctor and a social worker accused her of endangering her unborn child because she had refused to accept their order to start on an anti-addiction drug.

Ms. Beltran, 28, was taken in shackles before a family court commissioner who, she says, brushed aside her pleas for a lawyer. To her astonishment, the court had already appointed a legal guardian for the fetus.

Think about that for a minute: a grown woman was shackled and taken into custody because her doctor disapproved of what she (erroneously) thought she was doing. It could never have happened but for the fact that Beltran was pregnant. Apparently, she lost her autonomy the moment the egg met the sperm.

Why did this happen at all?

Under a Wisconsin law known as the “cocaine mom” act when it was adopted in 1998, child-welfare authorities can forcibly confine a pregnant woman who uses illegal drugs or alcohol “to a severe degree,” and who refuses to accept treatment.

Now, with Ms. Beltran’s detention as Exhibit A, that law is being challenged as unconstitutional in a federal suit filed this month, the first in federal court to challenge this kind of fetal protection law. Its opponents are hoping to set an important precedent in the continuing tug of war over the rights of pregnant women and legal status of the unborn.

Why does this law exist? It’s certainly not because it is effective in protecting children:

In 2011, the American College of Obstetricians and Gynecologists said that “incarceration and threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse” and that mandated testing and reporting lead women to avoid prenatal care that “greatly reduces the negative effects of substance abuse during pregnancy.”

Dr. Cresta W. Jones, an obstetrician and a fetal medicine specialist at the Medical College of Wisconsin who sees many women with histories of drug or alcohol abuse, said that even sporadic detentions had sowed fear.

“The women are scared to come in if they have dependency problems,” she said. “When you allow them to be honest you get better outcomes in their pregnancies.”

This law and laws like it are almost surely unconstitutional and violate the basic principles of medical ethics. They exist not because anyone wants to promote the best interests of an individual child, but as a shot across the bow in the effort restrict legal abortions; these laws substitute religious principles for both medical ethics and the law, and award personhood to embryos and fetuses. Indeed, this law went so far as to appoint a lawyer for the fetus, while not providing one for its mother.

Placing the purported best interests of the child above maternal autonomy, whether in the realm of drug use or the realm of homebirth poses more than a theoretical threat to the rights of pregnant women. Homebirth may be unsafe (as a variety of legal choices like smoking may be unsafe), but women, even pregnant women, have the right to make unsafe choices. The alternative is incarcerating women against their will when they make decisions with which their doctors disagree. This alternative is both ineffective and harmful, as well as unethical and unconstitutional.

161 Responses to “Why the autonomy of pregnant women really matters: the alternative could be incarceration”

  1. Lisa the Raptor
    October 28, 2013 at 4:44 pm #

    As a Chronic pain Mom on meds, this scares the tar out of me. While I was under a doctor and OBs care when taking my meds while pregnant, I’d hate to think that some ER doc or L&D nurse could have me locked up for my medication….

    • sdsures
      November 26, 2014 at 6:11 pm #

      I also have chronic pain (severe daily migraines). I don’t have kids (yet), but when I do, I’ll need to come off most of my meds (sodium valproate, among others) before even trying to conceive. Lord knows I never asked to need to be on that medication to function, but I need it.

  2. Eddie Sparks
    October 25, 2013 at 8:41 pm #

    Fantastic post.

    Even if we approach this issue from a “foetus-has-rights” point of view (which I don’t), overriding maternal autonomy is not a good idea. As the article points out, receiving proper antenatal care is in the best interests of the foetus. Receiving proper antenatal care is more likely to assist the woman with dependency issues (or any other issues) and to mitigate the effects of ongoing problems.

    Receiving proper antenatal care – that respects women’s autonomy – is also more likely to result in the woman presenting for antenatal care in subsequent pregnancies and for OTHER women to present for proper antenatal care. Can you imagine how many women are reading about the experiences of Ms Beltran and are hesitating about presenting to their doctors in early pregnancy? Overriding maternal autonomy not only harms THAT foetus but also many OTHER foetuses.

    The other point I wanted to make is that respecting patient autonomy – including providing all of the relevant information in a way that the patient is able to understand – is a much better way of changing patient behaviour. I have sat in on department-wide meetings about patients who discharged against medical advice, where everyone from the consultant to the medical student is concerned and wondering if they should “DO” something about the situation, only to have the patient represent later for treatment. Having had their autonomy respected they were able to go home, think about the information they have received, discuss it with other people, and come to a decision. They can then represent without feeling threatened that their rights would be trampled by the mere act of walking into the hospital.

  3. R T
    October 25, 2013 at 6:21 pm #

    This is terrifying! How can she be forced to take a medication unsafe for a fetus for a drug addiction she does not have?! It boggles the mind!

  4. Teleute
    October 25, 2013 at 2:11 pm #

    “These laws substitute religious principles for both medical ethics and the law, and award personhood to embryos and fetuses.”

    THAT is the very heart of it.

  5. attitude devant
    October 25, 2013 at 10:55 am #

    I do wish all your critics (you know, the ones who claim you hate our gender and want to force all women to have epidurals and forceps) would read this piece. This is just superb. (btw, I hope the young lady sues those involved for malicious prosecution and malpractice. This is outrageous!)

  6. Guest
    October 25, 2013 at 10:42 am #

    And so the take-home message is that pregnant Wisconsin women should simply tell medical professionals what they want to hear and let their own “maternal intuition” guide their compliance, or lack thereof. Good to know.

    Women planning unassisted births? Nod and smile at the doctor at every appointment, have your birth alone, and claim it was precipitous after the fact.

    Don’t have time or inclination to monitor your blood sugar levels or count kicks? Fill in your chart with normal values and bring it to your next appointment.

    Don’t want a postpartum pertussis vaccination? Lie through your teeth and say you got one before becoming pregnant.

  7. fiftyfifty1
    October 25, 2013 at 7:52 am #

    I’m glad they arrested that pregnant woman. Look at her fingernails in the picture Dr. Amy provided; nailpolish! Imagine the fumes!

  8. amazonmom
    October 25, 2013 at 2:41 am #

    Mom quits taking suboxone, tests negative for drugs of abuse. My God, they threw her in jail for that? So a currently clean employed adult is tossed in jail for what she MIGHT do in the future? Being forced to take a drug that may end up resulting in your child undergoing painful withdrawal or you get tossed in jail. I bet that asshat provider would have me tossed in jail if I refused his med of choice for my mood disorder when pregnant.

    • The Computer Ate My Nym
      October 25, 2013 at 9:18 am #

      So a currently clean employed adult is tossed in jail for what she MIGHT do in the future?


    • LibrarianSarah
      October 26, 2013 at 3:18 pm #

      It’s like that Tom Cruise movie that I never saw.

  9. Sue
    October 25, 2013 at 2:13 am #

    This appears to be very little about health and much more about moralising.

  10. Peggy Thatcher
    October 24, 2013 at 8:18 pm #

    Ms. Beltran’s big mistake was getting mad at a social worker. Child welfare workers are well protected from lawsuits by the public – they have way too much unchecked power. They can, and do, act at whim vindictively. Chances are that even Ms. Beltran’s OB was intimidated by the social worker.

    I wonder if the OB will face medical malpractice charges, what with there being little if any grounds for prescribing the naloxone.

    • nohika
      October 26, 2013 at 4:24 am #

      I think this is going a bit far, though, and unfairly stereotyping a large group of people. We’re only hearing one half of the story here, and although I agree it’s way out of bounds, maybe there’s something we’re missing. And even if that SW is completely an arse, that doesn’t make ALL of them that way.

  11. anh
    October 24, 2013 at 7:42 pm #

    OT. but UGH


    seriously, I thought it was parody. how the crap can you decide to birth unassisted when you’ve never even experienced labor before. are these women sociopaths?

    • Zornorph
      October 24, 2013 at 9:47 pm #

      I could write a book on how crazy that woman is, but her thought that the ‘lotus birth’ was so named because the rotting placenta resembles a flower was a real scream. In fact, it was named after the western kook who first came up with it, who had changed her last name to Lotus. Because nothing says ‘Eastern’ like making up a weird birth procedure that has never been practiced in any eastern culture.

    • auntbea
      October 24, 2013 at 10:19 pm #

      I was more appalled by her belief that parents should empower their child’s “innate wisdom.” Children don’t have wisdom. What they have is apparently an unquenchable desire to climb unstable furniture, smear poop on the rug and eat entire boxes of cereal in one sitting.

      • Zornorph
        October 24, 2013 at 10:27 pm #

        As long as it’s ‘raw’ cereal, it’s all good.

      • Tim
        October 24, 2013 at 11:49 pm #

        Mine has an unquenchable desire to climb up the outside of the staircase on the little lips of each step.

        • auntbea
          October 25, 2013 at 9:08 am #

          Obviously. Who *wouldn’t* want to do that?

        • MaineJen
          October 25, 2013 at 10:53 am #

          I vividly remember doing just this as a small child, and then thinking “….what?” when my mother freaked out at me. In my mind, I was Indiana Jones (the female version), climbing a cliff face with a precious artifact in my teeth. Imaginative? Yes. Safe? Hell no. I wouldn’t call that ‘wisdom,’ I’d call it being-too-inexperienced-to-know any better. Kind of like a FTM who has an unassisted childbirth, gets lucky and then assumes that everyone else will get lucky too.

          • sdsures
            November 26, 2014 at 6:19 pm #

            They should make rappelling gear in baby sizes, obviously!

      • Box of Salt
        October 25, 2013 at 5:25 pm #

        To me, empowering the child’s “innate wisdom” suggests the parent is trying to justify not supervising the child.

      • sdsures
        November 26, 2014 at 6:19 pm #

        As an adult, I have almost managed to cut down the cereal-out-of-box consumption to 1/4 of the box!

    • Pillabi
      October 25, 2013 at 10:17 am #

      “as long as the cord pulses, not only oxygen but also other precious nutrients such as iron and stem cells are also being delivered to the baby’s stores”

      stem cells?? do they float in the blood?

      • Young CC Prof
        October 25, 2013 at 10:29 am #

        In cord blood, yes. That’s why people bank cord blood. However, I can’t imagine what floating stem cells are going to do for the baby. They’d just sort of… float, and then break down. Stem cells need to be modified and administered in very specific ways to be medicine.

        Besides, there’s a difference between waiting a couple minutes to cut the cord, until it stops pulsing, and waiting a week until it rots off!

        • Pillabi
          October 25, 2013 at 6:07 pm #

          Thank you Young CC Prof, my question actually should have been: how does the baby benefit from more stem cells floating in his blood? I don’t imagine them placing themselves somewhere in his body and magically fitting … like in a Tetris game!

          • AlisonCummins
            October 25, 2013 at 6:29 pm #

            I think the fact that she calls stem cells a nutrient should be a clue.

    • AER
      October 25, 2013 at 5:03 pm #

      Read the comments on that article though… they are quite funny. I love xojane for the combination of idiotic articles and sharp-witted commentators.

    • LibrarianSarah
      October 25, 2013 at 5:17 pm #

      XoLame is natorious for publishing, self-indulgent, whiny, clickbait in lieu of actual content. Yesterday, they posted a story of a women complaining that she was “slut-shamed” by her doctor because he asked her about her sex life when she came into the clinic with obvious signs of an STI.

    • Lisa Cybergirl
      October 29, 2013 at 7:29 pm #

      I love the part where the baby TEARS THE DAMN THING OFF HIMSELF after six days. You know you’re bad when you’ve grossed out a baby.

      • sdsures
        November 26, 2014 at 6:15 pm #

        “…my lotus birth”

        Wait, didn’t she have her own birth about 30 years ago? That kind of terminology among NCBers drives me batty. It’s the BABY’S birth, not yours!

    • sdsures
      November 26, 2014 at 6:17 pm #

      Cos it’s just like when you’ve watched a cat having kittens, didncha know? Easy-peasy!

  12. Guest
    October 24, 2013 at 6:56 pm #

    I swear that some parts of the medical community must just exist in a twilight zone when I read things like this because I just can’t imagine anything like this in my community. Of course patient autonomy is paramount. As a provider I’m required to offer ethical, up to date medical opinion including a detailed discussion of the risks, benefits, and alternative of any decision that are made. I’m required to offer referral or second opinion if requested or if I’m just not the right person for the job. This includes gyn surgery, prenatal care, and office practice. If a patient reports a history of drug abuse to me I’ll inform her that I’d like to perform random drug screens throughout her pregnancy as they may impact her care (ie cocaine use can cause placental abruption and fetal demise, etc). I certainly don’t report the results to the authorities but she is aware that the pediatricians may screen the infant if report the results to CPS (because at that point it’s a legal person). I would never, ever perform surgery without someone’s written, informed consent with the exception of a perimortem C-section (then I have the assumed consent that seems to exist in the ED trauma bay). I’ve watched a baby die in utero after a patient refused to consent for C-section for fetal distress. It was heart-wrenching and just about destroyed my desire to ever practice medicine again but it was her right and that’s just the way it is. Sorry for the rant but this is outrageous.

  13. Felicitasz
    October 24, 2013 at 5:49 pm #

    OK – may I please tell the first thing I thought of? This was a DOCTOR who started the whole mess. Such stories send the messageto people to either lie to their doctors or avoid them altogether as a midwife of any kind would never have done such a thing. Dangerous? Yes. And very sad.

    • Lacy
      October 24, 2013 at 6:22 pm #

      According to the article it was actually a PA who reported her not a physician.

  14. Bomb
    October 24, 2013 at 4:34 pm #

    I was denied important drugs post partum (over a month post partum) because my doctor felt I should be breastfeeding. Loss of autonomy doesn’t end at birth.

    • auntbea
      October 24, 2013 at 8:32 pm #

      Did you already tell this story? Like a month or two ago? That was RAGE MONSTER!

    • rh1985
      October 24, 2013 at 11:52 pm #

      Your story made me so angry. I am so happy I found a doctor who is willing to work with me on managing medications during my pregnancy and who has no judgement about my decision to exclusively formula feed from birth.

    • sdsures
      November 26, 2014 at 6:21 pm #


  15. maria
    October 24, 2013 at 3:38 pm #

    The main problem is that women are silent when these laws are being passed. It’s usually a piece of news in the media, followed by some blog articles and discussions on some forums and then silence. Most women choose to stay silent, to convince themselves that these laws will not affect them (“I am a good women, not a drug addict, this law cannot affect me” etc).
    Women, why do you permit these humiliating laws to be passed?

    • October 24, 2013 at 3:49 pm #

      That’s a bit “blame the victim” – men have an equal responsibility to ensure the rights of their felllow humans aren’t violated. Voters – why do you let these laws be passed?

      • Karen in SC
        October 24, 2013 at 4:42 pm #

        When I read about these things, I am reminded about the dystopian future in “The Handmaid’s Tale.”

    • Wren
      October 25, 2013 at 6:17 am #

      Plenty of women support these laws when they are passed, claiming they help babies.

  16. Carolina
    October 24, 2013 at 3:38 pm #

    The Handmaiden’s Tale is supposed to be fiction, darn it.

  17. The Bofa on the Sofa
    October 24, 2013 at 3:22 pm #

    OK, so we all agree that we can’t take legal action against the mother who chooses whatever, and we can’t force her to do a procedure against her will. That’s good.

    However, there is still an open question regarding the responsibilities of the medical profession regarding patient “autonomy.” For example, what are the doctor’s responsibilities for a patient who says she is going to have a homebirth? The doctor considers homebirths too risky, and therefore will not attend. The patient asks for a referral, and the doctor says, I cannot recommend anyone, because I do not know consider anyone who is willing to attend a homebirth to be a quality provider. There are no OBs I know, and all of the homebirth midwives I have heard of are CPMs or otherwise not acceptable to me.

    So basically, the doctor has just told the patient that if she wants to homebirth, it’s a UC. That’s not very helpful, but what can the doctor do?

    Let’s change it to a little harder case: VBACS, aka the Joy Szabo experience.

    Patient wants a VBACS. However, the standard of care requires that, in order to do a VBACS, there must be an anesthesiologist available within 10 minutes. The hospital where the doctor works does not have that capability. Therefore, the doctor tells her that, he cannot attend a VBACS with her, because the hospital is not equipped to do it safely, and if she wants a VBACS, she needs to go to another hospital, which is not convenient for her. So she refuses. She is not going to have a c-section, but she is not going to another doctor?.

    How do you deal with this from an autonomy standpoint? Remember, the doctor is liable for any bad outcome that would occur. No matter what she says and what she does, if the doctor tries a VBACS, and there is a bad outcome because the anesthesiologist got hung up somewhere else, that doctor is liable, and will lose a malpractice case, because the doctor would have to admit that was wrong to do it. That patient’s “autonomy” is not only putting herself at risk medically, but is forcing a doctor to commit malpractice. How do you resolve that?

    Doctors have an ethical obligation to do what they can. However, don’t they also have an ethical and legal obligation to practice properly? How can a doctor do something that they know is malpractice, just because that is the patient insists on doing? Yeah, the patient can accept the risk, but does that mean that can force providers to take the risk, too?

    I don’t know the answer.

    • Carolina
      October 24, 2013 at 3:34 pm #

      As a lawyer, I would say adherence to the rules of professional ethics/responsibility trumps every time. You give the best guidance you can. If the patient refuses treatment that meets the standard of care, that is his/her decision. If a VBAC can’t be performed safely, the doctor does not have to bend the rules, even if it means the patient may do something risky. I’m ethically bound not to do certain things, and if a client demands unethical behavior, I do not have to refer him/her elsewhere. Granted, the stakes for ignoring legal advice aren’t life/death, but I am not risking my license for anyone.

    • October 24, 2013 at 3:35 pm #

      BOFA – I understand where you are coming from, however, the harm caused by the violation of autonomy is not being recognized. It’s not just – I don’t support what the patient wants and I can’t facilitate it either so I will force her to do what I want and she’ll live with it. A violation of autonomy for many women is a very serious matter that harms them to the core. Forced care is often traumatic. Traumatic experiences have serious consequences. This problem needs to be solved, and it would be nice if informed consent was an adequate defence for deviations from “standard of care”, when the patient finds the standard of care unacceptable.

      • The Bofa on the Sofa
        October 24, 2013 at 3:38 pm #

        I provided two examples of autonomy questions in my comment. What is your answer?

        • October 24, 2013 at 3:48 pm #

          What about having a discussion with the patient about the options available (homebirth with provider X, homebirth with CPM, Unassisted birth, hospital birth with you, etc.) and their risks and benefits – and ultimately giving her a referral for a second opinion on the matter? You can lay out the choices and let her decide among them.

          • The Bofa on the Sofa
            October 24, 2013 at 3:56 pm #

            I already addressed the provider issue. “There are no providers that I know of who are qualified to do a homebirth and are willing to do one. There are CPMs that do homebirths, but I do not consider them to be qualified medical providers, and I won’t refer you to any of them.”

            Yes, she can make her own choice, but you have not really offered her any choices. Hospital or UC. That’s the options you have given her. If she wants any medical help, the only option you’ve given her is the hospital.

          • LynnetteHafkenIBCLC
            October 24, 2013 at 4:23 pm #

            Would a form a la Dr Amy’s dead baby card signed by the mother help the doctor’s case?

          • Susan
            October 24, 2013 at 4:24 pm #

            Yes I think it would. And the truth is a lot of patients change their mind upon seeing such things in writing and being asked to sign them.

          • October 24, 2013 at 4:28 pm #

            A patient is allowed to make stupid decisions (ie, HBAC if VBAC isn’t an option at the hospital).

            A doctor is not required, and indeed is not allowed, to deliberately put patients at risk by not following best recommended practices, especially if legally liable for the outcome. Talk about fairness … it isn’t fair to the doctor to require hir to do something unsafe in order to prevent the patient from being even more unsafe. The patient has options- HBAC, VBAC at another hospital, or C-section with the doctor ze knows. If those are not acceptable options, that is not the doctor’s fault. The world isn’t always perfect. Pregnant women, like all people, do have a responsibility to be reasonable.

          • AllieFoyle
            October 25, 2013 at 7:18 am #

            Why is that a problem? Respecting patient autonomy doesn’t require the doctor to facilitate every choice. It does require him or her to have a respectful discussion with the patient about the available alternatives and the risks and benefits of each. He need not endorse or facilitate any course of action he considers unsafe, and the patient is free to disregard his recommendations.

          • Eddie Sparks
            October 25, 2013 at 8:13 pm #

            This is exactly what I was thinking. Patient autonomy does not mean that doctors have to guarantee that ALL patients have equal access to ALL options. A patient that lives near a hospital that has 24/7 OR and anaesthetist available is going to have a different set of risk factors and options than a patient that lives 2 hours drive away. Ditto with all the other variables surrounding pregnancy and birth.

            Patient autonomy demands that the doctor inform the patient about all options available, and the risks/benefits of each, and then both allow the patient to make the decision and respect that decision. It does not require the doctor to provide OR/anaesthetist facilities just so the patient has the same options as another patient who lives near a different hospital.

            From the example given … “the doctor has just told the patient that if she wants to homebirth, it’s a UC” … i think that it is VERY different for the doctor to say:

            a) I can’t offer you a VBAC at this hospital and I can’t recommend a home birth provider so you are on your own. Good luck with that.

            rather than

            b) I can’t offer you a VBAC at this hospital and I can’t recommend a homebirth provider to you that I believe is safe. However, I can refer you to a different hospital, if you would like to attempt a VBAC in a hospital. I understand that this could be inconvenient for you, but I believe that with the increased risk of a VBAC it is worth going to extra effort of being in a hospital that can handle an emergency situation. I can also let you know that, although I consider CPM qualified homebirth providers to be under-qualified and unsafe, some women chose to homebirth with them. If you decide to go down this path, please make sure to ask your provider about what training and experience they have had with handling a uterine rupture, what equipment they are planning to bring to your homebirth to assist in an emergency situation, what transfer criteria and plan they have in place in case things don’t go well and what could happen to you and your baby in the case of a uterine rupture. That information will put you in the best position to make a good choice for yourself and your baby.

            These two (admittedly off-the-cuff) responses by the doctor are essentially saying the same thing. “No VBAC here and no good option for homebirth.” But the second version is at least providing the women with some tools to question potential homebirth providers and planting these seeds of suspicion in evaluating the answers. It is also implicitly steering the woman away from an unassisted birth without endorsing the homebirth option.

            As other people have written, document, document, document. Get the patient to sign it. Write all this down for the woman to take away with her as well. And if she turns up in labour in the ED handle it in the same professional manner as any emergent birth that turns up in the ED. With lots of documentation.

        • October 24, 2013 at 3:50 pm #

          In the VBACS example – performing a CS without consent would surely be considered a battery would it not?

          • The Bofa on the Sofa
            October 24, 2013 at 3:51 pm #

            Of course.

            But doing a VBACS is malpractice.

          • Susan
            October 24, 2013 at 4:11 pm #

            huh? Lots of excellent hospitals and OBs do VBACs. Maybe I don’t get your point.

          • The Bofa on the Sofa
            October 24, 2013 at 4:14 pm #

            Doing a VBACS safely requires an anesthetist to be available within 10 minutes. If that is not available, as I described in my scenario above, then it cannot be done safely, and doing it would be malpractice.

          • Susan
            October 24, 2013 at 4:16 pm #

            Ok I get that. Actually, where I am working now IF that happens we have to make every effort to be within ACOG VBAC guidelines ( no VBAC policy ).

          • The Bofa on the Sofa
            October 24, 2013 at 4:18 pm #

            Are your good intentions considered sufficient? Would they hold up if the shit hit the fan? Admittedly, it’s probably the best you can do.

          • Susan
            October 24, 2013 at 4:20 pm #

            I think the truth, sadly, is that NOTHING will matter but the damaged baby being seen by the jury. ( but it doesn’t mean good documentation might help to keep it from going to trial ). I don’t think malpractice trials have a thing to do with the truth.

          • theadequatemother
            October 24, 2013 at 5:04 pm #

            the ACOG statement on VBAC/ TOLAC doesn’t mention your 10 minute stipulation but does mention a lot about counselling and informed consent, respect for autonomy, referrals to higher resource settings and what to do in other situations.


          • AllieFoyle
            October 25, 2013 at 7:12 am #

            I think you are mistaken about that claim. Ten minutes to anesthesia is probably prudent, but I know VBACs are regularly offered at my tiny rural local hospital, with no dedicated OB anesthesia.

          • Guest
            October 25, 2013 at 10:21 am #

            Honestly, if a hospital is ill equipped to handle a vbac, they are ill equipped to handle any birth emergency period. Cord prolapse, placental abruption, non vbac related uterine ruptures, etc happen in non vbac births and are just as likely to require immediate access to anesthesia and an OR.

          • fiftyfifty1
            October 24, 2013 at 4:30 pm #

            It’s not malpractice to do a VBAC in a low-resource hospital. To say so is nonsensical because sometimes women with a hx of CS go into precipitous labor and show up with the baby crowning. The safest option at that point is to deliver vaginally, so how could that be malpractice?
            This, of course, is an entirely different matter than agreeing to and planning on a VBAC. And there are procedures in place for what to do if your patient insists on VBAC during your pre-natal discussions (refer her to the nearest hospital that does it). And if a woman pulls a fast one on you and shows up in labor, you need to follow the law. It’s a hairy situation, and docs hate it, and you have to document the hell out of her refusal of CS and yes you should call anesthesia in, and yes you should call your hospital’s ethics team, and yes you still may get sued if baby is damaged. But hey, that’s how it works.

          • Guest
            October 24, 2013 at 6:21 pm #

            That is absolutely false. Please do share where in the world you are getting such inaccurate information.

          • EmbraceYourInnerCrone
            October 24, 2013 at 4:25 pm #

            It would seem so but its happened –



            From the wiki entry:

            “Laura Pemberton had a previous c-section (vertical incision), and with her second child attempted to have a VBAC (vaginal birth after c-section). However, since she could not find any doctor to assist her in this endeavor, she labored at home, with a

            When a doctor she had approached about a related issue at the Tallahassee Memorial Regional Center found out, he and the hospital sued to force her to get a c-section.

            The court held that the rights of the fetus at or near birth outweighed the rights of Pemberton to determine her own medical care.
            She was physically forced to stop laboring, and taken to the hospital, where a c-section was performed.
            Her suit against the hospital was dismissed. The court held that a cesarean section at the end of a full-term pregnancy was here deemed to
            be medically necessary by doctors to avoid a substantial risk that the fetus would die during delivery due to uterine rupture, a risk of 4-6%
            according to the hospital’s doctors and 2% according to Pemberton’s doctors. Furthermore, the court held that a state’s interest in preserving the life of an unborn child outweighed the mother’s constitutional interest of bodily integrity.”

            Interestingly Pemberton later gave birth vaginally to 3 other chidren…

    • Susan
      October 24, 2013 at 3:41 pm #

      The patient can find another doctor or a midwife on her own.

      • The Bofa on the Sofa
        October 24, 2013 at 3:43 pm #

        So the doctor just abandons the patient?

        • Carolina
          October 24, 2013 at 3:55 pm #

          No, the doctor exaplains the medical care he/she is able to provide. In the VBAC instance, she explains that a TOL is not safe under the circumstances, and sets forth the permissible parameters for delivery. If the patient demands a homebirth, the doctor explains why that is not safe and why she cannot assist. The patient then makes her decision. If she walks away, she’s denying herself the care, not the other way around.

          • The Bofa on the Sofa
            October 24, 2013 at 3:57 pm #

            So the patient’s wishes do not have to be accommodated then?

          • Carolina
            October 24, 2013 at 4:05 pm #

            I’d say no. It’s not a world of unlimited, equally valid choices. You want to birth at home? There’s no safe way to do it. You want to smoke 3 paoks a day? There may be some very bad consequences, and no doctor will endorse that. You think you need out-of-hospital IV anesthesia to sleep at night? Better find someone sketchy like Conrad Murray to assist. No good doctor will do it.
            Going back to my lawyer example, a client may not be able to find a lawyer willing to file a really dumb, sanctionable case.* Doesn’t mean his choice has been taken away. It means it was a bad choice and no professional is going to endorse it.
            *although in reality, there’s probably always a lawyer willing to do something if the price is right. We probably aren’t as ethical as doctors.

          • fiftyfifty1
            October 24, 2013 at 4:14 pm #

            What to do in these cases has already been figured out, Bofa. There are procedures you have to follow to fire a patient (written letter sent by certified mail, 30 day grace period etc). Likewise, there are rules about what you can and can’t do when a woman just shows up in labor (when you can transfer, when you can’t etc). You’re not the first one to have noticed that there are some potentially ethically sticky situations surrounding birth.

          • AlisonCummins
            October 25, 2013 at 3:28 pm #

            I had the impression that The Bofa on the Sofa actually wanted to know what they were. But maybe they just wanted to rant against malpractice lawsuits?

          • The Bofa on the Sofa
            October 24, 2013 at 4:02 pm #

            What if the patient insists on a VBACS, despite the doctor telling her that it cannot be done safely?

            She shows up at the hospital in labour, but refuses a c-section. The doctor a) can’t do a c-section, but b) knows that the vbacs is malpractice. But that is the only option she will accept.

            Despite the fact that he told her it is not permissible, how do you prevent her from doing it? The only alternatives are a) c-section, which she won’t do or b) not treat. Neither of those are options. The doctor has no choice but to commit malpractice.

          • Carolina
            October 24, 2013 at 4:07 pm #

            Document, document, document, document the hell out of that chart. It might not be enough to prevent the filing of a lawsuit, but it could prevent liability.

          • The Bofa on the Sofa
            October 24, 2013 at 4:12 pm #

            “Doctor, were you aware that a VBACS under those circumstances was not safe, and should not have been done?”
            “Yes, I did. I tried to talk her out of it, but she refused.”
            “So you knew it was not safe, but did it anyway?”
            “The plaintiffs rest.”

          • Susan
            October 24, 2013 at 4:15 pm #

            That’s entirely different because of EMTALA. If the patient shows up in your hospital it’s tag you are it and she has the right to refuse anything and a vaginal birth is something that will likely happen if no steps are taken to prevent it. It’s very different from refusing to attend or refer to a homebirth provider.

          • The Bofa on the Sofa
            October 24, 2013 at 4:16 pm #

            That’s why I described them as two different situations.

          • Susan
            October 24, 2013 at 4:17 pm #

            I think maybe I need to reread the whole thread to follow you. Sorry! I always find this issue interesting.

          • fiftyfifty1
            October 24, 2013 at 6:06 pm #

            Bullshit Bofa. You really have no idea how it works, so don’t pretend that you do.

          • Antigonos CNM
            October 25, 2013 at 1:31 am #

            If a patient explicitly refuses a C/S and signs a document to that effect, the doctor is covered.

      • Susan
        October 24, 2013 at 4:01 pm #

        There is either a new Susan here or discus is going batty again. I only made one post today beside this one saying all these Susan posts are not the regular Susan!

        • Susan2
          October 25, 2013 at 5:18 pm #

          I’m sorry, I didn’t realize there was already a Susan on this site. I should have lurked more 🙂 I’ll use a nickname next time so people don’t confuse our posts.

  18. October 24, 2013 at 2:52 pm #

    I cannot applaud this post enough. Thank you for laying it out so clearly.

    • Busbus
      October 24, 2013 at 3:16 pm #

      I agree. Thank you, Dr. Amy, for putting a spotlight on this. Great post.

  19. theadequatemother
    October 24, 2013 at 2:32 pm #

    I’m, frankly, horrified.

    During my medical training, it was emphasized to us over and over that the fetus was not a person. That if there was a conflict between what was good for the fetus and what was good for the mother, the mother had primacy every time. Most of the time there is no conflict – what is good for mom is good for the fetus generally. But when there is conflict…say distressed fetus, emergency CS, difficult airway, we were taught that it is unconscionable to put the mother at risk to prioritize the fetus. Which is sometimes hard, because you know this is a wanted baby and you know that the parents don’t see it as a “fetus” but as their baby.

    Even a perimortum CS is not designed to “save” the fetus. It’s primary aim is to improve our ability to resuscitate the mother which is why we do them even if the fetus is not yet viable (say in the case of major trauma).

    These laws are terrible. And what happened to this woman is terrible.

    Another natural extension, as per the discussion below, would be a change in the way medicine is practiced. How misogynistic does society have to get before you are being legally obligated to prioritize the fetus over the mother? What if the mother can’t make decisions for herself and her husband wants the health of the male fetus prioritized over her best interests? I can’t think of anything good that can come out of giving a fetus equal rights to a person.

    • The Computer Ate My Nym
      October 24, 2013 at 2:39 pm #

      Well said. I would put one caveat on this which is that the patient’s wishes have primacy unless you believe what she wants would be actively dangerous. So, for example, it might be acceptable to perform a maternal request c-section if there is…well, maternal request. And, of course, refusal of care must be honored unless there is reason to believe that the refusal is due to a temporary alteration in the patient’s ability to understand what the consequences of refusal are and that the “true will” of the patient is to go ahead (and even then you need a court order to allow treatment to proceed.)

      But there are already places making exceptions to the rule that the mother’s health and wishes come first. I think it was Kansas that has the law that allows or maybe requires medical personnel to lie to their patients about the state of the fetus in order to stop them from obtaining an abortion. Not to mention the state sponsored scripts regarding abortion risks and “risks” (like the flat out lie that abortion causes breast cancer or that fetuses feel pain at 20 weeks).

      • theadequatemother
        October 24, 2013 at 2:53 pm #

        most of the time the patient’s wishes have primacy. However, to take my example farther, if you have a fetus in significant distress and an OB that wants to do a crash CS and a patient that you cannot safely anesthetize quickly (i.e. you have to do it under regional or you have to do an awake intubation) then no matter how much she begs you to just knock her out and save her baby…you can’t because you can’t be forced to do something you feel is dangerous. That’s what I mean.

        Delaying a cs or an induction in pre-ecclampsia because the fetus is premature and that’s what the mother wants and she’s informed…totally different story.

        But laws like this, and those examples you give from Kansas – they mean the mother’s wishes DON’T matter. At all.

        • The Computer Ate My Nym
          October 24, 2013 at 3:11 pm #

          But laws like this, and those examples you give from Kansas – they mean the mother’s wishes DON’T matter. At all.

          Exactly. Unlike every other situation in medicine. If an adult patient refuses treatment then that’s the end of it: they are not forced to take the treatment. Except in pregnancy where she* suddenly loses her rights. Why? Why does the right to make bad decisions suddenly disappear for 9 months? Note that it does reappear after birth: parents are allowed to make all sorts of questionable decisions for their children including, in some cases, refusing life saving treatment. But only after they are born. This is not about saving children. It’s about punishing women.

          *Or he. Rarely transmen have become pregnant.

          • sdsures
            November 26, 2014 at 7:05 pm #

            OT: How did you italicise part of the post?

    • October 24, 2013 at 2:55 pm #

      Catholic hospitals do this all the time, actually. They do prioritize the fetus over the mother. Doctors are not allowed to abort, even if the life of the mother is at stake. Doctors are not allowed to do life-saving procedures if they will risk the fetus, even if the other outcome is the death of both.

      Women die in the United States because they went to Catholic hospitals. That is unconscionable.

      • Susan
        October 24, 2013 at 3:21 pm #

        Very true. Rest in peace, Savita Halappanavar.

        • October 24, 2013 at 4:22 pm #

          Well, Savita Halappanavar was in Ireland. But still.

          • Dr Kitty
            October 25, 2013 at 3:53 am #

            And she was Hindu, so I’m not sure if the RIP applies.

          • October 25, 2013 at 12:20 pm #

            One can always hope she was truly enlightened and escaped the cycle of birth and death, I suppose 🙂

          • sdsures
            November 26, 2014 at 7:05 pm #

            That’s part of what I find so incredible, that the hospital forced their views on a non-Catholic patient.

            I guess the “thou shalt not kill” bit is too inconvenient.

        • sdsures
          November 26, 2014 at 7:07 pm #

          Ah, you beat me to it (mentioning the Savita case)!

      • EllenL
        October 24, 2013 at 4:31 pm #

        The Catholic Church has been expanding in
        the hospital business. 1 in 6 patients in the US are cared for in Catholic hospitals (*from an ACLU survey). Catholic hospitals have different standards of care in women’s health issues.

        *Tubal ligations cannot be performed

        *Ectopic pregnancies may be treated
        differently, endangering women:


        care during miscarriages may be compromised:


        *Rape victims
        must jump through hoops to get emergency birth control:


        *Abortions cannot be performed

        *Hospital pharmacies cannot carry or dispense birth
        control products

        • Nashira
          October 24, 2013 at 7:45 pm #

          All of these are reasons why regardless of why I might need an ER trip, regardless of my Mirena IUD and its minute risk of failure, my husband knows to take me to any hospital EXCEPT the Catholic ones. I want a child so bad it hurts me, but I will not abide “caregivers” who will endanger me for a clump of cells.

          I loudly discuss this with my girlfriends too. Women need to know.

          • October 24, 2013 at 9:14 pm #

            My problem is I don’t know offhand which hospitals near me are Catholic. Some are, some aren’t, and I really should look it up. In an emergency, though, I don’t know that a longer car or ambulance ride is necessarily an option. This is why Catholic hospitals just shouldn’t be allowed to do this.

          • fiftyfifty1
            October 25, 2013 at 8:05 am #

            Research has found that hospitals called “Methodist” or “Mount Sinai” are statistically less likely (p<.000000001) to be Catholic. Hospitals with names starting with "Our Lady of …." are more likely to be Catholic. Scientists have been unable to determine why these correlations are present, but can affirm that there is a definite trend.

          • Karen in SC
            October 25, 2013 at 8:30 am #

            Large hospital system in St. Louis area is Barnes-Jewish. Interestingly, the Catholic hospitals there are either changing hands (and thus names) or changing affiliations. Another large hospital recently changed from St. John’s Mercy (commonly called St. John’s) to Mercy.

          • October 25, 2013 at 12:23 pm #

            Yes, yes lol. But hospitals are being rapidly bought, and they don’t always change their names (or change them to obviously Catholic ones) when that happens.

            I’m pretty sure Presby (short for Presbyterian) is not a Catholic hospital, for example. But I’m not 100% sure on that.

          • sdsures
            November 26, 2014 at 7:22 pm #

            Presbyterian is a variant of Protestantism, so it’s definitely not Catholic.

      • sdsures
        November 26, 2014 at 7:02 pm #

        See my post about, about Savita dying in an Irish, Catholic hospital.

    • Susan
      October 24, 2013 at 3:14 pm #

      Look at your own language though! Rather than referrring to the pregnant woman as “the woman” or “the patient”, you’re calling her “the mother”! Unless she has other children, she’s not a mother until the baby is born.

      • Susan
        October 24, 2013 at 3:39 pm #

        I just read the nytimes article in which the Times used the term “unborn baby” throughout. The language war is lost. From puberty to menopause we’ll all be pre-pregnant mothers with unborn children. Eventually abortion rights will be rolled back in every state except NY and Massachusetts and any woman trying to travel there or outside the country will be forced to first prove she’s not pregnant. A judge will rule on each pregnancy whether it would be best for the “unborn child” to be born via c-section or vaginal birth. Both options unmedicated, of course.

        • sdsures
          November 26, 2014 at 6:59 pm #

          Reminds me of the horrible, sad case of Savita, here in the UK, which happened in 2012: http://www.bbc.co.uk/news/uk-northern-ireland-20321741

          “Savita Halappanavar’s family said she asked several times for her pregnancy to be terminated because she had severe back pain and was miscarrying.

          Her husband told the BBC that it was refused because there was a foetal heartbeat.

          Ms Halappanavar’s death, on 28 October, is the subject of two investigations.

          An autopsy carried out two days after her death found she had died from septicaemia, according to the Irish Times.

          Ms Halappanavar, who was 31 and originally from India, was a dentist.

          Praveen Halappanavar said staff at University Hospital Galway told them Ireland was “a Catholic country”.”

          Even though the Halappanavars were not Catholic themselves, she was denied an abortion, and died as a result.

      • theadequatemother
        October 24, 2013 at 4:25 pm #

        that’s an interesting observation…i will have to reprogram my brain.

        • Susan
          October 24, 2013 at 4:27 pm #

          Oh gosh too if you think that is me correcting you it wasn’t my discus says Susan on about half these posts. Do you see that or is it just mine ( regular Susan here )

          • October 24, 2013 at 4:32 pm #

            I show you in blue (you have an account) and the other Susan in grey.

          • Susan
            October 24, 2013 at 4:34 pm #

            Thank you funny there is a new Susan. How confusing. That’s just never happened to me before… 🙂

          • Susan2
            October 25, 2013 at 5:35 pm #

            Me either! Not many other Susans born in the 70s. I’ll try to remember to use a nickname on this site from now on 🙂

      • Clarissa Darling
        October 25, 2013 at 12:08 am #

        OK, let’s not go overboard. While I understand and agree with the reasons why a fetus cannot be given legal status as a person, I don’t think there is anything wrong with a healthcare provider using language that is sensitive to the fact that most women who have wanted pregnancies do consider their fetuses babies and feel great responsibility for their “lives”. I was recently admitted to the hospital for fetal monitoring because of some concerns my doctor had at my last appointment. Luckily everything appears to be fine but, should the worst happen, I certainly wouldn’t want my healthcare provider to say “well, it’s not like you were a mother who lost her baby, it’s just a 39 week old fetus after all”. From a medical and legal standpoint that may be true but, from an emotional standpoint, that’s my son. I’d prefer my medical provider to be sensitive both to my autonomy as a patient and to the emotional connection I do feel to my fetus as it’s “mother”. I don’t personally see any reason they can’t do both.

      • Kumquatwriter
        October 25, 2013 at 9:40 pm #

        I’m sorry, but that’s deeply offensive to those of us who were mothers to babies who died during pregnancy. Im sorry, I can’t keep reading to see if this was clarified, I’m too angry. I most certainly WAS my first son’s mother! I may have only held his body, but dammit this kind of statement still stings. I’m mother to my living son too, and I’m kind of surprised at my own reaction – I’m at peace with my loss and rarely feel this strongly.

        • Lizzie Dee
          October 26, 2013 at 2:07 pm #

          Of course you are mother to your first child – and would have gone on being a mother even if you hadn’t have had other children.

          It sometimes seems to me that some who focus on the experience and the rights of adult women (which I would not dispute are important)the baby can stay remarkably abstract.

        • sdsures
          November 26, 2014 at 6:53 pm #

          While I appreciate your feelings on the subject, what @theadequatemother:disqus refers to (if I’m reading this right) is a matter of non-emotive medical terminology about a medical procedure, and the names given to the patients therein. “Mother” is to the “fetus” within, but we do not say she is the “mother” if we are performing an appendectomy – we say “patient”. In the case of the mom-fetus relationship, it is not only emotional, but also one of the mother being the fetus’ life-support system. Consider that when an operation is performed in utero on a fetus, the mother is the patient.

  20. I don't have a creative name
    October 24, 2013 at 2:26 pm #

    OT: http://www.nydailynews.com/news/crime/mom-newborn-found-dead-cops-article-1.1481688 A tragedy on so many levels. I don’t think bed sharing is ever safe, but especially please don’t do it if you’re on pain meds. 🙁

    • thepragmatist
      October 25, 2013 at 3:01 pm #

      Not that I bedshared with a newborn while on pain meds, but I think there was a lot more going on there. 🙁 I don’t think the pain meds killed her. No way should a small amount of oxycodone kill someone– a blood clot or infection and fever. But why was she alone in her apartment with a little tiny baby after surgery? Makes me want to cry, because I can’t imagine dying alone in your apartment with a newborn and two six year olds, and your teenage brother finding your dead body on top of your newborn. A horror story right there. Ugh.

    • R T
      October 25, 2013 at 6:36 pm #

      I think the fact she had a persistent fever and pain so bad almost two weeks after a csection is the alarming part of the story. She may not even have been co sleeping and laid down to die instead. There is more to this story than co sleeping. I think you’re missing the big picture if that’s what you get from it!

  21. Susan
    October 24, 2013 at 1:41 pm #

    I am appalled when pregnant women risk the health of their babies but I completely agree with you that women should have the same rights pregnant or not. The idea of any pregnant woman being arrested or jailed when she would not have been if not pregnant is much more outrageous. I worry that the reason Chervanak is on the homebirth ethics issue is the overlap with abortion rights too. I don’t want to live in a society that would haul pregnant women anywhere to give birth. That doesn’t mean that CPMs have a right to practice with a lesser credential, but the AAP statement that if you MUST have a homebirth these are the best guidelines to do so are far from condoning it. At least as I read it. And who knows, maybe if homebirth was conducted with those guidelines there would not be a much to talk about anymore.

    • The Computer Ate My Nym
      October 24, 2013 at 2:13 pm #

      Women have a right to give birth (or attempt to give birth anyway) under conditions that they choose. No one, man or woman, has the right to lie to women about the safety of certain conditions for giving birth. If someone understands the risks of home birth and decides to go for it, that’s her problem. If she is lied to and told that it’s safe that’s a different situation. Regulate the caregivers, not the patients.

      • Young CC Prof
        October 24, 2013 at 10:34 pm #

        Very well said. Most pregnant women, by the time delivery approaches, would do almost anything to keep the child safe, and a lot of the harms of the natural birth movement have occurred because women were misinformed about or misunderstood the risks of different choices. And yes, I will come down VERY hard on anyone who provides woefully inaccurate medical advice for their own profit.

        However, an adult of sound mind has the freedom to make bad medical choices. Unless this adult is endangering other already-born people in the process, we can’t ever take that away, no matter how dumb we think those choices are.

  22. October 24, 2013 at 1:25 pm #

    This. Women do not become lesser persons when they become pregnant. Slow clap.

  23. Antigonos CNM
    October 24, 2013 at 12:48 pm #

    In some ways, it is a logical step — but let’s go where it leads. IF it is assumed that sentient human life begins with conception then not only is a zygote a human being with the full rights of an adult, but one can make an argument that every woman MUST have sex EVERY time she is capable of conception or else she is willfully denying a potential human [not to mention a potential Shakespeare or Einstein] from coming into existence. [I suppose the male–any male–who does not impregnate any fertile female could be charged as an accessory of sorts] Further, anything she does deliberately which could possibly impact on that potential conception/human being can be regarded, if the outcome is fatal to the fertilized egg, as a form of murder. Indeed, if a woman habitually miscarries, and does not do anything and everything to avoid miscarriage, she could be held liable [forget such planned acts as termination of pregnancy; I’m talking about not getting progesterone shots, etc.]

    Rather absurd, isn’t it? Yet, if one accepts the concept that abortion at even the earliest stage of pregnancy is MURDER, one cannot avoid going to the logical limit.

    I don’t deny that I think the idea that a viable fetus at term is without any legal rights at all is about as bad as giving a blastocyst total legal rights. I’ve often written that the fetal/neonatal victims of some of the wilder and weirder “birthing” practices are in need of advocates. But there is a sensible limit. No one thinks amoebae should have legal representation yet they are alive, and reproduce the same way the fertilized egg does [at least initially].

    Judaism has always been sensible in this regard. A fetus is an appendage of the mother, like her fingers or toes, until so well developed that it can exist independently outside the womb, at which time, even if still in utero, it has certain rights. No gestational age is specified, and as technology has developed, this means the age at which viability is possible has declined. But there is an obvious limit based on the ability of fetal organs to be able to function once the baby leaves the uterus. Until viability is reached, no liability is attached to any or all decisions made by the mother.

    • The Computer Ate My Nym
      October 24, 2013 at 1:03 pm #

      Also, if abortion is murder, what should we say about refusal to donate organs or tissue? The potential recipients are definitely living people who will die without said tissue. And potential donors who don’t take care of themselves may be depriving said recipients of their tissue by making themselves too sick to donate. Maybe we ought to force all people who are in the marrow registry to not smoke, not drink, eat only the most healthy food, exercise regularly, etc. And we certainly can’t let them change their minds about donating…Only if we went there would we really be giving the fetus the same rights as an adult. Right now, we’re giving it more rights. (Most of which are lost at birth.)

    • Dr Kitty
      October 24, 2013 at 2:43 pm #

      If you want to know where this kind of thing leads, look no further than El Salvador, where you can face life imprisonment after a miscarriage, if someone suspects it was induced.


      Either adults with capacity can refuse medication and treatment, or they can’t.
      Either the law recognises foetuses as people or it doesn’t.
      Bright lines here, no grey areas.

      At 14 weeks Roe vs Wade already says (IIRC) that the state’s interest doesn’t supersede her right to privacy when it comes to ending the pregnancy.
      How then could Wisconsin’s interest possibly supersede her rights to autonomy or privacy when choosing whether or not to take medication? Badly thought out law leading to entirely predictable abuses of human and civil rights.

    • C T
      October 25, 2013 at 10:25 am #

      It is absurd. In your hypothetical above, you act as though the actual conception is not a defining line, changing a “potential” into a “done”.

      • Young CC Prof
        October 25, 2013 at 10:36 am #

        IS the act of conception a hard line, though? Biologically, it’s not clear. I think the current evidence suggests that if a woman has unprotected sex near ovulation, a zygote almost always results, but it doesn’t always implant, or very often fails within days of implantation.

        When does pregnancy begin, philosophically?

        • The Computer Ate My Nym
          October 25, 2013 at 10:47 am #

          For that matter, conception is not a single event, but a series of events. Is the defining line of “done” the fusion of the sperm to oocyte? The completion of meiosis? The fusion of the pronuclei?

        • C T
          October 25, 2013 at 11:04 am #

          I don’t claim to be defining when pregnancy begins. (Though I think it’s fair to say that when the nausea hits, a woman is definitely there….just passed the 6 week mark myself…ugh.) Most of the hypothetical talks as though a potentially fertilizable cell is ethically or biologically anything like an actually fertilized egg. An unfertilized cell is clearly not a fertilized cell any more than a single woman is a married couple. That is one undeniable hard line that her hypothetical ignores.
          Implantation is another hard line after that. I think that’s why many who are opposed to abortion don’t have a problem with birth control methods that can act secondarily to prevent implantation.
          Both “hard lines”–fertilization and implantation–are far easier to define and justify as hard lines than “viability”, given that we can now save some babies kicked out of the uterus at just 23 weeks.

        • Dr Kitty
          October 25, 2013 at 11:18 am #

          Medically and legally PREGNANCY begins with implantation.
          Therefore methods of contraception which work by preventing implantation are not abortifacient by definition (because they prevent pregnancy occurring). They do not end already occurring pregnancies.

          Now, someone who believes life begins at conception may not agree with these methods of contraception but they are NOT abortifacient using the agreed medical and legal definition of pregnancy.

          Definitions matter, words matter, and much as someone might want to change the definition of abortion or pregnancy to fit their own religious or philosophical beliefs, the rest of us don’t have to agree.

  24. Are you nuts
    October 24, 2013 at 12:48 pm #

    Yikes!! This women had a clean drug test and they arrested her??? Based on this, we should probably be arresting women who drank prior to pregnancy.

  25. The Computer Ate My Nym
    October 24, 2013 at 12:39 pm #

    I can literally think of no other situation in which something like this would happen. Anyone? Is there any other situation in which one person’s bodily autonomy would be taken away, violently, in the interest of another person? There is something about our society that simply hates pregnant women. There are so many examples, including abortion restrictions, arrests for supposed risk to the fetus, even the NCB insistence that women not have pain medication during labor. It’s all about punishing a woman for being pregnant. If the fetus doesn’t actually benefit or is harmed, that’s just collateral damage.

    • Amy M
      October 24, 2013 at 12:43 pm #

      I remember reading somewhere that pregnant women are among the most likely victims of homicide (obviously from boyfriends and husbands who are not so happy about the impending child). Can’t win, can they?

      Do you think the women are being punished for being pregnant? Or for having sex? You know, that whole Madonna/whore thing…..mothers are one thing, women who have sex are quite another.

      • The Computer Ate My Nym
        October 24, 2013 at 12:47 pm #

        obviously from boyfriends and husbands who are not so happy about the impending child

        Or boyfriend or husband who found that his plan to chain the woman to him with a baby failed and she was going to leave him anyway. Sabotage of birth control is a well documented form of abuse.

    • Antigonos CNM
      October 25, 2013 at 1:42 am #

      But this is the crux of the issue: at what point does an embryo/fetus become “a person”? At conception? When there is a heart beat? When it can survive ex utero? Or when it is born at term or very near it?

      • The Computer Ate My Nym
        October 25, 2013 at 9:23 am #

        Even if we assume that there is a soul that enters at conception so that the answer is “all of the above”, when do person A’s medical needs mean that person B must sacrifice xer body? In no other situation that I can think of. Heck, one of the legitimate, accepted reasons for stopping CPR is being too tired to go on. If “too tired” is an excuse for stopping doing the one thing that is keeping a person possibly alive, how can risking death from a million different causes be required?

  26. Zornorph
    October 24, 2013 at 12:28 pm #

    I locked my woman up in the basement after she was pregnant and fed her gruel. But it was organic gruel.

  27. FormerPhysicist
    October 24, 2013 at 12:21 pm #

    It’s not a very far step from that to my doctor jailing me when I wouldn’t go on strict bed rest.

    • FormerPhysicist
      October 24, 2013 at 12:27 pm #

      Except, of course, that I’m neither low-income nor minority.

      • The Computer Ate My Nym
        October 24, 2013 at 12:40 pm #

        That lowers your risk but doesn’t negate it. Simply being a fertile female makes you public property. Menopause can not come soon enough!

        • fiftyfifty1
          October 25, 2013 at 8:14 am #

          Ah yes, menopause. Then you too, like Dr. Amy, can qualify to get called a “dried up hag”.

          • The Computer Ate My Nym
            October 25, 2013 at 10:44 am #

            Cool! I’ve always wanted to be a dried up hag.

      • Susan
        October 24, 2013 at 1:31 pm #

        That really happened to you Former Physicist? For real?

        • FormerPhysicist
          October 24, 2013 at 3:09 pm #

          No, not to me. But this article scares me because it’s not a far step from one to the other. Or, not far enough.

      • Susan
        October 24, 2013 at 1:31 pm #

        That really happened to you Former Physicist? For real?

    • The Computer Ate My Nym
      October 24, 2013 at 12:35 pm #

      It’s happened. Ironically, IIRC, there is no good evidence that bed rest even prevents miscarriage. It’s done on theoretical grounds. (OBs, please correct me if I’m wrong and/or out of date.)

      • Ceridwen
        October 24, 2013 at 2:15 pm #

        It’s not well supported by the evidence. There are occasional studies that support it, and plenty more saying it makes no difference. I think it does depend a bit on the condition in question, but not very much. It seems to be recommended when there is nothing else that can be done because it’s seen as a “can’t hurt, could help” sort of thing, a way to make women feel like they are doing all they can. Completely ignoring that it *can* hurt. Both in terms of health for mom and baby (harder for mom to stay healthy, more weight gained, blood clot risks?) and welfare of mom and her family (can’t work, can’t take care of other kids…).

        I spent 3 weeks on bed rest during my pregnancy but my OB was completely up front that it was not well supported by research and was my choice. As it was, I was too sick to do much anyway (it was very early in my pregnancy), so having her write me off work for bed rest just made things easier for me. A lot of women with my condition (subchorionic hematoma) feel the need to stay on bed rest for their entire pregnancy, even after the issue has resolved. I find that worrying. And they seem to have a lot of guilt if they do miscarry, convinced they just didn’t rest enough.

        • The Computer Ate My Nym
          October 24, 2013 at 2:30 pm #

          blood clot risks?

          Definitely. Deep venous thrombosis and pulmonary embolus are both more common in pregnancy and more common with decreased mobility, i.e. bed rest. Not harmless. But one of the risks should NOT be being arrested if you fail to follow orders.

        • Amy M
          October 24, 2013 at 3:40 pm #

          My OB had me stay in the hospital for 4wks, but I think that was more about being as close to the NICU as possible if the pre-term labor that kept coming and going didn’t stop. I was also on tocolytics, and they were monitoring me/the fetuses closely with lots of NSTs. I’m pretty sure the OB said something about the lack of strong evidence for bedrest as a “cure” for pre-term delivery, but in the absence of anything concrete, plus all the monitoring, that’s what she went with. Whether that, or dumb luck, my babies held out until 36wk.

        • SkepticalGuest
          October 24, 2013 at 7:33 pm #

          @Ceridwen: Why to you “find it worrying” that women with the same condition as you (subchorionic hematoma) feel the need to stay on bedrest, even after the issue is resolved?

          Their choice doesn’t impact you in the least. Nor does it negatively impact their unborn baby. It really doesn’t seem to be anyone’s business but theirs.

          • Ceridwen
            October 24, 2013 at 7:44 pm #

            Because many of them are having financial or family difficulties caused or exacerbated by the bedrest, and it *can* have negative effects on both physical and mental health. While the idea seems to be to give them a feeling of control over the situation, that sense of control seems to be guilt inducing and paralyzing rather than comforting or empowering. I find it upsetting to see or hear about them going through those negative consequences of bed rest, when it is very unlikely (especially after resolution of the condition has been documented) that it has any impact at all on the outcome of the pregnancy.

      • Mrs Dennis
        October 25, 2013 at 4:22 pm #

        ‘She had to undergo an emergency caesarean section but the fetus was found dead’? Why perform a c/s if the fetus is no longer viable? As another punishment for the mother? A miscarriage is too good for the disobedient wench, let’s put her through surgery too?

    • SkepticalGuest
      October 24, 2013 at 12:35 pm #

      Actually, a woman in Florida *did* face court-ordered bed rest back in 2010: http://abcnews.go.com/Health/florida-court-orders-pregnant-woman-bed-rest-medical/story?id=9561460

      Especially difficult was that she had children at home that she needed to care for.

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