"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

Update on Breech Conference and the status of Breech Deliveries at The Woman's Place

Hi all, it has been quiet for a few weeks while I wait for clarification on the status of elective breech deliveries here in Ventura County. I was intially told in writing in no uncertain terms that this was not allowed at either of the CHW hospitals. After posting this fact on my blog it seems that the administration says I was misleading you. In a letter from last week they wrote that, in fact, elective breech deliveries are allowed at St. John's Regional Medical Center in Oxnard. While this is welcome news the contradiction is puzzling. I have written a certified letter asking for clarification. I will keep you posted.

I returned Monday from The Coalition for Breech Birth's conference with much insight, information and optimism. We were treated to a lecture by Dr. Louwen from Frankfurt, Germany which included some marvelous videos of natural breech birthing in the upright/all fours position. Topics included evidence why vaginal breech birth in selected cases is safe. Concerns all around regarding how future practitioners are to be trained. One idea is the model of Dr. Louwen where he runs a referral center for breech deliveries. Putting them in one place provides the volume and may just give us an idea of how we can give future doctors and midwives the experience they need to feel comfortable doing breech deliveries again.

The next group of speakers moved us all with their stories of birth options no longer available to them that led to birth stories and memories that were troubling to them even years later. It was very emotional and these strong women were inspiring in their desire to make changes so that others will not suffer their fate. I was honored to speak on a panel with Dr. Michael Hall of Denver, CO and three insightful doctors from Canada. Our topic was "The challenges and solutions to offering the choice of vaginal breech birth in the hospital." It stimulated much conversation afterwards. Finally, Ina May Gaskin gave a talk on breech with anecdotes and stories that kept us all enthralled. She also solemnly talked about women who have been lost due to complications of c/sections. Thanks to Robin Guy and all the supportive staff for putting together such a passionate and informative program.

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