"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, September 16, 2011

Trip to Israel

Every now and then it is beneficial and theraputic to take a mental and physical break from our routine. We all need a refresher course on what are the really meaningful things in life and a change of perspective that comes with traveling can be just the thing. Such was my experience in my first trip to the holy land. My daughter and I, along with 168 other Dennis Prager listeners, enjoyed 10 fantastic days touring Israel. From Tel Aviv to the Golan Heights, Ceasaria to Kfar Blum, Nazareth, Bethlehem, Masada, floating in the Dead Sea and, finally, Jerusalem we experienced history, religion and the co-existence of a vibrant working society. After a visit to these places it is unlikely that one can ever look at the world the same again. We had the opportunity to hear interviews and lectures from a cross section of ideas including the Palestinian Mayor of Bethlehem, a member of the Israeli defense forces and an amazing woman at Yad Vashem to a former ambassador along with the wisdom of Mr. Prager. As he always says, "Prefer clarity over agreement". Seems pretty clear to me that any real peace in the Middle East will not occur in my lifetime. Nonetheless, one must continue to try and it begins with open dialogue and free access to information for the children of the Arab world. For freely educated children are the only hope that old enmities will die out.

As I return to Los Angeles and the work that I love I am hopeful that some of the lessons I learned in Israel can be applied to my profession. I believe more than ever that my profession has been going in the wrong direction. Widening the divide between caregivers for birth by hardened rhetoric does not benefit those we wish to serve. We have a duty to educate the future generations of obstetricians in the skills needed for vaginal birthing and encourage them to reach out to our midwife colleagues in a way that organized medicine has vehemently resisted in my professional life. Collaboration benefits everyone and honored co-existence makes for a more peaceful world for children like my daughter to inherit. That would leave a beautiful legacy for the Middle East and for the birthing world. Dr. F

No comments:

Post a Comment