Forced Caesarean Sections

drkpower

This is an issue that is very likely to arise at some point in this state. It is somewhat surprising that it hasnt already. The situation does come up in medical practice from time to time. This is the type of thing I am talking about:

A pregnant woman is advised that for whatever medical reason (and there are many), the life of her baby would be at serious risk unless a caesarean section is performed. She refuses (for whatever reason). There is no substantial threat to the mother's health or life in performing a CS. Should the doctor be entitled to over-ride that refusal and forcibly perform a caesarean section?

Looking at the legal situation, this type of case did come up a few times in the UK courts a few years ago, and after a number of cases where courts ordered forced caesarean sections, the courts in the UK have now essentially settled this area of law on the side of the mother; she is fully entitled to refuse. However, the Irish situation is likely to be very different. First, there has been no case where this has directly arisen in Ireland. Second, a court, if faced with this situation, in this country, would need to consider the constitutional framework (which the UK obviously doesnt). And if applying A. 40.3.3 (The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.) in a situation where there is a serious risk to the unborn life but no risk to the maternal life, they would be likely to be obliged to vindicate the unborn life which necessarily would involve forcible restraint and operative intervention upon the woman.

So, what do people think? Is this going too far? Is it appropriate to forcibly operate on someone to save another? Personally, in these situations, however distasteful it may be, I feel it is justified.

While it is difficult to discuss this issue without the wider 'abortion' debate coming up, lets try and stick to this particular issue, as the wider topic has been done to death.

metrovelvet

drkpower wrote: »

This is an issue that is very likely to arise at some point in this state. It is somewhat surprising that it hasnt already. The situation does come up in medical practice from time to time. This is the type of thing I am talking about:

A pregnant woman is advised that for whatever medical reason (and there are many), the life of her baby would be at serious risk unless a caesarean section is performed. She refuses (for whatever reason). There is no substantial threat to the mother's health or life in performing a CS. Should the doctor be entitled to over-ride that refusal and forcibly perform a caesarean section?

Looking at the legal situation, this type of case did come up a few times in the UK courts a few years ago, and after a number of cases where courts ordered forced caesarean sections, the courts in the UK have now essentially settled this area of law on the side of the mother; she is fully entitled to refuse. However, the Irish situation is likely to be very different. First, there has been no case where this has directly arisen in Ireland. Second, a court, if faced with this situation, in this country, would need to consider the constitutional framework (which the UK obviously doesnt). And if applying A. 40.3.3 (The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.) in a situation where there is a serious risk to the unborn life but no risk to the maternal life, they would be likely to be obliged to vindicate the unborn life which necessarily would involve forcible restraint and operative intervention upon the woman.

So, what do people think? Is this going too far? Is it appropriate to forcibly operate on someone to save another? Personally, in these situations, however distasteful it may be, I feel it is justified.

While it is difficult to discuss this issue without the wider 'abortion' debate coming up, lets try and stick to this particular issue, as the wider topic has been done to death.

You are going to get the usual brigade of people who say 'her body, her choice'. I can see their point.

However, I was in a position where I was told, C section or you will have a child with a high risk of cerebral palsy. I didnt not argue with the surgeons and I think any woman who is told that and chooses not to get a section is a gambler and I cant see where they are coming from when it comes to taking such a risk.

I think in Ireland the life of the unborn has rights? So I would imagine a doctor could override it anyway?

Do I think the state has the right to over rule her? In a case like mine, if I had said no, I would hope the state would have over ruled me because I would have been so drugged and exhausted after a 23 hour failed induction I would not have been thinking straight.

Weighing it up, assuming the state/doctor would not abuse its power, I would say yes. [BTW my c section is technically elective and not emergency.] However, there should be very strick guidelines, at 20K a pop there is a financial motive for surgery which cant be overlooked either.

Eliot Rosewater

metrovelvet wrote: »

However, I was in a position where I was told, C section or you will have a child with a high risk of cerebral palsy. I didnt not argue with the surgeons and I think any woman who is told that and chooses not to get a section is a gambler and I cant see where they are coming from when it comes to taking such a risk.

The one time I was in hospital I, too, let the doctors make all the decisions: they have been through University and medical school and I simply haven't. I don't think that people should have to obey doctors, in the same way that I think people should be free to smoke, drink, take drugs, jump off of roofs etc: if you want to damage your own health off with you.

But the problem is that this isn't your own health; that of the baby most also be considered. What are the negative consequences of a C section? Are they mostly cosmetic?

metrovelvet

Eliot Rosewater wrote: »

The one time I was in hospital I, too, let the doctors make all the decisions: they have been through University and medical school and I simply haven't. I don't think that people should have to obey doctors, in the same way that I think people should be free to smoke, drink, take drugs, jump off of roofs etc: if you want to damage your own health off with you.

But the problem is that this isn't your own health; that of the baby most also be considered. What are the negative consequences of a C section? Are they mostly cosmetic?

Well, with surgery there is always risk. And if you dont trust your doctor, your, hospital, etc then you might not want to take those risks. There are risks with anesthetics, with possible infections, not being able to breastfeed, walk for a while, blood transfusion, and the likely hood that if you have more kids they will also be delivered by c-section.

The thing is - is the c section rate has risen dramatically since the 70s to now up to 25 or 30 percent and the younger doctors are so afraid of litigation [obstetrics has the highest law suit rate in the US] that they are a bit knife happy. Ultimately, imo obstetrics is experimental medicine. I ended up with a section basically because they got the dates wrong and the baby was just not ready and I should have never agreed to an induction. Should I have refused to comply and the state handcuff me and bring me in for one?

drkpower

metrovelvet wrote: »

I think in Ireland the life of the unborn has rights? So I would imagine a doctor could override it anyway?

Any doctor who restrained (physically and/or chemically) a pregnant woman is this situation without a court order in advance would be taking an enormous risk - they could be struck off and they could very easily be criminally convicted. An Irish court has never ruled on this issue and while my own view is that they would find that a doctor can and should perform a CS (based on A 40.3.3), it is by no means a certainty.

CathyMoran

This is a very emotive topic - I had a c-section for my son and it was a horrible experience. They let an intern try and put the needle in my back 4 times and they messed up every time, then blamed me saying that I have scoliosis (I do not), the consultant got the needle in at his first attempt. I am petrified now of this happening again (am pregnant with my second child). I think that forcing a petrified woman into a c-section does seem a bit barbaric unless there is a serious risk to the child and even then the mother should be allowed to be asleep for the procedure. I should state that I will be having a c-section again but may choose to be asleep for the procedure.

The scar from a c-section is minor, I can barely see it and it has not even been 7.5 months yet since I had my son.

silverharp

Another angle is that CS suits hospitals. In Holles street for example, if the women is not "progressing" to a clock, they start a number of treatments that setup a CS. While doctors do great work , they are not infallable and are subject to group think on certain issues if they are not black and white. I also saw it after our first was born as the community nurses/midwives (again great people) by the "average" our little one was below average weight and they wanted my wife to stop breastfeeding. She stuck to her guns, and everything was fine.

i think there is way too much medical intervention in child birth and elective c sections whether by the choice of the medics and or the mother are on the increase.

no doubt there are cases when a c section is advisable and in the best interests of the mother and or baby but the attitude that childbirth is a medical procedure is alarming and i feel detrimental to what can be a natural and empowering experience for any woman .

i had a child in america and was asked what drugs i wanted ? i gave birth naturally with a little help from gas and air a load of help from an amazing mid wife . The was a midwife in the room who had been working there 4 months mine was the first natural birth she had seen since working there :eek:

CathyMoran

In my case the c-section was necessary and advisable - I just had issues with the annesthatist (sp). If things like that happen then no wonder women are scared.

metrovelvet

CathyMoran wrote: »

In my case the c-section was necessary and advisable - I just had issues with the annesthatist (sp). If things like that happen then no wonder women are scared.

They shouldnt let students experiment on women in labour. I would have refused an intern tbh and insisted on a consultant.

Sleepy

metrovelvet wrote: »

They shouldnt let students experiment on women in labour. I would have refused an intern tbh and insisted on a consultant.

A bit O/T but how is the consultant of the future to learn without performing the actions in real life? Whilst I'd agree that the intern should never have been let get to their 4th attempt of (what I presume was) an epidural, I think allowing them the chance to at least try the procedure once before having to hand over to a consultant is a necessity.

metrovelvet

Sleepy wrote: »

A bit O/T but how is the consultant of the future to learn without performing the actions in real life? Whilst I'd agree that the intern should never have been let get to their 4th attempt of (what I presume was) an epidural, I think allowing them the chance to at least try the procedure once before having to hand over to a consultant is a necessity.

I dont know. Use prosthetics, use the morgue, but you are not experimenting on my spine. Not my problem.

Nevyn

Eliot Rosewater wrote: »

But the problem is that this isn't your own health; that of the baby most also be considered. What are the negative consequences of a C section? Are they mostly cosmetic?

No they are not. I suggest you do some research on it.
http://www.childbirthsolutions.com/articles/birth/cesarean/index.php

Yes with hospitals being busy some will push for intervention during labour with proceedures to speed the process up and if it fails to proceed to a certain point and there is a strain on the mother and a strain on the hospital resources then there is a push to have the baby by c section.


If there is immediate medical risk then yes by all means a c section to save the baby and the mother's life, but for convenience, I would be against and yes the rate of sections has gone up over the last few yes, yes babies are being born bigger due to a range of reasons but I still think the rates are driven up due to time management of resources and insurance reasons.

metrovelvet

Thaedydal wrote: »

No they are not. I suggest you do some research on it.
http://www.childbirthsolutions.com/articles/birth/cesarean/index.php

Yes with hospitals being busy some will push for intervention during labour with proceedures to speed the process up and if it fails to proceed to a certain point and there is a strain on the mother and a strain on the hospital resources then there is a push to have the baby by c section.


If there is immediate medical risk then yes by all means a c section to save the baby and the mother's life, but for convenience, I would be against and yes the rate of sections has gone up over the last few yes, yes babies are being born bigger due to a range of reasons but I still think the rates are driven up due to time management of resources and insurance reasons.

They are driven up imo by litigation. And inductions often lead to a section. THey think its better to have a section than risk the baby being gestating too long, choking on meconium, umbilical cord or amniotic fluid risks so an earlier birth is less risky than a late one. Its an inexact science, thats why I think OBs are experimental medicine. Naomi Wolf's "Misconceptions" has a lot of interesting informaiton about this, the thesis is ultimately that women are not to be trusted with their own bodies.

But sections come with their own risks aside from the obvious post surgical strains. Infection for example. If a hospital is not clean. I know a woman who had a section in the local hospital and a nurse had to come every day and drain the puss out of her for six weeks.

drkpower

metrovelvet wrote: »

I dont know. Use prosthetics, use the morgue, but you are not experimenting on my spine. Not my problem.

Off-topic but just a couple of points. There are no anaesthetic interns (unless things have changed recently). An SHO is the most junior doctor who would be performing an epidural. And they are fully qualified doctors. They are not students. Like with every service, you may not necessarily be served by the most senior person. The practice of medicine is dependent on the ongoing in house training of all specialists. Without it, the future of medicine will be far poorer. Performing procedures on prosthetics or on deceased patients (leaving aside the ethical issues with the latter) is not the same thing as performing procedures on real life patients. It is also worth bearing in mind that in the case of some procedures, a non-consultant hospital doctor may be often far better placed to perform it than their consultant, as the NCHD is the one who performs the procedure far more often.

Of course, if it becomes evident that one doctor having difficulty performing a procedure, another doctor should be called. Sadly, sometimes doctors are reluctant to do so; often because they feel that it is some kind of admission of defeat. That is wrong.

CathyMoran

drkpower wrote: »

Off-topic but just a couple of points. There are no anaesthetic interns (unless things have changed recently). An SHO is the most junior doctor who would be performing an epidural. And they are fully qualified doctors. They are not students. Like with every service, you may not necessarily be served by the most senior person. The practice of medicine is dependent on the ongoing in house training of all specialists. Without it, the future of medicine will be far poorer. Performing procedures on prosthetics or on deceased patients (leaving aside the ethical issues with the latter) is not the same thing as performing procedures on real life patients. It is also worth bearing in mind that in the case of some procedures, a non-consultant hospital doctor may be often far better placed to perform it than their consultant, as the NCHD is the one who performs the procedure far more often.

Of course, if it becomes evident that one doctor having difficulty performing a procedure, another doctor should be called. Sadly, sometimes doctors are reluctant to do so; often because they feel that it is some kind of admission of defeat. That is wrong.

They were saying that they had not performed it before to me - the consultant was there also - it was a very high risk pregnancy and surgery.

I had no problem with the c-section, I had been in bed for most of the pregnancy and was exhausted, I also have other medical issues. Our son was not growing (had not grown since week 31) and he needed to be out. The problem that I had was that the spinal block was done incompetently to say the least - the only reason why I left it be was because the obstatrician was amazing (so much so that if we have another son he will be named after him). I got one glitch in otherwise excellent care.

I can not be the only woman who has had a very traumatic birth - scaring pregnant women is not a good idea - yes, the child must be delivered safely but the option of being asleep for the prcedure might be a kinder option. Having said that, with me I will want to be awake again

Eliot Rosewater

Thaedydal wrote: »

No they are not. I suggest you do some research on it.
http://www.childbirthsolutions.com/articles/birth/cesarean/index.php

Cheers for that (and sorry if my cosmetic suggestion was insulting; don't know why I said that).