"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.

Thursday, August 20, 2009

Letter of Gratitude for Breech birth

Dear Mr. Murray,
I recently had the pleasure of bringing my daughter, Isabella, into the world in your hospital. I hadn’t planned or wanted to give birth in a hospital but because my baby was in a breech position and nothing was going to make her turn, being in a hospital was the responsible thing to do. All four nurses who attended to me during our stay, Elaine, Meredith, Becky and Brooke, were fantastic as well as Midwife Lynn who works with Dr. Fischbein. Lynn and Meredith were particularly amazing. They were extremely attentive and caring and were very respectful of the requests I made in my birth plan. I would also like to say that Dr. Rao was really great as Isabella’s pediatrician and did her best to accommodate my birth plan, which was all I could ask for.
But the main reason for my letter is to express my profound gratitude for being able to deliver my baby naturally and it’s all because of Dr. Stuart Fischbein. We even drove up from Hollywood so he could deliver her. There aren’t many obstetricians today who are willing, and many who aren’t qualified, to deliver a breech baby. It’s truly regretful that knowing how to deliver these babies is becoming a lost art. There is a wealth of evidence of the benefits of normal, spontaneous labor and vaginal delivery to both mother and baby, which shouldn’t be a surprise as the best way has always been the natural way. The routine use of cesarean sections circumvents this beneficial process. Of course, not all breeches are good candidates for vaginal delivery but many are.
I have become very passionate about this issue and am getting more involved with other ‘Breech Baby Advocates’, as I call them. I am pleased that there has recently been a shift in the way breech presentations are being viewed. Canada’s Society of Obstetricians and Gynecologists (SOGC) has released new guidelines stating that c-section for breech babies is no longer considered the safest way. The new approach was prompted by a reassessment of earlier trials. ‘It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.’
“Our primary purpose is to offer choice to women,” said André Lalonde, executive vice-president of the SOGC. With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births. We should follow suit. Dr. Fischbein makes it possible for women delivering in your hospital to have that choice and that alone puts St. John’s Pleasant Valley Hospital at an advantage over other hospitals. We are deeply grateful for our experience there.

Lindsay Sauvé

1 comment:

  1. Very thoughtfull post on gratitude. It should be very much helpfull

    Karim - Mind Power