A recent ProPublica report about patients in labor being forced to virtually appear before judges who force them to undergo a cesarean section against their will exposes the problems with laws and policies that bestow personhood on a fetus. In some states, hospitals can turn to the courts when a pregnant patient refuses a recommended intervention, arguing that the fetus has separate rights that must be protected. In one example that ProPublica brought to light, a Florida patient demonstrated a clear understanding that there was less than a 2% chance of her uterus rupturing if she delivered vaginally. She articulated an informed refusal of a recommended C-section. Even so, a judge on an electronic tablet that was brought to her bedside overrode her bodily autonomy under the guise of fetal protection.
A judge on an electronic tablet that was brought to her bedside overrode her bodily autonomy.
When one mother in the ProPublica story asks who will help her care for her newborn after she became unable to cook for herself for weeks after surgery, there was no answer. In a country with no paid leave and no free newborn care, the promise of such “protection” rings hollow. These policies prioritize the fetus and abandon the mother and child. Forced C-sections don’t happen in a vacuum; they occur in a country in which more women die within six weeks of giving birth than in any other high-income nation. (Deaths after a C-section, vaginal delivery, ectopic pregnancy, elective abortion or miscarriage are all included in this number.)
The ethical tradition of obstetrics and gynecology emphasizes patient autonomy. Our primary responsibility as doctors is to the patient. After we have explained the risks and benefits of any proposed procedure or medication, those patients have the right to make decisions for themselves. Being pregnant does not hinder and should not take away patients’ ability to decide for themselves. It’s true that pregnancy often complicates the matter, as patients must think for themselves and the unborn. A pregnant patient diagnosed with breast cancer, for example, may have to decide whether to remain pregnant and delay treatment or quickly end their pregnancy and start treatment.
One of the writers of this piece, Dr. Joia Crear Perry, has seen patients make such decisions many times. Those decisions have never been easy, and they have had little to do with what she, as the provider, would do if she were in their shoes. Such decisions are deeply personal, shaped by lived experience, family, faith and future plans. They are not a decision for anyone else to make.
Yet that is exactly what is happening when a doctor recommending a C-section brings in a judge to force a patient’s compliance. As the ProPublica story points out, Florida “has pushed to expand medical freedom for those who wish to avoid vaccines or fluoridated water, while constricting the rights of people in various stages of pregnancy.” Lois Shepherd, a bioethics expert at the University of Virginia School of Law, told the news outlet, “There aren’t any other instances where you would invade the body of one person to save the life of another.”
Courts have forced women into C-sections at least since the 1980s, and in 1994 the U.S. Supreme Court declined a case questioning the constitutionality of such orders.
Attorneys representing women in fetal personhood cases told ProPublica that they have seen more forced C-sections in Florida than anywhere else, and if Florida successfully passes a bill that would give embryos and fetuses the same legal status as people in wrongful-death lawsuits, the autonomy of pregnant people will be even more restricted.
The legal framing that the fetus is a person is not new. In Roe v. Wade, the Supreme Court stated that the word “person” in the 14th Amendment “does not include the unborn,” and almost immediately we saw proposals for a Human Life Amendment to the U.S. Constitution. Individual states have passed fetal homicide, negligence and abuse laws, further contributing to the conflict between states’ rights and human rights. Since 2022, when the Supreme Court overturned Roe v. Wade with its ruling in Dobbs v. Jackson Women’s Health Organization, we’ve seen more and more efforts to treat fetuses as people. At the same time, in this post-Dobbs era, we find courts intervening more often into the health care of birthing people, particularly Black birthing people. These decisions often come in states that have the worst maternal health outcomes, introducing the contradiction that increasing state control over pregnant people’s bodies also increases risk and rates of maternal death.
Dignity, autonomy and the lived experience of those who give birth must be at the center of care.
Our group, the National Birth Equity Collaborative, wrote an amicus brief in Dobbs v. Jackson that connected governmental interference in health care decisions with maternal death. But to no avail. An April 2025 report from the Gender Equity Policy Institute found that “women who lived in states that ban abortion were significantly more likely to die during pregnancy, while giving birth, or soon after the birth of their child, compared to those who lived in states where abortion care was legal and accessible.” The study found that in the first full year of Texas’ abortion ban, the maternal mortality rate increased 56% overall and 95% among white women.
If we are serious about ending maternal deaths, then dignity, autonomy and the lived experience of those who give birth must be at the center of care. We accomplish this by investing in communities and dismantling the systems that have long treated women’s bodies, especially Black women’s bodies, as expendable.
The laws that override a patient’s wishes and force them into a C-section they don’t want may appear to be a way to decrease maternal mortality, but they’re not. They do not address the drivers of maternal death, they become them, introducing legal risk that delays care, entrenches bias and replaces patient-centered care with fear.
Until we dismantle these oppressive systems, the United States will continue to be the most dangerous place to give birth among its peers. Reproductive justice is about access and autonomy. Pregnant people have the right to make informed decisions about their bodies and their futures. Forced C-sections violate that right. When we provide respectful maternity care and no longer coerce patients to have C-sections, it will not only improve our health outcomes, it will also show the globe that we listen to and trust women.
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