STI: US revives debate about mums' childbirth rights

May 31, 2004
US revives debate about mums' childbirth rights

PHILADELPHIA - Several cases in US courts in recent months have revived a debate about whether mothers have an absolute right to choose when, where and how they give birth - even if the health of their babies is at stake.

Some women's advocates said the cases illustrate a newfound willingness by legal officials to interfere with women's choices about their pregnancies.

Ms Lynn Paltrow, of the New York-based group National Advocates for Pregnant Women, said: 'My impression is that we have a political culture right now that falsely pits foetal rights against women's rights, and that you are seeing a kind of snowballing effect.

'We're at the point now where we're talking about arresting pregnant women for making choices about their own bodies, and that's not right.'

In one case last winter, Ms Amber Marlowe, who had already given birth to six babies each weighing close to 5.4kg, brushed off doctors who told her that her seventh  --  a 5.2kg girl could be delivered only by Caesarean section.

But the medical staff at Wilkes-Barre General Hospital wouldn't budge, so Ms Marlowe checked herself out and went looking for a new doctor.

While she was on her search, Wilkes-Barre General's lawyers rushed to court to get legal guardianship of her unborn child, giving the hospital the ability to force Ms Marlowe into surgery if she returned.

Ms Marlowe ended up at another hospital, where she had a quick, natural birth she described as 'a piece of cake'. She didn't know about the first hospital's action until her husband was told by a reporter.

'They don't know me from anything, and they're making decisions about my body?' she said. 'It was terrifying.'

Officials with Wilkes-Barre General did not return calls seeking comment.

Some groups representing doctors, including the American College of Obstetrics and Gynaecology, have said that physicians should refrain from doing procedures unwanted by pregnant woman, and that use of the courts to resolve conflicts is almost never warranted.

A spokesman for the American Hospital Association wasn't immediately sure whether the organisation has ever taken a position on the issue.

In Salt Lake City, an acknowledged cocaine addict with a history of mental health problems resisted having the operation for about two weeks before acquiescing. One of the twins she was carrying died during the delay. The mother was charged with capital murder but ultimately pleaded guilty to a lesser charge of child endangerment and was sentenced to probation.

Last month, prosecutors in Pittsburgh charged an unlicensed midwife with involuntary manslaughter for failing to take a woman to the hospital when her baby began to be delivered feet-first. The child died two days later. The midwife said she had been trying to honour the mother's wishes to have the baby at home.

And in Rochester, New York, a judge in late March ordered a homeless woman who had lost custody of several neglected children not to get pregnant again without court approval.

Legal experts and medical ethicists said attempts to prosecute women for pregnancy choices, or force them to undergo certain procedures for the benefit of their children, may be on shaky ground.    'There are 50 years of case law and bio-ethical writings that say that competent people can refuse care, and that includes pregnant women as well,' said Mr Art Caplan, chairman of medical ethics at the University of Pennsylvania.

In one influential case, a federal appeals court in Washington, DC, ruled in 1990 that a judge was wrong to have granted a hospital permission to force a pregnant cancer patient to undergo a Caesarean in an attempt to save the life of her child. The mother and baby died within two days of the operation.

Doctors' opinions on forced care for pregnant mothers have changed, too.

A 2002 survey by researchers at the University of Chicago found only 4 per cent of directors of maternal-foetal medicine fellowship programmes believed pregnant women should be required to undergo potentially lifesaving treatment for the sake of their foetuses, down from 47 per cent in 1987.

Dr Michael Grodin, director of Medical Ethics at the Boston University School of Medicine, said doctors should seek court intervention when a mother refuses care only if the patient is mentally ill.    He said: 'Women have a right to refuse treatment. Women have a right to control their bodies. It is a dangerous slope. What's next? If someone doesn't seek prenatal care, what are we going to do, lock them up?'  --  AP