"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

From the Coalition for Breech Birth


Respecting the Choices of Women

Vaginal breech birth was practically banned following a significant international research study in 2000. This study, the "Term Breech Trial" or TBT, appeared to prove that caesarean section was substantially safer for the delivery of all breech babies. The trial was highly criticized, but many birth care providers took this opportunity to do what they wanted to do anyway - to stop offering vaginal breech birth to their clients, and to insist instead upon a surgical delivery. Very few centres continued to offer vaginal birth. To read the original TBT report, click here.

In addition to all the professional criticism, the TBT's own two year follow up negated the original results, suggesting that any difference in safety between vaginal and surgical birth of a breech baby is negligible - for both mother and child. Despite this evidence, many Birth Care Providers (BCPs) still avoid balanced informed choice discussions with their clients, denying them the opportunity to make an informed choice. Most frequently, it is flatly stated that surgical birth is the standard of care, and that is what is going to happen - regardless of that mother's individual circumstances. If vaginal birth is mentioned at all, it is brushed off as an inferior, unsafe choice. However, caesarean surgery, while it presents many advantages for the surgeon, has lifelong ramifications for the birthing woman and her family, including issues with subsequent pregnancies, secondary infertility, Vaginal Birth After Caesarean (VBAC) availability, and depression, not to mention a risk of death in childbirth increased threefold over vaginal birth.

Women should not be obliged to accept these serious risks as "standard of care" when clinical research clearly demonstrates that vaginal birth of a breech baby does not pose an increased level of risk. In addition, the recommendations of professional organizations such as The Society of Obstetricians and Gynecologists of Canada do not support automatic caesarean for breech. Yet, time and again, vaginal breech birth is presented as tremendously difficult and dangerous, and caesarean risks glossed over.

Our mission is to fill the gap in the informed choice discussion by offering women the evidence-based information and the vital support they need to make their own decisions.

1 comment:

  1. Thank you for posting this Dr. I also wanted to mention that the CBB is organizing the Second International Breech Conference this year which already includes an impressive panel of birth professionals with research supporting the importance of offering informed choice about vaginal breech birth, but also invites consumers to part of the discussion about re-normalizing breech and birth. Check it out at www.breechbirth.ca .