WUNRN
This medical legal case
is part of a debate over the use of cesarean section births in the US. It
also raises issues about the rights of pregnant women to control their own
bodies.....
USA - MOTHER ACCUSES
DOCTORS OF FORCING A C-SECTION BIRTH AND FILES LAW SUIT
After
two cesarean sections, Rinat Dray wanted to give birth naturally.
But when she arrived at
NYC Staten Island University Hospital in labor, the doctor immediately began
pressuring her, she said, to have a C-section.
The doctor told her the
baby would be in peril and her uterus would rupture if she did not; he told her
that she would be committing the equivalent of child abuse and that her baby
would be taken away from her, she said in an interview this week.
After several hours of
trying to deliver vaginally and arguing with the doctors, Mrs. Dray was wheeled
to an operating room, where her baby was delivered surgically.
The hospital record leaves
little question that the operation was conducted against her will: “I have
decided to override her refusal to have a C-section,” a handwritten note signed
by Dr. James J. Ducey, thUSAe director of maternal and fetal medicine, says,
adding that her doctor and the hospital’s lawyer had agreed.
Mrs.
Dray is suing the doctors and the hospital for malpractice, charging them with
“improperly substituting their judgment for that of the mother” and of trying
to persuade her by “pressuring and threatening” her during the birth of her
third son, Yosef, in July 2011.
But more broadly, her case
is part of a debate over the use of cesarean sections. It also raises issues
about the rights of pregnant women to control their own bodies, even if that
might compromise the life of a fetus.
Across the country, nearly
33 percent of births, or almost 1.3 million, were by cesarean section in 2012,
according to the Centers for Disease Control and Prevention.
The World Health
Organization recommends that the rate of cesarean births should not be higher
than 10 to 15 percent.
The rate has been climbing
since 1996, despite warnings from health officials that C-sections are more
likely than natural births to cause problems for the health of the mother and
the baby. It has recently leveled off.
Indeed, in Mrs. Dray’s
case, her bladder was cut during the procedure, according to court papers.
The increase in the number
of C-sections has been attributed to a rise in high-risk pregnancies; a desire
by doctors and mothers to schedule their deliveries; and fears of malpractice
lawsuits should the baby be injured during a normal delivery, which typically
takes far longer than a cesarean. Obstetricians pay some of the highest
malpractice insurance premiums of any medical specialty because of the
frequency of birth-related lawsuits.
A spokesman for the
hospital, Christian Preston, said Friday that he could not comment on the case
because of the litigation and privacy concerns. But he defended the hospital’s
record, saying it had a 22-percent C-section rate compared with a state average
of 34 percent. Its 2012 rate of “vaginal birth after C-section” was almost 29
percent, much higher than the state average of 11 percent, he said.
The
lawsuit, filed last month in State Supreme Court in Brooklyn, where Mrs. Dray
lives, also names Dr. Leonid Gorelik, who delivered the baby, as a defendant.
Dr. Gorelik, in court papers, denied that he had taken Mrs. Dray for a
C-section against her will. He said that her own “culpable conduct and want of
care” contributed to any injuries she may have sustained.
Dr. Ducey’s lawyer did not
respond to a request for comment. In the medical record, he wrote that the
fetus was “at risks for serious harm without the C-section.”Dr. Howard Minkoff,
chairman of obstetrics at Maimonides Medical Center in Brooklyn, whose articles
on the subject of patient autonomy have been published in medical journals,
said he believed that women had an absolute right to refuse treatment even if
it meant the death of an unborn child. “In my worldview, the right to refuse is
uncircumscribed,” Dr. Minkoff said, cautioning that he was not commenting on
the particular facts of Mrs. Dray’s case. “I don’t have a right to put a knife
in your belly ever.”
Such
a person might be accused of being immoral or a terrible mother, he said, “but
we won’t tie you down.”
As she describes it, Mrs.
Dray’s experience illustrates the debate over C-sections.
Now 35, she is the mother
of three healthy boys. She found her doctors through word of mouth and the
Internet, she said, speaking in the office of her lawyer, Michael Bast. She
said the first doctor, at NewYork-Presbyterian/Weill Cornell hospital, began urging
her to have a cesarean after her water had broken and she had labored for a few
hours. Hoping for a different outcome for her second pregnancy, she
went to Lenox Hill Hospital, with the same result.
Still
hoping for a vaginal birth, she changed doctors again for the third pregnancy.
She also hired a doula to help her with the childbirth.
At first, she said, Dr.
Gorelik appeared to relent, saying he would give her an epidural for the pain
and then reconsider. “I was begging, give me another hour, give me another two
hours,” Mrs. Dray said. Her mother, who was there, supported her, and the
doctor said, “I’m not bargaining here,” Mrs. Dray said.
Mrs. Dray said she kept
begging on the operating table. His answer, she recalled, was, “Don’t speak.”
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