After two cesarean sections, Rinat Dray wanted to give birth naturally.
But when she arrived at Staten Island University Hospital in labor, the doctor immediately began pressuring her, she said, to have a C-section.
The doctor told her the baby would be in peril and her uterus would rupture if she did not; he told her that she would be committing the equivalent of child abuse and that her baby would be taken away from her, she said in an interview this week.
After several hours of trying to deliver vaginally and arguing with the doctors, Mrs. Dray was wheeled to an operating room, where her baby was delivered surgically.
The hospital record leaves little question that the operation was conducted against her will: “I have decided to override her refusal to have a C-section,” a handwritten note signed by Dr. James J. Ducey, the director of maternal and fetal medicine, says, adding that her doctor and the hospital’s lawyer had agreed.
Mrs. Dray is suing the doctors and the hospital for malpractice, charging them with “improperly substituting their judgment for that of the mother” and of trying to persuade her by “pressuring and threatening” her during the birth of her third son, Yosef, in July 2011.
But more broadly, her case is part of a debate over the use of cesarean sections. It also raises issues about the rights of pregnant women to control their own bodies, even if that might compromise the life of a fetus.
Across the country, nearly 33 percent of births, or almost 1.3 million, were by cesarean section in 2012, according to the Centers for Disease Control and Prevention. The World Health Organization recommends that the rate should not be higher than 10 to 15 percent.
The rate has been climbing since 1996, despite warnings from health officials that C-sections are more likely than natural births to cause problems for the health of the mother and the baby. It has recently leveled off.
Indeed, in Mrs. Dray’s case, her bladder was cut during the procedure, according to court papers.
The increase in the number of C-sections has been attributed to a rise in high-risk pregnancies; a desire by doctors and mothers to schedule their deliveries; and fears of malpractice lawsuits should the baby be injured during a normal delivery, which typically takes far longer than a cesarean. Obstetricians pay some of the highest malpractice insurance premiums of any medical specialty because of the frequency of birth-related lawsuits.
A spokesman for the hospital, Christian Preston, said Friday that he could not comment on the case because of the litigation and privacy concerns. But he defended the hospital’s record, saying it had a 22-percent C-section rate compared with a state average of 34 percent. Its 2012 rate of “vaginal birth after C-section” was almost 29 percent, much higher than the state average of 11 percent, he said.
The lawsuit, filed last month in State Supreme Court in Brooklyn, where Mrs. Dray lives, also names Dr. Leonid Gorelik, who delivered the baby, as a defendant. Dr. Gorelik, in court papers, denied that he had taken Mrs. Dray for a C-section against her will. He said that her own “culpable conduct and want of care” contributed to any injuries she may have sustained.
Dr. Ducey’s lawyer did not respond to a request for comment. In the medical record, he wrote that the fetus was “at risks for serious harm without the C-section.”
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Dr. Howard Minkoff, chairman of obstetrics at Maimonides Medical Center in Brooklyn, whose articles on the subject of patient autonomy have been published in medical journals, said he believed that women had an absolute right to refuse treatment even if it meant the death of an unborn child. “In my worldview, the right to refuse is uncircumscribed,” Dr. Minkoff said, cautioning that he was not commenting on the particular facts of Mrs. Dray’s case. “I don’t have a right to put a knife in your belly ever.”
Such a person might be accused of being immoral or a terrible mother, he said, “but we won’t tie you down.”
As she describes it, Mrs. Dray’s experience illustrates the debate over C-sections.
Now 35, she is the mother of three healthy boys. She found her doctors through word of mouth and the Internet, she said, speaking in the office of her lawyer, Michael Bast. She said the first doctor, at NewYork-Presbyterian/Weill Cornell hospital, began urging her to have a cesarean after her water had broken and she had labored for a few hours. Hoping for a different outcome for her second pregnancy, she went to Lenox Hill Hospital, with the same result.
Still hoping for a vaginal birth, she changed doctors again for the third pregnancy. She also hired a doula to help her with the childbirth.
At first, she said, Dr. Gorelik appeared to relent, saying he would give her an epidural for the pain and then reconsider. “I was begging, give me another hour, give me another two hours,” Mrs. Dray said. Her mother, who was there, supported her, and the doctor said, “I’m not bargaining here,” Mrs. Dray said.
Mrs. Dray said she kept begging on the operating table. His answer, she recalled, was, “Don’t speak.”
I think these text talks about a lot of interessant issues that involves the practice of medicine.
First, the using of C-section, for helpping the childbirds.
Second, the way we use the new techinces we have.
Third, the capacity we have, doing something against our patient, when we think it is better for him or her.
And finally, the problems we can be involve in, not only when whe disagree with the patient, but also when we agree and the resolt is not the waited one.
what do you think? I hope you'll enjoy it, and we could have a nice discussion.
:D
Neus
Este comentario ha sido eliminado por el autor.
ResponderEliminarI think in this case the doctors have done a good practice. At first they acted in order to respond to the desire of the mother, and when they saw it was impossible, they turned to make a C-section.
EliminarIt's true that she didn't want, and that she had a little sequel (her bladder was cut). But nowadays, the mother and the son are healthy people. I wonder what would have happened if doctors let her to give birth naturally.
In my opinion, doctors haven't got authority to do whatever they want, they should respect the desires of the patient, but in this case, doctors have two patients: The mother and the baby, and the priority is the health of both.
Hi girls!
ResponderEliminarI would like to give my opinion about the topic that are being raised in this article. Firstly, I would like to express my opinion about caesarean section, I think that this is a surgical technique that should be used when vaginal delivery can be risky for the child or the mother. However, different experts may differ in their views on the recommendation of caesarean section. This technique allows to save both the mother and the foetus.
Secondly, we must consider that a caesarean section is a major surgery, with all the risks involved and events, such as wet lung, potential for early delivery and complications, higher infant mortality risk…
Finally, I think that the case presents this article should not be very frequent because the mother in most of these cases will want the best for her son and herself. In the minority of cases as presented to us, I think like Ana because the most important is the health of mother and baby.
Hello! I think that this article is very suitable for us because, on the one hand we are women, and probably we will have kids ever. In the other hand we will be doctors so this can involve us sometime.
ResponderEliminarAs a future doctor, my opinion is that we have to respect the views of our patients, because we aren't paternalistic, and our labour is explain to the patient the pros and cons of the practice that we will perform. Then, he has the ability to decide from themselves.
However, there are some situations in which we have to decide for the patient. And in this case, I think the doctor had to, because there were a risk to the patient's life and her baby.
To conclude, I would like to highlight that we have to be aware of what we do because we can have real trouble with the law.
Good night, I finished reading this article and honestly I find an interesting topic from the point of view of the doctor.
ResponderEliminarFirst, I believe that the procedure followed by the doctor was correct given the situation of the patient and the baby. Nowadays we thank the media and advances we have achieved in health, allowing us to reduce the number of deaths or problems in childbirth. These improvements should be used to our advantage, however the patient has the right to say what they want or not, and the doctor must accept the decision.
On the other hand, I think the doctor also has a duty to make the best procedure for the patient, although this may be different from what the patient wants.
Finally, because of all this I think it is important to use medical consent in medicine, because without them doctors may have trouble with the law. Similarly it is necessary for the patient because it lets you know what they are exposed.
Hi girls!!
ResponderEliminarThis article is not only doing or not doing C-section.In this case C-section is the example but the real problem is explaining to the patient what it could be better for him or her.Sometimes the patient doesn´t agree with you,and in theses cases you must be patient,you must explain him/her everything(step by step),you must tell her/him all adavantages and contraindications.After that process,our patient will decide what to do and if his/her decision is not our decision ,the patient will sign a consent and he/she will assume all risks.
On the other hand,I think that doctors and generally,sanitary workers,don´t have to much time for staying with their patients.Int his case,C-section is quiclker than natural delivery.I would like to be wrong but in our days everything is possible,
In conclusion,treating with patients is not easy.When you open a door and you see a new face you don´t know how is him/her and you need to be sincere but being prudent.A doctor needs to talk,explain,advise,listen and accept,
Thank you all for your comments.
ResponderEliminarI’m happy to see that you enjoyed it!
As I can see everyone has her own opinion, but they aren’t much different, and we all are looking for our patient, and respecting his or her opinion if it is possible.
In some cases, we have some privileges, and according to the law, we can act against the patient. It is only in very specific situations, and always explaining why we act as we do, and with the judge’s consent.
May be in this case, I would ask for some help and explain the case to the judge and asking opinion to other doctors, verifying that my opinion or act is in benefit of the patient even he or she does not agree with me.
I introduce this new issue for anyone who is interested in, and want to comment or say something new.
I liked very much all your comments.
Lastly I want to say that I haven’t a definitive opinion, due to the complexity of the situation, and I would need to study more, every case, and evaluate everything that is implied in every single case.
Thank you!
Neus :D
Hi girls!
ResponderEliminarThis article explains the experience of a doctor and it shows a situation which can occur daily in the medical practice, that is the confrontation of the patient and doctor opinion. I liked so much this article!
Doctors have the duty to explain patients all their options of treatment and I think the patient have to decide in consequence. But sometimes there are risk situations where doctors have to take a decision quickly and maybe their decision isn’t the same of the patient.
I think it should be difficult to explain someone that you did something that she or he didn’t want, but when a life is in danger (like the case of the article) trying to save it, is the most important. And I guess if the result is good, there will be no patient complains.
Hi girls!!
ResponderEliminarIn this article we have been reported about an incident happened involving a childbirth. Often, we have situations like that. A person arrives to the hospital and pretends we do that he want that we do. In these situations, medicals have to do the role of a professional they are. However, respect the patient, in the same way, is a universal rule.
In this case the controversy was about the form of give birth, but in all cases the person is submitted by a surgical procedure, there must be an agreement between health workers and the patient which avoid or allow them be supported by this deal.
Despite this, sticks out the percentage of C-section childbirths were performed. Inevitably, lawsuits are very common, and all of us will know a case like that.