• Wed, Dec 11 - 4:30 pm ET

Judge Rules Mentally Ill Pregnant Woman Can Have An Immediate C-Section Against Her Will

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A serious blow has been struck against pregnant women’s bodily autonomy in the UK today. A judge has ruled that a pregnant woman with mental health issues can be ordered to have an emergency C-section against her will.

A 36-year-old woman of Bangladeshi origin who has paranoid schizophrenia, named only as Mrs P, is reportedly against the idea of a Caesarean section. She was detained under the UK’s Mental Health Act last month after it was determined she had been “severely neglecting herself” and not taking her medication. Her local medical health authority sought permission to induce her labor immediately and possibly do a Caesarean section. A judge ruled today that Mrs. P does not have “the mental capacity” to make the decision about whether or not she should have a Caesarean or when her labor should be induced.

The woman has three other children, two of which were born vaginally and one, a daughter, that was born by Caesarean in 2005.  She reportedly split up from her husband earlier this year. Mrs. P has type-2 diabetes, so her pregnancy is considered high-risk (Babies born to mothers with diabetes are at risk for macrosomia, another name for abnormally large).

The fact that she is high-risk and mentally ill should not negate her inherent right to have control over her own body. Of course the judge and the medical officials feel they’re acting in the best interest of the baby, but stripping away a mother’s right to even attempt to birth her baby is cruel and unusual, especially to a woman who probably feels incredibly confused, alone and disempowered. Reportedly, the medical officials want to give her a chance to have a vaginal birth (in her case, a VBAC) but they want to reserve the right to do a C-section immediately if they feel it’s necessary. One obstetrician said Mrs. P sometimes seems ok with the idea of a C-section, but that other times she’s resistant.

Still, the ruling gave Mrs. P’s medical team the authority to induce her labor and give her an emergency C-section right away, if that is what is deemed necessary. I am not a doctor or a midwife, but as far as I know, Caesarean sections are considered an emergency when the health of the baby or the mother is at risk. Although Mrs. P is having a high-risk pregnancy, I couldn’t find anything saying that the baby specifically (or Mrs P herself) is at an increased immediate health risk of complications aside from those that might arise from her diabetes. While lots of care providers routinely schedule C-sections for women with suspected macrosomia babies, especially if they have diabetes, that’s a scheduled C-section—not an immediate one. Although there is a higher chance of ultimately ending up with a Caesarean if you have diabetes, babies are often born vaginally to diabetic mothers with no complications. If there is a sudden risk during Mrs. P’s induced labor and a C-section becomes medically necessary, that’s one thing, but it seems like the ruling essentially says the operation can be performed whenever for whatever reason—without Mrs. P’s consent.

And let’s not forget that a judge just gave permission for a 35-37 week baby to be delivered. Again, I am not a doctor or a midwife, but I know that 35-37 weeks is not a full term baby, especially under the new definition of full term. That doesn’t mean that a baby born at 35 weeks or 37 weeks can’t just do fine outside its mother’s body, but it is my general impression that doctors generally like to err on the side of caution if mothers are unsure about their dates. If they were to deliver a premature baby who had underdeveloped lungs or other problems, these officials will be setting themselves and that baby up for a host of problems, including legal ones if something happens to go wrong with this baby’s health. Incidentally, here in the US, the American Congress of Gynecologists And Obstetricians does not recommend delivering babies before 39 weeks…and that includes suspected large babies.

Is there a reason these doctors can’t wait another two weeks until this baby is closer to term? There must be, but as I said, it wasn’t immediately clear in the Telegraph article I linked to above. If they can take this woman to court and declare her mentally unfit, I wonder if they can also do something to help her take her medication, so she can be in her best mind to birth her baby once it’s at term? I just don’t understand how or why the situation is SO DIRE with Mrs P’s mental health that these doctors are willing to deliver this baby anywhere from five to three weeks early, depending.

There’s also the other issue that Mrs P’s body and baby are her own and no one else’s. I understand the legal concerns about this woman’s ability to care for herself and her child, I really do. But forcing a woman to have an induced labor and/or a medical birth (Induced VBACs carry slightly higher risks for uterine rupture rather than labors where a woman goes into labor on her own, by the way) that she doesn’t consent to is uncaring, unjust, inhumane and in my opinion, morally wrong, no matter how mentally ill she might be.

This isn’t the first time something like this has happened to a mother in the UK. Italian Alessandra Paccheri‘s case drew support in recent weeks after it was revealed that her daughter was forcibly removed by Caesarean and then put into foster care when Paccheri was visiting England. Apparently, if you’re a pregnant non-UK native who happens to be struggling with mental health, that means the legal system in the UK thinks it’s just fine to cut your baby out of your body against your will. Beware, women. Beware.

Photo: Getty Images

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  • Meg

    While I will agree it seems appalling and against numerous basic human rights…we know the alternative. We’ve seen it. How many children must be born to parents incapable of caring for themselves, let alone a brand new human? How many children must be forced to live in squalor and fear, because a system so bound by red tape can do nothing but pop their heads ’round for a visit? I believe in a person’s rights over their body whole-heartedly, but this is not, and should not be treated as, a black and white scenario. We know mental illness is a disease. We know people who have witnessed the insides of psych wards, straight jackets, pills…who are now back in control of their facilities, bettering themselves and their lives. And you know what? Some of these people do not get better. That’s a reality. There are so many details here that we do not know; what was the care like for her other children? Was she a risk to herself and her child beyond what we can imagine?? I can’t say i agree or disagree, only that turning our backs and sending these babies home with parents we can see are suffering…well, that’s what we’ve been doing. While we need to be aware of what this means for women’s health in general, we just don’t know the specific situation that prompted this intense reaction.

    • http://carrie-murphy.com/ Carrie Murphy

      You’ll notice I didn’t say anything about what will happen after the baby is born. My concern is that a judge gave an order for this mentally-ill woman to have major abdominal surgery without her consent—not that she shouldn’t get treatment for her mental illness, not that her baby shouldn’t receive the appropriate care (whether that is with this woman or not) once it’s born.

    • Véronique Houde

      And what happens if the fact that the baby stays in there longer leads to serious and permanent complications to the child? Then society will probably have a debate about why the doctors had a feeling this could happen and not do anything about it and why is it that this woman, who was potentially not in a mental state of mind that was ready to make good decisions about her child, was allowed to stay pregnant against medical advice? Had she been taking reasonably good care of herself, the doctors would not have intervened, and this wouldn’t be an issue.

    • Peggy

      The judge likely did not give the order arbitrarily; being declared incompetent in the eyes of medicine and the law (at least in the US) usually requires a good amount of evidence and testimony. While I agree the situation is unsavory, my guess is the court and the patient’s physicians were acting in the best interest of the child (and possibly the mother-there is no mention if the mother is suffering from any pre-partum complications). Additionally, forcing her to take her medications while pregnant will likely cause further harm to the child-psychotropic medications are notoriously risky in pregnancy.

    • Angela

      If someone is not mentally competent and able to give informed consent (or refusal) then how do you propose that their medical care be handled? If someone is convinced that the Drs are implanting Nazi spyware into them through their IV do we then stop treatment? Even if we know they will die as a result and are not capable understanding the consequences of their actions any more than a toddler? As a nurse I have never worked in OB but I have cared for a few patients where we had to go through the courts in order to proceed with their treatment. I’m not sure how it works in the UK but usually what happens here is that once a person is declared incompetent then the courts will usually appoint a guardian to make medical decisions. If no next of kin is available then they try to find someone with a background in medicine such as a hospital social worker or a nurse. Usually they cannot consent to major surgery unless two drs certify that it is medically necessary. Going through the courts is an arduous and lengthy process and you have to have a great deal of proof that the patient is genuinely unable to understand consequences. I imagine that it is equally difficult in the UK. No, I don’t think that having the courts take over someone’s medical decisions is an ideal situation but you haven’t suggested an alternative. Should we just refuse care to anyone who is mentally incompetent because they are not able to give informed consent?

    • blh

      She’s not in her right mind how can she be allowed to make a choice about it? BC voices in her head are telling her not to do it??

    • http://ultimatemamacat.tumblr.com/ Hana Graham

      Hey, it’s not a disease. It’s a chemical imbalance.

    • Blueathena623

      How do you define disease? There are many chemical imbalances that are identified as diseases. The body has a ton of chemicals.

    • http://ultimatemamacat.tumblr.com/ Hana Graham

      Yeah, but I find referring to mental health issues as “diseases” does nothing to help the stigma against the mentally ill.

    • Blueathena623

      I would think the opposite. Having a disease means it is not an issue of mind over matter. Otherwise you could just refer to Parkinson’s, diabetes, and thyroid issues as chemical imbalances.

    • http://ultimatemamacat.tumblr.com/ Hana Graham

      Unfortunately, the world doesn’t see it that way for mental illness. Either we’re “sick” (which is unfair when it is a disease of the mind, imho), or we should “just feel better” or “just try harder”. It’s a hard one to explain, really, but disease has negative connotations which is why it bugs me.

    • Blueathena623

      We will just have to agree to disagree and define our _____ as we see fit :)

    • carosaurusrex

      Amen. Sadly, I see this literally every day, except by the time a child is in the program I work at, they’ve usually been traumatized, abused, and ultimately either abandoned by or taken away from their parents. The behaviors these children exhibit are so extreme that some of them can’t even be in foster care, they have to go live at a shelter. Although some children recover, they’re in the minority. Many will struggle to finish school, find a job, and have normal relationships. Some will wind up on the streets and some will probably wind up in prison.

  • Véronique Houde

    I’m sorry to say that I completely disagree with you. If doctors went above and beyond and brought this woman to court, there is reason for it. You are not a doctor and cannot evaluate this woman’s risks of keeping the child inside while not taking care of herself vs. being outside of the uterus. If the judge also ruled in this favour, most likely that there is well enough reason. At this point, this child has a right to be healthy, and perhaps has better chances outside of the womb.

  • FF4life

    I have severe bipolar disorder and I have been hospitalized for it twice. When paranoid schizophrenics have an episode or go off their medications their brain stops functioning normally. I have seen paranoid schizophrenics in full swing psychosis. They can be violent or a danger to themselves or others. Mind you, with active therapy and medication, most live normal and productive lives. But during pregnancy the medications needed to maintain mental health can be very damaging to a fetus and cause birth defects so many women go off their medications when they find out that they’re pregnant.

    Right now I am six months pregnant, completely unmedicated after having a miscarriage earlier in the year because I wasn’t informed that one of my medications actually causes spontaneous miscarriages. My doctor told me they were safe and was against me having more children. There’s a huge stigma against women with mental health diagnosises getting pregnant.

    Being unmedicated and pregnant is like flying a kite in a thunderstorm. I have been terrified of relapsing and needing to go back to the hospital. During pregnancy brain chemistry changes and without medication to ease the transition it can cause an episode. I actually read somewhere that women with bipolar disorder have a 84% chance of having their condition relapse during pregnancy.

    I think when this woman has her baby and she is stabilized by her medication again she’ll be thankful that the state stepped in because it’s likely that without intervention she may not have been in the state of mind to make sound decisions for herself and her baby.

    • Bethany Ramos

      I have a friend in a similar situation who is considering going off bipolar meds as she is TTC. I felt emotional enough in pregnancy already, and I can’t imagine that fear you described. Thank you for sharing.

    • Blueathena623

      I’m butting in, but I did not go off my main medication while pregnant. It really depends on what you take.

    • Bethany Ramos

      But away! I don’t know all the deets, but she has talked to me about it quite a bit in either cutting back or going off and how it will affect her.

    • Blueathena623

      Let me be quite clear that Im not judging whatever your friend does.
      For me, my main med is Lamictal, and I’m on 4 other adjunct meds. I quit the adjuncts, but stayed on Lamictal. I considered stoping it before TTC, but I’d have to taper off, then there was no guarantee I’d conceive right away, so I could have been looking at 1 year or more off meds. And I’ve heard that Lamictal can lose its effect if you stop and start again, and I couldn’t risk that. Finally, while it is associated with some series birth defects, they are mainly due to the med seriously decreasing the amount of folic acid in the body, so the birth defects are the same as folic acid deficiency. So I took 5 mg (yes, mg, not mcg) of folic acid a day.
      The hard part with mental health meds is that there is not a lot of data on how it effects pregnancy because so many women stop. Which isn’t to say there is no data, but there is much, much less compared to, say, Tylenol. If your friend does stay on her med, I would encourage her to look and see if there are any data collections going on that she can contribute to. I did one for Lamictal so they could increase their data.

    • Bethany Ramos

      That’s a really great point – I’ll let her know. And thanks for your POV too. It’s interesting to hear this perspective, and I’m not being sarcastic. :)

    • Blueathena623

      Last thing, sorry. One more reason I stayed on my medication is that I wanted to breastfeed and as my psych explained, if my kid was exposed to it in utero, the minute (in comparison) amount found in my breast milk would not affect him. If I had started my meds right after giving birth, the amount in my milk may have affected him.

    • http://ultimatemamacat.tumblr.com/ Hana Graham

      This is why I won’t be able to breastfeed.

    • FF4life

      I really wish it was possible to have stayed on medication.. it probably would have made this pregnancy much easier in the beginning. I was on Lithium, topamax, and Effexor during the pregnancy that miscarried. I was taken off Lithium and topamax immediately but she told me that the benefits for the effexor outweighed the risks. It wasn’t until after I miscarried that I learned what the real risks for it were.

      I made sure that I was completely off my medications and done with withdrawl before we tried again.

      Losing a pregnancy to my medications took the option off the table for me completely.

    • Blueathena623

      Believe me, I 110% don’t judge you. I know how lucky I am to be on Lamictal and not lithium, depakote, rispiradol, or any of the others. I dropped my lunesta, Xanax, cymbalta, and adderall for the pregnancy, but I can’t even imagine what it must be like for you. My hat is off for you and my prayers are with you and my fingers crossed for you.

  • http://anniedeezy.tumblr.com/ Annie

    Unless the woman is so ill that she’s in a long-term state of psychosis, or her illness is compelling her to act violently towards a viable fetus or herself due to the pregnancy, I don’t see how this is a good idea.

    • a

      from the original article

      “The 36-year-old woman, a paranoid schizophrenic, has been resisting the possible treatment claiming that voices in her head are telling her not co-operate.”

      “She was detained under the Mental Health Act late last month, shortly after returning from a visit to Bangladesh.
      A team of mental health workers visited her at her home and found she had been “severely neglecting herself”"

      “Doctors at the trust – in southern England – are concerned that they may have to perform an emergency c-section if her labour fails to develop.
      They are worried she may suffer a potentially life threatening rupture, along the scar left by her earlier c-section.
      Mrs P also has type 2 diabetes, meaning her baby is relatively large, further increasing the chances of a rupture.
      Her doctors warn she is a “very high risk pregnancy”.
      The medical team want to induce labour immediately, and allow Mrs P to try a natural labour.
      However, they want the option of performing an emergency c-section if they feel it is necessary to protect the welfare either of the mother or her baby.”

    • http://anniedeezy.tumblr.com/ Annie

      Which is what I’m saying. UNLESS the situation is extremely fucking dire, I don’t think it’s a good idea.

    • A

      And it appears that a judge has determined that in this case it is dire. And that a. C-section will only be done in the event of a medical emergency

  • http://ultimatemamacat.tumblr.com/ Hana Graham

    This story has me even more terrified than I already am about having a baby.

  • Emil

    If I had a psychotic episode at the end of my pregnancy I would hope that doctors would do what they needed to do in order maintain the safety of both me and my child.

  • Kay_Sue

    I do agree. It’s a frightening precedent to set. Having the court give permission for a baby to be forcibly removed from a woman’s body is wrong. Period.

    If they feel that she is that much of a danger to herself in the child, are they incapable of hospitalizing her for treatment and observation? If she is judged so incompetent that she can’t make the decision regarding how to deliver her baby, and whether or not she should undergo an invasive procedure with serious risks for complications, that should be a viable option. Then there would be doctors on hand for the woman when labor started.

    This just doesn’t sit right with me at all. I do believe in doing what we can for any child, but…this is just at such an expense to this woman’s person.

    • a

      I’ve just read the original article that this author cites. The original article states “She was detained under the Mental Health Act late last month, shortly after returning from a visit to Bangladesh.
      A team of mental health workers visited her at her home and found she had been “severely neglecting herself”.”

      So it appears that they have been observing and trying to help her for some time. The other article is also clear that they have been trying to speak with her about the potential need for a cesarean to be done in case of complication and that her willingness to consent has fluctuated, at times with her citing her reason for not wanting to agree to this treatment option being the voices telling her not to. In this case it appears that the mental health team has tried to help her to understand her treatment options but that her mental illness has robbed her of the ability to make reasoned and informed decisions. From my reading of the original article her medical team took this to court to have the judge give them the ability to intervene with a c-section only if there is an emergent need to do so when she is trying to deliver vaginally. And they have done so because she is fully unable to understand the risks associated with not consenting to this. So in short, the original article is a lot more clear and less biased than this authors interpretation.

    • Kay_Sue

      I can understand that a little better, but it still sets a scary precedent. C-sections, especially those that occur during a vaginal birth already in progress, are complicated, and the risk of infection higher. They are, essentially, forcing this woman to submit to those risks, with no real idea of what she is doing and no ability to consent to the procedure.

      Do you trust any government to really understand the ramifications of that decision? Does the original order state that she has to go into labor naturally, or can they decide to induce her without consent also?

      The simple fact is, we all have a right to control over our bodies. That right has a history of being seriously compromised for those with mental health disorders, and any time we see an example of that right being compromised, no matter how correct it seems, it still needs to be questioned, scrutinized, and criticized. If we get complacent, we run the risk of allowing such atrocities to happen again.

    • A

      I absolutely agree that we have to remain vigilant in ensuring that when a person decision making rights are taken away that it is highly scrutinized and that the bar for doing so remains high with the burden of proof being on those who seek to have the decision making rights taken away (I had written something to this effect in a response post to the article but apparently my respectful post disagreeing with the author was removed).
      However, facts in this case appear to support that this woman’s physicians were seeking the ability to make this decision if it is medically necessary as the woman was unable to understand the implications of refusing (I.e. The original article discussed the possibility of her scar rupturing as a possible reason for her medical team to need to intervene). While we do need to be highly vigilant in not taking away a persons right to choose we also can’t ignore the fact that mental illness and/or cognitive disabilities can rob a person of their ability to understand and appreciate some decisions and that there can be a need in this case for some of these decisions to be made by loved ones or if they are unavailable, a medical team with the approval of a judge.

  • Janok Place

    The judge ruled that she would have an immediate caesarian IF it was deemed necessary. It doesn’t seem to me he’s ordering it to be done just for the heck of it. I’m not sure I see the issue with this ruling. If it has to be done for the health and safety of mother or child and the mother is refusing treatment I’m not sure what else they can be expected to do. Allow harm to come to mother or baby? That’s really not a great option, even for the sake of protecting her rights. I would hope that if I was not of sound judgement and incapable of critical thinking, and this endangered my child, someone would save him/her.

  • SA

    I fail to see how this sets a dangerous precedent. This woman is unable to make logical decisions, is in a state of psychosis, is neglecting the care of the baby inside her, and has a high-risk pregnancy….seems like common sense to me. Although I would hope that they would hospitalize her and try to let the pregnancy continue on to term. Maybe there are more pressing issues.

  • CrazyLogic

    UGH