"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.

Monday, July 11, 2011

LA Times chimes in on rise in Home Birth

July 11, 2011: Writer Olga Khazan highlights the usual pros and cons of home vs. hospital birthing. Some of the usual suspects appear, including some quotes from me.


I did comment to the writer on the story as follows:

Olga, I saw your article today. I think it was objective but there are some clear disputes to some of the statements and facts presented. Risk of uterine rupture is 0.5 % and of those only a small fraction actually end up as disasters. This risk is similar to the risk of requiring an emergency in any mother having her 1st baby according to the NIH study. I am not sure why someone thinks that over 35 is a risk factor for home birth. Your 2 pro-hospital experts continue to espouse the anti-CPM biased position of ACOG but I do not know where else the USC doctor gets his information. As for Dr. Tuteur, did you actually check out her current credentials or did she just tell you her background? I do not believe she is a Fellow of ACOG nor is she practicing. When was the last time she was actually seeing patients? What do you really know about her? She has her web following but is a provocateur who oftens throws vitriol publically at home birth parents and advocates. I have had many encounters with her and have asked her on several occasions to debate. She has never responded even when asked through an academic intermediary. You quote her as saying "all the existing scientific evidence...that home birth increases the risk of death" but then go on to point out a major study that does not. Also, even if you accept ACOGs conclusion of a 2-3 fold increase risk of neonatal death it is still far less than 1 in 1000! You also point out a single tragic outcome from a homebirth but fail to describe multiple similar tragedies occuring in hospitals despite all that technology and often caused by the interventions that push the uterus and baby beyond normal. After our discussions about these issues I am disappointed that you decided to use an anecdote as something against home birth when clearly these things happen in hospitals as well. Just ask my partner. I know you are limited by the number of words you can write so I do understand your position. I hope you understand mine. Maybe someday you can sponsor a public forum where Drs. Ouzounian and I can debate. All the best to you, Dr. Fischbein

I think the recent increase in stories and publicity about home birth is a sign that the public interest is rising. Watch for those opposed to raise the canard of safety and push back with fear based rhetoric. Dr.F

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