Breech vaginal increases the risk of neonatal injury and death, not a lot, but an additional 6 will die and additional babies will be injured out of every 1000 breech delivery. And that’s only if breech vaginal delivery is restricted to a minority of patients who are carefully selected for specific characteristics: baby in the frank breech position at that start of labor (legs folded up against the body, head flexed on the chest and below a certain estimate weight).

In other words, in order to be safe, breech vaginal delivery needs to monitored very closely with ultrasound at the beginning of labor and careful attention to the progress of the labor. Therefore it is foolish to show up pushing in an attempt to avoid a C-section for breech, and it is reckless in the extreme to recommend to a patient that she show up pushing in order to avoid a C-section. Unfortunately, that’s what happened to this blogger’s cousin:

She had an uneventful pregnancy until the very end, when she found out her baby was breech. All along, they’d been having midwife care and were planning a home birth. … [T]hey sought out one of the only doctors in the state who would permit a breech vaginal birth. He did an ultrasound and attempted a version…then told her that she should show up at the hospital at 8cm and that they would allow her to attempt a vaginal birth at that time.

Evidently she and her doctor conspired to circumvent the rules of the hospital by having her show up when it was “too late” to perform a C-section. And she did avoid a C-section, and gave birth to a brain damaged baby as a result.

…She shows up fully dilated, and as she is wheeled into the OR, two feet emerge first. Bad. At that point, the clock starts. Owen’s vitals degrade and it quickly becomes clear that the cord is wrapped around his neck twice and his head is far too big to make it through the birth canal. The Dr. had to reach in and physically pull him out, breaking his shoulder in the process…

… [H]is brain had gone 9 minutes without oxygen. They rushed him to the NICU, and his brain began to swell so they put him on hypothermic treatments. They lower his body temperature and cool his brain for 72 hours in hopes of helping stop the brain injury and give it time to recover….

How is the baby doing now?

… [T]hey removed the body cooler and brought his body back to body temperature. They switched ventilators, and he took a few breathes on his own. All his vitals have stabilized, he is pinking up, gaining weight, and having plenty of wet diapers. But they don’t know if his brain has any activity.

The blogger is having trouble making sense of this:

… It’s just been so hard, because he was a perfectly healthy and perfect baby boy. He has loving parents. But the birth trauma just seems so unfair…

Unfair? No, not unfair, but a known complication of breech vaginal birth. The mother played Russian roulette with her baby’s brain function and she lost, or rather the baby lost.

Was it worth it? The mother avoided a uterine scar and the baby is saddled with serious disabilities for the rest of his life, however long that may be. Had that mother opted for a C-section, either electively or when she showed up in early labor and an ultrasound revealed that the baby was in an unfavorable position, she would not be standing vigil in the NICU hoping that her baby’s brain damage is only “minor” and not severe. She would be home with her new baby bemoaning he “unnecessarean” and whining about how she lost her perfect birth. Instead, she had a perfect birth and ended up with a lifetime of contemplating how she grievously injured her perfect baby.

Amid the hoopla surrounding the publication of the politically motivated Amnesty International Report on maternal mortality and the cynical Ina May Gaskin’s Safe Motherhood quilt memorializing mothers who died of iatrogenic childbirth complications, a curious thing has been happening: American maternal mortality has dropped for the second year in a row.

Maternal mortality, which reached an all time high of 15.1 per 100,000 dropped to 12.7 per hundred thousand in 2007. This strongly suggests that the previous increase in maternal mortality was not driven by lack of access to health care, since access has not increased. Moreover, it completely undermines that claims of natural childbirth advocates like Ina May Gaskin that the rising rates of C-sections and interventions have increased maternal mortality. The C-section rate, and presumably the rate of interventions, has continued to rise while maternal mortality has dropped.

Of course we have known all along that the bulk of the apparent “increase” in maternal mortality represents enhanced data collection, not a change in maternal deaths. Death certificates were revised in 1999 and in 2003 in order to more clearly establish which female deaths were maternal deaths. Prior to those modifications public health experts estimated that a significant proportion of maternal deaths were left uncounted because state documents did not require specifying the relationship of death to any recent pregnancy. The deaths were recorded, but the fact that they may have been associated with pregnancy were not. That’s why I’ve made the line for mortality rate discontinuous.

Could we decrease maternal mortality even further? Almost certainly. The latest statistics do not obviate the need to find ways to reduce maternal mortality. However, successfully reducing maternal mortality involves addressing the real causes. Based on the available data, neither access nor intervention rates appears to be the cause.

Advocates insist that homebirth is safe, but they don’t want anyone to look too closely. Hence the effort to resist coroner’s investigations by claiming that the a baby who dies during homebirth is not a person and therefore its death is not worthy of evaluation

The latest homebirth advocate to make this argument is Australian midwife Lisa Barrett of Homebirth: A Midwife Mutiny. Lisa is a vociferous opponent of Australia’s attempts to regulate homebirth, claiming that women have a “right” to give birth at home. What about the rights of babies injured or killed by homebirth? Apparently they don’t have any rights if the midwife can convince everyone that the baby was born dead.

The case is the typical homebirth tragedy, the kind that demonstrates that “trusting birth” is no substitute for emergency personnel and equipment. According to ABC News:

A coronial inquest has started into a home birth, but the coroner must first determine if the baby was alive.

The inquest heard Tate Spencer-Koch had a partial water birth at her parents’ home in 2007 but died from complications after getting stuck during the delivery.

Deputy South Australian Coroner Anthony Schapel must first determine if the baby was alive at birth and therefore a person under the law, before any full inquest can be held.

The court was told there had to be some sign of life, such as a heartbeat or a breath, once the birthing was completed.

All the ingredients for the typical “trust birth” fatality were present:

homebirth: check

birth pool: check

shoulder dystocia: check

midwife who didn’t anticipate the complication: check

absence of anyone skilled in expert resuscitation: check

Midwife Lisa Barret is claiming that the death should not be a coroner’s case because she was so inept at resolving the shoulder dystocia (40 minutes until delivery of the shoulders) that the baby died before the entire body was born. And because she was incapable of saving the life of an otherwise healthy baby, as opposed to merely rendering it brain damaged, she should escape investigation A news story explains:

… Common law holds a baby is alive, and therefore legally a person, if it has been “fully extruded” from its mother and breathes independently.

A 2005 NSW decision extended that definition to include babies who display a heartbeat or are breathing due to medical intervention.

This week, Mr Schapel was told Tate’s head was birthed 40 minutes before the rest of her body. Midwife Lisa Barrett said Tate never drew breath …

Unfortunately for Barrett, the paramedic reports that the baby did show signs of life:

… paramedic Alice Rowlands said officers detected electrical heart rhythms but no pulse.

Yesterday, Amay Cacas, counsel assisting the Coroner, said those rhythms were enough to justify an inquest.

“We have a fully-developed baby, a mother going into labour naturally and, right up until the head crowns, a good heartbeat,” she said. “Then, 40 minutes later, we have a completely unresponsive child with only the electrical rhythm.

“That rhythm means there is a possibility a heartbeat was present upon full extrusion, albeit weak or slow.”

The coroner accepted that argument:

South Australia’s Deputy Coroner will proceed with an inquest into a baby’s death during a home birth.

He has ruled the child was alive when she was delivered. Deputy Coroner Anthony Schapel ruled there was no evidence that the newborn took a breath or had a mechanical heartbeat when she was born.

But he ruled that electrical activity detected in her heart by ambulance workers after the delivery could be considered “the last vestige of her human existence”.

There are good reasons why a stillbirth should not be investigated in the same way as a neonatal death. However, that should not allow homebirth midwives to escape investigation simply because their mismanagement was so extensive that the baby died instead of being born alive and brain damaged.

In this case, the issue was mooted by the revelation that the paramedic found objective evidence that the baby was briefly alive after the body was born, but similar claims have been made in other homebirth deaths. The law should be amended to require investigation into any homebirth death that occurs in a baby with a normal fetal heart rate at the onset of labor. Otherwise, the more egregious the mismanagement by the homebirth midwife, then less likely it is that the mismanagement will be acknowledged and remedied.

I’m happy to report that transplant surgeon Dr. Tom Diflo, my college and medical school classmate, was found not liable for malpractice. I’m outraged to report that after the trial was over, the plaintiff’s lawyer admitted that he had known all along that Dr. Diflo was not guilty of the charges he filed against him.

The case was a medical tragedy (Man dies of uterine cancer; who’s to blame?). Kenneth Liew had been on dialysis for years before he received a kidney transplant in 2002. The kidney came from a woman who had died of a stroke. Unfortunately, unbeknownst to her and everyone else, she also had uterine cancer. Seven months after the surgery, Mr. Liew died.

In an interview with the New York Daily News, the plaintiff’s lawyer, Daniel Buttafuoco, seeking to explain his loss of the case, made the outrageous claim:

Dr. Diflo had no idea the organ was bad … We were forced to try a case against the most innocent guy of all.

Parse those sentences and you will come face to face with what is wrong with the malpractice system in this country.

“the most innocent guy of all”

Buttafuoco acknowledges that he knew that Dr. Diflo had not been responsible for the tragedy because the doctor could not have known that that the organ was defective. The widow and her lawyers mounted a legal case that lasted eight years and surely cost hundreds of thousands of dollars for no better reason than because they could. It certainly was not because they believed Dr. Diflo was to blame; they knew all along that he couldn’t possibly be to blame. Nonetheless, they went before a jury and offered testimony that they knew to be untrue.

In other words cases of medical malpractice are knowingly filed against doctors who haven’t committed malpractice. It’s like a lottery ticket; you file suit and hope you’ll strike it big. Just the luck of the draw for the lawyer and the client; too bad for the doctor who just wasted eight years of his life in fighting the claim.

“we were forced to try a case”

No, no one forced Mrs. Liew to sue, and no one forced Buttafuoco to file the case. Indeed, ethically, Buttafuoco was obligated to refrain from filing because he knew the accusations to be untrue. So why do they feel they were “forced”? That speaks to the prevailing view of bad outcomes and the purposes of malpractice suits.

Americans seem to believe that when something bad happens, it must be someone’s fault. Nothing is ever attributed to bad luck. Blame must be pinned on someone, or, more accurately, on someone else. Although it was well documented that Mr. Liew made the decision to keep the kidney, his widow and her lawyer argued that Dr. Diflo should have pressured him to have the kidney removed. But a bedrock principle of informed consent is that the patient should NOT be pressured into any course of action. The patient should be offered all available information and left to make his own decision. No matter; someone else must be blamed.

It’s not enough merely to blame someone. They must be forced to pay millions of dollars. The progression of thought appears to be: something bad happened to me (in this case Mrs. Liew lost her husband); it was someone else’s fault; I deserve lots of money for no other reason than because something bad happened.

“We were forced to try a case against the most innocent guy of all.”

The determination of whom to sue had nothing to do with guilt or innocence. It was all about who had a “deep pocket” that could potentially yield millions. The lawyer didn’t sue Dr. Diflo because he did something wrong. He sued him because he had insurance that could potentially pay millions.

Indeed, the fact that Dr. Diflo had done nothing wrong probably figured into his calculations. He might have thought that he could get a quick settlement simply based on “nuisance value.” The insurance company might calculate that it was worth paying him and his client a hundred thousand dollars rather than spend many hundreds of thousands of dollars on a suit that they would ultimately win. The lawyer guessed wrong in this case, but many other lawyers have made quick money by accepting a settlement to make a case go away.

Is it any wonder than that doctors condemn the current medical malpractice system? Doctors get sued when they haven’t done anything wrong because patients believe that if something bad happens, someone must pay them money. Doctors get sued when they haven’t done anything wrong because the doctor has insurance that could pay millions. Doctors get sued when they haven’t done anything wrong because patients can make easy money if the insurance company settles because it is cheaper to settle than to defend a doctor who hasn’t done anything wrong.

It’s no wonder that most medical malpractice suits end in a judgment for the doctor. Medical malpractice suits are often filed against doctors who have done nothing wrong. Fortunately, juries, like the jury in this tragic case, can see that.

Why do they even publish these papers?

The June issue of Obstetrics and Gynecology leads with a paper entitled Vaginal Birth After Cesarean: New Insights on Maternal and Neonatal Outcomes. VBAC is currently an extremely controversial topic within obstetrics. The issue is whether an attempted vaginal birth after Cesarean poses greater risk to mothers and babies that a planned repeat C-section. VBAC is known to increase the risk of rupture of the uterus, a catastrophic complication that can lead to death of the baby, massive maternal bleeding, hysterectomy and even maternal death.

How would we study the relative safety of the two choices? We’d need to compare the mortality and morbidity of women who intended to have a vaginal birth after C-section with those women who intended to have a planned repeat C-section. In other words, the study groups should be based on intention to treat, not the eventual mode of delivery. This is an absolutely critical requirement. That’s because women who have a uterine rupture during attempted vaginal delivery after C-section are almost invariably delivered by C-section in order to save their babies’ lives and their lives. If the groups were based on ultimate mode of delivery, all the uterine ruptures and all the associated complications would end up in the C-section group, and not the attempted VBAC group.

So what did the investigators do:

All studies on maternal and neonatal outcomes reported on actual route of delivery rather than intended route.

In other words, the results of the study are USELESS for answering whether attempted VBAC or planned C-section is the safer mode of delivery. The study does NOT compare women who attempted a VBAC with women who chose planned C-section. It compares women who had a SUCCESSFUL VBAC with women who had chose a planned C-section PLUS women who had a C-section because they couldn’t deliver vaginally or because they had a serious complication like uterine rupture.

The authors then proceed to detail their useless results. Not surprisingly, since the women who experienced complications during attempted VBAC were included in the C-section group instead of the VBAC group, the risk of maternal mortality was elevated in the C-section group. Both perinatal and neonatal death rates were increased in the VBAC group possibly reflecting the fact that C-section is generally safer for babies.

In contrast, the studies that looked at uterine ruptures and classified patients according to intended mode of delivery demonstrated clear superiority of planned repeat C-section.

Uterine rupture is a potentially life-threatening complication that has been directly attributed to VBAC. By itself, uterine rupture is a visible or palpable anatomic finding rather than a health outcome. However, its association with perinatal and maternal morbidity and mortality raises substantial concerns among patients, clinicians, hospitals, and policy makers… Four studies reported uterine rupture outcomes for both trial of labor and elective repeat cesarean delivery. Among these four studies totaling 47,202 patients, there were 154 uterine ruptures; 96% (n=148) of which were incurred by the trial of labor group… The risk of uterine rupture in the trial of labor and elective repeat cesarean delivery group was 0.47% (95% CI 0.28–0.77%), and 0.026% (95% CI 0.009–0.082%), respectively, with trial of labor group having a significantly higher risk of uterine rupture (RR 20.74, 95% CI 9.77–44.02, P<.001).

The authors conclude:

One of the major findings of this report is that the best evidence suggests that VBAC is a reasonable and safe choice for the majority of women with a prior cesarean.

However, the report shows nothing or the kind because the wrong groups are compared. The authors acknowledge:

Importantly, studies of VBAC compared with elective repeat cesarean delivery have traditionally reported outcomes based on actual route of delivery rather than intended route, leading to misclassification of patients who intend elective repeat cesarean delivery but go into labor before their cesarean or women who intended trial of labor but who are delivered by cesarean.

Not only is this an important point, it is a critical point because it means that the studies cannot tell us how attempting a VBAC compares with a planned repeat C-section, the one thing that we most wish to know. So this study, designed to determine the safety of VBAC when compared to planned repeat C-section tells us nothing about the safety of VBAC when compared to planned repeat C-section.

Dr. Biter has resurfaced and he’s asking for money:

Dr. Biter has resigned from Scripps Encinitas with full OB, gynecological & surgical privileges! At this time, he still has the ability to do full inpatient & outpatient gynecological care & see patients for prenatal visits with a plan for individualized care…

Sure he got his privileges back … as a condition of his immediate resignation. Who benefited from this? Dr. Biter, of course, by avoiding a Board of Medicine investigation into the events leading up to the suspension of privileges including the 6 pending malpractice suits.

The great man has a message for his supporters:

I am happy to say that I still am able to do 100% of my gynecological practice (see below for a complete list). As far as my OB practice goes, my staff & I are currently arranging the schedule only for pregnant women at this time. In many OB practices, a doctor sees a patient at some visits and a stranger delivers. You know that I do not practice that way. Everything that I have done has kept you, my patients, as first priority. This has cost me hospital privileges that I rightfully won back, a lot of money, and even more nights of lost sleep. I don’t know what to say to reassure you other than that. My commitment to you has never been up in the air. My refusal to allow your birth to be a political or financial deal has put me into this unwanted situation, but you and your baby are worth it. Ours is a huge trust of faith….keep the faith. Birth matters.

In other words, Dr. Biter has not been able to get privileges at any hospital. Possibly, Dr. Biter can no longer practice obstetrics at all, because his malpractice carrier refuses to cover him (OB and GYN coverage are separate) or is demanding an exorbitant fee since he has 6 pending lawsuits.

Dr. Biter details the services he will provide:

Full prenatal care with individualized delivery plans available

Gynecological Services:

1. Annual Pap Smear

2. Sexually Transmitted Disease Screening and Treatment

3. Breast Health

4. Treatment of Abnormal Pap Smears Including: Leep, Colposcopy, and Biopsies

5. Minimally Invasive Hysterectomies

6. Hysteroscopies to Evaluate Uterine Lining or Polyps

7. Adolescent Health

8. Ultrasounds for Pain, Abnormal Bleeding, and/or Ovarian Screening

9. Prenatal Ultrasounds for Home Birthers

10. Rectal Prolapse Reconstruction

11. Pelvic Prolapse Reconstruction

12. Vaginal Support Reconstruction

13. 3D/4D Ultrasounds

14. Surgical and Non-surgical Treatment of Abnormal Bleeding

15. Surgical and Non-surgical Treatment of Urinary Incontinence

Gynecological surgeries will be performed by Dr. Biter at Carlsbad Surgery Center located at …

Simply put, Dr. Biter offers prenatal visits, but cannot deliver your baby. He also offers routine GYN care and minor surgeries that can be performed at a surgi-center, but no major surgery.

But Dr. Biter wants your money. He wants it so badly that he hasn’t even bothered to set up a tax free foundation before asking for it. He wants it so badly that you must send it directly to his bank account.

Help us keep the dream of Babies by the Sea Birthing Center and its mission alive and well. Here is how you can help:

1. Use the DONATE NOW PayPal link on this website to make donations to the Birthing Center Fund. At the present time this fund is not tax deductible. Dr. Biter is not managing this account. Any monies spent must be approved by an independent Board of Directors. A 2.9% charge will be taken out of the donation if credit cards or debit cards are used on PayPal.

2. If you prefer to send checks please make payable to Robert Biter, MD and send to …

3. Deposits can also be made at any Chase Bank location. The account number is …

No one should be fooled; the chances that this birth center will open are slim since Dr. Biter must obtain obstetric privileges at a hospital and he must obtain obstetric malpractice insurance. If you donate money, Dr. Biter will be free to keep it whether he ever opens the birth center or not.

Dr. Biter, you should be ashamed. You have made fools of these women by encouraging them to protest on your behalf while withholding information about your malpractice history. Now you are trying to get these women to donate their money to YOU (you haven’t set up a tax free foundation) and there is a very real chance that you will never practice obstetrics in California again.

May you never be an interesting case.

That’s a cautionary proverb familiar to medical professionals. While it’s bad to get sick, it’s much worse to get sick with something uncommon or unusual. The more fascinating a case is for doctors, the more difficult it is for patients. Difficult to diagnose, difficult to treat, and often difficult to survive.

Kenneth Liew was doubly unfortunate. He was an interesting medical case and an interesting legal case. Now he’s dead and a jury is currently deliberating who, if anyone, is at fault.

Kenneth Liew was really, really unlucky. He was unlucky because he had serious kidney disease that necessitated debilitating dialysis treatments three times each week. He was unlucky because it took 10 years for a matching kidney to be found to give him in transplant. He was unlucky because after he received his kidney and after it was working well, an autopsy revealed that the kidney came from a woman who, though she died of a stroke, had unknowingly had uterine cancer as well. He was unlucky because there is not a single case like his in the whole world, so no one knew the odds that the cancer would be transmitted. He was unlucky because he died of cancer only seven months after receiving the transplant.

Despite being exhorted by her dying husband to forgive the doctor, Mr. Liew’s widow ignored his wishes and sued just about everyone she could think of including the doctor and New York University Medical Center where the transplant occurred. Eight years after Mr. Liew died, the jury has finally received the case.

First and foremost, this case has been a nightmare for Mr. Liew and his family. But secondarily, this case also represents a doctor’s worst nightmare. The doctor, transplant surgeon Thomas Diflo, lost a patient through a freak accident that no one could have known about or predicted and now he’s being blamed. I would feel sympathy for the doctor no matter what, but I am especially saddened because the doctor was one of my classmates in medical school.

Mrs. Liew is sure that somebody is to blame for something and that she deserves $3 million dollars in compensation, but it is not clear who is to blame or what they are to blame for:

·         Did anyone know of the donor’s uterine cancer? Both sides agree that no one knew or could have known that the donor had uterine cancer.
·         Was the patient informed that the donor had cancer? Both sides agree that the transplant surgeon informed the donor approximately 2 months after the he received the kidney.
·         Should the kidney have been removed immediately thereafter? Both sides acknowledge that there was no way to predict the chances of Mr. Liew developing metastatic uterine cancer. There had literally never been a similar case in the history of medicine. Therefore, the doctor left the decision up to the patient, advising him that based upon what is known about transplants and cancer and based upon the fact that uterine cancer does not metastasize to the kidney, the chance that Mr. Liew would develop metastatic uterine cancer was low. Mr. Liew’s widow argues that the doctor should have advised that the kidney be removed immediately.
·         Would removal of the kidney have made any difference? It’s unlikely. Whatever was transmitted to Mr. Liew from the donor kidney had already been transmitted.
·         What caused Mr. Liew’s death? That’s not clear. Mr. Liew died of cancer, but the metastatic cancer was so poorly differentiated that no one can tell what type of organ it came from originally. It could have been uterine cancer transmitted by the kidney, but it also could have been cancer that developed spontaneously in Mr. Liew.
So if no one could have known about the uterine cancer in advance, if removing the kidney would not have made a difference and if it is not completely clear what kind of cancer killed Mr. Liew, why are Dr. Diflo and NYU being sued? They are being sued because something bad happened and someone must be blamed. It wasn’t anyone’s fault; no one did anything wrong, but you can’t get any compensation for bad luck. Therefore someone, anyone, must be blamed and must be made to pay.

The jury has the case now, and within a few days we will find out if they agree.

A new study being widely reported in the mainstream media has recommended delayed cord clamping. However, the authors acknowledge that there is no scientific evidence that delayed cord clamping provides any benefits for term infants; their recommendation is based on pure speculation.

The paper entitled Mankind’s first natural stem cell transplant appears in the Stem Cell Review Series of the Journal of Cellular and Molecular Medicine. The authors of the paper include the founder and chairman of Saneron CCEL Therapeutics, Inc. a company that harvests stem cells from umbilical cord blood to use in developing new treatments for neurodegenerative and other diseases. It appears that the primary purpose of the paper is to demonstrate that cord blood collection for banking or research does not require immediate clamping of the umbilical cord.

The authors acknowledge that there is no demonstrated benefit to delayed cord clamping in term infants. While some studies show a reduced incidence of anemia in the first 6 months of life, this is only clinically important in developing countries where anemia is common in infants and children. The authors focus instead on potential benefits of transferring additional stem cells from the umbilical cord blood to the baby’s bloodstream.

The authors make much of the fact that delayed cord clamping leads to the baby’s “first stem cell transplant.”

… autologous transplantation of stem cells naturally occurs in nature at birth in mammals via the umbilical cord. A delay in the cord blood clamping may increase the stem cell supply to the baby, thereby allowing an innate stem cell therapy that can promote acute benefits in the case of neonatal disease, as well as long-term benefits against age-related diseases….

Yet the authors don’t provide any reason why a term baby has any need of or derives any benefit from a stem cell transplant. There is no scientific evidence that early cord clamping leads to a deficit of stem cells in the neonate or that delayed cord clamping has any impact on any neonatal system dependent on stem cells. The purported benefits are all entirely theoretical.

As any doctor knows, the history of medicine is littered with ideas that seemed to be great in theory, but surprisingly turned out to be dangerous in fact. Consider the use of 100% oxygen in the first incubators of the 1930’s. Reasoning that if some oxygen is good, more must be better, premature infants having difficulty breathing were treated with pure oxygen. It may have been better from a respiratory point of view, but it unexpectedly rendered many of the infants blind. That’s because the sensitive tissues of the retina develop best in a low oxygen environment, but no one knew this until they learned of the damage that resulted from exposure to 100% oxygen.

The reasoning behind delayed cord clamping is the same: adequate red blood cells are good, more must be better; adequate umbilical stem cells are good, more must be better. But we really don’t know whether either of those claims are true. As the authors acknowledge:

One important point to consider is the long-term effects of delayed cord clamping. The present authors are unaware of any studies in either animals or human beings that followed the organism to adulthood. In human beings the longest studies go to 6–7 months and some benefits can still be observed with respect to iron status and motor disability. It is crucial to perform long-term follow-up studies to determine whether the reported benefits of delayed cord clamping are long term, or whether additional benefits may become apparent.

It never even occurs to the authors to investigate whether there might be harms from delayed cord clamping. After all, some umbilical cord blood is good, more must be better, right? Wrong. Without studying the matter we have no idea of the long term benefits or risks. It is irresponsible to recommend delayed clamping as the standard until we have scientific evidence that it provides benefits without leading to unexpected harms.

Over the last few years, the public has been treated to the spectacle of prominent politicians facing serious allegations staging photo ops with a supportive wife at their side, such as the one of the former New Jersey governor and his wife above. And at many such photo ops, the wife is acting as enabler. She stands at the politician’s side implying that she believes his denial (of an affair or a visit to a prostitute or similar behavior) even though she knows or ought to know that he is not telling the whole truth.

Perhaps she truly doesn’t know; or maybe she knows but believes she is saving the marriage; or maybe she knows but is as invested in saving the political career as he is. In any case, she is an enabler in her own humiliation, standing before the public and pretending that the fact that she was betrayed is untrue or irrelevant, as if her feelings don’t matter, as if her job is to support her husband right or wrong.

Evidently that phenomenon is not restricted to marriages. NCB advocates seems to have no trouble standing by the side of the various “Dr. Wonderfuls” supporting them as if their deeds don’t matter, and as if it the job of the “little woman” to always support the man.

Witness Rixa Freeze’s outrageous claim after learning that Dr. Stuart Fischbein had been convicted of sexual exploitation of a patient (in the comments section of Another Dr. Wonderful needs your help!):

Regarding the controversy about the consensual sex issue: I see it as irrelevant to the issue at hand. Dr. F’s regrettable mistake in the past is being used as classic ad hominem and red herring arguments. It’s a way of distracting people away from the real issue at hand (women’s right to choose VBAC or vaginal breech birth, and physician’s right to support them in those choices) by attacking Dr. F’s character.

The conviction of sexual exploitation of a patient is irrelevant when determining whether other women should support this doctor? Only if you believe that turning a blind eye is an appropriate stance.

Barb Herrera, Navelgazing Midwife, has just written an astounding post that sets a new standard in enabling a “Dr. Wonderful”. You can read the piece here. Barb acknowledges that Dr. Biter is currently facing 6 malpractice lawsuits; she confirms that Dr. Biter was reinstated only so that he could resign and avoid the consequences of a suspension; she glosses over the fact that Dr. Biter, her friend and colleague, never bothered to tell her about those lawsuits or the truth about the reasons for his suspension; she proudly declares that Dr. Biter is giving his approval to what she writes on his behalf. And then … she ignores that information in order to continue to support the man that just abetted her public humiliation.

Several days ago, Barb wrote a long post in support of Dr. Biter which alleged a giant hospital conspiracy to get rid of Dr. Biter because he is “unconventional” and “non-conforming” in his support of natural childbirth. Barb had absolutely no idea whether her claims were true; she provided no facts to support her claims and obviously she was unaware of the actual facts of the case. In light of the information she has learned in the last few days, Barb now writes … EXACTLY THE SAME THING.

Oh, wait, not exactly the same thing. Yes she repeats the unsubstantiated claims of an elaborate conspiracy to remove Dr. Biter, but now she includes the deal apparently struck by Dr. Biter so that he could avoid further investigation and blames … THE HOSPITAL. Barb twists herself into a pretzel to generate this mind boggling conclusion:

… If Dr. Biter did something egregious… something dangerous… why didn’t Scripps Encinitas revoke his privileges and throw him to the dogs (the Medical Board)? In fact, it’s been brought up that Scripps Encinitas is named in four of the six Biter lawsuits out there (and remember, a suit does not infer guilt!) and if Scripps Encinitas’ lawyers felt that Dr. Biter was negligent, isn’t it negligent of them to “let him go?” It is because of this that I believe he did nothing illegal or outright dangerous, but that they had a philosophical (and financial?!) issue with his being there…

So let me see if I get this straight: the hospital is “negligent” if it let Dr. Biter weasel out of a more thorough investigation of his competence to practice obstetrics. But the hospital couldn’t be “negligent” so that must mean that Dr. Biter is competent and his suspension was a giant conspiracy to punish his practice style.

Barb starts with a fixed conclusion and fabricates backward from there. The fixed conclusion is that her Dr. Wonderful is worthy of her adulation, and anything else is unthinkable. Dr. Biter couldn’t have struck a deal to escape further investigation because … well because he just couldn’t have done so. Yes, he let her speak on his behalf without warning her that there were critical facts that she didn’t know, but that’s okay. The facts are irrelevant when the great man needs support.

Barb ends with another dollop of the gushing adulation that she’s been displaying all along:

He’s thanking me for my support, letting me know I am saying the right things, defending him appropriately and reminding me of the variation in the standards of care between providers while remaining within ACOG Guidelines. Dr. Biter is hardly alone, this Doctor-as-Renegade persona.

If that’s not enabling, I don’t know what is.

Dr. Robert Biter, an obstetrician at Scripps-Encinitas, recently resigned within hours of having his OB privileges restored, thereby avoiding a Board of Medicine investigation into his practice. Dr. Biter has been less than forthcoming about the circumstances surrounding his suspension (he failed to inform his supporters about the 6 pending lawsuits that have been filed against him in the past 5 years). In investigating Dr. Biter’s background, I have come across repeated mentions of the charities that he has started.

Dr. Biter’s boutique, Babies by the Sea, proudly claim to donate revenue to two charitable organizations:

Babies by the Sea Boutique will donate a portion of net revenue to non-profit organizations developed by Dr. Robert Biter called Her Hearts Wish and Seaside Giving. Her Heart’s Wish is a national organization dedicated to granting the wishes of women facing terminal illness. Seaside Giving provides medical care to pregnant women who cannot afford medical services.

Over the years, Dr. Biter repeatedly mentioned his involvement in Her Heart’s Wish such as in this 2005 profile of Dr. Biter by San Diego Magazine:

Six years ago, Biter was completing his residency at Penn State Hershey Medical Center when he met Beth, a young mother dying of ovarian cancer. After coming to terms with her condition, Beth expressed two final wishes: to bake cookies with her children one last time and take a weekend trip with her husband. Biter mobilized other residents and nurses to make Beth’s wishes a reality just days before her death. But before she died, Beth revealed another wish: for other terminally ill women to enjoy the same opportunity to fulfill one last desire of the heart.

In 1999, Biter founded Her Heart’s Wish, a charitable organization that has granted hundreds of wishes in nearly all 50 states…

As far as I can determine, neither of Dr. Biter’s charities currently exist.

Her Heart’s Wish was a Pennsylvania non-profit organization that granted wishes to dying women. It was established in 1999 and is officially located in Hershey, PA. It maintained a website and was mentioned in a variety of print and web publications. Dr. Biter may have been a founder, but according to the patient Beth’s husband, HE founded the organization:

Shortly after Beth’s passing, Jim rolled up his sleeves and spent the next two years creating an organization that would grant last wishes to other women. Navigating his way through the difficult legal and tax aspects involved in establishing a non-profit organization, he never gave up. Finally, in 2001, he launched Her Heart’s Wish, which in the following years has grown from a regional to a national wish-giving organization for women over 18.

The website went off line in late 2008 and the charity appears to exist no longer. Nonetheless, Dr. Biter continues to solicit donations for Her Heart’s Wish now located at a residential address in Encinitas, CA.

How about Seaside Giving? As far as I can determine from public records, there is no charitable organization registered in California under the name Seaside Giving and there has never been such an organization. There is no website, no list of beneficiaries, indeed no mention of it anywhere except on Dr. Biter’s own website.

It appears that Dr. Biter is soliciting funds for two charities that don’t exist. Of course,I’m not expert in researching charitable organizations, and it is possible that I overlooked sources of information. So I would welcome everyone’s help in finding information that would demonstrate that Dr. Biter’s charities are real, and are dispersing funds to needy individuals.