I’M sure I wasn’t the only woman who shuddered when she heard that Waterford Regional Hospital had sought a court order to compel a pregnant woman to have a caesarean section last Saturday.
Lawyers for the hospital asked the High Court to compel the woman to have a section because scans of the baby were “not reassuring.” The woman gave consent for the caesarean minutes before the court was due to give its verdict.
That we came so close to denying the pregnant woman control of her body must make us pause for thought. There are basic rights at stake, especially as a leak suggests that new proposed HSE guidelines on patient consent would allow for the intervention of the High Court in the case of pregnant women whose babies are considered “at serious risk” because of the Constitutional protection of the unborn.
Internationally, it is controversial to compel a woman to undergo a caesarean section. In the UK, in 1998, a court ruled that a mentally ill patient could not be subjected to a forced caesarean section, because the foetus could not be treated as a separate person.
The court also ruled that the woman’s body could not be invaded — no more than organs could be extracted by force to save another person’s life.
In a notorious case in Chicago, in 1984, a Nigerian woman was tied to a trolley, with leather straps, and wheeled in for a caesarean section following a court order.
She was hoping to return to her native Nigeria, and she feared that if she had a section she would not be able to have more children, because caesarean sections were less widely available there.
But the most famous case in the US is that of Melissa Roland, who was charged with first-degree murder in Utah in 2004, because she initially refused the caesarean delivery of her twins and one of them was stillborn. The judge said she had shown “depraved indifference” towards her baby’s life.
It was reported that Roland didn’t want a caesarean scar, but what she had said was that she didn’t want to be “gutted from breast bone to pubic bone”. She knew what she was talking about, because she previously had two caesarean sections.
She was also mentally unstable and had a history of drug use. She had been institutionalised by 12, pregnant with her first set of twins by 14, and abandoned by the father of her other two children.
Roland did three months in jail awaiting trial, but, due to public pressure, she was offered plea-bargaining and was charged, instead, with child endangerment.
She was sentenced to 18 months on probation and sent out of the state. But the case led to a national debate on the potential conflict between delivering mothers and their doctors.
In 2010, the influential American College of Obstetricians and Gynecologists recommended that caesarean sections not be forced on women.
The college also revised its guidelines on “vaginal birth after caesarean”, and said that it was a “safe and appropriate choice” for most women who have had a caesarean to have a “natural” delivery next time.
The woman in the Waterford case wanted to have a ‘vaginal birth after caesarean’, but a consultant obstetrician said a previous section had left a scar on the woman’s womb, which could rupture with a natural delivery.
This would constitute a “grave risk” for both the woman and her baby. The baby could die or have severe brain damage, and the woman was at significant risk of a haemorrhage.
I know nothing about the specifics of this case, and, even if I did, am not qualified to comment. But caesarean section, far from being “almost risk-free”, as one consultant obstetrician said in the High Court on Saturday, has risks including infection, haemorrhage, blood clots, injury to other organs, and increased risks for subsequent pregnancies.
Maternal death is three or four times more likely during a caesarean than during a vaginal delivery. Risks to the baby include impaired breathing and injury.
Another reason given for the threat of legal coercion was that the baby was 13 days “overdue”, the placenta was “ageing”, and the blood supply to the baby was diminishing.
The woman disputes the hospital’s due date and, as she was there at the time of conception, it is possible she knows what she is talking about.
In any case, the risks to the baby increase only slightly after 40 weeks, from 2-3 per 1,000 to 4-7 per 1,000. Most babies born post-date are perfect.
One of my friends was two weeks overdue with her first child when her mother-in-law died. My friend was told by a Dublin maternity hospital that she was compromising her baby by refusing to be induced, but she was adamant, because she trusted her instinct that the baby would come naturally after the funeral. The baby did. The registrar apologised to my friend for bullying her.
In the High Court, on Saturday, a senior counsel argued that there were “exceptional circumstances” in the Waterford case, which meant that it would not be a disproportionate response for the court to compel the woman to undergo a caesarean section.
THIS may be the case. However, as a woman who has been through the mill of the maternity system in this country, I do not always agree with its advocates.
I was subjected to the agonising induction of my fourth child, for which the medical staff could give no better reason than “in the past, people had endless labours”.
A friend, in another hospital, was talked into induction and epidural and was being wheeled in for her caesarean when she begged “let me have another chance”, and gave birth naturally.
The “active management” childbirth regime pioneered in this country keeps women prone and pliant. They are forced to give birth to a timetable and subjected to induction, or caesarean, if they don’t manage it. It is a regime that silences the woman.
We understand that doctors and midwives have difficult jobs. But we are not stupid. Rates of caesarean section, and other procedures, vary widely between hospitals: the National Maternity Hospital has a 22% caesarean rate for first-time mothers, while St Luke’s, Kilkenny, has a 43% rate.
Speaking in the wake of the Roland case, the distinguished US obstetrician, Howard Minkoff, said that while he would strongly advise and explain the risks of any course of action, he would not force it, because “the strongest advocate for the safety and health of an unborn child is the baby’s mother.”
Sadly for Irish women, they live in a country where doctor always knows best.
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