Last week, (yet another) article came out detailing the case of a woman who is suing her doctor for pressuring her into a cesarean against her will. There is so much to deconstruct within the narrative of that story, but I want to focus on the commentary from the Obstetrician in the case.
I have two patients. I don’t have just one patient …that is why I disagree with the statement of your, of the American, whatever, ACOG [the American Congress of Obstetricians and Gynecologists], that the desire of the mother has to supersede the desire of the fetus. I disagree with that. …I have an obligation now toward the baby. I’ve gotta speak for the baby because that is my second patient.”
The ACOG “whatever” that she is referring to is ACOG’s Ethics Committee opinion statement on “Maternal Decision-Making, Ethics, and the Law.” It reads, in part:
…practitioners should recognize that in the majority of cases, the interests of the pregnant woman and her fetus converge rather than diverge,” and that, “Pregnant women’s autonomous decisions should be respected. Concerns about the impact of maternal decisions on fetal well-being should be discussed in the context of medical evidence and understood within the context of each woman’s broad social network, cultural beliefs, and values. In the absence of extraordinary circumstances, circumstances that, in fact, the Committee on Ethics cannot currently imagine, judicial authority should not be used to implement treatment regimens aimed at protecting the fetus, for such actions violate the pregnant woman’s autonomy.
I was asked to speak in May of this year at an action staged outside of ACOG’s annual conference in San Francisco. What I chose to speak about was exactly this Ethics Committee position statement. Because, at face-value, this position lends to a perception that obstetricians are true allies to women. And to be fair, physicians have been overwhelmingly supportive – some on the front lines, risking their very lives – in the struggle for safe and legal and accessible abortion. But, somehow there is a disconnect in the Obstetrics community in what autonomy looks like at the beginning of a pregnancy vs. what it looks like at term.
For those of us who have given birth in the U.S. Maternity care system – for the staggering number of us who would describe our births as traumatic – we know that ACOG’s position statement is in conflict with an overwhelming number of their member’s actions. The OB in the referenced lawsuit isn’t an anomaly. She is part of a paternalistic Obstetrics network that fancy themselves as baby-saving superheroes.
The Good of the Baby
Every minute of every day, multiple women in multiple places experience coercion and abuse at the hands of their care providers all in the name of the “good of the baby.” Somehow, when a woman finds herself, feet in the air, strapped to an L&D bed, the fight for her dignity and humanity and autonomy have been tossed in the biohazard bin to the left. This socially accepted culture of violence that permeates birth is ground so deeply into our psyches that even unwavering feminists use phrases like, “I was allowed” and “he let me” in the narrative of describing their births without even a flinch.
An obstetrician’s obligation begins and ends with the pregnant and birthing person, and there is no need for an obstetrician to “speak for the baby.” The person carrying that baby – the one birthing that baby – is the only person who could possibly hold the most investment in that child’s health and life. Blatant disregard for a woman’s autonomy during pregnancy and birth – and overt disregard of ACOG’s position on a woman’s authority – demonstrates a fetish with power and control.
It is no coincidence that the field of medicine most rife with force and abuse is one in which women are tied to the beds with cords and wires, told to lay back, spread their legs, and do as they are told. It is this very imagery of historical and present-day dominance over women that makes all people who suffer under this system, victims of this form of gender-based oppression and violence.
There is no “Shared Decision-Making”
Ally-ship and partnership language is becoming more and more a rally cry in the abortion rights fight. And it’s understandable. Considering the right-wing political interference in women’s health, the reaction of “decisions are between a woman and her doctor” is a seemingly logical retort. But, there is no “shared” decision making in women’s healthcare. Bodily autonomy means I decide. Shared decision assumes consensus, and we’ve seen what happens (and who loses) when there is not consensus.
What this story, and countless experiences of birthing people everywhere demonstrate is why ally-ship language with physicians or science and medicine has no place in the reproductive justice discourse. There is a severe disconnect between a woman’s right to choose during the beginning of her pregnancy and the erosion of that right as a pregnancy progresses. Both the medical community and the reproductive justice movement need to start recognizing the inconsistencies in the ways that we discuss autonomy on all ends of the spectrum. Our autonomy is not based on science or medicine or physiology; autonomy is based on a right to make fundamental choices about our bodies.