Not Wanting A Cesarean Qualifies As Mental Illness?

Illustration for article titled Not Wanting A Cesarean Qualifies As Mental Illness?

A horrible case of accused neglect has taken a baby from her parents and raised questions about exactly why they were deemed unfit.


Here's how Salon's Kate Harding summarizes the situation:

In 2006, a woman known only as V.M. in court documents gave birth to a baby girl, J.M.G., at a New Jersey hospital. 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. And healthy. Oops...Nevertheless, a social worker at the hospital contacted the Department of Youth and Family Services, and J.M.G. was removed from her parents. Eventually, a judge agreed with DYFS that V.M. and B.G.'s parental rights should be terminated. Documents recently released by the apellate court say flat out that at that point: "the trial judge found that J.M.G. was an abused and neglected child due in part to her parents' failure to cooperate with medical personnel at the time of her birth. V.M.'s refusal to consent to a c-section factored heavily into this decision." And still, V.M. lost the appeal.


On the basis of these facts, the case provoked quite a bit of outrage, and understandably so: as Harding asks, when the parents haven't been allowed to take the baby home, how can they be accused of neglect? But as Harding looked into the facts, she found it was actually a bit knottier than this, and that the parents' behavior might, in fact, be called "erratic." To wit, neither parent showed at court hearings shortly after birth - and refused to deal with social workers on the phone - which is why the baby was placed in foster care. Evaluating psychiatrists claimed that they were "assaulted" when they tried to examine the mother (who had a history of mental illness and going off her meds), others diagnosed the mom as schizophrenic and unfit, and changing stories about whether the mother had, in fact, refused the C-section in the first place confused matters further.

While all these things in sum, from a legal standpoint, might meet the criteria for unfitness, it also seems like a bit of a chicken-and-egg: surely some of the hostility, paranoia and resistance to the process might be attributed to the fact that, I don't know, these people had their child removed, and were caught in a nightmare of red tape? If they weren't unstable to begin with, surely this could have pushed a lot of new parents over the edge. The fact also remains that none of this would even have been in question - their fitness, their mental state, anything - had the mom just gone along with the (unnecessary) C-section. And at the end of the day, that feels wrong.

Now, I understand why doctors err on the side of caution. Nowadays, the climate is such that lawsuits and prohibitive insurance policies are discouraging medical professionals from going into obstetrics, and you can understand why they'd want to avoid any complication that would result in harm to mother or child - as would most mothers. But insisting upon any procedure, even if a doctor thinks it best, is paternalistic. People have the right to refuse procedures - and often do, on, for instance, religious grounds. An appeals court judge agreed with this, in fact - stating that the Cesarean was, contrary to what internet outrage implies, the ultimate issue. A baby was not "taken from mom because she refused a c-section," - save initially - but that is what caused them to look into her mental fitness. The judge seemed to take the view, in my layman's understanding, that this was akin to an unnecessary incision - that led to the discovery of a life-threatening cancer, and allowed the courts an insight into what was best for the baby.

Now, it's hard to know what to believe. My gut tells me that, if parents want their baby, the court's first obligation should be to try to make that work: send a shrink to observe, if you must, but give them a chance to take their baby home first. Even if the parents have refused to cooperate, is foster care still a better solution? The truth is, though, I can't know anything, save that it's a tragedy. And that this whole case arose from too many people rushing to judgment.


Refusing A C-Section = Abuse And Neglect? [Salon]

Is A Woman In Labor A "Person"? New Assaults On Pregnant Women's Civil Rights In A NJ Case [Huffington Post]
Newborn Taken From Mom For Refusal Of C-Section [Babble]

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I'm Chuck Bass

I've been researching the hell out of medical care and the birth process. I don't want to bore everybody with too many details, but traditional obstetric treatment is, at least in my opinion, totally batshit crazy.

There are so many things that happen to pregnant women that make no sense — women are diagnosed with gestational diabetes based on a faulty test that usually can't be replicated, even though there is no documented evidence that treating gestational diabetes results in improved outcomes for mothers and babies. Women with GD are often induced early because an ultrasound reveals a big baby, but ultrasound is notoriously unreliable when it comes to estimating how big a fetus is. Oh, and plenty of women who don't have GD have big babies.

There's the cascade of interventions during labor — if a woman's labor isn't "progressing" fast enough for her doctor's liking, they may give her pitocin or misoprostal (misoprostal is NOT approved for this use) to speed up the labor. This results in more painful contractions, which in turn might result in an epidural, which in turn might result in labor slowing down and alleged fetal distress, which in turn might lead to forceps or vacuum delivery or a c-section.

The c-section rate in this country is insane and the vast majority of c-sections are not medically necessary. However, obstetricians are trained surgeons and naturally are inclined to perform surgery when they think there's a problem or there might be a problem (even if there really isn't). Unfortunately, so many women who have unnecessary c-sections don't complain about it after because they (thankfully) ended up with a healthy baby. So nothing changes.

Sorry for the rant, but as a pregnant person with a low tolerance for bullshit, this stuff really gets me riled up. If anybody wants to know more about these issues, I recommend "The Thinking Woman's Guide to a Better Birth" by Henci Goer, although there are probably more current sources out there.