"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.

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

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