"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, December 17, 2009

What Keeps Us Going....

Those of us that support a woman's choice, informed consent and the midwifery model of care often feel we stand alone. A thank you to this lovely nurse from Washington state for sending words of encouragement. SF

Dr. Fischbein:

I just had to take the time today to say thank you for all that you are doing for women and babies in this country. I first heard of you during an interview you did for "The Other Side of the Glass". I have since searched for and found other videos of you online. I was completely taken aback that there was an outspoken OBGYN who was being vocal about support for things such as breech deliveries and delayed cord clamping. You are a real hero in the birth world. It is so difficult to find MD's who are openly supportive of such things.

I am a registered nurse and I work in a small, community hospital in Washington state. I am a nursery and postpartum RN there. While I don't do labor and delivery, I am present at deliveries to be there for the babies. Lately, I have been asking myself how much longer I can stand there and watch the things that are being done to women without full consent.

I am very passionate about women's birth rights but lately I find myself wanting to give up. I find that I am simply beating my head against the wall and making a journey upriver without any paddles for my poor, dilapidated boat. Yet it never fails... just when I am ready to throw in the towel and give up on the whole political mess, another sick (or traumatized or injured or harmed) baby is placed in my arms and it serves as the fuel to keep me going. Despite the fact that we live in the information age, it seems nearly impossible to educate. It seems so hard to get the truth out and to be heard above the throngs of other voices out there.

There is a running joke we have in the hospital where I work. If a nurse says something, it doesn't mean a darned thing. But if a physician walks in and says the exact same thing, it's taken as gospel truth. We laugh about it because the words are exactly the same, but it makes a difference to patients who it's coming from. Patients trust their physicians implicitly. This is why I am so happy you are being so outspoken about the truth. Midwives and nurses and lay people have been shouting these messages for a long time, but I believe it will make a much larger impact on people if the same messages are being delivered by obstetricians (pun totally intended!)

Thank you for taking time out of your personal life to be an advocate for women and babies. You are making a difference. It is my sincere hope and prayer that if we all just continue talking about this and continue our attempts at educating women, that somehow, some way we can afford change through the upper ranks of administration and government. It is tiring, but it is worth it.

Christina Harris, RN

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