"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, March 28, 2011

Confirmation of ACOG damage

For the umpteenth time since release of ACOG's Committee Opinion #476 I have seen the propagation of its misinformation. I use Google Alerts to help me review stories around the world on home birth. In story after story having to do with this subject, other "experts", reporters and sources quote its conclusions of a 3-fold increase in neonatal death blindly and as definitive fact. Funny, how it is almost verbatim and the virtues of home birth quoted by ACOG are never equally extolled. I can only assume it is because an organization such as ACOG has a built in gravitas that writers will rely solely on its statement without doing any further research. I have spoken about this to ACOG leaders as a consequence of its standing in the medical community. With great power comes great responsibility. ACOG and Dr. Wax have much to answer for but almost certainly will not.

So, for the umpteenth time I have written to to the writer or posted a thought in the comment section to at least give another perspective. I encourage readers to take a moment to respectfully do the same when they come across a reporter quoting an expert who categorically uses the "3-fold" line. Dr. F

Here is what I wrote this morning in repsonse to an article in The Herald, an Australian newspaper:

Dear Ms. Hadfield, For the record, Dr. Andrew Pence is quoting data that is well known to be incorrect. It is from one flawed study by a researcher named Wax who cherry picked his meta-analysis data to reach his conclusion on the perils of home birth. Dr. Wax's motives for doing so are unclear. The truth is far different. He excluded the largest studies from North America and the Netherlands which showed no such risk and, in fact, in comparable low risk patients showed far less intervention and c/section rates and greater satisfaction in women who had home births. Dr. Pence makes a common mistake in relying on data that is supportive of the established medical position rather than looking critically as a scientist should. Then relaying this misinformation as if it is undisputed fact. Reporters often go to academic sources with a blind trust that they are objective and their advice is evidenced based. Sadly, neither is often true. Home birth in low risk women is a safe alternative and a choice that belongs to them when given true, not skewed, informed consent. I would be happy to discuss this further if you are interested. Warmest regards, Dr. Stuart Fischbein, MD FACOG

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