Case on Court-Ordered Bed Rest Highlights Reproductive Rights Concerns for Pregnant Women
By Rachel Walden — January 13, 2010
Oral arguments began this week in the Florida case of Samantha Burton, a pregnant woman who visited her doctor when she was 25 weeks pregnant with signs of a potential miscarriage. The doctor ordered bed rest, which Burton declined with the intent of seeking a second opinion, as her two job and two existing young children made bed rest a difficult prospect. The doctor then contacted the state.
According to the New York Times:
She was ordered to stay in bed at Tallahassee Memorial Hospital and to undergo “any and all medical treatments” her doctor, acting in the interests of the fetus, decided were necessary. Burton asked to switch hospitals and the request was denied by the court, which said “such a change is not in the child’s best interest at this time.” After three days of hospitalization, she had to undergo an emergency C-section and the fetus was found dead.
I am appalled. But I am not surprised.
The NY Times points to an ACLU rep’s statement at Daily Kos which neatly sums up the problem:
Don’t get me wrong — of course I want pregnant women to follow their doctor’s advice. But I do not think that pregnant women should be confined against their will if they are unwilling or unable to do so. If we allow the government to confine a pregnant woman for not following orders to remain in bed, what’s next? Will we forcibly hospitalize pregnant women for having a glass of wine with dinner? Or eating too much fast food? What if they don’t take their prenatal vitamins? Or miss their doctor’s appointments? What if a pregnant woman refuses a cesarean section? While we each may have strong opinions about such behaviors, our government cannot interfere in a woman’s personal private medical decisions. Allowing the government to make medical decisions for pregnant women means that literally every decision and every activity a pregnant woman engages in could be regulated by the state.
Of course, our government DOES interfere with a “a woman’s personal private medical decisions” — just look at abortion laws –and this case is just one more example.
The same values that lead to restricting women’s choices about following medical advice also affects the choices women have in birth. Many hospitals will not allow vaginal births after cesareans or allow women to chose whether they are continuously monitored, implying that the “only thing that matters” is getting a healthy baby at the end, and that the woman’s “experience” does not matter. In such a framework — where women’s desires are readily ignored (and made to seem trivial) — court intervention with regards to bed rest does not seem extreme. We have already seen cases in which court-ordered cesareans have occurred.
In this case — as in abortion and birth choices –the fetus is prioritized. A woman’s bodily autonomy and preferences for how her pregnant body is treated and used are held secondary to fetal outcomes. People other than the individual woman are allowed rights to control her reproduction.
The ACLU argued in its amicus brief [PDF] on the case that such interference “invites State requests for court intervention in nearly all aspects of pregnant women’s behavior and medical judgments,” and may discourage women from seeking care. “In turn, some women will be discouraged from coming to a hospital for pregnancy care if they know that any disagreement may lead to forced medical treatment.”
Archives of the oral archives should become available soon at available at the website of the Florida 1st District Court of Appeal.
Jill at the Unnecesarean also has a couple of posts on the case. For more on issues related to the rights of pregnant women generally, see the National Advocates for Pregnant Women.
[adapted from a post at Women’s Health News]
eh…very unfortunate on so many aspects. How often is this sort of thing happening? We seem to be hearing more about pregnant women being court ordered to follow the “advice” of their obstetrician- it’s either becoming more prevalent or the media is just hopping onto this “trend”.
When I hear about this sort of thing- women (particularly pregnant women) not following medical advice- it makes me wonder about all the non-pregnant people not following the medical advice of their doctor’s for things like diabetes, high cholesterol, high blood pressure…because that, I feel, can have just as devastating an outcome. I can already hear the arguments that with diabetes or high blood pressure in say, a 55 year old man, doesn’t involve an innocent fetus. However, uncontrolled chronic disease ultimately could cause harm to the individual’s body- and isn’t that the same for a woman and her body?
I could have sworn I’ve heard of research showing that bedrest does not necessarily prevent pre-term labor. Though where I read it confounds me at the moment.
As someone who has a toddler and a full-time job at a company where the promise of a permanent position is precarious at the moment, I can imagine the difficulty she faced with the prospect of possibly 15 weeks of bedrest, followed by 6-8 weeks postpartum recovery. I could not afford day care for my son without working, and am only allowed to accrue 4 weeks of PTO total. FMLA only covers you for 12 weeks (and many of that would be unpaid). Months of bed rest, whether or not it is indicated (and it may very well have been in this case), would be a catastrophe for the average family.
If she had a solid support behind her- affordable and safe child care, and guaranteed income during a long illness, would this situation even have arisen? How terrible this woman felt forced to choose between the child she carried and the family that depended on her.
The irony of this is that, like much of conventional obstetric management, bedrest to prevent miscarriage is both useless and harmful. Here is the conclusion of a Cochrane systematic review on the topic:
“Authors’ conclusions: There is no evidence, either supporting or refuting the use of bed rest at home or in hospital, to prevent preterm birth. Although bed rest in hospital or at home is widely used as the first step of treatment, there is no evidence that this practice could be beneficial. Due to the potential adverse effects that bed rest could have on women and their families, and the increased costs for the healthcare system, clinicians should not routinely advise women to rest in bed to prevent preterm birth. Potential benefits and harms should be discussed with women facing an increased risk of preterm birth. Appropriate research is mandatory. Future trials should evaluate both the effectiveness of bed rest, and the effectiveness of the prescription of bed rest, to prevent preterm birth.”
In other words, an obstetrician’s recommendation has now achieved the status of law without any consideration that it is at best, fallible, and at worst, dangerous. And, of course, even if the advice were correct, the principle that women can be forced to submit to invasive and harmful medical interventions on behalf of their unborn baby makes them no more than containers for something more precious than they are.
I’m appalled that she was “forced” to stay in the hospital; but I can also understand the doctors concern. The baby was unfortunately already dead by the time he/she was to be born-so it had they had good reason to be so concerned as to put her on such extreme bed rest. This woman was in a tough spot, because her lifestyle didn’t really allow her to make that choice. The current “daycare qualifications” for women who need assistance are not good enough. It takes a village to raise a child, but there is little help outside, and in so many cases within a family level. I had a similar case of bed rest, where my son decided he was ready to face the world at 6.5 months into my pregnancy-I was placed on home bed rest-and was skeptical because I had read the evidence was inconclusive. However, all 4 times I would try to get out of bed rest and even do something small, like make myself a sandwich-I would start going into labor again. He was born at exactly 7 months-I had gotten up for about 15 mins. to stretch my legs, and that was enough for his foot and part of the cord to proliferate. Thankfully, because I was already at the hospital he was born healthy, though small. I’m lucky that my son survived-but I do feel bed rest was necessary-at least in my case. Luckily-I also had the support of my grandparents to take care of my oldest son-who’d just started kindergarten that year-and moved me in with them so they could help me. I think if this woman had other resources out there to help her with time off from work (why isn’t maternity leave applicable at every job?) and her children, it could have made a difference in the outcome. The government, which isn’t really apt to make medical decisions, shouldn’t have been able to step in and force her to stay in the hospital. This is a sensitive case, but the death of the fetus shows that we need more research into high-risk prenatal care and more assistance to family and mothers. Not hospital/government interference and rule. This story is both saddening and startling; but it clearly proves it’s time for research and change. This is a sign of what federally regulated hospital care can do, coupled with a lack of research/study into this area.
The fetal death was not caused by the woman’s resistance. Henci’s comments are correct…there is no evidence that bedrest stops preterm labor. It’s appalling that the court could make such mandates without clearly ascertaining the current research results on this and so many other topics on which they have ruled on behalf of pregnant women…or so they say.
It’s not right for anybody to be forced to do something simply because one doctor’s ego is too big to take a conflicting opinion. From another version of the story that I read, this woman wanted a second opinion. It’s the same thing most people would ask for before undergoing major surgery. Should a doctor be able to take them to court, strap them down on a table and cut them open against their will? No. The courts were wrong here. If I were her I’d sue everybody involved.
“It makes me wonder about all the non-pregnant people not following the medical advice of their doctor’s for things like diabetes, high cholesterol, high blood pressure…because that, I feel, can have just as devastating an outcome.”
Ummmm, yes it can, but it also might not. It’s a common tendency amongst many in the medical profession to spell out the worst case scenario ( which i get is important!), but then pretend scare tactics or our larger risk culture isn’t influential. I think what we need to be careful of is implying that these “conditions” are not culturally mediated or (re)created- as though medicine merely identifies and objectively treats them.