"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.

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