"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 23, 2009

Just an Update

Hi all, Very little news to report this week on my interactions with my hospital. Seems as long as I "behave" to their liking and, as such, ignore certain patients rights issues and give consent and admit patients per their recommendations all is well. Except that I have had to refer 5 patients this past month to other doctors or institutions so that they could have a chance at a vaginal birth. I have also had 2 patients reluctantly agree to a repeat c/section because they would prefer to remain with The Woman's Place and my care. I am waiting for my attorney to review some of their letters to see if we can at least challenge the taking of my credentialed privilege to do vaginal breech deliveries. I have long been approved to do them and there is no official policy against vaginal breech delivery at the hospital and yet they have told me if I allow another scheduled breech delivery they will suspend my obstetric privileges. Your support through all this has been uplifting but the process of trying to do what seems right to me is so tedious and slow. I have been invited to speak at a health care forum in Westlake Village on October 1st at the Calvary Church. Open to the public. I am hoping to attend the international breech conference in Ottawa next month. I have also offered to attend a Catholic Healthcare West seminar in Sacramento, October 9th, on obstetric policies in the CHW system to provide an alternative voice. I need approval from the chairman of the OB committee at St. John's in order to go so I am not holding my breath. Its been more than a week since I sent my written request. Will keep you posted.

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