"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.

Thursday, August 26, 2010

Good Feelings

I just left the new client meeting at The Sanctuary Birth & Wellness Center in Mar Vista, CA. It is so nice to enter a space where nurturing and collegiality are the rule. What a breath of fresh air. We meet every Thursday afternoon to introduce the Center and its staff and our philosophy to potential new clients. All topics of home and the new birthing center births are touched upon in an open forum of discussion and Q and A. It is a time to describe pregnancy care in the true midwifery model and the way it should be. I believe I am in a great position to observe and comment on the amazing differences in low risk pregnancy care between the two competing models of care available in the U.S. And I can safely say there is no comparison. Little by little the word about true informed consent and birth choices is spreading. Kudos to my colleagues for their passion and success in the dream and, once again, congratulations on the opening of the beautiful new Sanctuary Birth Center. The only one of its kind in Los Angeles. Dr. F

Tuesday, August 24, 2010

ACOG review panel report

Hello to all and especially to those readers from the medical staff office at St. John's. Word on the street is that the ACOG panel that reviewed the policies, procedures and antics of the OB department at our local hospitals last June has issued its final written report. If I were to make an educated guess based on experience I would presume that this report will never see the light of day in its entirety. I hope I am wrong and would be the first to congratulate the new administration on their bravery if they were to release it. If this review was meant to be a learning experience for the department on evidenced based medicine and improving patient care then it should be shared with the medical staff without censorship. In fact, it should be shared with the community as a whole in the spirit of cooperation and transparency. I encourage all to call the new CEO at 805 988-2500 and ask if she intends to share the findings of this independent panel with the medical community and the residents of Ventura County. While I am no longer on the staff at these institutions I am still an active member of this medical community, and like many of my colleagues, must remain vocal when patient safety and quality of care issues need attention. Let us see what the American Congress of OB/Gyn thinks has been going on here. Dr. F

Thursday, August 12, 2010

Rediscovering the joy in childbirth.

As you must have heard by now, I am no longer attending deliveries at the hospitals in Ventura County (See previous blog). Turns out that things have evolved as they should and I am much happier for it. It is a liberating feeling to be away from such a toxic environment and find myself looking to the future with great optimism. Life is made up of the choices we make and I choose to look to the positive.

I was fortunate enough to attend my first home birth this past Tuesday as the primary caregiver. Sharing the joy with a wonderful couple who opened their home to me, doula Jen and midwife Karni. This was a beautiful early morning delivery just after sunrise and for me it renewed the joy to be found in my profession. The path to this point has been rough and winding and full of obstacles but I am very lucky to have reached this point. I am grateful to all of you who have supported me in the journey to find a way to practice my trade and use my skills in the way nature and common sense intended.

I would hope that you will spread the word to your friends and clients that I am fortunate to be able to now offer an out of hospital birthing experience as a choice to women and families who are interested in having a doctor collaborating with a midwife. I will be working with Karni in Ventura and the lovely staff at Sanctuary in Mar Vista as well as continuing to practice in my 2 offices during the week. Anyone with questions can be referred to my Century City phone number 310 282-8613.

We know that normal birth deserves much more reverence and respect than it has been given. I am proud to be associated with all of you who undertand this and respect the wonders of the human body and the mounting evidence that supports our perspective. Ultimately, if hospitals and organized medicine will not evolve to meet this knowledge and demand then women will look elsewhere. We need to be there to meet these needs. Lets support the development of the birthing center model such as Sanctuary and Santa Barbara Birth Center, work toward the development of a freestanding maternity center model and continue to educate the next generation of care providers and pregnant women. Emphasize the "normal" in low risk birth and spread the knwoledge that childbirth is a time of great human joy. Dr.F

Friday, August 6, 2010

Well, hello again. I apologize for being silent for so long. I was strategically waiting until things played themselves out here locally and now they have. Despite being vindicated by the ACOG review panel and in spite of the stellar record of care given by me and my Woman's Place colleagues over the years the administration at my hospital was still very unappreciative of my abilities and my worth in the community. Rather than face further ugliness and negativity I have chosen to withdraw my application for reappointment at my local hospitals. I am excited for all the positives the future has to hold for me as I now am free to head in the direction my long journey as an advocate of birth choices has meant for me to go. More on that to follow in the days to come. Below is a letter of explanation I have been distributing to patients this past week. I would be honored to hear your comments.

Dear Patients of The Woman’s Place,

Many of you are aware that I have long supported birth as a natural process and have advocated for changes in the current “birth as illness” medical model of obstetrics practiced at our local hospitals. The Woman’s Place, Inc. has been a haven for the collaboration between midwives and obstetricians and it has been a true joy to provide this option to so many of you. After much thought and consideration I have decided to stop delivering babies in the hospital setting here in Ventura County. This decision will allow me the opportunity to pursue new ventures including doing some birthing center and home deliveries while allowing me the freedom and time to create my dream of a free-standing maternity center run by midwives and supportive physicians. I will continue to work in the Camarillo office and perform ultrasound, office procedures, and gynecologic exams and see prenatal patients there in support of my colleagues, Michelle Marine, MD and Lynn Olson, CNM. Dr. Marine and I have been working together now for almost a year and I am confident in her dedication and ability to provide you with the same excellent standard of care you have come to expect from The Woman’s Place, Inc. My hope is that you will continue to rely on us for that excellence.

My presence in the office will remain and our great staff of Judy, Mimi, Wendy and Lynn, along with Dr. Marine and I are available if you should have any questions. For those of you who might like to have me attend your birth, that option will also be available. I have worked for 15 years with the Sunrise Birth Center in Ventura and its founder, Karni Seymour Brown, who has graciously agreed to collaborate with me should you desire an out of hospital birth at home or the birthing center with a licensed midwife and me in attendance. Please feel free to make an appointment with me to discuss this option.

Change is always unsettling and decisions like this can produce both anxiety and excitement. I know it will be difficult for some of you who expected me to attend your delivery but I hope you will come to see this decision as a positive in the long run. It will give me the time and freedom to advocate for normal birth options and choice here in Ventura County and nationally. It has been an honor to have delivered so many healthy Ventura county babies to happy and fulfilled Ventura County mothers these past 15 years. For me, the time is right to work towards the goal of giving women another choice of where and how to give birth. Thank you for your understanding and continued loyalty to The Woman’s Place, Inc.


Stuart J. Fischbein MD FACOG

Next up is the open house this Sunday from 11 to 3 at the new Sanctuary Birth Center in Mar Vista. I will be there with my co-author, Victoria Clayton, signing copies of our newly released, "Fearless Pregnancy, second edition", while soaking up the warm and nurturing vibes from the wonderful people there. Please stop by and say hello. Info can be found at their website: www.birthsanctuary.com

It feels liberating to be blogging again. Good things are going to continue to happen if we choose them to be. Dr. F