"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.

Wednesday, May 12, 2010

“There’s really been no change in anything,” said St. John's Chief of Staff

And so it goes. Despite a petition from over 700 residents of Ventura County calling for an end to the midwife ban delivered by BAC chairperson, Kim Rivers, St. John's continues to refuse to explain the hypocrisy or release any supportive evidence for their decision to ban midwives from Pleasant Valley Hospital. The Ventura County Star, to their credit, has written a followup story which confirms the title of this blog but at least feels the issue is unresolved and worthy of continued scrutiny.


Reading the comments section can be fascinating and frustrating as some just do not understand what midwives do. Others have the sky is falling approach to birth while voices of reason try to elucidate common sense. BAC is committed to keeping the issue alive. Here is a copy of their press release:

St. John’s Denies BAC’s Meeting Request to Discuss the
Community’s Response to Ban on Nurse-Midwives from Attending Births

Ventura, Ca. – On May 6, 2010 a representative from the Human Resources department at St. John’s Regional Medical Center canceled a meeting with Ms. Kimberly Rivers, President of the Birth Action Coalition (BAC), that was scheduled for 3:00pm on Friday May 7th. The meeting was set with Mr. John Bibby, Director of Human Resources and St. John’s Chief Medical Officer, Dr. Eugene Fussell. The meeting was requested and set in order for Mrs. Rivers to present BAC’s petition regarding the recent midwifery ban at Pleasant Valley Hospital in Camarillo. On Monday May 10th without an appointment Mrs. Rivers presented the petition to the Human Resources office desk at St. John’s and was told it would be delivered to Mr. Bebe.

BAC, a community organization focused on educating and advocating for supportive birth environments, has been calling for St. John's to respond to community member requests for access to midwives, and clarification over reasons for the recent ban on nurse-midwives at Pleasant Valley Hospital since the ban. Administrators at St. John’s Regional Medical Center, part of Catholic Healthcare West, cite “patient safety” and availability of a NICU (neonatal intensive care unit) at the facility as the reasons for approving the policy that prohibits certified nurse midwives (CNM) from attending births at Pleasant Valley Hospital.

BAC hopes to gain a response from St. John’s through its monthly protests in front of St. John's Regional Medical Center in Oxnard and is circulating a community petition The petition asks that St. John’s administrators immediately reinstate privileges for all CNM’s at Pleasant Valley Hospital, or, that St. John’s administrators provide evidence supporting their statements that the CNM’s have been removed from the Camarillo facility due to “patient safety” (we ask that this evidence show outcomes for all care providers who have attended births at Pleasant Valley Hospital), or that St. John’s administrators retract their claims that the midwifery ban is due to “patient safety”.

(See petition at: www.petitinonline.com/speakout)

On two separate occasions Ms. Rivers contacted St. John’s for a meeting requesting 5 minutes to present the petition signed by over 700 people. Finally on May 3 an appointment was confirmed with Mr. Bebe’s office for 3:00 pm on Friday, May 7 but was then canceled on May 6. When asked for a reason why the scheduled meeting with Ms. Rivers was canceled, it was suggested that Mr. Bibby and Dr. Fussell were advised not to speak with Ms. Rivers without further explanation. “St. John’s is now outright refusing to listen to a member of the community regarding a policy they have put in place that affects the birthing women of Camarillo,” says Rivers. “ BAC plans to notify Mr. Lloyd Dean of Catholic Healthcare West regarding this clear dismissal of the concerns of community members, and we will continue to speak out on this issue until the community receives a satisfactory response. ”

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