image copyrightCherise Gordon-Doyley
Cherise Gordon-Doyley had been in labor for nine hours at a hospital in the city of Jacksonville, Florida, when a group of between four and five people entered her room. An armed guard stood guarding the door.
They quickly covered her with a sheet and placed a tablet in front of her.
On the screen, Cherise could see the faces of eight people, including lawyers, medical consultants and Florida's Fourth Judicial District Judge Michael Khalil. It was he who explained the legal procedure that had just begun.
"I have not heard evidence or testimony but, based on the medical situation that is reflected in the request, the prosecution is requesting an emergency cesarean section," the magistrate said.
It was September 2024 and Cherise was about to give birth to her fourth daughter.
"I had two of my children in the room, ages 4 and 6. My doula and my sister were there, and we were all scared. Nobody knew what was happening," she tells BBC Mundo.
What they would later understand was that the hospital's medical staff had contacted the state attorney's office. He believed that Cherise should undergo a cesarean section to reduce risks and complications that could affect her life or that of her baby.
But having undergone three C-sections in the past, all with complications and long hospital stays, Cherise had been clear from the beginning of her pregnancy about her intention to have a vaginal birth.
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She was informed of the risks and benefits, and says she fully understood all the consequences.
With no legal representative to accompany her, Cherise drew on her 8 years of experience as a birth doula and 2 years of training as a midwife to argue before the judge from her hospital bed that, in her opinion, the risks of a vaginal birth after a cesarean section (known as a VBAC) were lower than those of having another cesarean section.
Despite her opposition, hours later Cherise would undergo a fourth cesarean section, throwing away, according to her, months of efforts to have a birth under her own conditions.
This case attracted the attention of the media and public opinion due to the images it left behind: those of a woman in labor trying to defend herself in front of a group of lawyers and doctors.
Problematic cesarean sections
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Caesarean section is one of the oldest abdominal surgical procedures in humanity. However, for centuries it was only reserved for cases of extreme danger because it almost guaranteed the death of the mother.
With the advances in medicine, from the 17th century onwards, caesarean section began to cease to be a fatal procedure.
Today, in a country like the United States, one in three babies is born by cesarean section, according to data from the Centers for Disease Control (CDC).
And although the mortality rate in the US is about 13 per 100,000 cesarean sections, it is impossible to eliminate all risks.
Cherise knows this well: with her first three C-sections she experienced all kinds of complications.
"I had very difficult recoveries," he tells BBC Mundo.
"I had to be hospitalized again after each of the cesarean sections I had had up to that point. I had to stay away for periods of two or three weeks from my babies. I had to receive blood transfusions," she exemplifies.
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That was why she made the decision for her fourth birth to be natural.
"There are always risks when giving birth, whether through vaginal delivery or C-section," says Cherise. "But I took into account the risks and benefits of each procedure when deciding, along with my medical team, to try having a VBAC."
Luis Martín Rodríguez Ortegón is a gynecologist and professor at the Faculty of Medicine of the Universidad de los Andes who is not related to Cherise's case.
As explained to BBC Mundo, the risks of uterine rupture increase with each cesarean section and that is why doctors would not recommend a vaginal birth after three previous cesarean sections.
A uterine rupture during a natural birth can generate complications that can put both the mother's and the fetus's life at risk, says Rodríguez, who adds that in many cases this ends with a complete hysterectomy, that is, removing the uterus in its entirety.
"It has been estimated that with a single previous cesarean section, the risk of rupture is below 1%; with two previous cesarean sections, that risk increases between 2% and 3%, and with three previous cesarean sections, the information is not so concrete, but some even speak of up to a 10% possibility of rupture, although in other studies they talk about a little more, a little less," he says.
The National Health Service of Northern Lincolnshire and Goole in the United Kingdom, for example, has guidance stating that "there are very few situations in which a vaginal birth is not advisable", listing four reasons. The first is having "three or more previous cesarean sections."
image copyrightCherise Gordon
Cherise says she understood.
"The main risk factor is a ruptured uterus, but in my opinion, the probability of this happening was quite low," she explains.
"Likewise, in my opinion, with cesarean section the risks associated with further surgery—including serious complications, whether permanent or life-threatening—were very high," he adds.
The day of delivery
According to Dr. Rodríguez, in the case of patients like Cherise, who have faced various difficulties with cesarean sections in the past, it is important to provide special support to mitigate the fear that the experience of a new surgery will be just as complex as the previous ones.
Cherise, however, says that during the months of pregnancy she shared her decision to have a natural birth with the obstetric team at the University of Florida Hospital in Jacksonville (UF Health). She assures that they were not opposed to the idea.
"It was the same hospital where I had my prenatal care. I went in to give birth thinking that we all had the same idea," she says.
Cherise claims that on the day of delivery, the medical team pressured her to have a cesarean section, even though she explained the decision she had made and that both she and the baby were fine.
Thus, after nine hours of labor, the unexpected moment of the video call arrived.
“Is there a real judge there?” Cherise is heard saying at the beginning of the Zoom hearing recording.
"Yes, yes, I told you I wasn't being hyperbolic," one of the nurses answers as she prepares her to appear on camera.
"This is the craziest thing I've ever seen," Cherise responds.
At the hearing, several medical experts speaking on behalf of the hospital argued that, based on Cherise's medical history, a natural birth was unlikely to be successful and that there was a risk of uterine rupture.
Additionally, they explained that the baby's heart was showing "signs of difficulty," so the medical staff on the call suggested it was best to "avoid an emergency" and proceed with the cesarean section.
After almost three hours of conversation in the midst of contractions, Cherise managed to convince the judge that the risk was not enough to require an emergency cesarean section as the hospital argued.
"I had to draw on all the knowledge from my experience as a doula and my two years studying to be a midwife to navigate the arguments they presented in court," Cherise explains.
"What's really scary about all of this is that the average woman who finds herself in a situation like this will not have the tools or knowledge necessary to defend her case like I did," she adds.
Despite everything, the judge ruled that, if the situation represented a risk, either to her or the baby, the hospital could have a court order to proceed with the cesarean section.
"Which is also crazy, especially since I had already stated that if an emergency arose or if the baby or I were in any danger or at risk, I would accept the cesarean section. So I thought the court order was totally unnecessary."
At the end of the hearing, exhausted, Cherise tried to rest.
emergency cesarean section
Cherise says that around 3 in the morning, they woke her up to warn her that the baby's heart rate was low.
According to Dr. Rodríguez, this is one of the main factors to take into account when determining whether a vaginal birth like Cherise's is presenting complications.
"They told me: 'This is what the judge was referring to, we have to do a cesarean section.' The next thing I knew was that they were transferring me on the stretcher to the operating room," says the woman.
"I was groggy because I had been sleeping for at least two hours, so I didn't have much of a chance to object to what they were telling me."
According to Cherise, she was accompanied by her sister during the cesarean section and stayed awake the entire time.
"Honestly, I was afraid I wouldn't survive the operating room, it was really difficult to deal with," he says.
The baby was taken to the neonatal intensive care unit and Cherise had to undergo a second hearing with the judge at 8 in the morning.
Through a statement sent to BBC Mundo, the Florida Fourth Circuit Prosecutor's Office, corresponding to Jacksonville, explained that "UF Health notified the state prosecutor's office that a full-term baby, at 41 weeks of gestation, was at serious risk of death if she did not receive medical intervention. The mother refused to receive such care."
"In compliance with our legal obligation, we brought the case to the Circuit Court, which held an evidentiary hearing. After hearing from the mother and medical professionals, the Court determined that a cesarean section was necessary to protect the life of the baby and the health of the mother."
"The state prosecutor's office does not make medical decisions; we made sure to present the facts to the Court so that a judge could make a decision in accordance with the law," they detailed.
BBC Mundo also tried to contact the University of Florida hospital in Jacksonville, which said it could not share information about the case because it had to "protect patient confidentiality."
Two of the doctors who were on the call with Cherise had also not responded to interview requests at the time of this article's publication.
Different in each state
Amy Yurkanin, journalist for the independent portal ProPublica, explains to BBC Mundo that it is the legislation of each of the US states that defines how much decision-making power a mother maintains at the time of childbirth.
"If you look at the situation across the country, you'll see that some states have ruled that they can't actually intervene in a pregnant woman's medical decisions," he says.
"On the other hand, in other places it has been established that it is possible—in certain cases—for a judge to intervene and basically annul the woman's decisions."
"In Florida, in fact, there have been several cases related precisely to this issue and the state courts have repeatedly ratified that, under certain circumstances, a judge can intervene and make decisions about a woman's medical care that differ from those she herself would have chosen," notes the journalist.
Yurkanin explained that, although cases like Cherise's are rare, they do occur in states like Florida. She herself wrote about another woman who had gone through a similar situation.
What's next
Two years after her hospital experience, Cherise still has mixed feelings: "I don't know how I feel: I'm upset, I'm sad, it hurts me that they treated me like this, and it's very hard for me to move on because this was a life-changing experience for me."
Cherise filed a lawsuit against UF Health arguing, among other things, that the hospital's medical representatives had denied her access to a legal representative during hearings and had exaggerated the risk to the baby in performing the C-section.
"Even with the baby's birthday, it's not just a birthday anymore. It's a trauma anniversary. I can't be excited for my baby's birthday because at the same time, I'm reliving one of the most traumatic moments in life with this judge-ordered C-section."
Cherise wanted to share her vision with other women.
"You should always have a say in your medical care and what happens to you and your baby. It's okay to speak up and stand up for yourself. In fact, I always say to stand up for yourself like your life depends on it, because that's exactly what it is, right?"
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