Saturday, January 16, 2010

Pregnant Woman Fights Court Ordered Bed Rest

***Helen added a link in the comments which I am posting here. It is a later article written about the case and goes into much more detail.***


http://abcnews.go.com/Health/florida-court-orders-pregnant-woman-bed-rest-medical/story?id=9561460&page=1

I first saw this story on a support group but have since seen it popping up all over the internet. I found it to be quite appropriate for discussion here since there have been many times when comments have been posted about how we should treat women/pregnancies where prematurity (or the threat of prematurity) is involved...

Personally I do NOT agree with what was done to this woman and reading the article brought back horrible memories of when I was admitted to the hospital 11 years ago. My husband and I were sat down and told that once I entered into the hospital at 23.2 weeks (it was the 2nd hospital that I was taken to. The first hospital didn't have a level 3 NICU) that the health of our baby took precedence over everything else and I would not be allowed to leave until I delivered our child. I wasn't even allowed to leave my room unless accompanied by a nurse. I had to beg the doctor to allow my husband to push me outside to get some fresh air and that was only allowed once (after 2 weeks of being in one room). Even though I felt trapped (overwhelmed, scared, angry, sad, depressed, etc) I was willing to stay. But I can't even imagine what it would be like had I really wanted to leave and was legally stopped from doing so.

27 comments:

sce said...

On a theoretical level I agree that woman should be able to make their own health care decisions, but on an emotional level, I am stuck on how she didn't want to give up smoking.

The article I read (could not access yours) said she "miscarried". Any pg ending at 25 weeks, which I understood to be the baby's gestational age is not a miscarriage, by definition, but aside from that we have a woman who refused to give up smoking wanting to go home, where it was more difficult to treat and monitor her.

Maybe she does have the right to make her own decisions, but I also have the right to be pissed off at her for not wanting to be doing everything she could to bring the baby to a safer gestational age. On the other hand, it sounds like the forced medical care was not effective, and it is my understanding that there is no real proof bedrest is effective in starving off PTL.

Without knowing all the facts, I WOULD say that if she was refusing to give up smoking, and refusing evidence based, potentially life saving care for her baby, all because she didn't want to be away from her family and stop smoking, she may not be a criminal in the eyes of the law, she is officially a "bad mom" in my book. And it makes me care less that her rights are being violated. On the other hand, if her reasoning was, well they are not really doing anything I couldn't do at home, and there is no evidence to suggest that their treatment will substantially increase my chances of a better outcome, and their treatment of me is degrading, then I am more understanding.

Helen Harrison said...

From the Cochrane Center's review of the evidence on bedrest for preventing preterm birth:




"No evidence to support or refute bed rest in preventing preterm birth.

Although bed rest in hospital or at home is widely used as the first step of treatment, this review finds no evidence to support or refute bed rest in preventing preterm birth. The current practice has been based on observational studies that found an association between hard work or hard physical activity and preterm birth. Due to the potential adverse effects that bed rest could have on women and their families, and the increased costs for the healthcare system, systematic advice of bed rest for preventing preterm birth should not be given to pregnant women."

Anonymous said...

I think this is horrifying. Women should not lose the right to accept or decline medical treatment just because they are pregnant.

FWIW, the article says she was having trouble quitting smoking, not that she didn't want to. Lots of people are addicted to tobacco and can't stop. It is more addictive than cocaine (though legal).

Either way, she is an adult doing NOTHING illegal. My Mom smoked with me and my siblings, and yes that is not ideal. But should she have been locked up to stop it? What's next--the caffeine police arresting pregnant women for having a coffee?

--jd

liz.mccarthy said...

Just personally REALLY bothered that the article called a 25 week pregnancy loss a "miscarriage"

Not sure how I feel on the court order....

Helen Harrison said...

There are so many ways we can react emotionally to the word "miscarriage," but let's just deconstruct the word itself.

"Mis" (something has gone awry) with a "carriage" (or pregnancy). I don't understand why this is such an insulting characterization of what has happened to all of us who are mothers of preemies.

As many of you know, I have no problem referring my son's preterm birth using these terms.

Many MDs and scientists,still use "miscarriage" to describe a birth (resulting in death) before term. ( I just clipped and filed an article in which MDs referred to any untimely delivery resulting in loss as a miscarriage up until term. I will try to retrieve the article from my files, if time permits, so you can write outraged letters to the editor of whatever journal it was.)

I'm currently dealing with some major, recurrent, life-threatening complications (all prematurity related) in my resuscitated child, who would otherwise have been a miscarriage in 1975.

I hate to put it in these terms, but this is what "personally" really bothers me: Sometimes the resolution of a miscarriage can take many, many cruel years.

Anne, Eliza Grace's mom said...

The term "miscarriage" has most certainly evolved over the years. My mother had three "miscarriages" at 33, 35, and 36 weeks. Of course this was in the late 1950's so science was not what it is today, but that is how those deaths are recorded.

Helen Harrison said...

To Anne:

You are so right! And please note, that even in the '50s these gestational ages were not uniformly (or even mostly) non-viable.

ThePreemie Experiment said...

During my 2 day stay at the first hospital, when my water broke at 23.0 weeks, every person who came into my room used the word miscarriage. At the 2nd hospital, the docs referred to my situation many ways but most of all they said that they were trying to stop me from miscarrying.

Someone, off list/blog, mentioned to me that something must have gone wrong for the baby to die at 25 weeks. But the truth is that not 100% of the babies born at 25 weeks live. The majority do, yes this is true, but not all. And, I can only imagine the amount of stress that mom was under and what role that stress played in this case.

Also, in case anyone is wondering... the comments that have been removed are spam not legitimate comments.

medrecgal said...

I'm all for doing whatever you can to continue a pregnancy and increase the chances of a healthy outcome for both parties, but this seems a bit over the top even for me. I think it was the "court-ordered" that got me. And when evidence is limited that bed rest helps, it does make you wonder what their authority to do this is coming from.

I think that she does suffer from poor judgment, however; while I can understand not wanting to be stuck in some hospital away from your family for an extended time, her apparent lack of concern for the baby she's carrying is appalling on some gut level. Perhaps it's because I had a mother who was completely the opposite of that and tried very hard both during and after her pregnancy with me to make sure I'd survive somehow.

Southern Crazy said...

medrecgal said,
" her apparent lack of concern for the baby she's carrying is appalling on some gut level."
I think you are making interferences on how this woman feels about her baby that we are not privy too. All because she doesn’t agree with bed rest doesn’t mean she doesn’t have concern for her baby. She does have two other children at home that need a mother. What if she has some feeling that something is “wrong” with this pregnancy? Maybe she doesn’t want to have a micro preemie and realizes the hospital will save at all costs. Isn’t this what we constantly debate here all the time?
-Tammy

Anonymous said...

This case is just another example of an individual’s rights being disregarded by people who think they know better or for the rights of the unborn. We give rights to the unborn by taking away the rights of the living. Something is clearly askew here.

medrecgal said...

That's why I said "apparent"; of course you can't step into someone's head and figure out the rationale behind their actions (or lack of, as the case may be). But the way it's written, it makes her look like the baby is her LAST consideration in the entire situation; IF that's the case (and that is a big "if", because as you said, we are not privy to her thoughts directly), then I stand by my belief that something doesn't feel right about that.

I'm not necessarily suggesting that what the court did is right, because as I said previously there's no guarantee that it will result in a better outcome for either of them; but the notion of a mere sense of something "wrong" is heading into questionable territory. There is no evidence presented that this is the case, and I'm not suggesting that either of them is more valuable than the other; what I'm suggesting is that it's her choices that are wrong, like continuing to smoke and completely ignoring medical advice (which could be detrimental to both her and the baby). They would be wrong whether she was pregnant or not.

Kate K. said...

In my opinion, when one becomes pregnant, one's body is simply not *just* one's own. One has an obligation to the other.

Also, has anyone ever met and/or been a pregnant woman who was emotionally volatile at times? Have you ever met a person who, because of hormonal imbalances, wasn't making sound decisions? I certainly have. And I wonder if in some cases, a woman isn't the best judge of what is *best* for her and her baby.

On the other hand, I have been at times very, very skeptical about the medical field. I don't think that many doctors stay up on literature like they should. I also don't think that they review their patients' files as well as they should...generally speaking of course. I know that there are some good doctors out there. Before a court orders a person to "follow doctors orders," I wonder how many medical opinions should be involved.

I don't know enough about the bedrest literature to know whether or not that's an effective approach. I know that I wish that I'd had that opportunity to go on bedrest (but didn't, thanks to an incompetent OB).

I do think that there should be severe consequences for women who pollute a baby's environment with tobacco and/or drugs. Let me contextualize this by adding that I'm a foster parent and know of a lot of situations where the bio parents have caused permanent harm to their children. And frankly, the world would be better off if the bio parents were sterilized. I realize that's a politically incorrect thing to say, but I'm tired of people being allowed to not only create lives that they have no intention of nuturing, but to act in ways that have significant and negative consequencs for their offspring. Another comment to add fuel to the discussion fire!

Thanks, Stacy, as always for a dynamic topic for debate!

Anonymous said...

I sympathize with Kate K's perspective, but respectfully, I have to disagree about punishing women who drink or smoke while pregnant. I think we should give people the best information available and let them make their own decisions. If all goes well, within 9 months a pregnant woman is going to become a mother who will continue to make life-altering (and potentially harmful) decisions for her child. Where does punishing someone for making a bad (but legal) decision end?

Should women over age 35 be prevented from having kids because the risk of birth defects is higher? Do we prevent people who live in polluted or industrial areas from having kids because they are more likely to have asthma and other health issues? Should we prevent women in crime-ridden neighborhood from getting pregnant because their kids could become crime victims (or criminals themselves)? Should farmers be prevented from raising kids because statistically kids on farms have more accidents? Do we put surveillance cameras in people's homes to make sure they are feeding their kids a healthy diet?

Most pregnant women want what is best for their fetuses, but that must be balanced by what is best for their families (which is a decision only they can make). I can easily see why someone with 2 kids would refuse bed rest, especially since it isn't proven to do anything. Sometimes people can't or won't make the medically recommended decision, but docs aren't gods. They don't know everything. At best, they just know a lot of statistics.

A friend of mine was really conflicted about having a baby at age 35 due to the risk of Down syndrome (chance about 1 in 250 to 300). I reminded her that a women with her tubes tied has a 1 in 300 chance of getting pregnant, yet we consider that permanent sterilization! If you are the 1, it doesn't matter if the chance was 1 in 2 or 1 in 200 or 1 in 2 million. All medical decisions are really about playing the odds. Some people just balance risk differently. I really feel strongly that a pregnant woman shouldn't give up her autonomy as a person just because she is pregnant.

Kristie said...

First off, I'll agree that the way the story is written, the whole court order seems totally absurd. Perhaps this was all just a huge hospital power trip. There's a lot we don't know though, like the mom's overall mental state and ability to communicate that she understood the consequences of not following whatever medical advice they were giving.

Also, we don't know what other interventions were going on aside from just lying in bed. Were their genuine concerns about fetal distress, was she requiring IV meds, was her BP all over the place, etc...? We can't be sure from the info we have that the care they wanted to provide was medically unwarranted.

Oh, and sce is right. Technically a miscarriage is medically defined as the loss of a pregnancy before the 20th week.

sce said...

I realize I am prolonging this miscarriage discussion longer than I should, but where I personally cringe, is when someone refers to my "miscarriage" or more commonly among my care givers my "pregnancy loss" instead of referring to my CHILD. Miscarriage used as a noun in place of a baby is annoying to me. My child was a person, not a "pregnancy gone awry". I think most moms would like to hear "your daughter" or "insert child's name here" instead of "your miscarriage" or "your pregnancy loss". I did not lose my pregnancy. I delivered, (by c-section) with an unfortunate outcome.

But pulling the conversation away from myself (which I should have done several sentences ago) do you notice how in the situation at hand "miscarriage" was used to gloss over what happened. Was the baby stillborn? Did they try to save the baby, and it lived for a short while? was there a decision made not to treat? None of my business, and we'll probably never know, and that's fine, but we have miscarriage instead of "preterm birth" and "the baby died". Just saying........

Kristie said...

sce -

I've only had a 1st trimester miscarriage, but it still felt awful cold when the doc doing my follow up kept referring to "the products of conception". My husband finally got pissed and yelled at her! I can only imagine how much more hurtful it would be for the mother of an extreme preemie, or a stillborn baby. Thanks for the reminder about how parents in that situation feel.

-Kristie

Heather V. said...

I don't agree with the court order to keep her in the hospital to monitor her closely. My daughter was born 2 months early. My doctor put me on bed rest at home for 3 weeks prior. I had home health coming in twice a day to monitor me. I think there are ways to monitor a pregnancy more closely without having to go to drastic measures of getting a court order.

ThePreemie Experiment said...

Kristie wrote: "Also, we don't know what other interventions were going on aside from just lying in bed. Were their genuine concerns about fetal distress, was she requiring IV meds, was her BP all over the place, etc...? We can't be sure from the info we have that the care they wanted to provide was medically unwarranted."

Kristie you have a very valid point... we don't know all of the facts. There could have been other instances that would have made me change my mind.

I also wanted to thank everyone for a wonderful discussion. I am a firm believer that the only way to truly learn is by hearing all sides.

Anonymous said...

From Laura

Let me start by saying that I've not read the article being discussed. I have no desire to read the article. I don't really trust the media as I know it's rather easy to slant an article based upon the author's beliefs.

My son is a smoker. He HATES it. He is just 21 and already has clubbed fingers. He has a history of airway growths that put him at a particularly high risk for cancer. He has tried to quit but has been unable to quit. Maybe this lady was unable to quit. Imagine the stress of being forced to stay in the hospital without family, unable to smoke. We have no idea about her health history. We have no idea if this was a planned pregnancy. Did she have anybody to care for the children she may have had at home?

There are instances in which I do believe in forced hospitalization. I don't like it and it kind of makes my skin crawl. I have a brother whose was at least the seventh child of an alcoholic birth mother. His life, because of that woman, was set up to fail. He grew up in a home without alcohol. He is now an alcoholic. He has fetal alcohol syndrome. I wish that someone had forced that woman to stay away from alcohol. At the age of three or four he took a sheet of paper and cut out a horse drawn chariot. He's never held anything more than a menial job.

I think that there are too many unknown variables to the case being discussed.

Helen Harrison said...

There is a story with more details at
www.msnbc.msn.com/id/35076853/ns/health-pregnancy/

The title of the article is: "Mom fights legal ruling that kept her in hospital." She has a lawyer and is being supported in her position by the ACLU. The issues her case raises and the precedents that may bear on it are also discussed.

ThePreemie Experiment said...

Thank you for posting the link Helen. I've added it to the main post. It's much more informative on the moms situation.

Sheila said...

I was horrified, but not shocked when I first read about this story when they were attempting to abridge this woman's rights. I hope the Florida Supreme Court hands this hospital, it's administrators and doctors their ass in a wringer. I was not however surprised given the number of preemie parents who've had their rights to ask for palliative care denied by profit drunk hospitals. It was only a matter of time before they're grubby little paws would extend to gestating "potential" revenue sources. It is patiently and totally ridiculous that a woman, who was NEVER stated to be mentally incapcitated or emotionally handicapped be denied the right to refuse care - any and ALL care.It doesn't matter if she wants to chain smoke and drink scotch every day, until they outlaw cigarettes and scotch, she isn't breaking any law. Whether any of us feel it is the "right" thing to do if you are pregnant is completely and totally beside the point. I am very glad the ACLU is working for the underlying rights violation. If hospitals in the 50's, 60's and 70's would have considered a move like this, they would have had to build entire hospital wings to house thousands of pregnant women. The mothers of my mothers generation, smoked, dyed their hair, had a cocktail with their husbands when he came home from work (and felt they deserved it if they'd spent a day cooking, cleaning, caring for a fleet of older children all while 28 weeks pregnant). We do not have the right to tell other parents what to do with their prematurely born child - and we don't have the right to tell a woman how to behave when she is pregnant. It's appropriate to allow scientifically vetted data regarding things which are risky to mother and their unborn fetuses to be readily available - but from putting the water in the trough, we must walk away.

Sheila said...

Stacy - sorry for the typos, spelling etc errors - trying to get a quick thought in between meetings.

Helen Harrison said...

Another link that may be of interest:

http://www.dailykos.com/storyonly/2010/1/27/830901/-Updated-For-Clarity:-Court-Orders-Pregnant-Woman-To-Bed-Rest

Anonymous said...

guys, the hospital would have been violating the standard of care had they NOT made her stay.. Her water had broken. That is a life threatening infection waiting to happen. I think they were right, the unborn child has a right in this conversation, especially as far along as she was. What sane parent wants to be up and around when their water is broken and being up and around could easily cause fetal demise.

Saying bedrest isnt proven is true, but we can all agree that once her water broke, all bets are off.

Anonymous said...

In regard to Kate K's comment about the sterilization of women that pollute the child's womb with alcohol and/or drugs..I simply can't agree with this.
Although it isn't ethical to smoke or take drugs while pregnant, what about doctors that prescribe their pregnant patient's pain medication that the child becomes addicted to? is that okay because someone with a degree says that it is?
Being a foster care worker, you should know that heredity plays a large role in how a child "grows up" so to speak. You can put a child in a foster home that was from a dysfunctional family to try to make them think a different way, but the bottom line is that they are a product of their environment. Children can end up becoming alcoholics etc. regardless of whether or not the mother drank while the child was in the womb if alcoholism runs in the family.