"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, March 6, 2011

A Comparison - You Decide

When I was on staff at my local hospital in 2009 I posted this data. Needless to say, I got yelled at and was ordered to remove it because it somehow violated confidentiality. No explanation given. Actually, I believe it was too revealing of the differences in practice styles and therefore embarassing to some. Well, I am no longer under threat of administrative retribution and therefore, once again, I feel this data deserves to be discussed. What it does show is that in a population of low risk mothers in 2008, comparing apples to apples, the midwifery collaborative model practiced by The Woman's Place for Health, Inc. had a primary c/section rate of less than 5% while another local large group of doctors adhering to the obstetrical model of medicalizing birth had a primary rate near 17%.
In this group of over 300 women an almost 4-fold risk of having a first time c/section in a comparable group of low risk pregnant women exists when birth is "treated" as a medical problem. In order to respectfully and honestly share the information of my collaborative practice and quell the naysayers I am in the process of compiling data from more than 10 years. I hope to publish "The Experience of an OB-Midwife Collaborative Practice" using statistical analysis and an evidenced based approach this year.
What those of us with common sense and the powers of observation have known for a long time about low risk birthing will benefit from as much objective data as we can get. Patients deserve as much truthful information as they can get to make an informed choice. I look forward to sharing my findings with you and with them. Dr. F

Small Community Hospital Deliveries from 12/1/07 to 11/30/08
Practice Total / # / Rate
Doctor A 75 / 10 / 13.33%
Doctor B 37 / 4 / 10.80%
Doctor C 51 / 12 / 23.50%
Doctor D 20 / 5 / 25.00%

Doctor E 14 / 3 / 21.40%

TWP 124 / 6 / 4.84%(Dr.F & midwives)
Other Large Group Total:
MDs A-D 183 / 33 / 16.9%
Deliveries and c/sections performed at a hospital that cares for almost exclusively low risk patients.

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