The Radiant Mission
The Radiant Mission
131. Birth Without Fear: The Podcast That Might Save Your Delivery feat Dr. Stu
What if everything we've been taught about childbirth is fundamentally flawed? Dr. Stuart Fischbein (Dr. Stu) takes us on a profound journey from conventional obstetrics into the world of home birth, challenging the very foundations of modern maternity care.
After decades as a hospital-based OB, Dr. Stu noticed something troubling: the medical model was creating problems rather than solving them. "I thought I was the sharpest tack in the box," he admits, "but I began to see that much of what I knew was wrong." His awakening led him to recognize that standard hospital procedures—from IVs to continuous monitoring to laboring flat on your back—directly contradict what mammals need during birth: quiet, safety, and freedom of movement.
The statistics tell a compelling story. When Dr. Stu shifted to a midwifery-collaborative model, his C-section rates plummeted to 7% compared to the national average of 30-32%. This wasn't because he took more risks, but because he stopped creating unnecessary ones. "I was an expert at about 15% of pregnant women and I was taking care of 100%," he explains. "What they need is midwifery care."
Perhaps most troubling is how fear permeates obstetrics today. From breech babies to vitamin K shots, medical professionals routinely use vague terms like "risky" without providing context or actual numbers. When pressed for specifics, they often can't answer. As Dr. Stu puts it, "All that matters to the medical model is a live baby in the bassinet, and how it gets there is not their concern."
Whether you're planning a pregnancy, recovering from birth trauma, or simply curious about our maternity care system, this eye-opening conversation offers a radical reimagining of what birth could be. Listen now and discover why your body might know more about birth than our medical system does.
Ready to reclaim the wisdom of natural birth? Subscribe, share your birth story in the comments, or follow us for more conversations that challenge conventional thinking.
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Hello and welcome to the Radiant Mission podcast. My name is Rebecca Toomey and we are on a mission to encourage and inspire you as you're navigating through your life and with your relationship with Christ. We are doing something special today. We are recasting one, two actually not just one two of our most popular episodes ever. Those are the episodes that we did with Dr Stu. It has now been two years since those episodes were released and they continue to be our most listened to, most downloaded episodes. So here we are today recasting them. Now, if you hear a little bit of a funny noise right now, I have my little newborn on my lap and she's just making all of the baby sounds here today, but this is the birth episode to listen to for anyone that is pregnant or planning to get pregnant. If you know someone that will be pregnant one day, dr Stu's episodes are the ones to listen to. So we're recasting, let's go.
Speaker 1:Hello and welcome to the Radiant Mission podcast. My name is Rebecca Toomey and I am here with my amazing co-host and sister, rachel Smith. Hey guys, we are on a mission to encourage and inspire others as they're navigating through this crazy life and with their relationship with Christ. Today, we have a very special guest with us today. His name is Stuart Fleshbein I hope I pronounced that, okay MD but he's also known as Dr Stu, so I'm going to go with that.
Speaker 1:He is a community-based practicing obstetrician and an associate of the American College of Obstetrics and Gynecology.
Speaker 1:He is a published author of the book Fearless Pregnancy Wisdom and Reassurance from a Doctor, a Midwife and a Mom, and peer-reviewed papers Home Birth with an Obstetrician, a series of 135 out-of-hospital births and breach-at-home outcomes of 60 breach and 109 cephalic planned home births and birth center births.
Speaker 1:So Dr Stu has spent 24 years assisting women with hospital birthing and for the last 12, he has been a home birth obstetrician who works directly with midwives. If you want to check out more about Dr Stu, his website is birthinginstinctscom and right now Dr Stu travels around the world as a lecturer and an advocate for reteaching, breach and twin birth, respect for the normalcy of birth and honoring informed consent. You can follow him on Instagram at birthinginstincts and at the birthinginstincts podcast with midwife Bliss Young on your smartphone app, and he offers hope, reassurance and safe evidence support choices really for women who understand pregnancy is a normal bodily function not to be feared, simply desire common sense and who cannot find a supportive practitioner for VBAC, twin or breach deliveries. So, dr Stu, thank you so much for being here with us today.
Speaker 2:Thank both of you for having me on. It's like I said earlier it's an opportunity for me to reach an audience that I might not normally get to. So I'm on a mission, like you guys are, to sort of normalize this beautiful thing that we've all been through, because all of us were, at one point, born.
Speaker 1:Yeah, that is true, we were, and we all have to be born. You know, everybody else that's coming.
Speaker 2:And we don't do it very well. So, there's such a better way to do things. And so again like I said, I'm just happy to be here. I'll just leave it at that, thank you, thank you, we love your story.
Speaker 1:You know, rachel and I both have been following you on Instagram for a while and tuned into your podcast, and that was really what sparked us to say, hey, I wonder if Dr Stu would come talk to us. We love talking birth. I sent you way too much information about what I went through and what she went through, so we're passionate about it. I had my first home birth this year after having a C-section for my first, and my sister has had two C-sections and now she's having a well, what do we call that? A birthing center, home birth with a midwife, and so we're all about birth. You know that and we love it here. But we love your story and how you were practicing as an in-hospital OB, but then you shifted to home birth. What really prompted that change for you?
Speaker 2:Well, there was no epiphany, it wasn't something that just occurred. Okay, it was a process of being an inquisitive, curious person who always had a little problem with authority. You know, I respect honest and you know trustworthy authority, but I don't respect stupid authority, sure. So I would always question things. I mean, even as a kid or growing up through high school and college and medical school, I would always sort of be the person that's asking well, why are we doing that? And what happens in residency and medical school? You get beat down and you stop asking because you just try to get through your days.
Speaker 2:So when I came out, I was very medicalized. I thought that the obstetrical model was the only way to do things, that I thought that I was the sharpest tack in the box and that anybody who did things differently was crazy. Anybody who did things differently was crazy. You know I did all the things that now I look back on and I say, jesus, I can't believe that I did all those things. And you know simple things like immediate cord clamping or taking the baby over to the warmer, away from the mother, or giving the mother an injection of something to dry up her supply of breast milk, or wearing a hazmat suit to catch a baby or making all women deliver in lithotomy position flat on their back and not thinking there's anything wrong with inductions and epidurals and pitocin and C-sections. That's what you're trained with. If all you know is Greek, then you only speak Greek.
Speaker 2:And so I came out speaking only Greek, out speaking only Greek, and as part of my building of a practice. It was a different era Back in the early 80s. You didn't just come out and get a job working for a big HMO like Kaiser or something like that. You built your own practice and now doctors essentially just come out and get a job. They're just a cog in the wheel, they're employees. But in those days you weren't. So I hustled to build practice and one of the things I did besides cover emergency rooms and assist other guys in surgery and all that stuff was and work at free clinics. I was a medical director of three free clinics in Los Angeles. I hustled a lot.
Speaker 2:I was approached by some local midwives and asked to take their transports from home and I was looking for revenue stream and I didn't think that midwifery was a good idea. I didn't know anything about it. I've never been to a home birth, so I of course I judged it, like like many of our colleagues do. You know it must be bad, cause I've never been to one, so I don't know anything about it. So let's just judge it. But I did it because I could make revenue off of that. But when the women would come in and they would get put in a bed and they get their epidural and they get their Pitocin and we're trying to make the labor at stalled out at home. These were generally non-emergent transports, which are what most transports are. I'd have time to sit in a lounge with the midwife and we'd be sitting there talking and I have a composite memory.
Speaker 2:I don't have any specific memories of any of those events, but I began to hear different ways of doing things and I began to see that the clients they were bringing in were not ill-informed. They were actually far better informed than anybody in my own practice and a lot of them were highly professional. They were intelligent people. They weren't just hippies or people who are counterculture. They were mainstream culture, lawyers, hollywood people, medicalized medical people. They had all chosen a different path and so I was curious.
Speaker 2:I was having intellectual curiosity and I'm a bit OCD, so I, you know, I started to look into things and I began to see that much of what I knew was wrong to things. And I began to see that much of what I knew was wrong and did not apply to women who don't have a problem. I mean, I was like most doctors coming out of residency, we're pretty well trained to take care of somebody with a problem. But what we do is we start to see everybody has a problem. We start to make problems where there aren't problems because that's our model.
Speaker 2:So I was an expert at about 15% of pregnant women and I was taking care of a hundred percent. So 85% of the women I'm taking care of I'm really not an expert in, because what they need is midwifery care. What they need is somebody who's going to give them time and keep their hands off of them and not over-test them and not project fear upon them, to help them realize that this is a normal function of your body, like breathing, like digestion. It does it. Whether you want it to or not. You're going to grow that baby inside of you and at some point you're going to go into labor and there's not a damn thing you can do about it. It's going to happen. So that's how I got in.
Speaker 2:So after about 10 years in private practice I I started a collaborative midwifery practice with two certified nurse midwives in a hospital setting still, and for 15 years or so we had a really great practice. We had low intervention rates. We had a C-section rate overall of about 7%. The next group that took care of the similar cohort of women. Their C-section rate was in the mid 20% at that hospital.
Speaker 2:So we were three to four times less likely to have a C-section in our practice than their practice, and it was simply because I followed the midwifery model of care, where anything that was normal I never really even took care of, unless I was filling in or covering for a midwife on vacation. But the midwives took care of all the normal stuff. The midwives did the well women exams, they did the pap smears, they did all that sort of stuff that you would do, prescribe the birth control, and I would come in when, say, a woman had an abnormal pap smear or a woman had a cyst on her ovary or a woman came in with an ectopic pregnancy or she ended up with a breech baby or twins or preeclampsia or some other problem, then I would step in and so it was the best of both worlds, because midwives are actually better at taking care of pregnant women than doctors are, because they're trained to take care of normal pregnant women and we're not.
Speaker 3:We think we are, but we're not, was this in Southern California, where you had your practice?
Speaker 2:Yeah, oh yeah. I did my residency at Cedars-Sinai in Los Angeles and I had the good fortune of those years. Cedars had a collaborative relationship with LA County USC, which at that point in time was the busiest hospital in the country. It's not that anymore. They were doing about 22,000 births a year there, which is about 65 babies a day. So if you break that down 65 babies a day and I'm there for three to four months every other day, so that's like 60 days I'm there you can see how many births are coming through across our plate.
Speaker 1:And if you have 65 babies a day, you're probably having at least two breeches and two sets of twins every day because, Because it's about 3% breach and 3% twin and you were delivering breach the whole time, or not, until you got involved with the midwives.
Speaker 2:Oh no, I learned to do breach in residency. It was just considered a normal variation, so you learned.
Speaker 1:In fact in the 80s they were teaching it because it's not something that really is taught to in medical school today.
Speaker 2:It was already fading in the 80s. It was already fading in the 80s and 90s. There were papers coming out. You know what I would call confirmation bias papers. They basically said we need a paper so that we can do C-sections. And suddenly there were papers coming out saying that C-section is safer for breach than not, were papers coming out saying that c-section is safer for breach than not? And there was a sentinel paper that came out in 2020, 2000 excuse me called the turnbridge trial, which got so much publicity and it was really a bad paper and had a lot of flaws in it and within two years it was sort of mostly retracted and yet the damage that it did was already there to stop all training of breach delivery around the world.
Speaker 2:Because they just jumped on it?
Speaker 2:Because, again, of confirmation bias. Because since that time there have been numerous papers much larger, with much better control for their study come out saying that there's really not a lot of difference between properly selected breach at term, vaginally or by cesarean, and it's better for the baby and better for the mother and for the mother's future babies to deliver vaginally. But it doesn't matter, because if they're not, if you don't learn how to do it when you're in training, you're never going to come out and do it. You can take a course like my course or Rick's and David's breach without borders course, and that's fine. You'll know, maybe, what to do. But if your partners don't want you doing it, if your employer doesn't want you doing it, if the hospital doesn't want it, doesn't matter, you're not going to do it. So if your malpractice insurance is going to say, yeah, you can do it, but we're going to charge you more on your premium, there's no incentive. All the incentives are to not do what's necessarily right for the women that we're supposed to be taking care of.
Speaker 3:Yeah, I wish I knew about you and your practice and your work with my first two pregnancies, because my first I delivered in Los Angeles. He was breech automatic C-section, although I did attempt a version with him that was unsuccessful. My second was in Orange County. He was breached and that was at a teaching hospital and that was a really traumatic C-section for me because no one told me that residents and med students were going to be in my birth and so I'm just in an OR with a ton of people that I don't even know. My doctor didn't even show up for it.
Speaker 3:The whole experience was what I walked away from that with not only birth trauma from that C-section but also very disturbed to actually experience how doctors are being trained in birth today, because they literally treated me like I was not a human, like I was their their lesson for that day, that I was like a test subject, that I was like a test subject and and it was. This is actually like why I like I have so much respect for you and not only like what you did in your, in your practice, but what you're doing in continuing education today, because you're you're impacting women like me who were affected negatively by the medical system in this way and who are seeking out something else, you know, seeking out a better, a better birth experience. You know that is our right. It's our right to have that.
Speaker 2:So, yeah, the educated the educated pregnant woman is is the bane of the existence of the current medical model, Because they don't want people to ask questions.
Speaker 2:And again, when I say these things, we're talking about the nebulous they. Okay, your individual doctor is probably a really good person and he or she probably loves her kids and is a good family person and all that stuff and wants to do good, but they're in a system that is not designed to allow them the individuality. Everything is done on an algorithm. And when you come in and you say you know, I don't think I want the genetic screening, you know I don't think I want vitamin K. You know I don't think I want a 20-week ultrasound. You know I don't want to be induced at 39 weeks or 40 weeks or 41 weeks, and no, my baby isn't too big. Or no, I don't think I want an IV, or no, I don't think I'm going to lay flat on my back. You cause them so much turmoil inside because they're on a hamster wheel and they don't know what to do and what you experienced, Rachel, being treated as sort of, you know, almost like veterinary medicine, where you're not really talking to the dog.
Speaker 1:Yeah, that is what it was like.
Speaker 2:Yeah.
Speaker 1:On the other side of that.
Speaker 3:I was not an awake human being. I was like a lab rat.
Speaker 2:Yeah, it violates every tenet of medical ethics, but we can get to that maybe further down the conversation. But when they do that, they don't know what to do with you if you step out of line on the lines that they've drawn and the lines that they've drawn have nothing to do necessarily with reality or evidence-based. You know, I always hate the term evidence-based medicine because it makes it sound like it's good evidence. But evidence-based medicine is only as good as the evidence you're using to claim that you have evidence-based. And the same thing goes for standard of care. You know what's the standard of care? Our hospital doesn't do breach deliveries. Therefore, if you come in here and do a breach delivery, you're breaching the standard of care.
Speaker 2:Well, yeah, but that's not what the standard of care is. It's defined by whoever has the power, defines what the standard of care is, defines what the standard of care is. So these terms are thrown out there and the use of language is something to really get us to toe the line. And so what happens is that they do these things and they don't know what to do with you. And there's an analogy that I love, because everybody's seen the movie, I think, A Bug's Life. I hope everybody's seen A Bug's Life. That's a the movie.
Speaker 3:I think A Bug's Life.
Speaker 2:I hope everybody's seen A Bug's Life. That's a great movie. Yeah, pixar used to make really great movies that didn't have any agendas in them. Oh, yeah, yeah, there's a scene at the beginning where they're bringing an offering to the big pile for the grasshoppers and the ants are all in a row. And you know how ants follow each other. They always follow each other. If you've ants in your kitchen, you know what I'm talking about. Um, and this leaf falls off the tree and it falls in front of the ants in the line and the ants behind the leaf they're in panic, they're in full-blown panic.
Speaker 2:We do, what do we do? What do we do in the one ant gets up on a rock and I'm paraphrasing every says something like calm down, we'll go around the leaf, and they figure it out. Okay, yet in the hospital, if you, if you say, listen, I don't want you to cut the cord, but we have to take the baby to the warmer. Well, why do you have to take the baby to the warmer? We have to check the baby out. Well, the baby's on my chest and he's just fine. But but then we, you know, I mean we have to dry it off. Well, why do you have to dry it. I mean, I'm just saying, and I and I'm, and again, these are good people, these nurses that do this, but if they don't do it, somebody on monday morning is going to yell at them if they don't check every box and if they don't document that they took. They said I, we, that they offered you this and they offered you that.
Speaker 1:That's a very good point. I work in business and in business it's all about process. You create the process. It's a good process. You follow it. When you deviate from the process and things go wrong, you got to go back to the process. You can edit the process. But that's what I'm hearing from you is, people are so used to being inside that process that when you go out of it or when you question it, it's like no, no, no, this is the process, this is what's working, but unfortunately it's not working.
Speaker 1:It might be working for the hospital but it's not working for the mothers that are giving birth, it's not working for the families. I mean the amount of birth trauma that comes out of the traditional system. I mean there's entire podcasts about this. I was on one and it's just. It's something that has become very interesting to me because I see a huge awakening happening right now that women are saying wait a second, this isn't right, and that's when they're starting to pursue and look into home birth.
Speaker 1:But then we're so programmed about going to the hospital with an emergency and we've been so programmed that birth is one of those emergencies. That then that's the big question that I get. It's actually one of the questions I have for you on my list, because I have a number of friends right now that are pregnant and they're considering having a home birth. But that's their one question that they always ask me is well, what if there's an emergency? What if something goes wrong? And of course, my question is what's going to go wrong? What do you think is going to go wrong? But I'd love to hear from you how you respond to that question when people say well, if I have a home birth, what happens if something goes wrong?
Speaker 2:Well, a couple of things. First of all, there's a documentary coming out that I just watched today because somebody sent it to me called Birth Time. It's from Australia and in that thing they say one third of all the women in Australia that were surveyed complain of birth trauma. And I'm surprised it's that low.
Speaker 1:Yeah, a third is even still.
Speaker 2:I would have thought it would have been higher, but anyway, we can talk a little bit about the topic that you just brought up, which is what if something goes wrong? I had another point to make, but my brain gets 10 feet in front of my mouth. It was my Greek example. There's so much fear involved in birth in the United States and other Western countries because women fear birth, and the reason that women fear birth is because the medical model has projected their fear onto the women of our country.
Speaker 3:Amen and they fear birth.
Speaker 2:So when people ask that question, it's a reasonable question to ask, but it shows they really have no idea what normal mammalian birth is like. So before I answer the what happens if something goes wrong question, I just want to digress a little bit to the mammalian birth issue and talk about how other mammals give birth. And the human female is a mammal with the same innate natural processes that go on the same hormones, the same natural processes that go on the same hormones, the same needs for birth. And, as Sarah Buckley likes to say, birth should be quiet, safe and unobserved. And if you ever watch any other mammal when they're in labor, where do they go? They go off to a place where they feel safe and quiet. They don't go to a noisy street corner. They don't go to the middle of your living room with the Super Bowl on TV. They go off someplace quiet. And who goes with them? No one, absolutely nobody, right. And if they're hungry they do something really amazing they actually eat. And if they're thirsty, they drink.
Speaker 2:And if your dog was in labor, you would never, ever think of taking the food and the water off the floor and putting it up on the shelf. You would never do that. Yet we do that to human females when they come in and labor. You would never have your dog sit still in one place. You would never duct tape your dog to the floor so it couldn't move. You would never do that. And if the little kids were running around the house and they happened to run into the room where the cat or the dog is in labor, what do you say to the little kids? Leave the dog alone, okay. And when the babies come out, nobody rushes in to cut the cord and nobody ever separates the baby from its mother.
Speaker 1:You're not putting your hands in there. That dog had just had puppies, no way.
Speaker 2:It's never done Like as my co-host likes to say. You know, no one ever does a vat exam on a tiger at seven centimeters.
Speaker 1:That's a good one, I like that.
Speaker 2:Yeah Well, you try it see what happens. So so, but what we do to the human female is pretty much everything that's done. When you go to the hospital is antithetical to nature's design. You have to come in and you have to sign paperwork Talks about death and consent forms about surgery and then you have to go in the bathroom and you have to change into a hospital gown. Why are you changing into a hospital gown? What does that make you feel like?
Speaker 3:A patient.
Speaker 2:A patient right, and why can't you wear your own jammies?
Speaker 3:or nothing.
Speaker 2:And you have to pee in a cup. And I always ask the question why do you pee in a cup? You're not complaining of urinary tract infection symptoms, you're not doing anything. My assessment is that somebody will say, well, we want to check for protein or whatever else. It's like no, no, you want to do it because it's a billable charge and you can bill for the urinalysis. There's no reason to pee in a cup.
Speaker 2:And then you stick an IV in them and then you draw blood on them. Why are we drawing blood on somebody coming in the hospital? We don't do it at home. Don't do it to your dog or your horse when it's in labor. Why do we do it? Oh, we have to have a clot in the lab in case you bleed. We can type and cross your blood faster. It's like well, what happens if I came in with a gunshot wound or a car accident, you'll find me some blood. If I need it that fast, you'll find it for me.
Speaker 2:And then we strap you down and put monitors on, which have been shown to have really no effect other than raising the c-section rate. We don't let you eat anything. If you're lucky, you can have a popsicle, and you're constantly being interrupted. Uh, you're interrupted for your blood pressure cuff machine going off like if you're blushing. If you come in with a normal blood pressure, what are the odds that during labor, if you're left unfettered, that the blood pressure is going to significantly drop or rise? And yet hospitals have a protocol that nurses must take your blood pressure every hour, every two hours. So anytime you do that you're interrupting.
Speaker 2:So in nature, what happens when a mammal is interrupted? What happens when there's a forest fire? What happens when the little kids run in the room? What happens when there's a predator approaching the mammal, puts out adrenaline. Adrenaline stops the contractions. The mammal gets up and runs away, and only when it feels safe does labor ensue, and that way nature ensures the best chance of survival.
Speaker 2:So the same thing. So when we take a woman from her home and we make them get in a car and drive to the hospital and go through all that I just described, it's no surprise that she was contracting every three minutes at home and now she's contracting every eight minutes because she's nervous. Now she's put out adrenaline and she's being interrupted. And sometimes, you know, the labor continues, because nature is amazing, but a lot of times it doesn't. And so now they check your cervix with an unnecessary vascular exam and say you're three centimeters. Oh, you're three centimeters, you're 40 weeks. We might as well keep you. You know why don't we just go ahead and break your bag of waters and then you start that whole cascade of interventions. And during that cascade of interventions I'm getting to your answer to that other question.
Speaker 1:You're right on, I'm following.
Speaker 2:You can see where I'm going with this. So then they rupture your membranes, but nothing happens. So then they say, let's start some Pitocin. So then they start Pitocin, which then shuts off your own oxytocin production and the contractions get pretty intense. And you say, can I have an epidural? Because you're told that epidurals are candy and there's nothing wrong with getting an epidural, because why would anybody want to have their tooth pulled without Novocaine? That's the analogy they'll use, as if a tooth and labor are the same thing.
Speaker 2:Labor is a complex hormonal symphony going on between you and your baby and the epidural shuts it off immediately because now you're not communicating, because you're not in discomfort anymore, you're not sending your baby signals to help your baby through its labor. So then the baby now you're numb and you're hyperstimulated because your contractions are too common, too frequent and the baby's heart rate doesn't like it anymore. And suddenly the baby's got a fetal tachycardia, which is where the heart rate goes up, or it has a D cells where it goes down. And doctor comes in and checks you and you're only six centimeters and they say, hmm, baby's not tolerating labor, I think we need to do a C-section. Thank God you're in the hospital, because what would you have done if you'd been at home?
Speaker 2:Not realizing what they just said is one of the stupidest things that they can say. Yes, things can go wrong at home. Things go wrong in the hospital all the time, but things can go wrong at home. But if you leave nature to its own accord, rarely does it go wrong suddenly and a well-trained midwife and educated parents can often see it coming way ahead of time, when there's plenty of time to say you know, your labor's stolen out or your baby's heart rate's rising a little bit. Oh, you spiked a fever, maybe it's time to go to the hospital.
Speaker 2:Those are not emergencies. Those are not 911 ambulance calls. Those are pack your bag, get in the car, drive to the, put a check on the seat before you get in the car so you don't make a mess and you drive to the hospital and you go in through triage and then you go through all those questions too. It's obviously not an emergency. Rarely when something really bad happens at home, yeah, there can be a problem with that, but the likelihood of a cesarean section, the likelihood of a bad outcome, the likelihood of a newborn intensive care unit admission is actually much higher in the hospital, and what everybody needs to understand, including occasional trolls that follow me on Instagram, is that no one guarantees a perfect outcome. There's no guarantee of a perfect outcome. Once the sperm hits the egg, you know what. There's no guarantee.
Speaker 1:There's no guarantees in life, dr Stu. I mean I must get out of this thing alive.
Speaker 2:Well, death and taxes. Death and taxes, oh yeah, you're right.
Speaker 2:So that's why you know when people say that and then they say, well, how can you do a breech at home? Or how can you do twins at home? Well, in all honesty, when I first started doing that at home I actually was we made a documentary called Heads Up the Disappearing Art of Breech Delivery, and in there I say you know, all things being equal, it would be safer for women to have a breech baby in the hospital because you have all the emergency things immediately available. And that was early on in my home birth career. I wouldn't say the same thing now.
Speaker 2:I wouldn't say it's safer to have your breech baby in the hospital because you're going to end up in the hospital, they're going to have a protocol for breech and every woman's going to have to follow the algorithm and you're going to have to be. You're probably going to have to have an epidural. They may not activate it, but they'll want you to have it just in case and then you'll have to be in the operating room to deliver your baby just in case. And all these things are disruptive. It's like get back to the think of how a mammal labors and think of all the things we do to disrupt it, it's still amazing, that's.
Speaker 2:You know, 68% of women in the United States can still have a vaginal delivery. Yeah, 30,. You know the C-section rate's about 30, 31% and 32%. And, and you know, one or 2% of women are having their babies at home. And if, if, we can all agree that the maternity system United States is broken and in the Western countries, australia, you know, europe is broken, it's not because 1% or 2% of women are having babies at home.
Speaker 1:No.
Speaker 2:It's broken because 99% of women are having babies in a hospital system that isn't designed to individualize care, to respect autonomy and decision-making, to give informed consent. You're a cog in a wheel of a machine that has to make money to survive and the fiduciary duty of the hospital is not to you.
Speaker 2:We need to understand that they don't care about you Individual people that work there. Maybe they do, and of course the risk managers don't want anything bad to happen, but the individual person is lost there. It's a system-wide thing and it needs to be thrown out. There was a great analogy in that documentary I watched today. They talked about the foundation being shaky and you keep putting more scaffolding on the foundation and if the foundation is shaky, the scaffolding is just going to collapse and we see it they don't want to deliver breaches as another opportunity to just c-section somebody, which is another way for them to make quick money and not have to deal with in all fairness, doctors don't make more money doing a c-section, but they save time they don't make more money.
Speaker 2:The hospital makes more money, don't they hospitals do?
Speaker 1:but the doctor themselves.
Speaker 2:Here's a simple solution to that problem if the insurance companies, the hospital makes more money don't know, hospitals do, sure, but the doctor themselves? Yeah, here's a simple solution to that problem If the insurance companies you know I know that this sounds a little snarky, but if insurance companies weren't in cahoots with the hospitals, the two lobbies getting together sometime figuring how we can manipulate things in Washington or Sacramento or wherever we are they could lower the C-section rate immediately tomorrow by simply just offering to pay more money for a vaginal delivery and less money for a cesarean section.
Speaker 3:Interesting. Yeah, it blows my mind. After my second birth, the one that I mentioned before, that was in a teaching hospital, when I got the bill that was charged for my insurance it was $78,000. And I'm like and that was more than my first C-section that was not at a teaching hospital, but I was like this is crazy, like there, like this was like a educational experience for all these med students in there and there was no you know like financial incentive for me or my insurance. It was. It's just insane how much they charge for that surgery.
Speaker 2:Well, it's a game. Billing is a game and anybody who runs a medical practice knows it's a game. It's all about coding and everything has to have a coding. If it doesn't have a code, then you didn't do it. So you fake, you make up codes, you make up things that you didn't do and then what happens is the hospital knows that they're contracted with the insurance company and the insurance company's got a cap on what they're going to pay them. So they inflate the bill as much as possible to try to get the maximum they can under their contract with the insurance company. That's why an aspirin is $5 and a box of Kleenex is $12. And I mean nobody. We all know that that's ridiculous, but that is true.
Speaker 2:And if people were to pay more scrutiny? Now see, and the problem with third-party pay? We're going to go off on a tangent here. The problem with third-party payers is they take away the direct relationship and every time you add a middleman to something, you decrease quality, you make it more impersonal, because you're not making that transaction with the person sitting across from you and the person in the middle is generally making the most money. The people actually providing the service make less.
Speaker 2:In California they always talk about oh, those greedy oil companies are making so much on a gallon of gas. Well, I read an article, several articles, and the oil companies make maybe a nickel to a dime on a gallon of gas. The state of California makes 64 cents on every gallon of gas. Right, because they put the tax on there. The state of California is making six to 10 times as much money per gallon of gas. And then on the press they badmouth those greedy oil companies. It's the same thing here. When you have insurance companies that get in the middle, then you're not negotiating with me and I'm at the mercy of an insurance company who says if I'm doing things that they don't like, they can kick me off the panel.
Speaker 3:Yeah.
Speaker 2:And if I have a practice that's got 30% Aetna and 50% Blue Cross, I can't afford to be kicked off Aetna or Blue Cross because my margins are really thin running a practice, or running a hospital for that matter. So, again, the individual people want to do the best that they can, but the system doesn't really allow it and in the end run what happens is that the patients suffer and the bigger it gets. And you know, and then the bigger it gets, there's no one to complain to. Yeah, tried to.
Speaker 2:You know, when I, my Instagram account got hacked a couple months ago, a month ago or whatever, and I was at the mercy. There's nothing I could do. The only way I got it back was somebody I know, knows somebody that works for Meta, and they got it back for me. That's helpful. I emailed them every day through their service, every day complaining about this, got either an automated response or no response whatsoever. I had lots of my followers send in. This account got hacked, blah, blah, blah, nothing, nothing. I found somebody who knew somebody who knew somebody who knew somebody.
Speaker 3:Yeah, to help you out. I'm glad you got it back.
Speaker 2:Right, but if it was a small company, you know, if I have an electrician come to my house and he screws up, it's between me and him.
Speaker 3:Yeah.
Speaker 2:Okay. So it's the same sort of thing in medicine. If you go to a small, individual practitioner, you're going to get better care. I truly believe that, not necessarily for something that's really complicated. Obviously, if you want to go to the Mayo Clinic or Cedars-Sinai or the Cleveland Clinic, yeah, when you've got something that's really wrong with you, you want to go to a big specialist. But for individual healthcare, your daily needs and stuff like that, you want to find a private guy. And what's happening, of course, is that governments and big medicine are trying to squash the private guy. They're making it impossible for us to call in prescriptions, they're making it impossible for us to run certain tests. They say you have to have this software in your office. Well, if you have a hundred physicians in your office, you can afford that software it's divided between a hundred people. But if you're a solo practitioner and you have to have this software, you can't afford it, sure.
Speaker 1:Hey, speaking of money, this is something that I read a lot about in.
Speaker 1:I joined some home birth, assisted and unassisted type of groups on Facebook when I was planning my home birth and there would be a lot of moms that would come and say I really want to have a home birth but I can't afford it.
Speaker 1:And what I can't afford it they meant five, six, $7,000 for to pay a midwife out of pocket was too much money for them. But it was hard for me to even like know how to respond to this, because in my mind I'm thinking don't pay for your health insurance. You know, just put the money that you would have put into a health insurance policy that's going to send you to this hospital and use it towards your midwife, or you know, this is worth it. It's worth it at the end of the day five grand to have somebody that is going to be supportive of you at home and you're not going to go through all those interventions at the hospital. They're going to cost you $78,000 to your insurance policy. I don't know it's an interesting conversation that's often had in these communities is we're so used to being in the system, in the health insurance system, that we don't know how to step back and say, instead of putting money into this, I'll put money into an account that I can use to pay a midwife.
Speaker 2:Yeah, it's the culture we live in. We have this third-party payer system, this insurance, or it's the culture we live in. We have this third-party payer system, this insurance, or Medicare or Medicaid, and so we think, well, if I'm sick, I should be able to use my insurance and we don't put a value on the individual health care like that, and that's something that people will have to break out of if they can't, because I'll tell you that the $6,000 that you spend on a midwife might be a big burden for you. So you put it on a credit card or you borrow it from your parents or, you know, you put a, have a ghost, a give, send go account and raise the money or have people who are going to give you a baby shower. Stop buying you stupid stuff that you'll never use anyway and just donate towards your home birth fund, because two, three years from now, that $6,000 won't even mean anything, but the memory of how you gave birth will be with you your entire life, exactly. But it's a cultural thing. It's hard to break out of that.
Speaker 2:It's kind of like a lot of my colleagues who are in internal medicine and one of my best friends. He's an internist, he's an intensivist. He takes care of really sick people in the ICU. He's semi-retired now but he did that for 35, 40 years. We talk sometimes about medical stuff and he knows more about it than I do. But I follow Del Bigtree, I follow the highway or I follow, I look into things all the time and he thinks that every person over 40 should probably be on a stat. You know what a statin is.
Speaker 1:Tell me more.
Speaker 2:Oh, it's a cholesterol-lowering drug.
Speaker 3:Okay, okay, oh wow. Yeah, everyone should be on who thinks this Because it's the greatest thing ever.
Speaker 2:But there's a lot of data that says it isn't true. But that's the culture in medicine is to immediately give a prescription for something rather than say you know what. You need to change your diet. You need to lose 30 diet. You need to lose 30 pounds. You need to start exercising. Then come back. We'll recheck everything, but no, because we have a pharmaceutical culture as well.
Speaker 1:Right, absolutely, absolutely. And there's another money pit that we could.
Speaker 2:And it's much easier. Doctors don't make more money writing you a prescription but they can get you in and out of the office faster. And they're taught and they're told by the drug reps who come to our office that this is the best thing since sliced bread and I'm just picking on statins. There's a lot of parallels right now out there that we could think about that, get injected into your arm, but we won't even talk, we won't go there. That we could think about that, get injected into your arm, but we won't even talk. We don't want to get censored or anything like that, but, um, but that's what they do and it's you know.
Speaker 2:It's the same thing in obstetrics. A woman walks in at 10 weeks for her first prenatal visit. Why does the doctor say to her you know, honey, you're over 35. Um, you know, likelihood that we'll probably have to start testing your baby later on because your placenta might get old. Or you know, you're only five foot six and your husband's six foot five. There's no way that baby's going to fit through your pelvis. And they plant these seeds of doubt and all they're doing is they're projecting their own anxieties and own fears. It must be, you know. Quite frankly, I don't think they're aware of it because of cognitive dissonance, but I think it must be awful yeah To go to work every day.
Speaker 1:To be nervous yeah.
Speaker 2:To be scared, you have to live that way, I would totally agree with that.
Speaker 1:My midwife sent me to have my scar checked when I was 35 weeks to see you know, just to make sure my C-section scar had healed from my previous birth, and the doctor that I spoke to after, by the way, my scar was healed, everything was good. She had so much fear inside of her because she experienced she saw someone's uterus rupture. Now I don't know if this person was on Pitocin or whatever. I don't know the scenario surrounding this.
Speaker 2:It happens, it can happen. It's something that can just happen.
Speaker 1:Sure, I don't know what the circumstance was, but this happened to her one time, one time. She's been a doctor for 20 years. This happened to her once and she was using that scenario that happened to her to try to scare me and I thought this is crazy, like this happened to you once. You've seen thousands of women and but, like you're saying, it must be very hard to live in that that you're projecting your own fears from an experience that you went through. You know it'd be like if I got into a really bad car accident and then I was like don't drive, you could get in a really bad accident.
Speaker 2:Well, there are some people that have PTSD and don't drive again. That's true, but they shouldn't become taxi drivers.
Speaker 1:They probably won't.
Speaker 2:So you know, if an OB is that traumatized by something like that, they maybe should consider giving up ob, doing just kind of I mean you can't really quit, you've got so much invested in your profession and I mean I totally empathize with that.
Speaker 3:But maybe you should be not doing ob anymore, sure, maybe you should just do gynecology, gynecologic surgery, sub-specialized in something where you don't have to deliver babies yeah it kind of seems like it's all I I guess I shouldn't generalize, but a lot of it is fear based because I know that's what I experienced as well of, oh, your baby's breach, so we need to schedule a c-section. And it's like, oh well, like what would? Well, you'll put your baby at risk if, if you, if we don't do this, and it's like okay, well then, I didn't ask these questions at the time, but now I have what are the risks?
Speaker 3:What is the percentage? What is the ratio of risking the baby from a vaginal breach delivery versus a C-section? And this is what's so great about organizations like Breach Without Borders that are putting these statistics out there and putting their research forward that it's not as risky as the doctor that's sitting in front of you in your OBGYN office is making it seem. And maybe that's all because that's all they know. They only read that one study.
Speaker 2:So I have a story for Dr. They probably didn't even read the study. Go ahead.
Speaker 1:I have a story for you, dr Stu, that relates to this, and then I think you can react to both of us. So when I was having my first, I put together a birth plan because I thought that a birth plan meant that they would actually follow it. Little did I know it doesn't mean anything, but I go to the OB's office with the birth plan prior to the birth, you know, just to go over it and she reads through it and she goes okay, yeah, this looks okay, but there's one thing that you really need to reconsider. I had on there that I did not want them to administer vitamin K and she said you need to change this. You really need to get the vitamin K. And I said why? And she said, well, because your baby could die.
Speaker 1:And I said, well, why would my baby die? She said, well, if there was some sort of trauma, like if you got into a car accident when you were pregnant, or if there was a trauma when the baby was born. The blood is too thin and if they don't have it, then they could die. And I said how many babies have died in your practice from not getting vitamin K? And she goes, uh, and was so flustered and then got the heck out of there and it just kind of circles back to this whole, you know fear-based type of conversation and when you ask the questions, she didn't know how to answer that question. All she knew is she's supposed to do this. This is a box that they check. She didn't know how to thoroughly communicate about this particular area.
Speaker 2:Anyway, they're just regurgitating information that they were once told they don't again. This is well, maybe it is meant to be insulting in some way. They don't know anything. When they say something is risky to everybody listening, that doesn't mean anything. The word risky doesn't mean anything unless you know what the denominator is, unless you know well what the alternatives are and what the risks of those alternatives are. And they don't know. They say words like risky, or you know lowish fluid, or you know large baby. They say these things to get you to do, to funnel you down the path, to get you to do what they want you to do. And I'll give you an example of the vitamin K thing that you brought up just a second ago. The instance of late-onset vitamin K-dependent bleeding, which is what they're worried about, has nothing to do with the baby in utero in a car accident or anything like that. I don't know what that even has anything to do with it.
Speaker 2:Right, wasn't that a fun story. You don't give it until the baby is out, but the risk of vitamin K-dependent bleeding is about six per 100,000, which, if you do it now, is about one in 16,500. So what you should tell a woman is if you don't get vitamin K, your baby has about a 1 in 16,500 chance of having this very serious problem of internally bleeding. Now, 1 in 16,000 is essentially zero. If you divide it out and multiply it by 100, you're going to find it's like 0, 0, 1% or something like that. So it's a very small number. But yet if you give vitamin K, it drops to about one or two in 100,000, which is also a very small number. So you're scaring people. You're scaring 15,999 people into getting vitamin K to save one person. That may be your decision of what your risk benefit evaluation is. Your assessment is, but it's not your assessment that matters. Sure, it's the woman's assessment and the family's assessment that matters.
Speaker 1:It is, and not for nothing. They don't share those inserts on the risks of getting vitamin K, the risks associated with having that.
Speaker 2:No, they don't. They don't talk about in the case of C-section for breech. I'm sure they didn't tell you about the risks of C-section.
Speaker 1:Oh, of course not. And they don't tell you the risks of repeat C-section either.
Speaker 2:No, yeah, or the risks to your future babies or the possibility of abnormal placentation in future pregnancies. No, it's the default position and this is a problem. And again, it comes from fear, as you said, rachel, but it also comes from an idea that what we're taught in residency program is we want to control everything. And, by the way, when you want to control everything in a world that's full of entropy and chaos, it only makes it worse because you can't. And so all these things that the medical model does is purely to try to control the outcome, because again and I'm not going to wax religiously or philosophical here, I'm not an expert in those things, but you know, it's that thing that says that there's more to the than just the destination, it's the journey too, and they don't care about the journey.
Speaker 2:One of my sayings that people come to my seminar knows all that matters to the medical model is a live baby in the bassinet and how it gets there is not their concern. And what happens to that baby and that mother and that mother's future babies is not their concern. It sounds harsh, but think of it like that. When you go to the hospital, that is their concern. Now you may have a great relationship with your doctor and that's great, but there are very few doctors who take call for themselves all the time. So if you're a doctor's in a call group of five other people and you go into labor, you only have a one in five chance that the person that you made relationship with is actually coming, sure. So the system again is it? It's run on a on a shift mentality, but this is one thing where it's not like an er. This is. This is a very personable thing and it's not. You know it's. It's the medical model treats it as a medical issue. It's not a medical issue until it becomes one.
Speaker 2:Yeah, definitely most of the time it doesn't become one, so don't we gotta stop treating it like this is a medical problem? Your body is designed to that to deliver a baby, to grow a baby and deliver a baby.
Speaker 1:As you've been hearing, we have been having a fantastic time talking to Dr Stu, so much, in fact, that we continued this conversation. So be sure to tune in next week for the continuation of our interview with Dr Stu. Thank you so much for listening and tuning in and for being on this journey with us. If you'd like to follow along outside the podcast, be sure to join the mission on Instagram and Facebook at the Radiant Mission. You can also find Dr Stu at Birthing Instincts and, of course, you can find this podcast in video format on YouTube as well. And today we will be closing with Ecclesiastes 11.5. As you do not know the path of the wind or how the body is formed in a mother's womb, so you cannot understand the work of God, the maker of all things. Wishing you a radiant week and we'll see you next time.
