Coerced Cesareans Struck Down Part 2: The Woman Behind Israel’s Landmark Ruling Speaks Out with “Esther” & Tamir Turgal

Jen Kamel: Welcome to The VBAC Facts® Podcast. I'm Jen Kamel, VBAC Facts® founder. And since 2007, our mission has been to provide accurate and objective information about vaginal birth after cesarean and repeat cesarean to parents, professionals, policymakers, and the court so all decisions can be informed, ethical, and just. Today we dive into part two of the story.

In our last episode, we ended with her pregnant after four prior cesareans , planning an unassisted birth, having someone in her life report her to emergency services and social services, both of whom came to her door. She wasn't in labor, there was nothing happening, and so they left. But now she's scared and she's wondering what she should do next.

"Esther": Emergency services can disagree with your medical choice and decide to intervene as we saw my previous birth. Obviously, I do not feel safe being at home.

Seeking Refuge and Medical Concerns

"Esther": So my children went to my sister in law and I went to a hotel and stayed there for two nights. But then it was the summer and some of the hotels are booked, so they didn't have any room after two days.

I went to a friend's couch for two days until I found an Airbnb. I had already spoken with them earlier because they're near a pro women, pro natural hospital. I just reached out to them at that point and said, "Can I come?"

I booked it for two weeks. We went there and on the way the first thing that happened was I got a call from my family doctor who had been doing referrals for my blood work throughout the pregnancy.

He knew I was pregnant. He said, "I was contacted by social services. They're concerned you didn't go to your scheduled C section."

I said, "I didn't schedule a c section."

He said, "Okay."

I said, "They want me to go over the risks and benefits with you."

He said, "Well, I know you're an intelligent, educated person, so I trust that you understand the risks and benefits."

I said, "yep." I didn't think my family doctor had additional information to add beyond that so that was the conversation.

But then I said, "But can I ask, is it illegal for me to not schedule a c section? I'm confused."

He said, "I have no idea. Do you want to speak with the social worker?"

Engaging with Social Services

"Esther": I got in touch with the social worker, and thought, "Oh, wonderful. Now I'll clarify. And this will close and we can go home and have a happy life."

Once I reached out, she was like, you know, very effusive in ' this is so wonderful that you're connecting with me because communication is key and we love when families are open with us and we can resolve this really quickly.'

"Esther": Okay. You know, I don't know if I trust her but it sounds good, I'm happy to cooperate. Not hiding anything. She asked to meet with me and we met on Zoom. I wasn't comfortable going in person, obviously.

We went on Zoom and I told her my work history. By the end she was crying and said, "Don't worry. I'm going to have this closed today." And I was like, "Wonderful. Thanks for, you know, taking care of this. Great."

"They Are Asking for a Psychiatric Evaluation"

"Esther": So that afternoon we started driving to this Airbnb and on the way, I get a phone call from her. She says, "I'm so sorry. They're, you know, they can't make you do this, but they're asking if you'll do a psychiatric evaluation." And I burst out laughing.

I told her I'm a clinical psychologist, licensed both in Israel and in several states in America. I run a group practice. I give trainings internationally. I'm a supervisor for many clinicians and I see many of my own patients. I do individual and group therapy. I train internationally. I told her in the interview, "Google my name. You'll see my talks. You can assess for yourself as a social worker whether I'm crazy."

This is a pretty low bar to force somebody to say that somebody is that incapacitated that they can't make their own choices. Like, come on, you know, how are you going to prove that? So, when she called, I was like, this is absurd. What do you even want?

She's like, "They can't make you, but they're asking."

I said, "If I do it, will they close it?"

She said, "For sure."

So I contacted a psychiatrist, we did an evaluation and I sent the evaluation to them quite promptly, which is quite impressive because these things could take time to get, but I had it to them by like the next morning.

And a few hours later, the psychiatrist called and said, "I got a call from the district psychiatrist. He just wants to make sure that I did an appropriate evaluation." We were both kind of confused. Why is he not just trusting the evaluation that he got?

The psychiatrist said, listen, I spoke with him at length. He seemed to grasp the situation. He didn't not trust me. You know, it seemed like the conversation went well, so I wouldn't worry about it. I felt comforted. But I decided, I'm not going home.

There's no way I'm going to feel safe staying at home until the birth. I already paid for this Airbnb for two weeks. Let me just hunker down and stay here. And if my husband will go home with the kids, they can get started with camp and whatever else. I decided this has been so stressful and this social worker can't be trusted.

She said multiple times she would close the case and she's causing me so much stress that's not going anywhere. I'm not getting anywhere by being open with her. So then I decided, "Let me block her number just so this way, she has my husband's number, she can call him if needed, but I'm not going to take her calls because it's just stressing me out."

And I had been obsessively careful about my stress during this pregnancy, because stress is connected with blood pressure, blood sugar, placental health, uterine health, tissue health, inflammation, thyroid health, all the things that I was trying to get to be as healthy as possible.
I was very careful about my health, my stress. I wasn't going to banter with this person when it wasn't going anywhere, that's when I blocked her number. So I'm going to sleep and at almost midnight, I get a WhatsApp, with something that said, [Hebrew] which means court, from a number I didn't recognize. My heart dropped. I went into a state of shock. I've never felt this way. I was shaking so bad. I could not get my body to stop shaking.

I was so shocked that I hit report and block which made it immediately disappear. I couldn't even then see it. So I'm starting to google lawyers, but everybody who I called was like "We'll give you a call back next week." I was very freaked out. So I called my friend and she says, "Oh my gosh, this is really bad. They could take your kids."

That was when I started to go into shock. I called my friends who had come to my previous birth who I'm very close with, she came over. And a different friend of ours, one of the women I invited to this birth, she's just very well resourced. She just knows everything. So I asked her if she knows a lawyer, and she connected me with Tamir. She said, "He's the right person to contact."

I contacted him.

Legal Battle and Court Hearings

"Esther": This is Thursday night after midnight. His assistant answers says, "He'll call you tomorrow." She didn't understand how intense it was. By the time he got it in the morning, he was like, "Oh my gosh, you have a hearing at like 11 o'clock in Jerusalem and I'm nowhere near there."

He was like, good thing you contacted me. You should have contacted me sooner. But here we are, we'll deal with it. Like, I don't even think I have like a suit on me or whatever. Like, I'm going. So he ran to the courthouse and he was very confident that it was work out, like, what's the problem already, right?

Tamir Turgal: It's like two stories that are meeting together because I am in Israel for a period of time. Normally I'm coming only for one week. No more than two weeks. Two weeks is a lot. I was planning to stay in Israel actually more because it was summer vacation. So I had more time. Not too long, but I had enough time. And was busy with other cases.

The call comes to my personal assistant. "There's some woman looking for you about pregnancy." And it's like, I'm not dealing with pregnancy. It's not something specific that I deal with. And she was persistent, so my assistant said "oh, you can call all night."

So that was also supposed to maybe made me "light a red." Maybe there is an emergency here or something, but that I wasn't thinking about it. I was coming back late that night.

I said, "I'll call in the morning." And I did, I called in the morning and that's where I got she was really much interested. You know, there is a court and I said, "Okay, can I see the court order for the hearing?" And she said, "No, I deleted it."

I was so funny and I understand. We immediately talked in English. So I understood like she's coming from the United States and she's only four years in Israel. So she's what you call [Hebrew] which is like a newcomer. So that means like she doesn't know the culture, the way that we do the laws.

I pretty quickly understood what's going on. I think everybody that hears this conversation so far already should understand that. We're not talking about just an average person. We're talking about a person that had a lot of experience in this field. Very conscious, very smart. Done her homework above the average person. And she has all these degrees and everything.

And another thing is that I got the case, no legal procedure yet until that morning, but there was already preparation. That's why she had an assessment from a psychiatrist saying"She's okay." The authorities wanted to know that she's okay. They wanted to see where can they put the pressure. So the court will give them what they want and they have to show she's unstable.

It's the common sense, but also the law, of course, doesn't let the government institutions to interfere in a person's life if there is no unique situation. So if you are a regular person, you can make mistakes in your life and that's allowed as well. It's funny that I'm saying that because we don't have to get permission from anybody.

There are some instances that the law says, okay, now you can interfere. That doesn't necessarily mean that you must interfere, but you have the permission, you have the authority. The judge, the prosecutors, the social workers, everybody that are involved are part of this puzzle. Nobody works alone.

So if this social worker was honest with her, and I saw her in court several times, she looks like an angel, really nice but very deceiving. She was not true with her, not nice to her. She was playing a game.

How do I know that? Once they got this report from the psychiatrist, I mean, again, what I knew in a half an hour talk was enough for me to understand, there is a logical person I'm talking with. It's not like crazy woman that I don't know. I'm not going to help somebody that is not stable. But she is. They knew it too.

So I realized in those 20 minutes that I understand something. And if I understand that these people that are already in a week with her in communication, they should know the law doesn't have permission to step into that domain.

There's no difference between me and her. If she's pregnant another issue is the fetus. But if we're talking about her as a person, it doesn't matter what a social worker, as a medical professional, even as a judge, it doesn't matter what's your opinion or what is your set of values.

It doesn't matter because if you want to live in a democratic society, my set of values is not superior on yours, but yours are not superior to mine.

But it's a system, it's a system that people come to work there and they know that they're hunting. From day one, it was a set up and it's not that we're talking about vicious people.

Tamir Turgal: We're talking about people righteous in their own eyes. They are vicious, but not consciously. There is a mindset. Why these people work where they work. Another thing, those people that assaulted at the labor that didn't went well. I have friends that told me that many people are volunteers, when working with what we call [Hebrew] right?

So many people that this is like. It's a volunteer work. But some people are drawing to that business because they like to see. They like the action, they like the drama, they like to see blood, whatever. I'm not saying it's everybody. I'm not saying that this is like the norm. I'm saying that some people have more, I would say inclination to operate those services.

And I'm saying that when they take somebody to be a volunteer, it doesn't matter if he's volunteering, he has to be checked, you know, how he's performing. What is the background, who is as a person, because he can attack people by the name of helping them. And not because he wants to really hurt people, but because there is a big lack of sensitivity in all society. Definitely when we talked about the medical profession, but not only that. It's an agenda.

When I went to the courts and I talked to the people and I see and every time, because it was a vacation time, was every time under a [different] judge. And every judge comes again with concerns and "how come she's going her own way." So people that work in a system, think in a systematic way. Everybody that does not do things the way that they had been told and taught how it works, it seems out of line. It's out of line for humanity to adopt this mindset. And it's out of line that we are 90 years after the Holocaust and we still have that mindset. And it's even crazier that we have it in Israel. So that's like the worst. But coming back to factual details.

So I'm getting this case. I don't know how to deal with that. I'm used to emergencies. Court at night, one day to another. I knew what I had to do, but got very bad cards to start. I'm getting a call from the social worker, then the DA, a colleague of mine, actually on the other side, a persecutor, a lawyer, and she said, "In half an hour, we have the hearing." So I said, "but I am in like an hour driving away. I don't have my suit." And I said, "All right, so let's ask the judge to wait an hour. That's all." She said, "Okay, we're going to call you from court."

They call me, put me on speaker and I talked to the judge and we are now in a conversation. And I'm saying, listen, just let me come over. I'll come with my jeans. Just let me come over and we'll talk. It's Friday. The day off in Israel. Most places are closed.

The judge said, "No, there's no time." When the judge tells you something like that, you already know that it's already written. It's just a waste of time, but you have to waste that time because never say never. And second, you want to understand the picture.

I'm getting a representation of a woman that told me a story. I don't know the background yet. I need time to learn the background and see what's going on. But you're saying that she is supposed to be delivering any minute now.

Physician Testifies: "Suicide Mission"

Tamir Turgal: And that's what the doctor that they brought said, he said, listen carefully audience, He said "If she's going to deliver on a natural birth, you can compare it to a suicide mission." So she might not be dead. Somebody wants to kill themselves, doesn't happen, you know, they didn't do it well. That's what he says. That's what he says on the protocol.

On Friday, he said he was the one to operate and on Sunday, he said, "I want to be clear. I checked the files. It wasn't me operating. I was one of the three doctors to sign it." Fair enough. He wanted to be accurate. Fine.

So I said, "Did you see her in the last year since that delivery?"

"No."

"Did you talk to her?"

"No."

"Do you know her medical condition right now?

"No, I don't. But I don't need to know it."

I said, "Why don't you need to know it?"

He said, "Because we have something else."

I said, "What is it?"

"We have protocols."

That's a protocol doctor. He said, it was so arrogant, he says, "Listen... if I..." because he's like probably a hot shot, "If I make a test, and my students write that a woman can make a natural delivery after two c-sections, they're going to be failed in the test."

I said, "How do you know? Every woman is different?"

He said, "Because we have protocols and protocols know better." Again, I managed to take the order off at that point.

The judge, she said, "Okay, but I want a medical doctor. At least a report from a doctor." I said, "Okay, we'll get that." We didn't get it. Nobody wants to go against the government. Nobody.

At the end, we found an amazing guy again. That was like the last moment, the last day. He did it on voluntarily, right? Amazing guy. And he wrote very nice report. So he talked to her, he met her on zoom, he didn't have to check her any physically anyway. As a very reasonable guy, he talked to her about risks and benefits.

And he said at the end, "Listen, I think that if I would have to make a decision, I would probably recommend for a c-section, but I know for sure that it might not be the right decision. Both options are possible." He would go that way.

We have two reports. One from a doctor involved in the previous birth. He doesn't have any connection, any history, any knowledge, anything about what's going on right now. He knows great for a year ago.

Now we have another person that he talked to her, check all this information with her, discuss with her about everything. He has an opinion which is much more moderate than the protocol guy that says this is a suicide mission.

Now a very radical person that never seen her since last time, and a very moderate person that seen her, talked to her. If you're a judge, which would you prefer? All the judges preferred this one. You know why? The government brought that guy.

Jen Kamel: I don't know what Israeli guidelines are relative to obstetrics and informed consent. In the U S the American college of OBGYNs says that under no condition should someone be coerced or manipulated into a decision. And that's because of our inability to foresee the future.
We can say populations of people with this particular clinical scenario might be at higher or lower risk of a complication occurring. But we cannot apply that to an individual person and see into the future for them on how will their birth or their pregnancy play out.

And that is why ACOG discourages people from being coerced to making decisions because we cannot see into the future.

What Jen Would Tell the Court

Jen Kamel: The ethical and accurate thing for that physician to say would have been, "The risks of vaginal birth after four cesareans is likely higher than after one cesarean, but we don't have solid evidence that has validated that increased risk. So this is an area of unknown risk and even in times of unknown, even elevated risk, people still have the right to make their own medical decisions.

That is a very different analysis, a very different education of the court than to say this is a suicide mission. That is clearly an opinion . That's hyperbolic. Certainly she's at an increased risk. Certainly she has a complicated clinical history. And like she has said she should be the person who is in the hospital and yet the hospital was not a safe place for her to be because they would not even honor her ability to labor.

Tamir Turgal: The judge tried to convince me to talk with her again and bring her back to her senses. And what does she want? She said, the judge, I don't want to give an order. And this is how they work. They used to threat without using the power because most people run away when threatened.

"All we want," and that's what the judge said, and now what's the DA says, "All we want her is to go and check herself and let us know she's fine." Who are you to even ask me that? And they were also surprised about me because not many lawyers would take that approach. They will try to cut a deal.

At the beginning you don't want to go against the judge. You don't want to call her. You don't want to do what I'm asking, it's impolite, so I said, yeah, I would talk to her again and then I'll come back to you.

So one, I was talking to her again and I told her this is what they want to do. We were both on the same page. Nobody's entitled to tell you what to do. And nobody is entitled to even ask you what's going on with your life.

I came back and said, "We're not going to do anything." She said, "Okay, well, we'll let you know my decision." Two hours later, something like that, I got through the WhatsApp from the DA, the decision of the judge, and she said, "There is no other way, we have to do coercion." I told her on the phone, "You don't have authority."

The DA still had to give the report from this psychiatrist, as it is, but you can see what else they give the court. They gave the court also a letter that they asked the district psychiatrist to allow them to ask her to do another psychiatry.

So they're not happy with this psychiatrist and said maybe he didn't get the picture right. You asked her to give a report of a psychiatrist that talks with you about this issue. So how can he's not going to ask you about the history? The district psychiatrist didn't give them that.

They could, they could put the story right, but they didn't do it. They put the story the way they got it from this person, and he said, "There is a woman, she's not mentally healthy. The husband is not mentally healthy and there was a bad labor a year ago and a home birth labor four years ago. The kid from four years ago is not perfect. He's mentally has some disabilities." All this package of lies. This guy got a rumor from another guy, I'm not saying he lied. This is the information they got. But they got it a week ago. Why give it to the court like that? Why would you send the report as it is?

The judge, in the hearing, understood that she is okay. She's okay. I explained this is not right, but why would they write it the way that they did? And another thing I want to say about this stage, another thing was very important, this is something I never heard of in Israel before, I hope I never hear about it again. They went to the judge on Thursday night. . The same judge that had the hearing on Friday. They wanted an order immediately. She said, "No, I cannot. It's too late. I don't want to give you anything before I see the woman, before I talk to her. So I'll do it tomorrow."

Tracking Her Through Her Phone

Tamir Turgal: They came to the judge at night and said, “Judge, she doesn't answer the phone. She blocked us and we cannot find her. We want you to get an order to trace the phone." So they go to the police and the police is tracing the phone.

Now in order to do that when I was a student, that was a very tough process. Because this is like in the heart of the privacy of a person. Now, they didn't say that she did something wrong. They said that she's not available. If it's not available, then call all your workers from all the other towns and go street by street.

You don't have the authority and the judge doesn't have the authority to give an order to tap somebody's phone just to find him? Insanity. She wanted to see her before she made the coercion, but she made the coercion anyway.

She didn't see her. It's interesting take, but no judge have seen her during this whole process. Even though at one point we wanted to go on a zoom but that was canceled at the last minute, but that made the court crazy because they're like, they don't like it. Judges doesn't like that.

Yeah, but there were times that we knew that if she comes close to the court, she is endangering herself. We knew that. And she acted accordingly. The way I would expect every citizen to act. I told them who has more concerns for that baby than anybody in this room in this world.

I've seen it happen in other instances. If they had managed to put their hands on her, she wouldn't be able to have a different delivery. She would go to the hospital. They're already waiting, you know, they're all waiting.

So how would you want to do it? Be around the hospital? What do you want to do? And we were consulting. It was dependent on the timing, but she said, you know what? I would prefer the best that I would have somebody around. But if I would go, maybe I want to be alone at that point. I don't know why she's saying that but I know she is experienced enough to know what she needs and wants.

For me, it was a little bit, what? You can be even alone and start giving a birth? Yes, you can. You can do a lot.

"Esther": But then when he saw which direction it was going, the social services really pushed the judges and the judges were considering, sending the police to find me.

Hiding from Authorities

"Esther": And then they did end up rolling that way [so] that they could send the police to find me and bring me for an evaluation in a hospital.

At that point, he explained the situation"they're coming for you" and I decided to go into hiding because I was not going to be taken by force for a medical procedure that I don't need.

Obviously, I mean, I think it's obvious, but I guess other people, it's not obvious to me. It was like, it wasn't a question. I wasn't sure what to do. It was obvious. So they were tracing my phone. They traced my phone's last place. We had a trick to make the phone not traceable. The last place it was in was the Airbnb.

So they went to the Airbnb multiple times. So now there are no Jews out Friday afternoon. The whole Sabbath, they're driving my husband crazy at this Airbnb. Freaking out the owner who ended up being delightful. He was so like supportive. He was like, she wants to come back. Like she totally can anytime and we'll help her out.

Other people in the neighborhood got scared because the police are circling and keep asking about this person. The neighbors also came to ask, what's the story? But meantime, I was safe in the middle of nowhere in the boondocks. And highly, highly, highly distressed. Obviously, that was a very unpleasant Sabbath and just being in a state of shock. I did move around locations multiple times, based on , first of all, people couldn't host me for forever. So I would be like one location and I had to go somewhere else. So it was not simple.

But my friend who took me was so gracious and her whole family was gracious. They were so good to me. Even the kids were like, "We hope you're going to have your baby and go home soon." They're really friendly and made breakfast for me and just really, really cute and they had a lot of animals that was like nice.

A Glimmer of Safety

"Esther": So there were parts that weren't horrible. There was this huge dog that they had and she would go barking outside every time there was like a passing car or something so I felt much safer. Every time there was a car, she would go out and I would freak out and run to the bathroom. She was like staying near me the entire time protecting me.

So this continued on for a couple weeks. The case, as you heard from Tamir, how that went. At some point, my friend said, she was seeing how every time I spoke with him, I would get ramped up.

"Esther": So even though usually I'm the kind of person who wants to understand everything and be involved in everything, she helped handle this throughout the whole period and really protected me and like kept me like moving every day.

I'm like, when is this baby coming? It's going to come at the right time. It's going to be great and all the good stuff. I didn't have a phone, so I was very nervous sleeping by myself. What if I go into labor in the middle of the night? It was stuff to navigate, not a simple situation at all but, that was the situation.

Navigating Work and Legal Challenges

"Esther": Eventually I did get my computer, so I was able to do a little bit of work. But that was really difficult. I couldn't explain to my employees or clients what was going on. I did eventually explain to some employees because they needed to cover my supervisees and missing sessions. At some point, we had, a client with a suicide attempt and this is on my license and I supervise this case, and I was not available.

Jen Kamel: Wow.

"Esther": That happened. I would be available even on the Sabbath when we don't use phones because I work with a high risk population. Sometimes I use my phone on the Sabbath to help my clients. I mean, I didn't know what was happening, but that to me is just insane that I was prevented from providing actually appropriate care.

Like a week and a half in, I did start having contractions that were like nice, strong, big contractions, but they weren't, picking up.

Courtroom Battles and Contractions

"Esther": They asked me to appear in court, via Zoom. I was totally willing but Tamir had said over and over, we have a doctor on our side who's willing to say that he does not think it's in your best interest of your health and your baby's health for you to appear in court. So if there's any reason why you don't want to do it, don't feel pressured. He was so fierce the entire time of protecting my ability to make my own decisions.

I was having contractions that they actually did start picking up that day. I was like, you know what? Nevermind. I'm not going to sabotage my birth over this. So I didn't go to that court hearing and they actually were, see in the decision, that they weren't happy I didn't comply. Why do I have to comply with anything? I guess, obviously should, but I was going to prioritize my baby over anybody else. This continued with increasing levels of stress. Each time it was assigned to a new judge, there was hope the judge would say in court, "I'm not doing this. This is ridiculous. There's no basis for this case."

Tamir would say, "The judge is on our side." There was even a judge who said, "Let her know that this is not happening and we're not pushing this. We're going to meet again in 48 hours. And it's for sure going to drop or whatever." Judges would say these sentences and then, and then rule the other way. So it seems like there must be somebody who is pushing from behind the scenes, but obviously I don't know. There were also each time it was like a new like decision, it was a new police put on the case.

So there was one police who was part of the case who said, "Tamir tell her that that even if she were in the room next to me, I would not take her. I would just go to her registered address and then leave." He said, "We will do everything to protect her."

I felt like that was straight from God's mouth. "I will do everything to protect you." I was so terrified given my previous birth. How terrified I was. So to hear those words, not that I trusted the police officer, it wasn't like, you know, I got reassurance in humanity. I got reassurance that God is protecting me and nobody can hurt me if it's not meant to be. So that was helpful.

Police Encounters and Relocation

"Esther": At some point because it seemed like things were going the right direction, I did take out my phone. Then because I had done that, they ruled against us again, I then couldn't be in that location again.

So I had to go to a different location and this third location was so nice. I was like for sure I'm going to give birth here. It was such a beautiful location. Every time I was cutting to like Friday, I was hysterical that the baby wasn't here yet because I just wanted to be with my other kids.

Being away from them was just completely insane. We did have one Sabbath that we were able to be all together in that Airbnb because the case was on hold. That was good for everybody and I was able to explain a little bit, but they are quite young.

Each Friday was extremely painful. The whole, neighborhood became aware that I was probably in that neighborhood. And that was really scary. They went to my friend's house. Asked the head of that neighborhood to send out a WhatsApp to tell everybody to look out for me.

They searched under beds, under a blow up pool that she had in the backyard. It was also the day after in an Arab neighborhood, two minutes away, a Jewish man had been killed by an Arab. There was a ton of police that night, and my friend kept saying, "Stop freaking out, they're not here for you, there's bigger fish to fry, nobody cares about you, relax." I was like, "See, this is insane because we do have bigger issues and yet, we're prioritizing this."

Her husband yelled at one of the police officers, "The country doesn't have anything better to do with your entire shift that we're paying for? We have nothing better to do with your time, to spend an entire shift chasing down this woman. What is this?"

The police officer kept saying , "No, we have to save her." I don't know what people think they're saving me from, but that's how they galvanize these police officers. Since our location was compromised, they were searching the neighborhood and told her they're going to come back to her house again. At one point, it was so crazy, I was afraid of going out with the police everywhere because of the killing.

The next day, I was like, you know what, I'm going to relax, I'm going to go over and use my computer in her house for a few minutes, and then go back. I came, nobody was there. The police had just been there, so she was going to explain to a friend what was the situation, And she came back and was like, "Oh my gosh, what are you doing here?" She didn't want to freak me out. So I realized I could relax and be here for a few minutes. She encouraged me to go back. But then the next morning we did leave in an unidentified car to another neighborhood.

Also earlier that week, another one of the women who I invited to be at my birth, who had been in touch with us this entire time, came just for a day to be with me with her nursing baby, and then her husband called her and said, "Stay with that woman until she gives birth." That was so, so, so special to me. And then just meant so much to me, like to feel like the pressure was off a little bit, obviously not a ton, but off a little bit.

So me, my friend, this other woman and the baby all go to this other neighborhood to another friend's house. She had like a little cottage I was able to stay in, but this cottage was not nice. There was no bathtub. No air conditioning, it was really disappointing. How am I going to give birth here? I was still like having these, again every day, I was having contractions, but it wasn't picking up. And again, it was Friday, I'm crying, and just want to be with my kids, and I don't know if I can take it anymore.

And that Friday, I kind of came to a place of, if I don't have the baby by Sunday, I don't know if I can do this anymore, and I might just have a c section, because I can't, I can't be with my kids any longer. That's the point that I got to.

Jen Kamel: Because how long had you been in hiding at that point?

"Esther": Four weeks and five Sabbaths without my kids.

Tamir Turgal: In my view, it's an obligation. We have an obligation to challenge the system. This doctor on Sunday when I managed to take off the court order, for about two weeks. Meanwhile, authorities are trying again to get the order back and I'm trying to push it. The judge wanted to talk with that doctor, the same doctor that was talking on the phone. She wanted to bring him over again. And I'm telling to the judge from the beginning, like it was two hours, " Why go in circles about her condition, if you don't have the authority?" And she always tried to push it back and all the judges after her, everybody, including the first one, no one, until we got to the

Supreme court that has to make the decision and has to finally make a statement. If you don't have the authority, what does it matter how dangerous it is?

The Birth Amidst Chaos

"Esther": I just was crying and crying. I could see I was having contractions a little more regularly. And I had like three nice ones and then they guided me back to the cottage. No pressure. Still nothing was happening. They were happening maybe every half hour.

At some point I went into the shower feeling an urge to bear down. We had borrowed a pool from another friend we went to for acupuncture. I went into the pool. And my friend said, "Oh, you got the purple line." I was like, "Oh, something's actually happening."

Until then I kept saying, "Nothing's happening. I can't take this anymore." I was like, Oh, something's happening. The purple line is a thing, right? It means something's happening. So, then I started feeling again, my contractions were still half an hour apart. Not anything, picking up really. But then I started feeling an urge to push and pushed for like less than 15 minutes. I think it was like four or five pushes, but my friends say it was a little less than 15 minutes of pushing.

The whole time I've been praying and in constant contact with God. But then that point when I was pushing, that few pushes, I was like, "I just want to be the next one. It could just be the next one." It was such a pleasure to ask that at that point.

Baby's head came out, one more contraction, and the whole baby came out. I picked him up and said, "Are you real?" He had a cord around his neck, I pulled the cord off. I think that's another mysterious thing. Use your hands and pull it up. He was just perfect and wonderful.

Actually I did want to stay in the pool until the placenta came out, but it was not coming out. So I moved to the bed and it still wasn't coming out, but I really wanted to leave him attached to the placenta for a while, but I also wanted to go to sleep. So I was like, okay, let's cut it and go to the bathroom.

And so four hours after I cut the cord, I went to the bathroom and plop the placenta came right out. The friend we were staying by had encouraged me, "Make a birthday cake for your baby. So I ate the birthday cake. And yeah, that's basically more or less, that's the story!

Tamir Turgal: The court did everything they could not to give me an answer about the authority. You can tell me, you have the authority, tell me, it's okay. But tell me that so I can go with that statement. If you don't give me that statement, you're just playing with me. Because it's vacation time, every time it's a different judge. Every judge likes to take this hot potato forward to another person. And nobody wants to really deal with that. So the judge dropped the order, but left the case open.

I went to the higher court and if the higher court didn't give it to me, I went to the Supreme Court. The whole thing was about 10 sessions. Six in court. Few in writing. Two of those four, I wrote to the Supreme Court and said, "Listen, there's nobody to help me. I'm alone and the government is very strong, so I need your help. You're the only one holding the key to my freedom."

They were polite and said, "You didn't get any decision about the authority, " which is also stupid in a way, because If I ask you about the authority, it doesn't matter who I ask, you have to give me an answer. It's a legal principle. Okay, it's by the law as well, but it's a legal principle because it's a fundamental issue. If there is a debate about the authority, the whole trial is on debate, so you have to make a decision. It's like somebody says to the judge, "You have to disqualify yourself."

The judge cannot tell him, "No," you have to deal with it now. If you want to leave, leave, but don't say, "Let's talk about other stuff." That's exactly what they've done. They're trying to do with me. You just pick the wrong client and the wrong lawyer.

We went to the Supreme Court the first and second time they told me, "It's not the time yet." They didn't close the door. They said, "It's not the time yet." If I got decision about the authority, then they would be forced to step in. But the court, even the Supreme Court says, "I don't want this on my plate."

And so I was trying to get there twice. And the third time, I was really tough with them. They're not used to it. But I knew we don't have much time. That was the end of the process. I told them, "If you don't let me in now, that would be the last nail of the coffin of the democracy in Israel."
They opened the door. And made the right decision. Even though. They're giving many discounts to the other side. They still want to maintain the system, even though they know they had to put a red line to the system, to the people that works in the system.

No Appearance, No Compensation

Tamir Turgal: We didn't get compensation even though she was hunted for no reason. No authority at the end, after many, procedures. So you came to the conclusion that this whole procedure was unlawfully. No authority to do that. But at the end, you say, "However, I'm not giving you compensation because she didn't comply." If the authorities are coming after somebody and at the end of the day, it's clear by verdict, by the Supreme Court, that was wrong and not based on the law, then how come you can say that she didn't show up when the court wanted her to show up, even though that would endanger her. So again, even the Supreme Court knew they have to do the right thing, and they did, still are protecting the authorities.

And I told them how many people, how many women don't get here. This woman, okay. she has the opportunity to come. I can come and represent her. What about everybody else? And this is daily. And you know what? I think they know. I think they know.

And I will tell you this, Jen, I was thinking about it today, about this talk today, and I said, "Who is the most important guy today?" I think people like you. Not even people like me or her . Everybody is important and everybody's doing their thing and we are fighting for rights on every place that we can. But you and other people that has this podcast, has this flow of information, because I don't know how many will hear it and listen to it. How many women are going to get this information and say, "You know what? I have to be doubtful. I have to be."

There's so many signs today that the medical establishment is so corrupt. How can we have a good science? How did you get to the stage that we have doctors that doesn't see a person? That they see protocols? This woman, she's gone through a lot. She has a lot of experience. You don't want to talk to her and you're willing to take her forcibly to do everything like that, you know? How come you can think that way?

So I pointed all those things because I want to give some ideas to people to think about. I still think it's a movie.

Creating Legal Precedents and Reflections

Jen Kamel: What was the ruling the Supreme Court made? What specifically did they say? And what was the rationale behind it?

Tamir Turgal: The Supreme Court ruling was that there is no authority. They went claim by claim. The authorities, when they went to court, said, "There is a clause in the law. There is a specific law about a guardian."

It's about parents normally because they're mostly the guardians. And it deals about their rights and their obligations. So that law specific has a clause about medical coercion and what are the conditions. And then when the DA went to the court, they went and said to the court, "We want you to coerce because of this clause."

The Supreme Court answered six claims. Five about her, one about the fetus. One said those three instances that you can coerce, they tried to claim that she could fit. She doesn't fit. That was obvious. Then they said, "Okay, there is another law. If you see somebody try to commit a suicide, you're supposed to the Good Samaritan." But that's not even close to coercion. That's actually mostly to protect somebody that tried to help somebody that he's not going to get sued later on. This is not about coercion.

Anyway, they wanted to give a clear answer, for future generations. It's good they went one by one. Even about the fetus rights. And in all places, they said the authorities could not show any source for authority for coercion.

Jen Kamel: This is the first ruling of its kind setting a legal precedent for coerced cesareans in the state of Israel.

Tamir Turgal: I think it's the first time that the court in Israel, the Supreme Court, is stating clearly where should be the boundaries for the authorities to step in. And I'm telling you again, Jen, the authorities knew from day one, or at least day two, exactly who they're dealing with, what they're dealing about and how unlawfully would be to build a case around it.

The Aftermath and Moving Forward

Jen Kamel: How did you hear about the ruling? And how did you feel about that after being in hiding and having your baby?

"Esther": Tamir was in touch with my friends. Once after the birth, they did feel comfortable turning their phones on at that point. Because they weren't going to find us there. So they just turn on their phones, they were in touch with him, and they heard about and I called him to ask and he told me about the hearing.

It was really, really, really hard for me to decide to stay in hiding another day. I really wanted to just be with my family and be at home. It was a painful decision, but when I understood how much was hanging on getting this decision to clear. I made that decision. It was only mine to make, but I did make that decision. If I would've had the baby earlier and the Supreme court decision would've never happened, I would've been free. Like it would have been over, but that decision wouldn't have been clear and done.

And so when I understood how much it meant, not only to me, but for like all women and everybody involved who helped me also. But also like everyone that we should all be safe, that we should all be able to make our own decisions and even complicated decisions.

Decision Making With Higher Clinical Risk

Jen Kamel: That's why I think this Supreme Court ruling Court is especially relevant. You were someone who had a higher risk clinical history. And even then, you still have the right to make your own medical decisions. The state does not have the right to compel you to have surgery and that's in line with what American ethical guidelines say. Even in situations of higher risk, people still have the right to make their own medical decisions because as you so eloquently stated, the complications live in our bodies. We are the ones who have to live with it. So thus, we are the ones who get to own that decision.

"Esther": It's not that this was an easy or simple, straightforward decision, but that I should be the one to make it based on complicated factors.

That's when I decided to go through with it. And I actually did contact a rabbi to just just confirm I was thinking in the right direction. I wanted to hear their thoughts also. And they agreed that it was the right thing. So that was helpful to get a little reassurance. That it was the right decision.
We waited one day and then after the hearing, we had a little party thanking God party. And that was special to have that, before I would go back into life. And then I went back to life.

How She Feels About the Decision

Jen Kamel: How did that feel when you heard that the Supreme Court ruled in your favor after everything you had been through?

"Esther": Actually, they didn't rule right away. Right after they said they'll have an answer within a couple hours. So a couple hours later, they did rule that the police should stop and that they're probably going to rule in our favor, but they're going to put out the full decision tomorrow because of the urgency of the matter. They didn't know I had the baby yet. And then they didn't give it for a full two weeks.

I would just ask Tamir, "Are you sure I'm safe?" He would say, "You are safe. You are safe." when I finally did get it, I actually couldn't even read it so clearly because my Hebrew is not so strong.
"Esther": So I read it, but I didn't feel like I grasped the whole thing. And also like, what does this mean? Like, where is this going to go? Are people going to hear it? And also like gratifying.

Deciding to Have Unassisted Births

Jen Kamel: I wanted to ask as someone who has had two unassisted births and a complicated clinical history, how did you go about deciding to have another unassisted birth and how do you identify? Do you identify as someone who is crunchy or how do you think about yourself and the decisions that you've made about childbirth?

"Esther": Yeah, no, I actually really consider myself somebody who's very into evidence based practice, my entire psychotherapy practice is about evidence based practice. I consider myself someone who sticks very closely to research and stays up to date with research, which is not always the case for medical or mental health professionals.

And so what happens with my evolution had nothing to do with me being like a natural minded blah, blah, blah. And it had to do with me being persistently, having my eyes opened to the fact that this is not evidence based practice. And this is not, and this is not, and this is not, and this is not, and this is not, and this is not, this is not, this is not, and actually it's actually harming you. Over and over again it's harming you.

And so if you continue to blindly go along with this you are going to end up losing your uterus in a couple years as a young woman. It was just ridiculous. In my second C section, I had a uterine window and everyone was like, Oh, see, you had a uterine window, right? See how dangerous this is. See, see, see, see.

And I was like, Let me like find out about that. And I looked into the research and we actually don't have data showing because most people will have another C section after that. So we actually can see what's the state of the uterus in the subsequent C sections. And mostly women who have a uterine window do not have damage to the uterus in subsequent C sections. That was the case for me.

In my third and fourth C section, the doctor said, "Your uterus was perfect. Easy". Actually, the third surgeon said, it was because she was a Russian woman, and she said, "It was beautiful. It cut through so easily." The way she said it was so funny, but she was saying like it was a beautiful uterus. But that was relieving to hear after I had been very nervous. Of course I was nervous, but it wasn't supported in the research. I had no reason to go with it. You need to pay attention to signs of rupture that has to be one of many factors.

Why Women Go "Underground" to Birth

Jen Kamel: Can you tell me more about women going underground who don't feel like they have choices? Because I know that you were very involved with the unassisted birth community. And I would love for you to just share what is the driving force behind people choosing unassisted births?

"Esther": Yeah, so I do think there is the community of people that were the group of people who are just more on the crunchy side, homeschooling out of the system, whatever. Who just are anyways leaning in that direction so when it comes time for birth, they are kind of headed in that direction. And so this is just another part of how they live their lives. And that's that.

But there is a significant amount of women who are being driven underground because of the fact that there is not appropriate support. So a woman who has had multiple c sections who now cannot be supported in a hospital setting for a VBAC is now going to look for other options once she becomes aware that this is not what she wants and not healthy or safe for her or her children. She is going to start doing this.

I remember a woman who I was in touch with who was planning an unassisted birth. And she just said that she wouldn't tell me her name. She just wanted everyone to leave her alone. She don't want anyone to know her. She really wasn't involved with any unassisted birth community in any overt way.

But there are many women across all cultures, I'm in the Orthodox Jewish community, certainly around the world in every culture, race, ethnicity, and clinical history, there are women who are birthing outside the system.

And some women, this is like part of what they want. But for women they are driven there by, such like a disillusionment with this system, that's not operating in their best interest, which is sad.

Feelings about Legal Precedent

Jen Kamel: How does it feel knowing that this whole journey culminated in this ruling that now is legal precedent in the state of Israel?

"Esther": I just hope it's going to matter. I really wouldn't want it to just slide by. I'm scared. I'm scared it will. It was already law in Israel that women are allowed to make their own choices about their births. The fact that this went so far without a legal precedent. If the Supreme Court decision does not do anything, we're in a scary place. You know, this could happen again.

Jen Kamel: Like you said, this was already established law, just like in the U.S., it's already established law. Everyone has the right to make their own medical decisions, even if they're pregnant, even after a cesarean, even if a doctor recommends a repeat cesarean, everyone has that right. And yet, there are situations like yours that necessitate it going all the way up to the Supreme Court in order to have that law, that ethical foundation of medicine, validated.

Conviction to Move Forward

Jen Kamel: I had one more question. Reader Winona said, "She is courageous through all the turmoil in and around her. How has she been so convicted to keep moving forward?"

"Esther": So I have not, and I think that that's what's hard for people to, people don't believe me. They think like you're just, in this rebellion place, blah, blah, blah. You're just anti and I'm not. I have kept my eyes and ears open the entire time. No, I have not been a hundred percent confident about this throughout. No, absolutely not.

What held me was, I'm going to do what makes the most sense now, and if it ever makes the most sense to have a c section, then that's what I'm going to do. That came with a lot of emotion. Fear of just having a c section after my experiences, but also fear of, "Am I going to know? Am I going to know if I need one? Or am I going to, can I trust myself to make the right choice? Can I trust myself to do that? And so really coming to a place of peace took almost the entire pregnancy.

Maybe around week 36, I finally got to a place of, okay, there are people in the world who can be hired to perform a service called bringing my child into the world through a surgical fashion when that is needed. I can make that choice in my full capacities at any point. This is what I came to before all this started, right? That can be the decision.

That was really hard to hold on to throughout this process. I cannot say that I held on to it 100 percent throughout the process, because towards the end I was just terrified of even going out of the house. But that's what helped me. I'm going to do the best thing for my baby, my body, my future children. I can trust myself.

Jen Kamel: I've been very surprised that I have not seen, other than the articles that you sent me, I have not seen any mention of this on social media, in the news. And so I really think it is so important for everyone, birthing people, clinicians, social workers, to hear this story and understand all the ways that the system really failed you. And that ultimately the Israeli Supreme Court ruled in your favor.

"Esther": Yeah, I want to just add that there was one article that was written quite soon after the Supreme Court hearing came out from an author who didn't speak with me or with my lawyer. Who just wrote based on reading the Supreme Court hearing and they twisted it at the end to say, "Look how liberal Israel is. It's even more liberal than America that we would even allow an abortion this late in a pregnancy, " which was such a shock to me as a religious person. Like, what? I'm not pro abortion.

And that's something I hadn't thought about a lot before. And what hit me is, what do you mean I actually am? I'm not pro abortion, but I'm pro women being able to make the choice that's best for them and their family. And women are able to make that choice and it should not have anything to do with the government. So that was something that kind of hit me. I think that what's going on in the world is a tragedy for women. I just hope that this ruling will make waves in that tragedy and wake more people up to the fact that healthy, happy, pleasant, delightful birth can be easy and available for all women. And it should be available for all women and this should not be the standard of care.

Jen Kamel: Thank you so much for being with us. I am so sorry for everything you've been through, and I too hope that this ruling in Israel communicates to all of the individuals who were involved in your case and involved in future cases, that what is the right thing to do? The right thing is to honor the informed decisions of birthing people.

"Esther": Thanks for having me.

Jen Kamel: Absolutely. And until next time, I'm Jen Kamel. This is the VBAC Facts® Podcast, and remember what we're here for, our focus is to share accurate information about VBAC and repeat cesarean with parents, professionals, policy makers and the court so all decisions can be informed, ethical and just. Thank you so much for joining us today, and I'll see you next time.