SPRING HILL — Lisa Epsteen thought she had an advocate for her high-risk pregnancy in Dr. Jerry Yankowitz, chairman of the University of South Florida's department of obstetrics and gynecology.
But Wednesday morning, she opened her email to find the well-known expert threatening to send police to her Spring Hill home unless she immediately reported to Tampa General Hospital for a caesarean delivery.
Epsteen, 35, was more than a week past the due date for her baby boy. Despite an ultrasound that alarmed her doctors, she wanted to wait until Friday to schedule the caesarean surgery, which would be her fifth.
"I am deeply concerned that you are contributing to a very high probability that your fetus will die or your child will incur brain damage if born alive. At this time, you must come in for delivery," Yankowitz wrote.
"I would hate to move to the most extreme option, which is having law enforcement pick you up at your home and bring you in, but you are leaving the providers of USF/TGH no choice," he continued.
Epsteen said she panicked.
"In a couple of hours there are going to be cops on my doorstep taking me away from home — in front of my children — to force me into having surgery," she recalled thinking.
Then, she became angry: "There are any number of things that they could have done without threatening me."
The stay-at-home, homeschooling mother sought help from advocacy groups that she had joined for women wishing to attempt a vaginal birth after caesarean, called a VBAC. That's what led her to Yankowitz, who had approved taking on her high-risk case and was serving as her liaison to other USF obstetricians, Epsteen said.
Within three hours, Yankowitz had been contacted by a lawyer for the New York-based National Advocates for Pregnant Women, which demanded he "stop immediately any further threats or actions against Ms. Epsteen."
"Pregnant women are no different than anybody else in terms of their constitutional and human rights," staff attorney Farah Diaz-Tello said. "The threat he was making was both legally and ethically unjustifiable."
A nurse called Epsteen to say her surgery was scheduled for Friday as she wished.
USF Health spokeswoman Lisa Greene said the university could not comment, nor even confirm that Epsteen was seeing USF doctors, because of patient privacy regulations.
"At USF Health, we have great respect for the privacy of our patients," she said.
Tampa General officials deferred questions on the matter to USF.
Tampa police couldn't recall a case in which they were sent to bring a pregnant woman to the hospital for an unwanted caesarean. Spokeswoman Laura McElroy said the only possible legal grounds would be if the doctor established the fetus' life was in immediate danger, which would be difficult under patient privacy regulations.
Pregnant women have been forced to have undesired medical care. In Tallahassee in 2009, a court ordered a pregnant woman to remain in the hospital after a doctor said she risked a miscarriage if she didn't quit smoking and stay on bed rest. An appeals court later overturned the order.
Epsteen said she was speaking out to help other women.
"Honestly, I feel abandoned. There has to be a level of trust between provider and patient, and that has been betrayed," said Epsteen, who said she now fears returning to USF and Tampa General for her planned delivery. "It's circumstances like this that make women feel like they have no options but to birth their babies on their own — and put themselves in more dangerous circumstances — because they feel bullied."
While it's rare to see written pressure, women frequently feel pushed by doctors to consent to unwanted caesareans at the end of pregnancy, Diaz-Tello said.
From the medical perspective, risk to mother and fetus can increase after the due date passes. But there's also growing awareness that too many caesarean deliveries are performed for convenience and reduced liability. The science of determining due dates is imprecise, so babies delivered just slightly early can actually end up being premature.
Yankowitz was frank with Epsteen about the risks she faced after four caesareans, she said. They met multiple times during her pregnancy, and he stayed in touch by email.
In their last meeting on Friday, she said he urged her to think about his recommendation that she have a caesarean. Epsteen had developed gestational diabetes, another risk factor, plus the baby was not in a good position for a vaginal delivery.
When an ultrasound Tuesday showed the fetus in possible distress, other USF physicians sent her directly to Tampa General and wanted to deliver right then.
But she questioned their alarm. Besides, she couldn't leave her 2-year-old son with strangers. She was driving the family's only car, so her husband, a team leader at a call center, couldn't get to her.
"In Dr. Yankowitz's defense, and all of the other physicians there, I don't think they are trying to cover themselves. I think they really do have the best interests of my child and myself at heart," she added. "On the other hand, this is not the way to go about protecting my baby or me."
Yankowitz was named the USF chair of obstetrics and gynecology in late 2010. He is one of the few doctors in the nation who is doubly certified in genetics and maternal fetal medicine, according to the USF website. His areas of expertise include ultrasound diagnostics.
After the lawyer got involved, Yankowitz sent a subsequent email saying he wouldn't send law enforcement to Epsteen's home. "I personally recognize and respect your right to make the medical treatment decisions for both you and your unborn child. . . . In that regard, please understand my frustration as I truly believe you and your child are in jeopardy."
Times researcher Carolyn Edds contributed to this report. Letitia Stein can be reached at firstname.lastname@example.org or (727) 893-8330.