"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, October 15, 2009

Update From Ottawa

OK, So we are on lunch break at the Coalition for Breech Birth's International Breech Conference. Very good lecture by Dr. Glezerman from Tel Aviv. Pointed out the reasoning and flaws behind the conclusions of the 2004 "Term Breech Trial" that has caused so much consternation. Much emphasis on what I have been saying about the obstacles to choice and the restrictions on practitioners in the hospital based model. So jazzed about the direction we are heading with a birth center in SoCal designed for supportive nurturing birthing. Whenever I go to one of these meetings surrounded by supportive, logical and caring people I feel like my gas tank gets filled up with super premium fuel. I know it is a leap from a small birthing center to one that serves more as full maternity center with the option of an operating room on the premises. You know that has been my vision for a while and I am convinced we can get there. For once we have such a set up then we can promote an environment that is accepted and nurturing to all appropriate women including breech and VBAC. Midwives may have to lead the way back for breech deliveries since the numbers of breeches out there are probably going to remain too low to retrain doctors unless we have some sort of referral center for breeches. Someday, maybe our place could be a model for allowing patients the dignity of choice while having the numbers to be a training facility for future deliverers of breech babies. Thus, removing some of the monopoly on obstetrics and the hospital model which is based mainly on fear and what can go wrong. Sacrificing the beauty and satisfaction of the majority of births that go right. More to follow. S

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