"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.

Tuesday, August 25, 2009

NY woman seeks VBAC provider

Dear Dr. Fischbein,
I just found out today that I am about 4 weeks pregnant! We are very
excited except that my OB, who delivered my two daughters, now nearly
13(emergency CS - due to distress of baby) and 11(VBAC) now tells me today
that a VBAC is "not allowed" because it is too dangerous. I am floored. I
do not want to have a c-section. The recovery from the first one so long
ago was very difficult. And since I did the VBAC successfully before, I
would like to do it again. However, now I must find another OB and
hospital that will allow it. I am having trouble finding a VBAC
supportive OB on the web. Perhaps you could help me - or at least tell me
a website that can help me locate one? I am located in Orange County, NY -
my zipcode is 10990. Thank you in advance for your help. Jen Emm

Dear readers: "Too dangerous" is routinely being substituted for true evidenced based informed consent. This sort of subjective counseling for a variety of motives is becoming pervasive and part of the culture. It is a prime example of the well known propaganda technique of, "Tell a lie, tell it often, tell it loud and it becomes truth". If you have any ideas for Jen please comment below and feel free to e-mail her. Thanks, Dr.F


  1. I'd suggest she get in contact with her local ICAN chapter, look at the ICAN VBAC policy database to find hospitals and providers willing to do VBACs, and perhaps contact some local doulas--they'd likely know which doctors or midwives to go to.


  2. I did not have a c-section with my first, but did have a homebirth with my second. I have a great midwife in Rockland County. It's kinda a drive for you but a great alternative since you know you can have a safe vbac, you've done it before!!

    Good luck to you.

  3. I know this was posted years ago, but who was your midwife in Rockland?