If you wander the Net, mostly Facebook, especially with me, you’ve been following the saga of Dr. Robert Biter’s expulsion from San Diego’s Scripps Encinitas hospital. His obstetric privileges were removed on Friday, May 7, 2010. No one, not the hospital nor Dr. Biter has said why he was suspended. The hospital states confidentiality; Dr. Biter has been silent.
But, I have some ideas, have alluded to them, have spoken to the press about them and wanted to share them here. Rumors are a’flyin’ and it’s time they stopped. I do understand nothing will quash all the rumors except the truth, but I’m not sure when/if that’s going to come out anytime soon.
Therefore, in the meantime, you get to see/hear what the press is saying, sound bites from various acolytes and my thoughts on the whole thing.
I’ve written about Dr. Biter since June 2007 after attending the Garden Labor (where I first coined the moniker “Dr. Wonderful”). The posts continued with A Birth Unfolds in Photos and Words, one of the most viewed pieces I’ve ever done. One more, VBAC (with a whiff of pit), was also photographed and its story told. Those pieces demonstrate the wonders of natural birth in the hospital, that it can be done –with the right care provider and supportive nurses. That how the way he practices is so odd; it speaks volumes about his style. Over the last three years, women have disclosed other doctors around the country who seem to practice in much the same way. I’m thrilled to know there are more! However, there aren’t that many.
On May 14, 2010, there was a huge turn-out in front of Scripps Encinitas Hospital that included Ricki Lake and Anna Getty. There was a rally on Mother’s Day; My Best Birth gave an overview of the situation, families rotated through the week and then this big rally was the culmination of a loud outcry of his being fired. Some of the pre-rally media included this piece from CBS, the San Diego News Network, the formation of Bring Biter Back and the creation of this Petition to demand Dr. Biter’s re-instatement. Last Friday, we saw plenty of press. ABC, CBS, the Union-Tribune-SignOnSanDiego and the North County Times hung out with us for awhile, even talking to the one nurse from L&D who dared come outside to protest.
Plenty of love is given to Dr. Biter. His reputation is stellar. Or is it?
You can find a couple of so-so reviews on Yelp!, and there are dissenting views out in the community, but most hinge on the, sometimes, interminable time it can take to see him in the office. Once he is actually in front of you, you have his attention 100%. It’s the getting there that can be challenging.
Yelp! has removed other negative comments that I’ve read over the past couple of years. A common one was that he was too chummy, too huggy. His physical kindness is a hallmark in Dr. Biter’s care and is welcomed by those that adore him. I’d almost forgotten the snarky things people had to say about how he hugged them too much until a Biter Rally attendant ran into a couple of RNs that alluded to the reason behind his expulsion was because he was too “friendly” with his patients and their families. When she mentioned it on-line, the topic quickly blossomed into “I noticed his affection for his clients in the photos you took,” and “At first I was taken aback by how he touched the women in the pictures.” Upon examination, we were able to see the sexism in the equation, that if he were a female OB, it wouldn’t seem out-of-place at all. I countered that I don’t often see female OBs hugging their patients, either. But, I suggested we exchange his male OB-ness for a midwife and the “ah-ha!”s had the picture. It isn’t inappropriate for a care provider to hug a client, it’s just crazy bizarre to see an OB doing it!
In the photo spreads I’ve done, I noticed that I took the pictures because Dr. Biter was doing something so unusual, so beautifully different than every other obstetrician –and many of the midwives- I’ve worked with in my life. I went over the photos again and smiled at the love that man has for life. I look and remember every moment of the births with him. Dr. Biter is so present with his clients. No matter how tired he is, no matter how much he still has to get done, he is there with whomever is in front of him. And women/clients/families feel that kind of adoration. It is returned to him a million-fold.
I’d heard about this man, this Dr. Biter, before I went to a birth with him. I swear angels and twinkling hearts live around his name as it is said out loud. When I finally got to the birth with him, I know a part of me stood in the corner with my jaw hanging open. Who is this person? He went to medical school? He stayed with the client, he encouraged her, he breathed with her –he helped her through the rough parts until she eventually birthed her baby into her own hands.
Was this a fluke?
The next and the next and the next births were the same. Well, not the same same, but similar in their tenderness and respect. I had a mom who transferred in during a complication and Dr. Biter happened to be the Doc-in-the-Box. This mama needed a cesarean and it was clear she did, but it wasn’t a fly-down-the-hall-in-hysterics kind of cesarean. Dr. Biter was gentle with her, talked to her about what was going on, brought her a photograph of what the baby looked like inside and then we all talked about what the cesarean would entail. When the time came to go to the operating room, Dr. Biter said I phrase I have heard repeated with a couple more women –and heard he had said to other women as they were wheeled in on the gurney: “We’re not just having a cesarean, we’re going to have a birth.” I swear I swooned.
Dr. Biter welcomed me into the OR on three occasions. The anesthesiologist also said it was fine. Who refused my entry was the “circulating nurse” –the nurse responsible for the patient’s safety during the surgery. Interesting how she came to be in charge. In every other hospital for over two decades, it is the OB and the anesthesiologist who decide who goes in. Suddenly, the rules changed.
So, with all the great things this doctor seems to be doing (and has done), why would Scripps Encinitas Hospital want to push him out of their system? Wouldn’t you think other doctors would want to mimic his style so they, too, could be busy to overflowing? Wouldn’t you expect doctors to see what women are asking for and strive to fill it? Initially, it seems baffling. But, if we look at this from another angle, the point of view of the hospital and other OBs, it becomes clearer. And let’s not forget the lawyers, shall we?
From this vantage point, we see a doctor in a lone practice… a lone busy-as-all-get-out practice. The doctor does all of his own prenatals, GYN surgeries and sits with his “patients” during much of their labors. If they are VBACs, he is required to stay the entire time (per ACOG) in the hospital. How can one man possibly do all of this and be safe?
Keep looking through the angle of the medico-legal world.
Dr. Biter is known to take wide berths with, what is professionally called, Friedman’s Curve. In a nutshell, once women are in active labor (3-4 centimeters dilated), she should (red flag word right there… “should”) dilate one centimeter an hour. She should only push for two hours if this is her first baby, one hour if it is her second or subsequent. When the mass-utilization of the epidural came into effect, second stage (pushing) was extended to three hours for a first time mom and two hours for a second (plus) mom.
In the one week period during the protests, I heard woman after woman talk about how Dr. Biter never gave up on her, never having a time limit on how long she could labor/push, how triumphant they were because they knew if they’d had a different doctor, they would have had pitocin or a cesarean. That Dr. Biter believed they could birth, even if it took time, meant the world to these women. Besides the immense joy, the financial cost was greatly minimized by the births they had. The physical cost was infinitely less than a cesarean would have cost. The time healing, the time away from the family… even the time spent processing a cesarean… is miniscule compared to a surgical delivery.
But, doctors who are ingrained in the Friedman’s Curve (even though other docs have insisted it isn’t accurate) –and those that believe the Curve should be even faster with pitocin- probably see what Dr. Biter does as renegade. If he steps out of bounds with something as basic as the Friedman’s Curve, what else is he rocking the boat with?
Dr. Biter is meticulous with monitoring. Intermittent monitoring (although, with my VBAC clients, they have had continuous monitoring, as per ACOG protocols), either being listened to with a doppler or getting a strip every hour or so, has been shown, over and over again, to be just as effective as continuous monitoring and continuous monitoring restrains a woman much more than doing it intermittently. So, if the woman is being listened to periodically, that means she probably isn’t in the bed; she’s “wandering around” – a phrase I have heard many nurses use over the years. It is much easier to keep track of a woman in bed on monitors that worry about her “wandering around” the hospital (or even just her room). If mom isn’t in bed and wandering around, that means she most likely doesn’t have an IV pole being dragged behind her. She, most likely, has a saline lock, but not necessarily. (Are you counting the red flags most OBs would be seeing about now?)
By bucking convention, other doctors must be spinning in their office chairs and their hands on their heads screaming, “Horrors!” You see, to them, these things are risky (at best) and dangerous (at worst).
Cutting out all the crap, Dr. Biter surely looks like a lawsuit waiting to happen to them. I can pretty much bet they are scared witless that they will be sued should something untoward occur and they don’t have the “proof” that “everything that could have been done was done.”
Defensive medicine. At its worst.
After the NIH VBAC Conference a couple of months ago, it finally sunk in that many/most doctors do not make decisions based on what is best for mothers and babies, but what is best for themselves and their lawyers. To me, this is an abhorrent way to treat women and practice medicine. Sadly, it is the reality of our obstetric world today.
But, for those of us who believe decisions should be made based on a woman’s and baby’s unique set of circumstances, this defensive medicine mess needs to be tossed into the dung heap. It is time to stop cutting women because all the doctor can visualize is standing in a courtroom defending himself/herself.
Doctors are going to be sued; whether it is because they did something or because they didn’t do something. As was mentioned during the NIH Conference (and beyond), it is the mindset of luck, responsibility and fate that needs to be changed. Our court system needs to be changed. Tort reform must occur. Something else has to be done instead of cutting women out of fear of being sued.
Scripps Encinitas’ cesarean rate is 28.9%. That 28.9% sounds low is astonishing to me and the others who are now so used to numbers that high we almost yawn hearing them. But, 28.9% is twice as high as it should be! While I don’t know Dr. Biter’s specific statistics, I have heard rumors that it is 5-7%. Of course, I would love validation of that, plus know what his VBAC rate is; I wish California gave out the doc’s stats like some other states, do.
I’ve often called Dr. Biter a midwife in OB’s clothing. I can imagine this very description has been said as an epithet amongst other OBs. Obstetricians hold a special disdain for many midwives, especially homebirth midwives. That we have a great working relationship with him as we doula our clients or if we happen to get him during a transfer when he’s on-call is another twist in their knickers. I expect he gets a great deal of flack for even acknowledging our presence, much less interacting with us. I will be very, very sad if he is ever required to eliminate us from his professional life.
If we now pull back, far enough to cram the whole picture into a large frame, you can see how different this man is, how unconventional… even non-conforming… he is and how that, most certainly, makes other OBs (and lawyers!) squirm.
I hope that with all the love and prayer and power we are sending Dr. Biter, he is bolstering his resolve to remain one of the most progressive (in his old-fashioned way!) obstetricians in the country. We need him now more than ever.
This is why we are out there marching ever single day asking for his reinstatement. He is worth every ounce of energy.
Dr. Robert Biter with Alisa while she labors, monitored, in the garden. She VBAC'd a couple of hours later.