#JenniferIsNotAlone

If you’re a birth junkie like some of us at WMC whose intimate circle consists mainly of other mamas in the local crunchy parenting scene, you may have noticed a hashtag popping up on just about every birth activists page in the world today on various social media sites. #JenniferIsNotAlone is trending among the likes of lots of birthy Facebook pages including VBAC Facts,  ICAN, Improving Birth, and the Facebook pages of countless doulas, midwives and women’s rights activists across the country. You might also be seeing chatter about the story behind the hashtag on birthy blogs and other online publications like RH Reality Check, Advocates for Pregnant Women, and IndieGoGo. There’s also a Change.org petition going and a Facebook event page that, as of press time has been sent to over 7200 people with over 1400 having responded that they’re “attending”. The event invites attendees to take a picture of themselves with a sign that includes the hashtag and help spread the word about what the #JeniferIsNotAlone fuss is all about.

What IS all the fuss about??

The story goes something like this… Jennifer Goodall is a Florida mama to 3 kids and is pregnant with her fourth. If she hasn’t delivered as of the time this blog post (and we’ve not seen anything about a birth when reading the most current sources of information on this story) and the dates that are widely being spread are correct, she is 41 weeks and 1 day pregnant today. The three babies that have made their way OUT of her belly have done so as the result of cesarean section births.  With this baby, she has opted to exercise her right as a patient to informed refusal of a repeat cesarean in favor of a Trial of Labor After Cesarean (commonly known as TOLAC). According to our understanding, Jennifer is lucid and of sound mind and, as such, should be able to comprehend the risk she intends to undertake by entering into a TOLAC.

We won’t downplay those risks and this blog post isn’t meant to imply that there are any decisions in birth that ultimately guarantee a good outcome. However, the risks and benefits of TOLAC and VBAC are well documented even if there is no reliable research on the safety of TOLAC or VBAC after multiple cesareans. Don’t be confused by the lack of research, though. There is no solid research upon which to base the decision to deny Jennifer her right to informed refusal of a repeat cesarean, either. In fact, according to the American Congress of Obstetrics and Gynecology’s (ACOG) practice bulletin from August 2010,

“…the chance of achieving VBAC appears to be similar for women with one or more than one cesarean delivery. Given the overall data, it is reasonable to consider women with two previous low transverse cesarean deliveries to be candidates for TOLAC, and to counsel them based on the combination of other factors that affect their probability of achieving a successful VBAC. Data regarding the risk for women undergoing TOLAC with more than two previous cesarean deliveries are limited.”

Even ACOG says that TOLAC is reasonable for otherwise low-risk women with more than one cesarean delivery. They don’t go so far as to explicitly advise TOLAC for women with more than two cesareans, they don’t warn against it, either.

We aren’t sure about many of the details of how the situation between Jennifer and her provider progressed to the point it is right now, but we do know that Cheryl Tibbett, Bayfront Health’s chief financial officer,  sent Jennifer a letter on July 10th. According to RH Reality Check, the letter stated, among other things, that:

“…her prenatal care providers intended to report her to the Department of Children and Family Services, seek a court order to perform surgery, and perform cesarean surgery on her “with or without [her] consent” if she came to the hospital.”

In response to the letter, National Advocates for Pregnant Women (NAPW) and Florida attorney, Patricia E. Kahn filed a request for a temporary restraining order to prevent the hospital from following through with the stated threats. When we think about Jennifer’s situation and the situations of many women who have had similar threats made against them, the question of who has the right to make medical decisions for patients just begs to be answered. When and why does a provider’s concession that they not be forced to “perform” a procedure (which isn’t really a procedure at all) trump a patient’s right to bodily autonomy? When is forcing major surgery on a lucid, non-consenting patient ever considered “doing no harm” or appropriate? These are the kinds of questions that Federal District Judge John E. Steele failed to answer in the wake of the ruling that he handed down when he denied the request filed on Jennifer’s behalf. Judge Steele stated in his denial that Jennifer doesn’t have the “right to compel a physician or medical facility to perform a medical procedure in the manner she wishes against their best medical judgment.” Does that mean that the physician and the medical facility have the right to force Jennifer to undergo a medical procedure that she denies consent for? Apparently, Judge Steele believes that they do. In fact, it’s clear that he believes that the rights of a businesses (and providers) trump the rights of individuals and consumers. The Change.org petition makes this same point:

“…vaginal birth is not a procedure.  It is a normal biological process and the absence of a forced surgical procedure.  Put another way: what Ms. Goodall and other mothers in your area seek with vaginal birth is the absence of a forced surgical procedure, so that a normal biological process may take place.” 

Judge Steele has essentially ruled that federally sanctioned medical assault is legal when women attempt to exercise their right to informed refusal. Informed refusal is a right of every patient that is based on multiple instances of case law and no woman should be forced to undergo major surgery if she is uncomfortable with the risks and denies consent.

What the hospital and the doctors involved in this case have essentially done is force Jennifer and her family into a position where they have no real options. If Jennifer presents in labor at the hospital, she faces an adversarial group of providers and the very real possibility of medical assault being perpetrated against her. Her other option isn’t much better. If she chooses not to go to the hospital when her labor starts, she could end up delivering her baby at home without trained attendants there to help in an emergency situation. From what Jennifer has said, she is terrified to go to the hospital. What would you do in her position?

Does the precedent set here scare you as much as it does us? If so, take a few minutes to show your support for Jennifer by signing the Change.org petition and RSVPing to the Facebook event (and participating in the #JenniferIsNotAlone hashtag).

WMC stands firmly behind Jennifer and with the organizations that have come together to support her during this very difficult process. In closing and to Bayfront Health and the providers there who are involved in this situation, we share the sentiments of the organizers who are petitioning on Jennifer’s behalf:

“Again, we call for your compassion and respect for her constitutional rights. The women of Florida, the United States, and all over the world are eagerly watching to see if you make the right decision.”

- Amy Jones

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