Forced C-Sections : The Legal Battle Over Bodily Autonomy during Childbirth
In the month of July 2011, Rinat delivered a healthy boy via cesarean, or “C” section at Staten Island University Hospital – against her will. Dray, who had suffered difficult recovery from previous C sections, hoped for a more natural birth. Doctors insisted on surgery because of concerns about fetal complications, including the possibility of uterine rupture. The doctors overrode Dray’s refusal and proceeded with the C-section.
Dray later filed a malpractice suit against the hospital and the doctors for “pressuring and threatening her” into the C-section. While litigation remains ongoing, Dray’s case highlights a broader debate in the United States: Do pregnant individuals have the right to refuse a C-section?
Below, I discuss what a C-section is, how courts have previously considered this issue, and what the future might hold for maternal rights in childbirth.
What is a C-Section?
A C-section is a surgical method of childbirth. Emergency C-sections are possible at any time in the third trimester of pregnancy. The procedure involves making an incision in the pregnant person’s uterus, opening the amniotic sac, and removing the baby and placenta, before closing the incision.
Historically, C-sections were a last resort to save a baby from a dead or dying pregnant patient. Medical advances in the 19th century, including improved surgical techniques, anesthesia and fetal imaging, dramatically reduced maternal mortality and morbidity. Doctors may recommend a C section if labor does not progress or if the patient or baby is at risk. Some patients may also opt for a C-section–potentially due to concerns about pain or anxiety associated with vaginal birth–although this is less common.
As with any major medical procedure, doctors and pregnant patients weigh the potential benefits against the risks of undergoing a C-section. In an emergency, C-sections are safer than vaginal deliveries. C-sections are associated with higher risks of complications for mothers than vaginal deliveries, including higher rates in maternal mortality, longer recovery time, and a greater likelihood of C-sections during subsequent pregnancies. C-sections can also pose risks to infant health, such as breastfeeding difficulties and respiratory problems. For these reasons, doctors typically recommend C-sections only when medically necessary.
Legal Considerations
Case law on court-ordered C-sections has been inconsistent. This reflects a tension between the right of a pregnant woman to bodily autonomy, and the state’s assertion of an interest in fetal development. Conflicting case outcomes hinge on varying interpretations of bodily integrity, privacy, and religious freedom.
Bodily Integrity
Both common law and the 14th Amendment establish the right to bodily integrity, which includes the principle that a competent patient can refuse medical treatment, even if it is life-saving. In other medical contexts courts uphold this right. However, courts diverge on whether this right applies absolutely to pregnant patients or whether fetal rights–framed as “state’s interests”– can supersede.
For example, in In re Baby Boy Doe, the Illinois Appellate Court ruled that a pregnant person’s “right to refuse invasive medical treatment … is not diminished during pregnancy.” The court relied heavily on Stallman v. Youngquist, an earlier Illinois Supreme Court case that explicitly rejected the notion that a pregnant patient’s rights could be subordinated to fetal rights. In Pemberton, a Florida district judge found that fetal interests outweighed the interest of the pregnant patient in maintaining her bodily integrity.
Privacy and Reproductive Autonomy
Courts have also derived an implied Constitutional right to reproductive autonomy from the 1st, 3rd, 4th, and 9th Amendments. This precedent is Griswold v. Connecticut. In Griswold, the Supreme Court held that the Constitutional right to privacy prevented states from infringing on married couples’ right to use contraception.
This reasoning has been extended to protect broader reproductive autonomy. In Taft v. Taft, the Supreme Judicial Court of Massachusetts applied Griswold in order to overturn a lower court’s decision requiring a pregnant patient to undergo a cerclage to prevent a premature birth. The Taft court determined that there was insufficient evidence to justify overriding the pregnant patient’s privacy rights.
However, some courts have interpreted Roe v. Wade as establishing a compelling state interest in “protecting the lives of unborn, viable children,” creating an exception to Constitutional privacy rights. In Jefferson v. Griffin Spalding County Hospital Authority the Supreme Court of Georgia decided that hospitals were allowed to perform any medical procedure, including C section, deemed necessary for preserving fetal life. Some courts have even extended this principle to pre-viable fetuses, compelling pregnant patients to undergo medical interventions earlier in pregnancy.
The legal landscape is evolving further in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overturned the Constitutional right to abortion. With Dobbs enabling states to enact fetal personhood laws, courts may increasingly weigh fetal rights against pregnant patients’ autonomy.
Religious Freedom
Courts have also grappled with whether the state’s interest in protecting the fetus can override a pregnant patient’s Constitutional right to free exercise of religion. In some forced C-section cases, pregnant patients have cited religious beliefs as a primary reason for refusing the procedure.
For example, the defendant in Taft was a “born-again Christian,” who objected to a cervical cerclage due to her belief in faith healing. The Massachusetts court upheld her right to religious freedom, reinforcing the principle that religious beliefs can form the basis of a medical refusal.
However, in In re Madyun, a Muslim woman refused a C-section after prolonged labor due to her religious convictions. The D.C. Superior Court ruled that the state’s compelling interest in preserving the life of the unborn took precedence, overriding her religious objections.
The Future of Forced C-Sections
While bodily integrity is a long-standing principle in American law, courts have ruled inconsistently in the realm of C-sections. The changing legal and political landscape post Dobbs complicates this debate. The resolution of cases like Rinat Dray’s will have lasting implications–not only for individuals facing these decisions but for the broader landscape of reproductive justice and medical autonomy.
About the author
Rupa Palanki
is a PFC student fellow and law student (J.D. Research interests include chronic disease policy and innovative medical technologies. She graduated from the University of Pennsylvania where she studied Economics. She also interned at the U.S. Department of Health & Human Services, and the Louisiana Department of Health. She worked as an analyst for ClearView Healthcare Partners before attending law school.
