"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.

Friday, August 21, 2009

Friday Meeting - My Take

So, met with the chief of staff, current and future as well as the head of the OB committee today. Bottom line is the OB committee does not want me to even offer the option of elective VBAC or vaginal breech delivery to women at either campus. If I were to agree to this then they seemed to suggest the disciplinary action might just go away. This is going to be a dilemma for me. An intolerable situation facing many private practice physicians today. Compromise your values to pay your overhead or compromise your practice to keep your values. In the meantime they are supposed to reinstate the midwives but I suspect it will not happen until early next week.

One thing was made clear to me today. The hospital believes the OB committee is the final arbiter of standards in this community and since none of them would offer a breech delivery then for me to do so is beneath the standard. Good outcomes and innovation are not relevant. They also essentially said that skewing your informed consent process is OK because allowing patients the option of VBAC affects other personnel such as anesthesia, peds and nursing and puts them at risk. While I do see their point, they did not want to hear that the patient has rights and is the one we are supposed to serve. There was no place for discussion of the risks of repeated c/sections or evidence supporting our midwifery model today. That was my take anyway. Will keep you posted.


  1. Dr. Fischbein,

    I'm so sorry this is happening. I've made a contribution to your legal defense fund. The women of Southern California need OBs like you!


    Jen from vbacfacts.com

  2. Hi Dr. Fischbein,
    Thanks for all you're doing. I've highlighted ths post on the ICAN blog's weekly feature "Best of the Birth Blogs" for this week (ending 8/23): http://ican-online.org/community/users/ican-blog/blog/best-birth-blogs-week-ending-august-23rd