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5 December 2013

Forced C-sections and stolen babies

The Alessandra Pacchieri case looks like the 'stuff of nightmares', but the problems it highlights are real. By Jennie Bristow.

The ‘forced C-section’ case that was recently brought to light by the Sunday Telegraph has sparked horror and condemnation across the British media and women’s rights organisations. Alessandra Pacchieri, an Italian woman who has bipolar disorder, was on a work trip to Britain in June 2012 when she had a psychotic episode. She was restrained and sectioned under the Mental Health Act; her baby was forcibly removed by C-section and then put up for adoption.

The specifics of this case are still somewhat unclear, but the reaction to it has focused on three main areas of concern: forced C-sections, the treatment of mothers with mental health problems, and the current policy trajectory of rapid adoptions.

Forced C-sections. Much of the horrified reaction to this case comes from the idea that it is permissible, in the twenty-first century, to sedate a pregnant woman and perform a medical intervention on her against her will. A central principle of women’s reproductive autonomy is that she cannot be forced to have a C-section, or any other obstetric intervention, even if not doing so might harm or even kill her, or her baby.

Any woman who has been through pregnancy and childbirth will be familiar with the extent to which medical professionals will ‘strongly persuade’ them to have interventions that are seen to be in their best interests, and also the extent to which women are denied interventions that they might want, such as C-sections or epidurals. But there is still a clear line regarding consent: and the image of a woman being forcibly anaesthetised and having her baby taken out of her, is indeed, as one human rights group put it, ‘the stuff of nightmares’.

It could be that things were more complicated in this case – and that the C-section was, as the journalist Zoe Williams writes, ‘the least controversial decision in the process’. Williams quotes Alex Sykes, a former family lawyer, saying: ‘Try looking at it in reverse. Imagine recovering from paranoid personality disorder to find that you’d refused a C-section and your baby was stillborn.’ The fact that Alessandra Pacchieri was, at the time, detained under the Mental Health Act complicates matters; this case does not indicate that pregnant women’s capacity to consent to surgical interventions is routinely being undermined. There seems to have been something else going on, to do with the degree to which Pacchieri was considered mentally competent to consent at the time.

However, detention under the Mental Health Act does not automatically equate to mental incompetence. And even if we assume that this C-section was conducted by doctors for the best possible reasons, the fact that the decision has been so contentious indicates that there are important unresolved issues here, in how the operation was decided upon and communicated. These, in turn, relate to questions about how mothers with mental health problems are perceived and treated.

Mothers with mental health problems. Alessandra Pacchieri’s case seems to have turned on the fact that she suffers from bipolar disorder. At the time she was detained under the Mental Health Act, she had stopped taking her medication. The reaction to this case has been informed by an understandable level of disbelief that Pacchieri’s condition could have led to her being branded unfit as a mother. Mental health problems such as bipolar disorder and depression are hardly unusual today, and for the main, they do not stop people from being able to do their jobs, raise their families, and sustain relationships.

In this case, the problem seemed to be that Pacchieri was not taking her medication: but again, this is not surprising. In recent years there have been growing concerns about the potential teratogenic effects of drugs used to control mental health conditions, and pregnant women often struggle to weigh up the decision as to whether they should continue taking medication to stabilise their condition but risk causing their baby to develop some kind of anomaly. Pacchieri herself says: ‘The drugs are strong and can harm an unborn baby, so I had stopped taking them’. Even if she may have been better advised to carry on taking the drugs, her decision not to certainly cannot be seen as the mark of a mad or irresponsible woman; it appears more like the decision of a rational, caring mother-to-be.

In recent years, there seems to have been a more widespread acceptance of the notion that mental – or physical – disability automatically makes somebody less fit to be a parent. Again, the logic of this argument is couched in terms of the ‘welfare of the child’; it is simply assumed that it is unfair to saddle children with the responsibility of having a parent who is prone to episodes of depression, or who is unable physically to do all of the tasks that able-bodied parents do.

I once listened to a conference speech by a blind mother, who described being given all manner of grief by her children’s school and social worker because she could not check her daughter’s hair for nits. The school nurse and social worker would not check the child’s hair themselves, and were highly disapproving when the mother suggested that she get her older son to do it.

This small anecdote speaks volumes about the lack of compassion, imagination and flexibility ingrained in assumptions about parents with mental or physical disabilities. The idea that a mother’s inability to do all the ‘normal’ things outweighs the love and care she might have for her child, and therefore means that the ‘welfare of the child’ is best served by taking the child away, is wrong on so many levels it is hard to believe that such ideas are even considered.

Rapid adoption. According to one recent report, this was the timescale of events:

‘Ms Pacchieri… came to Britain in mid June 2012 for a training course at Stansted airport when she suffered what her legal team insist was a “panic attack” which led to her being sectioned. Ten weeks later, in late August 2012, the local health authority obtained an order enabling doctors to deliver the child by caesarean section while Essex County Council began care proceedings which led to the girl being eventually put up for adoption.

‘Despite a ruling in February that the adoption could go ahead, Ms Pacchieri is still fighting to get her child back and the final decision will now be taken by Britain’s most senior family judge, the president of the Family Division, Sir James Munby.’

Again, it is not exactly clear how and why Pacchieri’s baby was so swiftly earmarked for adoption. But the speed of this process has drawn attention to a wider problem – that very swift adoptions, justified in the presumed ‘best interests’ of the child with very little regard to the rights or feelings of the mother, are now becoming the aim of policy.

This was the proposal of the Narey review on adoption, published in July 2011, which was supported by Prime Minister David Cameron. The report stated, in its first chapter, ‘Central to this report is my belief that there is a very strong case for radically increasing the number of adoptions in England and in the rest of the UK. But to do so will require us to intervene earlier in the lives of large numbers of deeply neglected children and to resolve their permanent future much more quickly. Delay in intervention and then delay in achieving permanency for children is deeply damaging.’

The aim of current adoption policy is that children should be adopted as quickly as possible, rather than spending time in foster care and children’s homes. The assumption is that these children, who are taken away from their mothers, will end up in adoption or long-term care anyway, so it makes sense from their point of view to complete the process early. Linked to this is a drive to increase adoption numbers: and as is well known, babies are easier to place in adoptive homes than older children. But these assumptions, too, are dangerous.

The reason that social services are supposed to take great care with decisions to separate children from their mothers, and why the adoption process takes time, is because, as Narey himself says, adoption is ‘the ultimate intervention in the life of a child’. To take this irreversible step requires that social services know that a child will be damaged by staying with the mother – that her circumstances or behaviour will never change. This requires, at the very least, some time to allow things to work themselves out, and for the mother to represent her interests legally.

As Zoe Williams indicates, the speed at which this process took place in the Pacchieri case shows that what seems to driven the decisions here are a set of assumptions about the mother’s capacity and the best interests of the child, rather than the actual circumstances:

‘The adoption is the decision that should truly worry us, since it relies on a set of assumptions: first, that a bipolar condition is an irredeemable state that can never be managed; second, that fluctuating mental health, which makes it impossible for you to be the main carer for your children, is reason enough for you to be erased from their lives; and third, that rights given up to the state following a paranoid episode can never be won back.’

Whatever the precise ins and outs of the case itself, it seems extremely hard to justify the speed at which this life-changing decision, to take the baby away from her mother, was made. The only good thing about the case is that it has focused attention on the way that pregnant women with mental health problems can find themselves treated, and some of the problems with the policy trajectory of rapid adoption. It is to be hoped that this wider attention will also bring about a more just and compassionate resolution to Alessandra Pacchieri’s case.

IN THE COURT OF PROTECTION - Before: MR. JUSTICE MOSTYN (In Private) IN THE MATTER OF: Re: AA. Royal Courts of Justice, Thursday, 23rd August 2012

IN THE CHELMSFORD COUNTY COURT Case No. CM12C05138. Before: HIS HONOUR JUDGE NEWTON In the matter of: Re: P (A Child). Friday, 1st February 2013

Adoption order made in ‘forced caesarean’ case. Family Law Week, 20 April 2014

Also read:

The inhumanity of a forced Caesarean. The Italian woman forced to have a C-section was effectively treated as a fetal container. By Barbara Hewson. spiked, 6 December 2013

Commentary: Keep abortion out of adoption policy. Jennie Bristow criticises the new official strategy that encourages women seeking abortion to give birth and do adoption instead. Reproductive Review, 13 June 2012

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