Cesarean Refusal – Ok, We’ll Take Your Baby

Ok, so I am taking another post from Unnecesarean’s blog… two actually.

3 years ago, a woman went to have her baby in a New Jersey. She was in labor, and when she got to the hospital she was to sign the consent forms for the procedures that might be used. She signed all but the cesarean form.

Here is what comes of you refusing treatment, as is your right…

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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 43.9 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,” “non-compliant,” “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 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 psychatrist 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 opinion, 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.

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The parental rights of a woman in New Jersey were recently terminated. The court findings can be found here in full, and a summary found here.

What I find most troubling about V’s situation are the diametrically opposed opinions of all of the so-called experts involved in the case. Reading the appellate court’s findings has given me a case of “folie à deux” and I am paranoid by proxy. I hereby use my B.A. in Psychology to diagnose myself with “folie à trois,” as diagnoses in this case are totally arbitrary, subjective and random.

V’s psychiatric history before pregnancy came into question.

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.

During labor, after having refused a cesarean and yelled at the hospital staff, V received not one, two psychiatric consults.

Although he acknowledged that V.M. was very anxious, Dr. Kurani concluded that V.M. was not psychotic and had the capacity for informed consent with regard to the c-section. At no time did anyone seek judicial intervention or the appointment of a special medical guardian.

After Dr. Kurani left, the staff requested a second psychiatric opinion from Dr. Jacob Jacoby. Before Dr. Jacoby’s evaluation was completed, V.M. gave birth vaginally to J.M.G. without incident.

V said her baby was fine and that she didn’t need a cesarean. Dr. Shetal Mansuria told her repeatedly that she needed her baby cut out from her uterus because it was in danger, but her baby was most definitely not in danger and V was correct.

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

The trial judge said the hospital reacted appropriately to V’s “extreme” behavior and was therefore justified in not sending her home with her baby after how she behaved in the labor and in the immediate two days postpartum while still in the hospital.

The judge identified the issue before him as whether J.M.G. was in imminent danger between April 16 and April 18, 2006. He observed 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 emphasized that although he believed that J.M.G. was in imminent danger, he did not base his finding solely on V.M.’s reluctance to consent to a c-section. In fact, he observed that there were probably many instances where a mother’s refusal to accept a c-section would not constitute abuse.

Then, the appellate court disagreed with the judge’s decision to include failure to submit to Mansuria’s cesarean as evidence of abuse and neglect, but agreed with the decision that the hospital acted appropriately.

The hospital responded appropriately to confront V.M.’s mental state and her refusal to consent to the c-section. After considering V.M.’s “extreme behavior” and signs of developing fetal distress, the hospital staff requested an emergency psychiatric evaluation to determine V.M.’s competency.

As a result of her birth, Dr. Jacoby called in DYFS because he felt V “need[ed] to be more fully evaluated by state social services.” And so the couple was forced to leave the hospital without their baby. He took V’s past psychiatric history into account, even though a different psychiatrist had called her “cured.”

Enter Dr. Vivian Chern Shnaidman in 2007…

Dr. Vivian Chern Shnaidman performed a psychiatric evaluation of V.M. and B.G. for DYFS. She stated that her review of Dr. Seltzer’s records indicated that V.M. was being treated for a psychotic disorder. She noted that despite V.M.’s high level of intelligence and education, she was not able to comprehend her situation. The doctor concluded that V.M. suffers from chronic paranoid schizophrenia and that her prognosis for improvement is poor without psychiatric treatment.

Dr. Shnaidman stated that B.G. was cognitively intact, but that he also suffers from psychosis. She described his diagnosis as “folie à deux,” a rare condition in which one person subscribes to the psychoses and paranoid delusions of another. She explained that V.M. and B.G. function in a very paranoid and secretive way, with each person’s paranoia supporting the other’s.

Dr. Shnaidman concluded that J.M.G. would not be safe in V.M. and B.G.’s care. She stated that it would be dangerous and reckless to return the child to them, because “[t]hese are parents who live in a world that has nothing to do with the world that we live in. And anything could happen there at any time and there’s no way to predict it.” Her written report concluded that “[w]ithout appropriate psychiatric treatment, including aggressive psychopharmacological intervention, neither [V.M.] nor [B.G.] presents as a fit parent at this time.”

Then comes Dr. Marc Cantillon, who concluded that it would be safe to return J.M.G. to her parents’ care immediately.:

Dr. Marc Cantillon… stated that B.G. was anxious and distraught over DYFS’s removal of his daughter, but he had no mental disorder of any kind. He concluded that B.G. would be a fit parent for J.M.G. He also believed that V.M. was a suitable and fit parent.

The trial judge favored Shnaidman’s very “strongly worded” diagnosis and recommendation over the apparently more weakly worded diagnosis and recommendation from Dr. Cantillon:

The trial judge found that he could not reunify J.M.G. with her parents. He commented: “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, he decided to maintain the status quo and obtain a qualified, impartial expert to offer a third opinion.

The family court judge ruled that it was not to return J.M.G. home in the foreseeable future because of the mother’s psychiatric condition and father’s unwillingness to accept mother’s psychiatric condition.

  • The parents did not want to “comply” with the repeated requests that they submit to psychiatric treatment because they didn’t feel they needed it and their psychiatrist, Dr. Marc Cantillon agreed.
  • V had a psychiatrist tell her she was cured before she ever got pregnant; therefore, the pre-pregnancy psych records should not be relevant. She had mental health issues, sought treatment in her own self interest and was cured.
  • She had a doctor try to force her into an unnecessary cesarean while in labor because her baby was supposedly at risk and the doctor was turned out to be wrong on all counts about what V.M. needed in order to give birth to a healthy baby.
  • One psychiatrist found her to be competent to refuse a cesarean while in labor, but the hospital didn’t agree and brought in yet another psychiatrist to try to prove their bias that V was clearly insane to refuse the unnecessary cesarean.
  • Dr. Shnaidman and Dr. Cantillon offered completely diametrically opposed diagnoses of the couple.
  • The trial judge issued one ruling that refusing a cesarean and erratic hospital behavior after birth was factored into the decision to keep J.M.G. from his parents, but the appellate court disagreed in part with this decision.

In the case of V and her baby, she has every right to feel paranoid. The “experts” and “authorities” determining the fate of her birth, her baby and her family’s cohesiveness have behaved in a schizophrenic manner. “The system” appears to be biased toward finding V unstable and unfit to parent, which all seems to stem from her behavior during birth and the immediate days postpartum while still in the hospital; otherwise, she and her husband would have gone home with their baby and had the chance to parent the baby.

I do not read anything in the findings questioning the mental stability or competence of Dr. Shetal Mansuria. Mansuria, who delivers babies at St. Barnabas, a hospital with a 49.3 percent cesarean rate, lied and attempted to coerce her patient into an unnecessary abdominal surgery while her patient was in active labor. Did any psychiatrists question Mansuria’s unjustifiable conduct? Has she been reprimanded for the incorrect diagnosis of fetal distress? Has anyone talked to her about ordering the second psych consult after Dr. Kurani found the patient to be competent? Did anyone look into Mansuria’s psychiatric history for evidence of narcissistic delusions that, using the hospital’s cesarean rate as an indicator, half of all babies will die or be injured without her provision of a cesarean?

And would any of this be happening if V had submitted to an unnecessary cesarean?

With all of the opposing views of so-called experts in this case, V.M. and B.G. are not the only ones who should have their competence come into question in determining the future of J.M.G.

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They didn’t see their child’s first steps, weren’t there when their child learned to crawl, sit, talk, they weren’t there to hold their child and wipe away the tears. They weren’t there for potty training, or sleeping through the night, or even just to watch them explore.

Their child is now 3, and it will no longer be their child. Their rights were officially terminated and it is doubtful they will ever get them back. This is their child, and it was taken from them just because she wouldn’t consent to a cesarean.

Whatever happened here? Women are being taken from their homes at night with court ordered cesareans if they wanted and are fighting for a VBAC, and now if you don’t consent to a cesarean, your child can be taken away from you?

Just the thought scares me to death.

I will have a VBAC with my next. But if I have to fight for it and am deemed “inappropriate” and “uncooperative” in the hospital? Do I have to worry about having an unnecessary surgery and also losing my child?

Is there any way to come back from this? Or are maternity services in this country just doomed to worse things?

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