"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

The Big Picture

Dear supporters of choices in childbirth,
Many, but not all, of you are aware that a woman's right to informed consent and refusal and the ability to self determine the path of her pregnancy and birth are rapidly eroding. Very personal decisions that belong to a woman, her family and her health practitioner have and continue to be usurped by outside forces. Medical organizations, hospital administrators and their lawyers, malpractice insurance carriers, government agencies and, yes, even physicians have intruded on the once sacred doctor-patient relationship. Policies that deny patients legal and ethical rights have formed despite a lack of evidenced based medicine. Although "patient safety" is always the tag line associated with these policies, when scrutinized, it is clear that they are about economics, expediency and litigation mitigation.
The banning of VBACs, the push against midwives and out of hospital births and the lack of training new physicians in techniques such as selected breech delivery have not only limited the choices of women across the country but evidence would support that it has put them at more risk. 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 and learning disabilities. We believe that the current trend is dangerous and needs to be exposed and confronted. 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. The decision of how to birth must be returned to informed women. The time has come to push back against the system that profits from fear and expediency before there are no health practitioners left willing to stand up.
One of our own, Dr. Stuart Fischbein, has long been a voice of reason for the rights of patients to true, not skewed, informed consent and informed refusal. He has written a highly publicized letter to the American College of Ob/Gyn, co-authored "Fearless Pregnancy, Wisdom and Reassurance from a Doctor, a Midwife and a Mom", been a featured speaker at The Contoversies in Childbirth Conference last March in Fort Worth, Texas and is a multiple award winner from the Doulas Association of Southern California. He has also walked the walk and supported patients who chose to attempt VBACs, home births and breech deliveries. One of only a few doctors left willing to support midwifery. In the past several months he has done 3 successful VBACs, allowed 3 first time moms to deliver vaginal breeches and accepted home birth transfers from licensed midwives. For that he is now being threatened with a disciplinary process by the hospital where he works in Camarillo, California for violating hospital policies. A process that threatens his practice and his livelihood. His loss would 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 of us 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. Being a dedicated obstetrician is a calling. The hours are long, the life is disruptive and there is not much money to be made. This bullying of doctors and midwives who do not conform will most certainly spread across the country. Many have just given up unable or unwilling to mount the energy and funds to fight back. On behalf of Dr. Fischbein, the midwifery model of care and pregnant women present and future we are asking for your help.
That is why we are forming the "Birth Choices" legal defense fund. We can wait no longer. The only effective way to regain choices for women is to go to the media and put together a legal team. This is an expensive process that no individual can sustain. Confronting large institutions backed by corporate money is an uphill battle. Lobbying Congress for legal protection for women will require funds and hopefully some pro bono legal experts. Please give generously by clicking on the PayPal link, code: angelfischs at yahoo.com and pass this message on to every family and friend you know. For the wonder and joy of giving birth should remain a very personal liberty and a special gift that touches everyone. We need you. Please help. Thank you.


  1. Thank you for doing your work so well.
    Please don't give up.

  2. As an unemployed mother of 3, just starting up a childbirth education business, I am unable at this time to help in a monetary way..however, I would love to help in any other way possible. Please look up my website at www.birthyourway.org to contact me!

  3. Oh please. Fucking patients is usually frowned upon!