"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, December 16, 2009

Laboring Patient Sits in Lobby

Last night I had a MediCal patient in labor. She had planned to deliver at Pleasant Valley Hospital but because there is no MediCal pediatric coverage there she had to go to St. John's Regional in Oxnard. There were available empty labor rooms at Pleasant Valley Hospital but there were none at St. John's where the nurses described the labor floor as "swamped". So, because of the failure of the hospital administration to solve this problem and, likely, in continued violation of their licensing requirements my actively laboring patient had to sit in the waiting room for nearly 2 hours until a room and bed became available. In this particular case she would have liked pain relief a lot sooner. Conincidently, I had sent an e-mail earlier that day on this issue to the administration:

Hi All, I spoke with Mike Murray and Laurie Bingham one week ago about the absence of MediCal pediatric coverage at Pleasant Valley Hospital. We had a cordial conversation where concerns on all sides were expressed. My colleagues and I would like an update on what is being done to remedy the situation and a timeline for when we can expect this issue to be resolved. Several of our patients have been inconvenienced by having to go to a hospital not of their choosing. It is also more difficult for us to travel back and forth. We believe the hospital has a legal obligation to provide MediCal patients a pediatric option and cannot turn them away from Pleasant Valley. We are happy to work with you on this but that would require the respect of being kept in the loop. I am available to discuss this at any time. On behalf of the patients we care for and their desire to deliver in their own community we hope to hear from you promptly.

Stuart Fischbein, MD
for The Woman's Place, Inc

No response so far. On behalf of our patients and the Camarillo community we will keep inquiring. SF

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