Concerned About Coerced Abortions? Try Saying No to Cesarean Surgery

The rise in cesarean surgery rates has not been accompanied by overall improvements in maternal or child health and creates risks to pregnant women and babies that do not exist with vaginal births.
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Last year Idaho passed a law making it a crime to coerce a woman into having an abortion. This year, legislators in twelve states, including Missouri, have passed or are considering bills that they claim would enhance informed consent measures for pregnant women seeking abortions and ensure that women are not coerced into having unwanted abortions. Although it is hard to disagree with legislation that purports to ensure free and informed medical decision-making, I have to wonder why legislators who profess to care so much about pregnant women are only willing to protect some pregnant women -- the ones who plan to end their pregnancies -- but not the ones who intend to go to term?

While approximately 800,000 women end their pregnancies each year, a far greater number of women, 4.3 million, go to term. By focusing exclusively on abortion, this kind of legislation also dangerously implies that pregnant women who are going to term are fully and adequately informed and that their medical decisions are never pressured or coerced.

Instances of poor communications, failure to fully inform, and coercion in hospital delivery rooms, however, are increasingly being documented in popular books, films and collections of first-hand accounts. Allegations of abuse have prompted one organization to provide a guide for filing complaints. Rigorous peer-reviewed research, moreover, has found that pregnant women are routinely subjected to interventions during labor and childbirth that have been proven ineffective, or are appropriate only in limited circumstances. Pregnant and laboring women are often deprived of information about and access to a range of good practices that have been shown to work.

For example, an increasing number of women in the United States now give birth by cesarean surgery. According to the World Health Organization the rate of births by cesarean surgery, based on actual medical need, should not be more than 15% of all deliveries. Yet, today approximately 30% of all US births are cesarean surgeries. Some providers and hospitals have even higher rates (40-50% of all births). This rise in cesarean surgery rates has not been accompanied by overall improvements in maternal or child health and creates risks to pregnant women and babies that do not exist with vaginal births.

According to Listening to Mothers II, the largest survey of women's experiences during pregnancy, childbirth, and the postpartum period, one quarter of the survey participants who had cesareans reported that they had experienced pressure from a health professional to have cesarean surgery, and 73% of women who experienced episiotomy, or vaginal cutting, during delivery, reported that they had no choice at all in the matter.

Supporters of so called abortion coercion laws claim that they will protect pregnant women and ensure that their decisions are made freely. Many commentators and organizations, however, have raised questions about these legislators' opposition to coercion, pointing to the fact that the same legislators often support policies that have the effect of coercing some women to go to term and others to end their pregnancies. Certainly, though, if protecting pregnant women and the "unborn" were really the goal, the legislation would not focus on abortion exclusively, but rather would make it illegal to pressure or coerce a pregnant woman to have any medical intervention. This would include policies that force pregnant women who have had previous cesarean surgery to have repeat surgery whether they need it or not.

The best available evidence supports vaginal birth after cesarean surgery (VBAC) for most women who have had this surgery. Nevertheless, the International Caesarean Awareness Network has documented over 800 hospitals with explicit policies that require women to undergo a planned repeat surgery. These women are deprived of both the right to give or withhold informed consent, and they are coerced into having repeat major surgery if they want to deliver in any of these hospitals.

The Missouri bill requires that women be provided with "medically accurate information that describes the proposed abortion method, medical risks, alternatives to the abortion, and follow-up care information." While such information is routinely provided in the context of abortion, there is significant evidence that critical information is not provided to women regarding childbirth delivery methods. Indeed, only two states in the whole country, New York and Massachusetts, have Maternal Information Acts that require health care providers to give expectant parents information about their cesarean surgery rates and rates of births using medical interventions such as labor induction and episiotomies. These laws give families the information they need to avoid providers who are not willing to or who are not trained to support vaginal birth.

Each year, state legislators introduce hundreds of bills that focus on abortion while ignoring serious health and consent issues affecting the millions of women who become pregnant and go to term. Legislators who are truly concerned with protecting pregnant women would ensure that all of them, not just those seeking abortions, are guaranteed informed consent and freedom from coercion.

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