Reader Fred Larsen writes:
Just thought that I would toss my two cents worth into the ring about the lady who is being charged for not submitting to a c/section to save the life of one of her twins. I am a board certified Ob/Gyn . . . (though now I only do infertility). I’ve delivered hundreds of babies. First a few thoughts:
1) I have been faced with this very situation. I had a lady who was at full term who was in labor. Her baby’s heart tracing was concerning for fetal distress, with indications that the baby was not receiving enough oxygen. I told the patient that I was concerned about the tracing and that if it didn’t improve, I would recommend a c-section. She told me that she would not consent to one, even if it meant watching her baby die on the monitors. I was taken aback, as you might imagine. Thankfully, the baby’s tracing improved, but I was still facing the possibility of it occurring again. Well, I tell you. I wasn’t going to go down alone on this one. I called the chief of Ob/Gyn and made him come put a note on the chart, I called the hospital lawyer and made them come in and put a note on the chart and I made the patient sign something saying that she understood…
On the one hand, I certainly couldn’t force her to go through surgery as I would be open to charges of assault/battery, etc. On the other, I have a responsibility to both patients, the baby and the mother. It’s an impossible situation to be in. You really can’t win, as the physician facing this. Thankfully, this story ended well, but it might not have.
2) In reading accounts of this case, it seems that she went to at least 2 and possibly three hospitals, all of which recommended admission and delivery. I do understand that we are not perfect at being able to predict fetal / intrauterine distress, but if they’re talking about slow heart rates, particularly prolonged ones, it’s not subtle or rocket science.
3) The one problem I see with your hypothetical “people would hesitate to find a woman guilty of murder when she aborts a child at gestational age 9 months because carrying the child (or having a caesarean) would cause her to, say, be permanently paralyzed, or would involve even a 25% chance of her dying” is this. Regardless of route of delivery, at 9 months the baby has to be delivered. If an abortion were performed (KCl into the heart, followed by induction of delivery), the fact remains that the ramins of the baby would need to be delivered. This would involve induction of labor and vaginal delivery of a large (full term “fetus”).
I cannot think of a single instance in which an abortion at 9 months would result in less risk to the mother than delivery of the child. I guess the only thing that I could even imagine would be one in which it was deemed that a c/section would be too risky and the labor is induced and during the labor process, fetal distress ensues and surgical intervention is not undertaken (allowing the baby to die). Otherwise, the hemodynamic changes that occur after c section or vaginal delivery with delivery of the placenta, all occur after the delivery of a dead baby too.
[Moreover,] it would be rare that someone would be unable to withstand a cesarean delivery yet able to undergo vaginal delivery. In the circumstances in which a c-section might result in death to the mother, it is a near certainty that a vaginal delivery would also result in significant risk of death as well. Granted, risks of death are higher with c section, blood loss is generally higher and so forth, but with modern obstetrical anesthesia, intensive care capabilities and high quality obstetrical care (particularly doing a c section as a scheduled procedure, not at the end of a long and failed labor), the magnitude of the difference in risks would be small.
Naturally, this does not remotely resolve the legal issues that my original post alluded to; but I thought it might provide a helpful perspective.
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