Before I delve into this subject, I think the important words to remember here are "if she chooses to go to this hospital." So she isn't being dragged, kicking and screaming, into the ER to give birth. But the connotations of that letter are still chilling.
In an attempt to stop the hospital from carrying out their threats, the National Advocates for Pregnant Women (NAPW) and Florida lawyer Patricia E. Kahn issued a complaint on behalf of Goodall in federal court earlier this week. They were seeking a temporary restraining order against the facility, Bayfront Health Port Charlotte. Unfortunately the federal judge ruling on the case disagreed and denied their request. From RH Reality Check:
"Federal District Judge John E. Steele denied the request, stating in part that Goodall has no “right to compel a physician or medical facility to perform a medical procedure in the manner she wishes against their best medical judgment.”
As I've talked about before, I typically believe strongly in trusting that your physician knows what's best in these cases, but unlike the situation in the aforementioned link, Goodall isn't a woman already IN labor. She merely wants to attempt a VBAC, which I think should be her right. Beyond the fact that she's had three previous c-sections, her pregnancy isn't high risk, so I don't see how forcing a c-section without at least trying to deliver vaginally is in her "best medical interest."
RH Reality Check goes on to make some excellent points about how VBAC is unfairly maligned in the medical industry:
"In decades past, VBAC was a common choice for women who had previously had c-sections, rising from roughly five percent of all deliveries after a cesarean in 1985 to roughly 28 percent by 1996. The rate of VBAC deliveries started to fall in the late ’90s, according to the American College of Obstetricians and Gynecologists, reaching 8.5 percent in 2006 due in part to “restrictions that some hospitals and insurers placed” on the procedure. In tandem with what some have noted as pressure on women to undergo cesareans, the rate of cesarean delivery overall in the United States simultaneously increased dramatically over the past four decades, from 5 percent to over 31 percent in 2007."
It's no secret that the U.S. and Florida in particular, have staggeringly high c-section rates. Now, I don't think c-sections in general are a bad thing. Hell, I even support elective cesareans. But these statistics do point to an obvious bias towards the procedure. Some of those hospitals in the link above have a rate as high as 60 percent. You can't tell me that 60 percent of the births (VBAC or not) at these facilities necessitated c-sections that year. The World Health Organization recommends only a 15 percent c-section rate, and they estimate that the cost of "excess" c-sections, world wide, to be $2.32 billion dollars. I would bet that, in the U.S., many of these "excess" c-sections are due to insurance fears over VBACs. And the American College of Obstetricians and Gynecologists president agrees. From RH Reality Check:
“The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns,” ACOG President Richard N. Waldman said in a statement. “[ACOG's] VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate.”
Goodall seems more than aware of the potential risks involved, and according to the statement she made through NAPW, she's done her homework on the issue. She specifically mentions her willingness to have a c-section if it becomes medically necessary. According to her statement:
"Instead of respecting my wishes like they would for any other patient, my health care providers have made me fear for my safety and custody of my children. The people who are supposed to be caring for me and my baby have put me into an even more dangerous situation. I know I’m not the only one to go through this; I’m speaking out because pregnant women deserve better.I would definitely consent to surgery if there were any indication during labor that it is necessary."
As I mentioned above, she merely wants to attempt to give birth vaginally. As long as she's willing to sign a waiver saying she understands the risks (to cover the hospitals ass), I see no reason why her wishes aren't being respected. And though she does have the option to potentially go to another facility, why should be have to? Not only that, but depending on her area, this might not be an option. In some places, hospitals are few and far between. Even in my neighborhood in Queens, NY I would have an issue choosing a hospital outside of my neighborhood. The second closest ER from my house is in Brooklyn, and would take me 40 minutes to get to by car. I'm sure this issue is compounded if you live in a rural area in Florida.
The way I see it, it's Goodall who is trying to avoid a potentially unnecessary surgical procedure. This isn't a case where an uninformed patient is trying to make risky health decisions. The stats back her up, a number of well-regarded experts and advocates are backing her up. I don't even understand the insurance liability aspect, since she's willing to take the responsibility for her choice. They wouldn't treat any other patient this way, so why are they doing it to a pregnant woman?
Thankfully this story as a happy ending. This weekend Goodall gave birth to a baby boy, after being allowed to attempt a VBAC and eventually consenting to a c-section...just like she wanted to originally.
(Photo: Heather Frackiewicz/Shutterstock)