"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

Followup Letter to ACOG President

I have found Dr. Waldman to be sincere and I hope I am right. It has been 2 months since I wrote to ACOG regarding Committee Opinion 476 on Home Birth. This e-mail is a followup to my correspondence with ACOG's president and is self explanatory.


Dear Dr. Waldman, Hope this note finds you well. In your email to me from January 25th you mentioned that Dr. Hale would be passing my letter on to the committee for what I had hoped would be some honest answers to my serious doubts about their science and motivation in releasing Opinion 476. Sadly, my expectations of receiving a response from them were very low from past experience and it seems that low expectations of your Opinion Committee were appropriate. I have the energy, knowledge, evidentiary support and willingness to discuss these issues with my esteemed colleagues who make up this committee. I am disappointed that a committee from my college is assigned the awesome responsibility to make statements that have a powerful effect on practice and policies in America but ignores legitimate questions and dissent from one of its own members. I hope you will accept my offer to contribute to any future discussions inside of or publically made by ACOG regarding the safety of home birthing, licensed midwives and patient's rights to true informed consent with the same sincerity that I voice my concerns to you. I am one of but a very few professionals in the country who have the legitimacy and wisdom of experience living and working in both worlds. Opinion 476 should never have been released based on the Wax paper. It damages the credibility of the College. If we as obstetricians really do care about honesty and truth towards the women we serve then there should be no other motive but those from an organization like ours.

Sincerely, Stuart J. Fischbein MD FACOG

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