Both the law and respect for women's humanity require that every pregnant woman be fully informed of the risks of all forms of labor and delivery in a language she can understand; that she be supported in her decisions about how to bring her children into the world, whether it be in a hospital, a birthing center or at home; and that she not be penalized for those decisions either medically or legally.
In addition to the potential health risks of the surgery, women who have C-sections face consequences that even conscientious health care providers may not recognize or discuss with their patients.
In many parts of this state, having one C-section delivery will require another at a subsequent birth, even over the objection of the pregnant woman and her doctor. Several Washington hospitals refuse to allow doctors to provide labor and delivery services to pregnant women who have had a previous C-section unless those women submit to a second C-section delivery.
Those hospitals claim they cannot allow those women to have the same care they provide to all other pregnant women because the small additional risk of uterine rupture requires an anesthesiologist on staff 24 hours per day. It is difficult to credit this claim, given that most if not all of those hospitals have emergency departments open 24 hours per day, and that other pregnant women are also at risk of complications during labor and delivery that may necessitate emergency surgery.
Frequently, there is no alternative hospital within a safe distance, or the pregnant woman's insurance (or lack thereof) limits her ability to seek care at another location. A pregnant woman must either submit to a subsequent C-section, whether she thinks it is a wise medical decision or not, or deliver her baby outside the hospital. For those women who do not want a home birth, or who cannot have one because of lack of health insurance coverage or lack of available midwives within a safe distance of home, this is coercion, not consent.
Insurance practices also harm women who have had C-section surgeries. The New York Times recently reported that health insurance companies have denied coverage to women who have had C-section deliveries, calling the surgery a "pre-existing condition." And here in Washington, midwives struggle to obtain insurance that will cover their care for women who have had a previous C-section.
Policies and practices that force pregnant women to submit to unnecessary surgery cannot be justified. We would never countenance that practice for any other patient. Pointing to potential risk to the baby does not justify ignoring the mother's decisions about her medical care.
Such reasoning inappropriately views a pregnant woman's decision about her and her baby's needs as suspect, and it ignores her legal rights as a patient. All pregnant women, whether they view birth as a natural event only rarely needing medical intervention, or whether they willingly accept medical assistance with the birth process, have the legal right to informed consent and to direct the experience of bringing their children into the world.
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