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Jul212009

Refusal of Unnecesarean Leads to Loss of Custody: V's Story

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On April 16, 2006, V and B, a married couple, went to Saint Barnabas Hospital after V began experiencing contractions. V is described in court documents as a 42 year old, college educated woman who was thirty-five weeks pregnant and in labor upon arrival at St. Barnabas Hospital in New Jersey, which boasts a 49.3 percent cesarean rate. V signed the consent form for the administration of intravenous fluids, antibiotics, oxygen, fetal heart rate monitoring, an episiotomy and an epidural anesthetic. However, she refused to the blanket consent forms for c-section or fetal scalp stimulation. According to the court documents, hospital personnel explained the “potentially dire consequences of not allowing a c-section in the event of fetal distress.”

 

In the hospital records, V is described as “combative,” “uncooperative,” “erratic,” “noncompliant,” “irrational” and “inappropriate” while in labor. V requested that the obstetrician leave the room and called the Livingston Police to report that she was being abused and denied treatment. She exercised the right to refuse to wear an oxygen mask, would not consent to fetal heart rate monitoring and “thrashed about to the extent that it was unsafe for the anesthesiologist to administer an epidural,” but records do not indicate whether or not she had requested an epidural. While yelling loudly, she exercised the right to refuse a bedside ultrasound.

 

Dr. Mansuria, the obstetrician, explained the possible complications that could occur if the fetus went into distress and a c-section was not performed, such as brain damage, mental retardation and fetal death. Mansuria claimed that “an examination” revealed a nonreassuring fetal status. B said that he understood the risks and V would not consent to the procedure.

 

The legal findings show that the “hospital responded appropriately to confront V’s mental state and her refusal to consent to the c-section.” The staff requested an emergency psychiatric evaluation to determine V.’s competency. Dr. Devendra Kurani spoke to V for approximately one hour and while Kurani was there, the anesthesiologist was able to administer an epidural. V informed Kurani that she had a “psychiatric history” and had been on medication prior to getting pregnant. B confirmed that V had been treated by a psychiatrist for post-traumatic stress disorder and had been prescribed Zoloft, Prozac and Seroquel.

 

Dr. Kurani concluded that although V was anxious, she was not psychotic and had the capacity for informed consent with regard to the c-section. The staff called in a second psychiatric evaluation from a Dr. Jacoby. Before the second psychiatrist was able to complete the examination, V gave birth vaginally to J without incident in spite of Dr. Mansuria’s repeated claims that V’s baby was in distress and could suffer brain damage, mental retardation or fetal death without the recommended cesarean.

 

A social worker at Saint Barnabas Hospital contacted the Division of Youth and Family Services on April 18, 2006, two days after J’s birth to report concerns over releasing the baby to her parents’ care. Caseworker Heather Frommer went to the hospital, interviewed staff and spoke to V and B, who denied that V “had ever received psychiatric treatment, had ever refused to consent to a c-section or had ever been evaluated by a hospital psychiatrist.”

 

Frommer was told by Dr. Kurani that he prescribed had Zyprexia for V (while in labor) but she refused to take it and that V “distorts everything that is told to her.” His interactions with V were while she was in labor.

 

Frommer told the parents that once J was medically cleared for discharge, she would not be going home with them. V became upset, started yelling and called the police. Frommer told B and V that there would be a court hearing on the matter on April 20, 2006, then V was discharged from the hospital.

 

Later that day, Frommer went to the parents’ apartment to complete a home assessment and reminded V.M. and B.G. about the court hearing on April 20, 2006. She called on the morning of the hearing to remind the couple of the hearing and B denied that he knew Frommer. They did not show up to the hearing and J was discharged from the hospital on April 24, 2006, and placed in foster care.

 

At another hearing on May 9, 2006, V’s PTSD and psychiatric history was discussed with the trial judge, who directed V to release her psychiatric records to DYFS, and if they confirmed what she said, J would be returned to her. V’s previous psychiatrist had diagnosed her V as suffering from post-traumatic stress, panic disorder and major depression as a result from being forced to participate in a boxing match at work in 1993. Notes showed concern that V had not made progress and was demonstrating paranoia and psychotic ideations.

 

According to the court documents, V offered the judge “information that proved to be in significant conflict with the hospital records,” stating that she signed the consent form as soon as she arrived at the hospital and “even though she was in extreme pain, it took the anesthesiologist several hours before administering an epidural. The first time he tried, the nurses were pushing her back and forth so violently that he could not administer the injection.” Dr. Kurani was called at V’s request to “deal with the inappropriate behavior of the nursing staff.”

 

V stated that she had been prescribed medicine prior to pregnancy for panic attacks, which she didn’t take due to side effects. She also said that she did not learn of DYFS’s involvement in the case until April 21 and that she never received notice of the court proceeding on April 20.

 

With regards to the issue of whether J was in imminent danger in the first 48 to 72 hours of life, the trial judge stated that “a series of events transpired in the hospital that were alarming and that might have caused a reasonable person to believe the child was in danger.” He did not base his decision that J was in imminent danger in the hospital solely on the refusal of a cesarean. The findings state that “he observed that there were probably many instances where a mother’s refusal to accept a c-section would not constitute abuse.”

 

The judge reviewed the medical records of V’s erratic behavior and commented that V.M. appeared to care about having a healthy baby, yet found that she was “negligent” in not acceding to the doctors’ requests and found that J was an abused or neglected child. The judge rejected B as a custodial parent because B allegedly did not comply with DYFS and agreed that J would be returned to B under the condition that B:

  1. receives a psychological evaluation within the next week

  2. the evaluator concludes that the child would be in no danger with B

  3. the child’s mother is not in the home

  4. a mechanism is in place for monitoring V’s visits.

 

B and V refused these conditions and the judge expressed frustration on September 15, 2006, observing that he “wanted desperately to reunify this family,” but the parents were “snatching defeat from the jaws of victory.” He asked if V would waive her right to sue psychiatrists so that the psychatirst would not be concerned that they would be sued if they undertook the evaluation. V said she would not waive that right.

 

At the March 19, 2007 permanency hearing, J’s foster mother stated that V and B visited J once every two weeks and always brought shopping bags full of supplies for the baby.

 

Dr. Vivian Chern Shnaidman performed a psychiatric evaluation of V and B for DYFS and noted that “despite V’s high level of intelligence and education, she was not able to comprehend her situation.” She diagnosed V with chronic paranoid schizophrenia and B with “folie à deux, a rare condition in which one person subscribes to the psychoses and paranoid delusions of another.” According to Shnaidman, V and B function in a very “paranoid and secretive way, with each person’s paranoia supporting the other’s.” She noted that J would be in danger in their care, as they are unpredictable and “want nothing to do with the world that we live in.”

 

V and B countered with the expert opinion of Dr. Marc Cantillon, who stated that B was anxious and distraught over DYFS’s removal of his daughter, but he had no mental disorder of any kind. He concluded that B and V would be suitable parents. Cantillon opined that V’s “bizarre” behavior at the hospital could have been caused by oxygen deprivation and that she expressed a willingness to obtain ongoing psychiatric care.

 

The trial judge stated: “I don’t think I’ve ever seen a case of mental disorder where the diagnoses … [were] so diametrically opposed. We’re in different worlds.” Observing that Dr. Shnaidman’s wording in advising against reunification was the strongest language he had ever seen in this type of case, the judge sought an impartial third party opinon, then entered an order on March 19, 2007, reflecting his findings that the couple would not get custody of their child.

 

Defendants V and her husband, B appealed this judgment. On July 16, 2009, the appellate court offered that did not concur with the previous ruling that V’s refusal to consent to a cesarean section can, as a matter of law, be considered abuse and neglect, but found that there was “substantial additional evidence of abuse and neglect that supported the ultimate findings.”

 

It all started with exercising the right to not sign St. Barnabas Hospital’s blanket cesarean consent form, which caused staff to question V’s competence. Things escalated when V refused an oxygen mask, electronic fetal monitoring and a (proven) unnecessary cesarean.

 

According to the author of the ICAN of Somerset County, NJ blog who has spoken with V since the findings were released, “…the custodial issue only came up because she delivered at St Barnabas and they wanted the freedom to do a c-section at will.”

She sat in on the proceedings and heard the judge tell V in one of her hearings that he felt she would be “too argumentative and that would wind up hurting her child. For instance, she would argue with teachers and receptionists at the dentist office.”

In her opinion, the undue burden of repeatedly trying to disrupt and stop V’s birth process while she was in the throes of labor would be enough to make someone paranoid and distrusting.

They call V paranoid and claim there is something wrong with her. I think I’d be paranoid too if someone took my baby away from me. Physically and emotionally, that has to take an incredible toll on a woman who is not expecting that. V wishes the doctors had told they didn’t believe she was fit to be a mother so she could have made arrangements to have her child cared for by someone she knew. V is being told that doctors can decide which people are fit to be parents.

This is a tough case. It was all instigated over a cesarean that was not ultimately needed. How much time and money are being invested into keeping V’s child away from her rather than trying to work with her and help her learn whatever parenting skills they feel she needs?

 

Read the appellate court’s findings here.

 

Related Posts:

Superior Court of New Jersey Terminates Cesarean-Refusing Mom’s Parental Rights (July 20, 2009)

New Jersey Cesarean Refusal Case: The “System” is Schizophrenic (July 23, 2009)

St. Barnabas Medical Center’s Cesarean Rate is 49.3 Percent (July 29, 2009) 

Anonymous Comments about New Jersey Cesarean Refusal Case (July 30, 2009)

 

 

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Reader Comments (46)

I am concerned here for a number of reasons.

1) I don't see any significant reason to take the child away. I get the she may (or may not) have a psychotic illness, and not been entirely cooperative. However, I didn't read about a demonstrated or potential harm to JMG. There are a lot of people who raise their children while also having a psychotic illness. I'm very disturbed that the first reaction was to take away the child and not get some help for this family.

2) For them stating that the section refusal had no bearing, they should spent a hell of a lot of time explaining how it was a bad sign for her, and irrelevant for him (because he didn't have the ability to anyhow).

It seems like a very tough case, and it's very possible that the mother is unfit, but I don't see justification here. I think that the trend to quiet, epidural-ed, sectioned, induced, etc., birth has maybe led to people thinking of birth as something different than it is. Yes, she's a woman birthing, and she may be uncooperative or irrational (from the views of others).

Hmm. I need to think more about this as well.

July 21, 2009 | Unregistered CommenterTara

Dou-la-la, my reason for jumping on this and publicizing it was to have as much of the rest of the story online as possible.

July 21, 2009 | Unregistered CommenterJill--Unnecesarean

Thanks for summarizing the case so nicely, Jill. It is another appallling set-back for pregnant women's civil rights! I also just wrote a blog-piece on this - should be appearing soon on Huffington Post.

July 21, 2009 | Unregistered CommenterLouise

I heard about this woman a couple months ago. I prayed it wasn't true, but I knew deep down it was.

I would love the hear the entire story first hand, since the media and other places twist things around so much.

Refusing treatment is not a valid reason to take a child away from its mother. Especially if the treatments were completely unnecessary and would actually cause more harm than good.

I so hope that this doesn't become a precedent because it went to court. Taking away children because their parents are actually making the best choices for them is just wrong.

July 21, 2009 | Unregistered CommenterKayce

It is no wonder that the U.S. has one of the worst infant and maternal mortality rates in developed countries. In many European countries national health insurance covers homebirths as well as hospital birth and the rates of intervention are much less (as unnecissary interventions do not get the hospital or doctors higher pay-in fact costs them more.) It's alarming that her instability is proved in other 'unstable and irratic' behaviour above refusing consent to a c-section in refusing efm and an oxygen mask (I and millions of women gave birth fine without them.) If anything, efm has proven to raise the rates of c-sec and intervention with no improved outcome to mother and baby. It's frightening that American Ob's wield such immense political power and a court can decide to remove custody of a child from parents based on the medical model of 'normal' patient (subservient) behaviour and conclusions that if applied to the public would remove thousands, if not millions, of children from custody of their parents. How she could be mistreated at hospital, have her infant taken away for not complying, suffering or having suffered from ptsd from child-abuse (as well as this occasion) and having to defend herself from accusations of psychiatric disorders-how is anyone surprised that she would commit defensive-lying. It's like attempting to strike someone but being surprised at him holding up his hands to protect himself. Noone would have sent this woman to psychiatric evaluation had she chosen an elective cesarean.

July 22, 2009 | Unregistered CommenterLeah

Jill,

I think you are confusing a bit here between where the appellate court is quoting the lower (family) court, and the actual appellate court ruling.

My reading of the decision is that the appellate court specifically states that a woman can not be charged with child abuse based on her decisions in labor or pregnancy--even decisions like illegal drug use.

Of course then toward the tail end of the decision the judge does then use some of VM's decisions in labor as support of her *potential* to be abusive. Which is infuriating.

July 22, 2009 | Unregistered CommenterJenn

Hi Jenn, the difference between the two rulings is pretty clear. VM never went home with her baby, though, which means what started the chain of events that led to her competence as a parent being questioned was refusing the cesarean and acting "uncooperative", etc. in labor and at the hospital. Even though the appellate court found it unlawful to use the refusal of the cesarean as evidence of abuse and neglect, her mental health would have never been an issue had she not refused to sign the blanket cesarean consent form in the first place.

The question left in my mind is how much of her paranoid diagnosis can be attributed to having her rights violated in the hospital, then have "the authorities" take her baby away, then having a decade worth of past psych records used to judge her even though a psychiatrist found her to be "cured" and no longer in need of treatment in 2005.

Thanks for your comment. :)

July 22, 2009 | Registered CommenterJill

Her paranoid pschizophrenia diagnosis was originally made before the birth--perhaps even prior to her pregnancy.

I do agree that her treatment during labor was--to quote the hospital--"inappropriate." It sounds like the hospital staff employed some pretty strong bullying tactics. But I do question things that went on AFTER the birth...and whether they truly indicating that this just highlighted a case where the parents really weren't fit?

July 22, 2009 | Unregistered CommenterJenn

Huffington Post has weighed in with much brilliance:

http://www.huffingtonpost.com/louise-marie-roth/is-a-woman-in-labor-a-per_b_242307.html

July 23, 2009 | Unregistered CommenterDou-la-la

Jenn, unless I missed it, the diagnosis of paranoid schizophrenia came in 2007 from Dr. Shnaidman. Prior to birth, Dr. Seltzer noted tendencies:

"As the years went by and V.M. made no progress in coping with the 1993 workplace incident, Seltzer’s notes increasingly discussed V.M.’s paranoia and psychotic ideations. "

And remember:

"Seltzer diagnosed her as suffering from post-traumatic stress disorder, depression and panic; but in 2005, a psychiatrist working for the State of New York Worker’s Compensation Board told her that she was cured and no longer needed treatment."

So, let's say (hypothetically) that prior to pregnancy, a woman is abused and struggles with mental health issues. She seeks psychiatric care. She exercises her own free will along the way regarding what medication she puts into her body and then, before pregnancy, gets an official diagnosis that she is cured.

She acted in the best interest of her personal health, no? She was "cured", no? Should anything prior to pregnancy have any bearing on the case?

You wrote: "But I do question things that went on AFTER the birth...and whether they truly indicating that this just highlighted a case where the parents really weren't fit?"

Of course, this is all just speculative since none of us were actually there, but what I'm understanding that you are saying is that how she acted in her two and half days at St. Barnabas might have just highlighted that they were already unfit parents to start with. Or by "after," do you mean after she left the hospital?

July 23, 2009 | Unregistered CommenterJill--Unnecesarean
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