Agoraphobic mum-to-be forced to go to hospital for the birth

On the face of it, the judge stated that the risk of home birth are higher than being forced into hospital against this woman's will and possibly induced against medical necessity rather than allowing her to birth naturally in a safe place supported by professionals. All of the evidence we have about birthing would say that this is incorrect

Sorry but that depends entirely on her health and the circumstances. Medical staff have carried out a risk assessment and a home birth is not appropriate here. Just because you have had one or your friends have doesn’t mean that it is appropriate for everyone. There have been home births where the baby has died or been severely disabled for instance.

This decision should be only about the woman, not considering the good of the baby

I don’t agree in this particular case. I’m all for abortions etc and women and only women should choose what happens to their body but this isn’t an unwanted child, this woman wants her baby and presumably would like a healthy baby as all mothers do. So why shouldn’t the baby matter when it’s clearly wanted and will be brought into the world?

Caveat: not all the circumstances in this case have been made public ..

On the face of it, the judge stated that the risk of home birth are higher than being forced into hospital against this woman's will and possibly induced against medical necessity rather than allowing her to birth naturally in a safe place supported by professionals. All of the evidence we have about birthing would say that this is incorrect.

I know many birth supporters have expressed their willingness to reach out and help her. I hope she hears this support and is able to avail of it.

Our of interest, if someone had a partner or family member who had an illness which needed hospital treatment (medical professionals had facilitated scans and tests at home, but there was a good chance they would die if they didn't go in- small chance they might be fine) but they were agoraphobic, would they just say ah well, your choice, even thought that choice cannot be an informed one as their illness cloud's the ability to do so?

False analogy as Alfonso has pointed out.

Justawoman
I didn’t read the judgment linked to but the woman whose case is the subject of the Birthrights blog (which I linked to above) seemed to be about if a really serious situation arose during a birth already started at home and the issues of then getting the agoraphobic woman from home to hospital.

However the judgment here involving the 21 year old woman who is subject of this thread seems perhaps even more difficult to live with for that woman because it could be potentially several days that she has to be away from home before the baby comes, couldn’t it? Unless they’ve decided she will get a c-section?. The judge basically said that she should be taken on a specific date in advance of the due date to hospital and stay there until the baby is safely born.
I don’t understand how this represents taking a minimum intervention proportionate approach to her consent to treatment. If she potentially needs force to get her to hospital, how are they going to keep her in there safely and humanely and while respecting her rights, for what could be several days if she is desperate to get back home? It doesn’t bear thinking about. Will they just force her straight into c section? What if she didn’t want a c section? These are massive decisions being made for her.

I know the facts available to us are very limited but it doesn’t feel right that the young woman has been deemed to lack capacity to make decisions around the birth as a whole which is a very wide scope of decisions, possibly quite far in advance. How do they know that the lack of capacity they’ve determined will persist over this whole period covering the birth?

I’d hope that they will keep on repeatedly offering this young woman choices and assessing her capacity for however long she may be in hospital against her stated will, to see what aspects of her care that she can make competent decisions about. Clearly there aren’t easy answers in a case like this and we don’t have facts, but norms of consent and capacity do seem at odds with a judgment possibly some way in advance of a birth, (and reportedly because the judge wants to avoid a rushed decision ‘in the middle of the night’) which then means on the very wide set of deeply personal decisions around birth, and with potentially quite different longer term physical and mental consequences for her depending on what her preferences would be, a woman’s right to determine what happens to her body on major issues like having surgery or not is removed from her for what could be several (physically and emotional pivotal) days.

I’ve been in that situation with a family member refusing lifesaving treatment due to a phobia (not agoraphobia). I wouldn’t wish it on my worst enemy. Although we persuaded/bullied them into it eventually it wrecked some family relationships beyond repair. I don’t know if they would have been judged to have capacity to refuse treatment if it went to court as thankfully it never got that far.

I think it was right in this case for the judge to take into account the risk of harm to the baby, if indeed they did, not because the baby is yet a person with human rights but because it would be enormously detrimental to the mother’s wellbeing if the child died or was seriously harmed because she felt unable to leave her home for the birth. That can’t be in her best interests. And that’s leaving aside the issue of whether there was direct medical risk to her. As others have said, these decisions are not taken lightly and we don’t know much at all about what happened.

In the court case under discussion, both the woman's mother and her partner want her to have the baby in hospital, not at home.

That's a false equivalency as the hypothetical situation you outline affects only the adult who is making that decision. In this case, it is a pregnant woman whose refusal to leave her house may put both her life and the life of her unborn baby in danger.

I agree. In some instances, there are necessary limits to rights and choices.

This decision should be only about the woman, not considering the good of the baby

I can't agree with this. No doubt this makes me a "forced birther" but I will not support a woman's right to irrationally choose a route which has the likelihood of a dead baby over a live baby.

As none of us know what the risk is (rightly so, none of our business really), its impossible to conclude whether the risk is solely to the baby, or to the mother as well.

The charity Birthrights seem to have a sensible take on the other case mentioned on the thread (not the scantily-reported case of the 21 year old who is the subject of this thread and no judgment available to read) see blog: www.birthrights.org.uk/2021/04/07/blog-agoraphobia-and-mental-capacity-a-new-obstetric-intervention-case/

They say: Yet it is perturbing to once again read a judgment that explicitly takes account of the interests of the unborn baby in drawing conclusions about GH’s best interests on the grounds that she was “desirous of a safe birth”, regardless of the impact on her of being forcibly transported to hospital and potentially given a Caesarean under general anaesthetic. Many people are desirous of a safe birth yet decline recommended care. GH did in fact go on to have the home vaginal birth she wanted “before it was possible to execute the arrangements authorised by the court”.’

I just think there but for the grace of God, when I hear about women in terrible distress around birth and how this can be handled, and with a wider cultural narrative surrounding women and birth in general that often (increasingly?) does not always support and respect women as autonomous human beings or see them as ‘birthing people’ - to use that stupid new euphemism in its true literal meaning.

@ChattyLion

Also in agreement with your posts.

@NiceGerbil Am in agreement with your last posts.

The Children Act now includes the category "future risk of emotional harm" and it was hotly debated in 2018 by people recognising how delicate the assessment of that and how damaging ham-fisted application can be to children and their families, so concerned posters can rest assured that the mother in this case is extremely likely to have been assessed as to her future parenting skills in the context of her MH issues and will continue to be so.

I agree 100% about increased prevalence of agoraphobia after lockdown in the general population which will obviously include pregnant women.

User, Becca and Quiet

The Guardian also reported on this www.theguardian.com/uk-news/2021/may/14/agoraphobic-pregnant-woman-can-be-forced-into-hospital-judge-rules

This decision should be only about the woman, not considering the good of the baby. Once the baby is outside her body, she no longer has veto and rightly its about the baby’s best interests regardless of her wishes, if she can’t make decisions in the baby’s best interests. We have to accept that also means in whatever poorer condition the baby may be in because of her rational (even if very disagreeable) decisions made prior.

That has to be how it is or pregnant women are only vessels without the same assumption of capacity to decide and that is completely unacceptable. We can’t say we want pregnant women not to be treated like vessels and then say ‘but not if that harms the baby’ or ‘not it that takes up extra resources’, can we?

HCPs should appropriately professionally treat, support and inform and engage with the woman in the situation she’s in. I’m sure it is frustrating and difficult for HCPs sometimes where a patient has capacity but acts irrationally against their own interests or their own baby’s interests.

But while the baby is inside her body, and she hasn’t been shown to lack capacity her autonomy over what happens to her, including her refusal of treatment should be absolute. Like any other patient who isn’t pregnant should have that same autonomy. Unless, like any other patient lacking capacity she lacks the capacity to decide. It just feels scarily easy given the cultural attitudes about baby brain and irrational hormonal pregnant women for authority figures to use a low bar to deciding that pregnant women lack capacity. The judge said she can’t decide about issues to do with the birth which seems very wide, given the consequences. It’s not the case that the answer to every question about a birth in a women’s best interests (especially taking into account this young woman’s specific issues) is ‘she has to be in hospital’
If that judicial decision is ever justified by the good of the baby then we need to be given assurance that looking at the mother’s best interests has been the relevant guide to her treatment while she lacked capacity.

We don’t know enough to know what’s happening here in this case but I think it’s definitely not irrational to worry about how pregnant women with mental health problems are treated and pregnant women in general are treated in terms of their decision-making. We can this see this even from examples like labouring women being forced to wear masks (against recommendations) which is also currently in the news. The rules aren’t always right and the right rules aren’t always followed.

And I never asked you to disclose anything.

You don't know my own situation.

My only point is that it's wrong to state, based on hardly any info, that the baby will not be cared for properly.

Loads of women with MH issues post birth don't seek help as they are worried what the consequences will be. That's not good.

And there's also the point that babies are aok with being at home with mum for the first few months of their life.

My point is that two posters who have no more idea of the situation than anyone else have assumed that her MH problems automatically mean that her child will not be cared for properly.

That's a massive assumption when only the bare bones of the situation are known.

One poster seemed to find it unsettling she had a partner and had got pregnant.

I don't understand those posts.

I have mental health issues myself gerbil, what’s your point? Would you like a list of what I suffer with? PTSD from two separate traumatic events that both lasted over a year, severe anxiety and depression along with suicidal thoughts and I struggle to leave my own home and rarely do.

Damn this computer - weird backwards scrolling thing happens from time to time.

Meant to say, depending on how close the original mother is to her due date, I find it hard to believe that all other avenues had been completely exhausted.

I hope Suespiciousminds covers this on her blog though, once the judgement is handed down - if it ever is, her perspective would probably be enlightening.