Weddingbee boards

There is a lot more information in this article.

A few key points from this article:

• During labor, V.M. "behaved erratically" and at some point refused to consent to a cesarean section, despite her doctor's concerns about fetal distress. The obstetrician ordered an emergency psychiatric evaluation, which found that "V.M. was not psychotic and had the capacity for informed consent with regard to the c-section." The staff then asked for a second opinion, but before the next psychiatrist could complete his evaluation, the baby was born vaginally.
• From the appellate court "irrespective of whether or not V.M. consented to the c-section, there was sufficient credible evidence to support a finding of abuse and neglect as to V.M. The majority therefore eschews any discussion of the issue of c-section
• Well, apparently, neither parent showed up to the first court hearing, days after J.M.G. was born, and when a caseworker called to ask where they were, B.G. answered, claimed he was not B.G., and claimed not to know who the caseworker was or anything about a hearing. Thus J.M.G. was placed in foster care. After the next hearing, where V.M.'s history of psychiatric illness and refusal to take prescribed medication came up, two psychologists who attempted to evaluate V.M. and B.G. ended up getting restraining orders against them; the second "was assaulted in the parents' home." Additionally, "The group contracted to provide parenting classes stated that it could not provide V.M. with services absent a psychological evaluation due to her disruptive and uncontrollable behavior." Oh, and somewhere in there, V.M. claimed she had consented to a c-section, despite all evidence to the contrary.

@vanilla frosting - Yes, bioethics are very frustrating.  For me, the question is whether it is ethical for medical staff to allow a pregnant woman in labor to cause severe life-long disabilities (or worse, death) of the fetus in her without trying to intervene?  Yes, this case turned out fine (the baby was born healthy), but what it the situation had went the other way?  Should medical personnel just let the baby die because a mother doesn't want treatment?  

Here is some more information I found citing the New Jersey appellate court documents.

"[VM]...consented to the administration of intravenous fluids, antibiotics, oxygen, fetal heart rate monitoring, an episiotomy3 and an epidural anesthetic.

She refused to consent to any other invasive treatment, however, including a c-section or fetal scalp stimulation. Hospital personnel explained the potentially dire consequences of not allowing a c-section in the event of fetal distress, but V.M. remained adamant in her refusal.

In the hospital records, V.M. is described as "combative," "uncooperative," "erratic," "noncompliant," "irrational" and "inappropriate." She ordered the attending obstetrician, Dr. Shetal Mansuria, to leave the room and told her if she did not do what V.M. said, she would be off the case. V.M. then threatened to report the doctor to the police.

In fact, at one point V.M. did call the Livingston Police to report that she was being abused and denied treatment. She told a nurse that "no one is going to touch my baby." She continuously refused to wear the face mask that provided her with oxygen and also refused to remain still in order to allow for fetal heart monitoring. She thrashed about to the extent that it was unsafe for the anesthesiologist to administer an epidural. She would not allow Dr. Mansuria to touch the baby or perform an ultrasound examination.

Throughout this entire period, V.M. "was very boisterous and yelling and screaming at the top of her lungs." B.G. was present while all of these events occurred. Dr. Mansuria explained the complications, such as brain damage, mental retardation and fetal death, that could occur if the fetus went into distress and a c-section was not performed. She also explained that an examination revealed a "nonreassuring fetal status."

B.G. said that he understood the risks, but V.M. would not consent to the procedure. The hospital responded appropriately to confront V.M.'s mental state and her refusal to consent to the c-section. After considering V.M.'s "extreme behavior" and signs of developing fetal distress, the hospital staff requested an emergency psychiatric evaluation to determine V.M.'s competency.

I can't find the article now, but there was a pregnant woman in Florida whose doctor ordered her to go on bedrest for a very long time. She had a work situation that prevented it, so she refused. Her doctor went to a judge and got a court order forcing her to go on bedrest.

Interestingly, Sarah Palin loves to tell the story of how she was working in Texas when she went into labor and flew back to Alaska before going to a hospital. Interesting how some people have choices.

This just goes to show you have to look at all possible biases before you completely trust an article.  I initially briefly read it, was disgusted, then noticed the site it was on "womensrights.change.org."  Of course they're going to make it seem like women are victims, and we need change!  I wouldn't have gone into as much in depth research as EvaBostonTerrier did but would have just written it of as extreme journalistic bias.  Thanks for shedding even more light on this fact Eva!

@CorgiTales: I understand your POV, but I can tell you I wouldn't sign a pre-consent. Then again, I wouldn't give birth in a hospital that had a high track record of C-Section. But I have resources to make a choice like that. I certainly wouldn't refuse a C-Section that became necessary, but FAR too many hospitals take this approach as soon as there are any problems.

@Zinzerena: I think you are missing the point here. We sign preconsent forms for emergency treatment and blood transfusions, but there isn't a minor epidemic going on right now of hospitals providing unnecessary and premature emergency treatment and blood tranfusions.

I don't think anyone on this board has stated that they would actually refuse a necessary C-section. What they have expressed is a deep concern about the fact that so many hospitals are performing C-sections too early and too often. If you would strongly prefer to make every safe effort to give vaginal birth, then giving the doctor the greenlight to override your preference doesn't make sense, especially if you are at a hospital with a reputaion of C-section at first sign of trouble track records.

The numbers on C-sections can be shocking. Some hospitals have C-section rates in the teens, some have an almost 50% rate of C-section. For hospitals specializing in difficult births that would make sense, but the numbers vary that much even among regular regional hospitals. I want my care based on my needs and preferences, not on a hospital's overly cautious (and sometimes profit driven) preference.

@CorgiTales: Sorry, I misinterpreted your post, and on re-reading it, the mistake was entirely mine.

I'm no medical ethicist, so I'll leave that thorny issue to others!