"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.

Sunday, September 13, 2009

Perspective on the Rights of a Fetus

ACOG has clearly come out against home birthing and last year made a formal statement that the safest place for giving birth is the hospital or a birthing center attached to a hospital. In a recent Today show interview, ACOG spokesperson, Dr. Erin Tracy, stated that in rare circumstances a home birth can go awry resulting in injury or death to the fetus and used this reasoning to argue against supporting a woman's right to informed consent and choice. So, my understanding from this is that ACOG has deep concern over the rights of the unborn baby and puts those rights above the mother's.

In July of 2007, ACOG reaffirmed their statement of policy regarding abortion. Paragraph #3 states: "Termination of pregnancy before viability is a medical matter between the patient and physician, subject to the physician's clinical judgement, the patient's informed consent and the availability of appropriate facilities."

Paragraph #5 states: "Informed consent is an expression of respect for the patient as a person. It particularly respects a patient's moral right to bodily integrity, to self-determination regarding sexuality and reproductive capacities, and to the support of the patient's freedom within caring relationships. A pregnant woman should be fully informed in a balanced manner about all options.....The professional should make every effort to avoid introducing personal bias."

"The College continues to affirm the legal right of a woman to obtain an abortion prior to fetal viability. ACOG is opposed to abortion of the healthy fetus that has attained viability in a healthy woman (Dilitation and Extraction or late term abortion). Viability is the capacity of the fetus to survive outside the mother's uterus." Although against this procedure, they do acknowledge that a late term abortion may be the most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman and only the doctor, in consultation with the patient, can make this decision. ACOG also states that a select panel they convened could identify no circumstances under which this procedure would be the only option to save the life or preserve the health of the woman.

I was sort of confused by this last paragraph so don't feel bad if you have to reread it, too. Anyway, their statement of policy on abortion concludes in bold print: "The intervention of legislative bodies into medical decision making is inappropriate, ill advised, and dangerous."

So, realizing that I am editorializing here a bit let me see. Hmmmm, they are on a lobbying campaign to discourage or eliminate a woman's choice of home birth because it can very rarely cause damage to a fetus but they are against legislation to prevent a woman's choice of a late term abortion which kills viable fetuses. Am I missing something here? Am I comparing apples to apples? Is this an amazing bit of ACOG hypocrisy? Please comment as I would love clarity here. Thanks, Dr. F


  1. I think the best and most consistent course of action here would be to recommend evidence based medicine in both situations that respect the autonomy of the main patient with irrefutable rights: the mother.

    The inflammatory language of the anti-choice movement has definitely influenced a "fetus outweighs all" attitude that encourages invasive testing, interventions and futile to cruel resuscitation attempts in the NICU.

    Legislative interference and ideological arguments are not more important than ethics of the patient's autonomy and bodily integrity. Which would support access to safe, legal abortion when appropriate (this does not usually if ever mean of a viable fetus), VBACs, vaginal breech deliveries, and other choices and treatments (or lack of treatments and interventions when unwarranted or harmful) during her reproductive years.

  2. I've actually thought about this recently myself. It doesn't add up. If women are given a choice about abortion, why then are they not given a choice about anything medically related to their baby, such as whether they give birth at home or in hospital?!