"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, December 24, 2012

Dissecting the Ethics of the Ethicist

Merry Christmas and much hope for a honest and healthy new year in 2013. As I mentioned in a previous blog there was an opinion piece in the American Journal of Obstetrics and Gynecology online version from November by Chervenak with which I took issue. Its titled, "Planned home birth: the professional responsibility response" and is intended to make the argument for health practitioners to use against those who desire or support out of hospital birthing. It would be all too easy for practitioners to read this, consider the source and trust it as gospel. Critical reading of this article, however, shows it to be flawed and biased and even on occasion purposely deceitful. It is deserving of a point by point review and rebuttal but to do so by prose I found too lengthy and confusing. I could not figure how to respond to the AJOG in a letter with an acceptable word count. So, the past few weeks I have been working on a power point presentation which has the ability to present Dr. Chervenak's positions and evidence based counterarguments in a meaningful and comprehensible manner. I intend to begin to offer lectures and gatherings so that this paper does not go unchallenged. Please spread the word to your local groups and let me know if you would like me to come and speak. Ideally, obstetricians uninformed or against home birthing would be a great audience but it would be an honor to present this debate to all interested parties. Warmly, Dr. F