Courts can't force women to undergo C-sections, judge rules
Published 03/11/2016 | 02:30
A High Court judge refused to grant the HSE orders forcing a pregnant woman to have a caesarean section against her will so as to vindicate the right to life of her unborn child, it has emerged.
While he could not see why the woman would choose to take on an "unnecessary" risk of injury or death to herself or her child, it was a "step too far" to order a forced C-section, even if that decreased the risk to both mother and child, Mr Justice Michael Twomey ruled.
The increased risk to her unborn child did not justify the court effectively authorising her to "have her uterus opened against her will", he said. That would constitute a "grievous assault" to a woman who was not pregnant, he noted.
The HSE sought the order after doctors said that if the woman's fourth child was delivered naturally after her three previous C-section deliveries, there was a risk her uterus would rupture, posing risks to the life and health of herself and her baby. A natural birth in such circumstances was "unheard of" here, the court was told.
The woman believed seeking a natural labour would expose her to a 3pc risk of uterine rupture and the risk of uterine rupture from an elective C-section was between 0pc to 1pc. The obstetric evidence assessed the risk from a trial of labour could be higher but that was only a guess, as a natural delivery had never happened in an Irish hospital after three C-sections, the judge noted.
The day after the emergency court hearing, held in private last month and believed to be the first of its kind here, the woman agreed to a C-section after her waters broke. Her child was born healthy.
The unborn was separately represented at the hearing. The child's father was not represented.
In his judgment, the judge said this was a case heard in great haste involving a woman then 40 weeks' pregnant whose baby was due the previous day.
A "crucial factor" was her three other children were all born by C-section. The evidence was natural delivery after C-section carries a risk of uterine rupture. Her obstetrician had said he could not oversee a natural delivery in the circumstances and no hospital here was willing to supervise natural delivery of a baby after three C-sections.
The medical advice was she should have an elective C-section rather than attempt a natural delivery. She was also advised opting for a natural delivery after three sections could require an emergency C-section, carrying "greater risks" to the health and lives of mother and unborn.
The judge noted evidence of a one-in-150 chance of uterine rupture during a natural birth after one C-section delivery and a one-in-50 chance of uterine rupture after two previous C-sections.
The court's right to intervene in a parent's decision in relation to an unborn child is no greater than the right to intervene in relation to born children, he said. The woman has no psychiatric condition and the HSE had not shown she did not have the necessary capacity to decide on medical treatment, he held.