"All that is necessary for the triumph of evil is for good men to do nothing" Edmund Burke, 18th century Philospher.

"A long habit of not thinking a thing wrong gives it a superficial appearance of it being right." Thomas Paine

"The welfare of humanity is always the alibi of tyrants." Albert Camus

"Choice is the essence of ethics: if there were no choice there would be no ethics, no good, no evil; good and evil have meaning only insofar as man is free to choose." Margaret Thatcher, March 14, 1977

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

Explaining the Cause

I am a practicing obstetrician who is a strong supporter of patients rights to informed consent and refusal. I believe a patient has the right to choose her own path given true and not skewed informed consent. Following that tenet, just as a woman should be able to choose to have an elective c/section she should be able to choose not to have one, as well. The American system of hospital based obstetric practice has been eroding those choices for women for quite some time. Due to concerns of economics, expediency and fears of litigation women are being coerced to make choices that may not be in their best interest.

I have had a long relationship collaborating with midwives and find the midwifery model of care to be evidenced based and successful. I was well trained at Cedars-Sinai Medical Center in the mid 80's to perform breech deliveries, twin deliveries, operative vaginal deliveries and VBACs, and despite evidence supporting their continued value, hospitals are "banning" these options. Organized medicine is also doing its best to restrict the availability of access to midwives.

Home birthing is not for everyone but informed choice is. Medical ethics dictates that doctors have a responsibility and a fiduciary duty to their patients to provide true, not skewed, informed consent and to respect patient autonomy in decision making. Countries with the best outcomes in birthing have collaboration between doctors and midwives. This is not what has been happening in the hospitals of America. Its time for a change and the return of common sense.

The midwifery model of care supports pregnancy as a normal function of the female body and gives a legitimate and reasonable alternative to the over-medicalized model of birth that dominates our culture. Through this blog I hope to do my part to illuminate what is wrong with our maternity care system and what is right with it. I do not expect all to agree and that is OK. We must all understand that given honest data it is not always reasonable to expect two people to come to the same conclusion. Our differences should be respected.

Monday, August 24, 2009

Another Support Letter

August 24, 2009

Mr. Michael T. Murray,

I am disappointed to hear about your hospital’s actions against Dr. Stuart Fischbein and his supporting CNMs. I believe it is wrong to punish them for helping women achieve the safe vaginal birth they desire. Those women would have been subject to a major surgery they were opposed to, and proved unnecessary, otherwise.
As an expectant mother, I hope to have freedom of choice, informed consent, and informed refusal during my birth experience. I consider this a basic human right. If I were in need of an obstetrician to safely deliver my breech or VBAC baby, I would hope the opportunity would not be denied for me to have a vaginal birth. I hope I would have the support of the medical community on my side to help me through.
I am not anti-cesarean. I believe there is a time and a place for it, and it has saved many lives. I am thankful to live in a society where such things are readily available to me and my child should the need arise.

However, I also believe in women’s ability to give birth safely, even in less than optimal circumstances. I believe a woman should have the right to review the available data without fear-mongering and make a decision that fits her beliefs and preferences. I also believe that once she makes her choice, it should be supported by the medical system. I believe the medical community is here to serve us, the people.

We are not to be held hostage to a system over our own bodies for monetary or legal concerns. Incidentally, failure to recognize and support my wishes concerning my own body is a more serious offense to me than the fact that some babies die. It is a fact of life that death cannot be thwarted. Heartbreaking as that may be, we cannot control the element of life. What can be controlled is how you treat those in your care. Dignity and respect are called for, even if their choices differ from what yours would be.

That being said, vaginal birth has not been proven more dangerous or life threatening than cesarean section. The statistics demand freedom of choice. VBAC and breech vaginal birth have happened safely and should continue to do so. Obstetricians should be trained to handle these events safely so that women can chose what to do with their own bodies.

I appreciate the efforts of Dr. Stuart Fischbein. He is a hero to me for safely supporting vaginal birth for those who wish for it. I hope you’ll train and hire more people with his character and skill set. Without skilled obstetricians, women who feel strongly about birth and their choices will resort to birthing at home without the immediate back-up and monitoring they should have the right to. Is this not more dangerous than allowing vaginal delivery in the hospital?

I urge you to revise your hospital policies to allow more freedom of choice.



1 comment:

  1. Thanks Dr. Fischbein for your support of women and their decisions and choices about childbirth. Thank you also for your support of midwives.

    Having been in similar circumstances as you and the midwives on many occasions myself, I know first hand how hard, infuriating, frustrating, and incredibly sad it can be.

    Good luck- many of us out here are rooting for you!