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 homebirth 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