An Orwellian scenario: Court ordered caesarean section and women's autonomy

Between 1992 and 1996, a small number of women in the UK were forced by the courts to undergo caesarean section against their expressed refusal. Analy sis of the reported cases reveals the blanket assumption of maternal incomp etence and the widespread use of thinly veiled coercion. Such attitudes and practices are themselves frequently compounded by inadequate communication . Medical discretion in such problematic cases seems to err on the side of safety and so appears to favour the life of the fetus over maternal autonom y. Despite current policy's placement of the pregnant woman at the centre o f maternity care, obstetricians' concerns appear to lie more with the unbor n fetus. In other words, there seems to be a point at which the value of fe tal life begins to outweigh, not so much the life of the woman, but her rig ht to self-determination, her plans and her choices. While it is important to acknowledge that these court ordered caesareans represent an unusual ext reme within contemporary maternity care in this country, that they have hap pened brings into sharp relief some of the stereotypical assumptions about women. These are assumptions that underlie much of current medical practice and may compromise or disempower women in other ways during their experien ce of pregnancy and labour. Using the first and last of the six reported cases as contextual illustrati ons, this article focuses on the complex interplay of processes that have b rought the medical profession to a position in which their own self-convict ion and determination to do what they believe is best for their patients ha s resulted in gross denial of women's autonomy and the use of the law to ov erride pregnant women's refusal of consent.