"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

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