"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.

Tuesday, March 1, 2011

Special Delivery

With permission from the family, it is with great joy and pride that I can announce my first home twin delivery. On Valentine's day my multiparous client went into labor at 37+ weeks with known breech/breech twins. The family had previously had 2 successful home VBACs and knew that no hospital would have allowed her desire to deliver breech twins vaginally. She approached the Sanctuary Birth and Family Wellness Center in Los Angeles several months ago and we agreed to care for her. She was a wonderful candidate, well-informed and highly motivated with a background in the natural birth community. Her labor started with ruptured membranes about 3AM. She finally kicked into high gear just after dinner. The little girls behaved smashingly in utero giving mom her opportunity. Baby A was born breech on all fours in water at 10:05PM on February 14th, 2011. Things then settled down with contractions spacing out and Baby B happy as a clam. Meanwhile mom tried nursing and dad and big sister took turns skin to skin with Baby A when mom needed a break. Shortly after midnight labor kicked back in and at 12:20 AM on February 15th Baby B was born breech on all fours on land. The family was amazing as was the birth team assembled. Much is possible with an informed patient with the right attitude and confidence in her body. Trusting the birth process and allowing nature to do its thing will often win out if we let it. I have to admit it feels wonderful to be freed from rigid policies and restrictive protocols, often void of common sense or evidenced based support. If hospitals will not allow women the right of true informed consent and refusal, I and the Sanctuary Midwives are proud to give them another option. Regards to all, Dr. F

17 comments:

  1. Wonderful news! I think the freedom to truly practice as you and your clients feel best is one of the best things about out-of-hospital birth.

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  2. Congratulations! Thank you so much for what you do!!!!

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  3. Wow! Where are all the other doctors like you? I'm so happy to hear of you and your incredible attitude!

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  4. Wow, that is really awesome!! You have brought tears to my eyes!!

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  5. Congratulations! To both you and the family! It is so heartwarming to know that other midwives have you and you have them... and that families have the both of you! As a midwife, I long for the type of care that you provide to be available in my area, but am thrilled that I can honestly say to people that there are wonderful OB's out there. Thank you for following your heart it's something to celebrate!!

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  6. Thank you for believing and trusting in women and babies :)

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  7. Was truly a wonderful experience. Can't wait to hear more stories like ours. Xo, becky

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  8. Thank you SO much for everything you do for women and their right to birth options.
    You are amazing!!
    I will share will as many as I can
    Dr. Kim Bruno
    www.BabyFoodDoctor.com

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  9. I am so glad this twin mom had the opportunity to have a natural vaginal home birth with her twins, but also both breech. I was told I "had" to birth my vertex/breech twins in the hospital. It was a natural vaginal birth, but still...after having had a home birth (after 3 great (for a hospital) births), I had to fight to get the birth I wanted and it still wasn't "great". My 19 year old was born on Valentine's day too! I did have a lovely home birth of my 7th baby, so my last birth was a good memory even if my twin birth wasn't as much!

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  10. I had one hospital vaginal birth, one home water birth and on my second home birth we found out he was double footling breech. After an ambulance ride and an exam the OB I was transfered to said I would need a c-section. I was kind of nervous, afraid and anxious. More than anything I just wanted a healthy baby.

    I remember feeling the urge to push as I was strapped down and that when I started to struggle a bit when I was going out. Then I remember waking up and hacking with the feeling like someone rubbed my entire throat on the inside with sandpaper and my stomach feeling literally like someone cut it open - they did. Looking back maybe they could have birthed him naturally and things could have turned out. In the end I'm thankful I had a c-section this time. He ended up stuck in there (he turned his butt around in the birth canal), had cord prolapse as well as the cord wrapped around his neck, he had lifted his hands above his head for some reason and then they had to do an inverted T incision to get him out. On his way out he took a really huge poop in me and on the doctor. He was then listed as a "vigorous male" and had a swollen butt and legs for a few hours from the pressures. Everything that could have went wrong did for this birth. In the end I got a huge scar and the likeliness that I will never birth naturally again, but at the same time my baby is hear happy and healthy.

    I am not against trying a breech birth or VBAC. I also think that too many doctors are afraid to take a stand because of liability. In the end of things they all did what had to be done and I was lucky. It wasn't the birth story I was hoping for, but it's interesting!

    I believe everyone has the right to decide what should and would be good for them and people should be supportive of their choices.

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  11. I only wish there were more MD's/DO's in the realm of obstetrics that were like minded. Have you thought about starting a school? Or perhaps you already offer some type of CEU's? Just a thought. Blessings to you.

    ~CB, RN from FL

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  12. I second that idea of a new school for obstetrics. Have you any thoughts on the subject?

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  13. I have thought about teaching role. It is so necessary as the skills of breech and operative vaginal delivery are going to disappear if not. I may look into a standard academic residency program someday. My concern would be that the hospital policies and risk managers would not let me teach what I know to be sound and evidenced based techniques anyway. Ideally, I would like to open my own freestanding birthing facility where midwives and like-minded obstetricians can collaborate. Then invite residents, midwives and all interested doctors to come, spend some time and learn. A place that would provide patient centered care in a nurturing environment for low risk moms all with the "security" of an on site operating suite. There is a growing knowledge and movement that it is time to take normal birth out of hospitals which are modeled on illness not wellness. Thanks for the suggestions and optimism. Dr. F

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  14. Congrats Dr F, welcome to the world of - you think it's high risk I think it's just a birth-

    I am interested to see you say "low risk" lots when there is no way in the world a VBAC, twins, breech, bmi over 35, age over 40 years, multigravid woman over 5 babies, blah blah would be seen as such. Assessment of risk is quite different when you understand that birth is a physiological event. That doesn't mean you don't need skills or sections or hospitals but keep risk where is belongs.

    Well done to the woman for great choices and well done you for supporting her.

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  15. Lisa, Funny when you think about it, isn't it. You are so right about the medical pigeon-holing of women into categories. I guess this mom was high risk by many textbook definitions and yet, taking each of her diagnoses separately and treating her as an individual, it really did not feel that way to my sixth sense. Trusting the process and having a sound relationship with a woman with the right stuff, as was the case here, made supporting her wish not seem all that radical. All made easier by the fact she really had no other choice of where to have a vaginal birth in this country.

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