A caesarean performed without consent

Originally published at My Elegant Gathering of White Snows

As with everyone, I am horrified by today’s article by Christopher Booker in the Telegraph about an Italian woman, in the UK on business, who was forcibly given a caesarian section and her child taken into care.

A woman being given surgery without her consent is assault. It is that simple. Women are not incubators and any society which sees women as human would not be forcing surgery on a woman without her consent; never mind a surgery which results in a child being delivered. Taking the child into care, without the woman being able to instruct her own lawyers, is disgraceful and inhumane.

But, and this is a huge but, reading Booker’s article, I have more questions that answers. I understand that Booker is limited in what he can publish due to the fact that family courts are closed for the protection of the children. Taking this into consideration, Booker’s article is still low on details.

Don’t get me wrong, there are serious problems within child protection due to chronic underfunding, massive caseloads and staff not being given appropriate training in dealing with sexual violence, male violence, and victim blaming. This is clear from the Rochdale and Oxford grooming cases for a start – and the sheer number of children who are forced to continue relationships with abusive fathers. Yet, child protection is more than just social workers [who inevitably get a bashing in these cases], there are medical doctors, psychiatrists, police, teachers, community support workers and any number of court officials involved in the decision to remove children from the home. Our culture treats children as possessions and we pay a very high price for the damage we cause them. In this case, it is clear that the police and medical establishment were involved before Essex social services were.

These are the questions that first popped into my mind when I read the article last night:

  1. Why hasn’t the Italian government been fighting this? They are certainly not bound by UK laws on child protection which keep family courts closed. Why hasn’t the Italian government gone to the EU Human Rights court on behalf of their citizen?
  2. I do not understand why the family suggested that the baby be adopted, in America, by the aunt of the baby’s stepsister (and does Booker not mean half sister rather than stepsister? If we’re talking about kinship carers, you need to get the relationship right). This isn’t the closest of kinship ties and I do think sending the child overseas is a drastic response. Was there no family in Italy who could care for the child in order to allow the mother to continue her relationship with the child? I support kinship adoptions because I do think they are the best outcome in such circumstances but not if the kinship adopter lives on the other side of the planet. The whole point of kinship carers is to try to continue the relationship with the birth parents, if possible. How would this continue if the child was living in the US?
  3. What on earth does Booker mean by panic attack and “bipolar” condition? These are medical terms which have medical definitions. A bit more detail to make it clear wouldn’t go amiss here.
  4. I want to know why the caesarian was preformed. This is an incredibly drastic move which only takes place, within normal circumstances when the mother can’t legally consent, if the mother’s health was at risk. Having bipolar disorder does not put the mother’s health at risk whilst pregnant. If the hospital performed the caesarian for any other reason than the baby or mother being in immediate risk of death, then they have committed assault. I would expect the Italian government, on behalf of their citizen, to being taking the hospital trust to court over this.
  5. I don’t trust John Hemmings at all. The moment he gets involved in any case involving social services, my brain starts screaming ‘ulterior motive’. Hemmings is never involved for the best interests of the child; he’s all about the publicity.
There are obvious constraints on the publishing of this case but Booker’s article is too full of holes to make sense of. If this is a clear case of the assault of a woman, then the there are a whole lot of people who need to be prosecuted and both the British and Italian governments are complicit in this abuse.
Forcible caesarians are violence against women.
Removing a child from their mother because the mother is bipolar is violence against women.
A society which treats women as more than incubators and believes children are not possessions would invest more money and training in the police, education, health, social services and judiciary to ensure that all have more than adequate training to support women who need a little extra help. A society which cared would offer more support to a pregnant women with a mental illness [and here the Italian government is just as complicit]. This is why we are supposed to have a welfare state: to help those in need and not punish them for needing help.

UPDATE:

Essex County Council have released the following statement in response to Booker’s Telegraph article. The obvious holes in Booker’s piece are clearly answered below. I still think the child should have been returned to Italy, even if the mother could not care for her herself but the case isn’t quite as cut and dried as Booker suggests but then these things never are.

Essex County Council responds to interest in story headlined “Essex removes baby from mother”

2 December 2013

Key Dates

There have been lengthy legal proceedings in this case over the past 15 months.
  • Mother detained under Section 3 of the Mental Health Act on 13 June 2012
  • Application by the Health Trust to the High Court 23 August 2012
  • Application for Interim Care Order 24 August 2012
  • Mother took part in the care proceedings ending on 1 February 2013.
  • Mother applied to Italian Courts for order to return the child to Italy in May 2013. Those courts ruled that child should remain in England
  • In October 2013 Essex County Council obtains permission from County Court to place child for adoption

Context

The Health Trust had been looking after the mother since 13 June 2012 under section 3 of the Mental Health Act. Because of their concerns the Health Trust contacted Essex County Council’s Social Services.
Five weeks later it was the Health Trust’s clinical decision to apply to the High Court for permissions to deliver her unborn baby by caesarean section because of concerns about risks to mother and child.
The mother was able to see her baby on the day of birth and the following day. Essex County Council’s Social Services obtained an Interim Care Order from the County Court because the mother was too unwell to care for her child.
Historically, the mother has two other children which she is unable to care for due to orders made by the Italian authorities.
In accordance with Essex County Council’s Social Services practice social workers liaised extensively with the extended family before and after the birth of the baby, to establish if anyone  could care for the child:

UPDATE 2:

The judge’s statement has now been released and is available here.

This is the first part:

NOTE BY MR JUSTICE MOSTYN (4 December 2013)

Although no-one has sought to appeal the judgment dated 23 August 2012 during the last 15 months, or to have it transcribed for any other purpose, I have decided to authorise its release together with the verbatim transcript of the proceedings and the order made so as to inform and clarify recent public comments about this case.

It will be seen that the application to me was not made by the local authority or social workers. Rather, it was an urgent application first made at 16:16 on 23 August 2012 by the NHS Trust, supported by the clear evidence of a consultant obstetrician and the patient’s own treating consultant psychiatrist, seeking a declaration and order that it would be in the medical best interests of this seriously mentally ill and incapacitated patient, who had undergone two previous elective caesarean sections, to have this birth, the due date of which was imminent (she was 39 weeks pregnant), in the same manner.

The patient was represented by the Official Solicitor who instructed a Queen’s Counsel on her behalf. He did not seek an adjournment and did not oppose the application, agreeing that the proposed delivery by caesarean section was in the best interests of the patient herself who risked uterine rupture with a natural vaginal birth. I agreed that the medical evidence was clear and, applying binding authority from the Court of Appeal concerning cases of this nature, as well as the express terms of the Mental Capacity Act 2005, made the orders and declarations that were sought.

Although I emphasised that the Court of Protection had no jurisdiction over the unborn baby, I offered advice to the local authority (which were not a party to or represented in the proceedings, or present at the hearing) that it would be heavy-handed to invite the police to take the baby following the birth using powers under section 46 of the Children Act 1989. Instead, following the birth there should be an application for an interim care order at the hearing of which the incapacitated mother could be represented by her litigation friend, the Official Solicitor.

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