having a baby

Judge Rules Mentally Ill Pregnant Woman Can Have An Immediate C-Section Against Her Will

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A serious blow has been struck against pregnant women’s bodily autonomy in the UK today. A judge has ruled that a pregnant woman with mental health issues can be ordered to have an emergency C-section against her will.

A 36-year-old woman of Bangladeshi origin who has paranoid schizophrenia, named only as Mrs P, is reportedly against the idea of a Caesarean section. She was detained under the UK’s Mental Health Act last month after it was determined she had been “severely neglecting herself” and not taking her medication. Her local medical health authority sought permission to induce her labor immediately and possibly do a Caesarean section. A judge ruled today that Mrs. P does not have “the mental capacity” to make the decision about whether or not she should have a Caesarean or when her labor should be induced.

The woman has three other children, two of which were born vaginally and one, a daughter, that was born by Caesarean in 2005.  She reportedly split up from her husband earlier this year. Mrs. P has type-2 diabetes, so her pregnancy is considered high-risk (Babies born to mothers with diabetes are at risk for macrosomia, another name for abnormally large).

The fact that she is high-risk and mentally ill should not negate her inherent right to have control over her own body. Of course the judge and the medical officials feel they’re acting in the best interest of the baby, but stripping away a mother’s right to even attempt to birth her baby is cruel and unusual, especially to a woman who probably feels incredibly confused, alone and disempowered. Reportedly, the medical officials want to give her a chance to have a vaginal birth (in her case, a VBAC) but they want to reserve the right to do a C-section immediately if they feel it’s necessary. One obstetrician said Mrs. P sometimes seems ok with the idea of a C-section, but that other times she’s resistant.

Still, the ruling gave Mrs. P’s medical team the authority to induce her labor and give her an emergency C-section right away, if that is what is deemed necessary. I am not a doctor or a midwife, but as far as I know, Caesarean sections are considered an emergency when the health of the baby or the mother is at risk. Although Mrs. P is having a high-risk pregnancy, I couldn’t find anything saying that the baby specifically (or Mrs P herself) is at an increased immediate health risk of complications aside from those that might arise from her diabetes. While lots of care providers routinely schedule C-sections for women with suspected macrosomia babies, especially if they have diabetes, that’s a scheduled C-section—not an immediate one. Although there is a higher chance of ultimately ending up with a Caesarean if you have diabetes, babies are often born vaginally to diabetic mothers with no complications. If there is a sudden risk during Mrs. P’s induced labor and a C-section becomes medically necessary, that’s one thing, but it seems like the ruling essentially says the operation can be performed whenever for whatever reason—without Mrs. P’s consent.

And let’s not forget that a judge just gave permission for a 35-37 week baby to be delivered. Again, I am not a doctor or a midwife, but I know that 35-37 weeks is not a full term baby, especially under the new definition of full term. That doesn’t mean that a baby born at 35 weeks or 37 weeks can’t just do fine outside its mother’s body, but it is my general impression that doctors generally like to err on the side of caution if mothers are unsure about their dates. If they were to deliver a premature baby who had underdeveloped lungs or other problems, these officials will be setting themselves and that baby up for a host of problems, including legal ones if something happens to go wrong with this baby’s health. Incidentally, here in the US, the American Congress of Gynecologists And Obstetricians does not recommend delivering babies before 39 weeks…and that includes suspected large babies.

Is there a reason these doctors can’t wait another two weeks until this baby is closer to term? There must be, but as I said, it wasn’t immediately clear in the Telegraph article I linked to above. If they can take this woman to court and declare her mentally unfit, I wonder if they can also do something to help her take her medication, so she can be in her best mind to birth her baby once it’s at term? I just don’t understand how or why the situation is SO DIRE with Mrs P’s mental health that these doctors are willing to deliver this baby anywhere from five to three weeks early, depending.

There’s also the other issue that Mrs P’s body and baby are her own and no one else’s. I understand the legal concerns about this woman’s ability to care for herself and her child, I really do. But forcing a woman to have an induced labor and/or a medical birth (Induced VBACs carry slightly higher risks for uterine rupture rather than labors where a woman goes into labor on her own, by the way) that she doesn’t consent to is uncaring, unjust, inhumane and in my opinion, morally wrong, no matter how mentally ill she might be.

This isn’t the first time something like this has happened to a mother in the UK. Italian Alessandra Paccheri‘s case drew support in recent weeks after it was revealed that her daughter was forcibly removed by Caesarean and then put into foster care when Paccheri was visiting England. Apparently, if you’re a pregnant non-UK native who happens to be struggling with mental health, that means the legal system in the UK thinks it’s just fine to cut your baby out of your body against your will. Beware, women. Beware.

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