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Coercive C-Sections

Coercive medicine

Increasingly in the United States, pregnant women are encountering legal or more subtle pressures to have c-sections. Currently, more than a million expectant women have the operation annually, as America's rate of surgical deliveries has hit an all-time high. In 2003, cesareans accounted for nearly 28 percent of births in this country, compared with just 5 percent in 1970. Many factors contributed to this rise  -- increasing numbers of repeat c-sections, doctors' fears of malpractice lawsuits, and women waiting longer to have kids (which is related to higher rates of complications), to name a few. But while the procedure is usually quite safe and can be potentially lifesaving for mother and baby, it also poses a number of potential risks, including severe bleeding, infection, injury to the fetus, blood clots, and even the mother's death in extremely rare cases.

Yet hospitals in at least a dozen states have obtained court orders to compel unwilling women to undergo this major abdominal surgery. And while Marlowe was able to escape the scalpel, other patients were operated on  -- despite their verbal or even physical resistance. In a tragic 1984 case, staff at a Chicago hospital forcibly tied a pregnant Nigerian woman who had declined a c-section to her hospital bed with leather wrist and ankle restraints. The woman objected to the surgery because she planned to return to Nigeria where the operation wasn't readily available, and she rightfully worried about health risks, including a ruptured uterus, if she became pregnant again and had another child vaginally back home. As she screamed for help and frantically tried to free herself, doctors, with a judge's permission, wheeled her off to the O.R. to perform the procedure.

Defying doctors' advice can even lead to criminal prosecution, as Melissa Rowland discovered last year. While pregnant with twins, the 28-year-old Utah mom initially declined a recommended c-section, even though doctors warned that without it her babies might die due to low levels of amniotic fluid and other problems. Several days later, on January 13, 2004, she changed her mind and had the operation. Her daughter, Hannah, survived after treatment with oxygen and antibiotics, but a twin boy was stillborn. Contending that the initial refusal caused his death, prosecutors charged Rowland with first-degree murder. After spending three months in jail, she accepted a deal in which the murder charge was dismissed in return for her guilty plea to two counts of child endangerment (unrelated to her c-section refusal). She's now free, and serving 18 months of probation.

"This case is a tragedy compounded by a shocking abuse of legal authority," contends Lynn Paltrow, executive director of NAPW and a lawyer specializing in reproductive issues. "It shouldn't be a crime for pregnant women to disagree with doctors and make their own medical decisions. Nor should they be punished for a bad outcome when there's always some risk to giving birth, regardless of whether it's vaginal or by c-section."

And you can't be legally compelled to undergo any other medical procedure for the benefit of another person. "You don't have to donate your kidney, your bone marrow, or your blood, even if someone else might die without it," explains Howard Minkoff, M.D., chair of obstetrics and gynecology at Maimonides Medical Center, in Brooklyn, New York, and coauthor (with Paltrow) on an analysis of the Rowland case published in the December 2004 issue of Obstetrics and Gynecology. You also can't be prosecuted for murder if you refuse. "So why should c-sections be any different?" the doctor adds. "That's saying pregnant women have fewer rights than anyone else, including a fetus."

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