"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, October 21, 2009

Excerpt on Patient's Rights from "Fearless Pregnancy...." 2nd Edition

When you come to see or consult a health professional it is most reasonable to expect that you will be given the best information based solely on the knowledge and experience of that practitioner. You have the right to expect the information to be discussed in a manner that you can understand. You should be educated about the diagnosis and presented with all options for treatment. Ideally, this information should be given to you free from the bias of the health professional providing it. Only in this way can you and your family make the decision that best suits you. This is called the right of self-determination and belongs to each of us as patients. Along with this right comes the responsibility to accept the outcomes of your decision.
The free flow of unbiased information between you and your caregiver is called “informed consent.” You have the right to know all the significant risks, benefits and treatment options for the problem you are confronted with. It is inappropriate for your practitioner to purposely leave out or skew this information in order to direct you toward the option he or she prefers. The best way to know your options is to do some of your own research on the Internet and come prepared with good questions when you sit down to talk to your caregiver. We at Fearless Pregnancy hope that you will take full advantage of your right to choose. Once you have been given this information it is perfectly appropriate to ask your expert caregiver what he or she might do in your particular situation. But remember, we each have different philosophies and experiences in life that make us unique.
Now that you have gathered and considered all the information and the recommendations proffered, you have the right to agree to those recommendation or choose a different path. The right to decline an offered treatment is called “informed refusal.” A common example: your doctor recommends you have a repeat c-section but you choose to try for a vaginal birth. Your wishes should be respected and you cannot be forced into a decision against your will. Realize that some caregivers may refuse to treat you if they are uncomfortable with your decision. As we say so often throughout this book, a good bond between patient and practitioner makes a world of difference. When you have this mutual respect, there is already existing common sense and trust that makes these situations very rare. It is important that each of us take responsibility for our own health and knowing your rights of informed consent and refusal is a big step in that direction.

Note: Hopeful release date of my book "Fearless Pregnancy...." 2nd edition is Spring 2010

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