"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, February 21, 2011

Talk at Yoga Works, El Segundo

Patricia Grube, an extraordinary doula and yoga instructor invited me to come and speak to her prenatal yoga class today. I talked about my journey to the present enlightenment and explained the differences between the midwifery and obstetric models of care, birth choices and the definitions of true informed consent and refusal. We discussed home and birthing centers as well as hospital births. Stressed was the normality of birth and how trust in the process often leads to a successful outcome. This was followed by some good Q and A and I handed out 10 copies of my book, "Fearless Pregnancy...". I was honored to speak to this group and give them a resource for all options. Sipping a cup of tea and listening to these women sing to their unborn babies made for a joyous event. Thank you, Patricia.
With affection, Dr. F

Sunday, February 20, 2011

A Year Without Midwives

Anniversaries are usually celebrated in honor of a positive life event. Weddings, first dates, career successes to name a few. They mark a milestone of sorts in our lives and are the means by which we keep track of those meaningful moments. Sometimes, however, they recall more tragic or sad events such as Pearl Harbor, yahrzeit in the Jewish religion for the loss of a loved one and, of course, 9/11. On a much smaller scale but still quite significant here in Ventura County it has now been more than a year since, by the stroke of a pen, the certified nurse midwives were banned from Pleasant Valley hospital.

While rumors have circulated for a while now as to whether or when they will return the fact remains that nothing has changed and no plausible explanation has ever been offered. One rumor has it they are trying to figure out how to have NICU coverage at PV. If they were really motivated to get this done there is no way it would drag on so long. Really does not seem that hard to solve. But since doctors still deliver there it can't be pediatric or anesthesia "safety" anyway as was the bogus reason given last year. Still veiled in secrecy, the process and motives baffle the mind. You don't need me to try to explain the inexplicable. When something defies common sense and the reasoning just doen't add up to all of you then it has to have some ulterior motive. If it looks fishy it probably is.

Some of the newer PV hospital administrators seem to support the return, however, nothing happens. Why? Maybe time for supporters of midwfery and honesty to write once again a letter to Ann Kelley, MD Chief of Staff or Laurie Eberst, the not so new anymore CEO. Call the Ventura County Star and wake them up while you are at it. Don't expect much from any of them in return. This is a anniversary that should never have happened. Dr. F

Wednesday, February 16, 2011

A must read!


John Bambanek, husband of a woman who desired out of hospital birthing has written a terrific piece titled "Taking Childbirth Home" in mercatornet.com (see link above). Please read and enjoy and comment there and here. Thanks, Dr. F

Wednesday, February 9, 2011

Defining the Straw Man

Dr. Amy Tuteur continues her crusade against home birthing. She offered a challenge that no one will debate with her. As you know, I have accepted her offer to speak in a public forum however she has never responded. Instead she publishes this last night:

10 Illogical Arguments in Favor of Home Birth
Opinion by The Skeptical OB
(16 Hours Ago) in Health / Women's Health
In addition to the problem of possessing inaccurate information, homebirth advocates have another, more serious problem, the tendency to construct illogical arguments. It is apparently such a pervasive problem that a brief review of these arguments is in order.

Let's look at the various types of illogical argument constructed against my core claim "the death rate at homebirth is higher than the death rate at low risk hospital birth." To make this exercise easier to understand, lets substitute a claim of the same form that is obviously true, so we will not get sidestepped by issues of truth or falsity and can focus only on whether an argument is logical or illogical. This is important because illogical arguments are automatically invalid arguments. We'll use the claim "there are more black cars in the US than lime green cars."

I say: There are more black cars in the US than lime green cars.

Don't say:

I saw a lime green car. - Can you understand how the fact that you personally saw a lime green car tells us nothing about the relative number of black cars and lime green cars in the US? That you saw a lime green car is perfectly consistent with black cars outstripping lime green cars 100 to 1, or even 1,00,000 to 1? Similarly, the fact that babies die in the hospital tells us nothing about whether the death rate is greater at homebirth.

I know ten people and not one of them has a black car. - This is an illogical claim based on an unstated assumption. The assumption is that the small slice you observe accurately represents the whole. However, tiny samples are often unrepresentative. Knowing 10 people who own black cars is perfectly consistent with the number of black cars exceeding lime green cars, BUT it is also perfectly consistent with lime green cars exceeding black cars, so it can't be used to support a specific claim. Similarly, the fact that you know ten women who had homebirths and not a single baby died tells us nothing about whether the homebirth neonatal death rate exceeds the low risk hospital death rate.

Lime green cars are prettier than black cars. - I hope it is obvious why value judgments about lime green cars tell us nothing about whether there are more or less black cars than lime green cars. Therefore, it should be obvious that claiming that women are more satisfied with homebirth tell us nothing about homebirth death rates.

You say that because you sell black cars. - Whether or not I sell black cars is immaterial; it has absolutely no effect on the number of black cars or lime green cars. This is essentially an accusation that I am lying and offering as "proof" the fact that I have a reason to lie, but a reason to lie is not proof of lying. So don't tell me that the fact that I am an obstetrician means that I am lying about neonatal death rates.

The people who make black cars have oppressed the people who make lime green cars. - Maybe yes, maybe no, but in either case, it does not affect how many black and lime green cars are on the road. Similarly, whether doctors have oppressed midwives has no bearing on whether the neonatal death rate at midwife attended homebirths is higher than hospital births.

There is a conspiracy against lime green cars. - We are supposed to believe that the number of lime green cars would equal black cars except for a public relations campaign designed to make lime green cars less desirable. It is theoretically possible that there is a conspiracy against lime green cars, but it is far more likely that other factors account for the difference in numbers. And in any case, it doesn't tell us anything about the relative numbers of black and lime green cars. So when confronted with the fact that homebirth death rates exceed hospital rates, it is illogical to counter with a claim that a conspiracy against homebirth exists.

There would be more lime green cars if the makers of black cars helped out. - That might be true, or it might not. In either case, it tells us nothing about the truth of the claim that black cars exceed lime green cars. And while it might be true that the death rate from midwife attended homebirth would be lower if doctors were more supportive of midwives, it doesn't change the reality of the current situation.

The Association of Lime Green Car Makers say that there are more green cars than black cars. - Cherry picking certain claims and ignoring all others is likely to lead people to the wrong conclusion. A lobbying group that disagrees with almost everyone else is not a reliable source of information. Similarly, professional NCB advocates and organizations are not reliable sources of information when they disagree with the bulk of the scientific evidence.

The color of cars is influenced by culture. - That is a non sequitur. It does not oppose the claim; it simply attempts to pin responsibility somewhere else and it is irrelevant. That's why the claim that hospital birth is culturally favored is irrelevant to any argument about homebirth death rates.

There are more important things about cars than the color. - That is what is known as "reframing the debate". It is a tacit acknowledgment that there are more black cars than lime green cars and a barely concealed effort to divert everyone's attention. That's why when someone announces that there are more important things than whether babies live or die, I know they have accepted the fact that homebirth leads to preventable neonatal deaths.

My Response posted this morning:

Dear Dr. Tuteur,
Your whole lengthy analogy is based on the assumption that home birth advocates possess inaccurate information and construct illogical arguments. You have yet to prove that either of these are true making your car anaolgy cute but meaningless. When you make a statement that you have failed to support and then build on that foundation you have a tottering structure. You have constructed a canard, the only purpose of which is, to confuse readers to accept your "core claim" and unsupported positions. The largest and most respected studies on Planned Home Birth vs. Hospital Birth do not show an increased neonatal death rate. In fact, in every measure of outcome and satisfaction, low risk planned home birth with a qualified attendant is equal or superior to comparable hospital based experience. And with less interventions which likely explains why.

Until you come out from behind your keyboard and defend your vitriol against midwives and alternative birth choices in person you have no credibility. We know this and your readers must be starting to wonder about the motives behind your fanaticism. Debate publically and we can respectfully discuss point by point all the lime green analogies you want. Sincerely, Dr. Fischbein

Saturday, February 5, 2011

A Homebirth Story by Dena Moes

I have invited Chico Midwife Dena Moes to post a guest blog. You can read more of her thoughts at:


I hope you enjoy this touching story and consider visiting Dena's site. Thanks, Dr. F

Special Delivery: A Homebirth after a Previous Stillbirth
This post is written with permission from the family involved. My intent is to inspire others to think through their choices and have courage. Deep thanks are given to Rachel and her family.

Eight years ago, Rachel was twenty-two years old, in a troubled marriage, and pregnant. Young, poor, and in a challenging life situation, Rachel did her best to take care of herself and eagerly awaited her baby. She used hospital-based midwives for her care, and had a normal pregnancy. Two weeks before her due date, her water broke. She called her midwives who advised her to come over to the hospital to be checked. She showered, got dressed, and came to the hospital. When she arrived, the heart beat of the baby could not be found. The baby had died. Rachel labored heroically and gave birth naturally after many hours to her stillborn son David. The cause of his death was never found, and the diagnosis of "unexplained stillbirth" was given to him.

The birth of David changed Rachel's life. She describes the changes as positive, because she used her grief as a catalyst for transformation. She began a profound spiritual journey, left her unhealthy marriage, and basically started a new life, listening deeply into her heart to find what was good and true for her. Rachel says "I believe that David and I had an agreement, made many lifetimes ago, that in this lifetime our time together would only last as long as it did. For whatever reason, that was what was meant for us. If it weren't for him, I would not be the person I am now."

Several years later, Rachel met Henry, a gentle, compassionate man who shared her spiritual approach to life and love of the wilderness. They married and bought property in the mountains together, to homestead and live "back to the land" . Rachel says "the urn of David's ashes stayed with me for years. I didn't know what to do with them. I often dreamed of a mountain, where I was to place his ashes, but I couldn't find that mountain. When we walked onto our property for the first time, I looked out and could see the mountain from my dream. I knew we were home." That summer Rachel climbed the mountain and scattered his ashes. A few months later, she was pregnant.

Rachel went back to the same hospital-based midwives for her care. She had felt well cared for with David, despite the outcome. The midwife explained that this pregnancy would be considered high-risk, due to her history. She outlined a plan that included multiple ultrasounds, non-stress tests for the last six weeks, and an early induction of labor. Rachel was surprised, and went home to think about all she had been told. She was now a wise, strong, healthy mother. She ate all organic, whole foods, and lived an active mountain life. Her life was full of love and joy. She listened deeply to her heart and discovered how strongly she knew that this pregnancy was entirely different from the last, that this baby was a healthy and strong girl, and that she would be born alive.

At the next prenatal visit, Rachel attempted to explain this all to her midwife. She says "With the last pregnancy I did everything I was told. I had every lab test, I had the ultra-sounds. I did all the medical stuff, and still ended up with a dead baby. Whether the baby lives or not has nothing to do with your lab tests and ultra-sounds. I intend to decline them all. The baby will live because the baby is meant to live." The midwife became tense at this response, and Rachel feared that a hostile disagreement was about to take place. But then the midwife took a deep breath, centered herself, and gave Rachel a gift. The gift was in the form of these words "I think you would be happier with a homebirth midwife. Let me give you a couple names."

Rachel came to me at the beginning of her third trimester. She shared her story, and we connected right away. She wanted me to help her have this baby, and I felt honored to assist. I was awed by her strength and clarity. We carefully selected some lab tests for her - blood type, iron, HIV, blood sugar. We did not do an ultrasound. We talked a lot about feeling fetal movement, and tuning in with the baby. We talked about her previous birth, and shed tears together. Henry came to most of the appointments, nervous but open to learning. They read Ina May's birth stories to each other at night. Again and again, Rachel clearly communicated her feelings; with a different father, her own self so evolved and changed , and everything about her life so different, she did not fear another stillbirth.

Rachel gestated away happily, and her due date came and went. She was taking evening primrose oil and a birth preparation tincture to encourage a timely labor. Her last prenatal visit was three days after her due date. This visit was different. She was starting to feel anxious, and with so much time "waiting", thoughts about the stillbirth were creeping in. I acknowledged her feelings and gave her reassurance that her feelings were normal. It is hard to wait and wait! We listened to the baby for a long time and heard the heart-rate accelerate with fetal movement, which is a sign of well-being. We decided I would come and listen to the baby every couple days until labor begins. I told her I thought she would have her baby soon.

That same night, Rachel went into labor. My assistant Amber and I arrived at her home around midnight. Rachel was sitting in a comfy chair, eyes full of tears. We sat down beside her, listened to the baby's heart beat, and then listened to her. Between contractions, she wept and told us how excited she was, overwhelmed with gladness. She told us she had been holding her excitement back all this time, just keeping that little piece of her heart safe by not getting too excited. But now that she was in labor, and was still feeling the baby move, she was suddenly feeling all the anticipation of having her real, live baby. The tears rolled down her face, and I told her how good it was to cry, and share her feelings.

Rachel labored beautifully through he night. She cuddled with Henry on a mattress on the living room floor for a long time. She was quiet and tuned inward , and we just listened to the baby every half hour and let her be. Each time we went to listen to the baby's heart, I felt a little extra charge, and then relief at the sound it beating away perfectly. I focused on taking slow calming breaths in those moments, in order to maintain a calm, peaceful atmosphere for Rachel. We gently reassured her how well it was going, how good the heart beat was. When her labor got intense, I asked her how she was doing and she said, "excited". She never complained, and seemed to enjoy the whole labor. I checked her once, and at three a.m. she was 8 cms. At four a.m. her water broke with nice clear fluid, and a half hour later she felt like pushing. She lay on her side for a while just lightly pushing as her body told her until I could tell the baby had moved way down into her pelvis. I invited her to sit on my Amish birthing stool and ten minutes later her nine pound baby girl was born. Zoe Elizabeth was born pink and healthy, and was contentedly nursing by the time she was thirty minutes old.

Rachel had been right- her baby was strong and healthy, and meant for this world. As her midwife, I trusted both her inner wisdom and her body's ability to birth. During her birth I was careful to respect who she is and what her personal process entailed. She was not just "another patient". This very personal, individualized approach is a hallmark of homebirth midwifery. I am very grateful to her for inviting me to be her midwife, and now for her generosity in allowing me to share this story with others. May it be healing to those that need healing, and inspirational to those that need inspiration!

Wednesday, February 2, 2011

Even on Vacation....

Darn those Goolgle alert search engines. While on vacation I was browsing my email and was alerted to a post by The Skeptical OB (Amy Tuteur)claiming MANA is trying to hide death statistics. Many of you know of this blogger from her vehement stance against VBAC, homebirth and midwives. I don't think she likes me much either. In her current blog at:


she says,"I have been hammering away at this issue in the past 4 years in every possible forum and with every professional homebirth advocate I could find ... and the silence has been deafening".

Well, I believe that most of us do not take her seriously so do not bother responding. However, since she has somewhat of a following and has the ability to confuse and upset many readers I decided to accept her challenge and offer to debate her in an open forum. I guess I just found relaxing in a tropical paradise too peaceful and so I responded to her as follows:

Dear Dr. Tuteur, You seem to be very passionate and knowledgeable in your blogs. I am happy to respond to you and break the silence you claim is deafening. Who are you really and what is your background and expertise in this subject? You have been pounding away at midwives, VBAC, homebirth and me from a place of anonymity for 4 years. Many professionals dismiss you simply as an agitator who likes to see herself in print. I am happy to give you the benefit of the doubt and accept your challenge. Lets have an open debate. I am inviting you to accept an opportunity to debate me on this subject at a public venue of your choice. Or, if you prefer, I will ask ACOG or MANA to set up a public forum in the next year where you and I can debate face to face and respond to questions from attendees. You can reach me via email at stuart@thewomansplace.com. Lets stop the hyperbole and name calling and debate our differences like professionals and like adults.
Sincerely, S. Fischbein, MD FACOG

I will let you know if I hear anything. For those on the east coast, please stay safe and warm. Dr. F