"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, February 1, 2013

Birth Center Outcomes

Few words needed from me. Read Tara Elrod's Blog at taraelrod.blogspot.com and find the full article at http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12003/full This is a huge study in both it's numbers and for support of the benefits of the freestanding birthing center option. Always nice when good evidence based medicine supports what we all know to be true. The authors, 2 midwives and a physician from Yale University conclude: This study demonstrates the safety of the midwifery-led birth center model of collaborative care as well as continued low obstetric intervention rates, similar to previous studies of birth center care. These findings are particularly remarkable in an era characterized by increases in obstetric intervention and cesarean birth nationwide.


  1. Great to see some research to support the midwife-based model of birth and birthing centers.All too often, all we hear about is (skewed... partial) scare tactics against birth centers and home births. For example, the recent home birth of Gisele Bundchen and Tom Brady's second child. In watching the news, I had assumed it had gone poorly. Every news person referred to the story as though there had been a problem during labor. The news anchors led the story with lines such as "Why doctors are issuing a warning in light of the birth of Gisele's new baby." A plethora of stories on the "hidden dangers" and "scary new trend in birth" ensued.

    Keep fighting the good fight!

  2. There are few places left to go for news and information you can trust. Pretty much everything has its alterior motives and or bias for sensationalism. Each of us has to create our own community safe zone filled with family and friends and neighbors we can trust. That's part of why I enjoy my professional life so much more these days. I have the time and motivation to listen to clients and give honest informed consent. But that is, sadly, the exception. Thank you for your trust and help in spreading the word one person at a time if need be.