The text below is a post that the above Obstetrician posted on his blog..
Explaining the Cause
Dear supporters of choices in childbirth, Many, but not all, of you are aware that a woman's right to informed consent and refusal and the ability to self determine the path of her pregnancy and birth are rapidly eroding. Very personal decisions that belong to a woman, her family and her health practitioner have and continue to be usurped by outside forces. Medical organizations, hospital administrators and their lawyers, malpractice insurance carriers, government agencies and, yes, even physicians have intruded on the once sacred doctor-patient relationship. Policies that deny patients legal and ethical rights have formed despite a lack of evidenced based medicine. Although "patient safety" is always the tag line associated with these policies, when scrutinized, it is clear that they are about economics, expediency and litigation mitigation. The banning of VBACs, the push against midwives and out of hospital births and the lack of training new physicians in techniques such as selected breech delivery have not only limited the choices of women across the country but evidence would support that it has put them at more risk. 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 and learning disabilities. We believe that the current trend is dangerous and needs to be exposed and confronted. 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. The decision of how to birth must be returned to informed women. The time has come to push back against the system that profits from fear and expediency before there are no health practitioners left willing to stand up. One of our own, Dr. Stuart Fischbein, has long been a voice of reason for the rights of patients to true, not skewed, informed consent and informed refusal. He has written a highly publicized letter to the American College of Ob/Gyn, co-authored "Fearless Pregnancy, Wisdom and Reassurance from a Doctor, a Midwife and a Mom", been a featured speaker at The Contoversies in Childbirth Conference last March in Fort Worth, Texas and is a multiple award winner from the Doulas Association of Southern California. He has also walked the walk and supported patients who chose to attempt VBACs, home births and breech deliveries. One of only a few doctors left willing to support midwifery. In the past several months he has done 3 successful VBACs, allowed 3 first time moms to deliver vaginal breeches and accepted home birth transfers from licensed midwives. For that he is now being threatened with a disciplinary process by the hospital where he works in Camarillo, California for violating hospital policies. A process that threatens his practice and his livelihood. His loss would 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 of us 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. Being a dedicated obstetrician is a calling. The hours are long, the life is disruptive and there is not much money to be made. This bullying of doctors and midwives who do not conform will most certainly spread across the country. Many have just given up unable or unwilling to mount the energy and funds to fight back. On behalf of Dr. Fischbein, the midwifery model of care and pregnant women present and future we are asking for your help. That is why we are forming the "Birth Choices" legal defense fund. We can wait no longer. The only effective way to regain choices for women is to go to the media and put together a legal team. This is an expensive process that no individual can sustain. Confronting large institutions backed by corporate money is an uphill battle. Lobbying Congress for legal protection for women will require funds and hopefully some pro bono legal experts. Please give generously by clicking on the PayPal link, code: email@example.com and pass this message on to every family and friend you know. For the wonder and joy of giving birth should remain a very personal liberty and a special gift that touches everyone. We need you. Please help. Thank you.
I am a obstetrician who collaborates with midwives and believes strongly in the midwifery model of obstetrics and the right of a woman to true informed consent and refusal in the birth process. The hospitals I work at have a malicious attitude towards me and those things I believe in. They have created policies that seem to violate basic human rights, patient autonomy, possibly EMTALA and may very well be illegal. They do not seem to care that these policies violate their own mission statement, as well. Policies such as "banning" VBAC are becoming pervasive. They also have a policy denying a laboring woman an epidural who chooses to violate that policy as well as one that says a woman transferred from a home birth no matter what the reason for transfer must not go to one of the two sister hospitals. This is just the tip of the iceberg of the extent to which the hospital committees, administrators and their lawyer have gone. Their malice and pettiness now threatens my privileges for allowing 3 women this year the informed choice of refusing a repeat c/section, 3 more for having a breech delivery and for allowing a woman to choose what hospital she feels most comfortable at. They have suspended the privileges of my 2 CNMs for the pettiness of reasons and when I was able to refute that one they came up with something else. Clearly we believe this is a combination of a witch-hunt against midwifery, personal animosity towards me and what I believe and, most significantly, an assault on a woman's right to self determination, likely for economics, expediency and litigation mitigation and not for their standard line "patient safety". Feel free to ask me about that one. This country now performs c/sections on nearly 1/3 of all pregnant women. Major surgery that carries significant short and long term risks to them and their babies of which they are rarely informed. VBAC is successful over 73% of the time and carries less morbidity that repeat c/section but all these women are told is that if they try a VBAC they could rupture their uterus and their baby could die. Thus skewing them into a choice the doctor or hospital wants them to make Easier on the doctor, more money for the hospital. Using the midwifery model last year my collaborative midwife practice had a primary c/section rate of 5% compared with 20% for the rest of the doctors at this hospital that only does low risk OB. (Overall rate 12% vs. 29% includes repeat c/sections). All 6 of my VBAC and Breech deliveries this year went well with great outcomes, bonding and patient satisfaction. These six women would all of had c/sections against their desire if I was not in the community. Now the doctors on the OB committee, the anesthesiologists and the hospital administration are going full bore to eliminate us from that community. I would not doubt that this sort of bullying goes on under the radar in numerous communities around the country and pregnant women are the real victims.
This poor man, and the midwives in his service are being victims of the oh so common hospital policy and the modern day midwifery witch hunt. Spread the word, pass it along, let people know what is happening.