“No one can force you to have a cesarean” is false

by | Jan 6, 2016 | Legal Issues, VBAC, VBAC Bans | 15 comments

Update: Since this article was originally published, it has been updated with several new resources (listed at the bottom) as well as a video.

“No one can force you to have a cesarean.” I see this all the time in message boards.

Don’t worry about

… the VBAC ban

…your unsupportive provider

… your provider’s 40 week deadline

… [insert other VBAC barrier here]no one can force you to have a cesarean.

That’s just not true.

Let’s start with what is ethical and legal: Yes, no one can legally force you to have a cesarean.

ACOG even says in their latest VBAC guidelines that “restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will.” So even if your facility has a VBAC ban, they still cannot force you to have surgery… legally or ethically.

But then you have reality: It happens all the time, but it may look different than you expect.

It’s often NOT a woman screaming “I do not consent” as she is wheeled into the OR, though that has happened.

It’s through lies. It’s through fear.

“The risk of uterine rupture is 25%.”

“Do you want a healthy baby or a birth experience?”

“Planning a VBAC is like running across a busy freeway.”

Hospital policy and provider preference are presented as superseding the woman’s right to decline surgery.

“No one attends VBAC here.”

“It’s against our policy.”

“We don’t allow VBACs.”

Or unreasonable timelines are assigned giving the woman the illusion of choice.

“You have to go into labor by 39 weeks.”

“Your labor can’t be longer than 12 hours.”

“You have to dilate at least 1 centimeter per hour.”

Or it can be a slow process where a seemingly once supportive provider quietly withdraws support exchanging words of encouragement with caution. Dr. Brad Bootstaylor, an Atlanta based OBGYN, describes how this can unfold at 4:00 in this video after a woman describes her experience:

Or, if the birthing parents don’t listen, it can escalate to calling social services, ordering a psychiatric evaluation, or even getting a court order for a forced cesarean.

It can be as simple as, “Your baby is in distress.” How do you know if this is true or not? Are you willing to take that risk?

Some people suggest that parents should learn how to interpret fetal heart tones so they can evaluate their baby’s status. But I think this is a wholly unreasonable expectation for non-medical professionals, especially when one is in labor. It is as much an art as it is a science.

In short, coercion frequently isn’t by physical force. It’s through manipulation. This is why it’s worth your time and effort to search for a supportive provider who you trust to attend your birth.

Don’t just think, “Well, I can hire anyone and simply refuse.”

Sometimes it’s not that simple as Rinat Dray, was forced to have a cesarean, and Kimberly Turbin, who received a 12-cut episiotomy while yelling “Do not cut me,” know all too well.

And this is why understanding the complete picture is important. It’s not enough to ponder how things are “supposed to be” or how we want them to be, but how they actually are. The difference between perception and reality is huge. Learn more in my online workshop, “The Truth About VBAC.”

Resources Cited

ACLU. (n.d.). Coercive and punitive governmental responses womens conduct during pregnancy. Retrieved from ACLU: https://www.aclu.org/coercive-and-punitive-governmental-responses-womens-conduct-during-pregnancy

Cantor, J. D. (2012, Jun 14). Court-Ordered Care — A Complication of Pregnancy to Avoid. New England Journal of Medicine, 366, 2237-2240. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMp1203742?

Hartocollis, A. (2014, May 16). Mother accuses doctors of forcing a c-section and files suit. Retrieved from The New York Times: http://nytimes.com/2014/05/17/nyregion/mother-accuses-doctors-of-forcing-a-c-section-and-files-suit.html?referrer=&_r=0

Human Rights in Childbirth. (2015, Jan 14). Rinat Dray is not alone, Part 1. Retrieved from Human Rights in Childbirth: http://www.humanrightsinchildbirth.org/amicusbriefpart1/

International Cesarean Awareness Network. (n.d.). Your right to refuse: What to do if your hospital has “banned” VBAC. Retrieved from Feminist Women’s Health Center: http://www.fwhc.org/health/pdf_about_vbac.pdf

Jacobson, J. (2014, Jul 25). Florida hospital demands woman undergo forced c-section. Retrieved from RH Reality Check: http://rhrealitycheck.org/article/2014/07/25/florida-hospital-demands-woman-undergo-forced-c-section/

Kamel, J. (2012, Mar 2). Options for a mom who will be ‘forced’ to have a cesarean. Retrieved from VBAC Facts: https://www.vbacfacts.com/2012/03/02/options-mom-forced-repeat-cs/

Maryland Families for Safe Birth. (2015, Jan 28). The truth about VBAC: Maryland families need access. Retrieved from YouTube: https://youtu.be/C5nymk3IGqE

Paltrow, L. M., & Flavin, J. (2013, April). Arrests of and forced interventions on pregnant women in the United States, 1973-2005: Implications for women’s legal status and public health. Journal of Health Politics, Policy and Law, 38(2), 299-343. Retrieved from http://jhppl.dukejournals.org/content/early/2013/01/15/03616878-1966324.full.pdf+html

Pascucci, C. (2015, Jun 4). Press Release: Woman charges OB with assault & battery for forced episiotomy. Retrieved from Improving Birth: http://improvingbirth.org/2015/06/preview-woman-charges-ob-with-assault-battery-for-forced-episiotomy/

What do you think?
Leave a comment.

What do you think? Leave a comment.

15 Comments

  1. I was literally scared into a csection with my first baby. I was told he was way to big and that i would break his shoulders if i delivered him naturally. He came out way smaller than they said he was…. i defiantly could have had him the way i wanted (naturally) i regretted it so much.. 🙁
    Im now pregnant with baby #2 and I’m going to try for a vbac! my new hospital actually encourages vbacs, and I’m so excited to get that chance of the birth I’ve always wanted.

    Reply
  2. I’m 23 weeks pregnant I first saw my doctor at 14 weeks . The nurse was asking my birth history I told her my first birth was a vaginal birth no complications at 37 weeks baby weighing 7pds 8oz 2nd birth 40 weeks mild shoulder dystocia with no complications ( a maneuver was used to allow her shoulders to pass through ) weighing 8 pds 12oz . When the doctor came in the room the first thing he said was I will not be your Doctor unless you agree to get a C-section which I didn’t want I have had both babies no drugs no epidural , so this is clearly against my birth plan. I was clearly upset trying not to cry . I said my baby was fine I’m fine he responded by saying your lucky you both could of died or your baby could be mentally retarded ! I said can we just see how things go ( in my opinion 14 weeks is too early to plan a C-section ) . He said no because your babies are to big and the risks of your baby dying are high ! My previous doctors never said anything like that .I have been trying to find a new doctor but very few accept my insurance . I feel like I have no options and I’m being bullied into to serving the Doctors interest over mine .

    Reply
    • Hi Carla!

      I am so sorry this is happening to you. Where do you live? Perhaps we can find you more supportive providers in your area. I’ve also posted your comment here to get more feedback.

      Best,

      Jen

      Reply
  3. You can be forced into a cesarean. I was.

    My first was 7 weeks early due to severe hypertension/toxemia. They induced at 33 weeks and I labored unsuccessfully for days until my liver started failing. This birth ended in emergency cesarean.

    My second, I wanted a VBAC and did my research to find a VBAC friendly doctor who in the end said I had to go into labor by 39 weeks and they would not induce. I felt pressured to induce it naturally any way possible (castor oil, walking, sex) I started having weak contractions most likely caused by the castor oil and “failed to progress”. The doctors convinced me to have a second cesarean after over 12 hours of what I believe now was false labor.

    By my 3rd little one, I was determined to find a truly VBAC friendly doctor. I struggled throughout the pregnancy trying to find one because my 3rd was conceived through a failed IUD and was not expected. I didn’t have the time I needed. I was literally being banned from local doctor practices because of how I felt and what I wanted. I have a letter from multiple different doctors telling me they were discharging me from their care because I wanted VBAC. I finally settled with a clinic out of the hospital who my first OB had rights to and who performed my first cesarean. It was 2 hours from where I lived. But they had anesthesiologists on site at all times for “in case” an emergency arose.

    My water broke 10 days after my due date. Nearing my due date the doctor who seemed so confident in the VBAC began telling me the baby looked too large to be born naturally. My research said that’s one excuse they will use to encourage cesarean so I ignored him. I rode 2 hours in a cab to this hospital I planned to give birth in with water leaking and contracting.

    I got there around noon and they hooked me up to the monitors and began the epidural (their procedure “in case” something goes wrong) Not much longer they were insisting the baby was in distress but that we couldn’t see it because the monitors weren’t picking it up right because of his position. I told them he seemed fine but they convinced my mother he wasn’t and that he needed a cord attached to his scalp to read his vitals. They basically got the go ahead to hold me down and insert it into me and onto him through my mother. I was of age and married! I was kicking and screaming, alarmed I was being held down against my will. My heart was racing. Once it was in they said the baby was definitely in distress and he had to be born RIGHT NOW. Like I couldn’t see his heart rate or didn’t know that the numbers were normal. They wheeled me in quite literally screaming, “I don’t need a c-section!” Injected me with something that knocked me out until half way through the “birth”. Still groggy I awoke to my mom excited over his size but puzzled by the incision. She noticed before I did and asked the nurse why was the line up and down? The nurse said, “Well, that’s so she can never try for VBAC again.” Just nonchalantly, like that’s what they do everyday!

    So, please, if you think you can’t be forced into a cesarean, think again! You can, as this article states, either by manipulation and twisted facts, playing on a mother’s love for her child and its safety or quite literally, physically and forcefully you may end up in OR because others intervene and think they know what’s best for you and YOUR baby.

    Reply
  4. I had my first cs at 19 years old after a failed induction at 40 weeks. My second was a planned RCS, because I was told vbac was 50/50 chance and I didn’t think those odds were very good. In my 3rd pregnancy the ob told me no way when I asked about vbac, and my fourth pregnancy the ob said my baby or I would die in a trial of labor. I finally learned to do my own research and have gone on to have four vba3c out of the hospital with supportive midwives. That was 3 unneccessary cs and 4 successful vbacs that would not have happened without supportive providers. I was coerced into believing what they told me and though I was a “lucky” one without complications, who knows what might have happened if I had believed the lies and continued to have cs. Thank you for supporting women and researching for us!!

    Reply
  5. Honestly I see things in what I say is a more well rounded and unbiased view. I am a Labor and Delivery nurse, who is very supportive of home births. I work in a hospital that has a C-section rate of 18% or less, I have seen many “provider” c-sections, as well as many true emergencies that are often the result of patients refusing them, I have seen babies born damn near close to death, with the most wonderful tracing, and babies with shitty tracing coming out all pretty. Bottom line is that you need to research your provider to death! you need to know what to ask, and most importantly every single mother needs to educate herself on what a c-section entails and what are reasons given for c-sections. ALL mothers! Half the trauma comes from patients that do not know what to expect, both from vaginal and C-sections. VBAC’s at my hospital is the norm. They are almost always encouraged.

    All that said, C-sections can be forced, mostly because patients are so vulnerable at the time, that even educated patients that are told their baby isnt doing well will often go will it. But education, and research pays of, and I often encourage patients in that direction! (without giving recommendations)

    Reply
    • Hi, so how can we tell if they’re lying about how the baby is doing? What should we ask? Or say?… I had 2 previous Cs & I want this last baby birth to be a VBAC & I’ve heard of all this crap doctors r doing & saying to prevent u from doing it the way u want to. And of course, all the info I try to find, u hv to pay to get it. The place I’m going is called The Birth Place where they support VBAC but they’ll send me to the hospital whenever is time bcz they’re midwife & I won’t meet the doctor til I’m about 32 weeks. It’s a lil scary bcz this doctor might tell me something else at the hospital after all my hopes hv bn raised at The Birth Place. So, I was reading about this & it said that unless the baby or myself or not in danger, we can deny the Cs. The question is, what to ask to see prove if they tell u that the baby is going through stress & a Cs is necessary???

      I’m 5 mth prego

      Reply
  6. My baby and I would have died without the emergency cesarean. It was still traumatic but we are alive.

    Reply
  7. With my first, after a very easy, almost pain free non medicated 4 hours of labor I was fully dilated and pushing with the urge to do so. The OB rushed in with several nurses, in a state of panic because the fetal heart rate was not on the screen (baby got very low very fast!) so two nurses forced me onto my back (despite my protests because I felt no pain on hands and knees but on my back the pain became immense) and proceeded to stick an IFM into me with no warning or asking myself or my husband, then told me baby’s heart rate was too low and-because we had compromised on intermittent monitoring-“I don’t know how long it’s been this low. We need to cut you open NOW”
    because I had no epidural, I was put under general anesthesia, but not before I was painfully and forcefully catheterized, which hurt worse than any part of my labor (I learned at my post partum checkup my OB “had to try and get it in 3 times, because his head was so low”). My husband was denied entry to the OR. we both completely missed the birth of our child. I ended up losing a lot of blood and needing a transfusion. I found out at a post partum check up, his heart rate was in the 90s as I was actively contracting and pushing. That is not even close to an emergency situation the OB presented it to be. I also found out they gave him hep B at birth against our wishes. He was bathed in the nursery so we missed that experience as well. They damn near wheeled him off to circumcise him and had I not been holding him, I have no doubt they would have just wheeled him off and done it.. I had severe ppd and ptsd-like symptoms (nightmares, flashbacks, deep depression and anger and obsessing over what happened, panic attacks) for well over a year.
    But no, no, surely forced cesareans NEVER happen. and the way I was treated while pursuing my VBAC any time I was in a medical setting, had I not had a homebirth, I most certainly would have been forced into another cesarean birth.

    Reply
  8. My first birth, and c-section was coerced. I fought long and hard one what what a loosing battle to birth my baby. However, when it came to me consenting to a cs, I was pushed by fear tactics, and threats. I was told, by an OB I had never met before, that if I did not consent within an hour I would loose my right to consent, and the surgery would be under general anesthesia. I was afraid, exhausted, and covered head to toe in a horrible PUPPS rash. I had been transferred into the hospital, one I had never stepped foot in prior to the transfer, and my midwives could not practice there, leaving me in the care of people I did not know. The OB went on to tell me about a “mom like me” who did the same thing and waiting too long to consent, and her baby died during the cs. Once delivered, he never held my baby up for me to see, I did not see her at all until she had been checked up, washed, diapered, and bundled. He was a hateful man, and stole my girl’s first moments from me. I realize now, having had 2 VBACs with wonderful midwives, that she was not coming out any other way, but it didn’t have to be so traumatizing. He wouldn’t even look at the emergency birth plan I had written out just in case.

    Reply
    • Erin, I’m so sorry for your experience. How traumatic. It sounds like you were planning an out of the hospital birth originally and then transferred to the hospital. Is that correct? If so, there is a group called Homebirth Cesarean that is wonderful. It is support for Mommas who had planned to birth at home or a birth center and ended up transferring for a cesarean. If that fits you, please check them out. I wish you peace and healing.

      Reply
  9. A friend of friend had her vbac turned rcs with a doctor I interviewed. This doctor had “hospital policy” automatic epidural and “progress normally” which I was told to be 1 cm every hour. I found a different provider, and have now had 2vbacs completely unmedicated, at nearly 42 weeks, and with a midwife. But this fellow mama was talked into scheduling her rcs by being told her baby’s heart beat was of concern. She was not kept for observation or even taken that day for a rcs. They had her schedule for the next week. A baby with an odd heartbeat is usually automatic hospital observation. This was a total scam to convince the mama to agree to another cesarean.

    Reply
  10. This comment sums it all up.

    “Some people suggest that parents should learn how to interpret fetal heart tones so they can evaluate their baby’s status. But I think this is a wholly unreasonable expectation for non-medical professionals, especially when one is in labor. It is as much an art as it is a science.”

    You are asking non-medical people (the laboring woman and her partner) to tell nurses and physicians that they are wrong about the need for a cesarean when you don’t think they should even take an 8 hr. class to learn to interpret heart tones.
    Yet, you insist that those same non-medical people know enough about birth to override the art, science, and experience that the nurses and doctors have acquired through thousands of birth.
    Cognitive dissonance?

    Reply
    • Linda,

      I think parents should hire providers that they trust. If they want to VBAC, they also need to find a provider who is supportive. Unfortunately, some parents hire providers who aren’t really supportive of VBAC thinking that they can either convince them otherwise or that they can simply refuse surgery in the heat of the moment. It’s just not that easy. Finding a provider that you trust who is supportive of VBAC is paramount. And if parents see red flags, they should seek a second opinion.

      Best,

      Jen

      Reply
  11. I was forced through lies and fear, with my first and only pregnancy, when I wasn’t even in labor. “Your BP is 135/90 and that’s dangerously high. You need an emergency C today!” I know now that’s not emergency high. I’ll always feel that they stole something from me and my child: the experience of a natural birth.

    Reply

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Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

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