Tag Archives: obstetrics

Before Roe v. Wade: The 50th Anniversary of a Landmark California Case

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Demonstrator at New York City Women’s March, January 21, 2017. Photo: © Edith Marie Photography

“Should abortion be legalized?” That was the question posed on a forum in 1964 on Pacifica Radio. Nine years before the Supreme Court would give its own answer in Roe v. Wade, a trio of panelists debated the issue for listeners in Los Angeles.

Prompting the forum was a bill in the Legislature to liberalize California’s abortion laws. At the time, abortion was illegal unless the mother’s life was at risk. The proposed legislation, endorsed by the California Medical Association, allowed exceptions in cases of rape or incest, or when a pregnancy was not life-threatening but posed other harm to a patient’s physical or mental health.

People v. Belous marked the first time a patient’s constitutional right to abortion was upheld in the courts.

Did the bill go too far — or not far enough? Each panelist had a different take. Attorney Zad Leavy discussed the legal quandaries of people facing unintended pregnancies. He was cautious about full legalization but critical of the existing ban. Dr. Robert Hood, an area surgeon, opposed the legalization of abortion and even questioned the validity of the medical reasons commonly cited for justifying abortions. In sharp contrast, Dr. Leon Belous, an attending physician at LA’s Cedars of Lebanon Hospital, did not mince words in his support for legal abortion on demand.

Belous felt outlawing abortion was an example of “man’s inhumanity to women.” As he put it, “An injured dog on the street is treated with more sympathy and concern” than the countless women dying annually, or who risked that fate, from self-induced or black-market abortions. “I have seen seven to 10 of these women every month for the last 32 years,” Belous continued. “I have been seeing them in my office, many of them in the operating room, and some of them in the morgue.” He told of one who had been raped and another in desperate poverty, unable to support a child.

Belous concluded by sharing his hope that California’s “antiquated, unrealistic, and barbaric” ban would be overturned. Five years later, Belous was at the center of a case that did just that. Continue reading →

Maternal Mortality: A National Embarrassment

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Americans spend more money on childbirth than any other country, but we’re not getting a good return on our investment.

Less than a century ago, approximately one mother died for every 100 live births — an occurrence so common that nearly everyone belonged to a family, or knew of one, that was devastated by such a loss. Fortunately, in most nations, those tragedies have declined over the years. In fact, in the decade between 2003 and 2013, only eight countries saw their maternal mortality rates rise.

Unfortunately, the United States was one of those eight countries, joining a club that also includes Afghanistan and South Sudan. Within the 31 industrialized countries of the Organization for Economic Cooperation and Development, an American woman is more likely to die as a result of pregnancy than a citizen of any other country besides Mexico. Among developed countries, the United States has one of the highest maternal mortality rates — and those rates are only getting worse.

Graph: CDC

U.S. maternal mortality has attracted the attention of organizations whose oversight you wouldn’t expect. Amnesty International, which most Americans associate with the fight against human rights abuses in far-flung authoritarian regimes, considers our high maternal mortality rates to be a violation of human rights. Additionally — and pathetically — one of the biggest sources of funding for maternal health in the United States comes not from taxpayers but from the pharmaceutical company Merck. The Economist quoted a Merck spokesperson as saying, “We expected to be doing all our work in developing countries.” Continue reading →

The Clash of Population and Prejudice in Madrigal v. Quilligan

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Mural (detail) in Boyle Heights, East L.A. Photo: Mictlan Murals

In August 1973, Guadalupe Acosta was admitted to the county hospital in East Los Angeles. She had been suffering from labor pain for hours, but she would soon endure even more misery in the delivery room. She recounted later how the attending physician worked aggressively to induce labor, pushing down forcefully on her abdomen — even hitting her stomach when he was caught in the swing of her flailing arms. In the end, all the torment she endured culminated in the death of her baby in birth.

Acosta later said she was “very inattentive” in the aftermath of the experience. “People sometimes have to tell me things twice. It’s not that I don’t understand them, it’s that I’m not there.” For Acosta, it was not just the loss of her baby that devastated her but also the loss of her ability to have children in the future. She found out, months later, that the hospital physician had decided to sterilize her. At the time, she had been too traumatized to understand what was happening.

Just as the right to access birth control and abortion should be defended, so should the right to have children.

The University of Southern California – Los Angeles County Medical Center (USC-LAC Medical Center), as it was officially called in the 1970s, was a hospital that many in East L.A. tried to avoid. It was a place they would only visit out of necessity if other hospitals weren’t affordable. For Dr. Bernard Rosenfeld, who worked there as a resident in obstetrics and gynecology, it was not hard to see how his own department reinforced that reputation.

Acosta’s traumatic experience was similar to other cases Rosenfeld witnessed — cases that showed a disturbing pattern of subjecting women, especially Spanish-speaking women, to sterilization without their informed consent. According to Rosenfeld, insistent medical staff would push sterilization on patients “before they go home” — often while they were still in pain or exhausted — so that they wouldn’t “change their mind by the time they come back to clinic.” Patients who had limited understanding of English were often uncertain of what was happening. Shocked by the unethical practices, Rosenfeld secretly copied hundreds of medical records to document what was happening at USC-LAC Medical Center. Continue reading →