"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.

Wednesday, November 23, 2011

More hypocrisy from Dr. Stephen Carter

I have not blogged in a while as I have been involved with some other great projects. "More Business of Being Born" premiered a couple weeks ago. I highly recommend this 4-part DVD as an adjunct to Ricki and Abby's BOBB for those who wish to educate themselves in birthing options. It was such a fun gathering of good souls. Great to see my colleagues Glen Elrod from Wasilla, Alaska and Robert Biter up from San Diego along with so many nurturing people who trust birth. I must say I did not know what to expect as we previewed the Celebrity Birth Segment. But I was pleasantly surprised as I found it both entertaining and informative. I have yet to see part 4 on VBAC but colleagues tell me I am in it and did not make a fool of myself so thats reassuring.

My co-author, Victoria Clayton and I were at the Ventura County Book Fair a couple weeks ago promoting "Fearless Pregnancy". I was honored to teach a suturing class to more than 25 birth professionals at the Santa Clarita Birth Center. And of course there is that birthing thing. In the past week I have had my first failed VBAC and another beautiful home delivery of twins. Please check out my summary in the news section of www.birthinginstincts.com

On a very sad note, my friend, mentor and colleague of 30 years passed away early Monday morning. Irwin Frankel was a wonderful physician, very hands on and old school. He was a passionate teacher with knowledge and patience and a calming influence and everyone adored him, patients and colleagues alike. They do not make them like him anymore and his passing signals the end of an era. I will miss him very much.

The contrast between an honorable man like Dr. Frankel and Pleasant Valley Hospital's own Dr. Carter could not be more stark. Some people actually fool themselves into believing what they say and some are just fools. I do not pretend to know the motivation of Dr. Carter and will leave that up to the reader. For those who have followed the antics of the obstetric committee and administration at PVH and St. John's in Oxnard in this blog and in the Ventura County Star towards midwifery you will know what I am talking about. In a recent article regarding the debate over closure of the maternity ward at PVH Dr. Carter, once again, stepped in it. Please take a moment to read the recent article "St John's Pleasant Valley Hospital Postpones Decisionon Closing OB Unit"

I commented on the article as follows:

Dr. Carter says, "I've worked here since '98 and I've never felt the lack of an NICU was a big deal. It's nine miles away." Yet Dr. Carter was an integral part of the OB committee that agreed on a year long ban of midwives for just that reason. Former CEO, Mike Murray, echoed Dr. Carter's position in a story in this paper at the time. Citing "safety" as the reason for the midwife ban. It would seem from Dr. Carter's words here that safety was never the issue. Which we all really knew anyway. The motivation for keeping or closing the unit will remain economics. Also, the reporter should try to see how much the anesthesia and pediatric departments have brought pressure to bear for closure. It is hypocritical to argue safety then but not now. The policies in place at that hospital over that past several years are what have destroyed the census. I agree with Ms. Graf that closure of the woman's unit at Pleasant Valley would be a blow to the community. Sadly, with the unexplained departure of the supportive Mr. Bibby and the current economic forces in the medical industry it would be surprising to see our little haven survive.

The health care system is set up to create and protect the Dr. Carters of the world while what is really needed are the Dr. Frankels. Irwin held himself to such high standards that he did not need administrators and lawyers and confidential peer review committees and investigative journalists to inspire him to do the right thing. While those at Pleasant Valley Hospital impersonally debate the future of the women's unit surrounded by syncophants and protected from liability let's not pretend you and I don't really know what is going on there. Dr F