It seems patients of Dr. Robert Biter's are everywhere here in North County San Diego. For a long time now, I've enjoyed playing the game of mentioning him when I meet one and just buttoning my lips to listen to the glowing stories that come back to me. Such tales were echoed over and over in comments on my recent post, "Why I'm Protesting for my Natural-birth Friendly OB."
The post chronicled the buzz over the recent suspension, reinstatement and resignation of popular OB, Dr. Robert Biter, from San Diego's Scripps Encinitas hospital last month, and the hundreds of people who showed up at local rallies in his support. Even though this piece portrays individual stories -- mine with Dr. Biter and his with a contentious hospital -- I'm glad to see the attention Huffington Post readers are giving it for the larger issues at play.
Dr. Biter was cleared of any wrong doing under a peer review panel and the California Medical Board declined any sanctions against him. But further facts pertaining to his difficulties with Scripps have not yet come to light. Given the continued silence of both parties, it's not clear what legal proceedings may still be underway. Regardless, his enormous, continued support in my community says a lot about what many women want as health care consumers today.
A central aspect of Dr. Biter's popularity seems to be his unique ability to incorporate much of the midwife's model of care (not the medical model), where birth is seen as a normal process. Like a midwife, he puts in endless hours to stay very present in a labor, however lengthy, and tailors the care to maximize a woman's innate ability to birth her baby without interventions. This prompted Barbara Herrera, local midwife and author of the blog, Navelgazing Midwife, to call him "an OB in midwife's clothing."
"Dr. Biter was willing to take the time to let my body follow its natural process," says Sacha Volek, 37, of Cardiff CA. "I certainly hope Dr. Biter is able to get his birth center built soon, so that other families can have such a positive experience with their births." Lori Shompe, 31, of Carlsbad CA says, "I too had a life-changing birth with Dr Biter. There is nothing more empowering then proving that your body is in fact perfect."
Over the years I've met more than one patient in Dr. Biter's crowded waiting room who has driven hours just to see him. They make one thing clear, Dr. Biter does things differently than most. In addition to being more sincere and caring than some of our past doctors, he has extremely low rates for interventions like labor induction/acceleration drugs or c-sections. He also encourages women to move around during labor, as desired, to help the baby move down and out of her pelvis.
By way of contrast, in the U.S. today, labor is medically induced or augmented 80 percent of the time in hospital births, versus. 9.5 percent in 1991 (Martin and associates, 2009). The use of an Electronic Fetal Monitor throughout labor has also steadily risen since its invention in the 1970s to the current rate of 75 percent, though women continuously hooked up to one cannot move around freely while laboring. And one in three women now have cesarean births, up from 1965 when it was the 4.5 percent that the World Health Organization still recommends.
Perhaps you are asking if Dr. Biter's way is less safe than the norm these numbers reflect. Statistics do not support this. Even though we birth with OBs over 90 percent of the time in the U.S. (as compared to less than 30 percent in Europe and Japan where midwives are used for the majority of uncomplicated pregnancies), we still have the second worst newborn mortality rate of any developing nation and our maternal mortality rate has doubled in the last 25 years.
Of course, there are plenty of women who aren't interested in a more natural birthing experience and options are abundant for them. But a real number of others are clearly starved for an OB who allows her to take her time in labor and resists the urge to intervene unless there is a genuine complication.
Like me, these women may want the option of having an epidural, or other medical tools available at their birth. But many of them don't feel their freedom of choice is respected once they walk through a hospital's doors.
Consider the story of Emily Behrman of Solana Beach, CA, who says she wanted to try to avoid an epidural if the pain of labor turned out to be manageable because she was aware of research showing early epidurals have been linked to increased rates of caesareans. "It was an absolute challenge to keep my ground and not get persuaded into getting an epidural when I delivered my first of two babies in San Diego," she said.
Or that of Huffington Post commenter 'Mybabysmommy' who wrote, "I had to actually FIGHT (during my unmedicated labor) my first OBGYN to deliver my first child the way I wanted to. He tried to give me pitocin, was super frustrated with me pushing for two hours..."
On the flip side, a birth that allows a woman to take her time and listen to her own body can be one of the most empowering and defining experiences of her life. I know that during my second birth with Dr. Biter there were many points at which I was given the time and space to ask my body what it needed and let that dictate what came next.
At one point, I lay down for a while and found that from that prone position my contractions became so light they almost stopped. The relief was heaven. But then I wondered, what is my goal here? Do I want relief or do I want to get things moving? Your body knows what to do, came the answer. And I knew: my goal was to get things going and have a baby. I sat up and moved onto a yoga ball and the pain came back with a vengeance. But within an hour, I was in transition and could soon tell it was time to push my baby out without someone ever needing to tell me. This is an experience I can draw on again and again in life because it affirmed that my body comes equipped with its own wisdom and this intuition is a very powerful, self-preserving force.
Even though stories like these abound, I have never assumed they mean doctors and nurses who behave differently from Dr. Biter don't want the very best for their patients in labor and delivery. Nor am I trying to convince anyone to go to Dr. Biter or support him in any way. He's already got a booming business, despite recent events. But I do wonder why more doctors don't offer a way of birthing with fewer medical interventions, when a doctor who does, like Dr. Biter, has such a groundswell of support?
As I've said, Dr. Biter's overwhelming popularity is just one story. But I wonder, if more doctors were willing to stay present with a woman in birth and allow her labor to move at its own pace, would they too have a packed waiting room and hundreds of picketers clambering to support their mission? If word of mouth has any place in medicine today, then Dr. Biter's success might just be a lesson to OB's everywhere: start respecting a woman's right to choose the kind of birth that's right for her, or lose your business to someone who will.
Follow Abi Cotler O'Roarty on Twitter: www.twitter.com/ACotlerOroarty
Ah well, on to the next unfortunate obstetrical practitioner who dares to do things differently. Peer pressure is a powerful tool. When I was in sixth grade, it was called "bullying."
No one disagrees with having the perfect birth and I agree with Abi on most things, just not on her support of Dr. Biter.
As for the issue at hand, all of these suits are gynecological, not OB and I still differ with you on one major point: how, in this litigious society in which we live, does a lawsuit filed mean there was harm done? Even suspected criminals are innocent until proven guilty and they have charges brought by actual criminologists, not average citizens who may be looking for money or other forms of solace. Also, it is true that Obgyns have the highest rate of lawsuits of any specialty and it keeps going up. Somehow, we have been convinced that if everything does not go exactly right in a birth, it isomeone's fault.. This engenders a great deal of defensive medicine on the part of docs and hurts women's right to choose the kind of birth they want in the process. I keep thinking of a doctor interviewed in the movie, "The Business of Being Born," who says she was taught by a superior while in residency to just cut when in doubt cause they can't sue you if you do a c-section. Sad for all of us, the docs, the moms-- everyone but the hospital owners and insurance comapnies, really.
Health Decisions.
It is quite clear what legal proceeding are underway. According to the records of the San Diego County Courts (which are available on the web), Dr. Biter is currently facing 6 malpractice suits that have been filed in the past 5 years. That's double the number of malpractice suits the average California obstetrician faces in a lifetime.
In addition, Dr. Biter has been unable to obtain obstetric privileges at any other California hospital.
"Dr. Biter was cleared of any wrong doing under a peer review panel."
No peer review panel cleared Dr. Biter of wrong doing. Dr. Biter apparently agreed to resign his position in exchange for the hospital not proceeding to the Board of Medicine with the charges. That's entirely different than being cleared.
The 6 malpractice suits have nothing to do with the suspension and they are for gynecological issues. He has not had any OB malpractice cases & that is what he was suspended for.
You're a "MD", so you should know that obtaining obstetric privileges takes a few months. It's not an automatic process.
How exactly do you know that "no peer review panel cleared Dr. Biter of any wrong doing"? Are you in contact with the hospital staff? Have you confirmed that with anyone or it is just speculation? You seem very quick to make assumptions. As a physician, you must know that if a Dr is suspended, a peer review is set up to finalize whether or not the Dr can be reinstated or if the suspension continues. Obviously, the peer review could find no fault on the part of Dr. Biter therefore, Scripps had to reinstate him. The reasons why Dr. Biter chose to resign haven't been revealed yet, but knowing how he treats his patients, the reasons must be sound.
It's interesting that you say he "agreed to resign his position in exchange for the hospital not proceeding to the Board of Medicine with the charges". Again, how are you aware of this info?
You might want to be careful what you post. Your statements could be found to be slander or libel.
Also it takes months to get on staff at a hospital so it is far too soon to tell, but it does look like Dr. Biter will have privileges at one of several local hospitals in the very near future.
Finally, if you have looked up lawsuits brought against him, you must know that they are all gynecological, not OB. Of course, you'd agree that in this country, having a lawsuit brought against you certainly indicates no wrong-doing.
For others interested in reading more about Dr. Amy and her views on natural childbirth, please feel free to visit her website http://skepticalob.blogspot.com/
Of course simply having a suit filed doesn't mean a physician is guilty of malpractice or professional negligence; Dr. Biter may simply be a statistical outlier. Whether or not the lawsuits have merit, and whether or not any of them were OB-related, I would be surprised if they played no part in Scripps' decision to institute a peer review. I would hope that if a hospital knew any physician had a significantly higher-than-average number of suits filed against him or her, they would start a peer review process. That's precisely why the protests against Scripps--which occurred before any outcome of the review was announced--were, in my opinion, utterly counterproductive from the standpoint of quality care concerns.
A deal to refrain from legally mandated 805 reporting would certainly have violated the statute in question had Dr. Biter's privileges been revoked or the suspension lasted more than 14 days. However, they were suspended and reinstated prior to the reporting deadline, vacating the requirement to report. This is not an uncommon method for skirting 805 reporting requirements (see http://www.medbd.ca.gov/publications/peer_review.pdf p. 80.)
The central paradox of intrapartum care is that inuries in childbirth cause gynecology 5-10 years later. We now know that it is injuries tp pelvic nerves that cause endometriosis, sdenomyosis and fibroids. We know the causes are difficult labors and that prolonged labor and prolonged second stages are key determinants - as are induced labor, forceps delivery, big babies, etc Willard Allen and Howard Masters knew all about it in 1955; Professor Sir Dugald Baird expressed the same view in 1957 - now we have some data.
Everyone contributes - doctors, midwives, mothers, babies - you cannot measure the outcomes in childbirth without providing a woman with the full information - not just C-section rates in labor but hysterectomy and incontinence surgery rates ten years later.
"Listening to your body" is great if everything is on your side. But women are not yet aware fo the consequences of the intrapartum choices that they make - I am not sure your article delivers that information which is the key to any such discussion.
better choices about their own care. Especially helpful would be
information on reducing harm-- which second stage positions are least
likely to lead to injury, for example, and do obstetricians support
women in choosing those positions?
In this piece I am not really referring to women with a difficult or prolonged labors/second stage, but normal labors that may be longer than average (which, by definitions half of normal labors would be). Also, I am not aware of the known risks of intervenive/cesarean surgery vs restorative surgery, which may be less invasive and not performed just as a new baby is coming home.
However, my concern is that obstetricians, at least in my area, don't seem to
be offering women the options they most want access to and the one who does has a level of popularity that would suggest a dearth in this arena.