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 . There is no excuse for ignorance and no room for arrogance in providing stellar maternity care.


Jeanne Batacan
Jeannie Batacan
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