"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, November 19, 2009

Mid November Update

Several weeks have passed and nothing new on the breech privilege front. I have patiently waited for the promised formation of a committee to discuss a breech protocol at my 2 hospitals. I have e-mails from September telling me the chairman would be in touch with me shortly. Well, at yesterdays OB Department meeting I did present my breech protocol and again reminded the chairman of the importance of addressing this issue. Patient's deserve the choice. We shall see how soon a meeting is set up.

I was interviewed by a writer from the Washington Post this week. She is doing a story on breech deliveries. She was introduced to me by Robin Guy, from the Coalition for Breech Birth in Ottawa, Canada. I will link the story when it comes out. She was very interested in what has happened at my hospitals and the process, or lack of process, that led to the banning of elective breech deliveries.

A group I have put together continues to research the options for a free standing maternity center. A place where the midwifery model of care and patient choice can occur free from the encumbrances of modern day hospitals. We are very excited about the project and have a highly motivated group. Anyone with any thoughts or suggestions feel free to contact me or Amy Tinney.

I will be going to Washington, DC again on December 9th for less than 12 hours to meet with our California Senators. I was asked by Docs4patientcare to lobby for reason and sanity in the healthcare debate. I plan to focus on just a couple of key points including the value of midwifery and the need for less special interest regulation that stifles innovative ideas that would lower cost and improve outcomes. There is so much about the massive health care bills circulating in the Senate and House that is just plain wrong that I don't even know where to start. So I will concentrate on just a couple of things. I am honored to go to represent the patient and practicing doctor. I have no delusion that anyone will actually listen but try, I must.

To all, a peaceful and loving Thanksgiving holiday. Stuart

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