Received this e-mail today. Points out another rarely mentioned consequence of lack of true informed consent. I was unaware of the extent of this problem and want to thank Jennifer Zimmerman for her good work. Check out her link in the supporters column.
Hello, I am from the non-profit organization Solace for Mothers: Healing After Traumatic Childbirth (http://www.solaceformothers.org/). I am very interested in your case because we have identified a lack of informed consent and the ability to refuse care as a major risk factor in developing traumatic stress (or PTSD) symptoms after childbirth. Women are unable to get a lawyer if their legal rights to informed consent and refusal were violated and caused them PTSD. Lawyers simply will not take these cases, which means that providers are free to trample over women's rights with no punishment for their illegal actions. Having a lack of true informed consent is leading to more and more women suffering from postpartum PTSD, which is often misdiagnosed and treated as postpartum depression. Our organization will soon launch a letter writing campaign to Lynn Rosenthal, the newly appointed Presidential Advisor on Violence Against Women (an office within the Department of Justice). We intend to inform her of the violence that is happening against women in maternity care, and the effect it has on these women. If you would like to add your voice to this campaign, I will inform you of when we begin.
Jennifer Zimmerman
Project Coordinator
Solace for Mothers, Inc.
www.solaceformothers.org
Sunday, August 30, 2009
Thursday, August 27, 2009
Always question motives.
From: Patricia Sent: Thursday, August 27, 2009 8:57:34 AM
Subject: Re: Couple of things about ACOG
Thanks, Dr. Fischbein, for this recent notice from ACOG. It does seem like we are going back to the Dark Ages! Well, at least, they are putting out a statement that it is "okay" from women to have more than icechips in labor. Really? Who are these people?!
Re: reporting of unsuccessful homebirths. It is curious that there is a need for data collection on numbers. I am suspicious as to the motive for data collection. But I hope that along with collecting the numbers, there is an assessment for the reasons for hospital transfer (i.e. emergency vs. nonemergency).
Have a great day!
Patricia
Dear Patricia, You should be suspicious. Last year they came out and made a statement against homebirth based on Level C evidence (consensus opinion). Now, it seems, they are out to find out if they were correct. This is ass backwards thinking and reeks of bad research technique. "Here is what I think now we will try to find evidence to prove it!!" By the way, if they don't, you will never be told. Completely lacking in objectivity and, as I said before, what do the anecdotal stories mean without comparison to successes? Also, I do not see them asking members to report data on bad outcomes in hospital births as they have already concluded that hospitals or birthing centers attached to hospitals are the safest place to give birth. This is just such a witch hunt. Thanks, Dr.F
Subject: Re: Couple of things about ACOG
Thanks, Dr. Fischbein, for this recent notice from ACOG. It does seem like we are going back to the Dark Ages! Well, at least, they are putting out a statement that it is "okay" from women to have more than icechips in labor. Really? Who are these people?!
Re: reporting of unsuccessful homebirths. It is curious that there is a need for data collection on numbers. I am suspicious as to the motive for data collection. But I hope that along with collecting the numbers, there is an assessment for the reasons for hospital transfer (i.e. emergency vs. nonemergency).
Have a great day!
Patricia
Dear Patricia, You should be suspicious. Last year they came out and made a statement against homebirth based on Level C evidence (consensus opinion). Now, it seems, they are out to find out if they were correct. This is ass backwards thinking and reeks of bad research technique. "Here is what I think now we will try to find evidence to prove it!!" By the way, if they don't, you will never be told. Completely lacking in objectivity and, as I said before, what do the anecdotal stories mean without comparison to successes? Also, I do not see them asking members to report data on bad outcomes in hospital births as they have already concluded that hospitals or birthing centers attached to hospitals are the safest place to give birth. This is just such a witch hunt. Thanks, Dr.F
Wednesday, August 26, 2009
What about Successful home Births?
ACOG is asking its members to report failed home births. Maybe I am biased but what good is this registry if there is no registry on successes?
Reporting of Unsuccessful Attempts at Home Delivery with or without Adverse Consequences
In 2006 there were 24,970 home deliveries reported in the United States[1]. Obstetrician-gynecologists and other members of the medical community may be faced with the presentation of an obstetrical patient who has attempted home delivery unsuccessfully. The need exists to quantitate the frequency and information of these events. The goal of this registry is to attempt to quantitate when home delivery is unsuccessful and what the outcomes are. To be HIPPA-compliant, no identifying information will be requested. Data points include the state of occurrence, as well as the month and year of delivery, maternal and gestation age, gravidity and parity and obstetric or neonatal complications. An attempt to identify the home attendant type if known will also be useful data.
ACOG appreciates your recognition of this issue and your utilization of this registry to assist us in data collection.
Reporting of Unsuccessful Attempts at Home Delivery with or without Adverse Consequences
In 2006 there were 24,970 home deliveries reported in the United States[1]. Obstetrician-gynecologists and other members of the medical community may be faced with the presentation of an obstetrical patient who has attempted home delivery unsuccessfully. The need exists to quantitate the frequency and information of these events. The goal of this registry is to attempt to quantitate when home delivery is unsuccessful and what the outcomes are. To be HIPPA-compliant, no identifying information will be requested. Data points include the state of occurrence, as well as the month and year of delivery, maternal and gestation age, gravidity and parity and obstetric or neonatal complications. An attempt to identify the home attendant type if known will also be useful data.
ACOG appreciates your recognition of this issue and your utilization of this registry to assist us in data collection.
No progress on Midwive's Privileges
My take: As of today, the hospital's legal counsel is still playing a childish game of semantics which is hurtful to both midwife and patient. We have honored their request for physicians willing to back them on days when I am in my other office. One of the physicians has not been approved because she requires proctoring for obstetric admissions. While this may sound reasonable it is really absurd. Her proctoring requirements have been in place since July of 2008 and have not changed. From July 2008 until January 2009 the midwives and I shared call with her and several other physicians. No one complained then. Since January she has covered several physicians in a call group without restriction. She has also covered me and the midwives when I had to go out of town. And no one complained then. When asked to explain this situation today, the chief of staff told me he would have to discuss this with legal counsel and get back to me tomorrow. It seems clear to me that these decisions are coming from a lawyer who benefits financially each time he can be obstructive and is in no hurry to respond or resolve this dilemma. Meanwhile it has now been 2 weeks since they abruptly restricted the midwives from caring for inpatients. Lets see if they follow through tomorrow and what they will think of next. Thanks for reading. Comments welcome. Dr. F
Consider taking the Birth Survey
http://www.thebirthsurvey.com/AboutProject.html
Here is an opportunity to contribute data on your birth experiences to a large study. Please check it out. Thanks, Dr. F
Here is an opportunity to contribute data on your birth experiences to a large study. Please check it out. Thanks, Dr. F
Milbank Report referenced in Support Letter
Dear M. Murray,
I have become aware that Dr. Stuart J. Fischbein is being threatened with disciplinary action for practicing evidence-based maternity care and defending woman’s autonomy and right to informed choice, as well as supporting midwives and the midwifery model of care.
According to your mission statement, “It is our goal that health care be provided in a holistic way, respecting all dimensions of a person. At a time of extraordinary technological advancement developed to cure disease -- one that focuses on the physical dimension of person -- we need to emphasize and embrace the psychological, social and spiritual dimensions of persons.
Health care is patient-centered. Patients have the right to make medical treatment decisions (including accepting or rejecting treatment), which includes free and informed consent, access to medical and other information regarding their care…”. Apparently your facility says, birthing women are insured and encouraged to make health care decisions autonomysly and are not forced to have procedures done on them and to them that could do harm. In this case I am referring to your policy for vaginal birth after cesarean and the midwifery model of care. Are your employees walking the talk?
Your own on-line statement says “A woman may or may not be able to have a vaginal birth with a future pregnancy, called a vaginal birth after cesarean (VBAC). Depending on the type of uterine incision used for the cesarean birth, the scar may not be strong enough to hold together during labor contractions”.
ACOG’s brochure on VBAC states:
Today, doctors know that many women who have had a cesarean delivery can later safely give birth though the vagina. This is called vaginal birth after cesarean (VBAC) delivery. VBAC can be a safe option for many women.
Of women who try VBAC, 60–80% succeed and are able to give birth vaginally.
There are some reasons why a woman may want to try VBAC over cesarean delivery:
· No abdominal surgery
· Shorter hospital stay
· Lower risk of infection
· Less blood loss
I will add to this; more success with breastfeeding.
It is your responsibility to know that uterine rupture happens less than 1% of the time. This is far less that the risks of other serious events in labor. If a hospital is not safe to have VBAC, it is not safe to give birth.
In 1987, Angela Carder, a pregnant cancer patient, died along with her baby at George Washington University Medical Center after a court-ordered Cesarean Section. As a result of this case, beginning in the early 1990s, hospitals began to set policies stating that decisions regarding pregnant patients would be made by the patient herself, her family, and her doctors.
When medicine is practiced primarily for profit, convenience and out of fear of litigation it is not good medical practice nor is it evidence-based medicine.
The c/section rate in this country is nearing 1/3 of all births. While the current hospital model will profit from this trend you must ask at what cost? Evidence is clear that repeated c/sections put women at greater risk and the evidence mounts that babies born this way have higher rates of breathing difficulties, breastfeeding difficulties and learning disabilities. Doctors and midwives who stand up for patients rights are often the target of ridicule and harassment by the very hospitals and organizations that their hard work supports. Does this sound like what is happening at your facility??
Losing Dr. Fischbein will have a devastating effect on the ability of midwives to continue to care for patients and for patients to have options other than c/section. Many believe that hospital policies that force women into surgery, deny them informed consent or tell them they must go to a different institution are unethical, in violation of EMTALA and even possibly illegal.
What other medical modality forces a healthy person to undergo major abdominal surgery against their wishes? Name one please.
Your policy is an assault on a woman's right to self determination, likely for economics, expediency and litigation mitigation, plain and simple.
I encourage you and your entire OB staff to get better informed by reading the Milbank Report – Evidence-Based maternity Care: What It Is and What It Can Achieve http://www.childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf . There is no excuse for ignorance and no room for arrogance in providing stellar maternity care.
Sincerely,
Jeanne Batacan
Jeannie Batacan
Help bring transparency to maternity care. Take The Birth Survey! Share, Connect and Learn. www.thebirthsurvey.com
Watch this video! www.reducinginfantmortality.com
I have become aware that Dr. Stuart J. Fischbein is being threatened with disciplinary action for practicing evidence-based maternity care and defending woman’s autonomy and right to informed choice, as well as supporting midwives and the midwifery model of care.
According to your mission statement, “It is our goal that health care be provided in a holistic way, respecting all dimensions of a person. At a time of extraordinary technological advancement developed to cure disease -- one that focuses on the physical dimension of person -- we need to emphasize and embrace the psychological, social and spiritual dimensions of persons.
Health care is patient-centered. Patients have the right to make medical treatment decisions (including accepting or rejecting treatment), which includes free and informed consent, access to medical and other information regarding their care…”. Apparently your facility says, birthing women are insured and encouraged to make health care decisions autonomysly and are not forced to have procedures done on them and to them that could do harm. In this case I am referring to your policy for vaginal birth after cesarean and the midwifery model of care. Are your employees walking the talk?
Your own on-line statement says “A woman may or may not be able to have a vaginal birth with a future pregnancy, called a vaginal birth after cesarean (VBAC). Depending on the type of uterine incision used for the cesarean birth, the scar may not be strong enough to hold together during labor contractions”.
ACOG’s brochure on VBAC states:
Today, doctors know that many women who have had a cesarean delivery can later safely give birth though the vagina. This is called vaginal birth after cesarean (VBAC) delivery. VBAC can be a safe option for many women.
Of women who try VBAC, 60–80% succeed and are able to give birth vaginally.
There are some reasons why a woman may want to try VBAC over cesarean delivery:
· No abdominal surgery
· Shorter hospital stay
· Lower risk of infection
· Less blood loss
I will add to this; more success with breastfeeding.
It is your responsibility to know that uterine rupture happens less than 1% of the time. This is far less that the risks of other serious events in labor. If a hospital is not safe to have VBAC, it is not safe to give birth.
In 1987, Angela Carder, a pregnant cancer patient, died along with her baby at George Washington University Medical Center after a court-ordered Cesarean Section. As a result of this case, beginning in the early 1990s, hospitals began to set policies stating that decisions regarding pregnant patients would be made by the patient herself, her family, and her doctors.
When medicine is practiced primarily for profit, convenience and out of fear of litigation it is not good medical practice nor is it evidence-based medicine.
The c/section rate in this country is nearing 1/3 of all births. While the current hospital model will profit from this trend you must ask at what cost? Evidence is clear that repeated c/sections put women at greater risk and the evidence mounts that babies born this way have higher rates of breathing difficulties, breastfeeding difficulties and learning disabilities. Doctors and midwives who stand up for patients rights are often the target of ridicule and harassment by the very hospitals and organizations that their hard work supports. Does this sound like what is happening at your facility??
Losing Dr. Fischbein will have a devastating effect on the ability of midwives to continue to care for patients and for patients to have options other than c/section. Many believe that hospital policies that force women into surgery, deny them informed consent or tell them they must go to a different institution are unethical, in violation of EMTALA and even possibly illegal.
What other medical modality forces a healthy person to undergo major abdominal surgery against their wishes? Name one please.
Your policy is an assault on a woman's right to self determination, likely for economics, expediency and litigation mitigation, plain and simple.
I encourage you and your entire OB staff to get better informed by reading the Milbank Report – Evidence-Based maternity Care: What It Is and What It Can Achieve http://www.childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf . There is no excuse for ignorance and no room for arrogance in providing stellar maternity care.
Sincerely,
Jeanne Batacan
Jeannie Batacan
Help bring transparency to maternity care. Take The Birth Survey! Share, Connect and Learn. www.thebirthsurvey.com
Watch this video! www.reducinginfantmortality.com
Tuesday, August 25, 2009
NY woman seeks VBAC provider
Dear Dr. Fischbein,
I just found out today that I am about 4 weeks pregnant! We are very
excited except that my OB, who delivered my two daughters, now nearly
13(emergency CS - due to distress of baby) and 11(VBAC) now tells me today
that a VBAC is "not allowed" because it is too dangerous. I am floored. I
do not want to have a c-section. The recovery from the first one so long
ago was very difficult. And since I did the VBAC successfully before, I
would like to do it again. However, now I must find another OB and
hospital that will allow it. I am having trouble finding a VBAC
supportive OB on the web. Perhaps you could help me - or at least tell me
a website that can help me locate one? I am located in Orange County, NY -
my zipcode is 10990. Thank you in advance for your help. Jen Emm
jensmail@warwick.net
Dear readers: "Too dangerous" is routinely being substituted for true evidenced based informed consent. This sort of subjective counseling for a variety of motives is becoming pervasive and part of the culture. It is a prime example of the well known propaganda technique of, "Tell a lie, tell it often, tell it loud and it becomes truth". If you have any ideas for Jen please comment below and feel free to e-mail her. Thanks, Dr.F
I just found out today that I am about 4 weeks pregnant! We are very
excited except that my OB, who delivered my two daughters, now nearly
13(emergency CS - due to distress of baby) and 11(VBAC) now tells me today
that a VBAC is "not allowed" because it is too dangerous. I am floored. I
do not want to have a c-section. The recovery from the first one so long
ago was very difficult. And since I did the VBAC successfully before, I
would like to do it again. However, now I must find another OB and
hospital that will allow it. I am having trouble finding a VBAC
supportive OB on the web. Perhaps you could help me - or at least tell me
a website that can help me locate one? I am located in Orange County, NY -
my zipcode is 10990. Thank you in advance for your help. Jen Emm
jensmail@warwick.net
Dear readers: "Too dangerous" is routinely being substituted for true evidenced based informed consent. This sort of subjective counseling for a variety of motives is becoming pervasive and part of the culture. It is a prime example of the well known propaganda technique of, "Tell a lie, tell it often, tell it loud and it becomes truth". If you have any ideas for Jen please comment below and feel free to e-mail her. Thanks, Dr.F
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