"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 22, 2010

The Other Side of the Glass

Janel's wonderful new film is now up for sneak preview viewing. Please watch, comment and pass it on.


Also, wishes for a merry Christmas and a very exciting and productive new year. Lots of good things going to happen in 2011 in the realm of birth choices. The public is waking up to know they have rights and options beyond the limitations of the medicalized hospital approach to birth. Dr. F

Wednesday, November 24, 2010

Cal State Northridge Jounalism Student Project

By Andrew Lopez

It was 3:00 p.m. on June 23, 2007, when Emory Rivas, 27, arrived at St. Joseph Hospital in Orange, CA, to give birth to her first child, Davian. Throughout her pregnancy, Rivas, a Costa Mesa resident, has had a clear idea of how she wants her birthing experience to unfold, yet over the course of the next several hours, nothing works out quite like she wanted. First, the doctor she has put all her trust into delivering her child is not available because it’s the weekend. Secondly, she is talked into both an epidural to decrease pain and Pitocin to speed up her contractions, though she had planned all along not to take any medication during labor. Finally, at 6:00 a.m. the next day, her hope to give birth vaginally is no longer possible. The nurses tell her that she is failing to progress and starting to develop a fever. Feeling the decision was never truly in her hands, Rivas agreed to give birth by C-section.

At 6:34 a.m., Davian Rivas is born. Instead of being able to spend time with her newborn, Emory holds him for only a few minutes before he is taken to the nursery while she is taken to a recovery room. The anesthesia is causing her to vomit and she is crying for her baby. Though she was glad that the surgery was successful, the experience of having a C-section and the hospital policies that kept her from Davian was deeply upsetting.

“It was the worst feeling ever,” Rivas said. “They didn’t respect my birthing plan. I felt like I was by myself. It was horrible.”

Rivas is not alone. According to the CDC National Center for Health Statistics, 32.3 percent of babies born in the United States were by cesarean delivery in 2008. This number is at odds with a 1965 analysis of births in the United States, when just 4.5 percent of babies were born by cesarean. These rising numbers are alarming to those who advocate against unnecessary C-sections.

“The healthy rate (of C-sections) is between 8-15 percent for industrialized nations,” Chelsea Shure, chapter leader of the International Cesarean Awareness Network, West Los Angeles, said.

While critics of unnecessary C-sections point to a hospital’s bottom line as the primary reason for such high rates, those closest to the trend believe that it’s much more complex than that.

“There are many legs to this,” Dr. Stuart Fischbein, who practices in Southern California, said. “The big three are expediency, economics and malpractice.”

Dr. Gary Nishida, whose office is located in Oxnard, CA, lists “failure to progress” as the most common reason for first time C-sections. The term itself means that the laboring process has come to a standstill. There are a variety of reasons for this, including the woman’s pelvis being too small for the baby, according to Nishida. Nishida points to the one and a half lb. increase in baby weight since the 1950s and the unchanged size of an average woman’s pelvis.

However, certified birth doula (a trained person in childbirth who provides non-medical support before, during and after labor), Patricia Grube, believes that there is more to it than just that. “Failure to progress?” Grube asked rhetorically. “Doctors just don’t want to wait around.”

Shure believes that more than a failure to progress, C-sections are increasing due to a lack waiting by medical professionals. She believes that the unpredictable nature of vaginal births cause doctors to act quicker than necessary.

“A normal vaginal birth is so wildly inconvenient,” Shure said. “Doctors won’t sit on their hands. They can’t wait.” Shure also believes that obstetricians opt for C-sections because they haven’t been properly exposed to unmedicated births in their training. Fischbein agrees. “Obstetricians are high-risk surgeons,” he said. The medical model is that of intervention, he explained. Fischbein believes that the fear of a lawsuit rather than finances, dictates how obstetricians are taught.

Nishida disagrees that the bigger bills generated by C-sections is the primary reason they occur. “It has nothing to do with finances,” Nishida said. “I’m getting paid one-third what we got paid 15 years ago,” he said. It is the fear of a malpractice suit that facilitates swift action. “None of us (doctors) get sued for doing a C-section, we get sued for not doing a C-section,” Nishida said. “If they (those who oppose the high C-section rates) want to pay my malpractice suit, they can go ahead.” Fischbein also points to the fear of a malpractice suit as a driving force for unnecessary C-sections. “No one wants to work with an anvil over their head,” Fischbein said. “It’s a huge burden.”

In 2008, Rivas found out she was pregnant once again. This time she did research on VBAC’s (vaginal birth after cesarean) and switched hospitals and doctors, hoping to fulfill her wish of giving birth naturally. To her dismay, her new doctor thought it best not to try for a vaginal birth. He explained to Rivas that her body shape wasn’t ideal for a VBAC. “He was basically saying I wasn’t fit for it,” she said. Not until she was seven-and-a-half months pregnant did she decide to once again go with a surgical birth for her first daughter, Daya. Once again, she felt pressured and regretted her choice. “With Daya I felt I made the wrong decision,” she said. “I kind of got screwed over.”

Nishida points to the strict guidelines that must be met to perform a VBAC as the reason so few actually take place. Not only must a doctor be on-call throughout the process, an anesthesiologist and a team of nurses must also be waiting around the clock as labor takes its course. Nishida finds these guidelines to be unrealistic, as neither he nor the anesthesiologist would be getting paid to wait for the laboring process. “There are cost issues and practical issues,” he said. “If someone wants to pay me to sit around they can go ahead,” he said. Nishida also cites the American College of Obstetricians and Gynecologists (ACOG) stance on VBAC’s, which states the risk of uterine rupture that could take place during labor might be catastrophic. Once again, Nishida fears a lawsuit if something were to go wrong in performing a VBAC. “You’d lose everything you got,” he said.

Shure doesn’t agree that the risks of a VBAC are any more dangerous than performing multiple C-sections on a healthy woman. “The risks of major complications from a second C-section is one-in-23,” she said. “That’s a huge problem,” she said. Shure does agree with Nishida that the strict guidelines for VBAC’s are unpractical and in place so no one can blame the hospital for an unsuccessful attempt at a vaginal birth. “It’s not fueled by doctors. Hospitals have policies that make it hard for vaginal births,” she said. “They’re covering their ass,” she said. Shure believes that the prohibition on VBAC’s reflects a combination of hospital policy, unnecessary inductions fueled by poor information to obstetricians and simple impatience.

Fischbein looks to the executives of insurance companies to explain why these contentious policies exist. Politics and bureaucracy, according to Fischbein, are the motivating factors behind many of the problems he sees in the healthcare system.

“None of these decisions are health-based,” said Fischbein, who summed up his distrust of those with the most authority in the healthcare system by quoting French philosopher, Albert Camus: “The welfare of humanity is always the alibi of tyrants.”

Just as Fischbein attributed three causes for the increase in C-sections, he sees three solutions as being the only ways those rates will decrease. First, he suggests that the cost of vaginal births go up to account for the high cost it takes to staff the delivery process. Secondly, he proposes some kind of tort-reform to limit the damages that may be sought in malpractice suits. Thirdly, Fischbein envisions a freestanding maternity center run by midwives, free of the bureaucracy that rule hospitals. He doesn’t see a reason for low-risk pregnancies to end up in a hospital at all.

“Hospitals are for sick people,” he said. “Pregnancy is not a disease. Labor is not an illness,” Fischbein said. “Midwives do regular births better than obstetricians.” Grube agrees. “For non-complicated pregnancies, a midwife should be the model,” she said. “Midwifes deliver babies naturally and healthily. They are very patient.”

Rivas is visiting her parents’ home in Fillmore as she sits on the front porch on a warm, Sunday afternoon. She looks out onto the quiet street as Daya rests against her chest, nodding off. She smiles from time to time during the interview, but there is an unmistakable air of regret that surrounds her as she revisits the past.

“I feel like I missed out,” she said. “I was robbed.” She doesn’t rule out the possibility of another baby in the future, and if she does, she plans on looking into the issue much closer. “I’m going to definitely prepare myself,” she said. She plans to look into hospitals and their C-section rates, as well as doctors’ tendencies to perform surgical births. She also plans on looking into the possibility of having a midwife deliver her baby. As she weighs her options for the future, Rivas becomes more at ease. It’s as though she realizes for the very first time that her desire to give birth naturally need not be tangled up in the problems of a defensive, bureaucratic healthcare system.

.....Hope this story struck a nerve. I would appreciate feedback which I will forward to the student writer. Happy Thanksgiving, Dr. F

Wednesday, November 10, 2010

Joy on the Job

Once again, I had the amazing honor of attending a beautiful home water birth in Tarzana last night. What a sweet, nurturing life event I bore witness to. Nice to know some decisions in life lead to a joyous new path. I am having fun in my profession again. Thanks to all the forces, good and bad, who have led me here. All have a great day. Dr. F

Sunday, November 7, 2010

Panel Discussions and Thank Yous

So many people to thank for their efforts this weekend. Saturday, the Sanctuary Birth and Family Wellness team sponsored a panel discussion after viewing 3 films, Laboring Under an Illusion, Guerilla Midwife and Orgasmic Birth, at the Santa Monica Library. The Q and A session was vigorous and well received. Thanks to Clara for her excellent work putting it together and to the staff at the library.

Today, I spoke on a panel discussing pregnancy, birth and child development in the context of nurturing the next generation of leaders at the Leaders Causing Leaders Conference at the Long Beach Convention Center. A very inspiring group joined me in sharing our stories and insights. Thanks to Cecily, Karen, Anna, Susan and Ishmael for their selfless and amazing contributions to the betterment of future generations. I was honored to be included amongst these visionaries.

Oh, and lastly, thanks to TIVO, Bret Farve and The Minnesota Vikings for finally pulling one out after making me a nervous wreck. And to beautiful sunsets like the one we had this evening. And to my daughter, Madeleine, who did a great job singing a Guns and Roses song at her recital this evening. It was a great weekend. Dr. F

Tuesday, November 2, 2010

Demystifying Birth Myths this Saturday in Santa Monica

Santa Monica Public Library and the Sanctuary Birth & Family Wellness Center present this enlightening look at the myths and cultural ideas of birth. Clips from the documentary films Laboring Under the Illusion, Orgasmic Birth and Guerrilla Midwife will be followed by a panel discussion with licensed midwives and doulas on the birth options available to parents today.


Time Saturday, November 6 · 3:00pm - 10:00pm


Location Santa Monica Public Library
601 Santa Monica Blvd
Santa Monica, CA

The Sanctuary midwives, doulas, staff and I will make up the panel. I look forward to seeing all of you locals there. Dr. F

Dr. F at Leaders Causing Leaders Conference this Sunday

You are invited to attend a panel discussion moderated by Cecily on November 7, 2010.

Leaders from Birth: Our leaders 25-years from now are in the womb!
JOIN US for an inspiring, empowering panel discussion amongst interdisciplinary pioneers connecting the dots between shaping our future and serving our children well.


Karen Gordon wholechild.org/home.html
Susan Kaiser Greenland susankaisergreenland.com/
Anna Getty pregnancyawarenessmonth.com
Dr. Stuart Fischbein supportdrfischbein.com/index
Ishmael Beah beahfound.org/Beah_Foundation/Home.htm

November 7th 2pm / Leaders Causing Leaders Conference / Long Beach Convention Center / Moderated by Cecily Miller http://baby-welcoming.com/

Monday, November 1, 2010

The Peanut Butter Syndrome

Of Peanut Butter, Birth Choices and Politics
November 1st, 2010

This is a peculiar trinity at the very least. While having nothing in common with or the monumental importance of the well known trinities of Christianity and the American trinity of e pluribus unum, liberty and in God We Trust, there is something very important to be said about the connection between these three subjects. Let me be very clear that I am a big fan of peanut butter and birth choices. Politics, well that leaves much to be desired. I have distaste for intellectual dishonesty and the nanny state so that gives you a clue as to my leanings in the political arena. Many of my friends and colleagues choose to ignore or avoid this subject because they find it exhausting or irrelevant in their day to day lives. But to ignore the reality that politics affects all of us is to live in denial. There is an election tomorrow that will have a great deal of affect on how we and those we care about will live our lives here in America.

I am a big supporter of true informed consent and birth choices as are all my wonderful colleagues in the birthing community. That is not a surprise to anyone who knows me. But many of my friends and supporters do not share my political views. I am not writing to try to convince anyone that one side is better or worse than the other. What I would like to do is make a logical argument in support of smaller government and personal responsibility and individual liberty. And, then let each of you decide what is best for you and your family.

So, what do peanut butter and birth choices have in common? We live in an era where government wants to control “fairness”. They want to raise equality to the level of a right and to constantly try to legislate morality and eliminate failure. Strange, as there is no right of guaranteed equality of result in the Constitution. Only the rights to equality of opportunity are implied. This has morphed into an America where all the soccer kids get a trophy no matter what place they finished. There are no winners and losers. Standards are lowered or eliminated all together. But by shooting for an egalitarian paradise those that desire this must, by definition, restrict liberty. Liberty is the freedom to succeed or fail on your own merits. Many think equality and liberty are synonyms when, in reality, they are exact opposites. Whenever you impose equality you necessarily restrict liberty. When a child is allergic to peanut butter, the school board often bans peanut butter for all of the other children. One child cannot be around peanut butter so 800 children cannot have a peanut butter sandwich. This is a perfect metaphor for the equality vs. liberty debate. What seems fair and kind and protective to one individual restricts the freedom of the vast majority of so many others. I call this overreaction the “Peanut Butter Syndrome”.

We see the “Peanut Butter Syndrome” everywhere these days. Kids are obese therefore we ban snacks and mandate certain foods in schools. Smoking is considered a danger so because of second hand smoke we have laws prohibiting any private business from allowing smoking. Mylar balloons may cause a power line short circuit so lets ban them. A child falls off a teeter-totter so all teeter-totters must be removed from playgrounds. Ban incandescent light bulbs and big screen TVs. And on and on it goes. Overzealous activism, often good hearted but often shortsighted, leads to restrictions on personal choice and liberty. And often without any evidence other than it feels good.

Now sweet sensitive people, mainly on the left, who mean well will see these things and say it is good that we are looking out for the folks and the environment. We need government to protect the few, the weak and those that cannot help themselves. They need to keep us safe. A fair argument but at what cost to liberty? If you agree with this premise then voting for bigger government and the Democratic Party is what you should do.

But here is the problem as I see it. We are for a woman’s right to choose the path of her own birth. We strongly support the right to informed consent and refusal. If you take the same sort of liberal thinking as described in the previous paragraph then why get upset when hospital policies, lawyers and politicians want to control our choices. They constantly argue that restrictions on midwifery and VBAC and breeches are for safety purposes. They are just protecting the folks. It does not matter that their arguments may not be evidenced-based. They are just trying to legislate out the possibility of a bad outcome. This may be noble but foolish in that over time this has been shown not to work. Not with birth choices nor food choices. Ever since nutritional information has been mandated on food products the American populace as a whole has only gotten fatter. Can you see the inconsistency here? If you think it is OK for there to be laws that restrict our choices in how we live and to surrender some liberty for the sake of a greater good then how can you be upset when those same rules are applied to birth choices?

My point is simply that I am a believer in allowing people to make their own choices. I think what makes our country special is her founding desire to allow all of us to succeed or fail of our own accord. This is the greatness of America and this unique quality of American life has been slowly whittled away by often well meaning people who tend to be on the liberal left. Not all, but most. Of course there has to be some regulation when individual choices can have massive consequences. But what I eat or drive or watch should have no more control from the outside then how or where I choose to give birth. If you agree with the idea that peanut butter and birth choices should remain free of politics then I hope you will consider voting tomorrow for the candidates and propositions that best fit this premise. Look at the big picture and do not get hung up on letting one issue decide how you vote. I hope you will see the folly in voting for bigger government. At least as it pertains to the freedom we long for and the profession we love.

Stuart Fischbein, MD

Monday, October 18, 2010

A Must Read Alert

I wish I had written this. The Big Push for Midwives has once again done great work in educating us in what goes on behind the scenes. Thanks to PushGirl Friday for her insight at:

Please read her blog.....
A Tale of Two MOMS: ACOG Pulls a Fast One on Groundbreaking Maternity Care Legislation

As many readers here know, last summer Congresswoman Lucille Roybal-Allard introduced the MOMS (Maximizing Optimal Maternity Services) for the 21st Century Act, a groundbreaking piece of legislation that has the potential to revolutionize our maternity care system. The bill makes increasing access to evidence-based care, reducing racial and ethnic disparities in birth outcomes, and bringing down maternity care costs national priorities by promoting a number of common-sense, low-cost solutions to addressing the maternity care crisis in the US, such as:

Creating loan repayment programs to increase the numbers of family practice physicians, nurse-midwives, and certified professional midwives, all of whom provide low-cost, high-satisfaction alternatives to traditional obstetrical care
Increasing access to culturally competent care and reducing disparities by taking measures to recruit more racially and ethnically diverse students into the maternity care workforce
Launching a public awareness campaign to inform women of the benefits of increasing access to evidence-based maternity care and reducing over-reliance on often unnecessary interventions, such as labor induction, electronic fetal monitoring, episiotomy, and cesarean section
Establishing an Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes
The MOMS Act has attracted a broad-based coalition of advocacy and professional organizations, including Amnesty International, Childbirth Connection, The Big Push for Midwives Campaign, the American College of Nurse-Midwives, the National Association of Certified Professional Midwives, the American Association of Birth Centers, and the Midwives Alliance of North America, all of whom have been working together with Representative Roybal-Allard’s office to build support for the bill both within Congress and among the general public.

Notably absent from the list of MOMS Act supporters is the American Congress of Obstetricians and Gynecologists, which is already busy lobbying Congress about its own forthcoming legislation. Not to be confused with the MOMS Act, ACOG’S proposed Making Obstetrics and Maternity Safer bill, which in the interests of clarity has been dubbed—wait for it—the MOMS Initiative, will, as ACOG President Dr. Richard Waldman stated, “lead the way” in making maternity care safer by promoting research into the causes of premature birth, obesity, and racial disparities in outcomes. Because as we all know, the problem with maternity care in the US is with the women who receive it, not with the care they receive.

Perhaps a better title for ACOG’s MOMS legislation would be the Making Obstetricians More Satisfied Initiative, because the proposal contains absolutely no provisions that encourage obstetricians to abandon current practices in favor of evidence-based care or to give up an inch of turf in their ongoing battle to protect their virtual monopoly on the maternity care market in the US—a monopoly that is responsible for creating the need for the Real MOMS Act in the first place. ACOG laid the groundwork for its sabotage of the bill in a recent letter that has been circulating in DC, assuring Congress that the organization has already put many patient safety measures into place and that their own MOMS legislation “can lead to direct measurable improvements in patient safety and quality of care, and to healthier births.” No promises that the Misleading MOMS Act actually will lead to improvements, but hey—it’s a start, right?

As for the Real MOMS Act? According to Dr. Waldman it is unacceptable because a) it promotes “the wholesale adoption of delivery models that have not yet been proven safe and effective, including doula support, group prenatal care, and home-birth,” and b) it “questions ob-gyns’ ability, compared to certified nurse-midwives, family physicians, and certified professional midwives, to deliver care that supports physiologic birth.” In other words, the Real MOMS Act told the Emperor he has no clothes, he took offense, and now he’s busy knitting himself a new Naked Suit.

Watch this blog for further developments on the Real and Fake MOMS legislative front as we head into a new Congressional session in January. In the meantime, please spread the word about Congresswoman Roybal-Allard’s brave stance in support of real maternity care reform. We need more champions like her who are willing to speak up on behalf mothers and babies and who won’t be fooled by ACOG’s bait-and-switch tactics.

As one who has seen pregnancy from both sides of this "debate" my wish is that ACOG and academic medicine would stop maligning evidenced based midwifery as in doing so they only malign themselves. There is a role for collaboration between the models but it is time for ACOG to realize that more medical intervention may not be the solution to the rising intervention rates. Nurturing care, individual attention and prevention do work and have been the way of the midwife for centuries. Dr F

Sunday, October 10, 2010

Midwife Celebration at Golden Bridge

Just a heartfelt thank you to the wonderful people at Golden Bridge and to Debbie, Carrie Anne, Ricki, Peggy, the choir and all the wonderful speakers whose names I can't even begin to remember. It was a joy to see so many smiling faces in that most friendly of places. A special thank you to Congresswoman Roybal-Allard for her advocacy. You all said so eloquently what we all know to be true. It is a marvelous feeling to be associated with you and I am proud to also carry the banner for normalcy and choice. I know now as much as ever that midwifery is the best choice for those low risk women who desire it. I came directly from the airport and the sadness of burying my beloved uncle in Minnesota to the warmth and nurturing of all of you. What a healing talent you all have. Thank you, thank you, thank you!!

Love, Dr. F

Midwifery Week Blog

This is Rebecca Spence's blog this week. Please check it out.

Today is the Midwife Gathering at Golden Bridge Yoga at 1:30PM in LA. I will be traveling back from Minneapolis this morning and hope to arrive in time to pay tribute to my midwife colleagues. Continuing to promote access to midwifery and birth choices is an honor and joy and every little thing helps. Please support the Big Push with letter writing and spreading the word client by client. Dr F

Saturday, October 2, 2010

Time Magazine Cover

Just a quick thought on the recent time cover story about the significance of external factors during intrauterine life that may play a much more significant role in our health and wellbeing than previously thought. Traditional teaching about how we end up has always been nurture v. nature, heredity v. environment. Well, it appears that there is growing data to support the idea that exposure to many things in utero may play just as big a role in determining our physical and mental health later in life. This comes as an interesting "discovery" to those of us brought up in the medical/scientific world but is well known to my colleagues trained in the more natural world of midwifery and common sense. The midwifery model emplores women to be in a healthy state of mind and body before and during pregnancy and has known the benefit of this knowledge for centuries. It is nice to see the science catch up with the empirically obvious and kudos to Time for a nonpartisan story that is beneficial to all. Dr. F

Monday, September 27, 2010

Internet TV interview

Here is a link to my interview on the Dr. Cassie Show on local KADY TV here in Ventura, CA. Dr. Cassie does great work with children and for the community and it was an honor to be a guest on her show. Check out what's happening with her at The Children's Therapy Network. Having good prenatal care and a nurturing birth will get babies off to a good start. Dr. F


First Waterbirth

Well, I am happy to announce I had the privilege of assisting on my first home birth in water. After 27 years of the lithotomy position it was really enlightening to experience another way. I was honored to be present for the birth of Eva and want to thank her parents for their trust. I also want to thank Karni and all my midwife and birthing advocate colleagues for their support during this transition. It seems the demand for information and alternatives to hospital birthing is growing. I am getting quite a few inquiries from women looking into all options. It feels really good to give them an open and honest discussion about choices. I have been contacted by women with previous c/sections, twins, breeches and medical issues. All seeking just an honest discussion about risks and benefits of their individual situation. It is with great respect that I thank those of you who send potential clients my way. While out of hospital birthing is not for everyone, the choice of how and where to give birth belongs to the woman and her family. All good things, Dr. F

Sunday, September 12, 2010

C-section rates higher at for-profit hospitals

From todays San Francisco Chronicle. This link below was sent to me by Brian Gilmore of Rumi Baby.
Looking only at low risk birth, women were 17% more likely to have a c/section at a for profit hospital than at a non-profit one. Each of us can draw our own conclusions but knowing what we know about what motivates many hospitals and physicians these days it is not surprising. In 2008, our practice in Camarillo at The Woman's Place had a 6% primary c/section rate compared to a greater than 20% primary rate at our local hospital overall in low risk women. I believe the difference is using the midwifery model vs. the obstetrical model for labor management.
This information has to rely on reporting of birth rates and methods by each institution. This may raise some question about honesty in reporting. I suspect the data comes from birth records so there is likely to be some credibility here. Just another reason pregnant women need to be educated and informed of choices, benefits and risks so keep spreading the word to your clients, family and friends.

Thanks, Dr F


Thursday, August 26, 2010

Good Feelings

I just left the new client meeting at The Sanctuary Birth & Wellness Center in Mar Vista, CA. It is so nice to enter a space where nurturing and collegiality are the rule. What a breath of fresh air. We meet every Thursday afternoon to introduce the Center and its staff and our philosophy to potential new clients. All topics of home and the new birthing center births are touched upon in an open forum of discussion and Q and A. It is a time to describe pregnancy care in the true midwifery model and the way it should be. I believe I am in a great position to observe and comment on the amazing differences in low risk pregnancy care between the two competing models of care available in the U.S. And I can safely say there is no comparison. Little by little the word about true informed consent and birth choices is spreading. Kudos to my colleagues for their passion and success in the dream and, once again, congratulations on the opening of the beautiful new Sanctuary Birth Center. The only one of its kind in Los Angeles. Dr. F

Tuesday, August 24, 2010

ACOG review panel report

Hello to all and especially to those readers from the medical staff office at St. John's. Word on the street is that the ACOG panel that reviewed the policies, procedures and antics of the OB department at our local hospitals last June has issued its final written report. If I were to make an educated guess based on experience I would presume that this report will never see the light of day in its entirety. I hope I am wrong and would be the first to congratulate the new administration on their bravery if they were to release it. If this review was meant to be a learning experience for the department on evidenced based medicine and improving patient care then it should be shared with the medical staff without censorship. In fact, it should be shared with the community as a whole in the spirit of cooperation and transparency. I encourage all to call the new CEO at 805 988-2500 and ask if she intends to share the findings of this independent panel with the medical community and the residents of Ventura County. While I am no longer on the staff at these institutions I am still an active member of this medical community, and like many of my colleagues, must remain vocal when patient safety and quality of care issues need attention. Let us see what the American Congress of OB/Gyn thinks has been going on here. Dr. F

Thursday, August 12, 2010

Rediscovering the joy in childbirth.

As you must have heard by now, I am no longer attending deliveries at the hospitals in Ventura County (See previous blog). Turns out that things have evolved as they should and I am much happier for it. It is a liberating feeling to be away from such a toxic environment and find myself looking to the future with great optimism. Life is made up of the choices we make and I choose to look to the positive.

I was fortunate enough to attend my first home birth this past Tuesday as the primary caregiver. Sharing the joy with a wonderful couple who opened their home to me, doula Jen and midwife Karni. This was a beautiful early morning delivery just after sunrise and for me it renewed the joy to be found in my profession. The path to this point has been rough and winding and full of obstacles but I am very lucky to have reached this point. I am grateful to all of you who have supported me in the journey to find a way to practice my trade and use my skills in the way nature and common sense intended.

I would hope that you will spread the word to your friends and clients that I am fortunate to be able to now offer an out of hospital birthing experience as a choice to women and families who are interested in having a doctor collaborating with a midwife. I will be working with Karni in Ventura and the lovely staff at Sanctuary in Mar Vista as well as continuing to practice in my 2 offices during the week. Anyone with questions can be referred to my Century City phone number 310 282-8613.

We know that normal birth deserves much more reverence and respect than it has been given. I am proud to be associated with all of you who undertand this and respect the wonders of the human body and the mounting evidence that supports our perspective. Ultimately, if hospitals and organized medicine will not evolve to meet this knowledge and demand then women will look elsewhere. We need to be there to meet these needs. Lets support the development of the birthing center model such as Sanctuary and Santa Barbara Birth Center, work toward the development of a freestanding maternity center model and continue to educate the next generation of care providers and pregnant women. Emphasize the "normal" in low risk birth and spread the knwoledge that childbirth is a time of great human joy. Dr.F

Friday, August 6, 2010

Well, hello again. I apologize for being silent for so long. I was strategically waiting until things played themselves out here locally and now they have. Despite being vindicated by the ACOG review panel and in spite of the stellar record of care given by me and my Woman's Place colleagues over the years the administration at my hospital was still very unappreciative of my abilities and my worth in the community. Rather than face further ugliness and negativity I have chosen to withdraw my application for reappointment at my local hospitals. I am excited for all the positives the future has to hold for me as I now am free to head in the direction my long journey as an advocate of birth choices has meant for me to go. More on that to follow in the days to come. Below is a letter of explanation I have been distributing to patients this past week. I would be honored to hear your comments.

Dear Patients of The Woman’s Place,

Many of you are aware that I have long supported birth as a natural process and have advocated for changes in the current “birth as illness” medical model of obstetrics practiced at our local hospitals. The Woman’s Place, Inc. has been a haven for the collaboration between midwives and obstetricians and it has been a true joy to provide this option to so many of you. After much thought and consideration I have decided to stop delivering babies in the hospital setting here in Ventura County. This decision will allow me the opportunity to pursue new ventures including doing some birthing center and home deliveries while allowing me the freedom and time to create my dream of a free-standing maternity center run by midwives and supportive physicians. I will continue to work in the Camarillo office and perform ultrasound, office procedures, and gynecologic exams and see prenatal patients there in support of my colleagues, Michelle Marine, MD and Lynn Olson, CNM. Dr. Marine and I have been working together now for almost a year and I am confident in her dedication and ability to provide you with the same excellent standard of care you have come to expect from The Woman’s Place, Inc. My hope is that you will continue to rely on us for that excellence.

My presence in the office will remain and our great staff of Judy, Mimi, Wendy and Lynn, along with Dr. Marine and I are available if you should have any questions. For those of you who might like to have me attend your birth, that option will also be available. I have worked for 15 years with the Sunrise Birth Center in Ventura and its founder, Karni Seymour Brown, who has graciously agreed to collaborate with me should you desire an out of hospital birth at home or the birthing center with a licensed midwife and me in attendance. Please feel free to make an appointment with me to discuss this option.

Change is always unsettling and decisions like this can produce both anxiety and excitement. I know it will be difficult for some of you who expected me to attend your delivery but I hope you will come to see this decision as a positive in the long run. It will give me the time and freedom to advocate for normal birth options and choice here in Ventura County and nationally. It has been an honor to have delivered so many healthy Ventura county babies to happy and fulfilled Ventura County mothers these past 15 years. For me, the time is right to work towards the goal of giving women another choice of where and how to give birth. Thank you for your understanding and continued loyalty to The Woman’s Place, Inc.


Stuart J. Fischbein MD FACOG

Next up is the open house this Sunday from 11 to 3 at the new Sanctuary Birth Center in Mar Vista. I will be there with my co-author, Victoria Clayton, signing copies of our newly released, "Fearless Pregnancy, second edition", while soaking up the warm and nurturing vibes from the wonderful people there. Please stop by and say hello. Info can be found at their website: www.birthsanctuary.com

It feels liberating to be blogging again. Good things are going to continue to happen if we choose them to be. Dr. F

Sunday, June 20, 2010

Where's My Midwife?

Check out this video by Kirsti Kreutzer!! Stay informed on what is happening around the country by viewing this 12 minute film from North Carolina. See if this story sounds familiar in your area. Support midwifery and never believe that a small voice can't change things. Dr. F


Saturday, June 19, 2010

Good News!!

Hi All, have been off the radar for a few weeks as some important issues sort themselves out. For now I must remain silent but hopeful that things will be improving for women's birth choices in my community. Your voices have helped and there is no reason to stop now. I speak out when injustice appears in the birthing world and there has been plenty to talk about but now there are some voices of reason appearing and lets see where this goes.

In the really good news arena, the second edition of "Fearless Pregnancy" is now available on line as a book or a download. You can find it at


and soon it will be linked directly from our website at www.fearlesspregnancy.com as well. It continues to remind women that pregnancy is not a disease state and does not need to be treated as an illness in almost all cases. We have added some updates in new technologies, ideas and evidenced based approaches that are confirming what many of us knew as truth before. The book still has the easy reading wisdom it had in the first edition. It would make a great gift for loved ones who are pregnant or contemplating pregnancy soon as it would help them have a calm enjoyable voyage through one of life's greatest moments. Dr. F

Sunday, May 30, 2010

Good news and Horrible news

It seems there are some rumblings about ready to spill over at my hospitals in Ventura County. Wouldn't it be nice if everyone involved could speak honestly about what goes on there behind closed doors. With all the secrets and suspicions and threats one might think that national security was on the line. To me it is a ruse the powerful play to make what they do seem so almighty important. Its the doctors and nurses and midwives that are saving lives and yet its the administrators and lawyers that act as if only they carry the burden of righteousness.

This past week I was called into a meeting with the Chief of Staff and the Chairman of my OB/Gyn department. Four weeks ago and almost 10 months since the investigation into my practice which started me on this whole blogging thing began the decision was made as to whether further disciplinary action should end or continue. It took more than 2 weeks for their lawyer to draw up a letter and another 10 days before a mandatory meeting was called. So they knew for a month about my fate but because of the way an administrative system "works" could not express any humanity by letting me know sooner. I arrived for the meeting early while the other parties were 25 minutes late. No apology was offered. I was handed a letter exonerating me from any wrongdoing and ending any investigation. That was it!

Yes, they had me sign a piece of paper saying I received the letter. Ever heard of certified mail? No explanation or apology offered as to why they sat on this decision for a month. Clearly, to me a total lack of concern or empathy for what I might be dealing with. Then we had a discussion about making sure professional conduct rules were followed and the problems with our department came up. Clearly, the Chairman of my department and I see things differently and it was enlightening to see how little truthful information gets filtered through to the Chief of Staff. Hidden behind those rules of confidentiality is an ugly process by which the powerful can pick on and destroy those with which they take issue. Despite the lack of courtesy, I feel fortunate that I am now out from under their threat. At least for the moment. With the ACOG review panel coming in 2 weeks to scrutinize this OB Department there are some of us who hope a day of reckoning will come. And maybe, when the balance of power shifts to those who lead justly and with reason we may again see things like Midwives in Camarillo, breech deliveries and even a way to bring back VBAC.

Now, the horrible news. Sadly, the committee did claim one most wonderful and innocent victim this past week. After almost 3 years of tormenting one of my colleagues and a patient and nurse favorite they called her in to administration Thursday afternoon and suspended her from the staff. What I believe to be a series of lies, distortions, discrimination, pettiness, fraud and ethical violations by certain members of the OB Dept. all went against her. Complicit in the process are numerous administrators and other physicians who never took the time to look deeper and question the motivation and conflicts of interest of those that persecuted her. And to all of the staff not privy to the "confidential" information there is a feeling of sadness and astonishment that this could happen. Those of us that work with her know her to be caring, competent and appropriate in all she does. So we cannot understand the WHY? She has no greater incidence of complications or bad outcomes. In fact, compared to the members of the committee who led the charge to remove her she has a far better track record.

For reasons none of us can comprehend she now faces an inquiry from the Medical Board of California and will likely never again be able to perform hospital based deliveries. It is very unlikely that once you are kicked off a medical staff at one institution that any other will allow you onto their staff. However, on the positive side she has immense support and good friends. With ACOG coming to investigate we may have some light shown on what really happened. Interesting timing of suspending her 2 weeks before ACOG comes so that now she does not have a chance to speak to the panel as a member of the department. But her voice will be heard. Also, now that the one-sided administrative hearing process is complete she does have the opportunity to appeal in civil court where there will be an impartial judge, subpoena power and a jury made up of civilians free from subterfuge. Having sort of been through this type of process myself, my heart aches for the fear, anxiety, helplessness and unrequited anger she must be feeling. I think she knows how loved and supported she is and those that have hounded her will have their day of reckoning and right soon.

How I long for a simpler time where honest men went into medicine for a single purpose of helping others. How that time was lost is a subject for a great novel at some point. When I see what has happened to Dr. Biter, my colleague, many midwives and myself to a lesser degree I want to cry for a moment and then I am energized to fight back to reclaim common sense and hold those who would abuse their positions accountable and liable. The peer review system is so broken at my institution and the undercurrent of discontent with those that abuse it and support it in its current form is about to explode. Sad, that it will take outsiders and the civil court system to make transparency and honesty happen. But happen it must! Dr. F

Wednesday, May 26, 2010

The Industrialization of Medicine is Unhealthy for Patients

Talk show host Dennis Prager has popularized the phrase, “The bigger the government the smaller the citizen”. Calm and thoughtful people should consider well this premise. It seems that following the news of the European union and from Washington to Sacramento to city councils we are seeing the demise of personal liberty. So it is with health care. As government intrusion and industrial micromanaging overwhelm my medical profession the individuality of patients and of doctors who care for them is crushed. You have heard me say many times that one size does not fit all when it comes to patient care. We are all different, with varied life experiences and unique personalities. Informed consent and refusal require a free flow of information free from coercive forces. Doctors should be free to advise patients of choices based on what is good for the individual. But as medicine has become the purveyance and money engine of government, businessmen and lawyers our choices are being funneled by processes not often born of reason or the spirit of Hypocrates. Individuality does not fit the business model of bureaucrats and cubicle workers. Too hard to count beans if we honor our differences! In plain language, it is too hard to control. So the solution becomes a takeover of our health care in every facet so that choices can be limited, a fa├žade of liability protection created and a sense of order mandated. As the beast grows it devours everything unique and special that was once the sacred doctor-patient relationship.

Last week I attended the biannual OB/Gyn department meeting at St. John’s Regional Medical Center. I have tried for years to be left alone and allowed to use my skills and allow patients their right of self-determination. Treating patients with that sort of individual dignity has led to conflict with the larger controlling machine of industrial medicine. While we are supposed to follow evidenced based medicine and rely on outcomes data to determine good health care policy, this only gets in the way of those who prefer power over preference. This is true today on almost every scale. When it comes to my local hospital I see a clear distinction. While I want to be left alone to provide the right of informed choice to each and every patient and allow other doctors to do the same, the hospital chooses a narrow path laid down by an admittedly dysfunctional committee. They make what often seem to be arbitrary policies sometimes lacking any sort of sound medical reasoning and then force them upon the doctors and nursing staff with little or no input from the rank and file. These blanket, often kneejerk, policies are not thought out beyond the immediate false satisfaction gained by the creating institution. Thomas Sowell calls this Stage 1 thinking. There seems to be almost no thought for the, Stage 2, long term consequences that result in less choice, higher intervention rates and far more paperwork but no evidence that outcomes will be improved. In fact, as we have seen with premature policies surrounding fetal monitoring and VBAC based on opinion rather than hard evidence, outcomes often worsen. At this department meeting we were provided with a list of policies and protocols put in place at my institution in just the past year.

Delivery Privileges for Certified Nurse Midwives (new, restriction)
Professional Conduct (revised)
Emergency Privileges during a Disaster (revised)
Oxytocin Inductions/Augmentation
Epidural analgesia/anesthesia During Labor
Post cesarean section routine orders
Bakri tamponade balloon protocol
Obstetric hemorrhage protocol
Admission and discharge criteria-St. John’s Pleasant Valley Hospital (restrictions)
Vaginal Packing policy
HIV, Preventing perinatal transmission of
Vacuum assisted vaginal delivery protocol
Post c-section routine orders
Admission/Induction orders
Updated 1-page guide to OB hemorrhage protocol (added per anesthesia dept.)
Final OB hemorrhage policy
Foley catheter policy

Now, maybe some of these 16 new policies will do some good but I have never seen any reports that show they were ever proven to do anything prior to their adoption. And with all these policies now in place will there be any evaluation as to whether outcomes have improved? Were things that bad that we really needed 16 new policies?While not all of medicine is yet lost to this sort of micromanaging, it is becoming pervasive. What is essentially gone is the “Art” of medicine. It seems to me that the job of so many hospital administrators these days is to constantly find things to change. It makes them seem busy and important and justifies their salaries but they so often leap before they look. Their premise is always liability mitigation and economics and sometimes just meddlesome. And it is all under the guise of patient safety protocols. As you can see from the list above, as these policies become more massive and micromanaging there is little or no room for the individual. Sadly, in the current monolithic healthcare model there is no going back. Choices in childbirth, caregivers, prescription drugs, facilities and procedures will continue to shrink and the single patient as a unique person model will fade into history. I am still hopeful that creating smaller alternatives such as birth centers and free standing maternity centers unencumbered by massive government or insurance industry oversight will provide an oasis for those pregnant women who desire the freedom to educate themselves and choose their own path. There will be a cost to remain free but it will surely be small compared to the cost of giving up our individuality. Dr F

Tuesday, May 25, 2010

Laying Low and letting the process work

I have not posted in nearly two weeks. But that does not mean things aren't happening out here in Ventura County. Some revealing events are taking shape but the details are protected by their veil of confidentiality. One important event happening next month is the arrival of an investigative panel sent by ACOG to review the policies, procedures and doings of the OB committee. Apparently, things have finally gotten so obviously bad with this committee that even the always complicit hospital administration had to do something. There was no hiding it anymore. So they have hired a group of ACOG physicians and nurses, at a price tag of more than $37,000.00, to come for 4 days and perform an "objective" investigation, chart, policy and meeting minute reviews and conduct personal interviews with all members of the department including midwives. At the OB department meeting I was specifically assured by one of the hospitals top administrators that anyone who wanted to be interviewed would have 30 minutes in private. Now, however, there are rumors that they may be backing away from this promise. There are many of us who would make a lot of noise if they even try something like that. I am hopeful that this will be the first step in returning honesty, common sense and reason back to our department. I would like to see those that have for so long abused their position of power be humbled to the point of apology and punishment and we can hope for a revamping of the committee model and a return to evidenced based medicine and national standards that benefit patients rather than a small totalitarian group of petty obstetricians forcing their will upon us.

Also, Joyce, Victoria and I have almost completed the final edits of "Fearless Pregnancy, 2nd edition" and hope to have a release date in early June. It will be available online in real soft-cover book form or as a download e-book format. Amy Tinney and I also have 2 meetings this week with persons possibly interested in helping with our maternity center idea. I see Laurel Phillips has some fundraising events going on up in Santa Barbara. Please check out the Santa Barbabra Birth Center web site for details. I may also soon be helping out with the Sanctuary birth team as a consultant in the Los Angeles office and I have heard exciting news that they will soon have a facility for midwife assisted out of hospital birthing on LA's west side. All the best, Dr. F

Wednesday, May 12, 2010

“There’s really been no change in anything,” said St. John's Chief of Staff

And so it goes. Despite a petition from over 700 residents of Ventura County calling for an end to the midwife ban delivered by BAC chairperson, Kim Rivers, St. John's continues to refuse to explain the hypocrisy or release any supportive evidence for their decision to ban midwives from Pleasant Valley Hospital. The Ventura County Star, to their credit, has written a followup story which confirms the title of this blog but at least feels the issue is unresolved and worthy of continued scrutiny.


Reading the comments section can be fascinating and frustrating as some just do not understand what midwives do. Others have the sky is falling approach to birth while voices of reason try to elucidate common sense. BAC is committed to keeping the issue alive. Here is a copy of their press release:

St. John’s Denies BAC’s Meeting Request to Discuss the
Community’s Response to Ban on Nurse-Midwives from Attending Births

Ventura, Ca. – On May 6, 2010 a representative from the Human Resources department at St. John’s Regional Medical Center canceled a meeting with Ms. Kimberly Rivers, President of the Birth Action Coalition (BAC), that was scheduled for 3:00pm on Friday May 7th. The meeting was set with Mr. John Bibby, Director of Human Resources and St. John’s Chief Medical Officer, Dr. Eugene Fussell. The meeting was requested and set in order for Mrs. Rivers to present BAC’s petition regarding the recent midwifery ban at Pleasant Valley Hospital in Camarillo. On Monday May 10th without an appointment Mrs. Rivers presented the petition to the Human Resources office desk at St. John’s and was told it would be delivered to Mr. Bebe.

BAC, a community organization focused on educating and advocating for supportive birth environments, has been calling for St. John's to respond to community member requests for access to midwives, and clarification over reasons for the recent ban on nurse-midwives at Pleasant Valley Hospital since the ban. Administrators at St. John’s Regional Medical Center, part of Catholic Healthcare West, cite “patient safety” and availability of a NICU (neonatal intensive care unit) at the facility as the reasons for approving the policy that prohibits certified nurse midwives (CNM) from attending births at Pleasant Valley Hospital.

BAC hopes to gain a response from St. John’s through its monthly protests in front of St. John's Regional Medical Center in Oxnard and is circulating a community petition The petition asks that St. John’s administrators immediately reinstate privileges for all CNM’s at Pleasant Valley Hospital, or, that St. John’s administrators provide evidence supporting their statements that the CNM’s have been removed from the Camarillo facility due to “patient safety” (we ask that this evidence show outcomes for all care providers who have attended births at Pleasant Valley Hospital), or that St. John’s administrators retract their claims that the midwifery ban is due to “patient safety”.

(See petition at: www.petitinonline.com/speakout)

On two separate occasions Ms. Rivers contacted St. John’s for a meeting requesting 5 minutes to present the petition signed by over 700 people. Finally on May 3 an appointment was confirmed with Mr. Bebe’s office for 3:00 pm on Friday, May 7 but was then canceled on May 6. When asked for a reason why the scheduled meeting with Ms. Rivers was canceled, it was suggested that Mr. Bibby and Dr. Fussell were advised not to speak with Ms. Rivers without further explanation. “St. John’s is now outright refusing to listen to a member of the community regarding a policy they have put in place that affects the birthing women of Camarillo,” says Rivers. “ BAC plans to notify Mr. Lloyd Dean of Catholic Healthcare West regarding this clear dismissal of the concerns of community members, and we will continue to speak out on this issue until the community receives a satisfactory response. ”

Monday, May 10, 2010

More absurd secrecy?

First, I admit I only heard about this through an email blast this weekend from L. Janel Martin. The details are sketchy but all too hauntingly familiar for me to ignore. Dr. Robert Biter from the Carlsbad, CA area has apparently lost his admitting privileges at Scripps Encinitas Hospital:

As of 5 pm Friday, May7th, Dr. Biter's privileges to deliver babies at Scripps Encinitas Hospital have been suspended. He will still be able to see his current patients postpartum (after they deliver) in the hospital. He is hoping that this will be resolved quickly & is working hard to ensure that there is a backup plan for his patients that are due to have their babies soon.

Here's what I know: There have been no obstetrical malpractice issues against him---ever. The hospital, specifically some OBs, have been attacking him for the last 3 years for protecting women's rights for natural birth. I believe it''s all out of greed for money--less interventions means less money for the hospital. Other doctors were losing their patients to Dr. Biter because they wanted a doctor who would support them & that trusted birth as being a woman's birthright rather than a medical procedure.

An effort to support him is being organized by Carol Yeh-Garner at:

Carol Yeh-Garner
3192 Corte Tradicion
Carlsbad, CA 92009


My own experiences suggest that the rules of peer review and the convenient veil of confidentiality will prevent us from knowing the real reasons for the hospital committee's actions. However, I do suspect that Carol's suspicions are likely correct. What we can do, if Dr. Biter so desires, is contact and barrage the hospital administration with calls and letters asking them for explanations. The one thing that hospitals hate most is negative publicity in the media and having a light shone on their internal policies and politics. If you have any information, please comment here on my blog to educate the rest of us. Also, for those who care to write here is an address:

Write a letter to the CEO of Scripps Encinitas:
Chris Van Gorder--President & CEO of Scripps
4275 Campus Point Court
San Diego, CA 92121

I have heard that Dr. Biter is planning to open a free standing maternity center supportive of the midwifery birthing model. The timing of this latest absurdity against him cannot just be a coincidence. I am hopeful that we will know more soon. Although, he may be restricted from discussing this openly by the rules of the hospital set up to always favor the hospital. Through my own experience I find such secrecy, when not directly involving patient confidentiality, to always be suspicious of nefarious reasoning. Dr. F

Sunday, April 18, 2010

Are we de-evolving as a culture?

I was sent this link to an Australian Documentary being made about the possibility that home birthing may be outlawed there. We cannot stand idly by as these personal choices and birth rights are systematically attacked. Whether one agrees with home birthing or not, we should always allow for self determination when it comes to our bodies. There is an insidious and totalitarian trend that has been speading its tentacles into so many aspects of the liberty loving free world. I encourage you all to make your voices heard so that clarity on these issues spreads to the sleeping giant that is the freedom loving peoples of the world. Please demand that politics and lawyers stay out of your homes. For if we remain silent we will get what we deserve and what will be next. I am not surprised about much of anything anymore. But I remain pissed off!


Thanks, Dr. F

Friday, April 16, 2010

Text of Tea Party Tax Day Speech

Here is the speech I was to give at the Tea Party Tax Day Rally in Thousand Oaks, CA yesterday. I think it is better when I am speaking but wanted to share my thoughts, as usual. Warmest regards to all, Dr. F.

"A wise man, in a past time of wisdom, a patriot named Thomas Paine, author of the original “Common Sense”, was quoted to have said, “The long habit of not calling a thing wrong gives it the superficial impression of being right.” So it has been with American citizens not paying attention to their own government. Sadly, it has taken the passage of this monstrously corrupt health care bill to wake the sleeping giant that is American Values. It is time to stand up for our liberty and call what is happening just wrong.

I am so honored to speak here today. I have been asked to give a practicing doctor’s perspective on what is happening to our health care system. Now, despite what words may follow, I am very motivated to help fix what I consider to be a broken leftist ideology about health care as a right. For if it is a right then it implies that people have the right to my services for whatever value the current democratic leadership decide I am worth

“I observed that in all the discussions that preceded the enslavement of medicine. Men discussed everything—except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve’.”
Ayn Rand, from Atlas Shrugged, 1957

Healthcare is not an inanimate commodity like oil or water. It is people!

What we will see as government and organizations and insurance companies begin to micromanage our lives are mandates based, not on evidence or the realization that each patient is an individual, but on ideological, nanny state one size fits all ideals that are determined by politically favored elites. Forcing behaviors upon us by any means possible is the fanatical religion of those on the secular left who are true believers in a society defined by what they think is best. You will begin to see laws and commercials and public service announcements, paid for by government stimulus money which entices you by reward or punishment to follow their advice. Advice based most often on emotion and not science. You will see more brainwashing type curriculum using your tax dollars in public schools with the purpose of indoctrinating our children early on towards the “correct” way to think. It is Orwellian and it is possible. No almost certain under this leftist administration.

You have seen it already. Crusades against second hand smoke (Have you seen the commercial about the little kid playing in the apartment building? C’mon, really?) or hetero-sexual aids or swine flu ( oops, where did those panics go?) and, now for Global Warming, excuse me, Climate Change and the need to go green no matter what the cost to our future generations.

The latest monkey business is legislation that will force restaurant chains to put the caloric content of their food on the menu. There is no evidence that this will do anything but increase costs to restaurant owners who will have to raise prices to us. In fact, there is evidence that exists that shows it will be pointless. But when you have a crusade and an ideology who cares about that little nuisance called facts. I submit that in the 20 years since we have been forced to put nutritional information on all grocery products Americans have gotten fatter, not thinner. I don’t go to a steakhouse because I care about caloric content. We need a congress that understands this and stays out of my pancakes!

Really, what we have now unleashed in our beloved country is a hostage situation to the American legal system. Whether it’s the local restauranteur, the small businessman, the ski resort, your family doctor or your local hospital or school we are all victimized by a lack of restraint on our legal tort system. Quite frankly, my biased opinion thinks that the biggest obstacle to American values returning is the American legal system. If any industry was in need of reform it is that one. Where are the future leaders who are willing to take on the trial lawyers? Now that would show real bravery. Dennis Prager and others have rightly labeled ObamaCare as, “The trial lawyers of America stimulus package”.

Recently, a midwife friendly hospital in Greenwich Village closed its doors due to its inability to stay financially solvent while trying to comply with all the mandates, regulations and legal protections required. The organization that runs residency training programs in the United States has predicted an increasing shortage of applicants in the next decade. Many doctors are already at the point where they cannot afford to continue to take on more patients for ever decreasing reimbursement. MediCal and medicare patients are going to find it harder to make appointments and are going to be waiting longer. The cost estimates in the ObamaCare bill are fictional. Everyone knows that or lives in denial. When costs cannot be contained there are only 3 choices. Raise taxes, lower reimbursement or ration care. Raising taxes will not solve anything as the well will run dry. And lowering reimbursement further will just push doctors and hospitals out of business, as it has in Greenwich Village and lead to rationing by default. This health care bill is unsustainable and un-American. Most doctors love our profession but hate what the business of medicine has become.

As for my practice: Carolyn asks whether I would consider giving it up and retiring early. The answer is really, can I afford to keep going? Is it worth it. Take the man who owns a horse. He adores that animal and derives much joy from riding and caring for it. But he can no longer afford to feed it. He cannot bring himself to sell it so he decides he will save money by cutting back each day on the amount of hay he feeds the horse. Each day he will feed it a little less and in that way save money. Finally, he reaches the day where he no longer has to feed the horse. He arrives for his joyful ride only to find the horse dead! What a shocker. (Horse and Hay story of Tim Conway Jr. from KFI Radio). Such is the analogy for this health care entitlement.

I have spoken about this many times before. Not only will doctors able to quit consider doing so but who in their right mind will become the future doctors in our country. Years of training, and sacrifice of social life. Loss of a decade of fun and earning power. Massive debt. Only to come out and see your expenses rising and uncontrolled but your earning power capped and regulated. The devastating threat of a career ending law suit hanging over your head like the sword of Damocles is no way to live. Having authorization for a test or procedure denied by some non-medically trained faceless cubicle worker who can’t even spell the diagnosis is maddening. Your decisions weighed and scrutinized by utilization review boards, government agencies and hospital committees. None of whom will ever bother to get to know the patient you are advocating for. How many of you would want to live like this? Would want your children to choose this?

And to this point I haven’t even mentioned the looming specter of Electronic Medical Records coming by 2014. Every detail of your medical history, and that of your children will be mandated to be online for bean counters of all shapes and motivations to peruse. Do you trust that it will remain confidential? I don’t! And there will be an amazing cost of installing the hardware, software and annual updates that will not be reimbursable to the practitioner. Adding another undo burden on the small, independent practice of doctor, midwife, chiropractor and therapist. Another not so subtle hammer to force doctors like me out of business or submit to joining large multispecialty impersonal groups run by large conglomerates or government agencies where the individuality and art of medicine I love will disappear.

Politics and politicians have no business invading the doctor patient relationship. The system is rotten to the core. We all saw this openly in the dirty tactics, special interests and bribery of all too eager politicians in the passing of Obamacare. People ask me why the AMA supported the bill. First, this may come as a surprise but less than 17% of America’s doctors belong to the AMA. And almost all of those are in academia, residency or retirement. Actually, I do not know any colleague who is a member. So the AMA does not represent the practicing doctor. The AMA represents the AMA. They do not care about you. They do not care about me. They do not really care about health care. They have a financial interest in this legislation just as does the AARP. They have made a deal with the devil, in my opinion. We have become a nation of deception by large special interests. The propagandists never say what they really mean.

Which brings me to the General Electric corporation, run by Jeffrey Immelt, one of president Obama’s biggest supporters and White House visitors. GE is apparently in line to be the major player in the EMR technology. Some say a 7 billion dollar deal. That’s our tax money, by the way! Numbers that are too big to really grasp. But here is an interesting tidbit. I was talking with a group of health care professionals about the legislation recently. Someone brought up an odd provision in the bill that increased payment to doctors for bone density studies. We all thought it odd that a bill that has few specifics would single out one procedure for increased reimbursement. How odd that in a 2700 page bill that this one test would be mentioned specifically! Well, here is my logical, yet cynical conclusion. With bone density payments diminishing over the last 5 years no one is buying bone density machines because it does not pay to own one. If reimbursement goes up, it may make sense for medical groups to purchase new machines again. Well, guess who is the leading manufacturer of bone density machines? Yep, General Electric.

So, we have come to a place where we have to decide who we trust. No longer can we be passive when it comes to something as important as health care. We have to take a stand. I trust the relationship I have with my personal physician. I trust my ability to judge him by his actions. I trust that he has my welfare as his primary concern. I trust that if he does not serve me well I can go someplace else. I do not trust big government or big business to have my back. I do not trust the nanny state to make decisions in my family’s best interest. I will do that and I want a country that allows me the freedom to succeed or fail. One size does not fit all. The government should not have the right to take my hard earned skills and demand of me to give them away for what they determine they are worth. I have never dreamed I would be before you all today making emotional speeches. All I wanted to do was to practice my profession as I was trained to do and love my family. But, I cannot sit idly by and watch this happen. I want my children to know that their dad stood up for self determination and personal responsibility.

I would close with this quote from Ayn Rand’s Atlas Shrugged. ““Let them discover the kind of doctors their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe if he is the sort who doesn’t.”
Ayn Rand, from Atlas Shrugged, 1957

The best and the brightest should be going into noble professions like medicine. Sadly, unless we elect leaders who pledge to repeal this horrible health care legislation, medicine will no longer be noble and the best and brightest will seek other interests. Possibly becoming lawyers or government workers because that’s where the money and lifestyle remain.

Thank you for allowing me to vent and for your passion and love of country."

Stuart J. Fischbein, MD April 15, 2010

Sunday, April 11, 2010

Good News from Ottawa!

Very telling of the times we live in that a simple normal vaginal birth makes the news in Canada. But, still, its a turn toward common sense and evidenced based medicine and that should never be taken lightly. Congrats to the family and health care practitioners on this happy event. Dr. F


Saturday, April 10, 2010

Another Casualty

Here is an article sent to me by Laurel Phillips in Santa Barbara from today's NY Times. Another sad example of the loss of our inalienable rights due to economic forces and fears of litigation. Is this the Health Care Reform we desire? And "Tort reform is off the table" says our President and Congress.

We cannot feel despair. For me, this sort of story motivates me even more to take positive action. Reinforcing my belief that normal birth needs to be taken out of the hospital model. Market forces would support free standing women's health and maternity centers. There are enough midwives and supportive doctors around to make this a reality. What is needed are motivated patients and funding. Keep spreading the dream and the right circumstances will fall in to place.

Amy Tinney and I are working with some leads and putting a business plan in place for a Los Angeles site. Any support or expertise in this realm would be welcome. Thanks, Dr. F

N.Y. / REGION | April 10, 2010
Big City: With the Closing of a Hospital, Women's Childbirth Options Diminish
Mothers-to-be will lose a midwife-friendly alternative after a decision by the board of St. Vincent's Medical Centers to close its flagship hospital in Greenwich Village.


Tuesday, March 30, 2010

No news is not necessarily good news

Well, locally, there is no news to report. The BAC held it's third in the ongoing monthly protests against the indefensible banning of midwives from Pleasant Valley Hospital. No official word from the administration concerning a reversal of their blunder. Continued delays from apologizing to the midwives and those of us who support them are unacceptable. The local press has dropped the ball and there is the appearance of apathy. However, behind the scenes we are doing what we can to keep this travesty on the radar screen. Off the record sources have indicated that some in corporate CHW are not too happy with the St. John's administration. CEO Mike Murray is leaving for unknown reasons. Because they never tell the truth about such things we can only speculate as to why.

There has been no movement from the OB committee on its unwritten ban on Breech deliveries. In light of the NIH VBAC concensus concluding that the banning of VBACs at many hospitals around the country is not evidenced based one would hope that reasonable minds would rethink the banning of other evidenced supported procedures like Breech delivery. But then, fairness, logic, science and collegiality are not values of the current hospital committee. And, since, these defacto bans do not hinder their practices there is no need for them to be reconsidered. Every week that passes continues to hurt their reputation, their bottom line and the patients of our community as many are becoming informed and looking elsewhere for birth options.

My hope is to see a renaissance of common sense and return of birth choices which will include an eventual disbanding or reorganization of the committee structure in the OB department. I will continue to write, speak and try to work with those in the administration who still remember their mission statement. Please continue to make your opinions known to CHW through e-mails and letters and protests, when necessary. The BAC website has the contact information. I would also urge you to join and become active with the Birth Action Coalition at www.birthactioncoalition.org . Thanks, Dr. F

Monday, March 22, 2010

Micro vs. Macro:

Some of my dear friends are excited about the events on Capitol Hill yesterday. There are parts of the massive health reform bill that suit their agendas. Such is the case with the Mama Campaign people who have done really good work in improving access and payment to CPMs. Or, the portion of the bill that improves access to health coverage for those in need. Worthy objectives, yes. While this sort of "Micro" thinking may be personally satisfying for a worthy agenda I would like to caution my friends from too much euphoria. For, in my opinon, the "Macro" of this bill, the corrupted process by which it came to pass and the inevitable intrusion by tax, mandate or yet to be determined legal quandries into our lives, will make America worse off. Those of you who know me, know I cherish personal autonomy and responsibility over the collective. Soon to follow will come the poison in this pill. Restrictions on choices and mandates on behavior with unforseeable costs and debt from a class of elites whose leftist philosophy believes, truly, that they know best. Watch for ads on TV frightening you or seducing you. Soon to come will be the tax incentives or punishment for behavior that they think is good or bad. One size fits all is not an American value. For me, this assault on our individuality transcends political bickering. I don't trust big government. But you guys know that. Their track record at ruining things they touch is pretty good. American education is a good example. My point here is not to suggest how you should think. Only that it is important to think. As we fight for the causes we believe in don't forget to look up and outside at the bigger picture of where this confusing, massive mandate is taking us. Thanks, Dr F.

Wednesday, March 17, 2010

New Facebook Page

Hi All, One of you was energetic and thoughtful enough to create a Facebook page for me at:


So now fans (and foes) have another place to check and see what I am up to or supportive of. Most of the news has been very positive towards what we believed all along. Nothing new to report at my local hospitals and it is doubtful that the NIH VBAC conclusions will cause even a ripple of remorse or guilt on the part of administrators and doctors who continue to uphold several policies without supportive medical evidence. I will continue to try to work respectfully for a return to common sense and patient autonomy out here.

Danielle from Momotics has posted a survey of 861 post c/section moms which looks at the feelings of the actual patient. What a novel idea! Asking the actual patients affected by the interventions modern medicine performs how it affects them. you can find it at:


Lastly, I believe the BAC is planning another rally at the corner of Rose and Gonzalez this Friday at 11 AM. Please check out the BAC website for details. Dr. F

Saturday, March 13, 2010

Final NIH VBAC Consensus Report

This is really welcome news. A government appointed panel has looked at the evidence objectively and concluded that VBAC should be a viable option for women. They also stated that in most instances it is as safe or safer than elective c/section, the opinions against VBAC were not evidence based and hospital policies that obstruct this option should be revisited. As always, they state more studies are warranted in several areas. Please read for yourself and forward to patients, colleagues and your institutions. Thanks, Dr. F


Trust Birth Dinner & Upcoming VBAC class

Julie and I had a wonderful time tonight at the Trust Birth Dinner in Redondo Beach. Thank you Carla, Heather and all the dedicated birth goddesses who honored me along with so many other deserving people. I am grateful for the energy you share that rejuvenates my drive for our common goals. So nice to meet Sara Buckley and see Paul Fleiss among the honorees, too.

Sunday from 1:30 to 5:30PM at my Century City Office is the VBAC education class led by Jen Kamel of VBACfacts. There is still room if anyone is interested. I will be attending and offering my 2 cents worth. Below is the information. If interested contact Jen through facebook or leave a comment here and I will get back to you. Dr F

There are still tickets available for the class this Sunday which will be the only class offered in Los Angeles for 2010. The class is close to being sold out, so if you are interested, don't delay!

Another reason to RSVP as soon as possible: I am printing up bounded books of the presentation and want to make sure I have enough for everyone.

Dr. Stuart Fischbein OB/GYN will be present to answer questions.

The latest couple who registered are driving 170 miles one way. Don't let distance hold you back from attending!



You are invited to the following event:
The Truth About VBAC - Los Angeles

Sunday, March 14, 2010 from 1:30 PM - 5:30 PM (PT)

Offices of Stuart Fischbein, MD
10309 Santa Monica Blvd, Suite 300
Los Angeles, CA 90025

Action Alert

Please view the following message from Docs4patientcare and send to to everyone you know. For I believe a government takeover of healthcare is the purpose and inevitability of the current bill and would be detrimental to our patients and the individual right to autonomous decision making that we cherish. Rationing and limits on birth options and choice would certainly follow.


We at docs4patientcare appreciate your attention at the vital time in history. Dr. F

Wednesday, March 10, 2010

Draft summary of NIH VBAC position

Very good news and reassuring that at least at the academic level evidenced based reasoning and common sense have prevailed. Please read the initial statement from the National Institute of Health on VBAC:


The conference was a worthwhile experience and I believe the panel members have the most honest of intentions. I am so glad I went. I hope some of you followed the webcast and if not, it will be up soon through the NIH website. My take on the conference was that it is clear from the presentations and the panelist conclusions that there is no convincing evidence that VBAC is inherantly unsafe nor is it ethically a choice that should be denied to any informed woman. While I do not think there is a snowball's chance in hell it will cause any immediate effect on hospital policy, I do believe if disseminated to patients they can make a convincing argument to their local hospitals that they cannot be forced into surgery and have the right of informed refusal.

One of the most compelling points of the conference to me was the following. ACOG's 1999 statement No.5 changing the word readily to immediately available was not based on any evidence. It was likely done to give ACOG members legal cover in cases where compliance was maintained and still a bad outcome ensued. The result was no real protection against the fear or reality of a disastrous law suit and only fed the fear which led to VBAC bans at more than 30% of American hospitals. Amazingly, neither before ACOG came out with the "immediate" guideline or in the ten years since has there been any studies undertaken that have ever shown that having emergency help immediately available has done anything to lower the incidence of cerebral palsy, neonatal death or maternal morbidity over the "readily" available (30 minutes decision to incision) standard! It is horrifying for me to actually learn that so many of these repeat c/sections were inflicted on women based on nothing but fear and economics. My profession should be ashamed of our cowardice.

I will post a link to the final NIH consensus statement when it appears. The BAC website and VBACfacts are also a great resource to follow the story. Spread the word!

Tuesday, March 9, 2010

NIH VBAC Conference

Hi All, Just home from Bethesda, MD and the NIH VBAC consensus conference. So much to tell but too late tonight. The evidenced based data presented was very supportive of VBAC and patient autonomy in decision making. Whether that will be the consensus and whether it will make any difference with the forces against it remains to be seen. I suggest for the greatest details and insights you look to Jen Kemel's site at www.Jen@vbacfacts.com

In the coming days I will do my best to summarize my thoughts and observations and report on the consensus statement due out tomorrow afternoon. The statement will be published online at www.consensus.nih.gov

Archived videocasts of the entire conference will be available in approximately 1 week at www.videocast.nih.gov

Dr. F

Sunday, March 7, 2010

VBAC support hits mainstream media

Very nice to see the NY Times publish this article on the eve of the NIH VBAC consensus conference. Kudos to Kim Gregory, MD for her honesty. So obvious what the burden of medical malpractice and money does to trump evidence based medicine. For when you remove them from the equation the safety and benefit from selected VBACs is clear. Hospitals and practitioners must recognize that the real battle on behalf of our patients should not be between them. United they should work toward insurance and tort reform. Although, I am not for a government takeover of medicine it is clear that it works for the women on this Reservation. Dr. F


Saturday, March 6, 2010

Where will future doctors come from?

Thomas Sowell wrote on this today. It is good to see this question asked in the mainstream media. It is a question I have asked and written about before on this site and a discussion I have had with many of you in person. Last year I attended a meeting to review a new product. About 30 of my Ob/Gyn colleagues sat through several hours of powerpoint presentations and discussions. The last lecture was by a lawyer working for the company sponsoring the event. There is no medicine without lawyers anymore. Actually, there is just about nothing without lawyers anymore but I digress. The conversation was interesting and eventually he asked how many of us in the room had parents who were doctors. About 40-50% of the hands went up. Then he asked the obvious next question. "How many of us would want our children to become doctors?" Not one hand went up. It was one of those indelible moments of reality and sadness to all attending of what our once noble profession was becoming.

I know many of my colleagues would agree with Dr. Sowell while some do see it differently. However, I would add this bit of thought. When you are sick or scared or need health advice would you prefer a shepherd or a sheep? For my part, I want someone who is a take charge person. One who exudes confidence, will go to bat for me with those that would obstruct my care and go the extra mile to make me and my family feel safe. I call those type of physicians shepherds. Shepherds do not want to go through 8 years of postgraduate education, 4-6 years of residency and fellowship training, costing them hundreds of thousands of dollars and leaving them in substantial debt ,spending the entire decade of their 20's in labs and libraries and lost hours and screwing up a normal social life.....Only to discover upon completion of their training that they will now have their salary, their decisions, their ability to plan their schedules and prescibe medicines all determined by an employer, an insurer, a government, a hospital and their lawyers. To be told what you can and cannot do confirms they are and will only ever be sheep. So, as the reality of what the future will be like reaches those eager premed students, the shepherd personality, the capable decison maker, the person who would take responsibility for their decisions, will not choose medicine.

Medicine will no longer be a profession but might still be a good "job". It will not be cost effective or individualized as it will be left in the hands of those incapable of taking charge. Natural selection and a training environment that emasculates decision making will lead to doctors incapable of making even a simple decision without consultations, extensive use of testing modalities and one size fits all protocols. (Ah, protocols....sound familiar?). This is where we are already and the future does not look brighter if trends in Washington continue. As Dennis Prager likes to say, "The bigger the government, the smaller the citizen." Anyway, I encourage you to read Dr. Sowell's piece linked below. Thanks, Dr.F


Tuesday, March 2, 2010

Dr F. to attend NIH VBAC Conference

Along with a number of VBAC supporters I will be traveling to Bethesda, MD next week to attend the National Institute of Health's VBAC Consensus Conference. Experts will be presenting a number of issues and then coming out with a position paper which will likely carry great weight. Probably more so if the consensus is against VBAC as a supportive consensus is still unlikely to change the current entrenched hospital mindset about birth. In light of some of the recent controversial recommendations on mammograms and pap smears by the NIH I believe it is important to pay close attention to this event. I hope to learn and contribute and ask those questions that need to be asked and have remained unanswered by institutions that choose to ban VBACs. I will post what I learn on this site. You can follow along with the free webcasts at:


Just follow the prompts to the log-in site. Feel free to send me comments, ideas or suggestions and I will pass them on to the faculty. Kim Gregory, MD, who I have worked with for years at Cedars-Sinai is one of the contributors.

Monday, March 1, 2010

Call for Birth Stories

I received this request from a group in Connecticut and would encourage us all to pass it on. It is important to gather to speak as one loud voice for birth choices. Thanks, Dr. F

Hello Everyone!
Connecticut Worst to First is working on a project that will be hopefully taking the national spotlight once it is finished. I am looking for women who are willing to speak about their negative birth experiences in hospital settings. Women who had unnecessary c-sections, rude comments, had to fight for their right to give birth vaginally, fight for VBAC, or other types of scary, sad, or shocking experiences.
There are so many women out there that are willing to tell their stories and if we can band them all together to help PREVENT others from going through the same thing, it will be worth the time and effort.

Anyone interested can contact me directly at Danielle@CTWorsttofirst.com
or at 203-615-3790

Please pass this e-mail along to as many women, providers, advocates, doula's or anyone else that may be able to help!

Danielle A. Elwood
Connecticut Maternity Care
Worst to First Campaign

Sunday, February 28, 2010

Ventura County Star Letters

Kudos to the Ventura County Star newspaper for continuing to print letters on the midwife ban and keep the story alive. Thanks to Ina May Gaskin, Deborah Frank, Patti Reis and Kim Rivers for their contributions. To read and comment please go to:

www.vcstar.com and put the leyword "midwives" into the search box. Dr.F

Thursday, February 25, 2010

Jen from Sundance Doulas recent blog

Jen points out, logically and eloquently, how the policies and procedures at St. John's seem to repeatedly violate the teachings and doctrines of the Catholic Church. I would recommend all my readers follow this link and participate in the process of reclaiming your rights. Thanks, Dr. F


Monday, February 22, 2010

Ina May's 2 Cents Worth

Let’s be honest. The decision to take away the option for women to have a midwife-attended birth at St. John’s Pleasant Valley Hospital in Camarillo as of February 8 had nothing to do with concerns for the safety of women or babies. If it had, the hospital would not have cancelled privileges for midwives Lynn Olson and Joyce Weckl. There is plenty of evidence that indicates that putting midwives in charge of caring for healthy women during pregnancy and birth actually produces better results for mothers and babies with fewer interventions at lower costs than having an obstetrician (who is trained to deal with pathologies of birth, not with normal birth) be the sole caregiver for healthy women. There is no evidence that newborns or mothers at St. John’s were put at any increased risk because of midwifery care. CEO T. Michael Murray knew this, I suspect, or he would have presented some with his cowardly statement that rescinded the midwives’ privileges.

A recent U. S. study showed that nurse-midwives spend an average of 24 minutes with a woman during each prenatal visit, compared with obstetricians, who spend only 10 minutes per visit on average. Another study of more than 4 million U. S. births found that midwife-attended low-risk births had 33 percent fewer newborn deaths and 31 percent fewer babies born too small, which means fewer brain-damaged babies. It is well known that midwife-assisted births are far less likely to be induced or to result in a cesarean. No wonder approximately 60 women in the Camarillo area per year took advantage of this option last year. But that’s over now—at least in Camarillo. This bullying of pregnant women and midwives is outrageous; it is especially insulting to explain it as a “safety” measure.

Without exception, the European nations in which 75 percent of births are attended principally by midwives (usually with no obstetrician in the birth room) have lower rates of newborn and maternal deaths than we have in the U. S. None of these countries spends nearly as much money per capita on maternity care as we spend, and in none of these countries are licensed midwives kept from working in hospitals providing maternity care. The U. S. is the only country among the highly industrialized nations that even has the concept of midwives who must beg for privileges, which can later be summarily withdrawn without any right of appeal.

It’s ironic that the St. John’s decision against midwifery took place only days after Californians learned that maternal death rates in California had nearly tripled between 1996 and 2006. Some have suggested that this rise in due to better reporting, which is unlikely, because California has so far done very little to improve the accuracy and completeness of maternal death reporting. Even if it were due to better reporting, it is about 5 times the maternal death rate set as our national goal for 2010 (3.3 deaths per 100,000 live births).

Some might expect that such a shocking news report would have been accompanied by a systematic analysis of the causes for such a quick increase in maternal death—a problem that most people think was solved long ago by high-tech obstetrical care. That has not yet happened. In fact, the state Department of Public Health has so far refused to issue a report on this trend that could help people learn the reasons for the sudden increase in this worst of maternity care outcomes. Surely, California’s women of childbearing age deserve better than this.

For over a decade, I have been tracking the problem of poor reporting of maternal deaths in the U. S., because I was so shocked to find out that the Centers for Disease Control (CDC) is unable to fix the problem they first stated in 1998—that the true maternal death rate in this country could be three times what is officially reported. I began collecting the names of U. S. women who died from pregnancy-related causes since 1982, the year of our lowest reported maternal death rate. I recently learned that by using Google and taking reports from family members or friends of women who have died, I have a considerably larger database of maternal deaths than the Joint Commission, the closest thing we have in this country to a certifying organization for hospitals and other health organizations. (It is suggested, but not mandatory, for hospitals to report maternal deaths to the Joint Commission). Judging by the stories of maternal deaths in my database, the rise in the death rate has much to do with the rising rates of cesarean and induced labors.

There are also similar sounding stories of women dying in hospitals of hemorrhages following birth, suggesting that some hospitals may not be employing enough nurses to provide the kind of watchful care that is necessary in the hours following birth. Making a greater use of midwives is an obvious way to begin reducing high rates of cesareans and induced births.

Ina May Gaskin, PhD (Hon.), CPM, MA
Speaker/Author: Ina May's Guide to Breastfeeding, Ina May's Guide to Childbirth, Spiritual Midwifery
Founding member of The White Ribbon Alliance for Safe Motherhood
Curator: The Safe Motherhood Quilt Project
149 Apple Orchard Lane
Summertown, Tennessee 38483
home: 931 964 2519
cell: 931 279 2992

The opinion of Ina May was reproduced with her permission. Comments welcome. Dr F