I agree. I like her husband's reply as well. I think he was spot on. This is ridiculous. If this is what the climate for the childbirth choices looks like in the next three or four years, I may hold off even more on having kids.

I would have a lot less sympathy for Szabo if she had been required to have a C-section on medical grounds

Really? This is sort of an epistemological question, but who determines "medical grounds"? And how do we know they are right? And at what point are hospitals justified in seeking recourse to the courts,
as the hospital CEO has threatened to do (link to my take on this in the Community section of the website).

As the case of Jessie Mae Jefferson shows, Jefferson v. Griffin Spalding Hospital Authority et al. 247 Ga. 86, 274 S.E.2.d 457 (1981) (authorizing a forced cesarean for a woman believed to have complete placenta previa, which carried a 99% risk of death to the fetus and a 50% risk of death to the pregnant woman, who delivered a healthy child via spontaneous vaginal birth in hiding), "medical grounds" can be wrong. Women can be wrong too, but I believe-- and you may disagree-- that such state intrusions are unsupportable under any circumstance.

Do we know that this woman is a candidate for VBAC based on her previous medical history? VBAC carries some risk to the mother with it because the uterus is weakened by the Cesarean. This woman may want a vaginal birth but the hospital doesn't want to get sued if she experiences uterine rupture. Should the mother be allowed to risk it? Maybe, but you need some tort reform legislation passed first.

Agreed. If they can't handle a VBAC, how many other situations that could crop up without warning would they also be unable to handle?

That would be nice but: "The mother of three children, she has given birth to all of her children at Page Hospital, the only hospital in the immediate area."

You say: "The fundamental issue here is economics, and a hospital budget that is too small to support natural childbirth. Unless Szabo is willing to pick up the difference in the budget, I don't see how the hospital can be faulted per se. Economics are as much a fact of life as gravity. And every bit as burdensome."

What if we put it this way? "The fundamental issue here is bodily autonomy, and a woman's only shot at giving this baby and her own body the lowest-risk birth possible. Unless the hospital is willing to pick up the difference in risk to her and her child, I don't see how Szabo can be faulted per se. The risk of medical procedures is as much a fact of life as gravity. And every bit as burdensome."

Why does the hospital have more rights than the patient?

You use the term "natural" childbirth like it's some sort of innovation or deviation from the norm. The issue is not that the hospital doesn't have the papaya face masque she wants to go with her massage, or doesn't offer certified organic bamboo sheets. She is seeking a VAGINAL birth, which is the way that the majority of people come into the world. The hospital is failing to support VAGINAL birth, and arguably not just VBAC but any vaginal birth, by failing to have the emergency management personnel that hospitals are ostensibly supposed to offer. Some people may argue that having a prior cesarean makes her high-risk, but unless this hospital automatically requires every woman with any condition that makes her high risk consent to a cesarean in advance or move to the next closest city for the final month of pregnancy, they are discriminating in a highly questionable way (particularly when you consider the studies showing the safety of VBAC).

Sure, doctors aren't slaves (very very offensive, btw), but this woman isn't demanding anything above and beyond what any woman who delivers in a hospital is demanding: a place to deliver where she can have access to obstetrical intervention if needed. If this is strictly a question of economics, they should either put away their shingle that says "Labor and Delivery" and offer exclusively planned cesarean surgeries, or get their act together to be able to offer what it is that they're advertising.

Sure, the woman has a right to decide what kind of childbirth she wants, but she can't force others to do what she wants. DRs are people too and they have rights as well. DRs are not modern day slaves, nor patients somebody's 'massa'. If my DRs and I disagree or if I question their practice or skill, I have to find another DR. In her case, she might find a mid wife, or make arrangements with the nearest big city hospital.

Choice is a 2 way street.

The hospital indicated that it would seek a court order. I don't that the court order would definitely be given, but the hospital shouldn't even have the ability to seek a court order. Where would she be if they succeed in getting a court order? Would she even have the option of leaving the hospital at that time? I was under the impression that midwives are not legally allowed to perform VBACs in AZ, find me a law that states otherwise and I will happily forward that info to Joy. If no midwives can perform a VBAC then birth centers or home birth aren't options. The nearest hospital that will perform a VBAC is almost 5 hours away. Forcing a woman to either stay near the Phoenix hospital to be close in the event she goes into labor or to force to drive 5 hours in labor is rediculous. What would they do if a non vbac mother has an emergency and that same anesthesiologist has to attend that cesarean? They'd go on like business as usual, or have a heap of trouble on their hands. Her potential emergency shouldn't be treated differently than someone else's potential emergency. Either a hospital has enough staff or it doesn't. And if they don't they shouldn't have open doors until they hire enough staff.

Which would be great except for AMAs deliberately witch-hunting midwives out of business and lobbying legislators to make midwifery and homebirth near impossible, as they did in my state of IL. I am very thankful my 2 babies were among the last my midwives were able to deliver before they were prosecuted out of business by the IL AMA.

Hell yeah! I had a VBAC at home four months ago, and it was wonderful. This whole "OMG! Scary VBAC!! High risk!!" is such BS, it's only high risk when you augment the labor with drugs like Pitocin, so duh, don't augment the labor, people.

But no, doctors don't want to give up being able to give people horrific drugs like Pitocin, (i.e. trying to control labor) so they get all freaky that VBAC is all so very dangerous!

I realized I'd have to fight tooth and nail just to have the CHANCE to have a VBAC at the local hospital, so I said no way and had my baby at home.

VBAC is better and safer than a repeat c-section, but since it's not something doctors can control, they opt for the "doing something" instead, to the determent of women and babies.

We need to trust women and trust their bodies.

This.

Yeah!! This! My reproductive freedom doesn't end when I choose to bring a pregnancy to term, for crying out loud!

Cosigned. I'm sort of shocked at the apparent inability to see the connection between access to VBAC and access to abortion or EC. So lack of access to non-surgical birth is okay just because it's not based on the moral position of the doctors? Because "VBAC is way too dangerous for county hospitals" is on approximately the same level of scientific rigor as "abortions cause breast cancer." "Just go find another hospital" is just millimeters away from "well she can go to the one PP in the state for that abortion." "VBAC carries a risk of uterine rupture" sounds a lot to me like "the pill/EC carry a risk of thromboembolism." And for some reason I don't see very many Feministing commenters supporting those positions on birth control and abortion....

I'm most shocked by this sentiment:

But the hospital can't just re-arrange everything to suit her preference. I mean let's say they have 4 OBs on staff. If they anticipate three other deliveries that day, and they don't have the staffing and resources to conform to her precise plan, what are they supposed to do? Tell two of the other three women to cross their legs because this other patient doesn't want a C-Section and it might be a while and it's a high-risk delivery and three out of the four OBs on staff have to be on hand to attend her delivery? Why does her needs trump the needs of the other women who might be giving birth that day?

First of all, it's not like vaginal births can be written into your palm pilot. That's how surgeries work, not biological processes. So what happens when there are 3 doctors on call, 3 women giving birth, and Ms. X who was "supposed" to deliver next week comes in in labor? Do you just section one of the other ones to free up a doctor? And anyhow, it's ostensibly not about the availability of an obstetrician, but about an anesthesiologist in the event of crash surgery. So what if ALL the OBs are in the building standing RIGHT next to Ms. X who is having a perfectly low risk pregnancy, and her water breaks causing a cord prolapse (which is just about as likely as a uterine rupture), necessitating a crash c-section. She's SOL, and it has nothing at all to do with Mrs. Szabo's decision to refuse unnecessary surgery.

And of course the whole "they can't drop everything to cater to her every whim" vein ... yeah because women, particularly pregnant women, make their medical decisions out of convenience and don't care what sort of risks or hardships it may cause to other people... (or "women are perfectly willing to murder a pre-born baby just so they can keep partying/go to college...")

No, Doctors should not be compelled to attend to a procedure that would jeopardize the lives and health of other patients. She has every right to schedule her birth at another facility that is adequately staffed and prepared to handle a high risk VBAC.

Let's say you are a midwife. You are trained in how to deliver "regular" birth and breach birth and even deal with birthing a baby that has the cord wrapped around its neck, but you are not trained, nor are you comfortable with high-risk births, for example, a birth where a uterine rupture is more than a 10% chance. You are interviewing a client and she says that she had a C-Section a year ago and now she wants to give birth naturally and you don't feel comfortable delivering that baby. You explain to the woman that you do not have the ability to deliver this baby, and suddenly, she starts screaming at you that you have to, that you're the only midwife in the area, that the nearest other midwife is five miles away, and how dare you refuse to deliver her baby. Furthermore, after you have explained to her that you are not qualified to deliver the baby safely in the way she would prefer, she says the moment her water breaks, she's driving over to your house and insisting that you deliver her baby, and when you reply that your action would be to drive her to a hospital because if the baby's coming you're not going to fuck around, she accuses you of raping her.

This is nothing like having EC denied to you for religious reasons. This is a hospital stating that they do not have the resources to safely deliver the baby in the fashion that the mother wants. This isn't the hospital saying that attempting to deliver a High-Risk VBAC is unGodly and because they are morally opposed to such a procedure, they will instead perform a c-section.

Pretty much. There are a non-trivial number of people for whom any advocacy for women goes out the door as soon as the woman who needs advocacy is one who wants or chooses about to have a child. You should see how a thread on access to fertility science goes around here.

"How would Page Hospital now handle a situation like Szabo's second birth - an emergency cesarean section with no prior indications? Not just for Szabo, but for any laboring woman they serve?"

My first guess would be "not very well."

The hospital that my insurance covers does not have updated equipment, does not employ perinatologists, and they don't even have a NICU. If you or your baby are high risk, delivering in that hospital is a very bad idea. When my pregnancy started going into the toilet, the doctors didn't know what to do.

I really think that when hospitals say they can't handle a situation, we should believe them. Unfortunately, they're usually right.

I'm frankly terrified that someone might even give me an unecessary episiotomy someday. I'd consider it straight up assault.

I heal slowly from surgical wounds. I've had to have two abdominal surgeries (not childbirth related, so no incision of the uterus) and it took months to recover from them. I can imagine there are situations where a doctor could tell me things could make me consider or agree to a c-section, but they happen far too often to be medically necessary.

It used to be hysterectomies. My grandmother had a multiple birth when she was around 20, the doctors took everything out. Everything. Considering how incredibly rare it is for such a procedure to be performed on such a young person these days, I have to think those guys had no idea wtf they were doing besides cya.

Further, having grown up as a Jehovah's Witness (not anymore), I belonged to a church that's singlehandedly responsible for a great deal of treatment refusal case law centered around their absolute opposition to blood transfusions. They are allowed to refuse them under virtually all circumstances where the individual is conscious, though hospitals may have latitude to intervene if the patient is a minor. This came up quite a bit when I had my childhood surgeries and my parents moved me from one hospital to a different one to find a surgeon working with a cauterizing technique that made him willing to perform extensive abdominal surgery without a transfusion.

JWs are as opposed to abortion as they are to transfusions, but why should their right to refuse even necessary, life-saving treatment be more protected than a woman's right to decide against unecessary surgery? I think the JWs' protections in the law are just, even if I no longer agree with their motivations, and I'd hold that belief up in front of any doctor who wanted to treat me against my will.

It is not their right to decide.

And a hospital, a real hospital with, one presumes, an emergency room and all, but irregular anesthesiology staffing? That's frightening. That's not a hospital prepared to handle 24 hour emergency care for a wide variety of conditions and injuries besides pregnancy complications.

People can literally die of shock from severe pain. You better be scared of showing up at a hospital with severe burns or auto accident injuries, particularly should emergency surgery be necessary, if they don't have an anesthesiologist on premises or on-call and close by. It's insane. And maybe this hospital has consistent anesthesiology staffing, but some of the arguments put forward by people in this thread about imagined difficulties surrounding that service seem to posit that all anesthesia-necessitating events happen during regular business hours on an appointment-only basis, and this is not shiny.

As others have suggested, if the facts being argued by the hospital's apologists here are true, this is a hospital poorly equipped for a wide variety of emergencies and they should perhaps just call themselves a clinic.

That's exactly my sentiment on the matter. I was thinking about the ethical issues for the doctors as well.

Woah, punishment? What kind? I'm not sure what purpose that would serve, exactly.

And just a question, since I'm not sure what the actual rules are: if you inform a patient that she will die unless a specific procedure is performed, can she not opt out of said procedure? Can she not decline the life-saving surgery if she is fully informed of her odds? I understand that doctors have an obligation not to harm their patients (like, letting them die, right?) but where does inaction on a fully informed patient fit? I see that things become much more complicated when the patient is pregnant, but generally speaking, how does this work? I'm just curious

A medical professional shouldn't have the right to override my own decisions about my own body. Even if they're right. Even if they're looking out for me.

When medical professionals DO this, it puts people in a position of choosing either health care OR autonomy. And that doesn't make people safer.

Why shouldn't patients consider the odds and see how many c-sections are performed unecessarily when they're weighing your advice? If doctors want expectant mothers to take them more seriously, they must perform fewer excess surgeries.

Some hypothetical situation where you have 99% certainty of impending doom is going to be very, very rare. That's the c-section argument equivalent of asking people if they believed it would be right to use torture if you had a ticking bomb ready to go off in half an hour and you had perfect certainty that a suspect in custody could tell you how to stop it - it's a vanishingly unlikely event that only distorts discussion of usual and customary policies.

For instance in this case, your example of knowing about some presumed problem excusing a forced, non-emergency surgery obscures the fact that this is a blanket policy being applied to a woman that's already had a successful VBAC.

Doctors are no more inherently fit to be granted ultimate, nonconsensual, unaccountable authority over the bodily integrity of others anymore than any other human beings. People should not have such power over each other and we should all be humble enough to recognize it no matter what our occupation.

I have to ask--what is the difference in liability between a VBAC gone wrong and a C-section gone wrong? Because she's going to have to do one or the other (although hopefully she and her child will come out fine on the other end).

It's kind of a weird argument to me, because that baby is coming out one way or another, and wouldn't it be safer in a hospital where the resources are more readily available to deal with an emergency should it occur (God forbid)? Liability aside, it seems as if by refusing to respect her wishes, the hospital is potentially pushing this woman towards a higher risk birth situation than is necessary.

1. Malpractice insurance/legal liability absolutely is a huge problem, and something needs to change in that regard or all our health care reform isn't going to amount to enough of a change (at least in obstetrics).

2. I don't think it's incongruent at all. If you compare giving birth to having an abortion, giving birth is dangerous. If you compare giving birth vaginally to giving birth surgically, giving birth vaginally is not dangerous. There are certainly different perspectives on that last one, but it's an entirely different issue than the first one and there's no incongruency in holding both beliefs.

3. Haven't been to med school, but I have heard nurses say "The only stable patient is six weeks post-partum".

That's a repulsively anti-choice comment. If a woman is fit to decide not to have children, there's no ground for saying she isn't fit to decide on having them. It's why a forced abortion in China is no less a travesty than the denial of all abortion in Nicaragua.

You have no evidence against this family's ability to provide an appropriate environment for their children. None. So while there might be specific cases where people prove they shouldn't have kids in their care, this is a decision appropriately left to the family in the vast majority of cases.

*looks at watch* Took a whole 24 hours. Impressive.