"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.

Tuesday, December 22, 2009

Community Standard ?

So, I finally got tired of being ignored and called Dr. Torres as he apparently did not have the courtesy to return my e-mails and letters. He told me that members of the OB committee met last week and decided there was no need to have any meetings or discussion about making a breech delivery protocol. Although in September I was assured that I would have some input in the discussion, it did not happen. Since no one but me in the community offers breech deliveries, he states that I am outside of the "community standard" and elective breech deliveries would not be allowed. When I pointed out that Terry Cole also does breech deliveries he mumbled something about not caring what Dr. Cole does at Community Memorial Hospital down the road. When I asked if only one doctor in our department was doing a certain special surgical procedure would that, too, be outside the "community standard" and be banned? He had no honest answer. I received a letter later today reiterating our conversation and suggesting that I seek privileges at another institution if I wanted to do breeches. This is a disingenuous suggestion as changing hospitals is not a simple task. So while I am credentialed to perform breech deliveries at my hospitals and ACOG and SOGC support this option the administration has made a final decision not to allow this without any meeting, hearing or due process. A sad day for the women of Ventura County. I am looking at all options and am open to any suggestions. Dr. F


  1. This is ridiculous and sad. I would have more respect if he just came out and admitted that he is afraid the hospital might have a bad outcome and might have to muddy its hands in a court case. Really... not a community standard? Ludicrous. It's sick that they have so much power that they can continue to make decisions like this. How is it that a few people can retain so much power? Where are the checks and balances? We have a similar "standard" in our hospital... breeches are simply NOT allowed. Neither are VBACs. Even if a woman comes in complete, they'll give terb and rush to the OR. I just don't get it...

  2. Thank you Harris' for your outrage. Knowing there are people like you who also see the malice and idiocy keeps me going. SJF

  3. Is it a silly suggestion to throw out the idea of some sort of protest outside the hospital? Something to show our support for you and a woman's birthing rights? Has this been done or is it inappropriate? Keep up the good fight Dr!
    Mandy Schutt CBD, CPD

  4. Hi Mandy, My experience tells me that if you could get the media (TV or newspaper) involved it would bother them. They do not like to be asked questions. They did not respond when a reporter from the Washington Post left several messages a few weeks ago. In a recent Ventura County Star article about declining local birth rates, the representative from the administration of my two hospitals was quoted as saying they have not noticed a drop in volume. This is patently false at Pleasant Valley Hospital. So, they cannot even tell the truth about something as benign and nonthreatening as that. It is something about the nature of people that administrate that prevents them from any honesty that somehow could be construed as looking bad. They do not care what I think, you think, midwives think or, for that matter, what any individual patients think. But they do care about their image. So, if you can come up with a way to honestly expose what they are doing it will make them very uncomfortable and possibly willing to have a discussion. There is little left they can do to me so please feel free to confront them any way you choose. You can count me in. SJF

  5. This doesn't make any sense. If there's no breech delivery protocol/policy, how can they say you can't do it? Either the hospital has a policy stating breech isn't allowed OR they have a policy stating it IS allowed. What is this BS about 'community standards'? Is going higher up an option? Contacting Dr. Torres's boss? This hospital needs to be exposed for their practices and failure to put women and babies first. Hope to see you at the BAC meeting at the end of the month.