The Realities of Modern Obstetrics: Dr. Stu’s Unfiltered Take
Show Notes:
[1:30] Our Reviewer of the Week, AAL3!, says "I can’t recommend enough!!! Your episodes always make me feel more calm about everything pregnancy related! I asked questions on Instagram and you made another episode about it to answer my questions. Thank you for always catering to the women you serve and ensuring we are informed about what is happening during pregnancy birth and postpartum. I always recommend your podcasts and the three exercises! I did the three exercises and had a fast labor and only pushed for 12 minutes with my first baby. Baby number 2 is due in July and hoping for a similar experience. Thank you again!"
[2:23] Disclaimer for this Episode:
This episode with Dr. Stu is not what I imagined when I wrote the outline, and we began our conversation. I had lots of questions about home birth, VBAC, twins, and breech babies. As well as experiences in these settings with Dr. Stu being an OB who attended home births. I think it is so fascinating and such a blessing to have someone like him doing what he did in the way of supporting women at home, and also what he currently does, speaking all over the world about the importance of body autonomy and trusting the birthing woman throughout the entire process, as well as teaching midwives and doctors how to support a woman giving breech birth vaginally.
However, I feel that the very in-depth and important conversation we had will bless thousands of women to understand true informed consent and to be empowered to take control of their birth space and birth experience like never before. I am also aware that this episode may make some listeners uncomfortable. Having someone speak openly about the injustices in health care and particularly in regards to pregnancy can make us feel a bit like we are in that flight or fight mode. More than anything I hope our conversation will peak your interest and give you the desire to search deeper for answers for your own birth experience. If you have questions or comments after listening to this episode I would love to hear from you. You can always send me an email to “[email protected]” or chat with on Instagram @myesssentialbirth. And with that, let’s dive into today’s episode!
[4:23] Our guest this week is Dr. Stuart James Fischbein or Dr. Stu! He has been practicing obstetrics for over 40 years. He's the co-author of the book, Fearless Pregnancy, Wisdom and Reassurance from a Doctor, a Midwife, and a Mom, and has peer reviewed papers on home birth, home breech birth, and very soon on home twin birth. After completing his residency at Cedars Sinai Medical Center in Los Angeles, California, Dr. Stu, spent 24 years assisting women with hospital birth and then for the last 13 years has been a home birth obstetrician who works directly with midwives. He travels around the world as a lecturer and advocate for re-teaching breech and twin birth skills, respect for the normalcy of birth, and honoring informed consent. You can follow him on Instagram @birthinginstincts and at the Birthing Instincts Podcast with midwife, Bliss Young, as he offers hope, reassurance, and safe, honest, evidence supported choices for those women who understand pregnancy is a normal bodily function not to be feared. His website is www.birthinginstincts.com.
[6:18] Dr. Stu walks us through his background on how he went from obstetrics to home births. He talks about how it wasn't a calling, but interactions that drove him towards that direction. He talks about his education and going through medical school and doing his clinical rotations. He found his passion during his obstetrics and gynecology rotations. He felt like he got to do a little bit of everything (catch babies, surgery, endocrinology, family medicine, psychiatry, etc.) For his residency, he matched in Southern California, which was affiliated with LA County's USC Women's Hospitals program. They were the busiest hospital in the country in the early 1980s, doing about 22,000 births a year there.
If you break that down, that's 65 babies a day. As Cedars residents, they were there every other day. So that's 60 days, 65 babies a day. You can do the math, and you're just seeing about 3,600 births in a matter of four months. And of course, 3% of those are breeches and 3% of those are twins. You're seeing a couple of breeches and a couple of sets of twins every day in every variation of normal. Dr. Stu talks about how things were done back then once babies were born such as not delaying cord clamping.
[13:40] He built his own practice from scratch. He covered free clinics, emergency rooms, was on call for other doctors when they went on vacation, he assisted in surgery, and slowly but surely built up his practice. He was approached by some local midwives and asked to take their home birth transfers, even though he thought midwifery was stupid because that's what he was indoctrinated to believe: that birth is a dangerous thing and only hospitals can save women from themselves. He started to learn a different way of doing things by working with the midwives, and he saw that their transports were very well educated, were not emergencies, and he had a lot of time to sit and talk to the midwives.
He was enamored by the model of care they used because it was so different than his. He started to go to some of their meetings and some of their peer reviews. He began to see that everything that he was doing was inappropriate for about 85% of pregnant women. He began to see a different way of doing things. He opened a collaborative midwife practice in another hospital. Over the next 13 years, he did home birthing, and he got braver and started to do women with medical issues like diabetes and hypertension. It was common sense to treat birth as a normal function of a woman's body.
[23:31] As moms who are pregnant today, understanding what's happening, and it's not that the people that they're interacting with are necessarily bad people, but the way that they are trained and the constraints that they have, make it very not conducive to what we would hope to have out of life. Our experience as pregnant and birthing women and how we're treated, that's what leaves us feeling like "What just happened? That was not the experience I wanted!" even if you can't pinpoint what it was.
[27:36] Why don't doctors see that their outcomes are so bad? That they need to make a change in their system. They don't. They defend the system. And then they have organizations that are completely bought off, like the American Academy of Pediatrics, the American College of OBGYN, or the American Medical Association, who are not responsive to their members anymore. They're responsive to the organizations that give them big money. ACOG took 11 million dollars plus from the CDC to push the COVID vaccine onto pregnant women. The AMA makes 80% of its revenue from the billing coding system that it has a monopoly on. Only about 14% of doctors in the United States belong to the American Medical Association.
[30:08] No matter what kind of conversation you've had from the very beginning about induction or about being able to go until 41 plus or whatever the conversation is, what can you do? What do you need to know? What do you need to know about induction and the safety of baby being in your body longer? The induction rate has been rising for the last 15 or 20 years. But in 2020, the rate of the rise increased. It rose faster and it's been continuing to rise faster. Everybody listening should understand that pregnancy is a normal function of your body. And it rarely goes wrong when you leave it alone. Occasionally it does, but the medical model is always on the alert for something. They're always going to be looking for something.
[35:37] Your baby is forming inside of you, and its a little neurons are forming. It's preparing itself to come out and is the world a safe place or is the world a scary place? We pass these things on. Rachel Reed talks about something called the "red thread." From generation to generation, women are passing on their knowledge and through their genes and so every baby born has some of the knowledge in its genes of its mother, its grandmother, and every woman that came before it along its own genetic line. When women are bathed in fear, then that's going to be a different red thread than if they aren't bathed in theory. So these are theories that are not taught in medical school because they seem a little bit too out there, and medical school is only looking at concrete, scientific things, but scientific things are constantly being proven to be wrong.
[38:50] If you intuitively feel the baby's growing fine, and the baby's doing fine, that baby's doing fine. If you do an ultrasound for no reason at 36 weeks, you have a 22% higher chance of having a Cesarean section simply because you did an ultrasound where they're going to find a "Oh, the baby's a little on the small side, or the fluid is a little lowish" or they'll unnecessarily turn on the color Doppler because they can bill for it. The color Doppler is used way too much by maternal fetal medicine doctors. It had very narrow use when it first came out, but like everything else, it had a creep emission creep, and now it's used pretty much on every ultrasound. It's higher intensity, non-ionizing radiation. You don't need your baby to be exposed to that.
[41:04] Dr. Stu talks about the importance the environment for birth and its effect on birth. We are a higher level species, and we forget where we came from. We forget that we're basically mammals and that mammals give birth a certain way. The instincts have been implanted in you for eons of how to give birth. If you think about any other mammal that's giving birth, where do they go? They go off to some quiet place and nobody goes with them. They understand it's a protected space, and they may even protect the space. A mammal finds a quiet place, and when they're hungry, they eat. And when they're thirsty, they drink. They don't restrict their intake. And they don't restrict their movement. It may do whatever she needs to do to help her baby navigate that system and to help her deal with her discomfort that she has.
[50:11] Dr. Stu talks about what the medical field has become in the last few decades. "It's about money. It's about power. It's about influence. It's about fear. And fear is the strongest emotion, stronger than love, stronger than hate. You can get anybody to do anything when you manipulate them with fear. And we've taken fear and we've integrated it, woven it into the obstetrical system in the United States."
[53:12] Should doulas be covered under insurance? Yes, insurance should cover doulas, but I don't know that women understand what they're asking for. Because when you involve somebody in a position to certify or to cover somebody under the medical side of things, you're also putting them in a position where they have to abide by certain rules and now they're now working for the insurance, they're not working for you anymore. The entire point of having a doula in your birth space is to advocate for you, is to be on your side, they're in your corner, they're for you. As soon as we allow other people to come in and have a say in those kinds of things, we lose our freedoms, and if we're talking about the birth space, that is pretty vital.
[1:11:00] For many other women, pregnancy is kind of the thing that launches you into that different way of thinking where you do start questioning things because you're like, "No, this doesn't make sense to me, and this is not what I feel is intuitively correct for myself or my baby." Women know their bodies better than any physician can possibly know their bodies. If you have the time, then you could hear them. The system doesn't give doctors the time or they don't have the training to do what integrative doctors and integrative practitioners will do.
[1:20:24] Why is choosing your provider so important? We want you to have good memories. It's worth it to do the hard thing. It's worth it to be uncomfortable and go interview providers as if this is like a big deal, and it's going to be the person in your very private space. But it's true. We get this like kind of the white coat syndrome thing. We walk into a provider's office and all of a sudden like you're in charge and I don't know my body and whatever you tell me is true. That's unfortunate. You need a really good, supportive provider. You will not have the birth that you desire, or you will have to fight a lot more for it if you do not have that in place. And, on the other hand, if you don't know what your options are, and you're not educated about what you're looking for in a provider because you're not aware of the things that can happen during pregnancy and labor, then you can't make those decisions.
[1:27:54] What is your one piece of wisdom for moms? "It would be interview and speak to a midwife. Doesn't mean you're going to stay with them, but don't just take your insurance card out and go from your insurance book to the path of least resistance, which is to go to the medical system and just become a widget in their machinery. Interview with a local midwife, and I'm not talking about a hospital based midwife. I'm talking about a home birth licensed midwife, certified professional midwife, CNM that does home birthing. Interview with one of them to get a taste of what prenatal care and what preventative health care and what nurturing care can be like. And then you can go ahead and do whatever your insurance or whatever you want, and then you can decide is this something I can tolerate or not, but if all you know is the medical model, then you never know what else is out there.
And you need to know what else is out there because there are really good choices out there. And while home birth is not for everyone, informed decision making is for everyone. And how do you make an informed decision if you're not given full information? And you're far more likely to get full information in the midwifery model of care than you are from an obstetrician who's got limited time and limited knowledge.
Do not fear birth, enjoy it. Your body knows what to do. Relish these months prior to getting pregnant. Get your body in the best shape possible. Eat healthy, cut out alcohol, cut out vaping, cut out as many GMO and modified foods as you can. Eat healthy, get lots of rest, secrete a lot of oxytocin, that sort of thing. Keep yourself in the right mindset. Don't worry if you don't conceive right away. The human condition is such that our ability to conceive in any given cycle is not great. We're not rabbits that get pregnant every time they have sex. It doesn't work that way.
Don't get stressed about it. The body's designed to do these sorts of things. Once you get pregnant, keep yourself as healthy as possible and as happy as possible because you want to bathe your baby in those happy hormones. Stop watching horror films, stop reading the news. Watch reruns of your favorite comedy shows and take good care of yourself. Take the supplements that your practitioner recommends or that you can find places online that tell you what supplements are good and what things are bad. And if you're not at any point in your prenatal care, if you're not feeling nurtured and comfortable, listen to your, listen to yourself, and do something about it.
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