Imagine if I wrote the following:
I cannot sufficiently describe the profound sadness and disappointment I feel upon hearing that the State of California has banned drunk driving. I wanted to write to you to express my thoughts on the matter. It is my sincere hope that you will reflect seriously on my comments, as the consequences of this decision are grave and impactful far beyond the catchment area of your state.
You’d think I was nuts, right? Drunk driving has a terrible death toll and results in tremendous human suffering. Moreover, the person who chooses to drive drunk might not be the person who bears the burden of the injuries and death. Innocent bystanders are often the victims.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breech vaginal birth has a HIGHER death rate than drunk driving.[/pullquote]
The words above were not written about drunk driving. They were written about breech vaginal birth, a practice that has a HIGHER death rate than drunk driving. I paraphrased a public letter posted by Dr. Emiliano Chavira, of ImprovingBirth.org. Dr. Chavira is objecting to the decision by Glendale Adventist Medical Center banning elective breech vaginal birth. ImprovingBirth.org is planning a demonstration in front of the hospital next Wednesday to protest this change in policy.
But drunk driving doesn’t kill that many people. And driving drunk after partying is a long standing tradition.
Continuing the paraphrase:
To begin with, a brief word about drunk driving. This used to be a standard procedure in which all young people (and many older people) routinely indulged. As is also true with sober driving, drunk driving was on occasion, fraught and serious injury or death occurred. A landmark study shows that in 2014 drunk driving accounted for only 4/1000 US deaths each year. Moreover, the majority of auto accident deaths (over two thirds!) involve no drunkenness. Nonetheless, officials in many states banned drunk driving. To this day, the option of drunk driving is denied to all individuals.
But 4/1000 deaths each year is more than enough to justify banning drunk driving. Are we supposed to believe that the HIGHER death toll of breech vaginal birth is trivial?
Dr. Chavira emphasizes that this is an issue of personal autonomy:
[ACOG has] expressed in explicit language that in honor of the ethical principle of patient autonomy, the mother is the ultimate decision maker in the setting of childbirth. They have stated explicitly that competent individuals have the right to accept higher degrees of personal risk. They have also stated that decisionally competent individuals have the right to refuse recommended care, even when needed to maintain life…
But we don’t accept that reasoning when it comes to drunk driving. Why? Because others may be harmed. In the case of vaginal breech birth everyone participating faces the potential harm that comes from losing a baby to a preventable cause. They and the hospital face legal liability. Moreover, society faces the harm that comes from the massive expense of raising a brain injured child.
But medical autonomy is extremely precious, so I have a proposal for how we can preserve women’s autonomy to choose breech birth while simultaneously protecting others.
The obstetricians that choose to offer elective breech vaginal birth should agree to a rider attached to their malpractice insurance. Malpractice insurers set rates by calculating potential financial exposure. That’s why obstetricians have much higher malpractice rates than internists. The insurer could therefore calculate the additional financial exposure posed by breech vaginal birth, divide by the number of obstetricians offering the procedure and charge those doctors more.
Wait, what? That would cost Dr. Chavira and like minded obstetricians hundreds of thousands of dollars? Correct! And that’s where organizations like ImprovingBirth.org come in. Instead of holding rallies and threatening hospitals that refuse to participate in unsafe care, they could indemnify those same hospitals, giving them the financial freedom to accede to ImprovingBirth.org’s demands.
It’s a win-win!
Wait, what? Dr. Chavira and ImprovingBirth.org don’t want to pay. They want hospitals to pay to insure procedures that are unsafe? They want all obstetricians to pay more for malpractice insurance even though most obstetricians think breech vaginal births are unsafe and would not perform them? That doesn’t seem fair, does it?
I believe deeply in women’s medical autonomy. Women most certainly have the right to refuse medical treatment, even life saving treatment. That’s a negative right; the right to be left alone. But they DON’T have the positive right to demand unsafe treatment.
Don’t want a C-section for a breech baby? Fine, don’t come to the hospital for a breech vaginal birth or transfer to the hospital when the baby’s head gets stuck at a homebirth. Doctors and hospitals also have rights; they aren’t required to provide unsafe care.
Freedom comes with responsibility.
Freedom does not mean that you are free to drive drunk and vaginal breech birth is MORE dangerous than drunk driving.
Those who demand the freedom for breech vaginal birth have a responsibility to pay for it. Let’s see them put their money where their mouths are.
