After the delivery: The mental health consequences of lost autonomy in childbirth

By Mylika Scatliffe
AFRO Health Writer

The healthy arrival of a baby is viewed as the ultimate measure of a successful birth, but for many women an unexpected departure from their birth plan can leave emotional wounds that affect maternal mental health long after they leave the delivery room. This impact may be particularly overwhelming when a woman’s autonomy in childbirth is eliminated by the courts, such as in the cases of two Florida women where the courts were implored to intervene and initiate cesarean deliveries against the laboring mothers’ wishes. 

These cases raised complex questions about medical ethics, patient rights, political implications, and the lasting psychological effects of forced obstetric interventions.

Brianna Bennett and Cherise Doyley both had babies in two different Florida hospitals in 2023 and 2024, respectively. They both had previously given birth three times by cesarean section and wished to avoid C-sections for their fourth deliveries. The process of giving birth vaginally after a previous delivery via C-section is called VBAC, or Vaginal Birth After Cesarean.

In March 2023, Bennett’s labor exceeded 24 hours at Tallahassee Memorial Hospital. At the time she had three children already, and each of her previous C-sections was harder for her to recover from than the last. She eventually questioned the medical necessity of them in the first place. The recovery after the third surgery was so arduous  that she was left so incapacitated that she was unable to go to the bathroom unaided.  

By the time she was in labor for the fourth time, she was assisting in her own mother’s care, who was at times wheelchair bound. Recovering from abdominal surgery while caring for her family members presented a daunting task. Because of her familial responsibilities, she was insistent on attempting a vaginal birth.

Doyley arrived at University of Florida Health Hospital in Jacksonville after her water broke. Doctors were concerned about the risk of uterine rupture and encouraged her to undergo a cesarean but Doyley, herself a professional doula, understood the risk of the potentially deadly complication to be less than 2 percent.  She refused repeatedly to consent to the C-section without at least attempting a vaginal delivery first. Like Bennett, Doyley endured difficult recoveries after her previous cesarean deliveries, including one where she was hospitalized after a post-birth hemorrhage.

Doyley and Bennett, in disturbingly similar circumstances, found themselves in court proceedings via Zoom from their delivery beds while in active labor,  a tablet shoved in their faces with a gallery of nine or 10 people, including a judge, attorneys, doctors and hospital representatives as they fought for their rights to make their own medical decisions, simply because they were pregnant women.

It was especially disheartening as Black women to be fighting for their rights while alone, in labor and vulnerable against a board of almost exclusively White faces.

Observed in May, Maternal Mental Health Month raises awareness about perinatal mood and anxiety disorders which affect one in five expecting or new mothers. Experiences like the ones endured by Doyley and Bennett highlight how issues of maternal morbidity, mental health and fetal personhood intersect.

Dr. Marilyn Berchie-Gialamas, a maternal health nurse practitioner, founder and executive director of Trinity Maternal Wellness, healthcare director of Trinity Wellness LLC, and assistant professor at Morgan State University, spoke with the AFRO about the importance of establishing a birth plan, and how it impacts a woman’s birth experience.

A birth plan encompasses the wants and desires of an expectant mother and her family for their baby’s delivery. It includes all aspects of birth, including but not limited to who should be present in the delivery room, pain management measures, preferred labor positions and delivery methods.

“There are so many things you can talk about with regards to a birth plan. ‘Do I want a vaginal birth? Skin to skin contact immediately after birth? Do I want to breastfeed immediately?’” said Berchie-Gialamas. She emphasized that both patient and medical provider should be educated, flexible and prepared for give and take because a birth rarely goes 100 percent according to plan.

Nevertheless, if a mother is stripped of her bodily autonomy, as what occurred in the Florida cases of Doyley and Bennett, the birth experience takes on a negative connotation and becomes a place of trauma, hurt and pain. That trauma can linger for years after the birth.

Doyley described in an interview with ProPublica how she could not shake the feeling of violation after her last birth experience. “When the courts basically strong-arm, bully someone into an unnecessary procedure against their will, it’s akin to torture in my eyes,” Doyley said. Over the course of her virtual hearing she requested a transfer to another hospital because she didn’t want anyone participating in the hearing involved in her care. This request was denied. 

Doyley’s concerns were not just limited to the risk of the cesarean itself. She was also concerned about who would care for her other children during recovery if she were to undergo this major surgery. She was not able to explain her concerns until the judge decided to unmute her during the proceeding.

Imagine having to be unmuted to express concerns about the care for yourself and your baby.

“This is where mental health comes in, because now when you think about the birth of your child, which should have been a joyous occasion, you’re reliving a traumatic experience,” said Berchie-Gialamas.

Since her experience during her last delivery. Doyley has taken largely to social media to discuss her experience and encourage and empower other women to advocate for their rights and bodily autonomy.  

Fetal personhood is the theory that a fetus possesses rights independent of the pregnant woman.  Advocates argue that recognizing fetal rights protects unborn life while critics assert that fetal personhood potentially creates conflicts between the interests of a fetus and the rights of the woman carrying it.

For Black women, debates over fetal personhood intersect with deep-rooted concerns about reproductive autonomy and medical mistrust and racism. In a health care system where Black women are already marginalized and at risk for disproportionately high rates of maternal morbidity and mortality, the worry exists that policies prioritizing fetal rights over maternal decision-making might further undermine patient autonomy and contribute to birth-related trauma.

While Florida’s legal battle over fetal personhood has raised concerns about the extent to which a pregnant woman’s medical decisions can be overridden in favor of fetal welfare, other healthcare systems have adopted the opposite approach where informed consent and maternal autonomy is emphasized and a model of care that recognizes pregnant patients as the primary decision-makers in their own treatment.

According to Dr. Aneesha Varrey, a board-certified obstetrician at Greater Baltimore Medical Center (GBMC), mothers are most important.

“The way we see it, as long as they don’t have impairment in judgment and have the mental capacity, mothers hold the utmost responsibility and right to make their own decision,” said Varrey.

Varrey encourages her patients to begin thinking about their birth plan in the first trimester so she can answer any questions they have or provide information for them to make informed choices. By the third trimester she has them print out a paper birth plan and note what they want and don’t want so she can go through it with the patient.

“We go into all the details of everything concerning the birth, even how to proceed with a cesarean if one becomes necessary. Some women may not want it as an emergency measure because the sudden flurry of activity of people rushing in and out can be traumatic while rendered immobile on a surgical table, so if we see it going the route of a likely emergency, we can proceed with the C-section in a calm and controlled way,” Varrey explained.

In situations where there are concerns the mother is at risk but does not quite understand, there are avenues for providers to pursue, without involving the courts.

“If there is ever a situation where we feel like this mother is acting in a way to harm herself or we’re not getting through to her about serious risks or don’t understand what we’re trying to tell them, we can to go to a hospital ethics committee where we can review the case with a whole board or there are other people we can champion to come and talk to the patient,” Varrey said.
“I always encourage patients to call a trusted family member so they can feel like someone is on their side.” 

Varrey emphasized that many babies have been delivered at GBMC and there has never been an instance where the hospital had to take a laboring mother to a virtual court proceeding and have a judge decide how she should give birth.

“It’s my job as a medical expert to dispel myths and provide good sources of information ahead of time to assist with their decision-making,” Varrey said. “Even in the most difficult scenarios, if we’ve had these conversations way ahead of time, mothers feel more prepared and confident to make informed decisions when the doctor comes in and says something like the baby’s heart rate has dropped.” 

In situations where a mother has experienced trauma or postpartum depression or anxiety, Varrey has made referrals to reproductive therapists and/or psychiatrists. She also encourages women to hire doulas to support and advocate for them during birth and the postpartum period.

The experiences of women like Doyley and Bennett who have been caught in Florida’s fetal rights disputes reveal the potential consequences when fetal interests are elevated in medical decision-making, leading to trauma for mothers and babies for years after birth and, possibly, death for the mother.

According to data collected in 2020 and published in 2024 by the Centers for Disease Control and Prevention (CDC), 83.5 percent or maternal deaths were categorized as preventable, and for Black women, cardiovascular conditions are the top underlying cause of maternal death.

GBMC has championed the cause of reducing the racial disparities in maternal morbidity and mortality rates. From 2022-2025, the Maternal Newborn Health team at GBMC decreased severe maternal morbidity due to postpartum hemorrhage from 7.6 percent to 2.75 percent. 

A multidisciplinary Maternal Newborn Health Equity committee formed in 2024 and collaborated in actionable ways to continue this positive momentum. Most recently, GBMC started a Respectful Care Committee to ensure patients are provided with the best experience. including making sure they feel heard, have them collaborate in decision making about their plan of care, and debriefing after traumatic events.

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