"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.

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.


  1. Power tends to corrupt and absolute power corrups absolutely. - Lord Acton

  2. "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."

    We already have restrictions on choices with the current system! Health insurance companies call all the shots. What doctor you can go to, how much they'll reimburse that doctor, what medications you can take and how much...

    Mandates on behavior? Seriously? Again, this is already common practice. Insurance companies decline coverage to clients that are too 'risky' due to their alcohol or recreational drug use. Sometimes even due to their sexual practices.

    Unforseeable costs? Like the current system where anyone can walk into an ER, give a phony name and contact info and get free treatment with the rest of us (society) left to pay the bill?

    I'm all for Universal health care coverage and I don't feel this bill goes far enough. I don't think that I know best... and I certainly don't think politicians know best. I think YOU know best. YOU meaning the physician. I want a system where my physician can make decisions with me based on the best course of treatment. I don't want the government OR a private health insurer to call those shots. I believe this bill brings us one step closer to having health care regulated by the government. Regulated meaning it isn't a free for all for the private insurers.

  3. "Insurance companies decline coverage to clients that are too 'risky' due to their alcohol or recreational drug use." - Sundance

    And this is wrong because ?