"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.

Saturday, January 30, 2010

Letter to the Ventura County Newspaper

The following letter was written and sent yesterday. Thank you, Dana, for caring and taking action. I hope others will follow your lead. The women of Ventura County deserve an explanation, no matter how lame. We have to try to hold accountable those that would limit a woman's right to choose. Dr. F

(To the) Ventura County Star

It has been brought to my attention that midwives are allowed to deliver at St. Johns Regional Medical Center but have just recently been prohibited from delivering at Pleasant Valley Hospital in Camarillo . Has there been any news of this in the STAR, or did I miss it?

It is disturbing to me to think that the community’s option of a midwife delivery in Camarillo has been removed. Mothers want to deliver their children where they live, right?

I have been a patient at The Woman’s Place in Camarillo for some time, and am aware that this office has thankfully provided Ventura County the option and choice of midwifery care. How, when, where and who delivers a child is a very personal and deliberate decision for a family. For us to accept that it is okay to force an expectant mother outside of her home/city/community, in order for her to receive the care and follow through on the birth plan she has so carefully chosen, seems degrading and insulting. What an unnecessary constraint and loss to our community. Catholic Healthcare West states on their website that they are making health care more accessible by bringing resources closer to where people live and work. It certainly doesn’t seem like it.

- Is it really true, that Pleasant Valley Hospital has prohibited midwives?

- Why has Pleasant Valley Hospital made this decision?

- What concern or consideration have they made for our community?

- Why can midwives deliver at St. Johns and not Pleasant Valley ? These hospitals are both owned by Catholic Healthcare West, right?

I believe our community would be very interested in this story and the impact this action would have on our community. The thought of midwives being limited to one hospital is devastating and culturally not a move in the right direction. What is this leading to? I hope to see answers to these questions and would like to see some coverage of this in the STAR.

Thank you for your consideration and time.

Dana Stoneking

Blogger's note: Although the revocation of midwife privileges has passed department committees and been approved by the Medical Executive Committee without public comment, it has not yet formally been approved by the Board of Directors. However, I have been informed that the chairman of the OB Dept. has been quoted as saying "It's a done deal." SJF

Friday, January 22, 2010

Another absurdity brewing at Pleasant Valley Hospital

Pleasant Valley......sounds like such a wonderful place. Wrong! The pediatric and obstetrical committees are at it again. I was forwarned but not yet officially notified that the ob committee has recommended and the Medical Executive Committee has approved a new policy that will forbid midwives from delivering babies at this facility. They will have to deliver in Oxnard at St. John's Regional Medical Center. Pleasant Valley, our home hospital, across the street from our office will now be off limits to midwives. The two midwives who are credentialed to work there were never consulted or informed of any problems or reasoning behind this new punitive policy. Neither were the physician groups who support and collaborate with the midwives. It was all done in secret and without explanation. I suspect the workers in the cafeteria knew before we did.

Midwives have had admitting privileges at the twin campuses since the mid 90's. In the entire history of the takeover of these two hospitals by Catholic Healthcare West the medical staffs have been comingled. Credentialed Practitioners can admit to either campus. This move to restrict access to one of the campuses is unprecedented according to those who have been in the community for years. This is yet another assault on the ability of certified nurse midwives to care for low risk pregnant women in any setting by doctors and an administration who treat birth as a disease.

While we attempt to get to the bottom of this and possibly appeal to the board of directors, your phone calls to the administration expressing your displeasure would be appreciated. 805 988-2500 and ask for Administration. Mike Murray is the current CEO but has tendered his resignation. This, too, is curious timing. Anyway, Anne Kelley, MD is the new Chief of Staff. taking over for Dr. Niesluchowski. Juan Torres, is still the OB Chairman. Contacting any of these people or going directly to the Board of Directors may be futile but make your voice heard, please. SJF

Could not make this stuff up!

OK, so my office manager today tells me that Triwest (Tricare), the health insurer for the U.S. Military, has denied me payment for assisting Dr. Lara on a c/section. They also denied our appeal. Their reason: Triwest has decided they will no longer pay for an assistant at c/section. Explaining to them that an assistant at a c/section is the standard of care, medically necessary and mandated by the non-teaching hospital I work at fell on deaf ears. They have done some absurd things in the past but this was a new twist. I called, myself, and spoke to a customer service representative. Well, as you guessed that was a waste of time. He said the policy was decided by their medical director. I asked for his phone number or e-mail but was told they can only be contacted by writing a letter via regular mail. We sent one but does anybody think I will ever get an answer let alone be reimbursed for my work? I was also told that I was not allowed to bill the patient. I guess we are expected to come in at any hour of the day, give of our skill and time, accept liability and do it for free. To not help would only cause difficulties for the attending obstetrician and the patient. So we are now placed over another barrel, not of our choosing, with no recourse because it is the government. Am feeling abused and helpless....again. Hate that feeling. Ahhh, medicine....what a great profession.

Saturday, January 16, 2010

Support Scott Brown

For those of you who love liberty, feel reason and common sense have been abandoned, and have had enough of government intrusion in their personal and professional lives, we may have a chance to reverse our frustration with the seemingly absurd march towards this mockery of a health care bill. I would encourage you to follow the link below, see what he is about and please consider donating to Scott Brown for Senate in Massachusetts. I did. Thanks, Stu


Monday, January 11, 2010

Thought Crime Radio Promo

You can listen to a discussion on a variety of relevant topics with Janel and Rich. Missed it? Check out the podcast. I will be on again next Monday at 3 PM Pacific Time.

Stuart Fischbein, MD/OB is LIVE tomorrow, Monday, January 11 at 5:00 central on KOPN 89.5 FM on "Thought Crime Radio: Voices for the Human Rights of Babies". We are talking about informed consent and history of misuse of drugs in obstetrics and the impact on women and babies. Stream it live on www.kopn.org. Podcasts of this and previous shows also on www.ThoughtCrimeRadio.blogspot.com.