The Fight for Black Maternal Autonomy: Forced C-Sections and a History of Exploitation

For many Black women, OB-GYN care carries a long and troubling history of exploitation and racial bias. This history extends back to the 19th century, with figures like J. Marion Sims, often called the “Father of Gynecology,” who performed experimental surgeries on enslaved Black women without anesthesia [1]. Today, concerns persist, with reports indicating hospitals are more likely to steer Black mothers toward cesarean sections than white mothers.

This fight for medical autonomy is escalating, as evidenced by the recent cases of two Black women who allege they were pressured into C-sections, violating their right to make their own medical decisions. A new investigation by ProPublica is bringing their stories to light.

Virtual Courtrooms and Forced Surgeries

In 2024, Cherise Doyley was in labor for 12 hours at University of Florida Health in Jacksonville when a nurse presented her with a tablet. She found herself in a Zoom court with a judge, several lawyers, and hospital staff. ProPublica reported that the hospital initiated this emergency virtual hearing to compel Doyley, a professional birthing doula, to undergo a C-section she had explicitly refused.

Doyley, understanding the risk of uterine rupture to be less than 2 percent, stated she would only consent to surgery if a genuine emergency arose. She reported being the only Black person on the call and expressed feeling overwhelmed, stating, “I have 20 white people against me, and because I am informed and I am making an informed decision, they are trying to take my rights away from me by force.” After requesting a Black medical provider, the judge reportedly dismissed the relevance of race, stating, “I don’t find that race really has much to do with this.” When Doyley later asked for assistance in seeing her newborn in the NICU, the judge indicated he could not help.

A Pattern of Intervention

Doyley’s experience is not isolated. ProPublica also reported on the case of Brianna Bennett, who went to Tallahassee Memorial Hospital in 2023. After three previous C-sections, Bennett desired a vaginal birth. However, when her labor extended longer than expected, a virtual court hearing was held from her hospital bed. As her baby’s heart rate increased during the hearing, the judge ordered the surgery.

This wasn’t the first instance of the hospital seeking court intervention to force a patient into unwanted surgery; similar situations occurred in 1999 and 2009.

Legal Framework and Disparities

C-sections can be performed as planned or emergency procedures, but ProPublica highlighted that when labor is progressing slowly, as in both women’s cases, the necessity of surgery is less clear.

These cases occur within a legal landscape where state laws govern the rights of pregnant women. Currently, 29 states have laws that can override advance directives, even when the fetus is not viable, according to Pregnancy Justice. This is the case in Florida, where both Doyley and Bennett gave birth. Florida lawmakers are considering legislation to recognize embryos and fetuses as legal persons in wrongful death lawsuits, which advocates fear could lead to increased forced interventions.

Because decisions often rely on subjective assessments, such as evaluating the pace of labor, bias can influence outcomes. This may contribute to the disproportionately higher rate of C-sections among Black women, even when their medical circumstances are comparable to those of white patients.

The Emotional Toll

For Doyley and Bennett, the consequences of unwanted C-sections extended beyond statistical data. Doyley stated she will no longer perform as a birthing doula, finding the experience “too traumatizing.” Bennett shared that she cried daily after her surgery, expressing a sense of disappointment and lack of joy despite being “supposed to be thankful.”