A mother recently pressed assault and battery charges against a doctor she claims coerced her into a C-section. She lost, but could her case carry a wider impact?
In June of 2010, Michelle Mitchell delivered her baby at Augusta Health Hospital in Fishersville, Va. But the birth didn't happen as she had planned. Mitchell claims she was coerced into an unnecessary cesarean section by the on-call doctor, Mark Brooks, M.D., even though the operation was not medically indicated. Mitchell sued Dr. Brooks for $2 million for assault and battery but lost the case on November 6, 2015 after the jury deliberated for just 20 minutes.
Vision of a different birth
Like many women, Mitchell had her mind set on a vaginal delivery. She took classes in natural childbirth, went to prenatal yoga, read numerous books and even hired a doula to support her through delivery. During pregnancy, she tested positive for gestational diabetes, which can lead to a larger baby (though Mitchell only failed the test by two points). But according to guidelines from The American Congress of Obstetricians and Gynocologists (ACOG), suspicion of a large baby, called fetal macrosomia, on its own does not necessarily constitute the medical need for a C-section. And there is no accurate way to measure a baby while in utero.
Mitchell's own obstetrician did not tell her a cesarean would be necessary to delivery her baby, but once she arrived at the hospital and was under the care of the on-call doctor, she felt she lost the opportunity to make decisions about her body. After examining her sonogram from a week earlier, Dr. Brooks told the laboring mother that a C-section would be necessary because the baby was likely big—too big, he claimed, to deliver vaginally.
But Mitchell says big babies run in her family, so she knew they could be born without surgery. "My aunt and several of my cousins have vaginally-birthed babies larger than my son with no complications at all," she said. Big babies are born vaginally under supportive care, when there are no signs of distress which, she insists, there were not. "He was hooked up to the monitor the whole time," she said. "My doula and I were both confident that me and my son were doing fine."
So the mom-to-be repeatedly asked for a second opinion, as she did not want to consent to an operation that wasn't needed, but her requests were repeatedly denied. When no medical reason was given, she signed a form exercising her right to refuse the surgery, but continued to be pressured and eventually, she says, threatened. She says Dr. Brooks told her he would call Child Protective Services and her baby would be taken away from her if she did not consent to the operation, so she agreed. The hospital staff did call CPS anyway, citing both "medical neglect" for not agreeing sooner, and "physical neglect" for insisting on breastfeeding when the hospital claimed the baby was losing weight and needed formula. The hospital initially refused to release the baby into her care and CPS proceeded to investigate the new mother for three months after the birth of her child. After the surgery, Mitchell was also told by Dr. Brooks that part of one of her ovaries had been removed during the C-section, but she says she was never told why this had occurred.
Mitchell claims the jury did not get to hear much of her case and she is already planning her appeal. She believes this kind of treatment in childbirth is "more common than people seem to realize." At least two other women have since come forward to tell her about their dealings with Dr. Brooks, claiming he also bullied them during delivery. One of those women said she actually walked out of the hospital while in labor because of his treatment, and delivered at a neighboring hospital instead. In regard to Mitchell's lawsuit and the other allegations, a representative for Augusta Health Hospital said "Dr. Brooks is not employed by Augusta Health; he is an independent practitioner with privileges at the hospital. We were not a party in the suit, but we understand that the case was quickly found in Dr. Brooks' favor. We have no further comment on the case."
A familiar tale
Mitchell was the first woman to successfully make it to court in a case like this, but strikingly similar lawsuits against other doctors around the country are pending. And while only a few mothers are filing lawsuits, mothers in support of Mitchell's case are coming out of the woodwork to recount their similar birth stories—stories of coercion.
Mother of two, Mercedes Thomsen, says nearly the exact same thing happened to her six years ago in a Maryland hospital, though she never filed a lawsuit. She wasn't threatened with CPS, but she was told that if she did not accept the drugs to speed up her labor she would lose her doctor. Thomsen says this was illegal. "First, it was illegal because it was coercion. But secondly, it is illegal in the state of Maryland for a care provider to drop care of a pregnant woman within 30 days before or after their delivery." Thomsen also ended up with a cesarean section, which she believes was a result of how her birth was handled. She is not surprised by Mitchell's story. "It seems that the clock and the pocketbook more and more are ruling the birthplace and the voices of mothers are being lost."
Pressure to have a cesarean is not the only type of forceful maternity care we're hearing about in the news. Earlier this year, a woman named Kimberly Turbin filed a lawsuit, also for assault and battery, against a doctor for a forced episiotomy. The procedure is no longer routinely recommended, as it can lead to longer and more painful recoveries. In a brutal video of the event (trigger warning), you can hear her exercising her right to informed refusal, as she pleads over and over, saying "please don't cut me." But the doctor did cut her, twelve times to be exact, in spite of her clear and persistent requests.
Turbin got in touch with the organization Improving Birth, an advocacy group for maternity care, who contacted over 80 lawyers before someone was willing to take on the case. Even with a disturbing video to support her claims, it took this mother a year and a half to find a lawyer, which is perhaps proof of the widespread acceptance of this kind of maternity care.
Kimberly is not in the minority. Six out of 10 women say they did not consent to the episiotomy they received and Improving Birth says they are informed of happenings like Mitchell's, Thomsen's, Turbin's, as well as the other pending lawsuits every single day. They even began a campaign on their website, using the hashtag #BreakTheSilence, in which women all over the country have shared their stories of abuse in maternity care. These kinds of practices are being referred to as 'obstetric violence'—a term that encompasses coercion, manipulation and malpractice involving laboring women.
Most doctors would argue that forceful practices like the stories these women have shared is absolutely not the standard of maternity care. Kristine Angevine, M.D., of Chattanooga, Tenn., was cautious to comment about Mitchell's case specifically. "I know nothing of the particulars of this case and cannot weigh in on any aspects of it, however, most OBGYN providers I know feel like it's a woman's body, a woman's baby and therefore, it's her labor experience. In most hospitals, all they have to do is have an IV in place in case there's an emergent need for it. For the most part, whatever else they want to do is up to them. Yet, as physicians, our role is to keep our patients and their babies safe, communicate our concerns clearly and balance this with patient autonomy."
Too many C-sections
While most doctors are hopefully practicing care that is evidence-based, one-third of all women in the U.S. give birth via cesarean and many of those cases are not medically indicated. C-sections are not without their own set of risks. While ACOG recommends a C-section rate of about 10 percent to ensure the healthiest outcomes for mothers and babies, the numbers in the U.S. remain staggeringly high under the supervision of trained and licensed medical professionals. One report showed that when doctors themselves gave birth, they were about 10 percent less likely than regular patients to come out with a C-section. This information seems to suggest that it is perhaps more difficult to convince a doctor of their need for a cesarean than a patient who may not have all the information to make a truly informed decision.
As Thomsen said, another consideration is the difference in pay that doctors receive for surgical versus nonsurgical birth. Doctors are paid far more for performing the major abdominal surgery than attending a vaginal delivery and hospitals earn thousands more dollars for the procedure. Some say this sets up a very dangerous scenario in which doctors may end up pressuring women towards unwarranted surgeries because of the massive financial incentive.
Supporters of Dr. Brooks say that Mitchell should simply be happy that her now 5-year-old child was born healthy. But it is clear there is a larger discussion to be had—a discussion about mothers' rights during childbirth and the ethics driving a cesarean rate far above what experts say is healthy. If in our discussions about birth, we continue to set the precedent that the only thing that matters is a healthy baby, then the health of the mother, both mentally and physically, risks being disregarded. And to assume a mother is negligent, for wanting to make informed decisions about her body, is clearly unjust. Cristen Pascucci, vice president of Improving Birth, spoke to this point, saying "childbirth is one of the few places where it is still acceptable to punish women for trying to use their own brains and bodies, and we've got to change that—starting with just believing women when they say 'I was abused.'"
Michelle Mitchell just wanted what every laboring mother wants—a healthy baby and evidence-based care. How her appeal pans out is left to be determined. But if she wins, it may be a first step in creating better practices in maternity care and giving women back the rights to their own bodies during birth.