Coerced Cesareans Struck Down Part 1: The Woman and Attorney Behind Israel’s Landmark Ruling Speaks Out with “Esther” & Tamir Turgal

Introduction and content warning

Jen Kamel: Hey there, just wanted to share before we dive in that we will be discussing a variety of topics that might be difficult for some listeners to hear, including discussions of suicide, unconsented cesareans, obstetric violence, fetal demise, miscarriage, forcible sedation, and medical kidnapping. Please keep this in mind when deciding if and when you will listen. Now, let's get started.

Her story

Welcome to the VBAC Facts® podcast. I am Jen Kamel, CEO and Founder of VBAC Facts®. Since 2007, our mission has been to provide objective and accurate information on vaginal birth after cesarean and repeat cesarean to parents, professionals, policymakers, and the court so all decisions can be informed, ethical, and just. Today's topic is how the Israeli Supreme Court overruled a lower court's ruling to compel a woman to have a repeat cesarean. Today we have with us that woman, a wife, mother of many, a clinical psychologist who lives in Israel, but was raised in New York and her attorney, Tamir who specializes in medical coercion.

Jen Kamel: I would love to start with why it was so important to you to share your story.

"Esther": I have a whole personal life. I don't need this to become my whole personal life and it's private and I didn't feel as strong a need to get this anywhere, to go into this so deeply. But at this point towards the end of this pregnancy, I just felt so strongly this absolutely must be shared. Not only for women to be empowered about the possibilities for birth, but also to understand a little more clearly: what is going on in the systems in which we are birthing and for medical providers to understand how far we've gone from serving the people at this point. It's important to me that this goes somewhere.

Jen Kamel: I understand that you don't want to share your video today, so can you share a little bit about that?

"Esther": I feel strongly to protect my family. I mean, at this point, given what I've been through, I really don't, unfortunately trust. You'll hear my story today and you can judge, am I crazy? Am I so out there? It never seemed that way. I was doing the best for my family my future health and my ability to mother my children. At every single point. I don't want this attached to my family. I need my family to be safe.

Jen Kamel: I think the thing that is so important is anytime we talk about birth choices, Often people feel like, well, that's not something I would have done. That's not the choice I would have made. And the whole point is all of us should have the freedom to make our own medical decisions, whether we want to birth vaginally, whether we want a cesarean, and that should be an option that's freely chosen rather than something that someone is pushed, coerced, or even forced by court order.

And I think it's really important as our listeners hear your story today to rather than think, what would I do to just be with you on your story and understand that this is your experience, and it's an opportunity for all of us to learn what can happen when people with good intentions don't quite understand who makes the ultimate choice. And that's you.

"Esther": And the reason you should be the one to make the final choice is not because you're smarter than the doctor, which you're not. You know, whatever that storyline is, but rather because you are the one who has to live with the consequences that's the concept of informed consent.

Nowhere is it as severe and as insane as it is when it comes to birth, where we just don't provide informed consent, and we don't trust women to make the best choices for their families. This is crazy.

Jen Kamel: And it's so interesting you use that phrase " because it happens to them," because I make that statement all the time. Women are the ones who will either experience that uterine rupture, that victorious VBAC, a placental complication in a future cesarean. That all happens within our bodies. So that's why we get to decide because every option has risks and benefits.
And I think one thing that's so important is for clinicians to be very clear on when we have good evidence. Your situation is a great example of where we don't have solid evidence on where your risk was, and so it was very interesting how people would describe your risk as you went through all of your pregnancies with such certitude, when in reality that is just not the case.

Women are entitled to be informed of unknown risk. "We don't have solid evidence for your situation, so you have to consider how you feel about levels of unknown risk so you can make the best choice for yourself," which is different than saying, " The risk is 25%. This is dangerous." Do you want to start with your first pregnancy and what brought on that first c-section?

Her first pregnancy and miscarriage

"Esther": Yeah, absolutely. So I got married in 2015 and a couple months later, got pregnant and I quickly had a miscarriage. I didn't know how normal miscarriage was so it was very shocking to me. I wish I had known how normal it was and how like, this is okay. It's sad, but it's not the end of the world. In those first few weeks of being pregnant, I started looking into connecting with a provider.

I had never heard of the term midwife. My mother used an OB GYN she was happy with for many years, and I was thinking of going to him. And I started looking into him and into other providers in the area.

What I started to notice right away is that every OB GYN listed specialties in complications. I'm a young, healthy woman, I was exercising regularly and eating very clean and nutritious diet and was really confused by that. Why would I want to go to somebody who specializes in all these issues? I don't have these issues. I don't have these issues. I don't have these issues.
I stumbled across the concept for the first time of a midwife. So I did connect with a midwife who worked within a practice of other OBGYNs. And because I was connected with her, I was actually offered the option of a D&C versus just miscarrying naturally at home, which a lot of women are not even told as an option.

So I was, I'm really grateful that as a young and completely uninformed woman, I was told that was an option because I obviously chose that option and miscarried at home and it was totally fine. And like a week after the miscarriage, I went for another ultrasound and basically cleared to go and I immediately became pregnant.

I didn't have a cycle in between. I immediately became pregnant and felt very intense pregnancy symptoms at around 11 weeks I started bleeding I was shocked, Oh my god, I'm having another miscarriage, clearly now there's something wrong. I was devastated.

The birth of twins and first c-section

"Esther": The next day we went for an ultrasound, the midwife said we were pregnant with twins. She mentioned she delivers twins naturally all the time. Not a problem. Just if Baby A is breech, then it will be a problem.

I didn't think anything of it because I'm a healthy, young woman. Everything went on and I was shocked by the intensity of it. They send you for extra testing and extra ultrasounds when you're pregnant with twins. So I was by a maternal fetal medicine specialist like every other week and a stress tests and all the good stuff.

Towards the end of the pregnancy, I was told, " Baby A is breech. When do you want to schedule your c-section?" I was shocked. Why would I, a young, healthy woman, need to have a surgical procedure to remove my children from me? If I'm young and healthy, then, theoretically speaking, everything should work regularly, right? There's nothing wrong with me. I was very confused.

I did a lot of research, but not enough to understand that breech birth is healthy. A very viable and safe option. I did not understand that at the time and I do carry resentment that I didn't have enough information despite all my best efforts.

I did try switching providers and everyone said, "We won't take you this late in your pregnancy, but come to us after for your VBAC." So that was that was that. And I fought with them and I would not schedule the c-section. And finally at 38 and a half weeks, I was like, fine, I'll schedule it. Cause I didn't know what else to do. And I was scared.

They were actually so mad that I hadn't scheduled it that they said ,"Okay, well, the only available we have availability we have is Friday night" and I'm Sabbath observant. So I was stuck and I mean, I was going to just do it. Like what else? What else am I going to do at this point? At this point, I understood it was a medical emergency because I don't have any other way of birthing my children. And then they called back after I'd already scheduled the day before and said we have availability next Wednesday.

It's a gentle cesarean

"Esther": I remember I went in for the c-section in the morning, they were prepping me and asking all these questions. And they said, "Wow you're really healthy." And I'm like, "Yeah, I am really perfectly normal, healthy, average 24 year old woman with no problems. You are about to cause my first problem, let's just be completely clear about what's happening right now."

As predicted, this was a completely textbook c-section. This was actually what they call like a gentle cesarean. Or a family centered cesarean. My husband was next to my head. Babies were brought to me right away on my chest. There was a clear drape. I saw the baby's foot shoot out. I had aromatherapy. I had some essential oils dropped into the water next to my head and music playing. Beautiful. I'm sorry. I find it all completely ridiculous because the bottom line is, this is a surgical procedure and you're not making it any nicer.

And in fact the first word my children heard were very unpleasant words from one of the doctors. I'm very disappointed that that was the case. And there was also, you know, all these people who I've never met in my life in a very brightly lit space while highly medicated feeling like a Looney Tune.

The babies are brought to you, but you've got a drape in your chin, so, this is, you know, a really special moment here, and you can smell your skin burning and feel your entire body shaking. There's nothing wholesome about this way of entry into the universe. This was my planned, scheduled, non traumatic, family centered, completely healthy and easeful c-section. This is as good as it's gonna get.

So after that I eased into life with my twins, And went back to work. At six weeks I was told, " You had a c-section, so you can't get pregnant for a year, so you have to take birth control. You're nursing, so take the mini pill. Here it is." And at some point, we got to a year. I went off birth control and immediately became pregnant, which was surprising because, I knew I became pregnant a week later than they were predicting. And so obviously my due date was off.
I did not know that this would end up being such a disaster, but okay, that's going to be a disaster. So, but fine. That's when they made my due date.

Planning for a VBAC and second c-section

"Esther": We also moved to New Jersey for my residency. So I was in New Jersey for the year and I chose a midwife practice. It was like seven midwives in this practice and planned for my VBAC. I had no understanding that planning a VBAC was complicated.

I thought, " Of course I'm a VBAC. I'm a perfectly healthy young woman with no issues who had a c-section for breech. And I'm not pregnant with twins. He's not breech So what's going to be the problem, right?" No additional prep. I did hire a doula. And that was pretty much it.
It was a stressful year. I had to make up hours for my maternity leave. So I was working crazy, crazy long hours and with my twins at home and there we are.

So we get to the end of the pregnancy, 36 weeks, they do an ultrasound and they say, "Oh, baby's breech when do you want to schedule your c-section?" And I said, what? So they sent me to their doctor who backs their practice to do an ECV. I show up and he does the ultrasound and he says, "Oh, it's a miracle. I turned the baby without even touching you." So the baby flips the next day.

So again, this fear mongering what I didn't know was I was being set up for a bait and switch kind of situation, which is what people talk about. So I was being, you know, kind of misled that like, "Of course, you're going to have a VBAC, what's the problem?" And when really nobody had any intention of giving me a VBAC.

At 40 weeks they did a cervical check, which is by the way, no good evidence for that and totally useless intervention. But okay, yeah, got a cervical check. "You're not dilated and we're not going to induce you because we see in your chart from your previous c-section that they did single layer reinforced sutures and we only do induction when there's double layer sutures. And so we're not going to offer you any induction options and you're not in labor at all. So you're never going to go into labor. So when you want to schedule your c-section?"

I was like, What? My grandfather died, the next day. I was like, leave me alone. Don't talk to me, in my head, I kept saying, my due date was off. First time average for going into labor is 41 weeks. So I shouldn't go into labor for another two weeks, theoretically So I don't get why you're harassing me. They were calling me every day to ask when I was scheduling my c-section.

So I'm extremely stressed about not being in labor yet. I did all the things. If you've read a thing, I did it. I was at a chiropractor. Bouncing on the ball. Using the pump. Taking black cohosh, blue cohosh, castor oil. At 42 weeks, I went to the chiropractor and I come home and my water breaks. Wonderful. And I have a couple of nice, beautiful contractions and we call them and they say, well, you're GBS positive and you're a VBAC, so rush to the hospital.

We rushed to the hospital and we get there. And I am one centimeter dilated and they say, "Oh, you're never going to dilate. You're never going to give birth. Let's have a c-section."

My husband lost it fighting with the doctor. " There's no medical necessity. She's fine. The baby's fine. She wants a regular birth. Why are you giving us such a hard time?"

And the doctor even pulled my doula out of the room and said, "You have to convince her to have a c-section." The doula was like, " Why would I do that? What's going on?"

And we stuck it out for 36 hours of nonstop fighting. They had this nurse tailing me. I went to take a shower. She followed me into the shower. She was just trying to get the monitors on me the entire time.

I'm bouncing on a ball. I'm doing everything I can do. And finally I sit down on the bed and she's tailing me the entire time with the monitors. And finally I sit down in the bed and she's like, "Oh, look, your, your baby likes it when you sit down." I was like, "No, your monitor likes it when I sit down, let's be clear what's happening right now."

They even sent the head of the hospital to tell us we had to leave unless we were having a c-section. I think things could have gone differently if I knew I could have left, but I did not understand that it was an option for me to leave. My waters are open. I'm 42 weeks. I was having contractions. They stopped by that point, which is normal by the way.

Highly recommend the book " Farmer and the Obstetrician," by Dr. Michel Odent. Talks about this idea that, yeah, women are not going to stay in labor if you shine bright lights on them, you stick your fingers up them and harass them, they will not stay in labor. That is not a normal physiological process. So yes, my labor stopped at that point. And I didn't know what options I had.

So at 36 hours, I gave up and we went to have the c-section and and the doctor said to me, "I don't understand why you're so upset. Today's going to be a wonderful day. Your baby's going to be born."

Now, this was the same doctor who a couple hours earlier had said to me, "In the state of New Jersey, there is not one hospital." I don't know if he's accurate. This is what he told me at the time. So this is now in 2018. " There's no hospital in the state of New Jersey that will allow a trial of labor after two c-sections. And after four or five c-sections, no doctor will allow another c-section." so I don't know if these facts are correct, but this is what he told me.

And so I said, " You just told me you killed my future children. So I'm not sure what's your game here? But no, I'm not happy that me and my perfectly healthy baby are about to be rescued by your unnecessary c-section."

Never asked about intended family size

Jen Kamel: I'm really curious. At any point, did anyone talk to you about your intentions in terms of the size of your family?

"Esther": No,

Jen Kamel: I think that's a really important to point out because we know that the risks increase with each prior cesarean. And so that's an important part of the conversation, that whole risk benefit analysis that every person pregnant after a cesarean should have with their clinician. One of those critical questions is how many more kids do you want to have?

"Esther": And as you're saying that, I'm actually getting a little angry because in my training as a psychologist, I will not tell you how many countless hours were spent on multicultural training, in different cultures, practicing psychotherapy with different cultures.

I happen to specialize in working with the Orthodox Jewish community. So I'm already quite knowledgeable about that community and I'm not necessarily working as much with other cultures, but I have tons of training in multicultural competence. If nobody along this journey, not the hospital administrator, not the doctor, not all the midwives, not the nurses on staff, and not the prior midwife, not the prior OBGYN practice, nobody has any cultural awareness that Orthodox Jews typically have much larger family sizes, that seems a little odd to me, just a little odd. I would think it would cross someone's mind, but maybe not.

Uterine window noted during second cesarean

"Esther": Yeah, so we went in for our delightful, completely unnecessary c-section. It was perfectly normal, except, oh wait, I had a partial dehiscence. I actually had what they call a uterine window. So they said that it could be that that's the reason why my labor wasn't really picking up. I don't know, that that is a possible, that is a possibility.

But I did have a uterine window, which is something that can happen along the scar, that there can be a partial separation where the uterus becomes quite thinned out by the scar. This is, mind you, after one c-section.

Oh, and of course now we're all anxious about the double sutures because there's such a big deal about the double suturing. And he said he actually couldn't do double layer sutures. " There wasn't enough room." I don't understand what that means, but that's, that was what I was told. So much for the double layer sutures.

Single vs double layer sutures

Jen Kamel: And I just want to share that the evidence on single versus dual layer suture does not show that one method is clearly superior to the other.

"Esther": So yeah, after the second c-section. I went back six weeks postpartum, the doctor said again, he said, "But I'm the VBAC king of New Jersey. I back all the home birth midwives." I said, "That's nice for everybody else, but you killed my future children." He really had a hard time hearing me and I felt very frustrated by the entire experience. So at that point, I'm three months postpartum, and I'm nursing.

Fourth pregnancy and emergency c-section

"Esther": Basically, I become pregnant. That was shocking to get pregnant that soon after. I really was not expecting that.

But we also, me and my husband, have now been so traumatized by the prior birth that going into this next pregnancy, we came in with a lot of emotion. So I immediately began researching. I actually met a home birth midwife in the neighborhood.

And that opened my eyes to the concept of a home birth and she connected me with Nancy Wiener Cohen, who wrote the first books on VBAC and coined the term VBAC. She was inspirational and helpful.

She directed me to my options, which was basically to pretty much go underground because there are no legal ways to have a home birth after two c-sections and you're not going to really get really great options in hospital.

Jen Kamel: Hey there, Jen here. I wanted to just pop in while I was editing because I wanted to address this statement regarding it being illegal for someone to plan a vaginal birth after two cesareans with a midwife in the U. S. Laws and rules regarding midwifery vary greatly from state to state, but in states like Oregon and California, people can absolutely plan a vaginal birth after two cesareans with a midwife either at home or at a birth center.

Can it be difficult to access vaginal birth after two cesareans in the U. S.? Absolutely. Studies indicate that only 3 to 7 percent of people with two prior cesareans actually labor, meaning that everyone else has elective repeat cesarean sections.

So while those are really low rates, how accessible vaginal birth after two cesareans is in your community may vary greatly. There are incredible providers across the country who support VBAC after two cesareans. You won't know what's available in your community unless you reach out.

I recommend the best way to do this is to contact local doulas, as well as call the labor and delivery units of the hospitals in your community. Ask the charge nurse, "Who is the most supportive VBAC clinicians on your floor?" Not only do you want to get the names of OBs and midwives, but you also want to get the names of nurses because if you decide to labor at that hospital, you may want to ask for a specific nurse by name.

We have an article summarizing the evidence on vaginal birth after two cesareans available at https://vbacfacts.com/vba2c as well as a continuing education training on vaginal birth after two cesareans available within VBAC Facts® professional membership. You can learn more about that at https://vbacfacts.com/membership. All of these links are in the show notes along with the other resources available for this episode. Okay, back to the story.

Uterine thickness conversation

"Esther": So I did find out that there was one doctor in all of New York. I mean, again, it's possible that I'm mistaken, but this was what was told to me. The only doctor in New York who has privileges to offer trials of labor after two c-sections. She had been in Columbia Presbyterian and they did not want to offer this anymore. So they kicked her out and she went to NYU.

As far as I know, NYU is the only hospital that offers trials of labor after two c-sections. I met with her for over an hour. We grilled each other, and it was actually one of the most eye opening experiences. We just fought with each other for an hour, in a, in a well spirited manner.

And so for example, one thing I remember very clear was she had said, "Well, one thing I would require of you would be to get this special type of ultrasound to look at uterine thickness."

And I said, "Well, what's the risk of a false positive" and she said, "It's actually extremely high. About as high as getting an accurate positive."

I said, "Okay, so that's really interesting. Why would you require that?"

"If it shows uterine thinning, which you had a uterine window, so if it shows uterine thinning, then I would not offer you this trial of labor." And there were many other things also. "So like if in labor, this happens or this happens or this happens, we would go for a c-section." We're now doing things that are going to make you more comfortable, but are not going to support my health. And that's where I started getting really aggressive.

So the first thing I did after my c-section, of course, was not like nap, but the first thing I did after my c-section was look at all the available research. And as a psychologist, I had access to libraries. Not a Google search, but I'm looking at the actual scientific literature that exists on uterine dehiscence and risk in future births. And what I found was astounding, which was that there was no significant research.

It's very hard to look after multiple c-sections because you don't have a sample size because women who are birthing after multiple c-sections aren't doing it in your study. But okay. So not that they're not doing it, but they're not doing it in your study. So we don't have good research on that, but here you actually can get good research because these women are having multiple c-sections.

So you can just look and see, do they have a dehiscence or a separation in the next [pregnancy] and they actually don't they actually don't see a significant correlation between one and the next birth. I am now living proof because I had that in my second and do not have it in my third or fourth c-sections.

We had this really delightful conversation that was very aggressive, but in an academic sort of way about the fact that the bottom line is you are going to prioritize your license, your insurance, your liability, your hospital privileges over my health both currently and in the longterm, which I respect. I respect that. I understand that.

I'm also a licensed clinician. I also do things to preserve my license and to preserve my ability to treat my clients. That is a reasonable choice. However, less so in my case and a lot more so in your case, that's coming at my risk. That is not a risk I'm willing to take. I am not willing to risk my health and my children's health and my future children's health on your insurance

"The Insurance Company Won't Event Let Us"

"Esther": I was already prompted for this understanding in the prior c-section when I'm being harassed by the doctor and the hospital administrator telling me to get out or have a c-section. The doctor exclaimed at one point, "Well, the insurance company won't even let us." And I remember just feeling like, "I am sad for you. I am sad for you that that's the best you can come up with. That's your argument to me as to why I should make this critical medical decision."

After this hour long conversation with this doctor at NYU, we hugged. It was sweet. She said to my husband, "I wish all my medical residents were as clever as your wife and fought with me the way she fought with me."

Jen Kamel: Awww.

"Esther": I really appreciated that because I said," We have an honest understanding of each other. This is what I'm looking for. Tell me the truth. 'I cannot, as a medical provider, give you the safest option.' This is what I can do for you. You make your own choice." She did that and I was so grateful and I walked out of there like, okay, I did that, done.

I started looking into options for home birth. And I did plan a home birth with an unlicensed professional or whatever, not the word professional, it's not the word I would use, who ended up being not a wonderful person, but that was sad for me but also speaks to, you know, the problem here, right? I was given very limited options and ideas. Now I'm aware of a lot more options and ideas than I was then. But at that point, that was the only real option I knew of.
So I hired this non licensed midwife, we'll call her. I connected with a wonderful doula. So I had this really nice support team and I approached my birth.

Unfortunately because I was spending a lot of time doing all the research to understand everything and to understand everything about birth and about the risks and to talk to all the right people and to get all the right supports people and to do all the right things, that I actually really neglected my health. I was really very stressed. I was working and also doing all this extra work to understand all this stuff.

Then at 40 weeks, my waters released and I had contractions, but they petered out, I was assessing all the time for signs of infection, there was no signs of infection, and by the way, if your waters are open, don't go to a hospital, because you're much higher risk of getting an infection that way, so I was home.

I was low risk for infection, but I was monitoring for signs there was a lot of stress, is this going to be okay? What's going to happen? My waters are open. Why is this happening? And as the stress was increasing and increasing, and with the people around me, I decided to use castor oil to bring on more contractions, which is a terrible idea. If you are a VBAC and if your waters are open, don't use castor oil. It's a terrible way to bring on pregnancy. I took castor oil, immediately felt terrible, passed out momentarily and came back and I was bleeding.

We went to a hospital. We were very anxious about this whole thing. So we had EMS waiting outside at that point. Like we were there within six minutes. But they took an hour from when we got there.

And then all of a sudden they say, "Oh, now it's an emergency because then her heart rate started to drop." They switched to an emergency c-section. It wasn't considered an emergency for over an hour that we were there. But then at some point it did switch to an emergency c-section.

She was born with an APGAR of one, but within one minute was up to seven. So there was placental abruption. She did swallow blood. And they brought her immediately to the NICU and she was fine pretty much right away. That birth was obviously traumatizing. I went straight into Corona from there. The end of January 2020.

Jen Kamel: You're still in New Jersey at this point, right?

"Esther": No, we moved back to New York for my postdoc and then it was Corona. So I didn't need to be anywhere cause everything was virtual we were trying to move to Israel as soon as I would get licensed. So we did move a few months later.

But in the meantime I decided to get an IUD. I didn't want to get an IUD originally. It sounded off to me that if you want me to have time to heal my uterus, why would you then use something that the method in which it works is by irritating the uterus was confusing to me.

I now understand there's the hormonal ones, which I was not interested in given my history. The Copper IUD was presented as the non hormonal option. But the way the Copper IUD works is by creating localized inflammation. But if you understand anything about inflammation, there is no such thing as localized inflammation. I was already struggling with inflammation, which I didn't know about.

But when I started doing research as to why I had this two times where I had my waters released with no real labor picking up, what I found, actually, I really was directed in this from the Evidence Based Birth® website. She had a handout on premature rupture of membranes. And on there, she had a little note about inflammation being a potential risk factor. And that was the only one that made sense to me. So I pursued that line of research and that made perfect sense to me that that was exactly what I was struggling with as a result of the birth control. That was likely causing that reaction.

It's something I continuously worked on and monitored very, very carefully for my future births.

Moving to Israel and unassisted birth

"Esther": But in any case I did get that IUD and then we moved to Israel and a month later I was pregnant.

I did not know that you could get pregnant with an IUD. That was pretty shocking. When I got the IUD out and the headache I went through to find like the nicest doctor who was not going to further traumatize us And it didn't go as well as I had hoped. I pretty much walked out of that saying, I'm not allowing anybody to hurt me anymore.

Starts considering unassisted birth

"Esther": I'm done with this whole story that I need to be hurt in order to be saved. I started looking into unassisted birth and discovered a large community and worked with different types of people to learn about this.

It took many, many, many, many courses until I actually did undertaking their training for what they call like birth keepers or birth workers who support women outside the system or unlicensed midwives. So I did decide to take their full training. And the reason I decided to do that was because I wanted to be as prepared as possible and have as much access to all the information as possible. And so I did that. I did many other trainings as well. I actually did a training in breech delivery with Gail Tully which was, you know, lovely and really empowering, given my prior experiences.

Did a lot of training, a lot of reading, a lot of listening to every single thing possible. And a lot of work on myself my diet, exercise, mindset, sleeping more, stressing less, did my own prenatal care.

I find the whole term prenatal care kind of funny because what we consider prenatal care is really not prenatal care in my opinion. It's prenatal monitoring. So I was doing my own prenatal care, diet, exercise, sleep, stress. I also was doing my own prenatal monitoring. Looking at blood pressure and blood sugar. I'd monitor my blood sugar which is way more accurate than doing the gestational diabetes test that OBGYNs do.

I had my baby at home at 40 weeks. It was a straightforward birth. I had two days of pre labor signs and then one morning at like 6:48 am, I believe if I'm correct, I started having nice real attractions about every 4 minutes. They never really picked up further than that. So it was about every 4 minutes. My baby was born at 1246 at night. So about an 18 hour labor that was very straightforward.

Meconium & postpartum hemorrhage?

"Esther": And I did basically, hemorrhage at home, if you choose that term, which I think it's just interesting to know that I did manage that at home and it's fine. I took shepherds purse, helpful with hemorrhage. And called in a friend at that point, a friend who goes to birth outside the system.

And so she came and helped me get food, drink, and sleep, and cover everything down, and then get settled, and then we stopped that, and that's pretty much his birth. That was that birth in 2021. Then I became pregnant again and had a miscarriage.

So at this point, I had my twins born by c-section in 2016, healthy, perfect, wonderful simple. 2018 c-section, baby, perfectly healthy, wonderful. 2020 emergency c-section, the baby is fine and healthy and wonderful and 2021, my baby born at home perfectly. I mean, probably my healthiest child. Very healthy happy, wonderful child.

Sixth pregnancy after four cesareans

"Esther": I became pregnant again, and that pregnancy, I was very relaxed I felt like, "Okay this is what's going to happen. I'm just going to keep getting pregnant and it's fine. And birth is not scary and birth is not dangerous. Everything's going to be fine."

I didn't think about the pregnancy much. I was very stressed at work. Sleeping little. I was not moving at all. At all. And I wasn't eating well. You know, nothing crazy, but I wasn't eating as well as I had been. And I think all those factors together were not doing me any good.

Health concerns and swollen foot

"Esther": At 39 weeks, one of my feet swelled up. I was suspicious that there was a blood clot because one foot is kind of weird. So I tried figuring out what my options were. So pretty much the only option was to go to a hospital where obviously they were going to give me a c-section. That was going to happen. So I was trying to figure out if there was another way to find out what's happening.

Struggles with medical care

"Esther": So I tried going to my doctor. He wouldn't see me. He said go to the hospital. So then, so then he said there's actually in Israel, there's an urgent care, particularly for pregnancy from like within your insurance company. It's a little different how insurance works over here. But more or less, I think that's the way to explain that.

So I went to that place. And oh my gosh. So first they took my blood pressure, 140 over 90. I was like, that's high. They were like, talk about it with the doctor. I had a little bit of protein in the urine.

So we went over to the doctor and he starts fighting with me. How do I know I'm pregnant? How do I know what I'm due? I just could not stop laughing in his face. My husband was trying to like mediate. I was trying to get him to look at my foot. He kept wanting to look at my stomach. Why do you need to look at my stomach to diagnose a blood clot?

Jen Kamel: Yeah.

"Esther": I'm not concerned about my stomach. I'm concerned about my foot. After all this fighting, he got angry. He said, "Well, I can't even help you. I can't even assess for a blood clot."

You need to either be able to do certain kinds of blood tests. He wasn't able to do an ultrasound on the foot . He said, "So what are we wasting our time here?" The blood pressure never got discussed. He never looked at it, so that was that.

I went home and decided, you know what, like, I don't know what else to do. I'm gonna stay off the foot, but movement is good, but also elevating. I was also trying to take a high dose of turmeric, ginger, garlic . So that was what I was doing. I was nervous, but also like, Okay we're dealing with it. I don't know what else to do. If I spontaneously die from a blood clot, that would be really bad. I was just dealing with that not knowing and not sure where to go next and not sure what to do. I was kind of stuck there. That's where it was.

A couple of days later, I thought the night before I was going into labor. In the morning we were signing on a mortgage, so we needed to get a health screen. I had to go to my regular family doctor. They checked my blood pressure and it was 140 over 90. I said, "Isn't that high?" I said again, second time now in a week. The doctor said, "You're nine months pregnant. It's normal." So that was what I was told twice.

I do think that was a little bit, like a little hug from God. I hadn't been to any medical care at all. And so this was a little like, See, you saw two doctors and, and nobody said anything. So that was a little we call 'em Hebrew, [Hebrew], healing thing before the bad thing comes.

I was having contractions. I went home, called my husband to come home, and I let my friend who was planning to be at the birth no, but not to come yet. Should I just come and hang out inside her house? Cause I can hear she's in labor but no, I'm going to respect her . Like she said, she's fine. She doesn't need me yet.

So my waters opened and there was a lot of blood. I felt winded, but fine, so I said, "okay, I'm going to sit in the bath and ask my husband to get me a drink and see how much I'm bleeding and how I'm feeling." My husband asks me at this point, "Can I call this woman from the neighborhood who works for emergency services?" I said, Yeah. that's a good idea. He called her and [she] said," I'll be there in a minute, but call the emergency services."

Confrontation with paramedics

"Esther": My husband called and they seemed confused. They put out an official call. Two male paramedics showed up. She was already sitting with me. We took my blood pressure. We're talking, looking at the bleeding, and these two male paramedics show up immediately screaming. I was in the bathtub and this woman is sitting on the toilet next to me. I had a couple different birth people who I know on the phone.

My husband was talking with them. I could hear shouting outside. I heard my husband say " You're shouting, you're getting hysterical, and she's not going to go with you. She's not going with you. Please leave. You're causing drama so please leave."

Threatened to "call her psychiatric"

"Esther": They said, " We're going to say you're psychiatric."

I'm a psychologist and work with suicidal clients. I have done involuntary hospitalizations when a person has had a, within the last day or two, suicide attempt. That is a time when I would actually involuntarily hospitalize somebody not, "I had attempted a year ago and I regret it, and I want to have therapy to help myself get better."

There's somebody who's in treatment with me and who yesterday tried to kill themselves. Took a bottle and a half of medication plus vodka. Slept for a day . Woke up with a suicide note and came to their session mad that they didn't die. Then I'm going to call an involuntary hospitalization. That's a very extreme situation where I'm calling that this person is not safe.

In Israel, you can't even do that actually. It's really hard to involuntarily hospitalized because you have to have like multiple providers and they're only specific types of providers are allowed to sign off. it's actually quite difficult to do an involuntary hospitalization, even on somebody who had a suicide attempt today.

So that was my first thought in my head, like, "You can't do that. On what basis are you going to say I'm psychiatric? What are you even going to say?"

So I was like, Okay, I'm not dealing with you. Nutso people over there. My husband's dealing with you and I'm not getting involved. I continued to talk with the emergency service assessing myself and deciding what to do.

Forcibly sedated her

"Esther": Then they come over to me and stuck a needle in my arm. And I stood up with my hands in the air in pure shock and terror. They picked me up and removed me from my house.

Hospital trauma and aftermath

"Esther": As I got into the ambulance, I never become, comfortable saying this story is just so insane. And I, I like, there's no way to come to terms with it. As I got into the ambulance, I smiled and thought, " Oh, it's a girl." I don't know why. I didn't have any ultrasounds of the pregnancy. I didn't know it was a girl prior. And all of a sudden I just knew it was a girl.

We got in the ambulance my friend then showed up who attends births outside the system. She asked to go in the ambulance. She knew what happened. I had been on the phone with her. They said, " Her husband's already here, so she can't." They said, "Are you a midwife?" And she said, no, this becomes significant later because they pressed charges against her, which is insane.

But they knew my husband ride in the front. So I had nobody in the back, except this person who attacked me, and he asked , "Can I hook you up to an IV?"

I was like, "What do you mean? You just kidnapped me. Do I have rights? Can you hook me up to an IV? What's the question? What are you asking me? What are you saying? " I'm in and out of consciousness thinking, " Okay, God, this is where you want me to be."

At that point, I did, think I might die. Until then I had been feeling fine, but then I started to not feel my body at all. And, which was like a crazy, sensation. I feel like no control and no sense of your body. I really did think I might die. I kept thinking, " God, this is where you want me to be."

Then we got to the hospital and I felt people sticking their fingers inside of me, which is normal in gynecological care. People their fingers inside without asking permission. that's what happens, right? Then I feel an ultrasound go inside and they said there's no heartbeat.

No heartbeat, but still cesarean?

"Esther": I was in and out of consciousness. I'm awake for this part and then I said, "There's no need for a c section." When I think back, I get frustrated. Everybody around me is hysterical. I have to be grounded, intelligent and not emotional even when told my baby doesn't have a heartbeat.

I couldn't advocate for myself because it's in a foreign language. I'm not a primary Hebrew speaker. I can speak it, but not argue my point. Also sedated.

The next thing I heard was, "Cut her clothes." I undressed myself in front of strangers, half sedated. It's just insane that like we go through this and like nobody would think like they did something wrong here, you know. No, I just yanked my clothes off and then I felt them like trying to take my jewelry off. I like helped them take my jewelry off.

They just said, "We have a bleeding woman who's unconscious, in labor, with a history of three c-sections." Since they said that, the hospital assumed I would need a blood transfusion, that I might die, that I might lose my uterus. So they prepared transfusions for me, which I did not need, and they obviously rushed me for surgery because they did not know why I was bleeding so heavily, which I was not bleeding so heavily.

They told my husband also that I might die or lose my uterus, so my husband has that trauma believing that I was dying and they saved me. I wasn't dying. There's no indication that I was dying, prior to being sedated in a room in my house.

I'm not saying everything was fine, clearly everything was not fine. But, I don't think I was dying, and I don't know that my baby was dying either. I do think she was compromised. If she wasn't already dead, I think sedating me is obviously what finished. Then they did an emergency C section. Told me the next day, they didn't know I had been sedated. They put me under general anesthesia. You don't understand how dangerous that was.

Jen Kamel: Yeah.

"Esther": They got permission to do a medical intervention without consent. You can get permission to do a medical procedure without consent. You gather, I think like three doctors is the requirement.

Three doctors to sign off

Tamir Turgal: The law requires three doctors on an emergency state sign. It also has to be under authorization of a court. So they have to involve the court. But they have this kind of procedure and it's kind of reasonable in cases that, you know, there is no way to talk to the person and there is a life threatening situation. Then doctors might do it.

So it might be that even in that point because they didn't know about the sedation. They were under the impression that she was losing blood. The other problem is that sometimes they don't really care. I think it's similar in the States in a way.

Normally you have to have an informed consent. So it's not only about the consent, it's about the information that the person has to get in order to make that. And that's very similar in many countries.

What evidence based medicine means

Jen Kamel: I think so often people hear that phrase "evidence based medicine," and they think, "Oh, that means you look at what the evidence says and you do that." And they don't realize that it's incorporating the personal preference of the patient. That is part of evidence based care.

It's not just the risk is X, therefore you should do Y. It is the risk is X, this is my recommendation on what you should do based on your clinical history, and how do you want to proceed? I will support that informed decision. That is what informed consent looks like.

Tamir Turgal: But there are some instances that there is no option, technically, to get the consent. Because a person, let's say, he's going in and out of conscience or totally unconscious. And if the situation cannot wait, then to rely on just one doctor, that's a problem.

So he's going to call two doctors to see the patient, look at him, and sign. They're making kind of a committee and then they make the decision. So normally he will call them to tell them that he needs them to sign, but they also have responsibility.

When you go to a hospital, you go into a country within a country. That's the mindset a reasonable person has to have. I'm not saying it was like this 10, 15, 20 years ago. Now, that's the way it is. The balance of power between the patient, the doctor, and medical care service people.

I'm talking generally not on specific people. There are great people in many places. But overall, as a system, it's problematic. That's what you said earlier that you felt like they're treating you like a material. They want to do good. Nobody wants to do bad. Giving birth should be really, really sensitive. It's far away from this point.

Jen Kamel: There's a law in Israel that three physicians signing off on a c-section when someone is unable to give consent in the event that they're unconscious?

Tamir Turgal: It's on any treatment. You cannot get informed consent. So it can be anything. Mostly an operation because that's normally the cases that you cannot wait for. Just one doctor. If the patient cannot give consent, one doctor is enough.

Jen Kamel: There might be policies on individual hospitals, but to my knowledge, there is not any sort of rule or law like that in the U. S. I know the people who watch our podcast here will chime in with their experience and knowledge. And so I'm really curious to hear if anyone watching is aware of an actual law or rule in their state. There is no law or rule federally in the US and, yes, a single doctor can make that determination.

"Esther": They wrote in their chart note that they had three doctors agree to this procedure. Whatever. Whatever. But then the next day they said, " We didn't know you received medication at home." I just know they were thinking, "Oh, clearly she was crazy."

But I didn't do anything. It took me a long time to be confident about that, but there were multiple witnesses. My friend's husband was there, who's a paramedic, so she had offered to send him because he was just in the area and she was on her way. My husband was there, and this female paramedic was there, and I was there, and all four of us know that all I said was, "I'm sorry, my husband's asking you to leave. If you're not leaving, we're going to call the police." That's the basis for this. That's insane.

Of course they charted that they had gotten permission from two doctors I don't know if they did but they documented that they did. The hospital chart wrote that I arrived sedated. They just wrote "history of three C sections, bleeding, and so we did a C section."

I had for months been complaining to different providers I was seeing for different things I was working on in my own health. I have a complaining of like a sensation. I couldn't put my finger on it wasn't pain, but a pulling sensation on my left side. Maybe where the scar is internally. Maybe scar tissue healing. I couldn't figure out what it was.

I see in the report, " We accidentally cut her abdominal muscles." They didn't tell me and for months I had this sensation. It went away towards the end of the pregnancy, but I am feeling it again now.

I'm assuming it's going to [take] time for healing, but that's just wild, you know, it's just completely wild. Yeah, so that was insane.

Reflections on stillbirth and loss

"Esther": I think one other thing I'll share is just that having having a stillbirth is insanely painful, and no one should go through that. Babies die. As women sometimes we bring forth death which is scary to come to terms with, but that is the truth. We are not in control of what happens.

I've had early miscarriages. No one would blame me. I think it might be connected with like a slight thyroid thing. I'm not sure, you know, So, you know, that's a real thing. We are not in charge of whether babies survive or come out healthy per se. We're not. There's things that we can do that influence that, but we're not in charge of that.

Not feeling safe in her own home

"Esther": That is something we have to come to terms with, but coming to terms with the lack of safety in my own house because I'm pregnant was something I couldn't come to terms with. I just kept thinking like anybody can do this to me at any time and I can't stop them. I can't protect myself or my children because people have opinions about medical care that I don't think are accurate, but it doesn't matter. They can harm me because they disagree. And that's hard for me to even say because probably the baby died because of placental abruption, but maybe she died because of the sedation. There's no way to know officially. There's nothing to do about that, and that's a lot to sit with.

Jen Kamel: Yeah.

The journey to trust God again

"Esther": It was a big test of faith. can I trust that God's not going to do this to me again? How do I trust that?

Seeing pregnant people was hard. Why do you get to be pregnant? I know lots of other people have emotional things tied to pregnancy.

I am not the only person. People could be pregnant and not have all this, in the background. Isn't it enough to be pregnant after a loss? To also have all this was a big thing.

Tamir Turgal: I would like to add one more thing because it's a really interesting story and it's actually about to unfold. What we've just heard so far, that's the background. It's important for whoever wants to dig in with us to understand that now when we're talking about a birth that didn't went well okay? In terms of the perception off many people, community, government, and professionals. That has a significant turning point.

Delivering and c-section and then at home and no problem, but now there is a history of a delivery that started at home and it didn't went well and most probably I would say now when I hear the story even in more details than I knew it before it makes really, really sense. That the tragic outcome had a lot to do with the way it went.

Even she says , "I " wasn't sure what I'm going to do. I wasn't panicking. I wasn't in, I knew what's going on." You know, that's really reasonable way to act in reality. And unfortunately this aggression and hysteric very much probably caused the outcome.

It also was the I would say the the ground for what's going to come later.

Mistreatment impacts how people engage with health care

Jen Kamel: I think this part of your story brings up such an important piece because I hear this often. That people are mistreated in the health care system, and it's not just they're mistreated once and they're like, okay, whatever, that's fine, but it impacts how they engage with health care for years, decades, the rest of their life. That assault that impacts access to care. And I think that is a very important thing for clinicians to consider . How is your interaction today going to impact how this person engages with health care for the rest of their life?

Tamir Turgal: I want to note Jen, because you mentioned that medical professionals that maybe can hear this should be aware of that. I would say that in my point of view, the medical professionals that are aware of that, and thank God there are many, their reaction would be like, duh. But the medical professional people, which there are many of them as well, that don't realize it, they would not be so much aware because their mindset is like, "I'm here to sell life. Don't waste my time being nice to people and everything." And that's again, small little hints about again what we were dealing with later on and how we dealt with that.

Staying private about pregnancy after four cesareans

Jen Kamel: With your latest pregnancy, you decided not to tell anyone about it. Can you tell us more about why you made that decision?

"Esther": There's many reasons. I didn't tell my clients because telling my clients that I had a stillbirth was horrible and I didn't want to do that again. I don't need to be vulnerable that way. It's too scary.

Anybody who's had a pregnancy loss, my first was a miscarriage, then I got pregnant right after. Even that, you just walk around like, "is the pregnancy going to last or not," you know? So, you have to come to terms with that, which was what ended up happening. Anybody who's pregnant after loss has to sit with this, " I cannot know I'm going to have a baby at the end."

The main reason I didn't tell anybody is I had so much stress from presenting myself in an acceptable way in previous pregnancies. People had a hard time with even thinking I might attempt a home birth. I didn't want to deal with that stress. I am going to protect this pregnancy.

I'm somebody who operates on a high strung level. I have several small children, once a week cleaning help, run a business, supervise, train, see clients, and run groups. I'm doing a lot. I'm not afraid of being stressed, pushing myself, or doing hard things. I'm not afraid of people confronting me about difficult things. I'm not afraid of that.

What I am afraid of is harming my children. I'm not willing to harm them. Placental abruption, blood pressure, blood sugar, placental health, uterine health, inflammation, thyroid functioning are all connected. They are all impacted by stress. Now stress can come in forms of not enough sleep.

Stress can come in the form of emotional stress, traumatic experiences, environmental stressors, like, detergent or cleaning supplies. There are many forms of stress. One would be family or friends screaming or trying to convince you, arguing with them, and spending emotional energy which is something I had done in a previous pregnancy.

In my fourth pregnancy, I did spend a lot of time learning all the information, taking all the courses, reading all the books, and answering everybody's information. I'm a good debater and I can convince people, but I wasn't winning.

I realized, I don't need to prove my point to do the best for my family. I can just do the best thing for my family without proving it to anybody else. The main reason not to tell was that I am not going to be involved in this pregnancy in explaining myself to anybody or in dealing with anybody else's emotions.

People get anxious which I find painful because you think I'm not dealing with my own emotions around this? And I wish people could be there for me instead of being in their own emotions. But that's the reality is that people have their own anxiety about this.

I am going to deal with one person's emotions, mine. I can't afford not to.

Tamir Turgal: She didn't tell anybody, honestly, it's an intimate issue. It's nobody's business and definitely there's no way that we should consider anybody in anything that related to health and definitely with regard to pregnancy. It's not like the default that you have to let people know. The default is you should do whatever you want. If this is where you want to go, this is where you want to go. And you know, like there is no way that people should even question that.

Want to point something out because we were just talking about . We're laughing about it. So that this is really a story for a movie. And, you know, most of the movies, when they start there is like a background and then something happens. And then, you know, and then starts the whole plot.

So here you see the background, was so focused on this pregnancy. She's done everything perfect. She went far and beyond to make sure everything is going to be perfect. She's already close to the end of the journey, close to the birth.

Now the last month and so far so good. After what she's been through, this is exciting and important. She's checking herself all the time. She's really happy. Then suddenly, the last thing she wants and the most dangerous thing right now is emotional stress. That's the last thing you want to have. That was a turning point.

Community interference and fear

"Esther": And so one of the very people who do you know, was telling a friend how they're scared I'm going to die. I don't know them. They don't know me. They don't know my personal health. They don't know anything about me other than what this person has been telling them.

And they thought to contact just a local person who works for emergency services to give them a heads up about my situation. Telling them, maybe you can buy the proper equipment to have to save her but they said, actually, they, they don't know what equipment. So they contacted emergency, just like local person and that person decided to reach out to social services because it sounded suspicious to them.

Emergency services came with social services and police on Friday night. They knocked on my door and asked if I was in labor. I said, "No, I'm not and I'm not sure why you're here. So I'm going to close the door now" which I did, and then locked it and was absolutely petrified.

The first person who was there, she really did just get a call, " Oh, there's a woman in labor who needs help." So she really didn't know. And she was like, oh, okay, fine, no big deal. And just was like with misunderstanding, but it was not a misunderstanding.

Tamir Turgal: So after the Sabbath was over, I tried to find out how this happened or who contacted them. And I found out, a friend of a friend reached out. But I still didn't feel safe at home because what if somebody does this again?

But just for the audience to understand how how strong shift is from the standpoint that you're comfortable and cool. It's a religious community, so everybody are quiet, no cars are driving, no music on, everybody are just, you know, chilling. And then she went out of her house and she sees that, like, a scene from a movie, which with all the police and the emergency organizations and neighbors and people and, like, all this commotion for a rumor that there is a woman that is going to give birth, which is like, what? Really? Okay, that happens a lot, at home.

Tamir Turgal: But because she's with extra risk because of her history, so everybody now become a doctor and a judge and an executor and forms their opinion. But at this point, it's not that the authorities have anything to do with that. They came, they saw nothing. There was nothing there. They went away. Everything is gone. However, because it's a close community, there is a risk that somebody would make another call. So that was the problem. Obviously wanted to make sure this is not going to happen again.

Conclusion

Jen Kamel: Join us next time for the conclusion of her story. And until then, remember what we're about. Since 2007, our focus has been to share accurate and objective information about vaginal birth after cesarean and repeat cesarean to parents, professionals, policymakers and the court, so that all decisions can be informed, ethical, and just. Thanks for joining us, and I'll see you next time.