"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, 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

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