On Facebook today, the organization Improving Birth posted this question:

What happens when a mom plans a VBAC with a fully supportive doctor, but then at birth gets an unsupportive doctor who refuses to “perform” a VBAC? Do you think the provider is “forced” to attend a vaginal birth, or is the woman “forced” to have surgery?

I approached this question in my post on rights, so let’s explore it.

Let’s look at the doctor’s side first:

The doctor wants to perform surgery on a woman who doesn’t want surgery.  Her original doctor says it is safe for her to forego the surgery.  Professional guidelines say that forgoing the surgery is perfectly fine as long as some basic conditions are met (and let’s assume they are, since the first doctor agreed the surgery was not necessary and the doctor in question appears not to have reassessed the situation).  Essentially, the doctor is arguing that is is the doctor’s personal preference to perform the surgery, and that the pregnant woman is forcing the doctor not to perform unnecessary surgery.

By this logic, I am forced not to perform surgery on people all day every day.  I am also forced not to do all kinds of other things to them, even if I feel like it.  Even if I am qualified to do things to people, I am “forced” not to do them.  No one has ever let me perform CPR or the Heimlich maneuver or a substance abuse treatment intervention on them just because I felt like it.  And I am qualified to do all of those things and have nifty certificates to prove it.

The doctor feels “forced” to attend a vaginal birth.  But this doctor does not have to ignore practice guidelines.  The doctor does not have to practice obstetrics.  The doctor does not even have to be a doctor.  This doctor could quit and go home.  This doctor could probably even decide to be “sick” and some other doctor would be found.

As for the woman:

She chose a doctor who agreed with standard practice guidelines indicating that she did not need surgery.

Another doctor showed up who apparently wanted to perform surgery whether it was needed or not.

If the doctor refuses to provide care for a vaginal birth, and there is not other doctor available, what choices are available to the woman?  Will the labor and delivery nurses assist her birth?  Can the woman deliver unassisted in the hospital?  Can she leave without signing AMA papers (as she was only refusing the advice of one doctor, but not the advice of her original doctor or of the hospital or of professional guidelines)?  Is there any qualified birth attendant available who can assist?

The woman cannot decide not to be pregnant.  She cannot decide that she will not go into labor and give birth.  She cannot get someone else to do these things for her.  If she goes home, they will still happen.

Is the woman’s choice compromising her life and health and that of her baby by either having an unattended birth or having an unnecessary surgery?  In such a case, it appears that she is forced to make  a bad decision, no matter what she chooses.

The commenters on Improving Birth’s question are champions of the autonomy and agency of women.  Here are a few of their comments–I recommend liking Improving Birth’s page on Facebook:

I think the provider should do his job, or find someone that can. As a mom has a right to decline any procedure that is not medically needed. At that time just because the doctor doesn’t want to do a vbac, does not make a csection medical needed.

Her body, her decision!

What happens when a patient with a cancer diagnosis needs to be seen by another doctor for a day? Or a patient with diabetes? Or someone who is getting occupational therapy for intellectual disability? When the regular provider is temporarily unavailable and a certain treatment plan or protocol has been worked on, all reasonable accommodations should be made to keep to that plan. On-call doctors should not get to say they will not help a mom planning on VBAC continue with her and her primary doctor’s plan.

I don’t think I would want a doctor at my birth who was “forced” to be there. But neither should a woman be “forced” to have unwanted surgery (whether it’s “necessary” or not!). The hospital I believe has an obligation to provide the care that a woman wants – if this doctor is unwilling to attend a vbac then the hospital should be finding one who IS willing to attend. Here in Australia the woman wouldn’t have a doctor there anyhow, unless something went wrong – it would just be midwives.

We have years of case law that competent people can refuse care, and it is an EMTALA violation to deny care to a woman in active labor, even if she is refusing surgery.

Doctors don’t “preform” a VBAC, mother’s give birth. This should not even be an issue, it is sad that it is.