"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.

Friday, January 21, 2011

ACOG opines again!

The American College of Obstetricians and Gynecologists, of which I remain a member, has once again issued an opinion regarding the safety of home births. Needless to say, they remain fervently against the practice in general. Furthermore, they go on to state that a prior c/section is an "absolute contraindication" to birthing at home. This does not come as a surprise and once again sacrifices their principle of patient autonomy and choice. My only comment here is my ongoing wish that they would come out as strongly in condemning hospitals and their members who won't allow women the choice of a VBAC, therefore, in a major way, forcing them, in many communities, to choose an out of hospital birth rather than an unnecessary repeat c/section. I will read over committee opinion number 476 and see if I can decipher what their "opinion" is based on. The previous statement was based solely on opinion (level C evidence) and not on evidenced based data. In many past condemnations of home birth the trend has been to lump planned and unplanned and attended and unattended into one group which completely skews the data to support their theory. I will let you know. Dr. F


1 comment:

  1. Just to be controversial, I believe hospital births should be banned. Due to anecdotal evidence from all the mums i speak to, few seem to have had a very good time at all in hospital, and are generally treated much worse than patients who are admitted to hospital for treatments or operations not of the maternal variety. My obgyn decided I was of course going to have a ceaser, because I am small and blonde! The final stage of my delivery was 27 minutes for my first child with no painkillers, I tore, but wouldn't have if they had simply applied a compression heat pack, fortunately i did have a midwife, but even so, she thought my baby was going to drown because she was born with the Caul intact!(superstition??). How dare the obgyn or anyone suggest my body was somehow not capable when I was in good health and strong. Women are designed for this. Let us do our job in peace without cruel and sometime malicious treatments, without the ownership of our magnificent power and strength being constantly denied us. We don't need pain killers and invasive instruments inserted or strapped to our bods, we need sensibility and a whole approach. Not the rubbish that is forced down our throats by people who hardly ever even witness a vaginal delivery! Thank you for your time in these efforts. I respect a balanced approach so much and wish that the powers that be did too. It all reeks of men owning womens bodies...liberation...not yet.
    Cheers from Australia (our c section rate is about the same and midwives are not far off being banned here too).