"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, June 17, 2011

HBAC in Water

June 16, 2011: Her first birth story was a nightmare filled with fear, unprofessionalism and coldness that is one I hear all to often. Ending in an "emergency" c/section in the pushing phase with little humanity or respect for family wishes was not what this woman had envisioned. What a difference from the events of today. Desirous of a nurturing environment for her VBAC and with a trust in the process that comes from education and faith, this marvelous woman delivered at home in water in her own living room held and surrounded by husband, family and the Birthing Instincts birth team.

There is another way to give birth that respects both woman and process. Individual demand is the catalyst that will lead to a change in the system. It has to be. Congratulations to all who witnessed this blessed event. It was an honor to be accepted as a part of your family. Dr. F

Monday, June 13, 2011

SOGC Understands

In celebration of the International Day of the Midwife on May 4th, 2011, the Society of Obstetrics & Gynecology of Canada (SOGC) has put out a news release calling for more collaborative care for pregnant women. The president of SOGC has this to say:

“The SOGC acknowledges that it is the mother’s decision to decide where she would like to give birth,” stated Dr. AndrĂ© Lalonde, executive vice-president of the SOGC. “Most babies are born without serious complications. As ob/gyns, our specialized training allows us to address the unique requirements of high-risk situations. What matters is that all professions acknowledge each other’s competencies and work together to provide mother and baby with the quality care they need, when they need it, where they want it.”

See the entire press release at:


Tuesday, June 7, 2011

Long Distance VBAC

On June 4th, just after sunrise, I was honored to particpate in the birth of a beautiful baby boy to a delighted couple who traveled down from Oregon to have their baby at the Sanctuary Birth Suite. Mom had a c/section with her first child and when it was difficult to bring the baby through a low transverse incision her physician had to "T" the incision to accomplish the delivery. Because of this incision her operative report stated that a repeat c/section should be recommended. She had a midwife in Oregon but could find no doctor willing to back up her desire for a VBAC. The couple researched her options and found me through the internet. After corresponding for a bit they decided to travel down and meet the team. We all hit it off and upon reviewing the records I did not see a reason she should be forced to have a repeat c/section and felt an attempt at VBAC was reasonable. In my training we often allowed women with low vertical c/sections to have a trial of labor with good success. This is not the same as a classical c/section. At 36 weeks she moved the family down to Los Angeles and just 2 days after her due date went into labor. Less than 12 hours later she gave birth to an 8 pound, 7 ounce baby brother.

We were honored that she chose to educate herself in the risks and benefits of all her birth options. This is a right that belongs to all pregnant women. That there was no one she could find in the entire state of Oregon to support her is tragic. This is a trend that I hope can be reversed by truth and example and loud word of mouth. Dr. F

You must watch this!

Andrew Laming, MP attacks Labor's sneaky attempt to snuff out home births in Australia. The liberal party in Australia wants to outlaw home birth. Yes, the liberal party. The one that favors abortion rights but decries home birth rights. Three cheers for Mr. Laming who makes a compelling argument for choice.


Wednesday, June 1, 2011

How headlines are often deceiving!

In the April 2011 edition of the American Journal of OB/GYN Dr. Wax responds to many of his critics in the letters to the editor section. Hope you can find it at www.AJOG.org

My comments to this were part of a conversation I had with my colleague Nick Fogelson in South Carolina and were as follows:

So much to say but will summarize. Everyone has bias. I do feel comfortable, however, with Wax's contention that he had none when setting out to do his study. His last point, that most criticism comes from birth choice advocates, is a bit silly as not much criticism would be expected from hospital birth advocates in a paper that is not critical of hospital births. That Wax concludes there is an increased risk of neonatal mortality of 1 in 1,333 in home vs. hospital birthing does not seem worthy of all the hullabaloo. Most people would not consider this number to be a reason to or not to have a home birth. So, even if we were to accept his paper as flawless, is this number so substantial as to base an entire ACOG committee opinion on? Not being adept in statistics I cannot comment on the science of his calculations. But if we give Wax credit for being truthful we do have to put some credence in the knowledge and science of those authors of some of the papers he uses who disagree with him as well.
When a headline says a 2-3 fold increase in neonatal death it looks scary. When you see the increased risk is really less than 1 in 1000 its not so bad to many. when I counsel patients on interpreting statistics I often use the example of disease X. Say it has a frequency of 1:1,000,000 last year and this year there were 2 cases or 1:500.000. Both very small numbers. However, advocates for funding of research into disease X can say the rate doubled. Very misleading.
Do you agree that the increased risk is still very small and, if so, why do you think organized medicine is so vehemently against informed choice? The risk of c/section in hospitals surpasses 1 in 3 and yet does not draw close to this much finger pointing from ACOG.

I thought it very important to point out the manipulation of statistics by ACOG to make a point and another way to look at the numbers it deems so impressive in its argument against home birth. Lies, damn lies and statistics! Dr. F