"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.

Monday, December 7, 2009

Pediatrics pulls out

Just a quick note to say that all the pediatricians on staff at St. John's Regional Medical Center have decided not to cover MediCal babies born at St. John's Pleasant Valley Hospital. As of December 1st they refuse to be on call for any patient who does not have a pediatrician. And since MediCal patients usually use MediCal providing doctors and there are now no pediatricians at Pleasant Valley Hospital who accept MediCal there is an obvious dilemma. My understanding of the explanation I have been given is that it is a combination of fearing that midwife deliveries are risky exacerbated by a recent tragic outcome, lack of an NICU for backup and poor reimbursement for their services. While I understand the latter two reasons, I am uncertain as to why they feel midwifery and its low risks patients are considered higher risk than physician patients. I have spoken to administration and offered to attend any meeting to help answer questions they may have about midwifery and to get some answers to my questions, too. So far no invitation has been offered. I had a low risk MediCal patient scheduled for a routine repeat c/section tomorrow morning at Pleasant Valley Hospital that I was ordered to either move to St.John's in Oxnard or cancel due to a lack of pediatric coverage which is required by their policy. This is inconvenient for and undesired by both the patient and my staff. I have been told they are working on a solution and are aware of the urgency of need for a resolution. For should a MediCal patient show up in labor at Pleasant Valley their would be no pediatric coverage. Hopeful they will come up with something soon.

Each one of these new twists and obstacles makes it crystal clear that another option for birthing in our community is essential.

Am off tomorrow night to Washington DC to meet with Senator Feinstein's office and Congressman Gallegly's staff on Wednesday. The topic will be the Health Care Bill with focus on reminding our representatives that medicine is not an inert commodity. We are patients and health care practitioners. We are individuals. Medicine takes place in the privacy of an exam room and is a very personal decision. Government probably won't listen but they really have no business being in the business of health care. But you already know that's my take. SF

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