"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.

Sunday, December 6, 2009

Dog days

Have not written in a while as not heard anything back from multiple cordial attempts at contacting the OB committee at St. John's Regional Medical Center about their "promise" to set up an ad hoc cmmittee on protocols for breech as well as reviewing others. Does this seem like a broken record? They make demands under severe threat. I respond with requests at their recommendation which they ignore. Feel free to right a letter or to call Dr. Juan Torres, current head of OB there. Let him know your dissent with their policies and their nonresponsiveness. For, every delay causes potential harm and inconvenience to some patients.

As I have said before, there is unlikely to be any movement toward respect for patient autonomy in this current model. The hospital has no competition and employs an economic model that favors ts policies as long as they live in a vacuum. So we need to create an alternative option for women and maybe then they will understand what we all do. Decisions belong to the informed patient. Amy Tinney, RN LM is working with me to organize our dream of a free standing birthing center, staffed by midwives, doulas, chiropractors, acupuncturists and doctors. A birthing center that also contains an surgery center option where c/sections can be performed. With safe policies that favor mother-baby and treat birth as a natural process. We are in the discovery phase of our planning but are confident that before 2010 is out we will have it up and running. We are open to any suggestions or offers of expertise or help. Comment here or e-mail me anytime.

Amy and I attended the wonderful Tribute to Women at The Sunrise Birth Center tonight. It was an elegant affair reflective of Karne and all the dedicated birth goddesses, new mothers, artists, musicians and generous donors. Bought some great smelling candles from Krystal McCauley. It was nice to see so many of you there. The Birth Action Coalition will benefit from the event and soon will have non-profit status. Things are happening. I heard there is an event next week in Santa Barbara hosted by Laurel Phillips in support of her birthing center dream up there. I have heard through the grapevine that there are happenings on the west side with Sacred Entrance as well. So, the movement is gaining momentum.

Lastly, I am flying to Washington DC Tuesday night to spend 10 hours on Capitol Hill. I am going as a representative from Docs4patientcare.org to speak with the offices of Senators Boxer and Feinstein about patient centered issues, protecting the sanctity of the doctor patient relationship and reminding them that one size fits all medicine cannot work. You can be sure I will put in the word for midwifery and its wonderful benefits and reigning in those that lobby against it and asking for a loosening up on all the regulations restricting access to them. We have to try.

You can be certain I will persist in getting a response from Dr. Torres. It would be so much easier and more professional for him to honor his word. The hypocrisy of that department is legend around the community. But I am biding my time, taking the high road and documenting everything they do. Oh, and I was interviewed last week by a writer from the Washington Post about the breech restriction. She has attempted to contact Dr Torres and Niesluchowski but as of Friday had no response. Watch for the story and I will post it once it comes out. So I guess there are things happening and worth wrting about. We will chat soon. Hope you all had a great Thanksgiving. Stu

1 comment:

  1. A free-standing birth center that includes a facility for emergency surgical birth and is staffed by physicians, midwives, doulas and other health care providers is EXACTLY what we need. Like the maternity hospitals of the 1920s but with a modern understanding of the physiology of normal labor and the compassion, sensitivity and understanding for women and newborns. I LOVE it! I would participate in whatever capacity I could. Keep up the good work!