Consent for a Forced Cesarean Section

Dr. Stuart Fischbein, MD OB/GYN, having studied and worked for several decades advocating for midwives and the autonomy of birth-people over their own bodies, unfortunately has heard many horror stories of unwanted and unnecessary cesarean section births. 

In the United States, 1 out of every 3 births is done via cesarean surgery. This is an extremely high rate compared to the rest of the world. As one of the most commonly performed surgeries around the globe, surprisingly, it is often performed without any medical necessity. In a 2016 release on the subject, “The World Health Organization (WHO), underscores the importance of focusing on the needs of the patient, on a case by case basis, and discourages the practice of aiming for ‘target rates.’” Meaning, doctors should treat patients as individuals, not as statistical inputs. However, if a patient who is competent and capable to make a decision, and who is well informed of the risks of both a vaginal birth and surgery, refuses to undergo a c-section, their contestation can be overridden by their physician as a result of a declination to humanize pregnancies.  

The American College of Obstetricians and Gynecologists defends that there is an “ethical obligation” to safeguard the pregnant person’s autonomy. Coercion is never an acceptable approach to providing medical care. Nonetheless, if a doctor is short on time, or unwilling to take the birth-person’s wishes seriously, it is all too easy for them to impose the surgery and reject allowing a vaginal birth. For this reason, The American College of Nurse Midwives (ACNM) began a project in 2015 to expand their efforts to normalize natural births. Their initiative, The Reducing Primary Cesareans Project, has brought together 25 hospitals across the country who are collaborating to decrease the number of unnecessary C-sections. They do this by honing the skills that midwives are experts at: allowing for a natural progression of labor while encouraging comfort and fetal monitoring during labor. 

Despite the fact that ACNM is working to make vaginal births more common in the U.S., there is still more progress that could be made. In response to this reality, Dr. Stu decided to write-up a document entitled, Consent for a Forced Cesarean Section. It highlights the fact that the birth-person has made an informed decision to give birth vaginally, but since the hospital physician is forcing them to have a C-section, they will be expected to compensate for any adverse side effects. In his blog, he tells the story of how this document came to be. Dr. Stu explains, that he believes a physician would probably never sign it, but that at least by reading through it they might understand something profoundly important; “wouldn’t it be great to have them realize what they are asking of the pregnant woman?”

We encourage anyone who feels that this could be useful for themselves or their friends to download and share the document. It might be good to pack a copy in your birth bag or give it to the people you know will be present throughout your birthing experience. 



Written by Gabrielle Cappelletti, the intern.

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