"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, 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

1 comment:

  1. Wow! Congratulations to all! What dedication! :)