Credit, Cherise Gordon-Doyley
Cherise Gordon-Doyley had been in labor for nine hours at a hospital in the city of Jacksonville, Florida, in the United States, when a group of four to five people entered her room. An armed security guard stood guard at 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 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 described in the request, the prosecution is requesting an emergency cesarean section," said the magistrate.
It was September 2024, and Cherise was about to give birth to her fourth daughter.
"I had two of my children in the room, aged 4 and 6. My doula and my sister were also there, and we were all scared. Nobody knew what was happening", she tells BBC News Mundo (BBC Spanish service).
What they later understood was that the hospital's medical team had contacted the state prosecutor's office because they considered that Cherise should undergo a cesarean section, with the argument that this would reduce risks and complications for her and the baby.
However, as the woman had already undergone three cesarean sections — all with complications and long hospital stays — Cherise had made it clear, from the beginning of the pregnancy, her intention to have a vaginal birth.
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She was informed about the risks and benefits of this method of delivery and states that she understood all the possible consequences. According to the woman, the hospital where she had the baby was the same one where she received her prenatal care.
Without a legal representative to accompany her, Cherise turned to her eight years of experience as a doula and her two years of studies as a midwife to defend her wishes.
Despite her opinion, hours later, Cherise would undergo a fourth cesarean section, throwing away - according to her - months of efforts to have a birth as she wanted.
The case caught the attention of the press and public opinion due to the images it left: those of a woman in full labor trying to defend herself in front of a group of lawyers and doctors.
Vaginal birth after cesarean section
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A cesarean section is one of humanity's oldest abdominal surgical procedures. However, for centuries it was only used in cases of extreme danger, as it almost always resulted in the death of the mother.
With advances in medicine, starting in the 17th century, cesarean sections began to cease to be a deadly procedure.
Today, in the USA, one in three babies is born by cesarean section, according to data from the Centers for Disease Control and Prevention (CDC).
And although the U.S. death rate is about 13 per 100,000 C-sections, it's impossible to eliminate all potential risks and problems.
Cherise knows this well: in her first three cesarean sections, she faced all kinds of complications.
“I had very difficult recoveries,” she tells BBC News Mundo.
"I had to be hospitalized again after each of the cesarean sections I had up to that point. I had to be away from my babies for periods of two or three weeks. I had to receive blood transfusions", she says.
Credit, Getty Images
That was why she had made the decision that her fourth birth would be natural.
"There are always risks when giving birth, whether vaginal or cesarean," says Cherise. "But I took into account the risks and benefits of each procedure when deciding, together with my medical team, to attempt a vaginal birth after cesarean."
Luis Martín Rodríguez Ortegón is a gynecologist and professor at the Faculty of Medicine of the Universidad de los Andes; he has no relation to Cherise's case.
As he explains to BBC News Mundo, the risks of a uterine rupture increase with each cesarean section; Therefore, doctors would not recommend a vaginal birth after three previous cesarean sections.
A uterine rupture during a vaginal birth can generate complications that put both the mother's life and that of the fetus at risk, says Rodríguez. He adds that in many cases, this results in a complete hysterectomy — that is, the total removal of the uterus.
"It is estimated that, with just one previous cesarean section, the risk of rupture is less than 1%; with two previous cesarean sections, this risk rises to between 2% and 3%. With three previous cesarean sections, the data are not as precise, but there are those who mention up to a 10% chance of rupture — although other studies indicate slightly higher or lower values", he states.
The National Health Service (NHS) for Northern Lincolnshire and Goole, in the United Kingdom, for example, has a guide that states there are "very few situations in which vaginal birth is not recommended", listing four reasons. The first of these is having "three or more previous cesarean sections".
Credit, Cherise Gordon
Cherise assures that she understood all of this.
"The main risk factor is uterine rupture, but from what I understand, the probability of that happening was quite low," he explains.
"Similarly, in my opinion, with a cesarean section, the risks associated with a new surgery — including serious complications, whether permanent or potentially fatal — were very high," he argues.
The day of birth
According to Rodríguez, in the case of patients like Cherise, who have faced difficulties with cesarean sections in the past, it is important to offer special support to alleviate the fear that a new surgery will be as complex as the previous ones.
Cherise, however, reports that, during her pregnancy, she shared her decision to have a vaginal birth with the obstetric team at the University of Florida Hospital in Jacksonville. She claims there was no opposition to the idea.
"It was the same hospital where I had prenatal care. I arrived for the birth believing that everyone was on the same page," he says.
However, according to Cherise, on the day of birth the medical team pressured her to undergo a cesarean section, even though she explained the decision she had made and emphasized that both she and the baby were fine.
That's how, after nine hours of labor, the unexpected video call came about.
“Is there a real judge there?”, Cherise is heard asking at the beginning of the recording of the hearing via Zoom.
"Yes, yes, I told you I wasn't exaggerating," one of the nurses responds, as she prepares her to appear on camera.
"That's the most absurd thing I've ever seen," reacts Cherise.
At the hearing, several doctors, speaking on behalf of the hospital, argued that, based on Cherise's medical history, a successful vaginal birth was unlikely. There would be a risk of uterine rupture.
Furthermore, they explained that the baby's heart showed "signs of difficulty", which is why the medical team, during the call, suggested that it would be better to "avoid an emergency" and perform a cesarean section.
After almost three hours of conversation, amid contractions, Cherise managed to convince the judge that the risk was not great enough to justify an emergency cesarean section, as the hospital claimed.
"I had to draw on all the knowledge I gained from my experience as a doula and my two years of studying to become a midwife in order to deal with the arguments presented to the court," explains Cherise.
"What's really scary about all of this is that the average woman, finding herself in a situation like this, wouldn't have the tools or knowledge to argue her case the way I did."
Despite everything, the judge determined that, if the situation began to pose a risk — whether for her or the baby —, the hospital could count on a court decision to perform the cesarean section.
"Which is also absurd, especially because I had already made it clear that if an emergency arose, or if the baby or I were in any danger or at risk, I would accept the cesarean section. Therefore, I found the court order completely unnecessary."
At the end of the hearing, exhausted, Cherise tried to rest.
Emergency cesarean section
Cherise says that, around 3 am, they woke her up to tell her that the baby's heart rate was low.
According to Rodríguez, this is one of the main factors to consider when determining whether a possible vaginal birth could lead to complications.
"They told me, 'That's what the judge was referring to; we need to perform a cesarean section'. The next thing I remember is being taken on a stretcher to the operating room," says the woman.
"I was in a daze because I had slept for at least a couple of hours, so I didn't have much of a chance to dispute what they were telling me."
According to Cherise, during the cesarean section, she was accompanied by her sister and remained awake the entire time.
"Honestly, I was afraid I wouldn't survive the surgery. It was really difficult to go through," he recalls.
The baby was taken to the neonatal intensive care unit (ICU), and Cherise had to undergo a second hearing with the judge, at 8 am.
In a statement sent to BBC News Mundo, the Florida Fourth District Attorney's Office explained that the hospital "notified the state attorney's office that a full-term baby, 41 weeks pregnant, was at serious risk of death if she did not receive medical intervention. The mother refused to accept such care."
"In compliance with our legal obligation, we presented the case to the Circuit Court, which held an evidentiary hearing. After hearing from the mother and healthcare professionals, the Court determined that a cesarean section was necessary to protect the baby's life and the mother's health."
"The State Attorney's Office does not make medical decisions; we just made sure to present the facts to the Court so that a judge could make a decision in accordance with the law," the agency wrote.
The report also tried to take a stance from the University of Florida hospital in Jacksonville, which said it could not share information about the case, as it needed to "protect the patient's confidentiality."
Two of the doctors who participated in the video call with Cherise had also not responded to interview requests at the time of publishing this text.
Differences from State to State
Amy Yurkanin, journalist for the website ProPublica, explains to BBC News Mundo that it is the legislation of each US state that defines how much decision-making power a mother has during childbirth.
“Some states have determined that, in fact, you cannot intervene in the medical decisions of a pregnant woman,” says the journalist.
"On the other hand, in other places, it has been established that it is possible — in certain cases — for a judge to intervene and essentially overturn the woman's decisions."
"In Florida, in fact, there have been several cases related precisely to this issue, and state courts have confirmed, on several occasions, that, under certain circumstances, a judge can intervene and make decisions about a woman's medical care that differ from those she would have chosen herself", points out Yurkanin, who has already written about a woman who went through a similar situation to Cherise, although cases like these are rare.
A date that brings pain and joy
Two years after her experience in the hospital, Cherise says she is still shaken by what happened.
"It's very difficult for me to move on because this was a life-changing experience."
Cherise filed a lawsuit against the hospital, arguing, among other things, that staff denied her access to a legal representative during the hearings and exaggerated the risk to the baby in order to perform the cesarean section.
"Even on the baby's birthday, it's not just a birthday anymore. It's the anniversary of a trauma. I can't get excited about my daughter's birthday because, at the same time, I'm reliving one of the most traumatic moments of my life with this cesarean section ordered by a judge", she laments.
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