"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.

Wednesday, August 26, 2009

Milbank Report referenced in Support Letter

Dear M. Murray,

I have become aware that Dr. Stuart J. Fischbein is being threatened with disciplinary action for practicing evidence-based maternity care and defending woman’s autonomy and right to informed choice, as well as supporting midwives and the midwifery model of care.

According to your mission statement, “It is our goal that health care be provided in a holistic way, respecting all dimensions of a person. At a time of extraordinary technological advancement developed to cure disease -- one that focuses on the physical dimension of person -- we need to emphasize and embrace the psychological, social and spiritual dimensions of persons.

Health care is patient-centered. Patients have the right to make medical treatment decisions (including accepting or rejecting treatment), which includes free and informed consent, access to medical and other information regarding their care…”. Apparently your facility says, birthing women are insured and encouraged to make health care decisions autonomysly and are not forced to have procedures done on them and to them that could do harm. In this case I am referring to your policy for vaginal birth after cesarean and the midwifery model of care. Are your employees walking the talk?

Your own on-line statement says “A woman may or may not be able to have a vaginal birth with a future pregnancy, called a vaginal birth after cesarean (VBAC). Depending on the type of uterine incision used for the cesarean birth, the scar may not be strong enough to hold together during labor contractions”.

ACOG’s brochure on VBAC states:

Today, doctors know that many women who have had a cesarean delivery can later safely give birth though the vagina. This is called vaginal birth after cesarean (VBAC) delivery. VBAC can be a safe option for many women.

Of women who try VBAC, 60–80% succeed and are able to give birth vaginally.

There are some reasons why a woman may want to try VBAC over cesarean delivery:

· No abdominal surgery

· Shorter hospital stay

· Lower risk of infection

· Less blood loss

I will add to this; more success with breastfeeding.

It is your responsibility to know that uterine rupture happens less than 1% of the time. This is far less that the risks of other serious events in labor. If a hospital is not safe to have VBAC, it is not safe to give birth.

In 1987, Angela Carder, a pregnant cancer patient, died along with her baby at George Washington University Medical Center after a court-ordered Cesarean Section. As a result of this case, beginning in the early 1990s, hospitals began to set policies stating that decisions regarding pregnant patients would be made by the patient herself, her family, and her doctors.

When medicine is practiced primarily for profit, convenience and out of fear of litigation it is not good medical practice nor is it evidence-based medicine.

The c/section rate in this country is nearing 1/3 of all births. While the current hospital model will profit from this trend you must ask at what cost? Evidence is clear that repeated c/sections put women at greater risk and the evidence mounts that babies born this way have higher rates of breathing difficulties, breastfeeding difficulties and learning disabilities. Doctors and midwives who stand up for patients rights are often the target of ridicule and harassment by the very hospitals and organizations that their hard work supports. Does this sound like what is happening at your facility??

Losing Dr. Fischbein will have a devastating effect on the ability of midwives to continue to care for patients and for patients to have options other than c/section. Many believe that hospital policies that force women into surgery, deny them informed consent or tell them they must go to a different institution are unethical, in violation of EMTALA and even possibly illegal.

What other medical modality forces a healthy person to undergo major abdominal surgery against their wishes? Name one please.

Your policy is an assault on a woman's right to self determination, likely for economics, expediency and litigation mitigation, plain and simple.

I encourage you and your entire OB staff to get better informed by reading the Milbank Report – Evidence-Based maternity Care: What It Is and What It Can Achieve http://www.childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf . There is no excuse for ignorance and no room for arrogance in providing stellar maternity care.


Jeanne Batacan
Jeannie Batacan
Help bring transparency to maternity care. Take The Birth Survey! Share, Connect and Learn. www.thebirthsurvey.com
Watch this video! www.reducinginfantmortality.com

1 comment:

  1. Wait - a woman was COURT-ORDERED to have a c-section? How the hell is this possible?

    This whole post just sickens me. What are we, drones incapable of forming rational thoughts and pinions, unable to decide for ourselves how to give birth, while being trusted at the age of 18 to make the decision to go risk our lives in war?

    I'm at a loss for words about disciplinary action for not keeping people in the dark and I just can't understand how someone can be forced into surgery. Complete loss.