Consent for a Forced Cesarean Section
”…. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing….Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free….” From The Hippocratic Oath
On the career road I have traveled to the place I am now I have had many opportunities to witness the deterioration of my profession. I’ve born witness to the influences of fear and money and to the corruption these have on good people. I’ve seen the informed consent process progress from honesty and humility to ignorance and cognitive dissonance and outright lying. I’ve seen academia and science develop marvels of technology but fail to teach the art of medicine and the respect for the autonomy of the patient. I’ve attended lectures and seminars promoting interventions and protocols and admonishing those like me who individualize care while never once mentioning the rights or humanity of the women they supposedly speak for.
In my current role as a home birth practitioner I am fortunate to see and hear from many in the birthing world on a daily basis. Through consultations, phone calls, email and social media I hear stories of birth. Many are beautiful and speak of wonderful experiences and practitioners in both home and hospital. But all too often, on a daily basis, I hear stories of abuse and deceit and misuse of power. This week a colleague of mine in Texas texted me with a story of frustration and bullying that I’ve heard a thousand times but really triggered us. His client, a woman with a vaginal birth, then a cesarean, followed by a successful VBAC was at term with her fourth baby. He recognized the reasonableness of her desired choice of another VBAC and counseled her as such. However, the hospital she had to deliver at has a VBAC ban and vehemently insisted she have a repeat cesarean while “discrediting” her doctor for his advice. The patient eventually went along with the unnecessary cesarean leaving my colleague feeling battered and dejected.
As our conversation progressed he confessed he just does not understand why the hospital was unwilling to even try to understand his reasoning. A sweet hearted man, he has yet to accept the realities of the business of medicine. I then jokingly said his patient should ask the hospital to sign a document saying she prefers the ACOG supported choice of VBAC. But since hospital policy restricts that reasonable choice then the hospital understands it will be held liable for any surgical complication in this or any future pregnancy. He responded, “Oh wow, I wasn’t aware of such a document. That’s awesome!” And I responded, “There isn’t one. I’m just suggesting it. Wouldn’t that be great?” Now even though we both believe they would never sign it wouldn’t it be great to have them realize what they are asking of the pregnant woman?
Well, not being one to pass up a chance to be a bit provocative and feisty, especially in the name of truth and ethics, I have created a document that I call “Consent for a forced cesarean section”. I ran it past some good people I trust and we all agreed that we should put it out there for all of us to share with our clients facing a similar coercive situation. They are asking a woman to sign a surgical consent against her wishes which supposedly alleviates the hospital and physician from liability for adverse outcomes to her and her baby, now and in the future. I’ve thought about this for quite some time and finally have concluded that if they will not honor her evidenced-based and ACOG and NIH supported choice of VBAC then they should have to accept responsibility for their choice to force her into a surgery. An equal taste of medicine, only fair, and an inevitable consequence of the road they have chosen. Just maybe someday they will get it.
Stuart J. Fischbein MD FACOG