"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, September 2, 2009

Comment on Huffington Post

As a newly trained physician just out of residency back in the 80s I remember inviting my parents to Las Vegas for my formal acceptance ceremony into the fellowship of ACOG. I was so proud to be a part of what I thought was the pinnacle of my profession. Fast forward 20 years and now I wonder what has happened. Did they change or did I? ACOG does many good things and their continuing education and promotion of some research and programs have been a benefit. But, all too often of late, they have done some really stupid things. ACOG has released several Committee Opinions that defy evidenced based research, common sense and even the the very foundation of their organization that purports to respect a woman's autonomy and choice. I have written them for an explanation as to who decided and on what evidence and received only anecdotal hogwash from their executive vice president. Whether they or their blind supporters and shills like Amy agree with out of hospital birth is not the real question. To make statements based on "consensus opinion" that are purposely designed to remove choice is unscientific, unprofessional and belittles their organization. Those that are behind these pronouncements know what they are doing will influence policy, insurers and hospital administrators. It is an abuse of power and wholly unhypocratic. Patient autonomy and choice as well as honesty are the issue here. Whether readers, shills or ACOG are supportive of home birth and midwifery or not we should all strive for respect of the patient's intelligence, dignity and liberty. ACOG comes out last year with a statement against out of hospital birthing and now puts out a call for stories to back up their opinion? Isn't that sort of backwards, insulting and poor research technique? Simply embarassing. Not the pinnacle anymore.


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