Forced Csection??

fiestynurse · Jan 19, 2004

"Do we let a baby in the NICU die because the parents don't want a transfusion? Do we let children die if their parents don't want to treat cancer with traditional medicine?"

THIS IS A TOTALLY SEPARATE ISSUE! It does not involve the invasion of a woman's body against her will.

I Give-up!

Dayray, RN · Jan 19, 2004

I have to agree, we aren't getting the whole story here.

This does sound like a drop in patient with no prenatal care I mean if she had had prenatal care did'nt ya think these concerns would have been discussed and a decision made ? If she wanted a lady partsl birth for such a large baby she defiantly could have found someone to do it.

As for the court decision I'm sure that was illegal and I don't think anyone here would say it wasn't immoral regardless of it's legality.

But I also believe that the doctors had the right to refuse to do a vag delivery. Yes we must respect the rights of the patient and in this case (at least based on the facts we've been shown in the article) everything turned out okay. However, a 13 pound baby is a very strong indication for a c/s.

This patient was afraid of C/S and while yes it was her right to decline it was not rational to do so. She probably didn't have prenatal care and obviously doesn't trust in her doctors opinion. She has the right to feel that way and to act on it but she cannot expect to have a doctor do something they believe is too risky and likely to cause harm to her when there is a reasonable alternative.

How many times have you run into people who talk all about how they know better then the doctor or nurse? Well maybe they do but then they need to find a Doctor or nurse that sees things the way they do. As doctors and nurses we should do as much as we can to respect the patients wishes but we cannot become automaton's devoid of professional discretion acting only as the patient directs us.

Shoulder dystopia is FREAKING SCARY (only way I can describe it) I spent some very scary minutes last night working on a baby that was stuck for only about 45 seconds and that baby was only 9 lbs. Babies and even sometimes moms die and the doctors were very well justified to refuse to expose this patient to that risk.

fergus51 · Jan 19, 2004

Originally posted by fiestynurse
"Do we let a baby in the NICU die because the parents don't want a transfusion? Do we let children die if their parents don't want to treat cancer with traditional medicine?"

THIS IS A TOTALLY SEPARATE ISSUE! It does not involve the invasion of a woman's body against her will.

I Give-up!

I guess I just don't think it's that different. For some parents, receiving blood will damn them spiritually, so they feel violated when that situation comes up. I thought that violation may be similar to a forced operation.

Soon2BNurse · Jan 19, 2004

There are religions that believe that getting another persons blood will be a sin. And from what they taught us in school, they said if they refuse it, it is like refusing treatment and we have to respect the wishes of the patient. But I'm still in nursing school so I don't know much

SmilingBluEyes · Jan 19, 2004

Originally posted by fiestynurse
I know these types of stories are hard to believe in a civilized society, but it happens! Court-ordered c-sections are a particularly egregious abuse of state authority because this surgery tends to be carried out on society's most vulnerable, powerless women. In 1987 the New England Journal of Medicine published a study of court-ordered c-sections that revealed that 81 percent of the patients were low-income women of color.

How many more people does the Newspaper have to interview before you "buy this story?"

SmilingbluEyes - You say "Refusal should be able to go BOTH ways" and our main concern should be the risk of litigation.

So, we intimidate a laboring patient until she's forced to walk out the door. After all we know what is best for the patient. She's just some stupid, crazy woman. Her and her husband have to drive from hospital to hospital looking for someone who will deliver their baby lady partslly.

I have seen more nurses, doctors, and hospitals get themselves into worse legal trouble because of fear of litigation, than from doing what they feel is the right thing. This story is a perfect example. Now, the hospitals involved face a possible civil rights lawsuit in federal court.

Thank God for the nurses and doctors at Moses General Hospital, who respect the rights of women and for Linda Paltrow of the National Advocates of Pregnant Women.

By the way, it is not a "failed home birth" it is an "attempted home birth" Right off the bat your judging these home birth moms and labeling them as failures. I was a Maternal/Child Health Nurse for 12 years and my experience with home birth moms has mostly been positive.

Always remember your most important nursing role is being a PATIENT ADVOCATE!

Ok we have a failure to communicate here, OBVIOUSLY. Let me ATTEMPT to clear it up from my end.

NO we DO NOT TRY TO INTIMIDATE PEOPLE WHEN THEY WALK IN OUR DOORS. there you are wrong; the nurses and doctors I work with are EXCELLENT patient advocates, and respectful of their rights/desires. I would NOT work there if this were NOT the case.

Oh, and yes I said "failed home birth" DELIBERATELY, cause that is what exactly THEY come in feeling....like they failed!!! It's up to US (the nursing staff), to pick up the pieces and help them come to terms with the new situation and help them feel good about the birth, regardless of circumstances that are at minimum upsetting to the laboring woman and her family. And my friend,we do that just that, my coworkers and myself.....

And we DO it under somewhat difficult circumstances, to say the VERY least. I did NOT say homebirth is NOT positive. I was not "dissing" homebirth at all and if you read my post, you would see that. I KNOW Better. I know it is an empowering and wonderous experience; one NOT ONCE DID I TAKE A THING AWAY FROM. You misread my post, I think.

I also think it would be helpful to put your self in OUR shoes, (with the experience you claim to have, it's not a far leap).

Imagine an case of abruption, extreme fetal distress, undiagnosed multiple gestation (this was just 3 weeks ago), or severe dystocia (you fill in the blank, cause I have seen most of these)--- comes thru your doors at 3:00 in the morning, when you have to think on your feet and learn as much as you can about a patient you know SQUAT about. You have no doctor in the house other than ER, and NO anesthetist. You are in the position of having to put all the pieces together, and yes, be an ADVOCATE all the while. And yet, you had better make things happen fast. Could be, one or two lives are riding on your very actions over the next 30 minutes or less.

All this, while, we are trying to win the trust of people who hold us as a "medical persons" in very low esteem sometimes. (and believe it or not, I understand this more than you know and respect it). It's difficult to say the least. They are understandably upset. Sadly, but quite often, their birth attendants actually fail to discuss with them the possiblity of the need for hospital back-up til the *poop* hits the fan! Can you spell **DIFFICULT** for BOTH SIDES when they do this? This is what we deal with, as well as these poor ladies and their families.

Where do you get in my posts I am not an advocate for my patients......? My wording bothers you? Hmmm...Did you bother to read and even understand what I am saying?

Oh well no matter, we don't see eye to eye on this and that is ok. We can agree to disagree and respectfully. Or, We can go round and round forever. I choose the first option.

But I leave asking you: don't ASSUME I am not a patient advocate cause I DOUBT the content of a story posted here, very likely for "headline-grabbing", like so many. I repeat, I don't believe everything I read. If that makes me a failure as a nurse and patient advocate in your eyes, so be it. I, fortunately, don't answer to you. And I don't need your cautionary words to remind me to do what I do best, *advocate for my patients*. You have a Good night now. :kiss

allnurses Guide · Jan 19, 2004

Deb, excellent post. Really excellent.

steph

fergus51 · Jan 19, 2004

Originally posted by Soon2BNurse
There are religions that believe that getting another persons blood will be a sin. And from what they taught us in school, they said if they refuse it, it is like refusing treatment and we have to respect the wishes of the patient. But I'm still in nursing school so I don't know much

This is the case if an adult is refusing treatment for themselves, but not so when it is a minor. There have been several court cases relating to this, and blood is generally given against the parent's wishes in such a case. It is VERY difficult for the parents, but the healthcare providers still do it. I was just using that as an example of patients' preferences vs medical needs.

Mimi2RN, ASN, RN · Jan 19, 2004

Sad story from a few years ago: Doc was called to a delivery when mom was crowning. He was the on-call doc, nothing in mom's prenatal to suggest any problems. Turned out to be a big baby, 12lbs, the head was out, the baby got stuck. A crash section, but the baby was dead, had to be pushed back into the pelvis to get it out.

I can understand any doc wanting to do a section, parents always assume the baby will be fine, but they don't know that when things go bad, it can be very, very bad.

Didn't the mom in this story have any prenatal care? She should have discussed this with her OB if she had one!

BRANDY LPN · Jan 19, 2004

Court delivers controversy

Mom rejects C-sections; gives birth on own terms

http://www.timesleader.com/mld/timesleader/news/7722217.htm

By DAVID WEISS

[email protected]

WILKES-BARRE - A judge late Wednesday afternoon gave a local hospital permission to force a woman to deliver a baby via Caesarean section against her will.

Doctors warned the expectant mother that not having a C-section could kill her and/or her child. But against doctor's orders, Amber Marlowe left the hospital.

Hours later, Wilkes-Barre General Hospital received legal permission to become guardian of the fetus and perform the C-section if Marlowe returned to the hospital.

Marlowe never returned. She gave birth lady partslly Thursday morning at Moses Taylor Hospital in Scranton to a baby girl, her and her husband's seventh child. Court papers said it was her seventh pregnancy in seven or eight years. The Marlowes said the mother and infant are healthy.

Attorneys for General Hospital sought the highly unusual action through a lawsuit because its doctors said Marlowe, who went to the hospital Tuesday night, adamantly refused to deliver the fetus by C-section because of "religious" beliefs.

Her refusal came after warnings by doctors that a lady partsl delivery could result in death for the fetus because it was expected to weigh 13 pounds. They also were concerned with complications Marlowe had in other pregnancies.

The hospital was acting to "preserve and protect the rights of (the fetus) regarding its health and survival," the hospital's attorney, Mary G. Cummings, wrote in court papers.

Luzerne County Court of Common Pleas Judge Michael Conahan late Wednesday afternoon approved the request.

Marlowe's husband, John, said the hospital made up the story, including the part about the religious beliefs and the fetus' size, after its staff was "arrogant" in trying to force Marlowe to have a C-section.

His wife was initially cleared to give a lady partsl birth at General, but doctors held her at the hospital for 13 hours, telling her "horror stories" in trying to change her mind, he said.

"They just kept telling me to do a Caesarean section," Amber Marlowe said. "They were forcing me in to it."

The events began to unfold Tuesday when the Marlowes, of Academy Street in Plymouth, first went to Mercy Hospital in Wilkes-Barre to give birth.

According to Cummings' court papers, which identify the Marlowes as Jane and John Doe for confidentiality reasons:

The couple went to Mercy Hospital where the staff advised them a C-section should be performed for the protection of the mother and fetus.

The couple refused, insisting the fetus be delivered lady partslly, and left the hospital.

Later, the couple went to the emergency room at General Hospital, which is part of Wyoming Valley Health Care System.

Drs. Lynne Coslett and Stephen Zeger on Tuesday and Wednesday repeatedly told the Marlowes a C-section was necessary.

But the Marlowes again refused.

"Jane Doe and John Doe have made it clear that they are adamant that they will not consent to a C-section, regardless of the danger that a lady partsl delivery presents to Baby Doe," Cummings wrote. "There exists the imminent threat of irreparable harm to Baby Doe in the absence of an immediate order."

John Marlowe said the hospital's request is full of "lies," and is considering taking legal action against General Hospital.

He said his wife wanted a lady partsl delivery because all of her prior six births were done that way, including births of children larger than her newborn. A friend of Amber Marlowe also died from a C-section, making her wary of the procedure, the couple said.

"It's up to the mother," said John Marlowe, who has lived in the area for just more than one year. "They insisted she have a C-section."

Amber Marlowe said she had no religious concerns about the procedure. John Marlowe said his family practices typical Christianity, and he does not belong to any radical sect.

The hospital court papers also say during a prior Marlowe birth, a fetus suffered a "shoulder dystocia." That's an obstetric emergency that can severely injure the mother and fetus.

That, John Marlowe said, is also untrue. So is the allegation that the ultrasound showed the fetus at 13 pounds, he said, adding the test showed the infant was just more than 11 pounds. The infant weighed less than 13 pounds at birth, Amber Marlowe said.

John Marlowe did not want the precise weight revealed, and he refused to reveal his or his wife's age. The couple has been married for more than nine years, John Marlowe said.

Conahan's court order gave the hospital permission to notify the Marlowes of the court order if they had returned to General Hospital. Cummings said the ruling was the first of its kind in Pennsylvania.

David Weiss, a Times Leader staff writer, can be reached at 831-7397.

BRANDY LPN · Jan 19, 2004

Posted on Fri, Jan. 16, 2004

Judge's and hospital's decisions in the wrong, say legal experts

By TERRIE MORGAN-BESECKER

[email protected]

WILKES-BARRE - An area hospital trampled upon a pregnant woman's rights when it obtained a court order that would have forced her to have a Caesarean section against her will, said several attorneys.

The extraordinary legal action by Wyoming Valley Healthcare System never played out - the woman gave birth lady partslly at another area hospital. But the potential ramifications of the order drew the attention of several attorneys from national organizations who fight for women's reproductive and civil rights.

The key issue, the attorneys said, is whether the rights of a fetus can override the rights of the mother.

"It's well-established common law that an adult has the right to make medical decisions on their own behalf. Pregnancy does not strip a woman of that legal right," said Colleen Connell, an attorney who handled a similar case for the American Civil Liberties Union in Illinois.

Attorneys for Wyoming Valley Healthcare System on Wednesday convinced Luzerne County President Judge Michael Conahan to name the health-care system as legal guardian for the fetus of Amber Marlowe of Plymouth.

Marlowe had left the health-care system's General Hospital against medical advice Wednesday morning after doctors, believing her fetus was too big to safely deliver lady partslly, insisted she undergo a Caesarean section. Marlowe and her husband, John, objected to the operation.

The court order, which was obtained without the Marlowe's knowledge, gave doctors the right to perform the operation, with or without their consent.

"This is unbelievable. They're basically saying we're going to force you to allow us to cut you, even if it's against your religious beliefs," said Michael Pendolphi, a Forty Fort attorney who deals with custody issues.

Kevin McDonald, spokesman for the health-care system, said officials would not comment on specifics of the Marlowe case. "We act in the best interest of our patients. Other than that we have no comment."

Pendolphi and several other attorneys questioned Conahan's order, saying they knew of no legal authority that gave the judge the power to appoint a guardian for a fetus.

"Even if you think the fetus is a person, in America we don't allow the courts to decide between two people and order one to undergo surgery for the other," said Lynn Paltrow, an attorney with the National Advocates for Pregnant Women in New York.

Connell, of the ACLU, once represented an Illinois woman who defeated a hospital's effort to force her to have a Caesarean section.

"The Illinois court ruled a woman's right to make medical decisions on her own behalf does not evaporate because she's pregnant. To do anything else would make a woman hostage to the fetus from the moment of conception to the moment of birth," she said.

Appellate courts in several other states have issued similar rulings, she said.

Betty Caffrey of the Human Life Resource Center in Wilkes-Barre, a group she said is alligned with the pro-life movement, agreed the case presented a unusual legal dilemma.

"We want the fetus to have all the rights under the law, but we understand where we're at right now. There are no protections for the baby at all," she said.

After leaving General Hospital, Marlowe and her husband travelled to Scranton, where she gave birth Thursday morning to a healthy girl. The couple said they're considering filing suit.

Paltrow and Connell were highly critical of the Wyoming Valley Healthcare System for seeking the court order, saying they believed the hospital violated Marlowe's rights.

"This hospital should be worried," Paltrow said. "It was bad medicine. They were about to force someone to have what turned out to be unnecessary surgery."

dawngloves, BSN, RN · Jan 19, 2004

What about the right of the doctors? PA has one of the highest rates for malpractice insurance in the country. OBs are leaving in droves.

If they didn't trust a doctor's medical judgement then yes, by all means, find a new doctor. Why they waited until she was in active labor to discuss options is beyond me. The docs decision was based on their education and clinical experience and if they though it in the best interest of all involved for a c/s, so be it. I'm sure they've delivered more than one baby over 11 pounds and there's a reason they thought a c/s was best.

This woman sounded like a lawsuit waiting to happen. And not only for the doctors, but for the nurses too.

imenid37 · Jan 19, 2004

ITA w/ you dawngloves. OB's are leaving the state in droves as are some other doc's like ortho surgeons. There is not only the possibility of getting sued for the baby being injured during the birth, but way down the road when mom may experience bowel, bladder problems, etc. I do not think anyone, even if they are an idiot (I don't know the whole story-so I don't know if this woman was one) should be forced to have a surgery, however, there should be some way that the court is able to issue a decree that the person may not file suit against their healthcare providers. I know in this case, that a suit would likely, though not for certain, be tossed out. There is no gurantee, but no one should have to pay money and waste their time hiring lawyers to address accusations when you have folks who so blatantly go against medical advice, esp. in a high liability area like obstetrics where the health and safety of two people are on the line. Just because pt. delivered lady partslly and baby seems ok, it doesn't mean she did the right thing. She may or the child may experience problems later on or perhaps she is very lucky and things will be just peachy. Though she deserves medical care, I think when you flagarantly defy medical advice like this, you should lose all rights to file a suit. I can't really see how you can force somenoe to have a surgery. What would you do, fell her w/ a tranquilizer dart when she entered the lobby and then strap her down to the or table? Lots of unanswered questions here. Who provided prenatal care? was there any? was she having a homebirth and that person advised C/S or delivery in a hospital? Is she a diabetic , compliant or non-compliant? I'd love to know more, but I am most glad she didn't travel south to see me in the middle of the night!