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Culture wars over reproductive health in the United States often focus on birth control and abortion, but there's another angle to bodily autonomy that's equally important: Pregnancy, labor, and delivery. Activists need to be discussing the active choice to carry a pregnancy just as much as they discuss the right to abortion services, and they need to be advocating for pregnant patients who need support, including those pressured into medical procedures they didn't consent to and those who have their children taken away for spurious reasons.
One concerning issue in the world of labor and delivery is that of the forced or coerced c-section, in which the patient is compelled to undergo surgery instead of being allowed to deliver vaginally. This is an example of so-called "fetus first" decisionmaking which puts the life of a fetus over the life of a pregnant patient — similar decisionmaking and sometimes legislation is used to justify prosecuting pregnant patients for using drugs, drinking alcohol, or engaging in other activities deemed dangerous to fetal health by authorities.
While c-sections can be lifesavers, when they happen against the will of the patient they can also be traumatic and invasive surgeries with serious emotional and physical complications. Patients who undergo c-sections may find it difficult to deliver vaginally in the future, and they can be at risk of loss of fertility, loss of sensation, and other issues depending on the circumstances and handling of the procedure.
A c-section can also be emotionally traumatic, especially when the procedure is a "crash" c-section conducted to save the life of a baby, even more so when patients were planning natural births and find themselves abruptly thrust into medicalized birth environments.
A growing number of patients are developing birth plans and requesting minimal intervention, preferring to control the circumstances of their labor and delivery. Some hospitals and physicians feel otherwise, as in the case of Michelle Mitchell, who is currently suing because she was forced to have a c-section in 2010 over her repeatedly expressed protests. Another patient, Rinat Dray, has a similar suit winding its way through the legal system.
Mitchell says she reported to the delivery ward with plans for having her baby vaginally, but was browbeaten over the course of hours into a c-section. She claims that the physician involved refused to allow her to request a second opinion, instead asserting that the fetus' size made it impossible to deliver vaginally, especially given the complications presented by her gestational diabetes.
Dray says that hospital personnel threatened to take her child away if she didn't consent to a c-section, with doctors claiming that her uterus would "rupture" if she insisted on trying to deliver vaginally. Her chart clearly indicates that her physician opted to override her birth plan, and that the hospital's attorney supported the decision, despite the fact that medical ethicists generally do not support compelling patients to undergo c-sections given their invasiveness and the lack of bodily autonomy implied by insisting that patients surrender their bodies to unwanted surgical procedures.
One patient, Angela Carder, actually died along with her baby when physicians decided to operate despite the fact that a c-section posed considerable risk to both the cancer patient and her pregnancy. In her case, medical evidence illustrated that providers made preemptive decisions without consulting her regular physician, and her family took the matter to court in what ultimately became tense legal proceedings as one side argued for the autonomy of pregnant patients while the other suggested that the life of a fetus should take precedence over the pregnant patient.
These situations are part of a disturbing national "fetal rights" trend that's creeping across conservative states but trickling into some liberal ones as well. In addition to laws that attempt to criminalize pregnant patients for engaging in behaviors believed to endanger pregnancies, some states are also attempting to pass fetal "personhood" laws, which would ensure that a developing pregnancy is treated as legally equivalent to a living human being.
Such laws are rightly targeted as a cause for concern among advocates who want to preserve abortion rights, but the problem runs deeper than that.
If the life of a fetus is prioritized over that of a pregnant patient, it means that hospitals can override the needs of that patient in the interest of the fetus, whether that results in forcing a patient to carry an unwanted pregnancy, deliberately ignoring a birth plan, or keeping a patient alive in order to ensure the successful delivery of an infant, as happened in 2014 in the case of Marlise Munoz. A Texas hospital insisted that the comatose woman be kept alive because of her pregnancy. The 22-week-old fetus she was carrying had severe anomalies consistent with oxygen deprivation and an unhealthy fetal environment — likely, it wouldn't have survived to full term. Her family finally prevailed and she was allowed to pass away peacefully. Another pregnant patient was kept on life support until physicians delivered a living infant earlier this year.
The rise of conservative viewpoints that override actual science in the United States makes medical ethics increasingly complex, and it's depriving pregnant patients of the right to make decisions about their own bodies, whether they want to terminate unwanted pregnancies or carry them to term and decide how to deliver on their own terms.
While there have been relatively few cases overall of patients forced to undergo c-sections, they're still worrying, especially if they take on an upward trend. Ethicists exploring the subject need to set hard boundaries, making it clear that forcible surgeries aren't acceptable.
In these cases, patients are deliberately speaking out against c-sections, with informed consent in mind. They're aware of the potential risks of choosing to deliver vaginally, and they're opting to make the decision they believe best serves themselves and their families. Hospital personnel may disagree, but their job still involves respecting patients, not dictating how they should manage their pregnancies.
When the law starts allowing hospitals to make those decisions, it treats pregnant patients as incubators and suggests that fetuses are more important than the human beings who carry them, which is an extremely disturbing precedent.