After two caesarean sections, Rinat Dray wanted to give birth naturally.
The mum of three said that during her first pregnant, her doctor began urging her to have a caesarean after her water had broken and she had laboured for a few hours. Hoping for a different outcome for her second pregnancy, she went to a different 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.
But when she arrived at Staten Island University Hospital in labour, 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 didn’t have the surgery, and that she would be committing the equivalent of child abuse and that her baby would be taken away from her, she said.
“I was begging, give me another hour, give me another two hours,” Dray said. In return, she claims, the doctor said “I’m not bargaining here … don’t speak.”
After several hours of trying to deliver vaginally and arguing with the doctors, 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 James Ducey, the director of maternal and foetal medicine, says, adding that her doctor and the hospital’s lawyer had agreed.
But 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.
More broadly, her case is part of a debate over the use of caesarean 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 foetus.
High caesarean rates
Across the country, nearly 33 percent of births, or almost 1.3 million, were by caesarean 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 normal births to cause problems for the health of the mother and the baby. It has recently leveled off.
Indeed, in Dray’s case, her bladder was cut during the procedure, according to court papers.
The increase in the number of caesareans 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. 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 he couldn’t comment on the case because of the litigation and privacy concerns. But he defended the hospital’s record, saying it had a 22 percent caesarean section rate, compared with a state average of 34 percent. Its 2012 rate of VBAC (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 Brooklyn’s Supreme Court, also names Leonid Gorelik, who delivered the baby, and Ducey as defendants.
Gorelik, in court papers, denied that he had taken Dray for the surgery against her will. He said her own “conduct and want of care” contributed to any injuries she may have suffered.
“We won’t tie you down”
Howard Minkoff, chairman of obstetrics at Maimonides Medical Center in Brooklyn, who has published on the subject of patient autonomy, 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,” Minkoff said, cautioning that he was not commenting on the particular facts of 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.”