You cannot perform a C-section on a woman without her consent, PERIOD!


Our right to bodily autonomy is one of the most important rights that we have. Simply put, a woman (or a man) has a right to refuse medical or surgical treatment, regardless of whether or not the refusal might lead to death. In the case of a pregnant woman, that means that she has an absolute right to refuse a C-section regardless of whether the C-section is life saving for either her or her unborn baby.

If the facts of the case as outlined in The New York Times are correct, Rinat Dray has an excellent case against her doctors for performing a C-section without her consent.

After several hours of trying to deliver vaginally and arguing with the doctors, Mrs. Dray was wheeled to an operating room, where her baby was delivered surgically.

The hospital record leaves little question that the operation was conducted against her will: “I have decided to override her refusal to have a C-section,” a handwritten note signed by Dr. James J. Ducey, the director of maternal and fetal medicine, says, adding that her doctor [[Dr. Leonid Gorelik] and the hospital’s lawyer had agreed.

They should not have done that, and, given the facts that we know so far, it is difficult to imagine why the hospital’s lawyer gave them the go-ahead to do so.

Ms. Dray had had two previous C-sections:

… [T]he first doctor, at NewYork-Presbyterian/Weill Cornell hospital, began urging her to have a cesarean after her water had broken and she had labored for a few hours. Hoping for a different outcome for her second pregnancy, she went to Lenox Hill Hospital, with the same result.

Still hoping for a vaginal birth, she changed doctors again for the third pregnancy. She also hired a doula to help her with the childbirth.

In other words, Dr. Gorelik agreed to take her on as a candidate for a VBA2C. This was clearly a priority for her, and Gorelik knew it and assented to it. Presumably he had extensive discussions with her during the pregnancy about the risks and benefits of a VBAC attempt. Yet after, Ms. Dray labored for several hours, Dr. Gorelik changed his mind.

At first, she said, Dr. Gorelik appeared to relent, saying he would give her an epidural for the pain and then reconsider. “I was begging, give me another hour, give me another two hours,” Mrs. Dray said. Her mother, who was there, supported her, and the doctor said, “I’m not bargaining here,” Mrs. Dray said.

Mrs. Dray said she kept begging on the operating table. His answer, she recalled, was, “Don’t speak.”

Those exchanges, if true, are shameful. It appears that the doctor substituted his judgment for Ms. Dray’s and performed surgery against her will.

There are, of course, situations in which a doctor can perform surgery without explicit consent, but it doesn’t sound like this was one of those situations. In emergencies if a patient is incapable of giving consent for life saving treatment (e.g. if the patient is unconscious after being shot), consent for life saving treatment is assumed since the patient would consent if she or he were aware.

Yet, Ms. Dray’s situation does not sound like an emergency. No one was suggesting that her uterus had ruptured, for example, or that the baby was currently dying. Moreover, Ms. Dray hadn’t been unable to give consent; she deliberately withheld it.

An emergency C-section without explicit consent might be performed if the doctor feels that the patient is incapable of understand what is going on. There’s no evidence presented thus far that Ms. Dray did not understand exactly what was happening. Indeed, there is no evidence that any of the factors that might imply consent were occurring here. The doctor wanted to perform a C-section, the patient refused and the doctor did it anyway. That is inappropriate and inexcusable.

Dr. Howard Minkoff, chairman of obstetrics at Maimonides Medical Center in Brooklyn, whose articles on the subject of patient autonomy have been published in medical journals, said he believed that women had an absolute right to refuse treatment even if it meant the death of an unborn child. “In my worldview, the right to refuse is uncircumscribed,” Dr. Minkoff said, cautioning that he was not commenting on the particular facts of Mrs. Dray’s case. “I don’t have a right to put a knife in your belly ever.”

I heartily concur, and I suspect that the court will, too.

We are not talking about someone who is unknown to the doctor, who is in the midst of a dire emergency, who is incapable of understanding what is going on. We are talking about a competent woman who had had extensive counseling by her doctor, who strongly wished to proceed with labor, who strongly expressed that she did not give consent, and yet was operated on anyway.

Ms. Dray has the RIGHT to refuse consent for a C-section. She has the RIGHT to let her baby die if that’s what happens as a result of refusing a C-section. She has the RIGHT to sacrifice her own life, too, if she understands that she might die as a result of her refusal.

Ms. Dray’s doctors apparently trod on all those rights and substituted their judgement for hers. If that is truly the case, they can and SHOULD be held legally accountable.

475 Responses to “You cannot perform a C-section on a woman without her consent, PERIOD!”

  1. Irène Delse
    May 22, 2014 at 8:23 am #

    Dr. Jen Gunter covers the case in her later blog post:

  2. AgentOrange5
    May 20, 2014 at 9:51 pm #

    Well, as detestable as I find it, I agree with the majority here that a pregnant woman has the right to kill herself. And its not like the mother was threatening to directly kill herself, while I suspect that the medical situation was such that death was almost certainly imminent for the mother and/or child, obviously the mother did not believe this. I don’t believe that having some false/crazy beliefs makes one automatically incompetent to make decisions for themselves (I would posit pretty much everyone, has some false/crazy beliefs, that generally have little effect on their life.) I do wonder, if as was suggested below, the doctor realizing he was in a position where he would be sued regardless of what he did, was advised by the lawyer that a lawsuit involving a dead mom/baby/both would fare worse for him, than a lawsuit involving his ignoring of patient consent when the result was a living mom & baby? Because while I believe intellectually & ethically the mother should have the right to continue a VBAC, even to the point of death…..reality is, she isn’t operating in a vacuum, and I can understand the physician looking at things from a lawsuit point of view and doing what he felt was the best option–that doesn’t mean I think he made the right decision, I can just understand that thinking. And reality, without knowing all the details of the case, there is no way I can know if the physician made the right decision or not. Certainly it sounds like he was in the wrong, in totally disregarding patient consent, but possibly there was more to the story that will come out in court.

    • Young CC Prof
      May 20, 2014 at 11:22 pm #

      Everyone does have some false or crazy beliefs. How’s this for a dividing line: If your life depends on getting treatment and you refuse because you believe your doctor is greedy and ignorant and your condition is best left alone, that’s your right. Other people can (and should) try to convince you to change your mind, but if you are an adult, they should NOT force you. However, if you refuse treatment because you believe your doctor is a green tentacled alien who wants to perform experiments on you, perhaps your refusal should be overridden.

      • AgentOrange5
        May 20, 2014 at 11:32 pm #

        I agree…its a judgement call, but there are qualified people to make that judgement call. There are crazy beliefs that people have rationally decided to accept (a bit of an oxymoron, but I think you know what I mean), and then there are crazy beliefs because of a chemical imbalance/physiological problem that is preventing that persons mind from being able to function the way it would otherwise function.

  3. Tired
    May 20, 2014 at 7:35 am #

    I’m an ICU nurse, and see this sort of thing happen all the time. One recent case that springs to mind, a lady with a long list of comordidities, living in supported care had an Advanced Care Directive specifically stating she only wanted comfort measures if she became unwell. She developed an infection and was admitted for antibiotics/ analgesia. She became more septic and according to the surgeon even though she had a systolic BP of 75, she had a “moment of clarity” and withdrew her Care Directive and “consented” to full care/ resusitation. 6 hrs of surgery later, she was in our unit ventilated, with inotropes and filtered.

    It’s horrible and actually really hard to get Dr’s/ surgeons to just let a patient die. I agree with Dr Amy. This lady shouldn’t have had this c/s -period. If someone is competent and knows the risks/ benefits then we absolutely have to respect their autonomy. After all they are the ones that have to live with the result of their decision, not we health professionals.

    • Gene
      May 21, 2014 at 3:40 am #

      An advanced directive can be rescinded at any time. If the patient said she wanted everything done, we MUST abide by her wishes even if we disagree with them. I see that in the ED all the time. Someone in hospice,etc with a DNR. Family comes racing in and demands: do everything! And we must.

      Although there was an interesting case in Texas about 10-20 years ago in which a family had a birth of a child with known issues, planned IN ADVANCE to do nothing (comfort care only) after the delivery. Baby born and father changed his mind and said “save her”. They did. Child has many many expensive medical issues. Family sued the docs for doing what they asked (“you should have done comfort care only!”) and won. Damned if you do, damned if you don’t.

      • Tired
        May 21, 2014 at 5:56 am #

        My issue with this situation was that I don’t believe a patient in septic shock, hypoxic and seriously hypotensive was competent to make a decision to rescinder her Advanced Care Directive.

  4. Howard
    May 19, 2014 at 8:37 pm #

    In medicine, most situations are rarely just white or black but mostly in the gray area.
    Forcing someone who is capable to make decisions to have a cesarean is wrong. But it’s also wrong like Dr.Minkoff to say a woman has the “absolute” right to refuse a procedure that’s relatively safe and to let the baby die.
    There are rarely absolute rights, rather there are legal and ethical issues involved. Legally, the woman was in her right to refuse a cesarean. But what are her ethical obligations especially when the baby/fetus is endangered? None? I don’t think so.
    In a country where abortion is legal until 24 weeks, and the woman chooses to not abort, she starts to have obligations towards her unborn child. That means she has obligations to not harm the fetus, eg no smoking, no drinking, no drugs, etc. And to deliver in the hospital to ensure optimal health for the fetus. Dr.Amy has said it before many times. There are ethical obligations.
    Those are ethical not legal obligations, and we need to understand the differences. The “absolute” rights may relate to her legal obligations, but one should not forget ethical obligations.

    • WhyNot?
      May 20, 2014 at 10:45 am #

      Is there some way to codify the woman’s lesser legal status and reduced rights after 24 weeks? Also, for voting and re-districting purposes, someone with lesser legal rights like that probably shouldn’t be counted the same as a full human being. Maybe pregnant women could be counted as three-fifths of a person for those purposes?

      • AllieFoyle
        May 20, 2014 at 12:48 pm #

        Ooh, snap.

        But is what he’s saying really that unreasonable? It’s not that women’s legal status diminishes after 24 weeks, but that at some point the fetus develops personhood and perhaps there are some ethical implications. If you feel like personhood is magically bestowed at the moment of birth then obviously you won’t agree, but if you feel that it isn’t as clear and that perhaps personhood develops gradually at some point after viability, then the issue is a little murkier.

        A woman can (and, in my opinion, should) maintain the right to bodily autonomy when pregnant, but does she have an ethical obligation to the fetus? We already restrict her autonomy to an extent. You can’t have an abortion at 35 weeks. Is that reasonable or an unnecessary restriction on the autonomy of pregnant women? Are women ethically obligated to do everything they can for the fetus? Are they obligated to do anything for the fetus at all? Legally? To what extent?

        It’s a complicated subject–there’s nothing wrong with discussing it and acknowledging the difficulties and nuances.

        • Medwife
          May 21, 2014 at 7:45 pm #

          Magically bestowed personhood status with birth? No. Legally bestowed right to be considered separate from the mother? Yes. You are trying to turn a spiritual question into a legal one, and you have lots of company these days.

      • MLE
        May 20, 2014 at 7:17 pm #

        I hate the 3/5 analogy because that was a GOOD plan. It prevented the slave owning south from having more representation than they deserved and thus more political clout based on an enslaved population. It would have been outrageous to include slaves in a count of full citizens enjoying the same liberties as their owners.

    • rg
      August 8, 2020 at 2:43 pm #

      except it said in the article the uterus hadn’t ruptured and the baby was not at risk of death but the doctor took her rights away anyway just because he could.

  5. Cold Steel
    May 19, 2014 at 7:19 pm #

    There are currently 429 comments and I have not read them all. However, Dr Tuteur overlooks a third scenario where overriding a patient’s wishes is ethically acceptable: where the patient is deemed to lack competence. This is separate from capacity. Competence is where the patient is capable of comprehending the risks and benefits to both acting and not acting, and making a measured decision.

    In adult medicine forced treatment of those who are deemed incompetent is rare, but it is slightly more common in pediatrics. As the physician and hospital are opening themselves to a great degree of scrutiny and legal risk this is usually undertaken only with lawyers and the hospital ethics committee (and occasionally the ruling of a judge, who provides temporary decision-making power to the medical team). Recent examples in the national news include a child with ALL whose mother believed in the healing power of prayer and refused medical treatment– the court ordered chemotherapy and the child survived; and a child with new-onset Type 1 DM in DKA, near death, whose parents again believed in faith healing. Court ordered insulin and resuscitation.

    What makes obstetrics so fascinating, ethically-speaking, is the maternal-fetal dyad. As the pregnancy progresses the fetus has a progressively larger voice. It might well be the case that the woman in question was unable to comprehend the immediacy of her uterine rupture, the imminent death of her baby, and as such was determined to be incompetent and the life of the baby was made the #1 concern. The very involvement of the hospital lawyers almost certainly means this was the course taken.

    • Gene
      May 19, 2014 at 9:14 pm #

      I’ve taken care of a young adult who believed God would cure the cancer that was killing him. No one on medical staff, nor his family or even his pastor, could convince him to undergo treatment. He was otherwise a competent and functional human. No court would touch him. I didn’t even bother calling the ethics committee because we couldn’t force an otherwise competent adult to accept treatment. You can’t fix stupid.

      The issue with kids is that they are NOT adults and may, in other circumstances, choose to undergo various treatments that their parents are refusing. But in the above case, the pregnant woman is an adult and only one patient exists (legally). Unless she was truly medically incompetent (which I doubt), the case as presented above constitutes an egregious breach of medical care and ethics.

      • Cold Steel
        May 20, 2014 at 4:21 pm #

        Exactly– this is rare to the point of non-existence in adult medicine, but relatively more common in pediatrics. It might well be the case that this was a landmark, watershed situation where the obstetrics department in question invoked the woman’s competence (as opposed to capacity) and substituted their judgement, in the best interests of the baby.

    • EmbraceYourInnerCrone
      May 20, 2014 at 12:10 pm #

      Nope, nope , nope
      I understand that its frustrating to have a patient who does not want to comply with what seems like the best medical advice, BUT being pregnant does not make one incompetant, it does not rob a person of their right to make their own medical decisions.
      We already have people who have been arrestd for not going along with their doctors advice for bedrest (this woman had 2 toddlers at home and her doctor wanted her to be in the hospital on bedrest for 2 months to avoid miscarriage/early labor):

      We have a pregnant woman arrested for declining a suggestion to continue take Suboxone (treatment for Percocet dependency, she had tested Negative for any drugs)

      Or the pregnant lady at a bar that was kicked out of the bar, for being pregnant; she wasn’t drinking, just in a bar while pregnant.

      A pregnant person has as much right to bodily autonomy as a non-pregnant person.

      • Cold Steel
        May 20, 2014 at 4:19 pm #

        In what universe did my comment say that pregnancy, as a condition, renders one incompetent?

        It’s merely a third option in the substituted decision-making metric, one which Dr Tuteur overlooked. I can’t at all comment on the facts of the case nor justify the decision, but again, it’s a possible explanation as to how things proceeded.

  6. Jenny Star
    May 19, 2014 at 5:26 pm #

    The doctor was wrong… but this stupid woman has ensured that that many fewer doctors will even consider taking on a patient who wants a VBAC again.

    • adayinthelife
      May 20, 2014 at 6:24 pm #

      Why is she stupid? For believing this doctor would support a VBAC attempt?

  7. The Computer Ate My Nym
    May 19, 2014 at 9:10 am #

    I haven’t read all the comments, so sorry if this is repetitious, but…

    The doctor was wrong to do this c-section. I’m sure the patient was an idiot for trying to continue with a vaginal birth. The doctor may well have saved her and the baby’s life. Nonetheless, if the statements that she had decision making capacity and that she was refusing were both true then what he or she did was assault and battery.

    I’ve been in situations that were a little similar: Jehovah’s witnesses dying of anemia. Some of them have continued to refuse even when they were told, in so many words, by both me and members of their church, that they would die without the blood. Even when they were told by members of their church that it was up to their conscience and the decision was between them and God. Some still refused. They died. Yes, it was terrible and traumatizing and I’ve spent time counseling everyone from the family to the residents afterwards. But the decision was theirs to make. I think they were idiots, but they were sane idiots aware of the consequences. And that’s where my right to decide for them ends. And where this woman’s doctor’s right to decide for her ends.

    • Guest
      May 19, 2014 at 10:37 am #

      “I’m sure the patient was an idiot for trying to continue with a vaginal birth.” Really? Even Dr. Amy said the doctor knowingly took her on as a patient, presumably throughout the entire pregnancy, and then only changed his mind in labor. Noting I’ve read so far really outlines what those “complications” were that led to this cesarean, and his notes on it don’t really seem to indicate that there was anything serious going on other than he changed his mind and did it anyway. You’re also forgetting or disregarding ACOG’s own guidelines (helpful but laughable, if no physician will honor them) that even women who’ve had two prior cesareans can be good candidates for VBAC.

      How patronizing to just assume the mother was stupid and that’s that.

      • AllieFoyle
        May 19, 2014 at 11:11 am #

        But we don’t know anything about the nature of the relationship. Remember, two doctors and a lawyer agreed that doing the c-section was the right course of action, and this is a hospital that is generally supportive of VBAC. Perhaps her doctor had counseled her that she could attempt a VBAC but on the condition that they convert to c-section under certain circumstances (fetal distress, signs of rupture, etc.) and she agreed beforehand and then refused to go along with the agreement later. It would be her right to do so, but I think it would be fair to criticize it.

        There’s just a lot here that we don’t know.

      • Irène Delse
        May 19, 2014 at 11:30 am #

        Even Dr. Amy said the doctor knowingly took her on as a patient, presumably throughout the entire pregnancy and then only changed his mind in labor.

        Yes, the doctor agreed to try for a VBAC, but a lot of things can happen during labor. Labor can fail to progress, fetal distress can occur, etc. We don’t know exactly what, here, because it’s confidential data, so unless this woman chooses to share the details of the case we may never know. However, doctors don’t recommend c-sections for trivial reasons. That would be and especially true of a doctor who does VBACs.

        You’re also forgetting or disregarding ACOG’s own guidelines (helpful but laughable, if no physician will honor them) that even women who’ve had two prior cesareans can be good candidates for VBAC.

        Not all candidates are elected. Not all women who wish for a VBAC can safely have one. I agree that they shouldn’t have c-sections forced upon them, because it violates body integrity and patient autonomy. But it doesn’t mean that women always can’t make a dangerous, unreasonable choice. Especially if they base their decision on ideological reasons like the supposed superiority of vaginal birth over c-section.

        • Guest
          May 19, 2014 at 11:49 am #

          And she could’ve gone on to have a perfectly normal vaginal birth with no complications whatsoever. Come on already… you’re basically acknowledging the doctor did something wrong – barely – and then shifting the focus of blame all back onto the mother. It’s hard to admit that sometimes, doctors DO recommend cesareans for trivial reasons – just because you haven’t personally experienced it, doesn’t mean it doesn’t happen.

          • yugaya
            May 19, 2014 at 12:01 pm #

            And she could have gone on to die with first killing her baby in the process of sticking with vaginal überbirth. Outcome that was apparently possible enough at the time for this doctor to break every ethical line he spent decades observing prior to this situation, and an outcome prognosis that was based on EFM results which she now claims in her lawsuit the doctors “misinterpreted”. LOL.

          • Irène Delse
            May 19, 2014 at 12:04 pm #

            Sometimes this and sometimes that… You can speculate all you want, but it doesn’t fit the little we know of this case. And unlike you, I think a doctor can be in the wrong ethically and at the same time a patient mistaken in her assessment of her medical situation.

          • Young CC Prof
            May 19, 2014 at 12:09 pm #


            The most plausible reason for the doctor to have done what he did is that he saw clear signs of an emergency and the patient didn’t believe it, but what he did was still wrong.

          • Amazed
            May 19, 2014 at 2:13 pm #

            She could have. Or not. And if she hadn’t had this lovely perfect normal vaginal birth with no complications whatsoever, she might have gone to play the part of the poor dumb dut oh so brave mom who was misled by the big bad doctor. No one wants to admit that they made a decision that harmed their child. The doctor had no way to know which way it would turn out. And if an entire hospital with a reputation for supporting VBACs, plus a lawyer decided that going this far was the better option, I’d say her chances for successful vaginal birth were pretty low.

            It’s hard to admit that sometimes, mother make selfish choices but it happens. From what I’ve seen from this case, Mrs Dray was such a mother. Am I supposed to sympathize with her because poor dear got the result that mattered less to her – a healthy baby – than the coveted vaginal birth?

            All this said, I think the hospital was in the wrong. And I’ll give my two cents why they acted this way: they figured that being sued for forcing a C-section on a woman was, for some reason, better than being sued because mother claimed that had she been adequately counseled, OF COURSE she would have undergone the C-section. She’s THE MOTHER!

          • Jessica S.
            May 19, 2014 at 9:29 pm #

            Trivial is in the eye of the beholder.

      • AllieFoyle
        May 19, 2014 at 12:20 pm #

        “You’re also forgetting or disregarding ACOG’s own guidelines (helpful but laughable, if no physician will honor them) that even women who’ve had two prior cesareans can be good candidates for VBAC.”

        Do you see the difference between “can be” and “is absolutely”?

        Did you notice that the hospital in question does support VBACs and has a higher than average rate of successful ones?

      • The Computer Ate My Nym
        May 19, 2014 at 12:53 pm #

        It’s possible that I’m misreading and/or the reporting is inaccurate. However. The article mentioned that uterine rupture was considered eminent. Refusing a c-section when your uterus is about to rupture is a very bad plan by any standard.

        We don’t have enough data to know whether the woman in question was a good candidate for a VBAC by the ACOG guidelines, since, appropriately, the details of her medical history were not reported. So I’m not sure what point you’re trying to make by bringing them up.

        The physician “changed his mind” during labor. Why do you think he did that? Has it not occurred to you that he might have changed his mind because something bad was happening during the labor? For example, the labor was not progressing or there was frank meconium or there were signs that uterine rupture might occur in the near future or actually be occurring?

        VBAC attempts don’t always succeed, even in the best of circumstances with ideal candidates. Just because she was a candidate for a VBAC at one point, that doesn’t guarantee that she will have a successful VBAC. Furthermore, it sounds like she doctor shopped until she found a doctor willing to take her, meaning she was likely higher than average risk, possibly not a candidate by ACOG criteria (though, again, I don’t know that for certain). When even a doctor who is very willing to do VBACs says you’re not going to be successful, maybe it’s time to rethink the plan. But if she didn’t, that’s still her decision. Not his.

        • Irène Delse
          May 19, 2014 at 2:25 pm #

          One thing I find problematic in the article is the framing: the Dray case is treated as “illustrative” of the debate around c-sections, when it seems clearly an issue of medical ethics…

          • The Computer Ate My Nym
            May 19, 2014 at 2:44 pm #

            Yeah, this case is not typical of c-sections at all. It certainly doesn’t have anything to do with the supposed overuse of c-sections that everyone seems to be seeing without ever being able to define which c-sections can be safely not performed.

        • Jessica S.
          May 19, 2014 at 9:26 pm #

          “Furthermore, it sounds like she doctor shopped until she found a doctor willing to take her, meaning she was likely higher than average risk, possibly not a candidate by ACOG criteria”

          Yes! Thank you. The ACOGs recommendations are far from universal. 🙂

      • Jessica S.
        May 19, 2014 at 9:24 pm #

        No, the ACOG says SOME women will be good candidates. Not every woman that’s had 2 CS will be a good candidate. This obviously doesn’t pertain to this case at hand, b/c the doctor had already accept her, but I’m making a general point about those guidelines. The ACOG recognizes that they are putting hospitals and doctors in a predicament b/c while they are saying “this is safe if the following criteria is met” when they acknowledge it is not possible for it to be made in all situations. And people will run with it saying “the ACOG recommends it so doctors are jerks if they say no” which is not at all accurate.

  8. guest
    May 19, 2014 at 7:18 am #

    Completely OT, I’d like to hear thoughts on this link. Basically asserting that “labor pain medication” is associated with three day delay in milk coming in.

    • May 19, 2014 at 8:54 am #

      The three day delay has nothing to do with medication; it is entirely normal, and due to hormone production which is related to nipple stimulation [not entirely, as engorged mothers who never give suck know well]. That’s why there is colostrum from birth, or even slightly before. As with a great deal else, this seems to be part of lactation/NCB misinformation.

      Nature seems to have worked this out reasonably well. Although [obviously] babies differ, most babies are not really very interested in nursing [despite all those videos and the current obsession with nursing minutes after birth] until the gut is cleared of meconium, which is thick and tarry. This usually takes a couple of days — at which time the higher-calorie and richer colostrum gives over to milk in greater quantity.

      • lawyer jane
        May 19, 2014 at 9:48 am #

        Do you really think nature has it right? I was reading about jaundice in newborns, and I concluded that breastfeeding is a pretty imperfect natural system, as most are … a few ounces of formula in the first days while the milk isn’t in yet is probably the best course of action. There’s even research showing that supplementation in the first week increases long term breastfeeding!

        • Young CC Prof
          May 19, 2014 at 10:44 am #

          The lactation delay system worked out fine for me and my brother. Would have killed my son, who was born without adequate fat reserves and with other risk factors for jaundice.

          Like most of nature, it works out well enough most of the time, but not always. Clever organisms like us can sometimes do better.

        • May 19, 2014 at 11:07 am #

          I’ve written about this before, but it just happens that I have had personal experience with all three feeding methods:

          #1 was exclusively breastfed — at 6 weeks of age, after hourly feeds [no engorgement, no letdown] and incessant crying, I was in a place where it was impossible to nurse and my son gulped down 250cc of formula, burped — and slept for almost 4 hours. I simply did not make much milk, and had a hungry child. But I was determined To Do The Right Thing.

          Because of severe mastitis, and mild pneumonia, I bottlefed #2 exclusively.

          With #3, I said to myself, to heck with it–she’ll get me first, and then I’ll top her up with a bottle. By far the most successful and easiest. I actually had more milk because I was relaxed, and [because I shared the feeds with my husband] was more rested. Anxiety and tiredness DO affect milk production negatively.

          And now 30+ years later? No one knows which child was breast or bottle fed; all are healthy, happy, successful adults.

        • NoLongerCrunching
          May 19, 2014 at 11:19 am #

          This is only true if there is insufficient colostrum, which unfortunately common, and it would be nice if bf advocates were more upfront about this. Some moms have loads of colostrum, which has a laxative effect and thus clears bilirubin quite well.

          • Trixie
            May 19, 2014 at 2:44 pm #

            I never had the feeling of my milk not being “in”. There was always milk, it was just orangish at first, which I guess was colostrum. Both my kids had jaundice (worse with the first due to ABO incompatibility), and neither needed supplementation because they were clearing meconium so quickly.

      • Mac Sherbert
        May 19, 2014 at 2:35 pm #

        Hmmm. My milk didn’t come in until 5 days with both of my babies. Baby #1 some labor followed by c-section, barracuda nurser, Baby #2 scheduled c-section, sleepy baby not interested in nursing.

        Ended up supplementing both, but only nursed #1 for six weeks and #2 until 18 months….#2 was supplemented way more in the first few weeks! I nursed #2 longer because she wasn’t trying to rip my nipple off and I was more relaxed about whether it worked out or not! (Oh, and thanks to the posters here I learned I could combo feed!)

      • Trixie
        May 19, 2014 at 2:41 pm #

        I’m wondering if some of the effect could be due to extra engorgement from IV fluids, making it harder for baby to latch in the first couple days.

      • rh1985
        May 19, 2014 at 10:03 pm #

        I had a c-section, chose not to attempt breastfeeding for various reasons, and I initially thought I was lucky and my milk was never going to come in, however I was also on a high dose of sudafed daily in my allergy meds. It started leaking more than two weeks after the birth. Three months later, it still has not gone away completely 🙁 though I’ve never had enough to get engorged. So it’s just annoying. I am so sick of having to sleep in a bra, I am considering going on the pill even though I don’t need it just to see if it dries it up for good.

    • Young CC Prof
      May 19, 2014 at 10:48 am #

      I commented on the abstract of the original article below. The sample size was fairly small, they had lots of subgroups, they threw prelabor cesarean women in there just for kicks, so I wasn’t convinced.

      This interview, however, implies that delayed lactation was patient-reported, which would mean the study is pure garbage, since patients with the strongest motivation to breastfeed exclusively would probably be most likely to labor without pain medication.

      • Trixie
        May 19, 2014 at 2:48 pm #

        There is an association between IV fluids and breast engorgement, and baby’s weight loss in the first 24 hours. Excess engorgement can make latching difficult, and babies who lose more weight might be monitored more closely, leading the mother to be more likely to be diagnosed with milk not coming in fast enough? Just thinking out loud here.

  9. Amazed
    May 18, 2014 at 10:41 pm #

    Let’s see whether I get this right.
    We have a hospital that has a high percent of VBACs, so we can safely assume they weren’t big for taking poor little innocent moms with pre-existing intent to dupe and C-section them. We have a doctor who, after a few hours of labour, saw that there was a risk to the child (it was mentioned in the article). We have a mother whose desire for a vaginal birth outweighed her concern about her child’s health. No, poor woman was begging to have another hour, two more hours to keep endangering her child.

    Yes, she was entitled to her selfish, idiotic, irresponsible decision. Yes, I said she was selfish, idiotic and responsible. And she had the right to make her selfish choice.

    Even so, I cannot help but wonder how many other selfish, idiotic, irresponsible mothers make this choice and then whine, “Poor me!” and sue.

    • Lena
      May 19, 2014 at 9:08 am #

      Yeah, that’s pretty much why I believe such women shouldn’t have the right to sue if something goes wrong after getting the vaginal births they insist on. The OB in this particular case was absolutely wrong, no question, and he needs to suffer some major professional consequences, but I’m willing to bet that if he did the right thing and respected his patient’s wishes, and something had gone catastrophically wrong, he would find himself in the exact same position he’s in now.

      • jennie c
        May 19, 2014 at 9:22 am #

        who are “such women?” everyone has the right to sue, no matter what the reason is. the question is whether you can find an attorney to take your case, and a judge who considers it serious enough case to take on. people who sue despite having refused treatment, generally claim they were not adequately counseled. thats a serious claim that can not be thrown out of court out of hand without both sides being heard.

        • Amazed
          May 19, 2014 at 9:31 am #

          Yeah, that’s why I wouldn’t want to be in the position of an OB who gave an adequate council and the mother understood it but believed the bad outcome wouldn’t happen to her. Then, after realizing that vaginal birth and woo friends wouldn’t help her provide adequate care for her damaged baby turned to the only direction money could come from – the doctor’s malpractice.

          Winning one’s case isn’t the only thing that matters. I am quite sure doctors would prefer not being sued at all instead of winning in court.

          I believe mothers like the one I described are ” such women” Lena meant.

          • AllieFoyle
            May 19, 2014 at 9:36 am #

            And it would be awful on a personal level to feel like you were forced to take part in a needless death or serious injury.

          • Amazed
            May 19, 2014 at 9:53 am #


        • Lena
          May 20, 2014 at 8:07 am #

          “Such women” are those that we read about here all the time–those that refuse all medical interventions no matter what the circumstances until the very last minute, who cry “birth rape,” who go on and on about how they can’t “bond” with their babies because they were born via c-section. Those are the women who will turn around and sue when they realize just how expensive a brain damaged baby is, like those piece of shit parents who sued Johns Hopkins for not performing a c-section fast enough–and won–after their midwife did everything wrong.

          Those women get adequate counseling from their OBs, they just refuse to listen because they think having an internet connection makes them educated. They shouldn’t be allowed to screw over OBs and hospitals because they don’t like the consequences of their “educated” decisions.

  10. Jenny_from_da_Bloc
    May 18, 2014 at 6:23 pm #

    Somebody brought up Melissa Ann Rowland down below and I found this article which addresses the medical autonomy issue as well. It’s insightful

    • Jenny_from_da_Bloc
      May 18, 2014 at 6:43 pm #

      This article on autonomy is actually much, much better

      • Irène Delse
        May 19, 2014 at 7:38 am #

        It’s a more scholarly article, but it has a glaring problem: it consistently uses precedents and comparison with other cases (child endangerment, reckless driving, etc.) where the autonomy of one individual impinges on the autonomy of another individual. So, basically, it assumes (but doesn’t spell out) that a fetus or unborn child has personhood, with the same rights as a grown adult. Which opens a serious can of worms right there.

        • AllieFoyle
          May 19, 2014 at 7:55 am #

          Personhood is the real question here, isn’t it? I’m not advocating a particular position and have always been pro-choice, but it doesn’t seem logical to me that a 28 week preemie is legally a person but a 42 week baby in the womb is not.

          • Irène Delse
            May 19, 2014 at 8:08 am #

            Well, it is still in the womb, and doctors can’t access it without going through the woman’s body. The same way that they can’t take marrow from a family member to save a child with leukaemia without operating on the donor.

          • AllieFoyle
            May 19, 2014 at 9:07 am #

            That’s definitely a dilemma, but does the existence of that conflict mean that the fetus is not actually a person? I’m not entirely sure.

            I can accept the idea that you can’t violate the rights of one person in order to help another (although, aren’t there times when we do restrict people’s rights or tolerate a lesser violation of someone’s rights in order to prevent a greater harm to someone else?), but why is the fetus not at all person when inside the womb and fully a person five seconds later when outside the womb?

            It makes sense to me to say that the mother’s right to bodily autonomy in this situation trumps that of the baby, but it also seems to me that a full term baby is, in some sense, a person (and in some cases, is legally treated as one). If there is some element of personhood it follows that the mother must have some responsibility to protect him or her from harm. So, while the decision should be solely up to her, she might still bear some responsibility for placing her child in harm’s way.

            I don’t love all the implications of that, but I can’t quite get away from the feeling that there isn’t enough of a distinction between criminally neglecting or harming a baby that has already been born and willfully choosing to place a baby of the same gestational age, or even older, in a dangerous position inside the womb.

          • jennie c
            May 19, 2014 at 9:16 am #

            i’d say that because it’s part of someone else’s body, it doesn’t have an independent identity yet.
            this being said, i would accept that personhood evolves over time alongside development. so i’m ok with the ban in most states against abortion post viability. but full personhood- birth seems the best place to draw the line.

          • AllieFoyle
            May 19, 2014 at 10:22 am #

            Maybe. I think anywhere you draw the line will be a bit arbitrary. Some cultures don’t consider birth the dividing line, so an infant isn’t considered a person until he or she reaches a certain age, usually marked by some sort of ceremony, naming, etc. Infanticide has historically been tolerated before a certain point in some cultures, even being mandatory in some cases (twins, too short an interval between births, etc.).

            I think most of us would find those beliefs and practices unethical. It may be that our view of birth as the dividing line changes as well, especially as our understanding of development and technological ability to observe and care for babies prenatally increases.

          • Zoe
            May 19, 2014 at 3:09 pm #

            Birth is a clear line. It’s not arbitrary. Please stop pretending you’re “not sure” or “don’t know.” You’re clearly pushing an anti-abortion agenda.

          • AllieFoyle
            May 19, 2014 at 3:43 pm #

            That’s untrue and insulting. I fully support abortion rights before viability (and afterward, in certain cases). I voted for Obama twice. I support Planned Parenthood.

            I believe a woman has the right to control what happens to her body, but I also believe that at some point a fetus becomes a person. Is it at viability? Birth? Somewhere in between? I’m really not sure exactly where the line is. I’d like it to be at birth so we could do away with the entire vexing maternal-fetal conflict, but I don’t feel like I’m being intellectually honest if I say that a 32 week baby outside the womb is somehow more human than a 42 week baby that hasn’t been born yet. Sorry.

          • rh1985
            May 19, 2014 at 10:12 pm #

            Ethically, I do view a viable fetus as a person, but that view might change if someday in the future technology became so advanced that we had the ability to save fetuses so young that they had little to no brain development yet. I think it should have the right to not be purposely, directly killed unless it is medically necessary to terminate the pregnancy in a way that won’t allow for a live birth. But I also don’t think the woman should have a legal obligation to save it via medical procedures on her body. I have trouble with viability abortion bans however that draw a firm line based only on gestational age, as I don’t think there should be a time restriction on aborting for something like anencephaly that means the fetus will never become viable.

          • Jessica S.
            May 19, 2014 at 11:02 pm #

            I totally agree about the restrictions.

          • Jessica S.
            May 19, 2014 at 11:01 pm #

            I’m following you, Allie. I don’t think you’re being “anti-abortion”. I wrestle with these questions, too, and I’m not anti-abortion.

          • anonymity@@
            May 19, 2014 at 9:15 pm #

            There you go. As soon as you open up this discussion you are immediately accused of pushing an anti-abortion agenda.
            Stop pretending everything is as straightforward as you would like it to be. I disagree with you and I perform medically indicated abortions.
            What does that make me?

          • Jessica S.
            May 19, 2014 at 10:48 pm #

            A saint. But I know you aren’t asking me. 🙂

          • lawyer jane
            May 19, 2014 at 10:02 am #

            I think that the difference between abortion rights and the rights of a 3rd trimester fetus that the mother intends to give birth to is that with abortion, the fetus is never going to become a person with autonomy. But the third trimester fetus is actually going to be born – so the mother’s decisions while pregnant affect its personhood. In my mine, personhood is dependent on the mother’s intention to give birth to the baby. So I think the best answer is that a fetus that is going to be born has personhood, but the mother’s personhood trumps it. At the same time, there surely is a limit to this balance between mother and late-term fetus, which is why we generally do not permit third trimester abortions for non-medical reasons. For that reason, I think that the idea that a pregnant mother has absolute legal autonomy is not quite right — unless you are also in favor of third trimester abortion on demand. However, in the forced c-section case, I think the balance is clearly in favor of the mother’s personhood and decision about how to balance risks and benefits for herself and her baby. This also calls into play the constitutional rights of parents to make decisions for their children.

          • anonymity@@
            May 19, 2014 at 9:11 pm #

            I couldn’t agree more. Maternal autonomy is not absolute and “stillbirth by vanity” is completely unacceptable.

          • anonymity@@
            May 19, 2014 at 9:05 pm #

            “why is the fetus not at all person when inside the womb and fully a person five seconds later when outside the womb?”
            The ‘born alive rule’ stems from the common law and dates back to 1601. A baby only becomes a legal person when it is fully expelled from the mother and alive.
            The rule is anachronistic and baseless in modern society. It arose in a time when the infant death rate was so high and medical standards so low, that the default position was that the baby was assumed to be born dead.
            It has been abandoned in certain states in America but is regarded by many to be too entrenched to remove.
            Having raised this previously, I have been accused of being anything from an anti vaxxer to pro-lifer and other laughable vitriol.

          • jennie c
            May 19, 2014 at 9:05 am #

            if it was a disattached womb walking around, you’d have a point, but have you forgotten that it’s inside someone elses body?

          • AllieFoyle
            May 19, 2014 at 9:16 am #

            I’m not forgetting about the person it’s attached to; I’m just considering how we should treat the baby/fetus/person (???) inside. Does the fact that it’s inside someone’s body mean that it isn’t a person? Some people believe it does. I don’t know. I’m not sure there is a right answer. Before viability it’s more obvious and intuitive that the woman should be able to decide not to continue the pregnancy. After viability though, is there a clear difference between causing harm to a child who has already been born and one that hasn’t yet? There are some physiological changes that happen at birth, but I’m not sure that’s sufficient to say that an unborn term fetus is substantially different from one that has already been born.

          • The Computer Ate My Nym
            May 19, 2014 at 4:48 pm #

            The position of the fetus in the uterus makes its personhood irrelevant. If we can’t do anything to the fetus without affecting the mother then her desires have to come first. The bone marrow McFall needed to live was lodged in Shimp’s body and the case was decided in favor of not forcing Shimp to put his health on the line in order to allow McFall to retrieve it. Even though the judge called Shimp “morally repugnant” (I tend to agree), the judgement was that society should not ever be forcing one person to give his or her body for the benefit of another person. So if a woman wants a full term fetus out of her body, the question is how to remove it in the way that is most acceptable to her, with issues of the fetus’ health being secondary.

          • anonymity@@
            May 19, 2014 at 9:29 pm #

            Does that mean you support a women’s choice to kill her normal term baby in the pursuit of a vaginal birth at all costs?

          • May 19, 2014 at 9:06 am #

            Back in 1968, IIRC, there was a huge brouhaha over a proposed abortion law in NY State. Doctors wanted the gestational age limit to be 20 weeks, because the bigger the fetus, the riskier the abortion. Feminists wanted abortion almost to term. Ultimately, a compromise was reached on 24 weeks, which no one really liked. At that time, not only was there no ultrasound, the lower limit for viability was 28-30 weeks because the technology was much more primitive back then. It was pointed out that inevitably, the limit of viability would become low enough that it would be possible to abort legally a viable fetus, and also that some women whose dates by LMP were unsure could be denied abortions to which they were legally entitled. It was a huge mess, with women with multiple pregnancies well under the 24 week limit denied abortion, and some aborted fetuses born alive.

            In extreme prematurity, often there is no time to determine the parents’ wishes. The fetus/baby is born, and before it makes any respiratory effort whatsoever, is placed on full ventilation. Fully oxygenated, the heart can carry on beating for months, and I’ve heard doctors refuse to discontinue treatment “because there is a heartbeat and no cerebral bleed” or, should there be a cerebral bleed, “because there is a heart beat” [entirely due to machines] And, of course, because, since it’s not in utero anymore, it is a legal person.

          • The Computer Ate My Nym
            May 19, 2014 at 9:12 am #

            In utero there is a heartbeat and no cerebral bleed because of the “machine” known as the pregnant woman. Her desires and health must come first.

          • AllieFoyle
            May 19, 2014 at 9:50 am #

            It’s a mess when biology and law collide. So many gray areas.

          • Young CC Prof
            May 19, 2014 at 10:32 am #

            Yup, we have reached the point where the legal abortion age of 24 weeks is below the potential threshold of viability, not that too many 23-weekers actually make it. Of course, lowering the abortion threshold runs straight over another issue: Anatomy scans.

            You can’t do the anatomy scan before 18-20 weeks, you don’t get enough information. Parents who get bad news might not be in a position to make a decision immediately, since they might want follow-up testing or specialist consultations to determine how severe the problems are, whether they might be treatable, and what that treatment might look like.

            And of course, if a woman is diagnosed with severe complications such as preeclampsia, abruption or IUGR during the second trimester, I think the choice of whether to continue the pregnancy ought to be hers, since it could mean all kinds of awful things she never expected. Months of hospital bed rest. Emergency classic cesarean performed for a baby with little chance of survival in either case. Severe prematurity, watching your child spend his first hundred days in an incubator, or die after you had the chance to meet him. In the case of preeclampsia, risk to your own life and possible organ damage or other permanent health consequences. This isn’t what most pregnant women signed up for, and to claim “you knew the risks” is disingenous.

            There aren’t a whole lot of good answers here, which is why I’d rather not try to answer them with a blunt instrument like the law.

          • Jessica S.
            May 19, 2014 at 10:39 pm #

            Well said.

          • Jenny_from_da_Bloc
            May 20, 2014 at 1:32 pm #

            My point exactly

  11. deborah
    May 18, 2014 at 2:36 pm #

    When this goes to court, the medical record will become public record, right???

    • An Actual Attorney
      May 18, 2014 at 3:59 pm #

      Probably not. The actual medical record will most likely be covered bya protective order.

      • Deborah
        May 19, 2014 at 12:24 am #

        Oh, that immensely sucks.

        • Certified Hamster Midwife
          May 19, 2014 at 12:09 pm #

          It’s not like the court of public opinion has any legal standing here. Why should her very private medical records become public?

          • Deborah
            May 19, 2014 at 1:36 pm #

            Because I’m really, really curious. That’s all.

  12. lawyer jane
    May 18, 2014 at 2:13 pm #

    As a legal/ethical matter, I agree that the mother has autonomy to decide on what she wants. But the problem with the rhetoric of “rights” and “autonomy” in childbirth is that it leads to placing too much of a burden on the mother, and may fall into the whole trap of encouraging mothers to “do their research” and mistrust professional medical advice. The mother has rights, sure, but an obsessive focus on autonomy can lead to a woman deciding that she’s the one who has to make all the decisions in her care based on Google University, instead of relying on her doctors.

    The fact is, most women WANT their doctors to make medical choices for them. That’s the whole point of the medical profession – to know the risks and benefits and decide on a course of action. You can’t just say “the woman has a right to chose” if she does not have the same training and understanding to make a choice. A choice that you don’t understand is no choice.

    • Amy Tuteur, MD
      May 18, 2014 at 2:18 pm #

      She has a right to make ANY choice she wants, whether it is reasonable or not, and long as she understands the risks. This is not someone who walked in off the street. She had a long relationship with her doctor who had counseled her extensively. She is not required to do what he says if she doesn’t want to do it.

      Unless the doctor can show that she doesn’t understand the risk, he cannot operate on her. Just because he thinks the risk is too high does not mean that he can override her decision. Otherwise, medical auonomy is a meaningless concept if the doctor can always override it by claiming that he knows better.

      • AllieFoyle
        May 18, 2014 at 2:28 pm #

        As far as understanding the risks, what if she refuses to acknowledge them? What if they try to tell her that she and her baby may die and she refuses to listen or claims that they’re wrong and that she knows that isn’t true? If you have been brainwashed into believing falsehoods, how can you truly understand the risk?

        • Ash
          May 18, 2014 at 2:32 pm #

          Ordering a psych consult to determine competency is an appropriate course of action. This has been discussed on the comments in previous discussions. After psych consult, one could consider requesting a court order.

        • Amy Tuteur, MD
          May 18, 2014 at 2:42 pm #

          She doesn’t need to believe them in order to understand them. Medical autonomy would be meaningless if patients didn’t have the right to refuse treatment, even if they are wrong about what the refusal means.

        • anonymity@@
          May 18, 2014 at 6:39 pm #

          It is of no consequence how ridiculous, bizarre or non sensible the decision appears to the doctor. The decision does not have to make sense at all.

          • fiftyfifty1
            May 18, 2014 at 9:42 pm #

            “It is of no consequence how ridiculous, bizarre or non sensible the decision appears to the doctor.”

            Actually yes it is. What if a woman were to say to me “I can’t have a c-section because you are the FBI and you are really trying to implant a spy device in me” ? If a reason is truly bizarre it can indicate psychosis.

          • anonymity@@
            May 18, 2014 at 10:55 pm #

            Sorry. I thought that went without saying. Consent isn’t consent if the person is mad. The point is that the person’s decision doesn’t have to make sense to you.

        • CBAC Mom
          May 18, 2014 at 10:47 pm #

          Pregnancy is not a mental illness.

          • AllieFoyle
            May 19, 2014 at 7:00 am #


            I never said it was. Generally, you don’t have the right to force treatment on someone, but there are exceptions, and since we don’t know all of the details of this case we can’t dismiss the possibility that the doctors involved had a legally/morally/ethically compelling reason to do what they did.

      • lawyer jane
        May 18, 2014 at 3:24 pm #

        Yes, to be clear, I absolutely agree with you as a legal/medical ethics issue, and especially if the facts in this case are as presented.

        It’s just that I believe that the discourse of autonomy OUTSIDE of the strict legal/medical ethics framework has contributed to the miseducation of patients who believe that they need to do their own “research” and mistrust their doctors. You see this in the legal disclosures of homebirth midwifes. You can’t really call it an autonomous choice when you embed it in ideology like this: doctors are bad, natural is good, you have the right to decide based on your own research. Then the notion of autonomy becomes something more like exercising control by rejecting medical care and adhering to an anti-establishment ideology.

        None of this is to say that autonomy is not very important, but that you’re not really exercising a free choice if it’s in the context of coercion or ideology.

      • AllieFoyle
        May 18, 2014 at 3:36 pm #

        I’m not sure it’s that simple. I’m not a lawyer, but just a quick google reveals that it’s not uncommon for women to be imprisoned or charged with crimes for drug use during pregnancy. Bush signed a fetal personhood bill to criminalize killing a fetus during the commission of another crime. Fetuses are sometimes appointed lawyers.

        There’s also the case of Melissa Ann Rowland, who was charged with murder when one of her babies died after she refused a c-section. The murder charge was dropped but it looks like she was convicted and served time for lesser offenses.

        Absent the time to get a psych eval and then a court order, wouldn’t the doctors have felt that they risked committing or abetting a crime?

        • Jenny_from_da_Bloc
          May 18, 2014 at 6:17 pm #

          But how long does it take to get a court order or emergency court order?

        • Zoe
          May 19, 2014 at 3:12 pm #

          All of which were anti-abortion moves to try to grant fetuses personhood and deprive women of rights. It’s that simple.

          • AllieFoyle
            May 19, 2014 at 3:19 pm #

            I’d like it to be that simple. Can’t stand anti-abortionists and find their actions despicable.

            And yet, it’s not clear to me that a 39 week fetus is the same as a 6 wk embryo.

          • Zoe
            May 19, 2014 at 3:21 pm #

            Right… it’s not clear to you… you just wonder… you’re simply asking… Yet somehow all your wonderings push towards considering a fetus a full human being, while at the same time depriving the woman carrying it of those same rights.

          • AllieFoyle
            May 19, 2014 at 3:53 pm #

            Screw you. You have absolutely no idea what you’re talking about. I’m asking questions, yes. What’s wrong with that? Can you not be a feminist or pro-choice if you don’t agree 100% that a 6 wk embryo and a 40 wk fetus are not exactly the same?

          • anonymity@@
            May 19, 2014 at 9:25 pm #

            She doesn’t want to think about it AllieFoyle so she reacts by insulting you.
            Didn’t you know that you must never ever question maternal autonomy, even in a philosophical debate?

          • Jessica S.
            May 19, 2014 at 11:11 pm #

            You’re completely misrepresenting what she’s saying, or just reading into what you want. She really is just asking questions! I know the kind of comments you think she’s making, you know the “I’m just sayin’, is all” comments and that’s not what I see.

          • MLE
            May 19, 2014 at 11:25 pm #

            Is it off limits to discuss these types of questions? I was actually pleased to see this discussion going on because it’s so taboo on BOTH sides to step out of line that I have only myself as a sounding board. That’s frustrating. Why is a nuanced opinion verboten?

          • Irène Delse
            May 19, 2014 at 3:32 pm #

            It’s not “the same”, but it’s still clear from an ethical point of view. You may not like the answer, but you won’t get another by asking again.

          • AllieFoyle
            May 19, 2014 at 4:07 pm #

            What’s clear? I don’t think anything about this debate is clear, unfortunately. Biology sets up a conflict. There are gray areas. Some people view things one way, others view them differently. There are ethical considerations and legal considerations and they don’t necessarily align. They aren’t consistent across states or countries or cultures.

            I’ve never said or done anything to deprive women of rights. I don’t agree with efforts to do so. The fact that such efforts exist is meaningful when you consider the ethical and legal context of a case like this. I do think that this woman’s choice might have been ethically wrong, while at the same time it would be ethically wrong to deny her the ability to make the choice. Then you have legality on top of all that. And you at some point, assuming he lives, have a person who is affected by that choice, even though he may not have been a person at the point that the choice was made. It must be nice if it seems simple to you.

        • Tina
          June 16, 2014 at 1:03 pm #

          Melissa Rowland was actually charged with child endangerment after her surviving twin tested positive for cocaine.

  13. innanni
    May 18, 2014 at 1:24 pm #

    There is precedence for the court to find in the hospital’s favor though. It will be interesting to see how the law is applied this time.

  14. Amy M
    May 18, 2014 at 11:28 am #

    Totally OT (and old):

    Another take on Ruth Iorio. He’s not a fan of homebirth either and calls her out on the hypocrisy.

  15. Beth S
    May 18, 2014 at 6:03 am #

    Here’s a question too, why is her Doula not speaking out for her? Are they bound by the same HIPPA laws that everyone in a hospital from Doctors to Housekeeping are bound to? If not you would think she’d have her name all over this case trying to push it into the public attention. I just had a unscheduled scheduled C-section, or in other words went into labor and they had to get me in the room fast but it wasn’t labeled emergant because it was a slow night, and OR was empty. I remember signing informed consent for the Surgeon, the Anesthesiologist, when the my ped came in to see the baby, it felt like I was signing papers for days. What idiot lawyer would tell a doctor to ignore informed consent?

    • jennie c
      May 18, 2014 at 6:21 am #

      Doulas do practice confidentiality, although not being licensed professionals your are correct that it may not be legally required- any attorneys care to weigh in on this?

      • jennie c
        May 18, 2014 at 6:23 am #

        my own opinion is that if the patient herself makes her medical case public, the accused individuals should be allowed to publicly provide information about the patient to the extent that is necessary to refute the charges. but that’s in my ideal legal world, not how it is.

        • Beth S
          May 18, 2014 at 6:30 am #

          I agree, if I’m suing a doctor for a boneheaded decision I made for myself, and I take it to the public that doctor should be able to open up my file and at least refute the charges. So many doctors get bad reps because legally they can’t say anything, I’m not saying show their whole patient file, just enough to show the reasons behind the decision making especially if a mother is suing for a birth injury because she refused C-section multiple times even though it was the best thing for the baby. Not saying that’s what happened in this case that was hypothetical.

          • Zoe
            May 19, 2014 at 3:16 pm #

            No. Because if they can release information from the mother’s records, they’ll find a way to release her number of sexual partners, any previous STDs, any doubts she may have expressed about paternity, etc. Anything that can be used to slut-shame her and make future potential plaintiffs think twice will be used by the hospital.

        • Box of Salt
          May 19, 2014 at 2:09 am #

          “the accused individuals should be allowed to publicly provide information about the patient”

          No. Confidentiality is confidentiality. Once you’ve breached it, you have no credibility. End of story.

          • jennie c
            May 19, 2014 at 2:12 am #

            oh i know thats the law, but i’m just suggesting that perhaps there are fairer ways it could be structured. the way it stands now.

          • Box of Salt
            May 19, 2014 at 2:20 am #

            jennie c “oh i know thats the law”

            I’m not only talking about the law. When you are ethically as well as legally obligated to maintain confidentiality, you must do that.

            Otherwise the concept of confidentiality means nothing.

        • Young CC Prof
          May 19, 2014 at 10:17 am #

          That would have quite a few unpleasant consequences. Nope, confidentiality is confidentiality. Just, as an individual, when you read about a malpractice case that’s still open, keep in mind you’ve only heard one side.

  16. Renee
    May 18, 2014 at 5:38 am #

    I would like to hear all the sides to this story. The NYT is not really the most accurate or reliable, and all we heard was one side.

    • Young CC Prof
      May 18, 2014 at 7:21 am #

      That is an issue in a medical malpractice case. Fair and balanced reporting means if you write a story about a lawsuit, you offer both sides the chance to make a statement. Here, the defense is literally in violation of the law if they say much of anything, meaning the article couldn’t have told both sides even if the author tried.

    • JC
      May 18, 2014 at 10:05 pm #

      The NYT isn’t perfect but I’d hardly call them not really accurate or reliable. Many times reporters will call the other side and offer a chance to speak. And many times the other side will decline. This fact should be included in the story. It’s so popular to bash the media these days. Sometimes they deserve it: sometimes they don’t but people still do it.

  17. Jessica S.
    May 17, 2014 at 11:25 pm #

    So, basically a woman would have to be unable to communicate and/or comprehend the situation – in short, unconscious, but I’m sure there’s a more technical word or more to describe such states – in order for a decision to be made for her regarding a c-section? What about the father? Can he step in and say “no, I don’t consent” and have it carry the same weight as the mother? I can’t remember if I signed anything prior to surgery, or during admittance, that stated who could make those decisions for me if I couldn’t.

    I know there’s also the case of mental capacity, but I don’t know how often that comes up. I assume all you doctors and nurses and the lot are such rockstar communicators that 95% of the time, you sweet talk your way to a healthy mom and baby! 😉 (no sarcasm there!)

    • Montserrat Blanco
      May 18, 2014 at 1:55 am #

      I work in Spain but the regulation is pretty much the same in all European countries.

      If you are unable to make a decision , not only unconscious but delirious, demented or intoxicated, you usually ask the family (next of kin). BUT their opinion is NOT enforceable. If I am convinced that their decision is not in the patient’s best interest OR I am convinced that the patient would have preferred other option, I could perform the procedure and inform a judge.

      I have never ever been on that situation. I sometimes doubt between two options so I ask what they prefer and do that. Most of the times in my field there is not a great option and a really bad option and most of the times both options are reasonable and acceptable.

      I have been on a position with a patient conciously not wanting a life saving procedure and in each of those (fortunately very rare) ocasions the patient died. The law states that you have absolute rights to decline every single procedure in the world, even life-saving ones IF you are conscious and capable of making that decision and you understand that the consequence is that you will die.

    • Beth S
      May 18, 2014 at 6:08 am #

      Here in the US it’s the mother’s next of kin be that the father because their married, or in some cases even the woman’s parents because the mother and father aren’t married and they’re considered next of kin. I know when my mom couldn’t give informed consent for her hysterectomy because she was drugged to the gills, my grandparents gave it even though her boyfriend at the time objected. He wanted her tubes untied so they could have more kids. Mom was grateful her parents made the right choice, she was three and done.

    • jennie c
      May 18, 2014 at 6:28 am #

      ugh. your last statement is extremely dismissive of both patients and professionals. and no the job of a dr and nurse is not to sweet talk , its to provide correct information.

      • Beth S
        May 18, 2014 at 6:32 am #

        I like a doctor to come in, give me straight facts. Let me know the reasons behind the recommended treatment the risks of not getting the treatment, then let me make that decision, but that’s just me.

        • Jessica S.
          May 18, 2014 at 2:54 pm #

          That was basically my “birth plan”: I trust the staff here is competent (and they were/are – excellent hospital!) and just ask that you give it to me straight and we can make the decisions together. I also said I don’t want to be a pain in the ass patient. They all thought that was really funny. 🙂

          • jennie c
            May 19, 2014 at 9:24 am #

            oh don’t worry about being a bitch. let that be the least of your worries. and you’ll get your pain meds faster.

          • Jessica S.
            May 19, 2014 at 7:56 pm #

            Ha! I’m glad I wasn’t eating, I think I would’ve choked laughing!!

      • Montserrat Blanco
        May 18, 2014 at 12:43 pm #

        I usually state the facts as understandable as possible on a quiet room with everybody seated down or on the parients bedside as quiet as possible. I try to be as calm as possible, to show as much respect as possible and to do not say anything judgemental at all. I explain everything in detail. It is basically giving all the information so that the patient sees what you are seeing. Even if you achieve that they are able to make their own decissions and that is absolutely fine. But you can not make a decision without knowing the facts. As most people is very reasonable and most people want the best outcome possible, they usually accept a life-saving procedure or the best available option. Of course you do not shout at them, call them names of be disrespectful because in that case even if you are right you are likely to get a no. I would not call it sweet talk though.

        • Jessica S.
          May 18, 2014 at 2:50 pm #

          “As most people is very reasonable and most people want the best outcome possible, they usually accept a life-saving procedure or the best available option.”

          You took the words out of my mouth! Er, fingers? 🙂 (see my response to Jennie above)

          ‘Sweet talk’ was apparently a poor choice of phrase. If I had all of my wits about me – and not 32 weeks pregnant – I may have chosen a better short hand. 🙂

      • Jessica S.
        May 18, 2014 at 2:42 pm #

        Jennie, take a beat. I was using that phrase tongue-in-cheek. If I were to stated it straight, I would say: “I like to assume [as in, I’m giving both patients and healthcare providers credit by assuming the best of them, which I tend to do in general about people until specific details show otherwise] that healthcare providers are skilled communicators who care about their patients and are able to speak frankly but compassionately, tailoring their methods to the situation as is appropriate [i.e. “reading” people]. And I always like to assume that the majority, vast majority, of patients are reasonable, competent people who care about their own health and the health of their baby, able to discern when healthcare provides are being straight forward.”

        Does that help clarify? Perhaps I’ll check my cheekiness at the door.

        • fiftyfifty1
          May 18, 2014 at 3:04 pm #

          Jessica you are completely right and I did not read any offense into it. Our job is to communicate. The vast majority of the time, plain old facts will do the job. But when facts alone won’t do it and we are dealing with a horrible situation, I am not above sweet talking or begging!

          • Jessica S.
            May 18, 2014 at 4:14 pm #

            Yeah, that’s exactly what I was trying to say. 🙂

    • jennie c
      May 18, 2014 at 7:03 am #

      ps by father i assume you mean the father of the fetus. the answer is no, he has no right to overrule the mother’s wishes as long as it is inside her body. her body, her rules.

      • Jessica S.
        May 18, 2014 at 2:47 pm #

        Yes, that is what I meant by father. My questions were driven purely out of curiousity of the law, as it pertains to this situation. My personal stance tends to lean in favorite of the mother being in as complete control as possible, and that there are legal aids (by way of forms, etc.) that protect her in the event she’s unable to speak for herself.

  18. Gene
    May 17, 2014 at 9:37 pm #

    In my career, I can think of exactly ONE patient in which we obtained a court order (and it took weeks of legal wrangling). It involved stopping life support on a baby who’d been violently shaken by his parents. They didn’t want him to be taken off life support. If he died, the charges went from attempted murder to murder proper. He was the only one.

    I’ve seen countless patients in the ED who denied potentially life saving treatments or left AMA. If they are competent, I have NO ability to force the to undergo treatment in any way. I can talk, cajole, and beg, but to do something without consent is assault. All I can do is document in front of as many witnesses as possible.

    This case doesn’t pass my sniff test. There are arrogant docs out there, but the idea of an OB performing a section without consent in the absence of fetal distress is just bizarre. And that there are two such doctors working at the same time? We are not hearing the whole story.

    • Sue
      May 18, 2014 at 3:09 am #

      It does sound strange, doesn;t it? Senior physicians are more than aware of the need to gain consent from competent adults – these days more than ever.

      Where I work, we use the common law (The Guardianship Act) to enforce life-saving treatment on people who are not mentally competent – either by virtue of the life-threatening illness or a separate mental illness). We need to detail the nature of the assessment of competence, and the nature of the threat to life, of course. I am not aware of any legal danger of doing this is such circumstances.

      Perhaps more information on this case will emerge in court.

      • An Actual Attorney
        May 18, 2014 at 4:13 pm #

        The other thing I find weird is the filing of the suit, if this is as open-and-shut on the records as claimed. The lawyer is likely working on contingency (as most personal injury lawyers do in the US). So, that incentivizes the lawyer to get the most in recover with the least work.

        When a case that is open and shut walks into our office (or looks like it could be open and shut), we write a demand letter. Basically, that’s a letter to the other side’s lawyer saying you are about to file suit, and you are open to talking settlement.

        Now, we see some nutty defendants, but this would go to the insurance counsel for the hospital and the doctor. They are less likely to be of the “bring it on” variety. What usually happens is that either we get told that we are missing a crucial fact and we walk away from the case or devalue it. Or defendants say “you got us with our pants down. Let’s talk money.”

        This whole story is just ever so slightly not right.

        • attitude devant
          May 18, 2014 at 10:19 pm #

          Also weird: I cannot imagine the nurses and anesthesia going along with this. The whole thing is just bizarre.

          • attitude devant
            May 18, 2014 at 10:20 pm #

            AND, why is this a malpractice case and not a criminal case for assault and battery?

          • anononymity@@
            May 18, 2014 at 10:58 pm #

            Agreed, this should be a case of assault.

          • jennie c
            May 18, 2014 at 11:46 pm #

            well one does not contradict the other. one can file both a civil suit and criminal charges for the same illegal behavior, or choose one or the other. the civil option may be more attractive to many people as criminal charges don’t involve any payment of damages. in addition, the bar is higher to convict someone of criminal charges- (i think. lawyers correct me if i’m wrong…) and if a person is acquitted of criminal charges, it doesn’t totally destroy the civil case but it definitely looks weaker.

          • attitude devant
            May 19, 2014 at 11:05 am #

            Yes, but technically what he did is not “malpractice.” He did not commit malpractice. He committed assault.

          • PrimaryCareDoc
            May 19, 2014 at 12:41 pm #

            Yes, but malpractice insurance won’t cover a civil suit for assault. No deep pockets.

          • jennie c
            May 19, 2014 at 2:44 pm #

            thats where the bladder injury comes into the picture

          • jennie c
            May 19, 2014 at 12:41 am #

            why not? they’re relying on the hospital attorney. as for anesthesia, she may have already had an epidural

          • attitude devant
            May 19, 2014 at 11:04 am #

            jennie c, you don’t understand much if you don’t understand this: at the start of every procedure I have to announce the patient’s name and the procedure and ask if all members of the team agree. If they don’t, I can’t proceed. And ‘already having an epidural’ is quite different from pain relief in surgery. The anesthesiologist is there dosing it up for the procedure (different dose than for labor), monitoring vital signs, giving IV fluid. She is an independent practitioner and is actually the one in charge of the operating room. I can’t imagine one just blithely going along with this.

    • LibrarianSarah
      May 18, 2014 at 11:58 am #

      What seems wired to me is that according to the story he flat out admitted that he was doing something that he knew was unethical and illeagal. That’s like me being on the phone with my mom ending the conversation with “I got to go I am about to rob this bank bye.” What ever happened to deny till you die?

  19. Jill
    May 17, 2014 at 9:24 pm #

    Any chance someone could break this down? Something just seems off for me and I saw someone post on FB about the evils of medicated birth to interfere with breastfeeding:

    • Stacy21629
      May 17, 2014 at 9:29 pm #

      ” evils of medicated birth to interfere with breastfeeding”

      Acknowledging that this is an abstract only and so the methodology and conclusions can NOT be truly evaluated from this, my first comment is that the abstract states that it is a delay in ONSET of lactation.

      The abstract at least makes no mention whatsoever about whether that delay in onset of lactation affects long term lactation rates, duration, etc. So if your milk doesn’t come in until day 4 but you still manage to breast feed until 2 years…is that delay really clinically significant at all?

      Did the children of these mothers that experienced a delay in onset of lactation experience greater weight loss in the first week? Were they slower to return to their birth weight? Were their weight gains over the first 6 months affected?

      Just saying “it delays lactation it’s evil” is a very narrow picture. Is that delay significant? Without looking at the entire paper we cannot even know if they addressed that at all.

      • NoLongerCrunching
        May 18, 2014 at 7:48 pm #

        It’s “significant” if it means formula supplements are given, destroying the infant’s gut.

        • Guesteleh
          May 18, 2014 at 8:19 pm #

          Hpw does formula destroy the infant’s gut? Is there any evidence that a few days of formula are harmful to the infant?

          • NoLongerCrunching
            May 18, 2014 at 8:23 pm #

            Absolutely not. But that doesn’t stop wooey people from pearl-clutching.

          • Young CC Prof
            May 18, 2014 at 10:05 pm #

            Indeed, virgin gut theory is very important for allowing the mothers who never gave their babies one drop of formula to feel superior to the mothers who supplemented with a few teaspoons of it during the baby’s first few days.

          • prolifefeminist
            May 19, 2014 at 12:14 am #

            I remember reading about this virgin gut theory when I was deep in the woo. Is there any real evidence one way or another? Has it ever actually been studied?

          • Young CC Prof
            May 19, 2014 at 12:20 am #

            The short answer is that it’s nonsense.

            The slightly longer answer is that for the one potentially lifesaving benefit of breastmilk, reducing the incidence of NEC in preemies, it does seem to work better if the first food the baby swallows is colostrum rather than formula.

          • jennie c
            May 19, 2014 at 12:39 am #

            a number of articles come up right away on google

      • jennie c
        May 19, 2014 at 9:26 am #

        4 days is delayed? i thoguht that was normal.

    • Young CC Prof
      May 17, 2014 at 9:49 pm #

      2366 women altogether, 23.4% suffered “delayed onset of lactation”, which is 554 women altogether who experienced DOL, and they apparently had 8 different subgroups! How many women were there in the “control” group of totally unmedicated labor, and could they have been more committed to breastfeeding to begin with?

      What’s more, I don’t see a dose-response relationship at all.

      And yes, we know planned (prelabor) cesarean can delay the onset of lactation, but that’s not the drugs, that’s the fact that the labor hormones didn’t start until after the baby was born!

      Looks like a pot of spaghetti thrown at the wall to me.

    • NoLongerCrunching
      May 17, 2014 at 9:55 pm #

      This jumped out at me: “Dewey et al7 found in their bivariate analyses that DOL was more common in mothers who received labor pain medications, an association that did not remain significant in multivariate analyses when controlling for mode of delivery and 29 other variables.”

      I wonder what those variables were?

      I also wonder what this means: “Most pain medications used during labor and delivery are highly lipid soluble, crossing the placenta and rapidly diffus- ing into the fetus (ie, bupivacaine, meperidine, fentanyl, and sufentanil).19,20”. I though ehen meds were put into the epidural space, they did not get into the mothers or the babies bloodstream.

      • Young CC Prof
        May 17, 2014 at 10:12 pm #

        I would guess, parity, previous experiences with lactation, socioeconomic, baby’s health during the first few days of life, labor complications or injury to the mother, and some measure of how committed the mother is to breastfeeding before the birth. Those are the basic ones I would control for, if I wanted to study the question.

  20. Who?
    May 17, 2014 at 8:48 pm #

    Absolutely-it is her right to make whatever choices she wants to for her
    body. Her right to produce a damaged or dead child vaginally; her right to suffer permanent injury herself or even die in the course of fulfilling this ambition.

    We talk such a lot about rights, but where does her responsibility begin? She has no responsibility to the unborn baby to do anything to protect it, clearly. Does she have any responsibility to those she drags into the situation? Will she punt financial responsibility to the insurer, professional harm to the hospital, doctors and nurses? Had the baby been born vaginally, and damaged, would she have taken responsibility or blamed the doctors for not explaining ‘enough’?

    In Realworldsville this doctor made a poor choice in taking her on, and won’t make that mistake again.

    These medical professionals were always getting sued unless the baby came
    out the old fashioned way, and perfect, which the outline suggests was not very likely. Which is not to excuse a decision to go against her will, just to point out the fact.

    In insurance world the financial cost of a dead baby is much lower than that of a damaged baby, so from a prudential point of view saving a damaged baby isn’t the most efficient decision.

    • guest
      May 17, 2014 at 9:12 pm #

      The responsibility begins and ends with her decision. No one else should be dragged into the vortex of her stupidity.
      Liability follows autonomy (or, at least, it should)

      • Haelmoon
        May 18, 2014 at 1:37 am #

        Even if liability followed responsibility legally, those care providers involved would still be traumatized. I am amazed how the NCB crowd makes birth all about them. We humans are communal beings, bad decisions affect a lot of people. We have lost nurses and residents to other specialities due to women making bad choices.

        • guest
          May 18, 2014 at 1:45 am #


        • Who?
          May 18, 2014 at 4:31 am #

          Thankyou for saying this-my friend just had a person in his hospital ward, dying for 2 weeks for want of a blood transfusion. The patient was an adult, perfectly entitled to make the choice, but why go to hospital to do it. Poor nurses and doctors were devastated, made him as comfortable as they could, but from their perspective it was senseless and saddening.

          The self-involvement of those who go to hospital intent on refusing life-saving or -enhancing mainstream treatment is difficult to stomach.

    • rh1985
      May 17, 2014 at 9:12 pm #

      I think a woman who makes a decision to carry a pregnancy to term and give birth has a moral responsibility to do all she can for that child to be born alive and healthy unless a serious risk to her own life/health develops. I think this woman is a crappy mother if her baby was seriously at risk and she was still refusing a CS. But I don’t think she has a *legal* responsibility to protect the fetus before birth. Pregnant women still have the right to medical decisions until the baby is born and can be cared for separately.

      • Renee
        May 18, 2014 at 5:30 am #

        I agree. While its not illegal- and should never be- its morally reprehensible to be so cavalier. If you don’t want the baby, abort it.

        • anonymity@@
          May 18, 2014 at 6:16 am #

          She doesn’t have to abort, she can have a “stillbirth by stupidity/vanity”. It’s her right.

          • Beth S
            May 18, 2014 at 6:17 am #

            It’s her right, but it’s my right to call her an idiot.

          • anonymity@@
            May 18, 2014 at 6:19 am #

            You are too kind.

          • Beth S
            May 18, 2014 at 6:36 am #

            I have a low tolerance for dead babies, especially when it’s because of a stupid decision.

          • anonymity@@
            May 18, 2014 at 8:47 pm #

            I don’t have a low tolerance, I have no tolerance.

    • Stacy21629
      May 17, 2014 at 9:14 pm #

      “These medical professionals were always getting sued unless the baby came out the old fashioned way, and perfect,”
      There is a recent legal outcome that someone linked in a post about 2 weeks ago. Mom in labor, failure to progress, initially declined C-section but later agreed. Wheeled into OR. Baby descended some. Agreed to wait and try for vaginal delivery. Baby delivered vaginally 1-2 hours later. Cerebral palsy. Mom sued and won.
      If she’d had a C-section she would have posted later about her unnecesarean. But doc tries to go “natural” (which was her initial expressed wish anyway), she delivers vaginally and baby is damaged.
      NCB folks decry C-section rates, but can’t acknowledge that birth is dangerous. We can decrease the danger but it requires C-sections. What else does this teach OBs but to section at their first nervous twinge and especially don’t opt to try for a vaginal delivery if mom has already consented to a C-section?

  21. Zornorph
    May 17, 2014 at 5:11 pm #

    I still think this woman needs a slap for being so selfish and stubborn. But the Doctor should have never taken the case, I think.

    • Stacy21629
      May 17, 2014 at 5:49 pm #

      I agree. If true as presented, this doctor completely trampled all over this woman’s right to autonomy…but this was a trainwreck waiting to happen. I still ask – why isn’t a healthy baby good enough for some people?

      This case reminds me somewhat of one Dr. Amy wrote about in the past – a med student chronicled a homebirth transfer declining every single intervention right up until her baby was dying inside her, then finally got the C-section and wanted to claim she wasn’t warned of the severe brain damage that resulted. That woman, too, had the right to do that to her baby…and could not and was not forced into her C-section.

      • anonymity@@
        May 18, 2014 at 5:24 am #

        Perhaps the lawyer made a financial decision i.e. is it cheaper to pay out for an assault vs. a pay-out for a damaged baby?

        • jennie c
          May 18, 2014 at 5:29 am #

          quite likely, but what the lawyer should have done instead was to make sure the informed refusal was airtight documented and witnessed. not a very good attorney in my opinion

          • Renee
            May 18, 2014 at 5:35 am #

            Informed refusal never seems to stand up

          • Beth S
            May 18, 2014 at 5:38 am #

            The whole thing seems a little fishy to me, in my state the doc would be charged with assault. I’ve seen it done with a doctor who used the letters UK with either a cauterizer or a scalpel as a guideline for some sort of surgery and even though the letters were gone by the end of surgery he was still charged.

    • Somewhereinthemiddle
      May 17, 2014 at 7:02 pm #

      I completely disagree that women are totally selfish for wanting a VBAC, especially since she is obviously doing so in a hospital with safety protocols in place. I understand that if a woman is refusing a cesarean when one is obviously indicated for the health of the mother or the baby, that is indeed being selfish. But the story as it has been told thus far, does not indicate that there was an issue happening with her labor. It may in fact be that there was a problem, but I do not believe that wanting a VBA2C in itself indicates that a woman is selfish.

      Again, there are valid reasons outside of “birth experience” that would cause a woman to want a vbac. Some people do not react well to anesthesia, the pain of surgery, some women want bigger families, some women do not want to recover from surgery again, etc.

      Again, I am a VBAC mom and had a CS with my first for a non recurring reason. I wanted 4 kids and didn’t feel comfortable with the idea of going through surgery 4 times. I vbaced both times, in large hospitals with adequate staffing, with FTM, and went to the hospital at the onset of labor. Outside of scheduling a repeat cesarean, I did it in the safest way I could manage.

      • Somewhereinthemiddle
        May 17, 2014 at 7:03 pm #

        I just wish we could change the vbac conversation to be a bit more balanced and less changed with such negative language.

        • yugaya
          May 17, 2014 at 7:14 pm #

          But you can’t change the conversation because NCB is not interested in arguments, only “truths” – the same way that they cry fowl over lack of hospitals supporting VBACs, how that is the same as banning them, they embraced the new recommendations in UK which limit the choice of women in exactly the same way. The doctors are bullying when they offer pain relief, but a doula in a hospital birth who ignores a request for an epidural from her client is just supporting her client’s “true” choices and so on… you cannot talk balanced with someone who will take any issue and just twist it around until it serves their purpose.

          • Somewhereinthemiddle
            May 18, 2014 at 9:50 am #

            But, in this particular case, this mother doesn’t necessarily represent “ncb” that we know from the details that have been reported. I suppose that assumption could be made just like the assumption could be made that this doctor is a criminal for committing assault on a patient. Painting women with the broad and negative “ncb” brushstroke when the isn’t evidence to support that outside of her wanting a vbac is counter productive and alienating.

          • jennie
            May 18, 2014 at 10:18 am #

            nobody represents NCB. NCB is not a person. this is a rather nasty rhetorical move to lump everyone and anyone into a faceless amorphous category, a strawmen that is easier attacked.

        • Stacy21629
          May 17, 2014 at 8:05 pm #

          Sure thing. As soon as the Unnecesesarean people agree as well.

          • Guesteleh
            May 17, 2014 at 8:27 pm #

            This is not a helpful answer. People on this site can be completely unreasonable about women opting for VBAC. Taking an “I know you are but what am I?” attitude isn’t helping.

          • guest
            May 17, 2014 at 8:36 pm #

            Your point is what exactly?

          • Amy Tuteur, MD
            May 17, 2014 at 10:07 pm #

            Please choose a screen name, since you are a regular commentor and others should be able to recognize you as easily as I can.

          • guest
            May 18, 2014 at 1:31 am #

            I am entitled to my anonymity, thank you.

          • Stacy21629
            May 18, 2014 at 4:05 am #

            You think Stacy is my real name?

            anonymity @@

          • guest
            May 18, 2014 at 5:17 am #

            I do find it intriguing that Amy feels the need to track me. It’s quite flattering.

          • Who?
            May 18, 2014 at 5:33 am #

            Dr T can recognise you anyway-I think her point is that other posters can’t tell which ‘guest’ you are, which makes it tricky for them to follow and respond to you. I doubt there’s any intrigue or anything to be intrigued about.

            I’m a guest for now but have a recognisable screen name, rather than just being ‘Guest’ or ‘Anonymous’.

          • anonymity@@
            May 18, 2014 at 5:37 am #

            Thank you everyone for your concern. I have adopted Stacy’s suggestion.

          • Beth S
            May 18, 2014 at 5:39 am #

            Is disqus being weird again and posting things under other’s screen names for anyone else?

          • Jessica S.
            May 18, 2014 at 6:08 pm #


          • Renee
            May 18, 2014 at 5:34 am #

            PICK A NAME. Its hard to follow the conversation without people using a handle. Call yourself anything you want.

          • Beth S
            May 18, 2014 at 5:36 am #

            I posted as a guest name for weeks before finally registering. Not under my real name either but like some have said with the name guest it’s hard to follow a conversation because we can’t tell if you’re the same one or a different guest.

          • Jessica S.
            May 18, 2014 at 6:09 pm #

            You guys are all sly. I think I’m being sly by not spelling my last name out. 😀

          • Jessica S.
            May 18, 2014 at 6:02 pm #

            It’s NOT?! I feel so betrayed, Not-Stacy. And that’s what I’m calling you from now on. 😉 Haha!

          • fiftyfifty1
            May 18, 2014 at 10:41 pm #

            Say it ain’t so Stacy!!!

          • Box of Salt
            May 17, 2014 at 8:47 pm #

            Somewhereinthemiddle and Guesteleh, I can respect that other women will weigh risks differently than I do when considering VBAC. But I can’t respect those who pretend that the risks are not serious, or just don’t apply to them.

            And what about the negative language regarding c-sections in general? How do you have a balanced conversation with people who imply–and some have stated explicitly–that women whose babies were born via c-section love them less than the vaginal birthers love theirs?

          • Somewhereinthemiddle
            May 18, 2014 at 8:22 am #

            That is why I am saying there needs to be balanced, reasonable conversation between “omg, cs are terrible and should be avoided at ALL costs” and “anyone who wants to avoid a cs/ have a vbac is a selfish horrible mother.” Kwim?

            And yes, of course there are risks that are specific to vbac. The majority of women that I know that have sought a vbac are well aware of the risks and chose to birth in a hospital. Not all, but most. And most of the women that I know wanting a vbac are NOT nutters willing to go to dangerous extremes.

          • Somewhereinthemiddle
            May 18, 2014 at 9:04 am #

            And I truly am not familiar with people who think that someone who has a cs loves their child less. Not personally anyway. Obviously that is stupid and doesn’t apply to 99.9% of people out there.

            I do agree that the language around cs can shift to something more positive and affirming. The whole shame aspect of having a cesarean is real and I’ve witnessed it personally, so I get that. But I think it is possible to support women in birth choices in regards to vbac made rationally and safely at the same time as supporting women who chose to birth surgically.

          • Jessica S.
            May 18, 2014 at 6:01 pm #

            I don’t think it’s true that it doesn’t apply to 99.9% of people. I would agree that most of the people (a good helping of “most”) who repeat the talking points that c-sections mess with the bonding experience (that’s what I believe is being referenced to, when saying some people believe that babies born via CS are loved less) don’t actually follow that line of reasoning to it’s logic end, which is that babies born via c-section cannot bond to their mothers the same. Which is ridiculous and offensive. And impossible to prove, anyhow. It is a small percentage of people (but sadly, they’re out there!) that would openly admit that’s what they’re saying. It’s particularly sad when you read women who believe that of their own children. 🙁

            I’m with you on the support, though. Because in the end, no matter how the babe comes out, Lordy, Lordy, to we need support! :/ (Like house cleaners and cooks. And mother’s helpers. Personal shoppers, too. Ha!)

          • jennie c
            May 18, 2014 at 10:16 am #

            i know a woman who had a home vba2c because no dr was willing to support her in the hospital. fact is, although horrible things could have happened, none did (as the odds were that they would not) and now she is running around proselytizing for homebirth. if drs support women in the hospital, she would h ave lessof an audience.

          • Jessica S.
            May 18, 2014 at 5:49 pm #

            It’s likely that no doctor would do it b/c she wasn’t an ideal candidate. The fact that it didn’t end in disaster doesn’t mean she was a good candidate – it means she was lucky. The ACOG is very clear that although they support, b/c there is reasonable evidence to support, trial of labors for VBACs for *some* women at *certain* facilities fully-equipped to handle any eventuality, they can only be supportive when the criteria is met to identified said women and facilities. The hard truth is, it’s not going to be available to all women. So in the case you’re citing, there are several things that could’ve been true: she wasn’t a good candidate (from what I understand, it’s not difficult to make a good assessment even before the attempt, based on past and present factors); no facilities in her area were equipped to handle a VBAC or perhaps her level of risk as a VBAC candidate; no doctors in her area were willing to accept VBAC patients or any doctors that do consider VBAC patients saw her as too high a risk.

            I’m sure none of that is news to you, so forgive me if I sound patronizing or something – it’s not my intent! It’s just that I’ve done some reading recently on the ACOG website regarding VBACs (I’m facing a likely repeat CS with our second babe in July, although it would be great if my body decided to go through the labor thing at a good clip and be home in a shorter period of time – I’m stressing about being away from my sweet little 3.5 year old monster/angel. But I digress.) and it annoys me to no end when people misrepresent the obstacles involved. I’m not saying YOU are misrepresenting, it sounds like the gal who home VBACed is

          • Box of Salt
            May 19, 2014 at 12:56 am #

            jennie c “although horrible things could have happened, none did (as the odds were that they would not)”

            Can you, jennie c, tell me exactly what those odds are and why you think they’re good enough odds to risk taking?

          • Stacy21629
            May 17, 2014 at 9:04 pm #

            And NCB folks can be completely unreasonable about standard, routine obstetric care that can SAVE their child’s life.

          • Sue
            May 18, 2014 at 3:11 am #

            “People on this site can be completely unreasonable about women opting for VBAC.”

            That’s not quite true. People on this site can be reasonably appalled about the choice of HOME VBAC.

          • Somewhereinthemiddle
            May 18, 2014 at 8:16 am #

            But in this case the woman is laboring in a hospital equipped to handle vbacs, not at home, and people are still appalled and talking about how selfish and negligent she is.

          • Young CC Prof
            May 18, 2014 at 11:22 am #

            That’s the thing. We don’t KNOW what really happened, we only have her version and she might not be telling the whole truth. Even in a hospital equipped to handle VBAC, it doesn’t always work.

            It’s possible that her story is the precise truth, but it’s also possible that during her VBAC attempt, things started going wrong that caused the doctors to fear for the child’s life or even her life.

            Like I said to you earlier, safe VBAC doesn’t mean just physically being in the hospital, it means listening to the doctor.

          • Somewhereinthemiddle
            May 18, 2014 at 11:42 am #

            Exactly, we don’t know what happened. She may be a woman who cannot birth vaginally and that was becoming obvious. They could have had a vbac rupture the day before at that hospital and were in no mood to tolerate a vba2c risk. She could have been acting in an antagonizing manner towards the physicians and nurses and they were done tolerating that stance. There could have been signs of rupture, fetal distress. Just like we can’t assume the physicians were acting in a criminal manner, we can’t assume that she wasn’t justified in her refusal. Just pointing out that vilifying her without evidence to do so is counterproductive and can be viewed as “ammo” for the nutter birthy folks.

        • fiftyfifty1
          May 17, 2014 at 9:45 pm #

          Dr. Amy has said time and again that she supports VBAC. Today’s post is yet another case where she argues in favor of the VBACing mother. And then there are a number of OB regulars here all of whom offer VBACs themselves. In what sense exactly do you see a lack of balance?

          • Somewhereinthemiddle
            May 17, 2014 at 11:50 pm #

            I am not talking about Dr. Amy and what she stated, I am talking about this mother being described as selfish and stubborn when there is not evidence thus far that anything was going wrong in her labor. I don’t think that sort of statement is at all necessary without evidence to support it.

          • Renee
            May 18, 2014 at 5:33 am #

            It’s an OPINION.

            You said
            “I just wish we could change the vbac conversation to be a bit more balanced and less changed with such negative language.”

            You did NOT say you wished no one had a poor opinion of the mother.

          • Somewhereinthemiddle
            May 18, 2014 at 8:14 am #

            But a poor opinion based on what? A story where the relevant information known is that the mother wanted a vba2c, in a hospital, under the care of a physician, underwent a cesarean against her wishes, and sustained a bladder injury. No wheere in there is a motivation, why she was refusing, what information had or had not been presented to her, what may or may not have been in her labor, etc to base on opinion on.

            It is painting women with broad strokes of “NCB” or “selfish” or whatnot that doesn’t make any sense when complete information isn’t known.

          • fiftyfifty1
            May 18, 2014 at 11:45 am #

            In this case more than one doc recommended this woman convert over to C-section. These are docs who are willing to support VBA2Cs, which is rare to begin with. They basically totally put themselves on the line in order to fulfill this woman’s wish to have a vaginal birth. They reached a point where the head of MFM and the hospital lawyer got involved. Do you seriously think that these doctors just decided to bring her back to the OR against her will for fun? Having to call the hospital lawyer about an OB case like this is a doc’s 3rd worst nightmare right behind #1 a mother dying #2 a baby dying. Seriously do you suppose that nothing was going wrong with her labor?!

            This mother does seem selfish and stubborn. A woman can be motivated to have a VBAC, fine. But wanting a VBA2C in the absence of ever having a successful vaginal birth and both previous c-sections done for poor progress in labor (as opposed to something non-recurring) makes this woman a much riskier than average candidate for a bad outcome to begin with. Would you yourself have chosen to VBA2C in her situation? And then when the OB recommended CS would you have refused? When the head of maternal fetal medicine recommended it would you have continued to refuse? When the whole department was desperate enough that they started calling lawyers would you STILL have refused?!

            It’s possible to fully support a woman’s right to autonomy while at the same time fully acknowledging that she was a total selfish stubborn idiot.

          • CBAC Mom
            May 18, 2014 at 11:29 pm #

            How do you reconcile fully supporting a woman’s right to autonomy while simultaneously operating on her without her consent?

          • anonymity@@
            May 18, 2014 at 11:30 pm #

            No one is trying to reconcile that.

      • AllieFoyle
        May 17, 2014 at 7:46 pm #

        But you realize that her actions make doctors less likely to accept VBAC patients, right? She’s not doing people who want to access safe VBACs any favors here at all.

        • Jessica S.
          May 17, 2014 at 8:54 pm #

          You’re right. And it’s sad, if she thinks she’s helping otherwise. But I think there are large misperceptions as to why VBACs may not be appropriate or available to all, in all situations. Hospitals that aren’t set up to perform them in accordance with the safety guidelines the ACOG lines out, aren’t going to offer them. Doctors have their own reasons, and if a recent survey done by the ACOG is any indication (I’d have to track down the link, but I found it by searching for VBAC on their site) legal reasons, and the costs of insurance coverage, play a role in their decisions not to accept VBAC patients. It’s not all black and white “doctors and hospitals are greedy control freaks” like the NCB camp makes it out to be.

          • CBAC Mom
            May 18, 2014 at 11:22 pm #

            A doctor is unable to pay for insurance to cover VBAC, but is willing to charge insurance companies for a surgical birth, which costs more than a vaginal one. Insurance companies should support VBAC so they don’t have to pay for the cost of a C-section.

          • anonymity@@
            May 18, 2014 at 11:28 pm #

            I don’t get paid any differently whether the delivery is vaginal or abdominal, or whether I do one delivery or twenty a day.

          • Jessica S.
            May 18, 2014 at 11:58 pm #

            From what I understand, going off of what many doctors here have said, they’re paid the same regardless of delivery method. What makes a C-section more costly is the added personnel needed for the surgery and then the longer recovery time in the hospital. Again, I’m relying on what I’ve learned here, so I can’t vouch for that 100%.

          • AllieFoyle
            May 19, 2014 at 7:34 am #

            A successful VBAC might cost less than a RCS, but an unsuccessful one won’t, and a large proportion of them aren’t successful. VBAC is statistically riskier too, and a few catastrophic outcomes can easily eat up any cost savings.

          • FormerPhysicist
            May 19, 2014 at 10:10 am #

            And does a VBAC under US rules actually cost less than a scheduled c/s? What’s the difference in cost between holding the OR ready the whole time a VBAC patient is in labor, and using it in a scheduled fashion?

            edited for clarity

          • Young CC Prof
            May 19, 2014 at 10:13 am #

            I think the same thing. Scheduling all your prior c-section ladies for RCS sometime in their 39th week allows ORs and staff booked back-to-back, which has got to be cheaper than, say, 12 hours of being ready to provide it at the drop of a hat!

        • Renee
          May 18, 2014 at 5:32 am #

          I am sure he will never do one again.
          I personally think that she was an NCB pain in the ass and pulled some BS.

        • Somewhereinthemiddle
          May 18, 2014 at 9:41 am #

          I didn’t suggest anything regarding what effect her actions would have on safe access to vbac. As far as I am concerned, this lady doesn’t have the responsibility to bear the weight of furthering the ‘vbac cause.’ She need only concern herself with the facts that are relevant in her specific case.

          • Siri
            May 18, 2014 at 11:52 am #

            I agree. I find the misogyny throughout this thread astounding. He chose to override her refusal! He put it in writing! What the hell is wrong with you people? My blood pressure is going through the roof; excuse me while I take a moment to stroke out.

          • fiftyfifty1
            May 18, 2014 at 12:01 pm #

            ” I find the misogyny throughout this thread astounding. ”

            I disagree. There is nobody on this thread stating that it is OK for the doc to override her autonomy. Find me even one comment where somebody says that the docs were within their rights to do it. But that does NOT mean we have to pretend that this woman was not unreasonable.

            Just because I fully support the rights of Neonazis to publish racist books does NOT mean I have to also say that their books are reasonable or that I can’t say that their books are selfish and wrong.

          • jennie c
            May 18, 2014 at 12:24 pm #

            except that calling the woman unreasonable is all based on conjecture. although i wouldn’t call it mysogyny, i’d call it more anti-patient.

          • fiftyfifty1
            May 18, 2014 at 2:58 pm #

            It’s conjecture, but it’s educated conjecture. I have been in situations where we have had to call in the department head and call the lawyer, and it is a Big Deal. It is not done on a whim. It’s not done when things are going okay or when a patient is opting for a run-of-the-mill bad choice. I can and do work with some pretty nutty patients on occasion. It’s part of the job. It’s not fun but you don’t call the lawyer or the department head for nutty or unusual or plain old risky. When you call the department head and the lawyer, the shit has hit the fan or is about 1 mm away from hitting the fan.

          • Siri
            May 18, 2014 at 12:26 pm #

            There is NOTHING in the blog post that even hints at the mother’s actions being unreasonable; nothing. And yet the majority of the comments are highly critical of her and supportive of the hospital. Please leave Nazism out; it’s not conducive to a constructive discussion. 🙂

          • AllieFoyle
            May 18, 2014 at 1:12 pm #

            I guess two people can read the same thing and disagree. I read the NYT piece and found a number of hints that her behavior was unreasonable, even thought it was almost exclusively her side of the story that was being presented.

          • Amy Tuteur, MD
            May 18, 2014 at 2:00 pm #

            But she’s under no obligation to be reasonable. She only has to understand the situation in order for her wishes to be respected.

          • Jessica S.
            May 18, 2014 at 5:27 pm #

            She’s not using Nazism as a mechanism to shut down the discussion, it was a valid analogy. You can insert whatever abhorrent actions or opinion is more fitting or not as offensive, it’s simply a place holder for the point. It’s not as if she’s comparing this woman’s actions TO Nazism – that would not be conducive. 🙂

          • An Actual Attorney
            May 18, 2014 at 8:25 pm #

            It is possible that is an analogy that reads more clearly to USAers, with the famous case of the neonazis fighting to march in Skokie, represented by the ACLU. I don’t know if that’s a story / value as close to home for others. I believe Siri is in the UK?

          • Jessica S.
            May 18, 2014 at 11:03 pm #

            I wondered if it was more centric to the USA, b/c as she pointed out elsewhere, there are other countries who have laws against expressing certain things and it’s viewed different in general. I hope I didn’t come off sounding ethnocentric!

          • Siri
            May 18, 2014 at 12:29 pm #

            There’s nothing in this blog post that even hints at the mother’s actions or wishes being unreasonable; nothing. And yet the majority of the comments are highly critical of her and supportive of the hospital.

            Please leave Nazism out of the discussion; in any case, many countries forbid the publishing of Nazi or racist material.

          • AllieFoyle
            May 18, 2014 at 1:00 pm #

            Read the NYT piece. Two doctors and a hospital lawyer–whose point of view is completely missing from the discussion–felt that the situation warranted extreme action. We are completely missing their interpretation of the situation, which has seriously affected them as well. I can’t imagine it’s a situation either of them took lightly. It’s not misogyny to take one-sided claims with a grain of salt, particularly if common sense suggests that there is more to the story than has been presented.

          • Amy Tuteur, MD
            May 18, 2014 at 1:10 pm #

            I’m trying to figure out what they could have thought that would justify overriding her wishes. It doesn’t matter if they thought the baby would definitely die or that she would definitely die. She still has the absolute right to refuse.

            If they couldn’t talk her into agreeing, they had no right to operate.

          • Life Tip
            May 18, 2014 at 1:19 pm #

            What could the doctor have done to protect himself, if she/he did have reason to believe that it was risky to continue with a vaginal birth?

            I have read that the courts typically sympathize with a family with a dead/disabled baby, and that parents can claim they didn’t really understand the risks.

          • Amy Tuteur, MD
            May 18, 2014 at 2:03 pm #

            He could have sought a court order.

          • AllieFoyle
            May 18, 2014 at 2:22 pm #

            How would that play out in an emergency with time being of the essence? Absent a batphone in L&D that connects instantly to a judge, I imagine it’s kind of a process.

          • Amy Tuteur, MD
            May 18, 2014 at 2:27 pm #

            The baby (or the mother) might die in the meantime, but that’s what the law requires.

            It’s no different from a Jehovah’s Witness who is refusing a life saving blood transfusion. You cannot transfuse him (or her) without consent even if he might die.

          • AllieFoyle
            May 18, 2014 at 2:29 pm #

            But you can and must transfuse his child, right?

          • Amy Tuteur, MD
            May 18, 2014 at 2:42 pm #

            But a fetus is not a child, so that is not relevant.

          • Dr Kitty
            May 19, 2014 at 10:34 am #

            You can’t transfuse a pregnant JW without her consent… AND you can’t do a life saving in-utero transfusion of her baby without her consent.

            Removing autonomy from pregnant women reduces them to vessels and takes away a basic human right.

            Yes babies may die if their mothers make bad choices, but removing their ability to make those choices is not something I could support.

          • AllieFoyle
            May 19, 2014 at 11:22 am #

            I’m uneasy with it as well. But I wonder: could you charge her with neglect or similar if the baby was seriously affected by her refusal? In the US at least, pregnant women who abuse drugs and alcohol have been imprisoned, charged with crimes, and have had their babies removed by social services. I’m not saying I think that’s necessarily right or helpful, but I don’t see a clear distinction between harming a fetus by using alcohol or drugs and harming it by refusing it medical care.

          • Young CC Prof
            May 19, 2014 at 11:25 am #

            I don’t see a difference, either, and I think criminal charges are inappropriate in either situation.

          • Irène Delse
            May 19, 2014 at 11:56 am #

            Removing a child from a mother’s care is not the same as forcing a pregnant woman to undergo a medical treatment or procedure for the benefit of an unborn child. Because that child is still is the womb. Period. I know there were cases where it was done, but even if it was in accordance to existing US law, it’s still unethical. Take the case of of a mother who abuses drugs and is shown unfit to care for a born child. The child is a distinct individual and society has a duty to protect him or if the natural guardians (parents) are incompetent. But a pregnant woman who drinks or takes drugs or refuses medical advice can’t have her autonomy overruled in favor of the baby she carries. Taking extra care to make her understand what is at stake, sure. And be sure she doesn’t have her judgement impaired. But otherwise, no, one can’t treat her just as a vessel for an unborn baby. Not if she’s a human being.

          • AllieFoyle
            May 19, 2014 at 12:51 pm #

            Oh, I don’t think you should treat a woman as just a vessel. I think she should have the right to dictate what happens to her own body, but does she also have some responsibility if she willfully chooses something that harms the baby?

            A baby who sustains a birth injury becomes a person who suffers. Legally, the baby can sue an obstetrician if the injury is caused by something the OB did or didn’t do while the baby was still in-utero. How is this possible if he didn’t have some essence of personhood when the injury was sustained? If an OB can be liable for an injury sustained during delivery, why not the mother, if she knowingly chose something that she had been counseled was unsafe?

          • anonymity@@
            May 19, 2014 at 9:50 pm #

            “How is this possible if he didn’t have some essence of personhood when the injury was sustained?”
            It is possible because the babies right to sue for damage done in utero crystallises at birth (if alive).
            The baby, or someone on their behalf, can sue the mother for stupid decisions that caused harm while still in utero e.g.. refusing antibiotics for syphilis, using garlic for GBS, refusing Vit K, refusing anti-D etc.
            Of course, if the stupidity kills the baby then it all fine.

          • Life Tip
            May 18, 2014 at 2:46 pm #

            Could the doctor still be sued if there was a bad outcome during the process of getting a court order?

          • anonymity@@
            May 18, 2014 at 9:08 pm #

            Theoretically not for the decision that was supported by the court order but you can bet they would try every avenue and probably succeed.

          • anonymity
            May 18, 2014 at 9:04 pm #

            He could withdraw from treatment, as long as he offered another practitioner as an option.

          • Guesteleh
            May 18, 2014 at 9:48 pm #

            I know someone who had the parent sign a statement that read “I understand that my refusal of a CS could result in the death or serious injury of my baby.” Mother signed, vaginally delivered a footling breech, baby spent six weeks in NICU. Mother was happy with the outcome. It’s nuts but it’s pretty much what the provider has to do if the mother is refusing a procedure.

          • AllieFoyle
            May 18, 2014 at 1:21 pm #

            Perhaps that is the case and there was no legal reason for them to operate. I think we can’t know without more facts. Maybe they had sufficient reason to question her mental state at the time. Perhaps she had already consented and was stalling for time when there wasn’t any. Perhaps she was acting under duress from her mother. Perhaps she wasn’t cooperative enough to give an informed refusal. Who knows?

            And beyond the legality of their actions, I have to wonder if they were not faced with a choice between a legal wrong and an ethical wrong.

          • fiftyfifty1
            May 18, 2014 at 3:20 pm #

            Could have been drunk
            Could have been high
            Could have been manic
            Could have been psychotic

            In the last week in my office I have had 2 patients with BALs over 0.25. I’ve had one patient who smelled of marijuana and was obviously stoned, I’ve had one manic patient and one delusional patient FBI cameras and all.

            It could have been a lot of things
            Or maybe they were just dead wrong to operate.

            Based on the half we have, the hospital looks wrong.

          • Dr Kitty
            May 18, 2014 at 3:40 pm #

            There is a UK case where the woman refused a CS, she was sectioned under the mental health act (wrongly) and a CS done against her will.

            While finding for her, that she had been a victim of assault and battery, she got £1 damages.

            You read that correctly, and I’m horrified by it.

            Just because I think a decision is stupid and reckless and morally wrong, doesn’t mean I think a competent woman with capacity should have her autonomous decision overruled.

            This blog really isn’t about the women who make bad decisions despite good advice. This is about women who make decisions based on bad advice, and who have been told to ignore good advice.

          • fiftyfifty1
            May 18, 2014 at 3:14 pm #

            “And yet the majority of the comments are highly critical of her and supportive of the hospital.”

            Not at all. The majority of the comments are critical of her AND critical of the hospital.

            As for the Neonazi reference, if you feel that should be off limits, feel free to substitute “anti-gay literature” or “anti-feminist books based on biological essentialism”.

          • Amy Tuteur, MD
            May 18, 2014 at 12:43 pm #

            In my view, what distinguishes this case from many others is the longstanding relationship between patient and doctor. Dray was not an unknown person who came in off the street in the midst of an emergency. Presumably the issues had been discussed and the patient had already explained what she would want in various circumstances. It would be difficult for the doctor to claim that Dray did not understand what was going on.

            It sounds like what was happening was that the doctor’s tolerance of risk was lower than the patient’s, but he is not free to substitute his lower tolerance for her higher tolerance.

          • fiftyfifty1
            May 18, 2014 at 10:07 pm #

            I absolutely agree that a doctor is not free to substitute his lower tolerance for a patient’s higher tolerance. This is true even if a woman changes her mind once she is in labor and decides she is more risk tolerant than she had previously thought. This is true even if the patient intentionally lied about what her tolerance really was during their pre-natal discussions in order to convince him to take on her case.

            That’s the problem. Cases like this might rightly make docs very reluctant to take on VBACs. And the more a woman seems to want a VBAC, the riskier she might be. It’s too bad.

          • Irène Delse
            May 18, 2014 at 1:03 pm #

            Exactly. It’s the woman’s body, so she gets to decide which risks she wants to take. No doctor should override the decision of a conscious, capable patient, pregnant women included. Recognizing this doesn’t mean that some medical decisions are unwise, though. It’s not against feminism to acknowledge that women are sometimes doing dangerous, unreasonable things, because they are human beings. The feminist perspective here is wanting to ensure that women are not deprived of such a basic right as bodily autonomy.

          • Who?
            May 18, 2014 at 6:49 pm #

            Er, NYT says she says he ignored her refusal and put it in writing.

            If that is what had actually happened, my bet as a recovering lawyer is that the insurer and the patient would now be waiting for the ink on the cheque to dry. The fact that they apparently aren’t means there is way more going on here than meets the eye.

          • AllieFoyle
            May 18, 2014 at 1:29 pm #

            Sure, but actions have consequences, and one of the consequences of a situation like this–which some people are holding up as some sort of landmark VBAC test case–is that doctors will be even less likely to be supportive of VBACs (or become OBs in the first place), knowing that they can be placed between a rock and a hard place, forced to participate in a needless tragedy, and then held responsible no matter what the outcome.

          • Somewhereinthemiddle
            May 18, 2014 at 1:45 pm #

            Unfortunately, that seems to be the nature of obstetrics as a specialty. Sometimes the mothers desires and what is best for the fetus are going to be at odds with one another. This is true of all types of situations, not just vbac.

            I still do not think that this woman or any women should place ideals or “the bigger picture” ahead of the particulars of her own situation.

      • Young CC Prof
        May 17, 2014 at 9:04 pm #

        The problem isn’t attempting VBAC. Women do that every day under safe conditions, just as you did, and wanting more children is a really good reason to try! The problem is making it a hill to die on, possibly literally. Presumably you, like most women attempting VBAC, would consent to prompt RCS if the doctor warned that things were going badly.

      • Stacy21629
        May 17, 2014 at 9:06 pm #

        “the story as it has been told thus far”
        There are 3 sides to every story. Her side. His side. What actually happened.

      • MamaBear
        May 17, 2014 at 9:17 pm #

        There is nothing wrong with wanting a VBAC, but when the VBAC becomes more important than the baby that’s where many people take offense. I do not know this woman or her medical history, or what, if anything in labor showed she needed th C-Section. We also do not know the doctor’s side of the story. Maybe he thought she didn’t really understand the risks, or was competent enough to make that choice. Maybe the hospital attorneys feared she would sue if the baby was born damaged or dead. This could also be a big case of she/he said. I would hope the doctor would not do the C-Section if she refused and was com patent enough too refuse. I hope no mother would put her child’s life in danger to have the ideal birth, but sadly that is happened. I hope more facts do come out because now I’m curious.

        • Anj Fabian
          May 18, 2014 at 7:11 am #

          Her history.
          Birth 1 c-section instead of VB, doctor 1, hospital 1
          Birth 2 c-section instead of desired VBAC, different doctor, different hospital
          for her third birth she changed the hospital and OB again, hoping for a successful VBAC.

          The hospital did in fact have a low c-section rate and a good percentage of successful VBACs. Simply going to the ‘right’ hospital and having the ‘right’ doctor doesn’t mean that you will have a successful VBAC.

          We don’t know the reasons for the previous c-sections, or if she was considered a good candidate for the VBAC.

      • fiftyfifty1
        May 17, 2014 at 9:37 pm #

        “I completely disagree that women are totally selfish for wanting a VBAC, especially since she is obviously doing so in a hospital with safety protocols in place.”

        But one of those safety protocols is accepting the doctor’s advice about when it is best to convert over to C-section. What is the point of going to the hospital if you refuse their help?

        It makes a lot of sense for some women to try for VBAC. But the important word is TRY, not insist.

        • Somewhereinthemiddle
          May 17, 2014 at 11:45 pm #

          Yes, but sometimes a physicians recommendations aren’t always 100% right. I have personal knowledge of situations where a physician provided an opinion that led to a less than ideal outcome for a fetus and I also have personal knowledge of a situation where a physician recommended a cesarean, the mother asked for another hour, and her healthy baby was born vaginally. A physicians recommendations, while incredibly valuable are not foolproof.

          Again, there was nothing in the initial story to suggest that there was anything eventful happening in this labor (even though there might have been and it hasn’t been reported), yet, this mother has been described as selfish an stubborn. Based on the information that is currently available, that description is hyperbolic and unnecessary.

          • Haelmoon
            May 18, 2014 at 12:12 am #

            Just because someone delivered vaginally doesn’t mean the physician was wrong to recommend a c-section. Take the lady I recommended a c-section for her twins. Yes she delivered vaginally and both babies are safe. However, the odds were against that outcome. If faced with a similar case, I would still recommend a s-section.
            Patients live their own experiences, the outcome is always black or white. Physicians deal ith more than one patient. If the odds are high for a bad outcome, I will always recommend intervention. Sure, if there is a 90% chance of a bad outcome, 10% of women will get away with out it. However, I cannot predict those ten percent.
            I frequently tell my patients that my job would be a whole lot easier if I had a crystal ball. Mod you happen to have one that you care to share?

          • Young CC Prof
            May 18, 2014 at 1:15 am #

            Dr. FutureCast has a 10% primary c-section rate and has never had a bad outcome with a full-term baby. Unfortunately, Dr. FutureCast doesn’t practice in my town, so I had to settle for an ordinary obstetrician with no crystal ball. She relies on training, experience, and clinical evidence alone, and prefers to err on the side of caution.

            Hence, my own unnecessarean. I mean, it’s theoretically possible my complete breech baby with asymmetric growth restriction and a failing placenta could have survived labor and birth! (Not likely, though)

          • Haelmoon
            May 18, 2014 at 1:35 am #

            That is exactly it. My 29 seeker was IUGR and breech after PPROM. I was supposed to have a c-section but when I went into labour, it went so fast that I delivered in the hall out side the OR. We got lucky, she is fine. Still knowing the odds, I was very traumatized that she wasn’t born by c-section. Odds are just odds, sometimes things workout well, but other times not. If I could rewind time (stilling knowing the outcome), I’d still want the c-section because I don’t trust my body, labour or nature.

          • Somewhereinthemiddle
            May 18, 2014 at 9:24 am #

            Right, but in the case of the woman wanting another hour, she was in a hospital, with an epi, IV in place, being monitored constantly. The issue was the slow progression of labor. Since it wasn’t an emergency, the mother requested an hour to pray, wait to see what happened, and have some time to wrap her mind around another surgical birth. By the time the hour was up, she was ready to birth.

            This was with an experienced OB. There is no crystal ball and I am FAR from suggesting that there is, so lets take that ridiculous sarcastic suggestion off the the table.

          • jennie c
            May 18, 2014 at 10:25 am #

            my guess is that there were at least some indications of fetal distress. this is a very common reason for c/section.

          • AllieFoyle
            May 18, 2014 at 10:40 am #

            But so what? I doubt the OB suggested that a bad outcome was 100% certain if she waited another hour, just that the odds of a poor outcome increased the longer they waited. And in this case “poor outcome” means a dead or damaged baby. A small increase in risk of a catastrophic injury warrants extra caution, even if the absolute risk is still not that high.

            Just for the sake of illustrating the point: imagine that the doctor’s training and experience suggest that in a particular situation a woman has a ~70% chance of vaginal birth with no serious complication, but a ~20-30% chance of serious complications without a c-section, and the odds get worse the more time goes by. The mother in this scenario would be more likely to deliver without complication than anything else, but the risk of something serious happening is still very high–unacceptably high to most people. Is the obstetrician wrong in recommending a section? Of course not, even though a healthy vaginal delivery is quite likely.

          • Somewhereinthemiddle
            May 18, 2014 at 10:47 am #

            Of course in a situation like this a doctor isn’t wrong in suggesting a c-section. But, as has been discussed here, individualized care, with all the different factors in the case should be weighed in and taken into account when discussing a course of action. I am not talking about the true emergent cases, but the “grey area” ones when deciding whether to proceed with attempting a vaginal birth or not.

          • Haelmoon
            May 18, 2014 at 12:07 pm #

            Sorry, I interpreted you previous comment to be sarcastic – that Drs. aren’t always 100%, but that we should be. Sorry, because its something I face frequency in my practice – the unrealistic expectations placed on medical care provider. I am sorry if I offended you.

          • Somewhereinthemiddle
            May 18, 2014 at 1:13 pm #

            I’m not offended, just don’t want my statements misrepresented or misundertsood. Sarcasm is definitely not one of my strong suits. I don’t expect care providers to be right 100% of the time. I think that is where I get annoyed with these types of discussions because on one hand, physicians admittedly aren’t always dead on with their recommendations. On the other, if you don’t listen to or have an opinion different from that your doctor, you are acting as a negligent, selfish mother. In my eyes, there are way more cases of “grey area” judgment calls than these discussions typically admit.

          • AllieFoyle
            May 18, 2014 at 1:24 pm #

            Sure, but you were using the example of the friend who went against her doctor’s recommendation and still had a healthy delivery as evidence that doctors are sometimes wrong. The point is that a good outcome does not necessarily meant that the doctor’s recommendation wasn’t correct.

          • Somewhereinthemiddle
            May 18, 2014 at 1:37 pm #

            I don’t understand what you mean by “correct”. Do you mean not harmful? I am asking in earnest. The mother wanted to avoid a cs and chose her provider as a physician who was supportive of that.

            From my knowledge, the conversation went something like Dr: I don’t think this happening for you and think we need to talk about moving forward with a CS. Pt: Do I have some time to think about it and wait and see if anything changes? Dr: Yes, things are looking good right now, we can wait an hour and reassess. Pt: Okay, let’s do that.

            Its not that a cesarean is ‘wrong’ but given that the mother wanted to avoid surgery.

          • jennie c
            May 18, 2014 at 1:41 pm #

            i might substitute reasonable for correct/ incorrect. the word correct and incorrect assumes we have absolute knowledge as to the outcome. a good outcome shows that indeed the dr was mistaken about the procedure being necessary. but the dr’s reccommendations could have still been the most reasonable choice, even if it turned out not to be correct.

          • AllieFoyle
            May 18, 2014 at 1:58 pm #

            I mean reasonable and sensible, reflective of reality, most likely to lead to a good outcome and avoid a bad one.

            I’m not really getting “sometimes the doctor is wrong” from your scenario. It sounds like a good doctor-patient conversation, honestly. He thought the odds of success in that situation were low, but there was no immediate danger in waiting and reassessing, so they did. I’m glad it turned out well.

          • Haelmoon
            May 18, 2014 at 5:16 pm #

            Absolutely. When I teach medical students and residents, I describe obstetrics in the following matter. Very little is black or white. Black is that the mother is pregnant, white is the baby is out. Everything that happens in between is the shade of grey that represents the art an science of obstetrics. Sometimes it is more art than science, any obstetrician who pretends otherwise is not truthful. However, on the other side, we don’t have to pretend that obstetrician know nothing when there is a grey zone. We will always err on the side of caution because it is babies lives and brains we are trying to protect. This does not me we should not respect maternal preferences and request, but we don’t have to sugar coat it. If there is an estimated 50% chance someone will end up with a C-section, I am not wrong to offer a pre-labour C-section. OB is very much about assessing risk, trying to explain those risks to populations with a wide background in education and experience, and then making a plan with moms. Just because we often recommend a C-section, doesn’t make it wrong, just the less risky option in some cases. The problem with the grey zone is that we can’t predict the outcomes. Its much easier after the fact to determine the best course of action.
            For example, I recently had a mom booked for a repeat C-section, but she came in in active labour. She really did not want to VBAC, but due to a very crazy unit, I was forced to make her labour. We gave her an epidural while she waited for her turn in the OR. Turns out she was 9cm by then (further than she ever got before) and decided maybe a VBAC would be reasonable. We let her labour, but it stalled at 9cm, likely due to the still high head and intact membranes. I consented her to an ARM, and it worked to bring the head down nicely, unfortunately, as the head rotated, a loop of cord came down. I pushed the head back up, replaced the cord and asked her to push the head back down. Sudden she was fully dilated, head a spines +1 with a reduced cord prolapse. This is a very grey zone – should I still go to section or just let her continue pushing (no problem with the heart rate problems at all). I elected to recommend a C-section because there was still a degree of uncertainty proceeding with an attempt at vaginal delivery. I suspect that she could have had a vaginal delivery, although I would have had a very low threshold to put a vacuum on the head (won’t use forceps because I really didn’t know where the cord was), but neither the mother or I thought the potential benefits were worth the risk. I think my point is when we recommend a C-section, it is just that, a recommendation, and we defend our recommendation with evidence whenever possible. But I never claim it to be an absolute certainty (although there are times I am pretty sure – such as the very next case that walked through the door; breech at 7cm, cord prolapse with bradycardia – straight to the OR with a general, very little discussion with mom because she also wanted to save her baby. I did have a long chat with her the next day to explain what happened).

          • fiftyfifty1
            May 18, 2014 at 10:27 pm #

            Oh what a night! Yikes!

          • Jessica S.
            May 18, 2014 at 11:19 pm #

            You really should write a book. 🙂 I would read it in one sitting!

          • Haelmoon
            May 18, 2014 at 11:37 pm #

            I have thought about it, but haven’t really got the time. It would definitely be why I don’t trust birth and neither should you. All cases of thins gone wrong. I would have to be careful for patient privacy – some stories are harder to shield patient identity than others. Especially for the few cases I have been involved in that made the newspapers. One even made it into the National Enquirer!! (Abdominal pregnancy diagnosed and delivered at 32 weeks). I am a true shit magnet, even my own pregnancies!!

          • Jessica S.
            May 18, 2014 at 11:42 pm #

            Ha! Well, ear-mark it for after retirement and find a good agent (editor? Not sure the correct title) to navigate the sticky stories. It sounds to me like these tough cases end up where they should be, you have a knack for navigating the shit with grace! 😀

          • Jessica S.
            May 18, 2014 at 11:38 pm #

            I’m curious about VBACs right now b/c I’m pregnant with my second and our first was a c-section after an induction that never really went anywhere. If a patient has never delivered vaginal before, let’s say someone like me who’s had one prior pregnancy/c-section, is she looking at the same time estimates for progression of labor? Does it depend on how far she progressed through labor the previous pregnancy, before switching to c-section?

          • Haelmoon
            May 19, 2014 at 1:55 am #

            Jessica S – Its actually quite variable because you would be comparing (hopefully) a spontaneous labour to an induction. They are not quite the same thing. I do find that women who progressed well in the their first delivery are more likely to do so in their next (ie. cord prolapse at 8cm with a breech, only in labour a few hours, likely a high chance of success). But I have also seen some women with 2-4 hours pushing, leading to a c-section that have quick deliveries the next time because the baby cooperated. I personally think the best thing for a TOLAC is an open mind. The physician can give an opinion, the mother can give an opinion, but not until labour can we get the opinion of the baby. The baby plays a large part in the TOLAC resulting in either a VBAC or a C-section. If only they would send us better notes ahead of time.

          • jennie c
            May 19, 2014 at 2:10 am #

            what do you mean by the “baby cooperating?”

          • Haelmoon
            May 19, 2014 at 12:02 pm #

            The baby is an active participant in the labour and delivery process. I don’t mean that the baby is willingly participating. BUT, if the baby does not rotate the right way, or if their are physiologically unable to tolerate labour, or if they are just too big, a vaginal delivery is much less likely. We just can’t predict those things as well as we would like. Stillbirth deliveries are actually quite different because the baby is not an active participant.

          • Irène Delse
            May 19, 2014 at 12:14 pm #

            Thank you, this is fascinating.

          • Jessica S.
            May 19, 2014 at 11:37 pm #

            Yep, this sounds a lot like what happened in my son’s case. He was big and would not or could not move down. So we gave up. Bless those doctors, though. They really gave it as much time as they could – not by my insistence, I told them whatever they felt best was fine. Luckily, when they made the decision there was no huge rush so they could take their time and do it just so. No emergent concerns to worry about.

          • Jessica S.
            May 19, 2014 at 11:28 pm #

            From Haelmoon’s description below, I can vouch that my son would be a perfect example of a non-cooperative baby! Little stinker was (thankfully) completely healthy and more than content to not make his way down to the exit, no matter what. 🙂 He was a big boy, though. The staff theorized that my body simply couldn’t move him down.

            P. S. Three and a half years later, he’s still pretty uncooperative and hard to move when being stubborn. So still healthy and normal, ha!

          • Jessica S.
            May 19, 2014 at 7:59 pm #

            Thanks for your response! I wish children came with indicator lights and warning messages. It would make life so much easier!!

          • fiftyfifty1
            May 18, 2014 at 9:46 am #

            “Yes, but sometimes a physicians recommendations aren’t always 100% right.”

            Yes, and physicians know that, just like meteorologists know it. But the OB is not “wrong” when s/he tells you that based on your labor patterns and fetal monitoring patterns you should go to the OR any more than the meteorologist is “wrong” was s/he tells you that based on the weather patterns you should get your ass down into the basement.

            Boo hoo, boo hoo the basement. No I won’t go and I won’t take my kids either! See, the tornado didn’t hit my house after all, it only hit my neighbor’s. That meteorologist was WRONG!

          • Durango
            May 18, 2014 at 9:54 am #

            The idea that since a physician isn’t 100% accurate any random opinion is valid makes me nuts.

          • Somewhereinthemiddle
            May 18, 2014 at 10:18 am #

            Right, but what we aren’t talking about are degrees of and levels of concerns. If you use the weather analogy, wouldn’t that mean the we should head to the basement every time there is a thunderstorm?

          • Durango
            May 18, 2014 at 10:23 am #

            It’s all about who says it–I’m not going to run to the basement every time there’s a thunderstorm. But if my local weatherman is saying I should, then yes, I would. Do you think these recommendations (MD and meteorology) are made frivolously?

          • jennie c
            May 18, 2014 at 10:11 am #

            i think in obstetrics this is definitely correct. massive numbers of interventions are required in order to prevent one negative outcomes. if the interventions are more or less benign, well then why not. but abdominal surgery is not a benign intervention. it’s much safer than it used to be but can have very significant short and/or long term effects. vilifying women who choose a different set of odds than you might have, is incorrect.

          • Who?
            May 18, 2014 at 6:43 pm #

            I’m not a doctor but I think the negative outcomes for mothers of difficult vaginal deliveries are well recognised, around pelvic floor and perineum (sp?) injuries, incontinence and bad tearing requiring surgical repair. My friend still feels her episiotomy scar in the cold weather, and our boys are 22! There are probably a lot more.

            Vaginal birth even when a healthy baby is the result isn’t always benign for Mum.

            Is it worth wearing continence pads for the rest of your life to achieve a vaginal birth? For me that’s a no thankyou, I get it others might feel differently.

          • CBAC Mom
            May 18, 2014 at 11:01 pm #

            An episiotomy is an intervention. Was your friend informed of all the risks and benefits of the procedure? Did she give her explicit consent? Or did she refuse and the doctor just cut her anyway?

          • anonymity@@
            May 18, 2014 at 11:04 pm #

            She is entitled to tear.

          • jennie c
            May 19, 2014 at 12:57 am #

            drs sometimes just cut without seeking consent, the patient is sometimes so focused on pushing that she doesnt notice. or they include in in the standard admission consent form- possible cesarean, possible episiotomy. i remember that vividly. doesn’t count as consent as far as i am concerned. at least they did a decade ago. here’s hoping thats changed

          • Box of Salt
            May 19, 2014 at 1:26 am #

            anononymity@@ “or they include in in the standard admission consent form- possible cesarean, possible episiotomy. i remember that vividly. doesn’t count as consent as far as i am concerned..”

            Not consent as far as you’re concerned? Nonsense. If you signed it, you consented.

            Don’t sign consent forms you did not read and understand.

          • anonymity@@
            May 19, 2014 at 1:33 am #

            That wasn’t my comment.

          • Box of Salt
            May 19, 2014 at 1:47 am #

            apologies to anoonnymity@@ – Disqus messes up the names on large comment threads. This is why I include a quote when I respond.

          • Box of Salt
            May 19, 2014 at 1:49 am #

            And extra apologies for my failure to fix my own typos in your screen name (which I won’t attempt to type again)

          • anonymity@@
            May 19, 2014 at 9:39 pm #

            No problem.

          • Who?
            May 19, 2014 at 1:05 am #

            She had a haematoma on her vulva that came up as the baby’s head was crowning. No time for conversation-the haematoma was opened with some kind of blade, he was scooped out, the room filled with doctors etc and off she went to surgery to be stitched up. And this is at 39 weeks, after a normal pregnancy and an unmedicated 8 hour labour.

            We signed all sorts of forms going in, perhaps approval was one of them? Either way it was an emergency and she was happy with the overall outcome, but could do without the discomfort of the scar.

            The point that not all vaginal births end 100% without consequence for mum stands, I think.

          • yugaya
            May 18, 2014 at 10:14 am #

            What kind of less ideal outcome are we talking about? Death? Permanent injury? That is the kind of less ideal outcome that is most often, in vast majority of cases the consequence of not listening to recommendations of medical professionals when it comes to childbirth.

            Personal knowledge of a handful of contrary situations i.e. second-hand hear-says provided by lay people only trumps the above mentioned fact in NCB universe.

          • jennie
            May 18, 2014 at 10:22 am #

            define vast majority? the less than .05 % of homebirth women (i forgot the exact number) who suffer perinatatl deaths???? i am not saying that these deaths are insignificant , but to present it as a vast majority, aren’t you stretching the truth just a tad?

          • yugaya
            May 18, 2014 at 10:28 am #

            Vast majority of babies that die in homebirths would have been saved if they were delivered in hospital and according to recommendations of medical professionals regarding the safest mode of delivery. Two out of three, to be exact. Out of a hundred, that is 66.67%. In my country, a party with that percentage of seats in the parliament has what is called an absolute majority.

            A breech baby’s chances of dying in homebirth are up to nine times greater than dying in hospital birth and being delivered according to recommendations of medical professionals.

            Chances of baby suffering injury at birth that requires cooling treatment are 18 times greater than chances of babies born in hospitals requiring it.

          • jennie c
            May 18, 2014 at 10:34 am #

            you are changing the argument. you wrote that the vast majority of folk who go against medical advice suffer adverse consequences, and in this case thats just not true. the majority are fine. maybe not as many as would have been otherwise, but the majority are fine. EVEN in tthe home vbacs 98% were fine. now thats terrible odds compared to hospital. absolutely awful. but the vast majority?

          • yugaya
            May 18, 2014 at 10:38 am #

            So a dead baby is definitely not a bad outcome? For some people that is true. For vast majority of people it is not.

          • Somewhereinthemiddle
            May 18, 2014 at 10:27 am #

            I know this seems like a weird line to draw, but I don’t want to get into the actual outcome.

          • Durango
            May 18, 2014 at 10:32 am #

            But the outcome is all that matters!

          • yugaya
            May 18, 2014 at 10:37 am #

            Oh ffs. Throwing slogans around in an ironic attempt to try to derail the original conversation is a) not funny and b) too childish for me to continue to interact with you.

          • Durango
            May 18, 2014 at 10:44 am #

            Sorry, it wasn’t meant to be sloganeering/ironic/funny. It was off-topic,as in this article the outcome of healthy baby and mother was met, but by overriding the human rights of the mother, and I apologize for going off thread.

          • yugaya
            May 18, 2014 at 10:49 am #

            Apologies then. 🙂 I already left a comment somewhere earlier on what I think about that, regardless of the alive baby outcome. If the c-section was done without her consent, the fact that both she and the baby are alive as a consequence does not change one bit how wrong it was.

          • yugaya
            May 18, 2014 at 10:33 am #

            Ok I understand that.

          • AllieFoyle
            May 18, 2014 at 10:26 am #

            There was the opinion of at least two doctors and the hospital lawyer that the situation was dire enough to require a c-section, even knowing that taking such an action was very likely to have serious repercussions for them personally. The only information available right now is what is being stated by the plaintiff. Even reading only her account, I still feel it’s reasonable to call her selfish and stubborn in wanting to place her baby’s life in jeopardy by going against medical advice. Further, if the situation was anything like as dire as I’m imagining, I think she’s outrageously immoral for putting those doctors in that position in the first place, and especially for pursuing legal action against them when they most likely saved her son’s life and possibly her own.

          • Somewhereinthemiddle
            May 18, 2014 at 10:37 am #

            That sounds like a well reasoned, well explained reason for having that sort opinion.

        • anonymity@@
          May 18, 2014 at 11:02 pm #

          They are fully entitled to insist.

          • Jessica S.
            May 18, 2014 at 11:14 pm #

            Absolutely, they are fully entitled to insist on TRYING – to insist on a Trial of Labor. But no one, except those most prescient, can insist on an actual VBAC b/c it’s only that once the baby is born vaginally. I believe that is what fifty means by “try, not insist”.

          • anonymity@@
            May 18, 2014 at 11:25 pm #

            Nope, I don’t think that is what she meant but you make good point that it is only a VBAC (or VSBAC) once delivered vaginally.

          • Jessica S.
            May 18, 2014 at 11:45 pm #

            I’ll take the good point!

      • Irène Delse
        May 18, 2014 at 10:00 am #

        “some women want bigger families, some women do not want to recover from surgery again, etc.”

        The thing is, sometimes you can’t get all you want, not safely anyway, and it’s not reasonable to persist. In your case, you were able to have a vbac as safely as possible, and it’s great. But some women aren’t good candidates for vbac and the best course for them would be to reconcile themselves to a change of plans. Reality can be a real honey badger: it just don’t care!

        • Somewhereinthemiddle
          May 18, 2014 at 10:03 am #

          Good thing haven’t suggested anywhere or at any time that everyone can and/or should have or want a vbac.

          • Irène Delse
            May 18, 2014 at 10:21 am #

            Newsflash: this is not all about you. I can use a comment you made as a starting point to discuss a related issue with a wider application.

          • Somewhereinthemiddle
            May 18, 2014 at 10:33 am #

            But your response was made *to me* in a manner that suggested that you were arguing a point that *I* made.

      • OBPI Mama
        May 19, 2014 at 6:00 am #

        I’m so happy you were able to get your vbacs! Super jealous. I would love a 5th baby, but my husband does not want to see me go through another c-section recovery (it’d be my 4th c/s and to be honest, I’d have to fight a lot of fear during pregnancy too, but I still want one more!). If I would have been a good candidate for a vbac (I wasn’t) I also would have tried so I could cut down on the risks of multiple c/s and get my large family! I am content with my 4 kids if he doesn’t soften upto the idea, so while I reconciled myself to my reality, I still get that empty feeling in my arms for just one more baby. From your posts below, it sounds like you feel alone in your vbac experiences as a commenter, so I just wanted to let you know that I also value the reasons for wanting one for a good candidate. I get it!

        And I hope this didn’t come across anti-c/s. I loved getting my healthy babies because of them and would do it that way all over again. So thankful.

    • jennie c
      May 19, 2014 at 12:53 am #

      your language is sexist and promotes violence against women. please emend.

  22. theadequatemother
    May 17, 2014 at 5:08 pm #

    I don’t understand how this could have happened the way she’s and her lawyers are presenting it. At every institution I’ve worked at, in a nonemergency, anesthesia doesn’t proceed without a valid consent being present or a documentation by two physicians of pt not being competent. In addition the nurses certainly wouldn’t bring a patient into the OR without a valid consent.

    • R T
      May 17, 2014 at 5:13 pm #

      What I gather is the lawyers told everyone to go ahead without a court order and they did!

    • jennie c
      May 18, 2014 at 5:28 am #

      unfortunately nurses always do what drs tell them to do or they get fired

      • anonymity@@
        May 18, 2014 at 5:30 am #

        That is definitely not the case where I work.

        • jennie c
          May 18, 2014 at 5:31 am #

          the exception, i’m afraid, but may there be many more like yours….

      • Lori
        May 18, 2014 at 10:14 pm #

        What!?!? I am not sure if that was sarcasm so my apologies if it was but just in case you are serious, I have worked at 4 different hospitals in two different countries and I find that comment to be outrageous. Most of us like to keep our licenses and it is certainly not as if, “the doctor made me do it, your honor,” would stand up court.

      • theadequatemother
        May 18, 2014 at 11:06 pm #

        I find your comment outrageous too. That’s not the case in my neck of the woods.

  23. Jessica S.
    May 17, 2014 at 3:52 pm #

    Out of curiosity, what are the risks of bladder ‘nicks’ and are they more likely to happen in an emergent C-section as opposed to a scheduled? (I.e. – the former being rushed in deference to mom and/or baby’s health). I suspect they are rare either way, but what do I know. I’m not a surgeon! 🙂

    • Jenny_from_da_Bloc
      May 17, 2014 at 4:20 pm #

      I believe that because her water broke she was more at risk for a bladder nick or perforation. I think the risk increases if your water breaks before surgery.

    • Somewhereinthemiddle
      May 17, 2014 at 4:54 pm #

      I don’t know the exact stats about this, but there has to be some numbers floating around out there about it though. I have two friends who have had planned cesareans with bladder lacerations, but don’t personally know anyone who has had this happen during an emergent CS. Not stating this in relation to any sort of evidence, but that is my only personal knowledge of this sort of situation.

      • Jessica S.
        May 17, 2014 at 5:41 pm #

        Interesting! I’m probably having a repeat c-section in July – at least, I prefer it to a trial of labor b/c I don’t have a lot of faith in my body (blasphemy! Haha). I’m not concerned about the what-ifs, but I thought it was worth asking.

    • Haelmoon
      May 17, 2014 at 7:31 pm #

      The risk of bladder injury is generally less than one percent. Most often it is a result of the previous scar tissue that holds the bladder against the uterus after a previous c-section. The amount of scar tissue is variable. The preferred site for the uterine incision (low transverse) is under the bladder, so a “bladder flap” is created to allow for this incision. Each time, the bladder will scar back down on to the uterus. At the first C-section, this is a very easy surgical plane to dissect, but in subsequent pregnancies it becomes more difficult, but to varying degrees (some times not an issue, some times very difficult). Bladder injuries rarely cause long term problems (unlike at hysterectomy where they are associated with an increased risk of fistula formation).
      I have only had a few bladder injuries, not all were emergency C-sections, but they were all repeat C-sections. The biggest ones were associated with uterine ruptures, accrete (doesn’t count as an injury when we invite urology to remove part of the bladder due to a percreta) and women who were fully dilated at C-section (tissues are more swollen than). I have never be sued (phew!!) or had a complaint against me for a bladder injury.

      • Jessica S.
        May 17, 2014 at 8:23 pm #

        Thanks, what a great response! 🙂

      • Sue
        May 18, 2014 at 3:15 am #

        I’ve never understood the exaggerated concern about nicking the bladder. Sure it’s better avoided, but some people who have a bladder outlet obstruction have a tube placed through the lower abdominal wall, through the bladder wall, to drain the urine directly. (Suprapubic catheter). This is inserted under local anaesthetic. When the tube is removed, the hole in the muscular wall of the bladder heals without needing to be repaired. It’s not considered a complication.

      • jennie c
        May 18, 2014 at 5:30 am #

        thanks for providing that excellent information healemoon, here as well as in other comments

      • OBPI Mama
        May 18, 2014 at 6:01 am #

        Mine was nicked during my 3rd c-section due to a lot of scarring. I had a loss of feeling of when I needed to pee for 5 days after, but got that feeling back… maybe that was a catheter thing though? Anyway, I never filed a complaint or anything. I was thankful he was trying to remove all the scar tissue because I had pain after my 2nd c-section due to scar adhesions and did not want that pain again! And it worked.

  24. Jessica S.
    May 17, 2014 at 3:49 pm #

    It’s terribly inconsiderate of you, Dr. Amy, to be so consistent in your principles and author such an excellent piece, so as to make it that much harder to pan you as a hypocritical, Big Hospital-shilling, meen-y head.

  25. Lizzie Dee
    May 17, 2014 at 3:44 pm #

    Black and white absolutes make ethical decisions easy, don’t they? No-one could possible argue that women should not have absolute autonomy over decisions about what is done to their bodies. No one can argue that a doctor who cynically calculates that he has the power to override that is wrong, guilty, monstrous. In the greyer world of actual dilemmas maybe not quite so easy? A woman who puts a wish for a vaginal birth over the life of her child ain’t too admirable, nor a doctor who would shrug off a dead baby as a reasonable price for being fireproof legally either. Both probably happen more often than forced caesareans.

    None of us know if this woman is a victim or a fool, the doctor conscientiously taking care of two lives or a villain. The principal is right, of course.

  26. Beth S
    May 17, 2014 at 3:37 pm #

    The only time I can think of where it would be acceptable to perform a C-section or any surgery on a woman without her written consent is if she were unconscious or otherwise unable to give her own informed consent, at which time they would go to the woman’s next of kin to get that written consent.
    I agree with what other’s have said on this site, there has to be more than what’s being said about this story. As Attorney said I don’t know of any doctor who would admit he was breaking the law on a chart. Not to mention if he really had done a C-section against her will she could have him legally charged with assault if not even stronger charges and it doesn’t sound like those charges were ever brought.

  27. AllieFoyle
    May 17, 2014 at 3:24 pm #

    We only know one side of this story. I expect there was a level of danger, urgency, and denial to the situation that isn’t revealed in the NYT piece. If, for instance, the doctors knew she had a good chance of rupture because of the previous scars or she was showing signs of a rupture or the baby was in distress, what good choices did the doctors have? None. It may be that they were legally proscribed from performing the c-section but ethically required to do it, if they knew she and her child would likely die otherwise.

    We have literally no idea of the doctors’ side of the events or what was discussed prenatally or during labor and delivery. What a horrible situation to be placed in. It will probably profoundly affect them the rest of their lives and careers. Ms. Dray, on the other hand, is healthy and free to go back to her life with her three healthy sons.

    • not an incubator
      May 17, 2014 at 6:31 pm #

      She was conscious and refused the c-section. It’s a patient’s right to refuse medical intervention, even if it means he or she dies. There was only one patient until the baby was born.

      • Stacy21629
        May 17, 2014 at 6:38 pm #

        “There was only one patient until the baby was born.”
        If that’s true, then why do doctors do C-sections for fetal distress? Why monitor the baby during labor?

        The mother might be the one making the decisions because the baby is unable to consent, but there are 2 patients there and decisions can be very different if one is handling labor worse than the other.

        • not an incubator
          May 17, 2014 at 6:52 pm #

          Your reply doesn’t make any sense. The doctors do c-sections and monitoring, with the woman’s consent, to achieve her goal of a live birth. When it is outside her body, it becomes a patient.

          • guest
            May 17, 2014 at 7:35 pm #

            The law has different views on the feto-maternal construct. Some courts have accepted the two separate entities idea while others refer to a not-one-but-not-two configuration. Other courts accept the fetus as a ‘unique being.’ A UK court summed it up nicely by saying that whatever the fetus is, it is “not nothing”.
            Some patients have had there wish to die overturned on a ‘public interest’ argument (i.e. that the court has a public interest to preserve life).
            The born alive rule (i.e. that the baby is not a legal entity until born alive) has been abolished in certain American states.
            So, sorry, not as simple as you think.

          • AllieFoyle
            May 17, 2014 at 7:43 pm #

            Well, we do place limits on a woman’s ability to access abortion after a certain point in pregnancy. Women can be charged with crimes if they endanger their babies lives by using drugs during pregnancy. Doctors can be sued by the baby himself, if he is harmed during delivery.

            Teleport that kid out of the womb, the exact same kid, and you do anything to harm him or place him in danger and you are committing a serious crime. To be a doctor in that situation is comparable to being asked to be complicit in a criminal neglect or manslaughter. The distinction is not as clear as you’d like it to be.

          • anonymity@@
            May 18, 2014 at 9:26 pm #

            Stacy’s reply makes perfect sense. If the unborn baby is of no legal consequence, why bother monitoring it?
            We could just connect an “maternal experience monitor”
            and leave it at that.

          • Who?
            May 18, 2014 at 9:47 pm #

            Perhaps the answer is that where the mother’s experience is the point of the delivery some form of consent to not monitor the foetus would protect the doctors legally? Then the only decision for mum would be to save herself or not in the event of catastrophe. Shall we open a book on how that decision might usually go?

          • anonymity@@
            May 18, 2014 at 11:18 pm #

            If only it was possible, but in the real world the doctor is damned if they do and damned if they don’t no matter what form is signed.
            If things go in their favour the doctor was exaggerating and if they don’t then the doctor didn’t explain properly.
            I like the hypothetical book that you raise.

          • jennie c
            May 18, 2014 at 11:31 pm #

            no; a doctor can not fail to deliver the standard of care in one area because a patient is refusing to accept his reccommendations in another area.

      • Haelmoon
        May 17, 2014 at 7:38 pm #

        Its not entirely true, I think most obstetricians consider it that there are two patients. We often have to consider this when caring for pregnant patients. However, only one of the patient’s is capable of making decisions, only one can give consent. We can’t do anything for the second patient without the explicit permission of the first, because it resides in the first. However, we do consider them to be distinct beings. If one needs to be treated, we weigh the risks for the other (ie. a mother with cancer going onto chemotherapy or a fetal surgical procedure to treat spina bifida). There are times that our treatment clearly only benefits one of the two patients, but we always ask the mother to make that decision. Moms can make decisions we don’t agree with, but we must always respect her decision.

        • jennie c
          May 18, 2014 at 2:06 am #

          that is incorrect from a legal perspective. The fetus does not have legal rights until it is born.

          • regularguest
            May 18, 2014 at 2:09 am #

            The born alive rule has been overturned in certain American states, so that does not apply universally.

          • Haelmoon
            May 18, 2014 at 3:14 am #

            Legally is only one part of it. Medically, we have to accept that there are two patients, sometimes with competing needs.

      • AllieFoyle
        May 17, 2014 at 7:45 pm #

        We also don’t know what exactly was said when and by whom. Did she sign a c-section consent form before attempting the VBAC and then verbally decline? Did the doctors perhaps judge her as being mentally unfit to make the decision for some reason? Again, without more information we really just have no idea.

  28. CBAC Mom
    May 17, 2014 at 2:16 pm #

    There are many documented cases where automony was denied to pregnant women. “Arrests of and forced interventions on pregnant women in the United States (1973-2005): The implications for women’s legal status and public health,” Journal of Health Politics, Policy and Law

    Women do not lose their ability to make decisions simply because they are pregnant. Doctors do not have the right to perform interventions on patients against their explicit refusal.

    • PrimaryCareDoc
      May 17, 2014 at 2:46 pm #

      Yes. There was a very recent case about a woman being forced into drug treatment because she was pregnant.

      • May 18, 2014 at 4:39 am #

        We may be thinking of the same case or not- but the case I’m thinking of, the woman was forced into drug treatment even though she was no longer abusing drugs (she disclosed that she had been an addict in the past but had been clean for quite some time). She was forced into an inpatient facility after a court hearing in which her fetus was appointed a lawyer but she wasn’t. She lost her job because of it and was denied prenatal care on top of that.

        It was … truly amazing in a really awful way.

    • Stacy21629
      May 17, 2014 at 5:56 pm #

      Haven’t lawyers argued just that, though? That women in labor are incapacitated? I read a piece on Dr. Jen Gunter’s blog recently about Jon Edwards (disgraced politician and lawyer) saying that that’s how he made his money.

      So you have to respect autonomy…but you could also be sued because no way can a laboring woman really understand what you’re saying.

      • theadequatemother
        May 18, 2014 at 12:36 am #

        There was a study looking at whether women in labour had the capacity to give informed consent for epidurals. The researchers measured recall of the risks benefits and alternatives discussed during the consent conversation. Overwhelmingly women were able to recall that information and say they understood it at the time of the discussion. The conclusion was that labour and pain did not destroy a patients capacity.

  29. R T
    May 17, 2014 at 2:14 pm #

    This story makes me sick to my stomach! How horrible! She must have felt so trapped and helpless! I hope this doctor loses his medical license, and if not, that women stop using him!

    • CanDoc
      May 17, 2014 at 10:07 pm #

      Wait until we hear the whole story before making such strong pronouncements. Is it possible these physicians plus legal experts were in the wrong? Certainly. But in this case, she can tell whatever version of events she wants, and the doctors involved can’t disclose a word due to patient confidentiality. There is much more to this than meets the eye. No physician would perform surgery on a non-consenting patient, unless there was an extraordinary reason worth risking your entire career for.

  30. An Actual Attorney
    May 17, 2014 at 2:12 pm #

    I put $10 on “a whole lot more to this story than was in the press release.” And, since the article cites to the WHO “recommendation” of a 15% CS rate, I bet it was mostly taken from a press release.

    • R T
      May 17, 2014 at 2:15 pm #

      It says he notated he was performing a csection against her will. What more could there be?

      • Young CC Prof
        May 17, 2014 at 2:27 pm #

        My only hesitation has is that this article is about a lawsuit where one side is legally barred from saying anything at all. Again, assuming the article is even partially correct, it’s outrageous, but I currently have no way to be sure.

        • An Actual Attorney
          May 17, 2014 at 2:37 pm #

          The article quotes the Complaint, written by her lawyer. It isn’t evidence. We don’t know what the notations actually say. Something’s fishy. It’s exactly that I don’t think any doc educated in the last 60 years would NOTE they were violating the law. A smoking gun like that is what we in the business call too good to be true.

          • jennie c
            May 18, 2014 at 2:35 am #

            i don’t think so; it seems likely to me. The patients doc did NOT write in the chart that he was overriding her lack of consent- his superior, the director of the department did. my guess is that there was some sort of fetal distress, however the pt’s doc refused to go ahead with the c/section due to his understanding that it was illegal, until the director and the lawyer noted that it was their decision in the chart. a doc surely might choose torely on the opinion of his own hospital legal team over his own understanding. seems he was in between a rock and a hard place. i’m guessing that the lawyer felt the legal risks were greater if the baby wouild be born with something wrong with it. then the hospital would be sued for not performing a c/section, with the patient claiming she had not been adequately counseled. A reasonable assumption, but The lawyers screwed up. What they should have done is had multiple witnesses affirm the detailed counseling that the patient received and her subsequent refusal.

          • jennie c
            May 19, 2014 at 1:13 am #

            he may have done it because the patients doc was refusing to perform the c/section without having a higher authority to lean on.

      • Stacy21629
        May 17, 2014 at 9:32 pm #

        Have the mother and her lawyer released the ENTIRE medical record? Or just the choice bits they want the media to reprint?

  31. MLE
    May 17, 2014 at 2:11 pm #

    Who wrote this, Mrs. Hyde??

    • Guest
      May 17, 2014 at 3:58 pm #

      No, this is Dr. Amy Tuteur. The woman who advocates fiercely and consistently for practitioner accountability and patient autonomy and informed consent in maternity care.

      • MLE
        May 17, 2014 at 7:09 pm #

        Sorry guest, that was a joke….like this is her alter ego writing. Dr. Jekyll/Mr. Hyde, or in this case, Dr. Amy/Mrs. Hyde. Because we all know Dr. Amy wants a 100% c-section rate 😉

        • Jessica S.
          May 17, 2014 at 8:28 pm #

          I must be slow today b/c it took me two passes to get the joke. But only b/c I was wondering if Hyde was part of the story. 😀

          • guest
            May 17, 2014 at 8:30 pm #

            Coffee is the answer, what is the question?

          • MLE
            May 18, 2014 at 12:34 am #

            Given the dearth of lines on my original post and the 13 likes on guest’s reply, I would say it was my problem.

          • Jessica S.
            May 19, 2014 at 12:09 am #

            Ha! Well, I just up-voted it, seeing as I get it now.

  32. fiftyfifty1
    May 17, 2014 at 2:04 pm #

    Every competent woman has the absolute right to refuse C-section even if it means her baby dies. If the facts of the case are as she describes, she will have a great case and I hope she wins, because autonomy is that important.

    At the same time, she’s a complete idiot. These women who place the experience of a vaginal birth above the health of their babies are so selfish.

    • yugaya
      May 17, 2014 at 2:25 pm #

      Agreed. If he performed this c-section without legally overriding her right to refuse it he committed an aggravated assault on that woman, and he used his position of power of a doctor over a patient to do it.

      Lifetime ban from practicing medicine is in order, whatever state of mind or reasons made him resort to such desperate measure.

      • Jenny_from_da_Bloc
        May 17, 2014 at 4:32 pm #

        I don’t believe a lifetime ban would be appropriate. We are only hearing one side of this story and for all we know she could have been rupturing or hemorrhaging or the baby in the process of dying and the patient might have been 100% unreasonable and jeopardizing her own life as well as her baby’s life. I don’t believe a doctor would go this route knowing the consequences of overriding her decision to have a vaginal birth. Especially considering how easy it is to sue a hospital and a doctor these days. I’m sure this doctor had a conversation with legal before the c-section and they probably were all pretty sure she was going to sue them no matter what the outcome of her delivery. How do we know that the bladder injury was or was not because her abdomen was filled with blood from a rupture? How do we know her uterus did or did not rupture? We don’t… because we are only given her account of events and I highly doubt that a doctor would note he is overriding her consent with one simple sentence and not complete details of the situation which seem to be omitted from the article to sway the public’s opinion in her favor. I don’t believe her

    • AllieFoyle
      May 17, 2014 at 3:34 pm #

      Something needs to be changed. Doctors are placed in an impossible position in cases like this. If the mother refuses a c-section, they are responsible if they don’t do the c-section and the baby dies or is injured AND they are also responsible if they do the c-section against her wishes.

      I’m as pro-choice as they come, but the existence of the baby in this scenario makes this a very murky legal and ethical question. That same exact baby, in a different location (i.e. outside the womb) would be viewed as a full human being, and the people caring for him or her would have legal and ethical obligations to keep him or her safe. No, you shouldn’t be able to violate a woman’s bodily autonomy, but should you allow her to kill her infant? I don’t think there is a good answer here but if I were a doctor I’d be very careful of taking on patients who were likely to put me in this situation.

      • fiftyfifty1
        May 17, 2014 at 4:08 pm #

        “if I were a doctor I’d be very careful of taking on patients who were likely to put me in this situation.”

        Exactly. This is another reason this woman is an idiot. Does she think this lawsuit will decrease c-sections? It will do the exact opposite by discouraging doctors from offering VBACs. Doctors want to avoid patients like her who will put them into impossible situations. They will be especially wary of women desiring a VBA2C as such women are even more likely to be zealots.

      • not an incubator
        May 17, 2014 at 6:37 pm #

        The baby’s not outside the womb though. That’s the precise issue.

        Imagine a toddler has a rare blood type and desperately needs an immediate infusion. However, the only way for the hospital to get the correct blood type is to force the toddler’s father to give a pint of blood, can it physically restrain him and take that pint of blood by force?

        • AllieFoyle
          May 17, 2014 at 7:49 pm #

          That’s not a real situation and they’re not really equivalent. Ethically, the father would be guilty of horrible neglect and endangerment, I suppose. It would be difficult to physically compel a person to go to a hospital for no other reason, but in this case the woman had voluntarily gone to the hospital expressly to have her child delivered safely by placing herself in the care of doctors.

  33. Somewhereinthemiddle
    May 17, 2014 at 1:26 pm #

    Am I the only one wondering if her bladder injury is the only reason anyone would touch this case? If she and her baby both were uninjured, would this case still have the traction that it seems to have in both the media and legally? This is not the first case of its kind, so what makes this one different?

    And I have to admit that it crossed my mind that her injury was not a true accident, but possibly a retaliation for being a difficult patient.

    • CanDoc
      May 17, 2014 at 1:33 pm #

      No, as a physician you would NEVER retaliate against even the most difficult of patients with a surgical misadventure, for the simple and selfish reason that the risk of litigation and damage to your professional reputation is SO high. (P.S. A bladder cut at cesarean section is inconvenient because the patient has to keep a catheter in for 4-7 days while it heals, but otherwise is basically a non-event in terms of long-term consequences. They heal up very well.)
      I wonder if the bladder laceration was in fact related to a uterine dehiscence or rupture that the patient has conveniently not told the media about? OR if the cesarean was of such incredible urgency that there just wasn’t time to carefully dissect the bladder off the uterus because the baby HAD to come out immediately? What a nightmare situation for all involved.

      In spite of all this, IF she was competent and able to refuse consent, then the obstetrician involved had no right to operate on her against her will. Until she was unconscious from blood loss related to a uterine rupture or similar event that rendered her incompetent.

      • Somewhereinthemiddle
        May 17, 2014 at 2:05 pm #

        Of course not, Hippocratic oath, malpractice, and all that are in place to ensure that things like that don’t happen. More just thinking out loud that I can’t be the only one considering that scenario. I am generally not one to mistrust a physician’s ethics behavior. I am related to and friends with 4 physicians and countless other nurses, PAs, etc, and I am generally the first one to give physicians the benefit of the doubt.

      • R T
        May 17, 2014 at 2:21 pm #

        Considering there are physicians who have raped unconscious patients or molested their child patients, I think you’re in some extreme denial if you think a doctor would “NEVER” retaliate against a difficult patient during a surgical procedure. Doctors are humans and some humans can be very cruel regardless of the consequences.

        • Medwife
          May 17, 2014 at 2:33 pm #

          No TRUE Scotsm- I mean doctor, would do such a thing 😉

          • Young CC Prof
            May 17, 2014 at 3:18 pm #

            Indeed. Unfortunately, there are some not-so-true doctors out there.

          • R T
            May 17, 2014 at 3:29 pm #

            No, “normal” human would, but doctors can suffer from all the same personality disorders the general population does! Unfortunely, mental health disorders can be hidden for long periods of time! Also, doctors can simply turn out to be aholes too! We would like to think only people with the best of intentions would enter careers giving them so much power over vulnerable people ie police officers, doctors, priest, teachers but it’s not always the case!

          • Somewhereinthemiddle
            May 17, 2014 at 3:51 pm #

            Right. My thinking is along the lines of if a physician forced a woman into a cesarean against her will, a nick of the bladder doesn’t seem like it would be that difficult to accomplish or to disguise as an accident. Obviously, there is a LOT of information that isn’t available about this case and the timeline of events, so obviously this hopefully is not anywhere close to being true.

          • AllieFoyle
            May 17, 2014 at 4:06 pm #

            I can’t imagine the point of a doctor, even one with malicious motives (and we have only one side of the story here–which, at worst, seems to imply they were motivated by a desire to save the baby), would think he was accomplishing by nicking someone’s bladder intentionally. It’s one of the commonly acknowledged risks of c-section, and with two prior sections and associated adhesions, etc., might have been even more likely.

            Please, let’s not rush to convict and concoct new accusations solely because of what was reported in a one-sided NYT article (which also used the old incorrect WHO ideal section rate and set the whole thing up as part of some national c-section epidemic against women). It’s really not clear who, if anyone, is the victim or the villain in this situation.

          • Somewhereinthemiddle
            May 17, 2014 at 4:08 pm #

            Good thing no one is doing that.

          • AllieFoyle
            May 17, 2014 at 7:38 pm #

            People are condemning the course of action taken by two doctors and a lawyer based only on the claims of the plaintiff. If that weren’t enough, now we have speculation about them lacerating her bladder purposefully.

          • R T
            May 17, 2014 at 5:12 pm #

            I’m not rushing to concoct any accusations in this case. I’m pointing out its hypothetical possible for a surgeon to also be a mental ill or vengeful person. It is not realistic to believe not one surgeon ever could possibly purposely cause harm to a patient.

          • CanDoc
            May 17, 2014 at 10:14 pm #

            Again, there’s no “payoff” for the physician in this. It just doesn’t make sense. So you have a personality disorder and are a sociopath and want to “retaliate” against the patient – then do something awful that actually affects her quality of life like taking out her fallopian tubes, giving her a bowel injury and a colostomy, don’t close her fascia so she gets a hernia, sew your initials into her incision. But a bladder injury has no lasting punitive effects and potential negative effects such as loss of license and litigation.
            This is an asinine line of reasoning that merits a tinfoil hat!

        • CanDoc
          May 17, 2014 at 10:11 pm #

          But in those horrific situations (rape, etching initials, etc), there is a “payoff” (however heinous) for the physician – pleasure, permanency, etc. With a bladder laceration there is none. Except that you’re stuck looking after the patient for longer due to the catheter.

          • R T
            May 18, 2014 at 2:47 pm #

            Rape isn’t about “pleasure” it’s about power and causing someone harm in anyway can get the same sense of power for the perpetrator.

      • yugaya
        May 17, 2014 at 2:27 pm #

        Bladder injury is debatable, her not consenting to the procedure is not.

      • Guestleh
        May 17, 2014 at 3:15 pm #

        A doctor in NYC etched his initials in a patient’s abdomen during a CS. Another doctor branded a patient’s liver with his name. There are sick people out there in any profession.

  34. CanDoc
    May 17, 2014 at 1:23 pm #

    I keenly await the details of this case. My gut feeling is much like yours. I have use these exact words before in consent discussions: “I can’t and won’t tie you down and force you to have _____ (intervention), that’s not how ‘consent’ works.” But I’ve had some very, very dicey situations in which I pleaded with women to allow me to intervene. There is no angle from which this cases isn’t a nightmare for all involved.

  35. May 17, 2014 at 1:12 pm #

    Bravo, Dr Amy. You are unfailingly fair in your blogging – even if a cs might have been the medically best option, the doctor in this case was clearly proceeding the wrong way and I’m horrified at his actions. So much for you being anti autonomy, anti choice, or anti woman. Well written, too!

  36. Guest
    May 17, 2014 at 12:55 pm #

    Consistent and ethical as always, Dr. Tuteur. The heart of it is here: “I don’t have a right to put a knife in your belly ever.” If she withheld consent and they did it anyway — Guess what? That IS birth rape.

    Of course, also at fault is the NCB movement that has convinced women they’d rather let their own baby die than consent to a c-section.

    The irony is that Mrs. Dray probably will (absolutely rightly) win a major settlement in court and never once pause to thank these guys for sacrificing their livelihoods and possibly their ethics to save her child.

  37. Amy Tuteur, MD
    May 17, 2014 at 12:03 pm #

    What I don’t understand is why her doctors didn’t seek a court order if they felt it necessary to operate without her consent. That would have been an excellent defense against any claims for a damaged baby.

    • PrimaryCareDoc
      May 17, 2014 at 2:43 pm #

      It sounds like they took the hospital’s lawyer’s advice and ran with it. Problem is, the lawyer was wrong.

    • May 18, 2014 at 1:07 am #

      My first thought also was why didn’t the doctors seek a court order, although even that can be problematic. I’ve had several experiences with Jehovah Witnesses where it was necessary — and in one case, the parents refused to take the child home, disowning it, since it had received an exchange transfusion for severe jaundice.

  38. OttawaAlison
    May 17, 2014 at 12:02 pm #

    And the Internet’s ncb community’s collective head explodes at this post.

    Very good post BTW and I agree with you 100%

    • Trixie
      May 17, 2014 at 2:56 pm #

      Yeah, my thoughts exactly. They’re going to be so confused after they read this. Lol.

      • jennie c
        May 18, 2014 at 2:41 am #

        “They”, the “collective head” that you speak of doesn’t actually exist, it’s a bogeyman this bog has created for the purpose of driving their points home by making their phantom opposition look stupid. Same as some opponents of Amy have turned her into a bogeyman as well. get over it yall. address the points, not an imaginary opposition bogeyman.

        • theNormalDistribution
          May 18, 2014 at 5:53 am #

          That doesn’t make any sense.

          • Beth S
            May 18, 2014 at 5:55 am #

            Me either esp since my birth club is infused with them

        • Stacy21629
          May 18, 2014 at 6:01 am #

          Have you been to Like ever?

          • Jessica S.
            May 19, 2014 at 12:22 am #

            Exactly what I was thinking!! Ha!

          • jennie c
            May 19, 2014 at 12:49 am #

            exactly my point. if you are referring to, call it by name. don’t assume that every person holding one particular belief holds countless others.

        • Beth S
          May 18, 2014 at 6:04 am #

          Try Baby Center, the only reason I stick around my birth club is there are a few mothers there that ignore the woo and we support one another.

        • Trixie
          May 18, 2014 at 9:14 am #

          umm….okay then

        • anonymity@@
          May 19, 2014 at 9:58 pm #

          Are you really suggesting that is no delusional cult of woo out there?

  39. Babydoc Mom
    May 17, 2014 at 12:00 pm #

    The one exception would be if she was judged to be incompetent to make decisions because of mental illness. You would have to have a certification by two physicians of this fact. And have a substitute decision makes explicitly identified to give consent.

    As reported, this is clearly abusive. I have been part if a team explaining and re-explaining the risks of an acutely emergent situation and hoping the mother will consent to forceps/c-section to allow us to try to save the baby. I have seen mothers/couples wait too long, and been unable to resuscitate their baby, or had that baby badly damaged. Not often – most people will see the level of anxiety and concern on the part of the whole team, and accept the urgency and the need. I have seen Registered Midwives and doulas gently explain why the birth plan has to go out the window RIGHT NOW. I have NEVER seen a woman taken to the OR against her consent, and I hope I never will.

    I wonder what is missing from this story. I hope, for the sake of all involved, that there is more information that would make this make sense. And while I am glad that this woman and her child are both intact, if this story is true I am gravely sorry for what was done to her.

    Dr Amy, please keep us updated if more information comes to light.

    • CanDoc
      May 17, 2014 at 1:26 pm #

      Agreed, I’ve been in the exact situation also.
      Curious as to what will come out of this. Did her uterus rupture? Was the fetal heart 60? Who knows, because the patient *won’t* tell and the doctors *can’t* tell. But I can’t IMAGINE how a competent, academic physician could take a woman to the OR against her will without an excellent leg to stand on, it makes absolutely no sense unless there are major pieces of this puzzle missing. Awaiting what other information will come to light about this.

      • Haelmoon
        May 17, 2014 at 7:44 pm #

        I have not found the hospital legal department overly helpful. When we had a rare case they wanted to be involved and make sure that we were on the right side of the law. However, it seemed that us OBs were much more clear where we stood legally than the legal department was.

    • PrimaryCareDoc
      May 17, 2014 at 2:42 pm #

      I’m not convinced there’s anything missing from this story. I’ve heard some stories (and seen some instances myself) of hospital lawyers giving shitastic advice that is just plain wrong.

  40. Young CC Prof
    May 17, 2014 at 11:37 am #

    Definitely. Assuming the account in the media is at ALL accurate, this is NOT a fuzzy line here, it’s black and white. If you can demonstrate that you know what’s going on, and you refuse surgery, you don’t get surgery, period.

    It’s possible that the medical situation was not as the woman describes it, that there was an immediate emergency and she or the child would have died if the doctor waited any longer. I don’t care, her rights were still violated.

    Now, once the child is born by any means, the child’s right to live outweighs the parents’ right to make medical decisions. (One exception is, as noted yesterday, with truly dire cases where treatment is unlikely to lead to any reasonable quantity or quality of life, parents should be able to choose between heroic measures and comfort measures.)

    However, you do not violate one person’s bodily autonomy to save another. Period. If the baby is inside the mother, she has the legal right to let it die through lack of medical care. I would turn myself inside out to convince her to change her mind, but you cannot force her.

    • AllieFoyle
      May 17, 2014 at 3:45 pm #

      In general, I agree with you. However, things are not at all cut and dried in this situation. What if she and her baby were both in danger? What if her refusal was due to a lack of understanding about the urgency of the situation? Should she be allowed to kill the baby and herself if that’s the clear outcome of honoring her refusal? Should the physicians caring for her be forced to participate? Should they be held responsible? If not, who?

      • Jessica S.
        May 17, 2014 at 3:59 pm #

        I definitely think there’s a problem if, in a situation where a mother can refuse care that may result in injury or death to one or both of them, doctors et al can still be liable for said results. But I’ve read many times from various commenters here that one’s right to litigation can’t be signed away. I don’t know enough about the laws applicable here to weigh in, but it does seem like healthcare providers could be put in sticky situations that aren’t exactly fair to them.

        • jennie c
          May 18, 2014 at 2:45 am #

          i believe the patient often claims that they didn’t counsel her adequately.

      • not an incubator
        May 17, 2014 at 6:47 pm #

        It’s her body. Yes, she should be allowed to refuse surgery, even if it kills the fetus. Again, as so many people on this board seem to have difficultly understanding this: IT’S HER BODY!

        • AllieFoyle
          May 17, 2014 at 7:51 pm #

          Then there should be some mechanism that allows her to take full responsibility for the death or disability incurred as a result of refusing recommended care.

          • guest
            May 17, 2014 at 8:23 pm #

            If the baby is born alive an damaged, the baby (or someone on their behalf) can sue the mother.
            That is why stillbirth is ‘safer’.

        • Stacy21629
          May 17, 2014 at 11:14 pm #


          Mom CAN make decisions that kill her baby. And I CAN judge her as being horrible immoral in doing so, even if it was her “right”.

      • Haelmoon
        May 17, 2014 at 7:51 pm #

        We are taught this specific case in ethics. Can a mom refuse a C-section, even if it means death of the fetus. The answer is yes, we cannot force her to have a C-section under any circumstance, so long as she is capable of making a decision. I have don’t C-sections on women who were NOT capable of this decision, but we still tried to get the mom to understand what we were doing and why – most people are reasonable and would agree given a good enough reason. Some people are not, and are willing to let their baby die instead of a C-section. Doesn’t make sense to me, but if they fully are aware of the risks, I can force it.
        I have had two cases when a women refused a C-section. Both times, everything luckily turned out fine, but I can tell you we had a lot of documentation in our charts – never once was it though to do surgery against mom’s explicit wishes. The worse was a set of twins, with B >2lb larger than A, and mom flat out refused a C-section, acknowledging she would let baby B die before she consented to a C-section. The delivery was difficult (cord prolapse on B, internal version to vertex after replacing the cord, and a >1hr interval to delivery and a lot of silent prayers), but we had out hands tied. Amazingly, B was fine (cervix finally dilated enough, she also refused oxytocin). This had been a planned UC until someone convinced her to get an ultrasound because she might have twins – it was mono/di with TTTS. Lucky me was on call that day, she came for her initial consult in labour.

        • Guestleleh
          May 17, 2014 at 8:32 pm #

          Holy shit. You must still wake up in a cold sweat thinking of that case.

        • Jessica S.
          May 17, 2014 at 8:45 pm #

          Good gracious – what a scenario! I truly want to know what mindset one must be in to say this: “acknowledging she would let baby B die before she consented to a C-section”. I wonder, she must have been a fish out of water there in that hospital – I mean, if she was hard core enough to be planning a UC, didn’t know about the twins b/c I assume whatever prenatal care she had (IF she had it, I know that’s a “thing” too, to tra-la-la through your pregnancy b/c “nature” and all) I’ll bet she just firmly believe y’all to be the devil incarnate and the hospital a kind of hell. Gah!

          • Haelmoon
            May 17, 2014 at 10:21 pm #

            The nice ending to the story is that she changed her tune by the time the babies came home from hospital. It was the case that first lead me to seek out what these women were reading online. She told us she could not believe how respectful we were, that we never forced her to do anything. The babies were 33 weeks and did well in the NICU. She was surprised by the support for breastfeeding and the encouragement to have parents involved in their care. She essentially learned that everything she thought about the hospital, nurses and doctors was completely wrong.
            She had no prenatal care until her friends encouraged her to see someone because her size was so far ahead of dates. The midwives she call all refused to care for her unless she would consent for an ultrasound. She finally saw her GP (who happened to be a maternity GP) and got the ultrasound. Everything happened very fast from there – the radiologist saw the problem, call the GP. The GP call me and I saw her within a few hour, and delivered her twins ~7 hours later. It took lots of time and communication, but she ended up having two IVs for access (massive poly in twin B, risk for PPH), had an epidural and delivered in our case room, with the anaesethesia standing by in case she changed her mind and would let us do the C-section. She wrote us a very very nice thank you letter, and will be seeking prenatal care in her next pregnancy. I suspect she will still go for the homebirth, but with a qualified MW in Canada (especially the ones I work with), I would consider it a successful change in attitude.

          • Jessica S.
            May 17, 2014 at 10:55 pm #

            Wow, wow! I didn’t realize she delivered that quickly after discovering she had twins. That’s a lot to take in, even if you’re not opposed to conventional care. She’s lucky she had you and the rest of the staff to care for her. I’m so glad it had a happy ending. B/c of her positive experience at the hospital, she’s more likely to transfer if necessary. That’s definitely a win!

          • fiftyfifty1
            May 18, 2014 at 8:59 am #

            “The midwives she call all refused to care for her unless she would consent for an ultrasound.”

            Finally the way it should be!! We hear the lie so often of “but if I as a homebirth midwife make any stipulations then they will all just go UC”. It’s not true. The vast majority of these women trust homebirth midwives. When they refuse to take a case, the woman might threaten to UC as a first reaction, but they would almost always come around in the end.

        • Stacy21629
          May 17, 2014 at 9:03 pm #

          Again – Why isn’t a healthy baby (or two!) enough for these women? That said baby/ies MUST MUST MUST MUST MUST come out her vagina – dead OR alive! – is so sickening.

          • guest
            May 17, 2014 at 9:07 pm #

            Because she can.

          • Stacy21629
            May 17, 2014 at 9:21 pm #

            And as I tell my 4 year old:
            “Just because you can, doesn’t mean you should.”

        • fiftyfifty1
          May 17, 2014 at 9:30 pm #

          Nice work Haelmoon. That baby owes its life to you.

          • Haelmoon
            May 17, 2014 at 10:21 pm #

            To the team really – I may have delivered it, but there was a team that helped convince this women to seek care and come into the hospital.

          • fiftyfifty1
            May 18, 2014 at 9:08 am #

            Yes, they deserve a lot of credit for convincing her to seek medical care. But that medical care was you. And holy cow how amazing: prolapsed cord replacement followed by internal version to vertex in a 2+ pounds bigger TTTS second twin. Those are some awesome skills–that I hope you never have to use ever again.

          • jennie c
            May 18, 2014 at 9:50 am #

            you do sound like one good doc

          • fiftyfifty1
            May 18, 2014 at 9:56 am #

            I assume you meant that for Haelmoon. I personally have none of those skills, that’s why I admire them so much.

    • Jenny_from_da_Bloc
      May 17, 2014 at 4:49 pm #

      And I’m sure if her baby died because the doctor said, “Fine wait and hour or two hopefully you both don’t die…etc,etc.” and the baby died or they both died they would still be suing him and the hospital anyways. He probably knew it was a lose/lose situation and at least if the baby lived he would have that on his side during trial. If the baby died she would have sued him for negligence and not pushing her to have a c-section or not giving her enough information or whatever nonsense they could come up with during trial.
      I just don’t believe these are all the facts and it seems like information is being omitted to make the mother’s case seem more sympathetic.Sure she didn’t want a c-section, but you don’t just show up at a hospital in labor without having a doctor who consents to put his license, livelihood, patient and baby at risk without any knowledge, planning or forethought. It was extremely selfish of her to put those doctors and the hospital in that situation without the doctors prior knowledge of her situation or wants and needs for delivery. If she wanted the VBA2C and couldn’t find a hospital or doctor willing to see her through the delivery then maybe she should have considered all aspects of her situation and why maybe multiple doctors refused to attend her VBAC.
      Did she had GD or Pre-eclampsia?

      • Jenny_from_da_Bloc
        May 17, 2014 at 4:50 pm #

        Why not share her complete medical history and the reasons why the doctor or multiple doctors were refusing to attend her VBAC? I feel bad her autonomy was violated, but I feel worse for the doctors involved

        • Jessica S.
          May 17, 2014 at 11:15 pm #

          You’d think that if the truth was on her side, more details would be a good thing. It’s unsurprising to see a story about the evils of c-sections so I wouldn’t be shocked if this one was spun in that direction. I’m not saying it’s impossible for a CS to be forced upon someone, but think of how many people are involved in a c-section! It ain’t just the doc doing the cutting! I’m to believe that every other person was either completely ok with an unethical practice going in or was too much in fear to speak up? I know they had the OK from legal, but still – I’d like to think I could overcome any fear of reprisal and say “hell no, this is not a situation where this is called for.” I don’t know, the whole thing is weird. There has to have been something more serious going down than we know.

  41. NoLongerCrunching
    May 17, 2014 at 11:09 am #

    But… I read that Dr. Amy wanted all women drugged, strapped down, and their babies cut out of them. Maybe a rebellious sock puppet posted this.

    (I am sorry for what happened to Mrs. Dray. I hope she gets justice.)

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