"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

No progress on Midwive's Privileges

My take: As of today, the hospital's legal counsel is still playing a childish game of semantics which is hurtful to both midwife and patient. We have honored their request for physicians willing to back them on days when I am in my other office. One of the physicians has not been approved because she requires proctoring for obstetric admissions. While this may sound reasonable it is really absurd. Her proctoring requirements have been in place since July of 2008 and have not changed. From July 2008 until January 2009 the midwives and I shared call with her and several other physicians. No one complained then. Since January she has covered several physicians in a call group without restriction. She has also covered me and the midwives when I had to go out of town. And no one complained then. When asked to explain this situation today, the chief of staff told me he would have to discuss this with legal counsel and get back to me tomorrow. It seems clear to me that these decisions are coming from a lawyer who benefits financially each time he can be obstructive and is in no hurry to respond or resolve this dilemma. Meanwhile it has now been 2 weeks since they abruptly restricted the midwives from caring for inpatients. Lets see if they follow through tomorrow and what they will think of next. Thanks for reading. Comments welcome. Dr. F

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