"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, October 18, 2010

A Must Read Alert

I wish I had written this. The Big Push for Midwives has once again done great work in educating us in what goes on behind the scenes. Thanks to PushGirl Friday for her insight at:

Please read her blog.....
A Tale of Two MOMS: ACOG Pulls a Fast One on Groundbreaking Maternity Care Legislation

As many readers here know, last summer Congresswoman Lucille Roybal-Allard introduced the MOMS (Maximizing Optimal Maternity Services) for the 21st Century Act, a groundbreaking piece of legislation that has the potential to revolutionize our maternity care system. The bill makes increasing access to evidence-based care, reducing racial and ethnic disparities in birth outcomes, and bringing down maternity care costs national priorities by promoting a number of common-sense, low-cost solutions to addressing the maternity care crisis in the US, such as:

Creating loan repayment programs to increase the numbers of family practice physicians, nurse-midwives, and certified professional midwives, all of whom provide low-cost, high-satisfaction alternatives to traditional obstetrical care
Increasing access to culturally competent care and reducing disparities by taking measures to recruit more racially and ethnically diverse students into the maternity care workforce
Launching a public awareness campaign to inform women of the benefits of increasing access to evidence-based maternity care and reducing over-reliance on often unnecessary interventions, such as labor induction, electronic fetal monitoring, episiotomy, and cesarean section
Establishing an Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes
The MOMS Act has attracted a broad-based coalition of advocacy and professional organizations, including Amnesty International, Childbirth Connection, The Big Push for Midwives Campaign, the American College of Nurse-Midwives, the National Association of Certified Professional Midwives, the American Association of Birth Centers, and the Midwives Alliance of North America, all of whom have been working together with Representative Roybal-Allard’s office to build support for the bill both within Congress and among the general public.

Notably absent from the list of MOMS Act supporters is the American Congress of Obstetricians and Gynecologists, which is already busy lobbying Congress about its own forthcoming legislation. Not to be confused with the MOMS Act, ACOG’S proposed Making Obstetrics and Maternity Safer bill, which in the interests of clarity has been dubbed—wait for it—the MOMS Initiative, will, as ACOG President Dr. Richard Waldman stated, “lead the way” in making maternity care safer by promoting research into the causes of premature birth, obesity, and racial disparities in outcomes. Because as we all know, the problem with maternity care in the US is with the women who receive it, not with the care they receive.

Perhaps a better title for ACOG’s MOMS legislation would be the Making Obstetricians More Satisfied Initiative, because the proposal contains absolutely no provisions that encourage obstetricians to abandon current practices in favor of evidence-based care or to give up an inch of turf in their ongoing battle to protect their virtual monopoly on the maternity care market in the US—a monopoly that is responsible for creating the need for the Real MOMS Act in the first place. ACOG laid the groundwork for its sabotage of the bill in a recent letter that has been circulating in DC, assuring Congress that the organization has already put many patient safety measures into place and that their own MOMS legislation “can lead to direct measurable improvements in patient safety and quality of care, and to healthier births.” No promises that the Misleading MOMS Act actually will lead to improvements, but hey—it’s a start, right?

As for the Real MOMS Act? According to Dr. Waldman it is unacceptable because a) it promotes “the wholesale adoption of delivery models that have not yet been proven safe and effective, including doula support, group prenatal care, and home-birth,” and b) it “questions ob-gyns’ ability, compared to certified nurse-midwives, family physicians, and certified professional midwives, to deliver care that supports physiologic birth.” In other words, the Real MOMS Act told the Emperor he has no clothes, he took offense, and now he’s busy knitting himself a new Naked Suit.

Watch this blog for further developments on the Real and Fake MOMS legislative front as we head into a new Congressional session in January. In the meantime, please spread the word about Congresswoman Roybal-Allard’s brave stance in support of real maternity care reform. We need more champions like her who are willing to speak up on behalf mothers and babies and who won’t be fooled by ACOG’s bait-and-switch tactics.

As one who has seen pregnancy from both sides of this "debate" my wish is that ACOG and academic medicine would stop maligning evidenced based midwifery as in doing so they only malign themselves. There is a role for collaboration between the models but it is time for ACOG to realize that more medical intervention may not be the solution to the rising intervention rates. Nurturing care, individual attention and prevention do work and have been the way of the midwife for centuries. Dr F

Sunday, October 10, 2010

Midwife Celebration at Golden Bridge

Just a heartfelt thank you to the wonderful people at Golden Bridge and to Debbie, Carrie Anne, Ricki, Peggy, the choir and all the wonderful speakers whose names I can't even begin to remember. It was a joy to see so many smiling faces in that most friendly of places. A special thank you to Congresswoman Roybal-Allard for her advocacy. You all said so eloquently what we all know to be true. It is a marvelous feeling to be associated with you and I am proud to also carry the banner for normalcy and choice. I know now as much as ever that midwifery is the best choice for those low risk women who desire it. I came directly from the airport and the sadness of burying my beloved uncle in Minnesota to the warmth and nurturing of all of you. What a healing talent you all have. Thank you, thank you, thank you!!

Love, Dr. F

Midwifery Week Blog

This is Rebecca Spence's blog this week. Please check it out.

Today is the Midwife Gathering at Golden Bridge Yoga at 1:30PM in LA. I will be traveling back from Minneapolis this morning and hope to arrive in time to pay tribute to my midwife colleagues. Continuing to promote access to midwifery and birth choices is an honor and joy and every little thing helps. Please support the Big Push with letter writing and spreading the word client by client. Dr F

Saturday, October 2, 2010

Time Magazine Cover

Just a quick thought on the recent time cover story about the significance of external factors during intrauterine life that may play a much more significant role in our health and wellbeing than previously thought. Traditional teaching about how we end up has always been nurture v. nature, heredity v. environment. Well, it appears that there is growing data to support the idea that exposure to many things in utero may play just as big a role in determining our physical and mental health later in life. This comes as an interesting "discovery" to those of us brought up in the medical/scientific world but is well known to my colleagues trained in the more natural world of midwifery and common sense. The midwifery model emplores women to be in a healthy state of mind and body before and during pregnancy and has known the benefit of this knowledge for centuries. It is nice to see the science catch up with the empirically obvious and kudos to Time for a nonpartisan story that is beneficial to all. Dr. F