A Florida hospital has threatened to force a pregnant patient to undergo cesarean surgery against her will and to report her to child welfare authorities for exercising her right to medical decision-making.
The threat was made in a letter from the chief financial officer of Bayfront Health in Port Charlotte to Jennifer Goodall, a Cape Coral, Florida, mother of three who at the time was nearly 39 weeks pregnant.
The letter informed her that because she decided to have a trial of labor before agreeing to cesarean surgery, her prenatal care providers intended to report her to the state Department of Children and Family Services, seek a court order for the surgery and to perform cesarean surgery on her "with or without (her) consent" if she came to the hospital.
Goodall had three previous cesarean surgeries and based on that experience and careful informed consideration, seeks to avoid additional surgery if possible and to allow labor to proceed in hopes of having a vaginal birth after cesarean.
According to medical research, both VBAC and repeat cesarean surgery carry risks. The risk of uterine rupture increases for women who labor after having had previous cesarean surgeries, but the risks associated with another surgery also increase.
In fact, undergoing a cesarean surgery for the fourth time carries a 1 in 8 chance of major complications and the American College of Obstetricians and Gynecologists says that 60-80 percent of women who attempt VBAC are successful.
"I would definitely consent to surgery if there were any indication during labor that it is necessary," Goodall said. "I am trying to make the decision that will be safest for both me and my baby, and give me the greatest chance at being able to heal quickly after my child is born so I can care for my newborn and my three other children."
National Advocates for Pregnant Women, with Florida attorney Patricia E. Kahn, filed a complaint on behalf of Goodall in federal court seeking a temporary restraining order preventing the hospital from carrying out its threats.
U.S. District Judge John E. Steele denied the request, stating, in part, that Goodall has no "right to compel a physician or medical facility to perform a medical procedure in the manner she wishes against their best medical judgment."
Farah Diaz-Tello, staff attorney for NAPW, expressed disappointment in the ruling: "The process of labor and delivery isn't a procedure; our client is the one trying to avoid a compelled medical procedure. Deciding whether and when to consent to surgery is a constitutionally protected right."
Diaz-Tello said that every appellate court to rule on this issue on a full record has held that pregnant women retain their constitutional rights, including rights to medical decision-making and bodily-integrity.
"No woman should fear that because she's pregnant, she can be threatened, coerced, or deprived of her constitutional rights," the attorney said.
According to declarations of medical experts filed with the lawsuit, the hospital's actions violate medical ethics. Mary Faith Marshall, Director of the Center for Biomedical Ethics & Humanities at the University of Virginia School of Medicine called the hospital's actions "troubling."
Diaz-Tello acknowledged the hospital's concerns about malpractice liability, but noted that there is no legal or ethical authority that supports managing liability concerns by forcibly performing unwanted surgery.
Here's Jennifer Goodall's complete statement, released on July 25:
My decision to allow labor to proceed before consenting to a surgical intervention is based on years of research, careful consideration of the risks to me and my baby, and my family's needs. All I want is to be able to go to the hospital when I'm in labor and have my medical decisions respected - and my decision is to proceed with a trial of labor and not have cesarean surgery unless some medical complication arises that makes cesarean surgery necessary for my or my baby's health. Instead of respecting my wishes like they would for any other patient, my health care providers have made me fear for my safety and custody of my children. The people who are supposed to be caring for me and my baby have put me into an even more dangerous situation. I know I'm not the only one to go through this; I'm speaking out because pregnant women deserve better.