"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

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