Sunday, February 17, 2013

A "Fischy" Doctor...

How many out there have heard of Dr. Stuart Fischbein?

I have heard about him a couple times b/c I read about his issues and probation on another blog and read about James Van Der Beek's wife's breech baby home birth (cringe) that he attended as the main care provider but did not realize he was so, um, in my community. My immediate community. He apparently has won (two times) Physician of the Year at the Doulas Association of Southern California awards - an association of which I am a member. And recently I saw photos of him on Facebook at a home birth with a midwife I know (she taught childbirth ed classes to my husband and I).

Anywho, all this mention of him so close to home and of course I had to Google him. I came across his website and saw that he's asking for money. I read the explanation for what the money is supposed to go toward but I'm still confused? It didn't make much sense to me and I still don't understand what his fund is for. Anyone know what he is using the money for?

I read a couple articles about him, like this one here which states:
"In Los Angeles Superior Court last year, he pleaded no contest to a misdemeanor charge of sexual exploitation involving the same patient and was sentenced to three years probation. A second count of the same offense was not prosecuted."
"According to findings presented by Reyes with his proposed decision, Fischbein first met the patient at his Camarillo office. They had sex twice, both times during a period when Fischbein had advised against sex because of the surgery."
""It's illegal under the business and professions code 726 for a physician to have sex with his or her patient," [Medical Board spokeswoman Candis] Cohen said. "And consent is no defense.""

So that explains his trouble with the law. So, I had to go to the Medical Board of California to see if I could find out more and see if they took any action. I did (find out more). And they did (take action).

Here's what I found at the Medical Board of California. There are two public record documents.

The first document (2007) details out the relationship between Dr. Fischbein and his patient. Things of note:
- respondant = Dr. Fischbein; S.K. = his female patient
- he performed surgery on S.K. on September 16th. S.K. was in a relationship at the time.
- Then there's this:

- on September 28th (12 days after surgery), he visited her at her home and "the two had consensual sexual intercourse"
 - on October 1st, they had sexual intercourse again
- another physician weighed in on this:

- I'm pretty sure he deviated from the standard of care by having sexual intercourse with S.K. period. Well, obviously, the law and the Med Board agree see it that way as well. Anywho.
- soooooo... her doctor told her she shouldn't have sex with anyone for 4-6 week (which would mean for her to not have sex with her then boyfriend).... and yet, 12 days later, her doctor has sex with her. Did he not care about the surgery he just performed on her? Or did he just not want her to have sex with anyone else?
- He ended up getting 7 years probation, more details of the order and his probation begin on page 11 of the above Med Board link

The second document (2011) details out his request to have his 7 year probation cease. I had read about this on another site as well. Things of note:


Can you imagine that poor patient of his if he actually made that movie about their relationship?! I would FREAK. That is horrible.

So he's still on probation. And I don't know if he has hospital privileges anywhere? It says he was asked to leave as Medical Director at a clinic and that he resigned from Cedars-Sinai hospital.

Anyway, apparently he does home births now. And he's asking for donations from people.

I don't know.... this all sounds horribly fishy to me. I can't say I'd be comfortable having him as my doctor. B/c I wouldn't be. At all. Sorry, my exact thoughts can pretty much be summed us as "ew, noooooooo."

He seems to have so many supporters and followers and people who worship him. Do people not know about this stuff? Do they know and not care? Thoughts?

Sunday, February 10, 2013

Protection of Home Birth

As I was writing my last blog post, several questions kept coming to mind that I just have to get out there....

Why is it so easy to believe that there are OB's out there who practice unethically and/or convince women of unnecessary interventions and cesarean sections but it is so hard to believe that there are home birth midwives out there who practice unethically and/or are under-trained? 

Why does it mean that if one accepts that our home birth midwifery system is flawed here in the US it means that person is anti-home birth and anti-women's right to choose? 

Why can't it mean that someone who is advocating for SAFER out-of-hospital standards mean that they care (maybe, even more) about women and protecting a woman's right to choose?

Why must home birth midwifery be protected so much that the preventable losses at home births are hidden and/or ignored by the home birth community?

Why does it mean that if we accept that birth may not always be normal, even for a woman who is low risk, it means we are living in fear?

Friday, February 8, 2013

Of Ethics and Home Birth

Or... Of Care Providers and Home Birth

Caveat: This was a hard blog post to write. Reading stories about the death of a baby is hard enough, but to read some of these stories from the mother's perspective is just heart-wrenching. As I have put this together, it seems very cut and dry... but I assure you it was not easy for me to do this as these are not easy stories  about which to read. I cannot imagine actually living through them and my heart goes out to each of these mothers, fathers, siblings, grandparents, etc and most especially, these sweet babies. I tried to use the names of the babies where I could but in some cases, the names were not given.


Hospitals of course will see their fair share of infants that die b/c they obviously have much higher risk clientele. They have women who have zero prenatal care and walk in off the street. They have babies born at 23 weeks gestation. They have babies born to drug addicts. They have babies born with congenital birth defects. They will see and deal with every sort of high risk pregnant woman and the baby she carries.

When I was debating between home and hospital, I found one key question that really got to me:

Are there healthy, full-term babies routinely dying in hospitals that would have lived had they been born at home?

Are there?

Here are some stories of healthy, full term babies that have died or were injured at home births.... babies that  (most likely) would have lived had they been born in hospitals. And these are their care givers.

(You can click on the link for full the story or investigation. I am providing what I found to be the most shocking details in bullet-form lists under the names.)

Karen Carr, Certified Professional Midwife (CPM), Virginia
- baby was in breech position, which the midwife knew prior to labor; mother was 43 years old and was a first time mother
- baby's head entrapped during delivery for more than 20 minutes
- an additional 13 minutes passed while midwife attempted resuscitation before she called for emergency medical help
- baby died two days later
- money was raised by Karen Carr's supporters to pay for her legal fees... none raised for the family whose baby died
- Ina May Gaskin planned to testify on behalf of Karen Carr (Karen Carr accepted a plea agreement to avoid trial) 

Faith Beltz, Certified Professional Midwife (CPM), Texas
- midwife either ignored or did not recognize the signs of placental abruption (placenta detaches from the uterine wall)
- mother had a fever during labor, baby's heart tones were above 180, mother was passing blood clots and there was meconium in the amniotic fluid
- quote from the mother: "in the birth records, Faith repeatedly states that I was refusing to transfer. She NEVER said “transfer” to me. She never said “emergency”, or “abruption”. This is backed up by the other 3 people at my birth."
- quote from the mother "Please pay close attention to these words…the hospital was 3 MINUTES from my house. But that means NOTHING when bad things are happening and you are in hard labor. It took at least 30 minutes to get to the car. 30 MINUTES. Don’t fool yourself into thinking you are safer than you are."
- Baby Aquila was born still at home from an infection and complete placental abruption

Evelyn Muhlhan, Certified Nurse Midwife (CNM), Virginia and Maryland:
Complaint #2 of 5 of the investigation:
- administered Pitocin at a home birth, used vaginal chlorhexadrine (Hibiclens) to treat GBS infection, fundal pressure applied to help baby descend in second stage, misdiagnosed fetal station resulting in unnecessary episiotomy
- the mother called ambulance after 3 hours of pushing
- hospital transfer, baby born limp and blue, was OP with a nuchal cord, NICU stay for almost one month before transfer to a pediatric rehabilitation center, suffers from HIE and seizure disorder
- Johns HopkinsHospital ordered to pay out $55 million to the parents because the parents believe it was the hospital's fault the baby was not born in time to prevent the brain damage. The jury was not aware that it was an attempted home birth. The hospital is appealing the award.
Complaint #4 of 5 of the investigation:
- attempted HBAC (Home Birth After Cesarean)
- at 40.5 weeks, ultrasound indicated estimated weight of 9 lbs, 3 oz
- fetal heart tones indicated distress, 911 called, midwife delayed hospital transport and asked the EMS to "stand by" for over 20 minutes while the mother continued to push; EMS finally insisted on the transport
- cesarean performed immediately upon hospital arrival, baby was OP with tight nuchal cord and the uterus had ruptured
- baby was born still
- her license has been suspended by the Maryland Board of Nursing
- money was raised to help pay for the midwife's legal fees

Colleenand Jerusha Goodwin, Certified Professional Midwives (CPMs), Idaho:
- June 2008: baby girl born without oxygen leading to permanent brain damage, $5millionsettlement awarded to the couple (not sure if they will get a dime though as the midwives are planning to file for bankruptcy)
- October 2010: umbilical cord not clamped before it was cut, significant blood loss to baby; on admittance to hospital, baby had respiratory failure and severe HIE. Baby died 14 days later.
- June 2011: diabetic mother; baby in distress during labor; midwife delayed paramedics from entering the patient's room for at least 4 minutes; baby died.
- August 2011: 48 hours of active labor, 10 hours of pushing; baby born limp and unresponsive with meconium staining around the mouth; midwife didn't call for paramedics for 11 minutes after birth. Baby died. Autopsy performed and stated "the cause of death was anoxic brain injury secondary to a prolonged vaginal birth complicated by meconium aspiration."
- a RALLY was staged in support of the midwives. What a slap in the face to the loss moms and dads who lost their babies at the hands of these midwives....

TheGreenhouse Birth Center, combination of CNMs and CPMs, Michigan:
- the parents were reassured that it was safe to have a vaginal breech delivery at their birth center
- quote from the mother, regarding breech vaginal delivery: "They made it seem like it was even safer than having a C-section at that point. There was no discussion, no use of the phrase ‘high risk.’ No discussion of how your baby may not survive or your baby may become entrapped."
- baby boy's head became entrapped in her pelvis after his body was born
- baby Magnus was born without a heartbeat, transferred to the hospital and died after 13 days in the NICU
- the mother is now an activist for safer out-of-hospital birth practices. Please visit SaferMidwifery for Michigan.
- Ina May Gaskin, along with a slew of other midwives, offered her support to the midwives but not to the couple who have been all but shunned by the community that once embraced them. The loss mother responded to this with an openletter to Ina May.
- pretty much par for the course that money was raised to help the midwives pay for their legal fees but not for the family, who is also paying legal fees and also had to pay for birth center fees, EMS fees, hospital fees, and funeral fees. 

Dr.Biter, OB/GYN, California:
- 7 cases of Gross Negligence investigated by the Medical Board of California, which led to license suspension
- after a new and completely separate incident, his license has been suspending indefinitely after a July 2012 home birth in which the baby died
- he still has followers that believe he lost his job b/c of his popularity and support of natural childbirth

CaraMuhlhan, Certified Nurse Midwife (CNM),New York:
- this is the midwife featured in the movie The Business of Being Born
- one mother labored for over 72 hours after her water broke, transferred to hospital, had 103 degree temp, baby born and rushed to NICU for a 5 day stay; midwife told the couple at the postpartum visit "I had a plan the whole time, and you just didn’t trust me."
- in 2003, a mother sued Muhlhan b/c her son suffers from Erb's Palsey as a result of trauma from shoulder dystocia during birth, which may be due to the way the midwife handled the dystocia; the mother also believes the midwife was negligent that she did not recognize the baby to be too large for vaginal birth
- in 2007, a mother lost her baby under Muhlhan's care. After a long labor, the baby's heartbeat began to decel during second stage; the baby was born still
- in 2009, another couple lost their baby under Muhlhan's care and is sueing her for negligence and for failing to transfer. The mother labored for 3 days before giving birth to a stillborn baby.

Tamra Roloff, Certified Professional Midwife (CPM), Washington:
August 2009 birth: warned by her midwife against ultrasounds, the mother did not know her baby was breech until she was in labor. The baby was partially born during the hospital transfer in their car but the head was entrapped for the remaining 15 minute drive. A doctor rushed out and delivered the baby with forceps in the back of the car. Mother needed surgery to repair her 4th degree tears. Baby needed resuscitation and was LifeFlighted to Portland. The baby boy died due to brain injuries.
March 2010 birth: after 34 hours of labor after the mother's water broke (labor that was plagued with maternal fever and high blood pressure), the mother suffered a seizure; hospital transfer; baby was born still after cesarean due to placental abruption that took place while she labored at home. The mother nearly lost her life as well and was LifeFlighted to Portland, due to eclampsia and acute respiratory distress.

Hurt by Homebirth stories, which highlights far too many negligently practicing midwives


These are just some of the stories I have read that got to me. Sadly, there are more. A lot more. More negligence. More sweet babies lost. There have been (and continue to be) many more stories in the news and there are other stories that didn't make the news but the moms have shared their home birth loss stories on their blogs or in online forums, etc.

I don't think trusting what we see in dramatic television shows is the answer but we can't just cover our ears, yell "la la la la" and pretend that either birth always goes perfectly if a "woman is left alone to give birth as our bodies are designed to do" or that it only goes awry for those who don't fully "trust birth". Those are extreme beliefs that are not only dangerous but they are setting up any woman to feel like a failure if her birth does not go exactly according to plan. I can't tell you the number of times I have read a woman's birth story who feels that she has failed if any interventions come into play.

We also cannot support home birth midwifery to an extreme extent that we won't accept or acknowledge that not every birth will be normal, that low risk does not equal no risk, that not every home birth midwife is ethical, that not every home birth midwife is skilled enough to be able to handle certain emergency situations, even if they are certified.

Why is it such a hard pill to swallow for so many home birth advocates? Is it b/c it affects their livelihood? Is it pride? Is it ignorance? Is it fear?

As we are all very different, unique people, we will all process things in our own unique manner. Two people can witness or experience the exact same thing and walk away with a different perception and opinion of the event. These stories might not even make you bat an eyelash. They instead may make you roll your eyes and think "this crazy doula is just trying to scare me." But for me, reading stories like these didn't scare me. They shook me. They added a big dose of reality to a very romanticized notion that I once believed in... that birth is natural and normal, we just need to trust it and trust our bodies.