The following statement has been made available to the public and the media today, in anticipation of the hearing for Rinat Dray vs. Staten Island Hospital, et al., where a judge will decide whether to admit amicus curiae (“friends of the court”) briefs submitted by advocacy organizations in support of Ms. Dray and all childbearing women. Full text below. PDF available here.
February 10, 2015
Joint Statement by
Birth Rights Bar Association (U.S.)
Choices in Childbirth (New York)
Human Rights in Childbirth (International)
Improving Birth (U.S.)
International Cesarean Awareness Network (International)
National Advocates for Pregnant Women (U.S.)
The organizations listed above represent tens of thousands of women in New York and across the United States with overwhelming interest in the outcome of Rinat Dray vs. Staten Island University Hospital, et al. On their behalf, we have submitted legal briefs as “friends of the court” (amici curiae) in full support of Ms. Dray and her right to medical decision-making, including refusal of surgery. With Ms. Dray’s case hangs in the balance rights that are in dire need of legal enforcement.
We are consumer and advocacy organizations engaged in efforts to improve U.S. maternity care for women and babies, including protection of the legal and human rights of women giving birth. We have observed around the country widespread violations of the rights to Informed Consent and Refusal, so frequently violated as to be commonplace and with no effective systems of accountability in place. We speak for ourselves and countless women who have reported to us their experiences of physical and emotional harm resulting from coercion in their maternity care and obstetric violence. Our briefs include a record of 42 such firsthand accounts.
In the United States, all persons are entitled to Informed Consent and Refusal in their medical care: rights that rest on constitutional concepts of bodily integrity, autonomy, and self-determination. The amici have asked the court to affirm that these rights are not diminished in pregnancy and childbirth. Contrary to what the hospital claims in Ms. Dray’s case—that doctors have special legal authority over patients while they are pregnant—she and all women have the constitutional right to make their own informed decisions about their medical treatment and to refuse surgery.
These legal protections are especially important in a system that Amnesty International has called in “crisis,” pointing to poor prenatal care, high rates of expensive medical interventions, and dismal maternal and infant health outcomes compared to other developed nations. The U.S is one of just a few countries in the world with a rising maternal mortality rate, which researchers have partially attributed to the overuse of Cesarean section.
See attached: Amici Information, Press Release: “Pregnant Women Ask Court to Affirm Their Constitutional Rights,” Fact Sheet, and Article: “Rinat Dray is Not Alone”
Amici Information
Birth Rights Bar Association (U.S.) is a lawyers’ network dedicated to promoting rights associated with childbirth including: the right to physical liberty, bodily integrity, due process of law, equal protection, religious liberty, and the informed consent of all those involved.
BirthRightsBar.org
CONTACT Indra Lusero, President: (303) 902-9402
Choices in Childbirth (New York) is a New York-based non-profit organization dedicated to educating, advocating, and shaping policy to help families make informed decisions about where, how, and with whom to birth and to improve health outcomes.
ChoicesinChildbirth.org
CONTACT Michele Giordano: (212) 983-3867
Human Rights in Childbirth (International) advocates for the recognition of every birthing woman’s fundamental human rights, by connecting consumers and advocates; educating the public and policy makers; and coordinating legal, political, and grassroots efforts around the world.
humanrightsinchildbirth.org
CONTACT Hermine Hayes-Klein, Director: (203) 409-3867
Improving Birth (U.S.) is the largest consumer organization for improved maternity care in the U.S., with over 100 locations and thousands of representatives around the country. It advocates for evidence-based care and humanity in childbirth, raising public awareness and providing information and support to women and families.
ImprovingBirth.org
CONTACT Cristen Pascucci, Vice President: (443) 622-2892
International Cesarean Awareness Network (International) is a nonprofit organization whose mission is to improve maternal-child health by preventing
unnecessary cesareans. With volunteers throughout the continental U.S. and abroad, our vision is a reduction in the cesarean rate driven by women assuming responsibility for their healthcare by making evidence-based, risk appropriate childbirth decisions.
ICAN-online.org
CONTACT LaQuitha Glass, President: (800) 686-ICAN, ext. 105
National Advocates for Pregnant Women (U.S.) was founded in 2001 to protect the rights, health, and dignity of pregnant and parenting women. NAPW works toward a world where no one loses their constitutional or human rights at any stage in pregnancy, labor, or delivery.
AdvocatesforPregnantWomen.org
CONTACT Farah Diaz-Tello, Staff Attorney, (212) 255-9252
FOR IMMEDIATE RELEASE
JANUARY 15, 2015
CONTACT CRISTEN PASCUCCI, IMPROVING BIRTH (443-622-2892)
Pregnant Women Ask Court to Affirm Their Constitutional Rights
Hospital claims women lose right to refuse surgery when pregnant
New York—A New York hospital has claimed that it has the right to make decisions for its pregnant patients. It said in papers filed last week that women are not entitled to due process in childbirth, asserting that if doctors call an “emergency,” a court order is not needed for a doctor to force a woman to have surgery.
The claim was made in a motion to block amicus curiae (“friend of the court”) briefs submitted by consumer organizations Improving Birth, International Cesarean Awareness Network, and others in support of New York mother Rinat Dray, who filed a lawsuit after being forced into a third Cesarean section at a Long Island hospital in 2011 (Rinat Dray vs. Staten Island University Hospital, et al.). Ms. Dray had planned a vaginal birth after Cesarean with the support of her own doctor, but he was not present when she went into labor. Instead, the on-call doctors sought and received permission from the hospital’s own legal department to “override” her decision to give birth vaginally, even while noting “the woman has decisional capacity.” Ms. Dray was restrained and taken by force into the operating room, where doctors extricated her baby by surgery (more detail at www.bit.ly/draycase).
“Obstetric violence like what Ms. Dray experienced is widespread and accepted in United States maternity care,” said Cristen Pascucci, vice president of Improving Birth. “We hear from women on a daily basis that they are pushed into risky, unwanted interventions in childbirth. Especially in light of the well-documented dysfunctions in American maternity care, we look to the court to clarify that women, not hospitals with profit motives, hold the rights over their bodies in birth.”
In the United States, all people have the right to informed consent and refusal in their medical care, rooted in constitutional rights to autonomy and bodily integrity. The right to refuse treatment, especially, is strongly upheld by U.S. courts, human rights law, and ethical guidelines for obstetricians. Unfortunately, as advocates have long observed, these rights are routinely violated in maternity care (see Improving Birth’s blog article “Caught on Video: Improving Birth Breaks the Silence on Abuse of Women in Maternity Care“: www.bit.ly/nodontcut).
Improving Birth and International Cesarean Awareness Network joined the Birth Rights Bar Association, Choices in Childbirth, and Henci Goer on two amicus curiae briefs filed by Human Rights in Childbirth (HRiC) and the National Advocates for Pregnant Women (NAPW). The HRiC brief “Women’s Voices: Informed Consent and Refusal” includes 42 stories from U.S. women recounting personal experiences with nonconsented and forced interventions in childbirth (brief and stories here). The HRiC brief and the NAPW Brief in Support of Liberty, Equality, and Dignity in Birth can be accessed in full at www.advocatesforpregnantwomen.org/Dray. The court will decide whether to admit the briefs at a February 10 hearing.
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Published online at: www.improvingbirth.org/2015/01/press-release-rights
“Rinat Dray is Not Alone”
By Hermine Hayes-Klein, Founder, Human Rights in Childbirth
Introduction
On December 23, 2014, Human Rights in Childbirth submitted an amicus curiae brief in the New York case of Rinat Dray vs. Staten Island University Hospital et al for a forced cesarean section that she received in 2011. We submitted the brief together with the US Birth Rights Bar Association, Improving Birth, and the International Cesarean Awareness Network (ICAN) as fellow amici, with the purpose of informing the court about the context and significance of Rinat Dray’s experience in US maternity care.
Rinat Dray’s Experience
Rinat Dray swore to the following facts for her Affidavit for this lawsuit. Ms. Dray wrote that she and her husband had always intended to have a large family, “as many children as G-d would give us,” as was common in their community in Crown Heights, Brooklyn. Her first pregnancy was healthy, but resulted in a c-section for “failure to progress.” As she wept on the operating table, her doctor said, “Don’t worry, next time you come here, you will do a VBAC [vaginal birth after cesarean].” Her recovery from surgery was long and difficult. When she became pregnant a second time, she did extensive research about VBAC and sought a doctor who would support her in giving birth vaginally rather than plan a repeat cesarean section. However, when the time came for that birth, she was pressured into agreeing to another c-section, writing later, “I concluded, for a variety of reasons, that birth via c-section was foisted on me by the doctor for his own convenience rather than for any legitimate medical reason.”
When she became pregnant a third time in 2010, she sought out a doctor and hospital willing to support her in attempting a vaginal birth, and hired a doula to support her in labor. On July 26, 2011, she went to the hospital in labor. The doctor who had promised to support her wasn’t there. Instead, a doctor she had never met before, Dr. G., came in and told her to have another c-section, “saying only, ‘You had two before, why not have another one?’” When she explained that she understood the risks and was planning a VBAC, he started to bully and threaten her, telling her that she could either agree to cesarean now or go home and not come back to the hospital.
Despite the threatening environment in which she was laboring, Ms. Dray’s labor progressed over 2 hours until her cervix was dilated 5-6cm and her baby was starting to descend. When she expressed her joy that the labor was progressing, Dr. G. said, “I don’t have all day for you. Don’t be so excited, this isn’t going to be natural.”
A few hours later, Dr. G. returned with a colleague, Dr. D., who also tried to pressure Ms. Dray into a c-section. When she asked if they could transfer her to another hospital if they wouldn’t support her in a vaginal birth, Dr. D. refused, and said, “We are going to go to court to force you to have a c-section.” Shortly later, Dr. G. returned, and said that he would only perform a vaginal exam, to check her dilation, if Ms. Dray agreed to a cesarean and signed a consent form. When she refused, he said, “I am not bargaining here.” He repeated the threat to get a court-ordered cesarean, and then added that if she didn’t submit, “the state is going to take your baby away.”
Neither doctor ever advised Ms. Dray of any particular signs or symptoms of danger to her baby. Instead, she was told that her uterus could rupture, a known risk of VBAC that she understood, and informed that the doctors found that risk unacceptable. Nor did they get a court order to override her right to refuse surgery. Instead, the doctors called the hospital’s lawyer to ask if they could force her into a c-section. The hospital lawyer told them to go ahead. Both doctors then returned to Ms. Dray’s hospital room, with nurses, and informed her that she was being taken to the operating room. Dr. D said, “We got the approval to do it,” and ordered the nurses to push her to the operating room. As she wept on the operating table and begged the doctors not to do this, Dr. G told her, “Don’t speak.”
Ms. Dray wrote in her affidavit, “Dr. G was rough during the surgery, almost as if to punish me. He ended up severely injuring my bladder, cutting it from the back and front.” A healthy, non-distressed baby was delivered with APGARs of 9 and 9. Ms. Dray, on the other hand, was hospitalized for 6 days after the surgery and suffers a “variety of urinary and other pelvic symptoms” to this day. She wishes to have more children, but she fears getting pregnant again. A fourth pregnancy also carries significantly increased health risks to her and her baby, because of the prior three surgeries, including potentially life-threatening placental abnormalities and higher risk of stillbirth.
Despite the physical and psychological damages that Ms. Dray sustained from this forced surgery, and despite the fact that her competence and non-consent were actually written into her medical chart, numerous lawyers refused to bring her case, until she finally found the law firm of Silverstein & Bast. They filed a lawsuit for her, against the doctors and the hospital that violated her right to informed consent and refusal while she was in labor with her third baby. This suit asks a New York court to recognize that Ms. Dray’s providers violated a fundamental duty of care toward her when they overrode her competent decisions to refuse their offer of surgery.
Rinat Dray Is Not Alone
Organizations that address disrespect and abuse in maternity care, like the amici that joined for our brief, hear from many women whose fundamental right to informed consent and refusal was ignored and violated during childbirth. The themes are familiar– women’s options for choices as fundamental as vaginal birth prescribed by hospital policies, so they seek out a doctor and hospital that promise to support their choices. The prenatal doctor who promised supportive care isn’t on call at the birth, and the doctor on call has another agenda. The bullying, coercion, and threats faced by women as they attempt to ask questions or exercise their right to make the informed decisions about their care. The primal threat to take the woman’s baby away if she doesn’t obey. The providers’ dismissal of the risks of intervention, risks that are borne out in physical damage suffered by the women long after the provider has left the scene. The lasting physical and emotional damage, including PTSD, suffered by women whose physical integrity and autonomy was violated at one of the most vulnerable moments of their lives. We’ve heard other women say that they would love more children, but are afraid to get pregnant again after the way they were treated the last time they gave birth.
We wanted the court to understand that Rinat Dray isn’t alone. Following Improving Birth #breakthesilence campaign, which used social media to overcome taboos around obstetric violence, we invited women to share their stories of non-consented interventions in childbirth for use in a Women’s Voices brief on informed consent and refusal. We wrote a brief that wove their voices together to humanize and illustrate our arguments, and attached the full stories to the brief as an appendix.
The stories offered for this brief are not only forced c-sections, but a wide range of non-consented interventions that occurred in different childbirth scenarios. They are united under one of our mottos at Human Rights in Childbirth: “How much would change if it were clear, to everyone in the room, that the birthing woman has the right to make all the decisions about her treatment and that of her baby?” In each of these stories, much suffering could have been avoided if that right were clear. And so the amici have united in this brief to ask the New York court where Rinat Dray brought her lawsuit to enforce the right to informed consent and refusal in childbirth.
The full brief and appendix are available on our website, but we will also release each section of this brief as a blog post in the coming weeks. It was our honor and privilege to amplify the voices of the brave women who shared their stories in order to prevent the abuse of other women and babies. As Hungarian mother and human rights advocate Anna Ternvoszky said in the documentary Freedom for Birth, “Now is the time to let our voices be heard.”
Published online at: www.humanrightsinchildbirth.com/amicusbriefpart1