Month: July 2009

I read about the case of New Jersey Division of Youth and Family Services v. V.M. and B.G. with horror. The story of a laboring woman refusing a cesarean section and, as a direct result, having her newborn daughter (healthy after a vaginal delivery) removed from her custody shocks me. She was declared to have abused her unborn daughter and was described as having been uncooperative and belligerent in labor.

I am not a lawyer and am sure there are nuances to this case that I do not understand. But at the most basic level this case privileges the medical establishment and judgment of a doctor over the rights and instincts of a woman in a way that I find tremendously alarming. I utterly reject the logic that says that for challenging the medical establishment’s assumptions, V.M. is a mother so unfit as to deserve having her daughter permanently removed from her custody. How is this different from a parent deciding to spare a child with cancer a painful and low-odds chemotherapy treatment? In that case, the parent is deemed humane. Here, V.M. was deemed unfit and reckless.

My understanding is that informed consent is a part of all medical procedures, particularly those involving major surgery. Clearly there is a fine line here to be walked; in some small percentage of cases, cesarean sections unquestionably save lives. That said, the US averages about 33% of deliveries by c-section, whereas in western Europe it is about 5%. This discrepancy suggests, at least to me, that a great deal of US c-sections might be avoided. We know for a fact that there are many interventions in modern childbirth that are neither medically necessary nor, perhaps more alarmingly, completely understood by the laboring mother. I do not judge in the least how people choose to deliver their babies, but I think it is understandable that the laboring V.M. might have questioned the absolute need for a c-section in her case (and she was proven right).

By implying – in fact, asserting – that V.M. ought to have submitted without question to the medical authorities and procedures, the ruling sets a scary precedent that reminds me of the era of “twilight sleep” at the beginning of the 20th century, when women delivered their babies in a semi-conscious state and often had no memory of the experience. Do we really want to return to a world where a laboring mother is nothing other than a vessel, whose rights are forfeited in favor of the norms of the medical establishment?

This case seems to tread on both the tricky landscape of the abortion debate (where the rights of a woman intersect with those of her unborn child) and that of the neonatal ward (where questions of when and how much lifesaving effort should be applied to very very premature babies). I am no expert on either topic and I understand that there are deep moral complexities involved. I do believe, however, in the primacy of a woman’s right to her own body and, certainly in this case, where a healthy vaginal delivery ensued, find the removal of the baby from the mother’s care to be punitive in the extreme. It is one thing for a hospital staff to be disgruntled that a mother would not sign a blanket c-section waiver, but quite another to deem that mother as unfit after the child has been born and the c-section is proven to have been unnecessary.

Furthermore, to use V.M.’s “uncooperative” behavior during labor as evidence of her unfitness as a mother is ludicrous. I’ve delivered two babies and I was certainly neither placid nor quiet during either experience. There is no reason to extrapolate from a woman’s behavior in labor that she is not concerned above all with the health of her baby. While I absolutely acknowledge that there may be more to this case, both legally and medically, than I understand, the basic facts of it trouble me deeply. A woman who questions the assumptions of the modern hospital birth and chooses to follow her own intuition is not abusive, and she does not deserve to lose her maternal rights. In fact, I would go further and say that a woman who is educated, engaged, and aware enough to actively participate in her own labor and delivery deserves to be celebrated, not punished.