"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, November 1, 2010

The Peanut Butter Syndrome

Of Peanut Butter, Birth Choices and Politics
November 1st, 2010

This is a peculiar trinity at the very least. While having nothing in common with or the monumental importance of the well known trinities of Christianity and the American trinity of e pluribus unum, liberty and in God We Trust, there is something very important to be said about the connection between these three subjects. Let me be very clear that I am a big fan of peanut butter and birth choices. Politics, well that leaves much to be desired. I have distaste for intellectual dishonesty and the nanny state so that gives you a clue as to my leanings in the political arena. Many of my friends and colleagues choose to ignore or avoid this subject because they find it exhausting or irrelevant in their day to day lives. But to ignore the reality that politics affects all of us is to live in denial. There is an election tomorrow that will have a great deal of affect on how we and those we care about will live our lives here in America.

I am a big supporter of true informed consent and birth choices as are all my wonderful colleagues in the birthing community. That is not a surprise to anyone who knows me. But many of my friends and supporters do not share my political views. I am not writing to try to convince anyone that one side is better or worse than the other. What I would like to do is make a logical argument in support of smaller government and personal responsibility and individual liberty. And, then let each of you decide what is best for you and your family.

So, what do peanut butter and birth choices have in common? We live in an era where government wants to control “fairness”. They want to raise equality to the level of a right and to constantly try to legislate morality and eliminate failure. Strange, as there is no right of guaranteed equality of result in the Constitution. Only the rights to equality of opportunity are implied. This has morphed into an America where all the soccer kids get a trophy no matter what place they finished. There are no winners and losers. Standards are lowered or eliminated all together. But by shooting for an egalitarian paradise those that desire this must, by definition, restrict liberty. Liberty is the freedom to succeed or fail on your own merits. Many think equality and liberty are synonyms when, in reality, they are exact opposites. Whenever you impose equality you necessarily restrict liberty. When a child is allergic to peanut butter, the school board often bans peanut butter for all of the other children. One child cannot be around peanut butter so 800 children cannot have a peanut butter sandwich. This is a perfect metaphor for the equality vs. liberty debate. What seems fair and kind and protective to one individual restricts the freedom of the vast majority of so many others. I call this overreaction the “Peanut Butter Syndrome”.

We see the “Peanut Butter Syndrome” everywhere these days. Kids are obese therefore we ban snacks and mandate certain foods in schools. Smoking is considered a danger so because of second hand smoke we have laws prohibiting any private business from allowing smoking. Mylar balloons may cause a power line short circuit so lets ban them. A child falls off a teeter-totter so all teeter-totters must be removed from playgrounds. Ban incandescent light bulbs and big screen TVs. And on and on it goes. Overzealous activism, often good hearted but often shortsighted, leads to restrictions on personal choice and liberty. And often without any evidence other than it feels good.

Now sweet sensitive people, mainly on the left, who mean well will see these things and say it is good that we are looking out for the folks and the environment. We need government to protect the few, the weak and those that cannot help themselves. They need to keep us safe. A fair argument but at what cost to liberty? If you agree with this premise then voting for bigger government and the Democratic Party is what you should do.

But here is the problem as I see it. We are for a woman’s right to choose the path of her own birth. We strongly support the right to informed consent and refusal. If you take the same sort of liberal thinking as described in the previous paragraph then why get upset when hospital policies, lawyers and politicians want to control our choices. They constantly argue that restrictions on midwifery and VBAC and breeches are for safety purposes. They are just protecting the folks. It does not matter that their arguments may not be evidenced-based. They are just trying to legislate out the possibility of a bad outcome. This may be noble but foolish in that over time this has been shown not to work. Not with birth choices nor food choices. Ever since nutritional information has been mandated on food products the American populace as a whole has only gotten fatter. Can you see the inconsistency here? If you think it is OK for there to be laws that restrict our choices in how we live and to surrender some liberty for the sake of a greater good then how can you be upset when those same rules are applied to birth choices?

My point is simply that I am a believer in allowing people to make their own choices. I think what makes our country special is her founding desire to allow all of us to succeed or fail of our own accord. This is the greatness of America and this unique quality of American life has been slowly whittled away by often well meaning people who tend to be on the liberal left. Not all, but most. Of course there has to be some regulation when individual choices can have massive consequences. But what I eat or drive or watch should have no more control from the outside then how or where I choose to give birth. If you agree with the idea that peanut butter and birth choices should remain free of politics then I hope you will consider voting tomorrow for the candidates and propositions that best fit this premise. Look at the big picture and do not get hung up on letting one issue decide how you vote. I hope you will see the folly in voting for bigger government. At least as it pertains to the freedom we long for and the profession we love.

Stuart Fischbein, MD

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