The policy, which is outlined in an article in the Guardian, allows SIUH doctors to overrule a mother's lack of consent when they determine there is a "reasonable possibility of significant benefit" for the fetus that "outweigh[s] the possible risks to the woman."
]]> Such a policy runs contrary to ethics guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). Both condemn the idea of performing procedures for the benefit of a fetus without the mother's consent.The practice likely also constituted a criminal assault upon the mother.
"Pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment, even treatment needed to maintain life," the ACOG said last year. The ACOG and AAP both said in 2014 that "even the strongest evidence for fetal benefit would not be sufficient ethically to ever override a pregnant woman's decision to forgo fetal treatment."
SIUH does not deny that it forced the Brooklyn woman to have an unwanted C-section -- an experience she found "frightening and degrading." Instead, it claims that the procedure probably saved the newborn's life. A note by the head of obstetrics in the woman's chart reads that "The probable benefits of C-section significantly outweigh the possible risk to the woman ... I have decided to override her refusal to have a C-section."
Public records requests by the Guardian to several of the nation's largest hospitals found a number that had no policy about what to do when a doctor and birthing mother disagree about treatment. Those few that did have a policy did not grant the doctor the complete authority to overrule the mother, however.
We recommend reading the entire Guardian article, which discusses a variety of issues surrounding the lawsuit and C-sections in the U.S. The SIUH policy, however, shows one way in which the medical establishment has attempted to resolve the question of what to do when a doctor believes a certain treatment is necessary in order to prevent a birth injury but the mother remains unconvinced. By law, however, patients must always have the final say on what procedures are performed on them.
]]>The more you know about birth injuries and their causes, the better your chance of getting an answer to that urgent question.
]]> Shoulder dystocia can happen when the baby's shoulders get stuck during deliveryWhen a baby is very large or the mother's pelvic opening is small, the baby's shoulders can become stuck. Depending on how the situation is handled, it can be quite serious. Improper delivery techniques can cause nerve damage to the shoulder, arm or hand, and even a broken collarbone or arm. Long term, it can cause tremors or even paralysis. A baby being stuck for too long can result in an oxygen shortage to the baby's brain.
When there are risk factors, it's extremely important for the delivery team to know how to handle the possibility if it arises. Inexperienced doctors and nurses may not know how to deliver the baby without causing trauma.
For example, the nurse may push on the mother's belly, which merely pushes the child's shoulder into the mother's pubic bone. Or, a doctor may pull on the child's head, which can cause injury to the child's brachial plexus region.
Erb's palsy can result from stretching or tearing of nerves
Another common birth injury that can occur with very large babies is Erb's palsy. Having a baby larger than nine pounds is a risk factor, as is maternal diabetes. First pregnancies are also at higher risk. Erb's palsy is entirely preventable, yet it can cause extremely serious harm.
If the child is too large for vaginal delivery but the delivery team moves forward anyway, they may accidentally stretch or tear the nerves between the baby's neck and arm. This brachial plexus injury may require multiple surgeries, or even result in total paralysis.
Cerebral palsy can be the result of oxygen deprivation or trauma
A set of neurological disorders permanently affecting bodily movement and muscular coordination is known as cerebral palsy, and it can be extremely debilitating. It is sometimes unpreventable, but often medical malpractice is to blame.
Over-sedation of the mother during delivery, obstructed delivery, the use of a vacuum extractor or forceps during delivery, or oxygen deprivation can be responsible for cerebral palsy. In particular, the baby's heart rate needs to be monitored for evidence of fetal distress. If that is detected and the child is lacking sufficient oxygen, an emergency C-section is called for. If the doctor fails to perform the appropriate monitoring or the emergency C-section, it may be medical malpractice.
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