April 19, 2007

Forced Pregnancy, Forced C-Sections

The Supreme Court's ruling yesterday upholding a ban on the most widely used second trimester abortion procedures didn't fall out of the sky. Their decision that an an anencephalic fetus isn't a reason to allow a woman to end her pregnancy wasn't some anomaly. It came as the crest of a wave of disrespect for women's health choices and the devaluation of our lives and autonomy within the medical profession.

For one thing, there are places in this country where it was already damn hard to get the morning-after pill:

Last month, feminist blogger Biting Beaver wrote about a nightmarish experience she'd had with a broken condom and a callous medical system that refused to give her emergency contraception over the counter or by prescription.

Instead of getting medical care during the critical 72-hour window of opportunity, BB was stalled, humiliated, scorned, quizzed, and deceived. A nurse tried to tell her that EC was "the abortion pill," and other health care providers grilled her about her sexual history and her marital status. Her pharmacy wouldn't sell it to her OTC, her doctor wouldn't call in a prescription, and the local emergency rooms wouldn't give her a 'scrip because she wasn't raped or married.

Pat yourself on the back, culture of life, Biting Beaver is pregnant and she's getting death threats. ...

And let's not forget the ongoing drumbeat of doctors forcing women to have c-sections against their will. Emphasis mine:

... Amber Marlowe anticipated an easy delivery when she went into labor on January 14, 2004. But after a routine ultrasound, doctors at Wilkes-Barre General Hospital, in Pennsylvania, decided that the baby--at what looked like 13 pounds--was too big to deliver vaginally and told her that she needed to have a cesarean. The mom-to-be, however, wasn't convinced: After all, she'd given birth to her six previous kids the natural way, including other large babies. And monitoring showed that the fetus was in no apparent distress.

After she said no to surgery, doctors spent hours trying to change her mind. When that didn't work, the hospital went to court, seeking an order to become her unborn baby's legal guardian. A judge ruled that the doctors could perform a "medically necessary" c-section against the mom's will, if she returned to that hospital. Meanwhile, she and her husband checked out against the doctors' advice and went to another hospital, where she later gave birth vaginally to a healthy 11-pound girl. "When I found out about the court order, I couldn't believe the hospital would do something like that. It was scary and very shocking," says Marlowe. "All this just because I didn't want a c-section."

... 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.

... However, doctors' opinions can also be tragically wrong. Years ago, a Washington, D.C., hospital got a court order to perform a c-section on Angela Carder, who was gravely ill with cancer. Since the mom was in such poor health, the hospital's doctors believed that delivering the 26-week fetus immediately would give it a better chance of survival than waiting for a natural delivery. The result? Carder and her baby both died soon after the operation. Later, in a landmark 1990 ruling, an appeals court overturned the order, finding that Carder had a right to make medical decisions for herself and her unborn child. Her family also received an undisclosed financial settlement from the hospital. ...

Yeah, Angela Carder. I've heard of her. I quote liberally because, again, these stories should be front page, can't-miss news everywhere, imnsho. Emphasis mine:

... At age 13, Angela was diagnosed as suffering from a rare and fatal form of cancer. Despite the odds, she survived and was cured after years of aggressive and often experimental chemotherapy and radiation. Ten years later, however, she developed another form of cancer. She bravely fought for life again, returning to chemotherapy and radiation and resorting to multiple surgeries. Ultimately, she consented to a hemipelvectomy, the surgical removal of her left leg and hip. After more chemotherapy and radiation, there were no signs of cancer anywhere. In 1986, three years into remission and confident in her ability to rob the grim reaper, Angela married and became pregnant. Because of her disability, she was eventually referred to the High Risk Pregnancy Clinic at GWUMC, where she was enthusiastically accepted as a teaching case.

According to her clinic obstetrician, Angela emphasized two points about her health care: she wanted to be watched closely for any signs of recurrence of cancer and, having struggled so long to survive, she wanted to be sure her own health was not compromised because of her pregnancy.

Unfortunately, during the 25th week of gestation, Angela was admitted to GWUMC and eventually diagnosed as having a lung tumor. Again, fighting to live, she wanted everything possible done to prolong her life. Surgery was ruled out, leaving chemotherapy and radiation as the only means of prolonging her life. Angela was informed that her baby was too small to be born, meaning too premature to have a good chance to survive, 2 and that her doctors did not consider intervention on behalf of the fetus appropriate until 28 weeks.3 She was also informed of the added risks to the fetus from chemotherapy and radiation, but Angela still decided to institute aggressive treatment of her cancer. This course was so clearly understood that her attending obstetricians did not consider, much less attempt, intervention for the fetus later that night when Angela's condition rapidly deteriorated, depriving Angela and the fetus of substantial amounts of vital oxygen for many hours.

The next morning, events took an unexpected turn. The hospital's administrators (who were also its liability risk managers) learned of the decision not to attempt delivery of the fetus. The administrator questioned the right of anyone but a court to make decisions affecting a potentially viable fetus, particularly in light of the political controversy over fetal rights. Although the decision was supported by Angela's parents and husband and by the obstetrical department as a whole, as consistent with the wishes of their patient, and despite the advice of legal counsel that the doctors should exercise their best medical judgment under the circumstances (which was not to deliver the - extremely premature and highly compromised fetus), the hospital required a court to decide what should be done for the fetus. Technically, the hospital sought a declaratory judgment as to "what it should do in terms of the fetus, whether to intervene and save its life."

In response to the hospital's petition, a court hearing was hastily convened at the hospital, counsel was rounded up in the hallways of the courthouse and appointed to represent Angela, counsel for the fetus was also appointed, and hospital counsel appeared for GWUMC. The hospital summoned all the witnesses who would testify at the hearing. Angela's family was brought to the hearing just before the proceedings began, with only minutes to confer with Angela's counsel. Angela's long-term cancer specialist, who had been at GWUMC the day before to consult on her case, was not contacted at all.

At the hearing, family members, including Angela's husband, opposed Caesarean surgery because Angela was not expected to be able to survive it and because all agreed that Angela would have opposed it. The treating physicians also opposed intervention based on their understanding of Angela's wishes and the clinical status of Angela and the fetus. However, a neonatologist, who had no familiarity with Angela's medical status, also testified at the hearing that the fetus had at least a 60 percent chance of survival (just slightly less than a fetus from a healthy woman at that gestational age). (Other medical experts have since concluded that there was virtually no chance of survival and that the fetus was already brain dead)

At the hearing almost no attention was paid to what was clinically best for Angela or to what she would want since, according to the hospital, it was "the apparent desire of the patient and her family" that no intervention be done on behalf of the fetus. Instead, the hearing focused on whether to "rescue" the fetus. Balancing Angela Carder's life expectancy as a cancer-ridden patient against that of the fetus (based on the neonatologist's unduly optimistic guesswork), the court ordered the Caesarean. Despite the court's order, the obstetricians refused to carry it out. The hospital was then in the ironic position of being in contempt of an order that the hospital itself had sought. Reluctantly, a staff obstetrician agreed to perform the surgery.

Although assumed to be near death and unconscious, Angela was lucid and able to communicate when, after the court made its ruling, one of her obstetricians told her about the court's decision. When her doctor explained that she might die as a result of the ordered surgery and that he would not perform the surgery without her consent, she said repeatedly, "I don't want it done." However, this declaration did not sway the hospital to withdraw its petition or the court to amend its order. A three-judge appellate panel upheld the decision during an emergency telephone appeal. Minutes later, having just been told that she probably would not survive the surgery, the woman who had courageously cheated death for fourteen years was rolled into the operating room. The fetus died within two hours. Two days later, Angela Carder died, never having received the cancer treatment she requested. ...

Angela Carder died before this execrable ban on a medically necessary procedure was instituted. She died because the American medical establishment is riddled with misogynist, wingnut creeps who don't care about the lives and choices of the women in their care.

Unfortunately for them and for the politicians who support their murderous bigotry, they forgot to take away women's right to vote before their pet Justices made it impossible to ignore the contempt they have for us. But we can vote, we are still citizens, and we're going to organize, organize, organize until our government once again restores our full rights to determine our own medical care.

And btw, to hell with NARAL. Those useless prats are never getting another dime from me.

Posted by natasha at April 19, 2007 12:27 PM | Women | Technorati links |

Part of the problem regarding cesareans is that they are perceived as "safer" because doctors can plan around the event and be better prepared for surprises. There was a New Yorker article about this recently, and the focus was on the idea that cesareans have a higher probability of a safe delivery, but that it calls into question the whole idea of vaginal birth, and potentially creates a class of doctors unable or unwilling to handle it. In western Europe, it's almost standard procedure now to schedule births via cesarean, as though vaginal birth just isn't an option.

A byproduct of having a safer birth via this method, though, which wasn't discussed in the article, and is stated plainly here in this post, is that control of the birth goes decisively to the doctors, and away from the mother.

This is a battle that's going to go on for a long, long time. When my ex was pregnant, we allowed use of an electronic fetal monitor to gather information on our daughter's state before she was born, but we made it clear that only under extraordinary circumstances did we want it to decide the status of her as she was being born. In the mid-1980s and early 1990s, a lot of hospitals were fighting giving parents-to-be this choice, but we stood firm.

But we also did that knowing that we were taking the risk unto ourselves. And guilt plus worry is a dangerous weapon in the hands of a doctor that wants what he or she thinks is a "simplified" process.

My two bits...

Posted by: palamedes at April 19, 2007 01:03 PM

I remember reading about Angela Carder in Backlash. It was the story that stood out the most for me, among a lot of very powerful anecdotes. The kicker, for me, was a quote from Carder saying that the hospital administrators had tried to wave the baby at her and convince her that it had been viable, followed by a synopsis of the "L.A. Law" episode dramatizing the incident, in which the woman gives her life for the fetus, which lives. Because, you know, that makes the hospital administrators right, so we can all go home now, justice was served, and so on.

Posted by: grendelkhan at April 20, 2007 09:51 PM