Twenty women are suing Texas (Zurawski v. State of Texas) after being denied needed abortions. While each case is horrific (limbs turning black, double sepsis infection, etc.), one woman's experience has continued to haunt me because of the overt obstetric violence she was forced to endure.
Obstetric violence “refers to harm inflicted during or in relation to pregnancy, childbearing, and the post-partum period. Such violence can be both interpersonal and structural, arising from the actions of health-care providers and also from broader political and economic arrangements.” [1] “Obstetric violence is a specific type of violation of women’s rights, including the rights to equality, freedom from discrimination, information, integrity, health, and reproductive autonomy,” [2] and “can be manifested through: the denial of treatment, the disregard of a woman’s needs and pain, verbal humiliations, invasive practices, physical violence, unnecessary use of medication, forced medical intervention,” and more. [3]
One of the most common forms of obstetric violence is forced cesarean section [4] - a highly invasive, major abdominal surgery that puts the pregnant patient at increased danger of morbidity and mortality both during and following the procedure. [5] While cesarean section can be life-saving, the procedure should never be performed unnecessarily, because of the risk involved. [6]
Below is a brief description of what Kylie Beaton, one of the women suing Texas, experienced this year due to Texas’s inhumane abortion ban.
After undergoing several fertility treatments, Kylie Beaton (see pgs. 23-27 of the lawsuit) and her husband were thrilled to learn she was pregnant. That joy turned to heartbreak when, at twenty weeks gestation, the couple learned that their son, who they had named Grant, was “diagnosed the baby with alobar holoprosencephaly, a condition in which the brain does not develop into two hemispheres as it normally would, and the major structures of the brain remain fused in the middle.” [7] The condition also causes the Fetal head to grow abnormally large.
A Maternal Fetal Medicine “specialist confirmed the diagnosis and explained that the baby would likely only survive for several days or weeks past birth, if at all.” [8]
Before Texas’s abortion ban, Kylie’s “doctors would have been able to perform a D&E or an induction abortion before the baby’s head got too big, but that was no longer legally possible.” [9]
There were only a handful of out-of-state abortion clinics that could provide Kylie with care due to Grant’s large head, and Kylie and her husband could not afford the $10,000 cost of the procedure. Kylie had no choice but to continue her pregnancy. “In the meantime, the baby’s head would continue to be abnormally large for its gestational age.” [10]
At her twenty-eight week ultrasound, Kylie learned that Grant’s head was so large (measuring at 39 weeks gestation) that “this would be the last point at which she would be able to deliver vaginally.” [11] Kylie “begged the doctors to induce her.” [12] “Her specialist called other doctors to make sure there was nothing more they could do. But her specialist was told that her baby’s large head size alone was not enough of a reason to justify an induction abortion under Texas law.” [13] Even though Kylie would, after this point, be physically incapable of delivering her son, no one would induce her.
Instead, Kylie would be forced to undergo a cesarean section - against her will - further into gestation.
At thirty-five weeks, Kylie was in excruciating pain due to the size of Grant’s head. “Kylie’s OB/GYN performed the cesarean surgery, making a larger incision than normal to accommodate the baby’s head.” [14] While the average newborn’s head is 35 cm, Grant’s head measured 49 cm in circumference. To put this in greater perspective, the CDC lists the average head circumference of 28.5 months old children at 49 cm. [15] Yet this was the size of Grant’s head at the time he was born, at just 35 weeks gestational age.
Grant spent the next few days in unceasing discomfort (due to the pressure on his head) until he slowly passed away.
Texas didn't just mandate that Kylie remain pregnant; it mandated she be cut upon on an operating room slab. It forced her to endure surgery. Texas law thus translated into state-mandated obstetric violence.
Two of the key tenets of a patient's rights are (1) the right to refuse medical intervention and (2) informed consent. “If the individual has no real choice, consent is not freely given and it will be invalid.” [16] Kylie was denied the option to deliver her son while she was still physically able to do so. Hence, she was given no other choice but to undergo a cesarean section. As such, her consent to the cessation section should be considered invalid.
Kylie’s experience offers important insights into the reverberations of the Dobbs decision. As a recent academic article elucidates:
“The loss of the federally protected constitutional right to an abortion is a threat to the… autonomy of pregnant people, and may augur future challenges to their right to refuse unwanted obstetric interventions… In Dobbs v. Jackson Women’s Health Organization, the Supreme Court found that the right to liberty espoused in the Constitution does not extend to a pregnant person’s right to an abortion. With Roe’s demise, the right to request specific types of care has been vitiated. The same argument underpinning that holding may now become ballast for attacks on the traditionally more robust right, the right to refuse.” [17]
Kylie was literally forced to carry a fetus that she could not physically deliver, a fetus who had no chance of sustained life. Her bodily integrity, her health and wellbeing, and her autonomy were sacrificed with the cut of a knife as her abdomen was sliced open, a sacrament in the Texas legislature's Church of Forced Gestation.
If Kylie’s experience of obstetric violence and forced surgery proves illustrative of future treatment of obstetrics patients in the Dobbs era, we should all be very, very concerned.
Citations
[1] O’Brien, E., & Rich, M. (2022b, July 11). Obstetric violence in historical perspective - the lancet. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01022-4/fulltext
[2] May 28. (n.d.). Obstetric violence. May 28 . http://www.may28.org/obstetric-violence/
[3] Ibid. 2
[4] TM;, P. (2017). Legal briefing: Unwanted cesareans and obstetric violence. The Journal of clinical ethics. https://pubmed.ncbi.nlm.nih.gov/28614080/
[5] Morris, T., & Robinson, J. H. (2017). Forced and Coerced Cesarean Sections in the United States. Contexts, 16(2), 24-29. https://doi.org/10.1177/1536504217714259
[6] Haelle, T. (2018, May 10). Your biggest C-section risk may be your hospital. Consumer Reports. https://www.consumerreports.org/c-section/biggest-c-section-risk-may-be-your-hospital/
[7] Zurawski v. State of Texas. P. 24. https://reproductiverights.org/wp-content/uploads/2023/11/Second-Amended-Verified-Petition.pdf
[8] Ibid. 7
[9] Ibid. 7
[10] Ibid. 7
[11] Ibid. 7, p. 25
[12] Ibid. 7, p. 25
[13] Ibid. 7, p. 25
[14] Ibid. 7, p. 26
[15] Centers for Disease Control and Prevention. (2001, August 23). Growth charts - data table of infant head circumference-for-age charts. Centers for Disease Control and Prevention. https://www.cdc.gov/growthcharts/html_charts/hcageinf.htm
[16] What is valid consent?. ICO. (n.d.). https://ico.org.uk/for-organisations/uk-gdpr-guidance-and-resources/lawful-basis/consent/what-is-valid-consent/#:~:text=If%20the%20individual%20has%20no,consent%20easily%20at%20any%20time
[17] Marshall, M. F., Minkoff, H., & Villikanti, R. U. (2023, October 13). The two front war on reproductive rights—when the right to abortion is ... Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.1080/15265161.2023.2262960