Letter to ACOG

In response to the big can of worms ACOG is trying to open regarding home birth, read this letter, shared earlier today with my local birth network:

Douglas H. Kirkpatrick, MD
The American College of Obstetricians and Gynecologists
PO Box 96920
Washington, DC 20090-2188

Dear Sir:

I am a practicing OB/ GYN in southern California and Fellow of ACOG
and recently was informed by midwife colleagues of your recommendation
and encouragement for the AMA to lobby Congress for a law banning out of
hospital birth.

Funny that I had to hear of this decision from outside sources and
was never approached by my college to see how I or my local colleagues felt
about it. I have grave concerns regarding my organization taking such a stand. I think
we are all agreed that ACOG has a statement regarding patients¢ rights to
informed consent and informed refusal. Yet, it seems with every decision our
organization moves further away from that basic tenet.

ACOG's little "guideline" paper on VBAC in 2004 where the word
readily was changed to immediately has had the chilling effect of doing away with
VBAC options at hundreds if not more hospitals. Not due to patient safety,
or the ideal of giving true informed consent but really, let's be honest, to fear
of litigation. I have seen how patients have become counseled by
obstetricians at facilities where VBAC has been banned. They are clearly given a
skewed view of the risks of VBAC but rarely told of the risks of multiple surgeries. If
you think this is untrue you are, sadly, out of touch with real clinical
medicine.

As to out of hospital birthing, please give me the courtesy of an
explanation as to the data you used and the process by which an
organization which is supposed to represent me came to this conclusion. Any statement
saying that it is as simple as patient safety and that one-size fits all hospital
birth under the "obstetric model" of practice should be applied to all patients
is, putting it nicely, not really in line with what best serves all our
patients. In many instances, hospitals are not safe, certainly not nurturing and
have a far worse track record for disasters than home birth. Even when emergency
help is nearby this is true. The focus of all of us in medicine should be on
reigning in trial lawyers and tort reform and lobbying Congress for that. The
best interest of the college members and the patients we serve would be
for my organization to spend its time and energy on something that has true
benefit.

Removing choices from well-informed patients and caring doctors and
midwives is wholly un-American.

So please send me detailed information on how ACOG decided outlawing
home birth was a wise thing to do. You must have scientific data to take
such a drastic stand. Please make it available to me so that I may share it
with like-minded colleagues. I would also like to know the process by
which this came to pass. Who first raised this issue and why? What committee reviewed
all the data and did its due diligence in interviewing those of us with long-
standing experience in backing midwives who perform out of hospital births.
There must be a fine, non-confidential paper trail you can share with your members.
Specific names of committee member who voted for this would be enlightening
and I am requesting this information. I would like to know the background and
expertise regarding out of hospital birth for each member who had a hand in the
decision to go to the AMA.

We live in an odd era where once something is said or recommended by
a legitimate organization such as ACOG it has deep ramifications never
intended, such as becoming fodder for trial lawyers trying to squeeze the lifeblood
and dignity out of your members. Or forcing women to travel hundreds of
miles in labor to find a supportive facility. Or even worse, to have them arrive in
a VBAC banned hospital and refuse surgery. Can this be the best we can do
for our patients? Remember, your VBAC statement was meant to be only a
recommendation but quickly became the rule by which hospital administrators, risk
managers and anesthesia departments of smaller hospital banned this option for
thousands of women. An option, that in proper hands, was the safe and accepted
standard of care for 30 years. In fact, you still have an ACOG VBAC brochure that
recommends this option!

For those of us working at smaller hospitals where VBAC was banned
due to lack of emergency help (anesthesia, OR crews, etc.) there is a big
question that has perplexed us, that no administrator seems to be willing or able
to answer. That question is: "If a hospital cannot handle an emergency
c/section for VBACs, and most emergencies are for fetal bradycardia, hemorrhage
(ie. abruption) or shoulder dystocia, not for ruptured uteri, then how can
they do obstetrics at all?" For they seem to still be able to have a
maternity ward without in house anesthesia. Will someday ACOG, in their great wisdom but
seeming disconnect from reality, make a "recommendation" that little
hospitals stop providing obstetric services? Will this better serve women and their
communities throughout America?

I am frightened and angered by what you have done in my name. Now I
ask you to defend your position in encouraging the AMA to lobby Congress for
another restriction on the freedom of choice that belongs to women and their
families. Those choices include midwifery and the right to have the most
beautiful and life changing event occur wherever best fits their desire.

Midwives are well trained and required to have obstetrical backup.
They have very special relationships with their patients and want the very best
outcomes for them. They do not need me or you to police them. We have
a habit in our country over the past 40 years of thinking we can legislate out
stupidity. All that has done is erode the individual freedoms that belong, by
birthright, to each of us. I would hope you trust your Fellows to know their
specialty, their colleagues, and what is best for the patient as an individual.

These decisions do not belong to politicians or faceless committees.
You should have more faith in your members to give balanced informed
consent. Again, my recommendation to you is to put all your considerable energy into
changing our legal malpractice system. Those of us actually practicing
medicine and caring for patients know this to be the greatest threat to the
mission and responsibility we have chosen to undertake.

I look forward to your response and possibly the beginning of a meaningful
dialogue.

Sincerely,

Stuart J. Fischbein, MD FACOG
Medical Advisor, Birth Action Coalition