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Baby taken away after mom refuses C-section

A woman in New Jersey refused a c-section during labor. She gave birth vaginally, and the child was healthy. But the baby was taken away and placed in a foster home, because the woman allegedly “abused and neglected her child” by refusing the c-section. She was also accused of behaving “erratically” — to which I can only point out that she was in labor. I hear that hurts a lot.

Apparently when women are pregnant, they give up their bodily autonomy, civil rights and right to informed consent. Louise Marie Roth pretty much covers it:

First, from a legal perspective, individuals have a right to informed consent and bodily integrity. In obstetrics, informed consent is a blurry concept since many hospitals perform obstetric procedures on laboring women without informing them of the evidence concerning those procedures or their risks. Perhaps this legal case illustrates how paternalistic hospitals can be with respect to pregnant women — assuming that the hospital staff know best and that informed consent is unnecessary. Never mind that hospitals tend to be run with organizational efficiency, rather than patient interests, in mind. In this specific case, one obstetrician who tried to convince the mother to consent to a c-section concluded that she was not psychotic and had the capacity for informed consent with regard to the c-section. It is clear within the law there is no informed consent without informed refusal, so this obstetrician’s conclusion should have made V.M.’s refusal to consent to the c-section her decision alone. If this mother is not legally permitted to refuse major abdominal surgery, then she is clearly stripped of her civil rights to informed consent.

In fact, individuals are not legally required to consent to invasive procedures even to save other individuals, including fetuses that lack full legal status. But in this case the district and appellate courts subverted a pregnant woman’s informed medical decision-making in the name of fetal rights, arguing that her refusal was a form of abuse and neglect of the child that had not yet been born. This is another dangerous precedent, along with other court-ordered cesarean cases, that will allow all pregnant women to lose their rights to bodily integrity and informed consent. It may be understandable, if not excusable, that the courts don’t understand medicine or recognize that medical judgment is fallible, but it is hard to understand how they could so fundamentally misinterpret the law, in which performing surgery on an individual without that person’s permission can constitute criminal “battery” under common law.


40 thoughts on Baby taken away after mom refuses C-section

  1. When I first heard about this, I was shocked too – but it looks like it’s rather more complicated than you make out here. A post at Salon examines the decisions more carefully – while the ball was set rolling by her refusal of a C-section, and she was presumably partially ‘suspected’ because of that, the appelate court was clear that she had behaved unfitly *regardless* of that. Roth is twisting their words quite severely.

    Not that there’s nothing for feminists to discuss here, just that it doesn’t seem to be as cut and dried a case of medical paternalism as all that.

  2. The article said that she had a previous history of psychiatric treatment, but it also said that nobody was moving to take that child away until she refused the c-section, which…yeah, that was kind of the point of the article.

    It does get a little chicken and egg, though: Was her psychiatric history called into question BECAUSE she refused the c-section, or was her refusal of the c-section considered irrational and abusive BECAUSE of her psychiatric history?

  3. I posted part of this comment at Feministing, but I want to share it here, because I’m troubled that some people are trying to distinguish this woman from other women (read: “us” – whoever that is!) based on the Court’s characterization of her as being “unfit” or “mentally ill” (that is actually a generous way to describe what the Court is doing here).

    Having worked on these kinds of cases before, I want to stress how important it is for feminists not to think of issues in silos, as the Salon author does. In this case, reproductive rights is intimately connected to both a long history of society (and especially the legal system) characterizing women who challenge authority as “mentally ill” AND a punitive, arbitrary, class and race-based child welfare system (please see “Shattered Bonds: The Color of Child Welfare” by Dorothy Roberts).

    When the Salon author flippantly states that “this woman isn’t the poster girl for reproductive rights” she is explicitly rejecting an intersectional analysis in this case and basically telling VM that “we don’t want you and ‘your issues’ in OUR movement.” Whose “movement?” The “movement” of State-approved “fit” mothers? And consider how the State has and continues to construct “fit.”

    Finally, the “poster girl” statement is cruel and glib to a woman who has had her parental rights terminated by the State. As one my friend says, in reaction to that throwaway line: “Every girl is a poster girl for reproductive rights because we all have them and we all deserve them.”

  4. Refusing the unnecessary cesarean and electronic fetal monitoring in labor made hospitals staff call for a psych consult. The first consult showed that V.M. was competent. The staff disagreed and called for a SECOND psych consult and before the second one was completed, V.M. gave birth vaginally.

    Because of this and her alleged behavior in her two days at St. Barnabas, V.M. was sent home without her baby. She never parented the child and a case was built against her with wildly dissenting “expert” opinions. Even her psych records prior to birth showed two different opinions—one showed that she was “cured” and one showed that she was struggling with PTSD and psychotic and paranoid ideation. She was not previously diagnosed with schizophrenia.

    Roth didn’t build a case for why V.M. should have custody of her child. She’s taken heat for holding V.M. up as a poster child, which is silly. The appellate court might have disagreed that refusal of a totally unnecessary cesarean had anything to do with her loss of parental rights, but the whole reason she had the child taken from her in the first place was based entirely on her alleged erratic behavior while in labor and in the two days following labor at St. Barnabas Hospital. They built the case for loss of custody later.

    The appellate court’s decision shows diametrically opposed opinions about the defendant. My favorite was the psychiatrist that diagnosed V.M.’s husband with a rare psych disorder called “folie à deux” because he agreed with his wife that the system was out to get her. Come on now.

    St. Barnabas has a 49.3% cesarean rate. Apparently they’re not used to anyone refusing their unnecessary surgeries.

  5. This sort of thing has happened before. I think a woman in Florida had some sort of trouble where she wanted to give birth normally and the doctors went to a judge to get a court order to get her in for the process.

  6. It should be noted that the woman was not forced to undergo the procedure, thus her right to informed consent/refusal was honored. It was separately judged as neglect to the child. Not that it doesn’t raise critical issues and it certainly isn’t cut and dry.

  7. It should probably be pointed out that a history of psychiatric care doesn’t mean a goddamn thing. Really, it isn’t relevant. If she wasn’t actively psychotic at the time she refused the procedure, its a non-issue. Invoking it is a bullshit move whose only possible utility would be to cast this woman as inherently incompetent because she has had treatment for a broad class of issues which generally don’t include incompetence. Her psych history here is being used as a cudgel to keep her in line and as a shield to protect those wielding the cudgel from public scrutiny. “Hey, we’re not being paternalistic assholes” they can say “this bitch is nuts! Just go about your business, nothing to see here.”

    Its a dodge, and the fact that anyone is even discussing it means we’re taking the bait.

  8. William, EXACTLY.

    The Salon article also mentions that she had a history of refusing to take her medication. So do I. While I was pregnant, I had more than one OB chastise me and offer me substandard care because I was refusing to take medication.

    I was refusing psychiatric medications because of potential harm to the fetuses, but the OBs didn’t seem to think that I was qualified to make that decision, not because of my demeanor (I was perfectly lucid, functional, employed, and my shrink had signed off on the lack of meds) but because it said MANIC DEPRESSIVE on my chart.

    They felt I was being irrational. Why? Because I was “anxious” about having pregnancy induced hypertension and going into preterm labor (I wasn’t concerned that I *might* go into preterm labor–it had already happened). I was advised to seek psychiatric care instead of medical care for both the hypertension AND the preterm labor.

    What might those doctors have said about me later, after I delivered? If you think Post Partum Depression is bad, try Post Partum Psychosis, which I had and subsequently demanded help for.

    Everything turned out okay for us, but if the courts had been after me? If they’d been evaluating me in the ten days post partum that I was actively losing my shit and begging for medication and relying heavily on family and meds to get me through it? I might have lost my girls.

  9. CaraHerself:

    “It should be noted that the woman was not forced to undergo the procedure, thus her right to informed consent/refusal was honored.”

    Not exactly. The article said that after the first shrink said she was competant to refuse the c-section, the OBs pursued a second opinion (because they didn’t like the first one?) and while they were doing that, she gave birth to a healthy baby. Honoring her decision didn’t really enter into the equation.

  10. “A post at Salon examines the decisions more carefully – while the ball was set rolling by her refusal of a C-section, and she was presumably partially ’suspected’ because of that, the appelate court was clear that she had behaved unfitly *regardless* of that.”

    How the hell do you behave as an unfit parent to a child when you were involuntarily separated from it immediately after passing it through your birth canal? Or is this one of those situations where the state basically stole a woman’s baby and her initial unfitness has been retroactively demonstrated by her unwillingness to jump through three dozen different hoops in order to regain custody that never should have been revoked in the first place? And here I thought those cases were ten tons of fun when they involved being arrested for resisting arrest.

  11. St. Barnabas has a 49.3% cesarean rate. Apparently they’re not used to anyone refusing their unnecessary surgeries.

    Jesus. There’s one hospital I’ll never have a baby in. I can’t imagine why this stat wasn’t brought up in court. If anything is relevant to this case, that is.

  12. Hey, dumb question here.

    WHY? I know a lot of hospitals push the C-section like crazy – my own mom was pressured into one and into taking massive painkillers when she was actually doing extremely well and feeling like she had a good handle on it (the nurse accused her of trying to play the martyr).

    But who does it benefit? Why are C-sections something some hospitals feel the need to impose?

  13. The issue has been raised that “failure to take meds during pregnancy” could constitute evidence of being an unfit parent. Nu? What happens if the woman in question did take the meds during pregnancy and then there was damage to the fetus, would the woman then also be called unfit? Damned if you do, damned if you don’t?

    Also, the so-called pro-life community should be up in arms about this, because of the slippery slope from “you can be coerced into having a Caesarean to remove a live baby” to “you can be coerced into having an abortion” if you are deemed “unfit”.

    Of course, they won’t because they are more interested in controlling women’s bodies (“we can forbid you to have an operation and we can coerce you to have an operation”) than actual fetal life …

  14. But who does it benefit? Why are C-sections something some hospitals feel the need to impose? – Yonah

    Hospitals (and a lot of expectant women) like (non-emergency) C-sections because of the predictability of when the baby comes out. No more waiting around for delivery to occur at some odd hour: you schedule the operation when it is convenient for everyone involved.

    I’m sure there is some financial benefit to the hospital for doing the procedure if the patient is well-insured, as well.

  15. Refusing the unnecessary cesarean and electronic fetal monitoring in labor made hospitals staff call for a psych consult. The first consult showed that V.M. was competent. The staff disagreed and called for a SECOND psych consult and before the second one was completed

    Thats…unusual. That kind of behavior by staff reeks of doctor shopping and the fact that a second consult was called before the first was completed is all kinds of suspicious. I’d be willing to bet that what happened was that the psychiatrist on call refused to declare the woman incompetent and that that was what triggered the second request.

    Even her psych records prior to birth showed two different opinions—one showed that she was “cured” and one showed that she was struggling with PTSD and psychotic and paranoid ideation. She was not previously diagnosed with schizophrenia.

    Which is both quite common and completely irrelevant. We throw around words like “psychotic” a lot, but in a strict psychiatric context they are descriptive, not determinative. Mere psychotic ideation isn’t generally enough to trigger an involuntary commitment and the fact that experts were disagreeing about what was being seen tells us that she was on the very edge of what is generally a very low standard. We’re talking about a woman who likely held some beliefs that staff found odd or objectionable, not someone who believed the CIA had put a chip in her brain.

    but the whole reason she had the child taken from her in the first place was based entirely on her alleged erratic behavior while in labor and in the two days following labor at St. Barnabas Hospital.

    Which again was documented by people who seemed to have a pretty specific idea of what standards this woman ought to have been conforming to. Talk about an unreliable narrator.

    My favorite was the psychiatrist that diagnosed V.M.’s husband with a rare psych disorder called “folie à deux” because he agreed with his wife that the system was out to get her.

    Thats not a rare disorder, its a descriptive term. I’m fairly certain there isn’t even a DSM-IV TR coding for that.

  16. It isn’t clear what happened in the 2 days that she was in the hospital after giving birth. Has anyone seen an article that says if she had contact with the baby during that time? If she did, then it’s not true to say she was removed from the child immediately.
    Also, the Salon article mentions the the parents did not show up for thier first hearing to attempt regain custody, then they had situations with 2 court psychologists that ended in restraining orders, then they assaulted another psychologist. I don’t think its unreasonable to think that parents who are behave in that way showed signs of irregular or dangerous behavior while still at the hospital.

    I agree with everyone the the mother’s medical decisions should never have influenced custody, but it seems that things may have turned out in the best interest of the child.

  17. DAS:
    “Also, the so-called pro-life community should be up in arms about this, because of the slippery slope from “you can be coerced into having a Caesarean to remove a live baby” to “you can be coerced into having an abortion” if you are deemed “unfit”.

    Of course, they won’t because they are more interested in controlling women’s bodies (”we can forbid you to have an operation and we can coerce you to have an operation”) than actual fetal life …”

    THIS exactly. I am interested to see if they have anything to say about this.

  18. “Also, the Salon article mentions the the parents did not show up for thier first hearing to attempt regain custody, then they had situations with 2 court psychologists that ended in restraining orders, then they assaulted another psychologist. I don’t think its unreasonable to think that parents who are behave in that way showed signs of irregular or dangerous behavior while still at the hospital.”

    Part of me feels oddly compelled to propose a study in which the state seizes neonates from a representative sample of the populace for nebulous reasons and then tracks parental behavior to establish a baseline of distress/anger/paranoia that it’s “normal” to exhibit in such circumstances.

  19. Um, yes. What preying mantis said.

    How calm and collected would YOU be if someone took your newborn away and then sent people into your house to watch you, people who said that adoption was in your baby’s best interest?

    If your answer is “Why yes, I would be totally objective, dispassionate and utterly composed,” I will have to respectfully suggest that your pants may currently be on fire.

  20. Part of me feels oddly compelled to propose a study in which the state seizes neonates from a representative sample of the populace for nebulous reasons and then tracks parental behavior to establish a baseline of distress/anger/paranoia that it’s “normal” to exhibit in such circumstances.

    THANK YOU. I can’t imagine why the parents wouldn’t have faith in the system after having their INFANT TAKEN AWAY FOR REFUSING AN UNNEEDED C-SECTION.

  21. Having read the full appellate decision, I find myself reluctantly agreeing with Kate Harding’s Salon article.

    This is the paragraph that sums it up, for me:

    There’s no doubt that the doctors and staff at St. Barnabas were both paternalistic and ridiculously egotistical in their assessment that refusing a c-section equals neglect. There’s no doubt that the original trial judge should never have factored that into his decision — just as the appellate court unequivocally said. But given that that is what the appellate court unequivocally said, why are we now talking about this in terms of a legal system gone mad? That decision is actually evidence that the system worked, albeit far too slowly, to defend V.M.’s right to make medical decisions about her own body. It just didn’t defend her right to be a mother, based on the preponderance of the incredibly complex, conflicting evidence against her.

    And the evidence, as far as I can read from the legal decision, is truly complex and conflicting.

    I think it’s worth noting, too, that DYFS was not involved in the case until April 18th, two days after the child’s birth, when a social worker from the hospital called to report concerns about releasing the child to the care of the parents. The appellate decision says, with lamentable vagueness, that the original trial judge found that between April 16th and April 18th “a series of events transpired in the hospital that were alarming and that might have caused a reasonable person to believe the child was in danger. . . He emphasized that although he believed that J.M.G. was in imminent danger, he did not base his finding solely on V.M.’s reluctance to consent to a c-section. In fact, he observed that there were probably many instances where a mother’s refusal to accept a c-section would not constitute abuse.”

    N.B. I fully agree with Akeeyu and others above that documented history of psychiatric treatment is often abused by authorities as an excuse to mistreat people.

  22. “He emphasized that although he believed that J.M.G. was in imminent danger, he did not base his finding solely on V.M.’s reluctance to consent to a c-section.”

    Yes, but that does seem to be the point at which psychiatric intervention was introduced, and once you’ve been painted with the Crazy Brush, it can be hard to wash that shit off. It’s unlikely that the hospital staff who called the authorities were unaware of the previous situation.

    Absent the prior history and attempts to force a c-section, would they have found her behavior odd, or chalked it up to new mother nerves and baby blues?

    Absent the removal of her child (I’m going to go out on a limb and speculate that the loss of a child could cause a psychotic break in even a perfectly stable woman), would her behavior warrant state attention and be deemed dangerous?

    Yes, it is entirely possible that it was appropriate to remove the child.

    It is also entirely possible that, under acute stress and keen observation, a large percentage of perfectly good parents would be deemed unfit by the state.

    As the Kingston Trio said, “Hear me out: THIS COULD HAPPEN TO YOU.”

  23. I have a history of mental illness and I had a psych consult called on me while I was in labor. Apparently because I said that I would jump out of a window if they didn’t do something to stop the pain, constituted a possible suicide risk, as opposed to demonstrating that their anestheseologist was incompetent (I had two epidurals, neither worked). Did I mention that it was 42 hours of labor during which I didn’t eat and barely slept?

    She showed up with her little clipboard as I was in active labor with my feet up in stirrups and kept insisting that she had to talk to me *right now* and it was “just a few quick questions”. I seemed to remember telling her (between contractions) that, with all due respect, I had another task to attend to that involved expelling a small human from my uterus and she was just going to have to come back later. That was more or less verbatim what I said to her. The labor nurses were cheering me on from the side-lines as I did this. It would be funny in it happened in a movie instead of, you know, real life. Assholes.

  24. “Absent the prior history and attempts to force a c-section, would they have found her behavior odd, or chalked it up to new mother nerves and baby blues?”

    Because the language in the decision is so vague, I’m going to have to say I can’t venture a guess on this. Her later behavior, as reported, does seem pretty odd, including claiming that she HAD consented to a c-section and that the first psychiatrist was called at her request to “deal with the inappropriate behavior of the nursing staff.”

    I’m absolutely not arguing that she was treated fairly. I don’t think she was. I just agree with Harding’s point in Salon that this is not a simple case of a woman whose child was taken permanently because she refused a C-Section. Those cases definitely have occurred – I just don’t see this as one of them.

  25. If her baby was taken away because of a mental illness, instead, how is that any less paternalistic? A baby is taken away from hir mother because her mother has a disability, rather than because she insisted on bodily autonomy. That doesn’t suddenly make the decision any better.

  26. Jenna, I’m not saying that taking a baby away is okay just because the parent has mental illness, I’m saying that it is inaccurate to hold this particular case up as being solely an issue of disregard for a woman’s right to bodily autonomy. I’m saying that the appellate decision supported her right to refuse a c-section, and held that the c-section refusal should never have been an issue in the first place. Harding’s article may fail to adequately consider the mental illness issue, but it is correct in its analysis of the c-section relevance.

  27. Just to be perfectly clear, because I really, really don’t want to come off as some anti-mental illness troll: It would be super-dumb of me to advocate that it’s okay to take away people’s children because the parents have a history of treatment for psychiatric illness, because I’m kind of fond of my own kids and would like to keep them.

  28. How can we be certain the parents were properly informed of the hearing? Or that they had reliable transportation? Surely the possibility that extenuating circumstances prevented them from appearing exists, right?

  29. It’s not totally misleading. I think there was also an assumption on the part of the doctors that she refused the c-section because she was mentally ill. I have this suspicion on the basis of the fact that they ordered a second psych evaluation, after the first one declared her competent.

    When my mom was pregnant with my younger brother, she stopped taking anti-depressants. She gave birth via c-section. Reading this, I can’t help but wonder, what if she had refused?

  30. Jenna, okay, not misleading. How about oversimplifying? I think you raise a very interesting and relevant point: How frequently are the rights of people with documented history of treatment for mental illness violated re: bodily autonomy, particularly in childbirth? Probably a lot. The case under discussion is as much about that as it is about the medicalization of childbirth, the ungodly high c-section rate in this country, and the autonomy of women’s bodies in the context of pregnancy and childbirth. Obviously, since that’s the way this commenting thread has gone.

    I guess the reason I’m being so picky about this is that I think it is actually unfair to ignore that discussion and instead focus solely on the issue of women’s bodily sovereignty. Also at issue in this case: I think it’s clear from the subtext of the legal decision that V.M. and her family are people of color (there is talk of her paranoia about “societal discrimination,” and she claimed that nurses or social workers talked about her baby’s and her husband’s skin color). How might racism have factored into this incident?

  31. Jenna, okay, not misleading. How about oversimplifying?

    I don’t think its an oversimplification. While there might have been other factors besides her refusal of the C-Section which lead to her child being taken away, we cannot know how many of these factors either run to the same source or are tainted. The mere suspicion of mental illness radically changes the way in which doctors interpret even normal behaviors. To borrow from Laing, once you’ve entered the asylum you will always be walking through it’s doors. Ultimately all of the write ups, all of the interpretations, all of the other factors which surround this case likely have a great deal to do with the interpretations staff made based upon the mother’s status as mentally ill and her decision the narcissistic injury they received as a result of this crazy woman refusing their good judgment.

    I think you raise a very interesting and relevant point: How frequently are the rights of people with documented history of treatment for mental illness violated re: bodily autonomy, particularly in childbirth? Probably a lot.

    Not probably a lot. The rights of the mad are universally and constantly violated. Right now I work at a county hospital in a major metropolitan area doing psych intakes and individual therapy. Abuse of patients is rampant and the ways in which the judgment and autonomy of patients is treated is frankly horrifying. The fact that the hospital called for a second consult, the fact that they couldn’t convince the first on-call doctor to play ball, is in itself strong evidence that the staff in question was out of control. Calling someone crazy is the first cudgel doctors reach for when someone gets uppity with them.

    How might racism have factored into this incident?

    Thats what I think you’re missing. The medicalization of childbirth for women who cannot afford higher levels of treatment, the high c-section rate that has a good deal to do with moving people out of valuable spaces quickly and generating more dollars for doctors and hospitals, the autonomy of bodies, the way the mad are abused, the racism that shades all of these interactions, you cannot separate these things. Its all part of the same game. These are different levels of power which are used to control bodies. Her anger was invalid because she was crazy or of color, her belief in discrimination was paranoia because staff didn’t see it (which provides more evidence for calling her crazy), her refusal of the c-section showed she wasn’t thinking properly because doctors thought it was the right idea and she isn’t a doctor. These are interrelated means of control.

    The point was to force this woman to behave in a certain manner, to cause her to conform to the demands and expectations of people who have power, to maintain her utility to others. All the rest is just justification and props. Race provides one handhold for control, madness for another, gender for a third. Together they provide the justification that people in power used to punish this woman for disobedience.

  32. William – Actually, I completely agree with everything you’ve said here. Maybe I didn’t express myself well, but all this is what I was getting at. The OP makes no mention of mental illness or race, and the Roth article touches on the former only to dismiss its relevance. That is why it was oversimplifying.

  33. Ahh, gotcha. I had gotten a somewhat different impression of your post. Apologies and all that.

  34. The staff at St. Barnabas hospital is delusional in that they believe they have the right to force medication, sugery, testing
    and treatment on pregnant women and they use the threat of
    calling child protective services(called DYFS in N.J.) if the pregnant women try to exercise their right to fefuse medical
    treatment. There is something very wrong at that hospital. In
    addition, the DRS. at St. Barnabas allow the nursing staff to make the medical decisions for the patients and the nurses make
    comments that they will lie to the DRS. and get the DRS. to
    believe. If that isn’t sociopathic behavior then I don’t know what
    is.

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