"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, March 11, 2011

Collaboration at work

2 Days ago I was asked by one of my midwife colleagues to come to their clients home and assess the mom for a prolonged second stage. The mom had reached that "wall" and could no longer push effectively. After about 4 hours of trying different things in an otherwise healthy, nurturing environment they were talking transport as the standard option. However, now that I am contributing to the out of hospital birthing community we had another choice. I arrived to find the baby doing well and mom leaning on an exhausted but incredibly supportive husband. After talking it over with dad and the amazing team we decided that a vacuum delivery was a good option for them as they did not want to go to the hospital after such heroic efforts at home and for financial reasons. I examined mom and felt the baby to be OA, slightly asynclintic and +2 station. Not much molding or caput. We repositioned to the sofa and with a cooperative baby and a revitalized mom they gave birth by vacuum assisted vaginal delivery to a beautiful baby girl in their living room illuminated by the late afternoon sun. Beautiful relief on parents faces. Birth team, too. It was a great example of combining the skills and knowledge of the midwife-OB-doula in a collaborative effort to give families another choice. Love to Molly, Heather Anne, Kim and the trusting family. Dr. F


  1. Wow! Incredible to combine what are truly the best of both worlds!

  2. Situations as you describe here, when all team members are informed, on side and in agreement are when everything goes really well with a skilled medical intervention. Brilliant work by everyone. Thank you for sharing.