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Hi friends, welcome to the Pain Free Birth podcast. I'm your host, Karen Welton, a certified doula, childbirth educator and mother of three. In this space, we'll hear positive, supernatural and yes, even pain free birth stories from women just like you. We'll explore the deeply spiritual side of childbirth and how God designed women's bodies brilliantly for birth. Let's get started. Welcome to the Pain Free podcast, everyone. And today I have
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The great honor of interviewing one of my favorite doctors in the world, Dr. Stuart Fishbein. He is a community based practicing OBGYN and has over, I think, 30 years experience as an obstetrician practicing in hospital settings and at home and has delivered.
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many twins and breech babies at home and is an advocate for women and birthing rights everywhere. So welcome to the pain free birth podcast, Dr. Stu. Thanks, Karen. It's actually I'm going on my 41st year. 41st year. Since I started my residency back in 1982. I was a whole decade off. Oh my goodness. You I was trying to remember is it 30 or 40 years? You certainly are an expert in this field and it's an honor to have you.
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I feel like I'm uniquely positioned sometimes because of my journey through traditional medical training, coming out thinking that I was the sharpest tack in the box and think that I knew everything about birth and to spend five or 10 years just practicing like most obstetricians do and then gradually beginning to change over to a collaborative practice with midwives in the hospital, eventually to leaving the hospital.
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to doing home birth for 12 years. So I, you know, I'm one of those rare unicorns they like to call me for somebody that's experienced all those things firsthand. So I can legitimately comment on what goes on in the hospital. And even though I've been away from the hospital for 13 years now, I can tell you that nothing has changed. If anything, it's gotten worse. Yeah, I know it's true. And, and you're someone who, you know, when the
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the people come out to say, oh, well, you just don't understand to all the home birth midwives and doulas and women who want to birth at home, that's so dangerous. And so say if you don't know how dangerous birth is and all these emergencies that happen in a hospital, well, you've been there. You've seen them. You've attended those births. You know how things happen in a hospital. And now here you are attending births at home, even breach and twin births, which most people would say, that's absolutely crazy.
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What would you say to, you know, I'm trying to think of what question I want to ask here. I know what you want to ask me. And ultimately it all depends on how you view birth. Yeah. And the American. Citizen has been taught over the last three generations or more to really fear it. And the American obstetrician has been taught.
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during that same period of time that it's something to be feared. Yes. And if you come into it that way and you think it's a disaster waiting to happen, then you couldn't understand why nobody would want to deliver in a hospital. It's the poor analogy of saying, if you think you're going to choke when you eat certain food, you should eat it in the emergency room. Because then you've got emergency help immediately available. And although that's a poor analogy, it's not that far fetched.
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to what people actually think, that the birth is something that's going to turn south at any moment. And they never think to the fact that, well, first, how do all the other mammals do it? And secondly, maybe things turn sour not because, well, because you're in the hospital, not because you're pregnant, but because you're in the hospital. And I can just say after all the years that I've seen things happen, that the way
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birth is feared and managed in a hospital leads to a lot of the problems that go on. And so safety is in the eyes of the beholder. And safety is determined by what you know, what you know. Yeah, yeah. You know, there are people that that perform in X games that do all kinds of crazy stuff. Do they consider it to be dangerous? No. But if somebody watching it on TV like me says that's ridiculously dangerous, but I don't I know, I've never done it. I don't know anything about it.
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And you're not trained or skilled in doing that.
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Or even worse, I've been trained to believe that it's dangerous. Not even that I have an independent thought. It's been that I've been indoctrinated to believe that it's dangerous. And therefore, you know, it's kind of like the, this you say the same thing over and over again, even if it isn't true, it eventually becomes, even if it's a lie, it becomes true because it's just, so you get propagandized and the medical model. We, we like to think of all of us as.
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is in my generation is all Dr. Wellby's and Dr. Kildare's and the, you know, the doctor has your best interest at heart, but that is not the way the system works anymore. It just doesn't. Yeah. The system does not care about the individual person or her individual desires. It just doesn't. And anybody who says that that's
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Propaganda or that's hyperbole just doesn't understand it. I'm not talking about an individual person working in the system The problem with that is that individual person has no ability to change the system and if they try to do things outside of the system they themselves will get pounded on right so This is about the the medical system that we have right now for obstetrics is not safer and it's in and so for those people who think that it's
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that all women should deliver in the hospital and it's crazy to deliver at home, they just don't know anything. Yeah. That's what midwives come in because midwives are skilled in taking care of normal birth. And when you have a normal pregnancy, you really don't need medical intervention. As a matter of fact, it gets in the way. And when you have something that isn't normal, then a midwife who's trained in normal will recognize it right away. And they'll say, we need to go to the hospital.
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And hospitals are great when they're needed, but they're maybe needed 10 or 15% of the time. They're not needed the other 80, 85, 90% of the time. And that's well documented. The world literature contains lots of data on the safety of home birth. The problem is that it doesn't feed the coffers and the egos of people running the medicalized model. And so
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The classic form of cognitive dissonance is to ridicule people who think differently than you. And so they call people they call midwives, you know, less, the lesser subset of obstetricians, they're, they're inadequate, they're dangerous. This is what they say. It makes them feel better, but it doesn't solve the problem. Yeah, and it further divides people in the birth space and create makes it very hard to have any kind of collaborative care or transfer of care when it is needed.
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So it certainly doesn't help among the birth workers. And I think you said it perfectly. Like it's hospital birth is not safer. It has its own set of problems. And the people that work there are not bad people. They are just trained in a certain way of thinking. And they can't act autonomously against the system because the system they're working in is broken. And I would even go so far as to say abusive to many women in labor.
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humanity. And when you talk about like starving women in labor, not allowing them to eat and forcing them to into tests and vaginal exams and hooking up to monitors when they don't even ask permission for a vaginal exam, for example, they're just going to do it, you know, so there's, we could go on about that all day. And I speak about that a lot on my account. But I, I think what many people face is this fear of the what if, what if something goes wrong and they're willing
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fight against the abuses and what they know to be, you know, a real issue, real problems in the medical system in order to be in a place where it is considered safe, right? We have emergency care need there if we need it. What would you say to those, you know, young parents, young moms, young dads who are preparing for birth, who want to have a physiological birth, want to have a supported, you know, empowered autonomous birth, but
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What if something goes wrong? Okay, those two things are bipolar opposites. You can't have a physiologic birth in the hospital. You can have a vaginal delivery in the hospital, but it won't be physiologic. It's just, it's not. So let's go back, back up before we answer that question. And just again, for people, sometimes you and I, I think we preach to the choir. I think our followers, you know, they follow your podcast, they follow my podcast, they do that sort of thing. So we're, I would love, I love reaching a new audience.
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So I love branching out this last couple of days. And next week, I've got some opportunity to speak to people I don't think who've ever heard what you and I are talking about. We have to get back to mammalian birth. Yeah. We really just have to think about it, right? When a mammal goes into labor, right? There are certain physiologic things that happen. There's a beautiful symphony of hormones and things that are going on that are instinctual that involve the primitive brain.
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between mother and baby. They've been going on for nine months, or less if you're a dog or cat, but you know, whatever, how many months it is. But they've been going on for that period of time. And the cognitive brain, which we have a much higher functioning cognitive brain, I'm not sure it does the world a lot of good, but we do have a higher functioning cognitive brain. And our cognitive brain can easily override our primitive brain and shut it down.
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And a perfect example of that is the example of breathing or digestion, which are two things that you and I do all the time and are not thinking about at all. We're digesting our breakfast and we're breathing air. We don't think we don't have to remind ourselves to take a breath. But when you have to give a speech or when you're taking a test or when the FBI knocks on your front door, suddenly the, you know, your cognitive brain takes over and breathing and digestion might be malfunctioned.
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In other words, you might get stomach cramps. You might hyperventilate. These are your cognitive brain taking over your primitive brain's function. Same thing happens to a mammal in labor. When a mammal is laboring and they're disturbed or they're anxious or there's a predator that approaches or a forest fire or little kids run in the room, the mammal will put out a series of hormones. Autonomic nervous system will kick in, labor will shut down, and the mammal will flee, fight or flight.
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they're not going to fight when they're in labor, they're going to flee. And that's what happens. So when we keep that in mind, when we trust mother nature, the things that people hear about that go wrong in the hospital, that go wrong suddenly, those things, my experience and the experience of many, many midwives I've worked with and the multitude of midwives before me.
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tell you that when you don't mess with mother nature, you don't see this sudden deterioration of fetal status, except in rare occasions, you might see a prolapsed core, you might see something. Yeah, those things might happen at home. But they're just as likely to happen in the hospital, and they're likely to happen in the hospital because of what the hospital is doing. Right, they're introducing more stress and fear. Numbing you up. Disconnecting you from your baby. Not letting you eat. Constantly interrupting you.
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doing vaginal exams. I mean, Bliss used to let my co-host likes to say that just walking into the room of a laboring woman is an intervention. Yeah. Because you change her mindset. She knows you're there. She starts thinking about something else, whatever. She comes out, you know. So you need to act like ninjas, which is what my friend Alex says. And I think it's interesting that they actually, male doctors actually knew this back.
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like decades ago, probably in the fifties, I'm not sure, but they would actually wait and listen. This is, I think from Grantley Dick Reed talked about this, they would wait and listen outside the door and wait until the woman finished her contraction, quietly enter and they would only go in if absolutely necessary. They'd make sure they didn't disturb the laboring woman. And I, I find it interesting that even back then they had an understanding, at least to a small degree of this physiology and not to disturb the laboring woman, just like we know.
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you're a farmer or on a farm like and you've ever seen an animal give birth you know don't disturb the laboring mother because it interferes it can prevent breastfeeding and bonding and and lots of disconnection with the baby it's it's very unhealthy for animals it's equally unhealthy for humans but it's like we've lost that whole body of knowledge in modern day obstetrics and they have no understanding or reverence for the physiology of birth and it does astound me
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knowledge among people who are deemed experts in childbirth. And once you understand that, then you can have the discussion with a family that might be reluctant to deliver it outside of the hospital. And you can say, listen, if you feel safer in the hospital despite everything we just talked about, we respect that, we honor that, but don't expect to get the kind of birth that you maybe have been talking to us about in the hospital setting. They're going to do their thing.
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And you're going to have to sit there and try to stop them from doing their things. And that's disruptive. That's like walking in the room when the dog is laboring. You're going to have to have a discussion or an argument with somebody, no, we don't want an IV right now. No, please stop asking us if we want an epidural. No, we want to get up and move around. No, we don't want the belts on anymore. No, we're going to, I understand you only want us to eat a popsicle, but we brought some applesauce and some yogurt.
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some honey and I'm going to feed my wife this food. And that's what you're going to have to do in the hospital setting. Yeah. It's a battle. And if you can avoid a lot of what they're doing for you and keep your mind focused in inwardly, you can have a nice birth in the hospital. You can, and then you're going to have to fight afterwards with delayed cord clamping and let the placenta come when it comes in.
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and skin to skin all the time. No, my baby's not gonna go to the nursery. No, if you wanna check my baby's heart rate or whatever, come listen to the baby on my chest. No, my baby isn't getting any injections right now. No, you're not putting that stuff in my baby's eyes. Yes, we wanna go home later this afternoon. You're gonna have to deal with those sorts of things. So there's a trade-off. But in my mind, after knowing what I know and seeing what I've seen, the trade-off is an easy.
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easy decision to make. And that's if you have a trusted team and a pregnancy that you do not find that they don't find or you don't find to be something that warrants medical extreme medical attention, stay out of the hospital. Just stay out of the hospital. It's coming. It's growing. The problem is the forces are all funneling people into the hospital. And that's generally what your insurance will make mandate that you do. You know, people don't have a lot of spare change anymore.
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And we talk about that. We talk about that a lot on the podcast in the past about, about saving for your births, like you would for your wedding or something else and putting, putting money away, starting health savings and count when you're 18 years old. If your kid is two years old, start putting $20 a week into a bank account for, for them, for when they're 30 and they're having their baby, they'll have plenty of money to pay for a midwife and a midwife team and all that stuff. If you just plan ahead, but if you expect, if you expect your, you know,
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employer's insurance company. And by the way, your employer doesn't pick your insurance company what's best for you. Your employer picks the insurance company what's cheapest for him or her. That's how it works. I know, I was an employer. And we paid a lot of extra money because we didn't believe in just getting the cheapest insurance. But it would have been much easier, and not safer, but easier and expedient for us to just pick the cheapest HMO.
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Yeah. Option. But we didn't want that because then we feel really hypocritical. It'd be like telling people they have to go to public school, then send your kids to private school. It's the same thing. So we tell our employees, we love the private doctor model, but here's your HMO. Right, right. So you're absolutely right. Like birth and having the birth you want, you truly desire, whether that's home birth or whatever team you want, is an investment. And it's a worthy investment.
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one of the best things you could ever invest in, I believe, for your childbirth education, a good provider that you trust, that also trusts birth, that believes in you and your ability to birth, and that you really do your homework. And for those who can't birth at home, because there are a group of women in a population who it's generally not safe, or they have, like you said, financial restrictions, or for whatever reason, maybe, it's not a good option.
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things you can do to stack the odds in your favor to have a better birth in a hospital. And I wouldn't say it's entirely impossible to have a physiological birth in a hospital, but I do agree with you. It is very difficult. It takes a lot of work, a lot of advocating for yourself, and it really requires a provider that is there and understands the physiological process and can step in and protect you. And the ones I've seen that are the women I've seen that have the most successful
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or physiological births in a hospital setting, number one, did the work to prepare. They knew what they were facing. They weren't going in there like with blinders on. They knew exactly what they'd have to advocate for. And they had a provider, usually a midwife. And sometimes they had hospital experience, but they ultimately trusted birth and they acted as a shield to like protect that mother from the system, from all the rules and the regulations. And they were there to help protect her space. And those are the cases I've seen.
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most success and many of my clients having really beautiful births, but it's absolutely rare. And in most of those cases, the staff and the nurses were all shocked because, oh my goodness, here's a woman in full mobility. She's walking around, she's laughing, she's declining pain meds. They don't know what to do with you. So because it's so rare to even have an unmedicated birth in a hospital, forget physiological, right? Like we don't even see that these days. So it definitely takes some advocating.
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It's in the hospital. Well, that's the problem is that.
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All these things you just, I, I, I, I, my autonomic nervous system is misfiring right now, just listening to the things that you just said that you have to fight for earlier. This is not how you should be giving birth. Right. It's not a scenario. This is not a scenario that's conducive to a high success rate. Right. I mean, do any of your listeners really believe that somewhere between three to
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out of every 10 women have to have a C-section because that's the number in the world somewhere between 30% and 70%. Like countries like Brazil and Armenia and South Africa have 70% C-section rates. Whereas, you know, 40 and 50 years ago, the C-section rate was 5%. Yeah, it's unheard of today. And the outcomes aren't better. The rate of cerebral palsy hasn't changed. The rate of
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slightly worse. Yes, so we're intervening more with same or worse outcomes. Right. And when we don't get good outcomes, what do they do? Intervene more. Intervene some more. Yeah. Yeah, this is why the system is getting worse, not better. This is the administrative state. This is what we live in. This is what, you know, you look at public schools, you look at kids reading at math, reading at.
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grade level or doing math at grade level. And it's dropping every year. And what does the teachers union want? More money. Yeah, to do the same thing. To do more of the same. Well, yeah, it's more of the same. Exactly. And the studies that they use reinforce more medical intervention, more management. And so even the studies they're looking at to inform them, they're picking ones, like we discussed, that are just they're cherry picking and using only that.
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the information and the studies that show, oh, you should intervene more and you'll get a better. Administrative people, Karen, love algorithms. They love to, if A then B, this is what they like to do. And it takes all the individualization out of it, but it also doesn't work. Yeah. Because it assumes that everyone is right on the mean. Yeah. And that's not how bell-shaped curves work.
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It's sort of idiotic to believe that that's the case. And so it's how they look at pretty much everything. You asked earlier, you know, if something really isn't safe, maybe it should be done in the hospital. But who decides what really isn't safe? The model says, oh, go ahead. I said, I would love to hear your opinions on some of these situations because women are told every day, oh, you have XYZ, you're high risk, you have to induce, you have to give birth in the hospital.
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Yeah, let's let's pick Dr. Seuss brain. Here we go. Here we go. The model is is again, they fear birth doctors don't like uncertainty. So excuse me, they don't like nature's uncertainty. Yeah. So they will do things to control nature's uncertainty and in the process of doing things, they will create their own chaos.
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But their chaos is fine because it's chaos they created and they know how to deal with it. Controlled chaos. And in that process, they decide what's, somewhere along in the past, somebody decided this is high risk. The term I hate, because high risk doesn't mean anything. Increased risk does not mean high risk. And what is risk? Yeah, I mean, it depends. You can't define, you have to, you need number, you need.
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something subjective to define it. But when you just label someone high risk, that doesn't give you any information that's helpful. No, and it's not supposed to. It's designed to get you to disempower yourself and to be more malleable by the system. So let's talk about things that are traditionally considered high risk that if you just stop for a second and take a deep breath and think about it, you'll say, well, that makes no sense at all.
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And one of the number one, one I think that people talk about, oh my God, you're 35 years old. I was making my list. AMA, advanced maternal age. Let's shoot that one. That's the number one thing that people, that anybody, any doctor who wants to funnel you down a path of interventions, will bring that up at your first visit. You'll be eight weeks pregnant and they'll already be telling you about how they're gonna manage you in the last month or two months of pregnancy and that you better be induced because you're old, your placenta will die, your placenta will give out, the baby will die.
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Blah, blah, blah, blah, blah, blah, blah, blah. That is so far from the truth that it doesn't even deserve acknowledgement. Air time. And yet so many women are afraid of it. There are increasing chances of things happening as you get older. But as Sarah Wickham likes to say, increased chance doesn't mean a high chance or high risk. It just means it's increased. Twice a very small number is a very small number.
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The analogy that I use all the time is when I used to live in California, there are 40 million people in California. If something happened once last year, the incidence would be one in 40 million, which is essentially zero. Say it happened 10 times this year. So somebody could say, my God, there's been a tenfold increase in this event happening. That's awful. And it sounds awful if you say that. It sounds risky. But the incidence is still one in four million, which is still zero.
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So that's relative risk versus actual risk, which is what you were trying to mention earlier. So with advanced materially, it doesn't mean anything.
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Why can't a person who makes a deterrent with a 37-year-old woman, who makes a deterrent, have a labor that's unfettered? What's going to happen to her in labor because she's 37 years old? Right, right. I would be much more interested in her metabolic health, her nutrition, her diet, her exercise. Like, what's going on on the inside? Because you could have a 40-year-old woman who has a much healthier pregnancy than a 28-year-old unhealthy woman. Of course you can, but that falls outside the algorithm. Right.
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They don't know what to do. Yeah. So they see some increased risks of certain outcomes, fetal demise, stillbirth, fill in the blank, for women who are 35 or older. And it used to be 40 or older. And so even though it's a very small number, we're going to induce everyone over 35 or put restrictions on everyone over 35. And it's usually these numbers. You want unnecessary testing on you over 35. Yeah.
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going to test your baby, we're going to do this, that, that, that, and the other thing. Yeah. That makes no sense. And by the way, nobody can defend it. They can, they can, they could say, well, you know, Williams of Cetric says this, or the green journal says that, yeah, so what? Think about it outside of the box, get outside of your goddamn box, and start to think about these people as individuals, and individualize it. So when I first started doing home birthing, I was, you know, I, I'd been backing Midwives for 24 years.
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taking their transports from home. So that was my exposure to the midwifery model, but it did alter me over that period of time from the doctor who came out originally thinking that I was this medicalized physician, but I knew everything because I was a Cedars-Sinai, you know, the Brigham and Women's Hospital of the West resident graduate. I was the administrative chief resident. I was a hotshot resident, whatever you want to call it.
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coming out and I was this guy wearing the full hazmat suit with you in the thought of me position, draping your legs with blue drapes and washing your vulva off with betadine and catching your baby doing vaginal exams while you're in labor and catching your baby and immediately cutting the cord, not even delayed cord clamping, immediately cutting the cord, showing you this marvelous thing that you just created and then walking across the room and setting it down in the warmer. This is what I did. I did it for probably a decade before I started to realize how stupid it was.
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And that's the thing that my colleagues are stuck in. They're stuck in the hamster wheel and they don't realize a lot of things they think that are, you know, are protocols or, or, or guidelines are, are, are really stupid because they don't apply if they, if they don't happen. So take, take somebody who's got type one diabetes, not even gestational type one diabetes type one diabetes, isn't the same disease in 2023 that it was in, in 1975, right?
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Most diabetics have implants now. They can look at their phone and get an immediate reading of what their blood sugar is. They can push a button on their phone and give themselves a dose of insulin. So they're in much tighter control. And the risk of type 1 diabetes is really not macrosomia. You could see that sometimes with gestational diabetes, but it's growth restriction and it's stillbirth. That's what everybody's worried about. But those things really only happen when you're in poor control. If you have a diabetic who's in good
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she's really no different than a woman who's regulating her own blood sugars normally. Yeah, that's, you know, that is such an important point because all, almost every mother with gestational diabetes is told you have to induce it 37 weeks or something somewhere around there. They don't even look at the numbers, the blood sugars or anything. And what you just said was if their blood sugars are well controlled, there's no difference.
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in that pregnancy, that baby to a mother without gestational diabetes. Did I hear that right? Yeah, no significant difference. Okay. All right. There might be, there might be like, you know, a tenth of a percentage point or one percentage point difference, but ultimately you're not giving people informed consent when you're just telling them that it's dangerous. And that they have to induce. And what is the reason they induce? Is it because they're afraid of macrosomia or a big baby?
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Uh, if it, yeah, in gestational diabetics, that would be their reason. And then also the big fear is stillbirth. Okay. But I can guarantee you, if you ask your doctor who's telling you, you need to be induced to avoid that what's, what's my risk of stillbirth doctor at 38 weeks versus 39 versus 40, I would bet you a hundred dollars. And it's all I can afford actually, um, that they have no idea because all they're doing is repeating something they learned in residency. Yeah.
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And once it's ingrained in their mind, that's just it. Again, it's because they can control that sort of chaos. They don't care, as I said earlier, they don't care that they're causing chaos. Then we have a, you know, we have a.
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rising rate of childhood chronic diseases that, you know, there may be lots of explanations for that, but certainly all these interventions and cesarean birth and pharmaceutical products and stuff like that are contributing to that. Right. And that's the other side of this whole discussion is that they never tell you the risks of the intervention. They never tell you the risks of the induction, the cesarean, of causing your body to go into labor three weeks or four weeks
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before when it's actually ready or when your baby is ready. And that has lots of risks and downstream effects that they don't talk about. Yeah, anytime you're gonna deviate from mother's nature's design, the burden of proof is on the deviation, not nature's design. So true. And that's something that they just don't do. I mean, the American College of OBGYN has lost its way for a long time, but now they've gone off the deep end.
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And they are not an advocate for women's health care. They will, they're great at propaganda. They put out stuff all the time. But they're advocating that a pregnant woman, every pregnant woman should get four vaccines while she's pregnant now. Wow. A perfectly healthy pregnant woman should get four vaccines while she's pregnant. And they advocate, and by the way, they encourage people, people, they encourage doctors.
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to counsel their patients in such a way that they'll take the vaccines, which I would call skewing your informed consent. And then if the patient decides not to take the vaccine that you just counseled them on, then it couldn't be because the patient has an independent mind, it has to be because you counseled them wrong. This is what ACOG says. And their counsel I would call manipulation. Yeah, you know what? And again, it's propaganda and they've lost all authority. The problem is, is the media
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And most people in America still consider them to be a spokesperson for pregnant women. And even worse than that is the American Medical Association, which doesn't even represent practicing physicians. It represents who? It represents the American Medical Association. So we have these sideways, you know, almost corrupt medical associations and colleges informing doctors.
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who are trained by colleges who are also run by pharmaceutical companies in many cases or influenced by them. And you have a whole system that is essentially them all watching out for each other's back, but not the mother, not the family, not the bond. At this point with what we know, if you have an obstetrician that's encouraging you to get a DTAP shot or COVID shot, or now this RSV shot in pregnancy, that is a doctor I would run away from immediately.
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Because that doctor doesn't know anything. The doctor hasn't done his research. And if they tell you that this is safe and effective, those are two words that need to be eliminated from the English language because they don't mean what they think they mean. It's like that little guy in Princess Bride who kept saying inconceivable. And I think Andre the Giant or somebody, or no, Manny Patinkin and Zanigo Montoya keep saying, I don't think that word means what you think it means. Right, right. Because it doesn't.
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it doesn't mean they're not safe, but they've never been tested for safety. So getting back to your issue, getting back to your issue Karen about other high risk situations. Yep. So why can't we do a diabetic at home? And we have. And how comfortable would you be with with a gestational diabetic woman going 40 weeks in labor or 41 weeks even? Like most doctors would balk at that idea. Yeah, but they
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But they couldn't tell you why. They'd say, well, the risk of stillbirth rises. Okay, great. It rises in non-diabetics too. So beyond 36 weeks, the risk of stillbirth rises in every pregnancy. That's not the issue. The issue is what's the actual rise? What's the actual, show me the data. Right, and what's the downside of your intervention? What's the downside of you wanting to intervene upon me? What's the negative there? And then let me weigh those two things.
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Yeah. So I started doing diabetics at home. Even before that, I obviously I started doing breeches at home and twins at home. Now, I was lucky because I trained in an era where breach and twin delivery were just considered a variation of normal. And part of being a Cedars-Sinai resident, I spent four months in my second and third year of residency at LA County USC, which in the early eighties was the busiest hospital in the country doing about 22,000 births a year.
35:37
which is about 65 babies a day. So we were doing 65 babies a day. There was a team of us, the younger doctors did most of the deliveries, the older doctors just hung around in the lounge. That's sort of the residents and how we did it. There was no attendings on the floor. We ran the entire floor and it was great training. It wasn't necessarily great medicine, but it was great training. So if breach is 3% of the population and we're doing 65 births a day, we're seeing two breaches a day. We're seeing two sets of twins a day.
36:07
uh you know every day for four months every other day excuse me for four months so that's 60 days that's that over 100 breaches over 100 sets of twins a lot of experience so you're not going to get that kind of training anymore but i was lucky and um sort of made it my mission now as i've slowed down away from clinical practice to go around the world and teach these skills because they are dying out and they're so and they're so easy to do and they're so beautiful and yes
36:37
There can be a problem with a breech birth, but there can be a problem with a head down birth. And the British have taken a good look at this and they have come up with rounded numbers that tell you that the chance of having a neonatal death with a vaginal breech birth at term, properly selected with a skilled practitioner, the chance of not having it happen is 99.8%. Chance of it not happening with a head down birth at...
37:05
firm is 99.9%. And the chance of not happening with the caesarian section for breach, that term not having a neonatal death, is 99.95%. So you increase your, if you do a c-section for all breaches, you increase your safety from 99.8 to 99.95. That's a fourfold increase in safety. But if you told somebody that you have a 99.8% chance of not having a problem with your labor, how many people are going to choose the caesarian section when they know
37:33
that that cesarean section causes problems. The cesarean section causes problems for their baby, potentially with the microbiome and breastfeeding and skin to skin and the lack of hormonal things. And we're learning about babies having to navigate themselves through the pelvis is very important in their early development. And when they are denied that, there's developmental delays that occur as well. And then what's the problem with all that mom's future babies? Yeah. Say she wants a second pregnancy or a third pregnancy and now she's got a scarred uterus.
38:03
And she has to deal with all the hysteria over VBAT. Yeah. And the risk goes up for those first cesarean risks with each subsequent cesarean. So even though you might get a very slight decrease in the chance of still field demise with the first cesarean, your future cesareans go up and up and up. And so for mothers who want to have more kids, it's very important to have this conversation and to know the real numbers. And I love the fact that you gave women the real numbers. Like, here are the actual risks.
38:32
We're not going to sugarcoat it. We're not going to, you know, sway your opinion. You get to decide what's a risk worth taking for you. And I think if many women were presented with those options, they would see like, this is a risk I'm willing to take, or maybe not. Maybe this is their only kid. They're only having one kid. If I want to get you to have a C-section for your breach or for your VBAC, not try a VBAC, I could skew my statistics and make you fearful of it. It'd be really easy to do. This is what my colleagues are doing. And so much of this is fear and how.
39:01
We talk about birth, how we view birth, how we present birth and these risks to women and to families. And I find that like really a lot of this is fear that gets in our heads. If we're talking advanced maternal age, gestational diabetes, delivering a breach or twin vaginally, women are bombarded with this high risk, danger, fear, like emergency lights going off. And it's really hard to decipher through all that noise and not let it get to your head.
39:30
but so much of it is like not allowing it to get in your head, in your heart, and actually making an educated decision and choosing to piece, choosing to walk forward and have confidence in your body that it knows what to do and having those skilled providers there to support you. So let's talk about twins, because that's a similar situation. You even deliver twins at home, which is unheard of.
39:58
I think, I don't know of any, I mean, there are others that do it and because of you and other obstetricians and people training in this skill. There are states where it's legal for midwives too, Karen. So yes, midwives are doing it. And I was just at your training. You came to Rock Hill and we're teaching a whole group of midwives there and the skills of reach and twin delivery, which is a dying art. And so I want to give you the, the mic a little bit and have you just share a little bit about that because it's so important. Yeah. I mean,
40:27
The twin birth, again, requires some knowledge of twinning, and you need to be experienced in deciding which moms are good candidates for out-of-hospital care and which aren't. And that's not hard to do. They will declare themselves. And I know I'm not going to get into a big lecture on the core ethnicity of twins and all that other stuff, but the most common kind of twins are fraternal twins or non-identical twins or what we call die-die twins.
40:57
stands for diamniotic, dichorionic twins, and that's about 80% of twins. And about 20% of twins are gonna be identical. And that's where there's potentially more problems when you have a shared placenta. But assuming that no problems arise and twins get to about 35 weeks. And the only reason I use 35 weeks as a cutoff is because we don't have
41:27
high levels of respiratory assistance at home. We can deal with that. But babies born a little prematurely sometimes need respiratory assistance. And I know when hospitals are good at that, the problem of course is then that once the baby gets in the NICU, you have the whole NICU or baby jail scenario, which maybe we'll talk about another podcast sometime. But so 35 weeks or beyond. And then really doesn't, when you're a skilled breach practitioner, it doesn't matter if baby A or baby B or both are breach.
41:56
If they're in an improper breach position, then there's no reason that they can't deliver. And Rick said, Friese and I are having a paper that's coming out. We're dealing with a peer review guy that's the most anal peer review guy I think I've ever seen in my life, we've got to answer like a zillion, zillion different semantic questions. We're going to deal with that tomorrow. But then you could have, then it's just having a baby followed by another baby. And yes, there's a higher risk of.
42:25
having to do something with the second baby, there's a higher risk of postpartum hemorrhage. There is. These are all things that midwives are trained to manage at home. Yeah. And most people don't live in a maternity care desert. And if they have to call an ambulance, you're usually not that far from a hospital anyway. There's a false sense of security being in a hospital because they believe if you're in the hospital that you're only 20 feet away from an OR. But that doesn't mean the OR is staffed. There's people.
42:55
sitting around waiting for this disaster to happen that you have an anesthesiologist and a scrub tech and an OR crew all just sitting around waiting. So things don't necessarily happen that fast in a hospital either. That's why they used to have this 30 minute rule. And they may not be paying attention to you at that point when you're hemorrhaging or, you know, checking up. There's that's definitely an error. Yeah, there's a lot of that's definitely true. Right. So again, bad things happen in the hospital and you should ask yourself, well, why?
43:24
If the hospital is so safe, you know, there's a money, it's the money ball theory. I don't know if you ever watched the movie money ball, but there's a line in there where I think Brad Pitt says, um, you know, the, the, the scout was telling me, this guy's a really good hitter and Brad Pitt says, well, if he's such a good hitter, how come he doesn't hit good? You know, so it's a, you know, if the hospital is so safe, how come the hospital is so unsafe? Yeah. And then you have to start to really analyze it and it makes people really uncomfortable.
43:52
to look at something that they've been supporting all their lives. It's this cognitive dissonance of saying, you know, it really isn't that safe here. Maybe you're better off being at home and only coming in if you're, if your midwife believes it's really necessary to come in. Yeah. I love what you said about the twins that what, what if it really is just that simple as you have one baby and then another one comes out, but we've been trained to think that there's like this something so special or different or unique about twin birth and that.
44:21
It's so much more dangerous and all these complications could happen. I find that most of those fears are really relegated to the breach. What if the second baby is breach fear? And like you said, there's other risks, other slightly higher risks involved, but most of it's all this fear about breach. But if a provider is trained in breach delivery, that's not an it's a non-issue. Like we just deliver the baby if it's a butt down. OK, the baby still comes out.
44:49
If there's a foot hanging down, okay, grab the other one. Like what's the big deal? Yeah. As we talked about it, rock hill. And I talk about it. Most of my seminars, one of the, one of my hugest pet peeves, and I've got a lot of them about the medical model. But one of my biggest is that doctors who aren't comfortable with breach birth. In other words, they, if you had a Singleton breach, they'd offer you a C section only, and if you had twins, then one of the babies with breach, either A or B. And they say, listen, uh, it's not safe. They lie. And they say, it's not safe.
45:19
because they don't know how to deal with it. And so we need to do a C-section on you. Those people are not twin experts because in more than 50% of twins, at least one of the twins will be in a transverse or breach presentation. So if you know that at 10 weeks when you come into my practice and I'm diagnosing you with twins and I don't do breach delivery,
45:47
An ethical physician would say to that woman, wow, congratulations, this is really exciting. I'm not your guy. I don't know how to do breaches. More than half of twins are gonna have at least one breach. You should go see somebody who knows what they're doing, but that's not what they tell them. Yeah. They start to groom them. So almost like grooming. To imply that this is so high risk and so dangerous and you need all these ultrasounds and we're gonna refer you to a maternal fetal medicine specialist and they're gonna do extra ultrasounds and we're gonna use a lot of color flow Doppler and there's no danger to color flow Doppler.
46:17
There's no danger to all these ultrasounds who've tested it. No, we haven't. But they're going to tell you all these things, and then you're going to have to be, oh, you got mono-dye twins. We're going to have to consider inducing you at 35 or 36 weeks to avoid the rate of stillbirth. Them, again, not knowing any of the data about stillbirth. And we did a whole workshop on breach and twins, which is in my e-course. So if you're listening to this and you
46:47
are concerned about a breach or you have twins, I encourage you to check out, it's in the Pain Free Birth eCourse as a special bonus for breach and twins. Cause this has been something on my heart when the more I've seen the home births and the breach and the twin home births and how beautiful they can be and how much they are sabotaged in a hospital and how highly medicalized and how much they have interventions that are frankly unnecessary, which is what I'm hearing you say is that
47:15
All of these things are unnecessary. And so it really was on my heart to give women the information. And so you were so gracious to come on and share. We talked for over an hour about specifically breach and twins, what the risks are, what the numbers and the studies actually say, what you've seen in your practice as an expert delivering breach and twins at home, and giving women all the information they need to make the best medical decisions for those mamas. So I encourage you to check that out. It's a great way to do it.
47:42
Dr. Sue is just a wealth of information when it comes to this topic and truly a pioneer in this field. I want to ask you about another situation Tell me can I say one more? Can I say one more thing about that? One of the things that that your listeners should pay attention to also is not just where it's being done, but what's the success rate? Yeah If you look at papers around the world, you'll see success rate of hospital breach or hospital twin deliveries are 50 to 60 percent And you'll see that the success rate in first time moms
48:13
Without any complication at all, the success rate is going to be about 75%. It'll be about a 20 to 25% c-section rate. You take those same three categories, breeches, twins, and properly selected head-down babies at home, and you're going to have over a 90% success rate. And that matters too. You know, it's not just the major rate. It's also the success rate because the non-successful, again, that's a bad term, but.
48:41
A non-successful vaginal, I mean success with a vaginal delivery, I don't mean successful pregnancy. But if you end up with a cesarean section, as you will, 20 to 25 to 40% of the time in those scenarios, and you want another baby, as you said earlier, that's going to put all those other babies at more risk than they would have had had you been able to have a successful vaginal twin or breech birth. So.
49:08
Yeah. And that's the rate of a normal singleton delivery. You have a 30% cesarean. Well, in the midwife model, the singleton success rate is between 90, I would say 93 to 98%, depending on which midwifery practice you're in. That same low risk cohort of women, not talking about preemies, preeclampsics, anomalous fetuses, anything like that, they're going to have at least a 25% C-section rate in any hospital.
49:37
And the only difference is the model by which they're cared for. That dangerous, terrible midwifery home birth model that has a success rate of 95%. Right? Yeah. I say all the time, your number one risk is your choice of provider. Because they let mammals labor how they're supposed to labor. And there's no time. There's no time pushing. Nobody's looking at their watch. Well, not in front of the patient anyway. But you know, we're not. We don't have, oh, you've been ruptured for 18 hours. Now it's a danger zone. As if bacteria suddenly know.
50:07
No, we don't do vaginal exams in the home. Yeah, that's another great question is the having your water break, PROM, right? Like they say it 24 hours, you have to have your baby with it 24 hours as if the clock ticks midnight and you switch into having an infection. It's just preposterous. And the other vaginal exams that whole time on you. The data doesn't support that. And that's the problem is they're doing vaginal exams.
50:34
Yeah, introducing bacteria, which is going to cause the infection they're trying to prevent. Right. And then they give you antibiotics because they don't believe there's any downside to antibiotics either. Yeah. So these are all the risks of hospital deliveries and birth in an environment that is prone to this type of care and this type of medical management. These are the real risks we need to be looking at here. Yeah. And we haven't even gotten into the
51:03
hormonal disruption that occurs when you go to the hospital and you're induced and you're put on, so you're given prostaglandin and then you're given pitocin, and then you're given an epidural. And essentially you're cutting off the mother from communicating with her baby. And the baby is then left to its own accords. And obviously sometimes more frequently than I'd like to admit that you see this thing that they label fetal intolerance to labor, and you end up with a category two fetal heart rate tracing, which no one knows what it means.
51:33
And then they end up doing a C-section on you and the baby comes out screaming. And they say, see, great. We, we, we saved your baby. And ultimately if the baby came out screaming with Apgar's of nine and nine, um, did your interpretation of my fetal heart rate tracing actually make sense? Did I really need to have this intervention in the first place? That's never, there's no self-reflection there. They never look back and say, geez, how come we're getting these good babies, uh, for these diagnosis of fetal intolerance?
52:03
the labor. The baby was fine. You guys are brilliant in your memes. You say things like it's not fetal intolerance labor, it's doctors and inpatients with, you know, with labor. Yeah. When we're introducing fear, when we're disrupting your physiology, when we're putting you on drugs that disconnect you from your baby. And then we wonder why did baby go into fetal distress? Hmm. Maybe it was all the interventions we did, all the fear we did, all the chaos we brought into the situation that would have happened quite normally had we not.
52:33
than in the room, right? And so it goes back to that fear once again, and what environment are we? And that gets back to the mammalian birth thing too. It's like, you cope much better when you're not in a fight or flight, autonomic, high level situation. It always goes back to the physiology because the physiology is at play, no matter where you birth, whether you're at home, whether you're in a hospital, whether you're in the woods, like.
53:00
And this physiology also plays out at home if you have people there who are bringing fear into your environment. Because it's not that hospital birth is always bad and home birth is always good and beautiful. There are home births where there is fear, there is anxiety, and the same physiology can disrupt a woman in labor. And you can see higher rates of hemorrhage, higher rates of stalling in labor, higher pain, you know, lots of, you know.
53:29
questions and I think any kind of fear or disruption makes birth less safe. Right. You know, it's not as complicated as maybe we've spent almost an hour talking about it. It's not that complicated. It really is quite simple that what we're doing in the medicalized hospital birth model pretty much from the moment you're getting your car to drive there and not
53:57
till the moment you put your baby in the car seat to drive home, everything that they do, everything that they do, did I say everything that they do? Is antithetical to nature's design. And almost none of it is for the benefit of the woman. Almost all of it is for the benefit of the hospital, for their systems, for their pocketbook, for their misguided policies, whatever. That's what these are things are for.
54:25
They, you know, they that's that is not how birth should be. And that's something that's got to change. And my belief is, is that this obstetrical system will last another 30 or 40 years, sadly, but it will eventually collapse of its own weight. And because women are figuring it out. And, you know, medical tyranny has never been more exposed than it has been over the last three years. Yeah. And people are starting to
54:52
ask questions, which makes people who have a house of cards very uncomfortable. Yeah. And it's, it's fascinating to watch people wake up to the truth of what's going on with the corruption in the medical of the medical establishments and all of this behind the scenes that you guys do such a beautiful job exposing and discussing intelligently on your podcast, Birthing Instinct. So for any of you who have not checked out Dr.
55:22
so informative and you really do expose what's really happening in the world today, in the birth world, in the medical world, and it's profound. We've never seen this in our life. What do you see happening in the future? You said 30 to 40 years, then it collapses. I feel like there's going to be people who stand up and say, you know what, I don't want to participate in this model of care. It does not serve me. And I feel like...
55:47
physicians, doctors, midwives, patients, families are going to band together and create their own networks. But that's because I feel like there has to be something, right? But I think that the corporate entity of medicine is so big. Yeah. And they have so many tentacles out there. I mean, most people cannot afford to live outside the insurance realm. And the insurance realm, first of all, most often doesn't not cover out of hospital birth.
56:14
And even if they did, they wouldn't cover it to the extent that a midwife needs to make a living because a midwife is limited because of the model of her care and the attention she gives her clients to not taking that many clients a month. Doctors, because they work on shifts and rotations and in large groups, they can see 40 patients a day, they can do a hundred, you know, their group can do a hundred births a month and you'll, you know, and the doctor will come in the room, doesn't even know who you are. Um, that's not care.
56:43
Whereas a midwife, you know, she knows you, she knows your husband, she knows your kids, she knows that your grandmother is ill, she knows, you know, she knows all this stuff. And so it all comes into play because of the model of the care that they're giving. Yeah. So I just think it will eventually collapse of its own weight, but they have all the cards on their side and so, and they'll put up a stink because they. It's hard for people.
57:10
on their career and say, you know what, I was really doing it wrong. I really need to apologize to myself and to the women I've cared for. And I'm not going to continue to do it anymore. But if your paycheck is dependent upon it, if your ego is dependent upon it, um, there's a real difficult thing with, with self-reflection. Uh, there's a cognitive dissonance that sets in because no one wants to admit that they've been doing something wrong to people for a long period of time. Right.
57:39
And so they'll fight to the end and defend their position, much to the detriment, more so more to the continuing detriment of the women that they're supposed to be caring for. Like the doctor I told you won't send the twins to a doctor who's comfortable with breach. They'll just justify it in their own mind. Yeah. Well, I'm an obstetrician. That makes me an expert in everything obstetrics. No, it doesn't. Yeah. No, it doesn't.
58:08
And so, so women really have to learn to fight for themselves. They have, they have to have this knowledge and, and understand how to navigate this. Cause it's, it's a bit of a dangerous world out there in modern obstetrics. Well, modern medicine in and of itself. I mean, you're talking about, you're talking about pushing vaccines. You're talking about pushing statins, talking about pushing SSRIs. You're talking about finding out that over-the-counter Sudafed has not had for the last 20 years since they changed it to pseudo-Phedron.
58:38
thing from a fedron or whatever it was before doesn't even work. And they knew it and telling you it's the greatest thing ever. You know, now maybe there's a placebo effect because I used to take Nyquil and I used to fall asleep with Nyquil. Now maybe, maybe I was just believing that it worked, but they're saying that the medicine that's the decongestant in there doesn't work. So there's tyranny and propaganda all over the place. I mean, they've got, they've got a new drug out now for depression, postpartum depression begins with a Z. I can't remember the name of it.
59:08
And then they've got the new a Brizmo, the new RSV vaccine. That was never tested. That was never tested in pregnant women. Yeah, or in newborns. It just never stops. Right. The new booster was tested and apparently 10 mice, new COVID booster. And you're supposed to, you know, and you've got your government telling you, you should get the shot, get the shot. You got Travis Kelsey, who just lost all esteem in my mind, doing a commercial.
59:37
to get the shot. This is a, this is a 20, I don't know, 28, 29 year old athlete and crime physical condition does not need the COVID shot. Yeah. Yeah. I love your advertising. They sell their soul. Right. This sort of thing. And that, and that again, it gets back to the, bring it back to the obstetricians. My colleagues believe this stuff. ACOG has sold their soul. They, they took, they took money from the CDC to promote
01:00:07
COVID vaccine to pregnant women, despite the fact that the Pfizer knew that it wasn't safe in pregnant women. They knew this and they did it anyway. And then they go out there advocating that they're the face of women's health care in America. Wow. It's a lifeguide. You're not. Yeah. It's crazy. It's a clown show.
01:00:32
I want to ask you about one or two other of these high-risk situations. Tell me about cholestasis. Is that a reason to induce?
01:00:43
Uh, in rare occasions, yes. What would those occasions be? Like for women who have the diagnosis, they're on the conveyor belt to induction, what should they be asking their doctor? Well, first of all, let's just talk about if, if you are at near term and you have cholestasis where the the bile acid level, all right, is anything above 10 is considered positive. So
01:01:11
anywhere from 10 to say 70 or 80 or 90, you're not gonna be at risk for stillbirth. The threshold for stillbirth is 100. And there's some good papers out on that. But you might be miserable. You might be itching so badly that you might take the idea that the benefit for you of induction outweighs the risk of, or the misery of waiting. So you might choose to be induced for, symptom-wise for that reason.
01:01:41
But colostasis in and of itself, and there is medicine you can use to try to decrease the itching. And sometimes it works and sometimes it doesn't. But there's, and there's, midwives have this thing called, they talk about liver support, which is a herbal homeopathic remedies and stuff. And again, I'm not an expert in that. I always defer to my, my caldron loving midwives. And because I believe that stuff works too. Well, yeah, you're treating the root.
01:02:09
not the symptom. And if the root is you're not digesting bile, let's support the liver. That makes sense to me. Right. So in other words, you have those rare cases where somebody is miserable, or you have rare cases where the bile salts are getting over 100. Those would be reasons to potentially... So only if the bile salts get over 100 would you induce? Yeah, you look at all the other factors involved. But if you're saying that's the only reason to induce...
01:02:37
and you get a, you know, you get a bile acid level of 47 and you're 37 weeks. Should you induce that woman? No. No. Thank you for sharing that because we, we, I get women ask me this all the time and I'm like, I want, I'm going to ask doctors to do the only reason to induce. The only reason to induce is to prevent stillbirth. That's the fear. Yes. Or, or, or the other as my other, my other example is a woman who's completely miserable.
01:03:05
Right, right. And that's her choice to do it. And then she can weigh the two risks. But she doesn't have to. Just to do it. Yeah. So good to, I love that information. Black and it really is, in some ways, when it's just cholestasis, it's not a nuanced answer. No, the risks in my mind, again, this is being a little dogmatic here, but the risks in my mind of induction are worse than the risks of continuing the pregnancy and waiting for labor to incur.
01:03:35
Normally following them, trying to do some liver support, keep well hydrated, doing all the things that you can do and following it. If it's continuing to creep up and up and up and up, then it's sort of a race between, are you gonna go into labor before it gets to a point where it's making you nervous? But you shouldn't just be nervous because your doctor says you have a diagnosis of colostasis. And that's what makes doctors nervous. Because if I said to most obstetricians, and again, I'm picking on them because they deserve to be picked on.
01:04:05
But if I said to most interested, this woman's 37 and a half weeks and she's got cholestasis, uh, should you induce her? They would say, yes. They wouldn't even ask what her bile salt level was. They would just say that, yeah, I'm telling you, she has, uh, elevated bile salts, bile acids, um, and they would say, yes, they wouldn't even really care what the number is. I know this because. Uh, no, I know. I, I fully agree with you. That's exactly what they say. That's what my.
01:04:35
I've heard women tell me. What about preeclampsia? When would you do for preeclampsia? Well, preeclampsia is a potential problem. And that's one of those things. You know, you asked me what are the, you know, what are, what's risky to do at home? What isn't risky? And we talked about diabetes and advanced maternal age or hypertension. Hypertension is not a contraindication of home birth, but things like placenta previa, obviously, contraindication of home birth.
01:05:04
Severe growth restriction, probably true growth restriction, not your baby's in the eighth percentile, right? I'm talking about a baby that's struggling, that's falling off its growth gear, that has oligohydramia, it's got decreased amniotic fluid, it's got those kinds of things. Preeclampsia is an issue because generally the only cure for preeclampsia is delivery. You can treat it by bed rest.
01:05:34
and doing some other things to try to buy some more time. But if you have true preeclampsia or it's developing into help syndrome, which is where you have elevated liver function tests, low platelet counts or hemolysis, which hemolysis is the one that no one ever looks for, but you could have that too. Or your blood pressures are really high, like doing 160 over 110 or something like that. And you're at a point where the baby's viable and probably will do well.
01:06:04
then yes, there's a reason for induction in those particular cases. There's never a reason to do a cesarean section just because someone's pre-eclamptic or even if they've just recovered from an eclamptic seizure. That's actually the wrong thing to do. And you'll see that people will have an eclamptic seizure at home, they'll be brought in by ambulance, they'll get them stable and they'll take them for a cesarean section. That is the dumbest thing you can possibly do. Interesting.
01:06:34
I guess I shouldn't say it in all circumstances and almost all circumstances. Again, we don't use always or never on the breathing instincts podcast. So we won't do it on yours either. But the reason being is because if they're, if they have an eclastic seizure, they may very well have low platelet count. They may well have other unstable in other ways. The last thing you want to do is major surgery on somebody who's unstable. Yeah. And I have found, um, through experience and all through just some
01:07:02
I don't remember where I read it, but that women who are eclamptic or even pre-eclamptic, when you induce them, somehow the body knows, and the labors tend to go quicker than average. Yeah. Yeah, it's like, I think in some cases where there is actually something wrong with baby with placenta, you know, the body like picks up on it, and it goes right into labor and birth that baby and or the mother's intuition kicks in and they go something's not right.
01:07:31
And it's like the body knows we got to get this baby out. Like at some point it does kick in. And I think that's really interesting what you're sharing about this. Because women find themselves in situations where, well, now we have a hard time trusting and believing what the doctors are telling me is truly dangerous or risky. Because everything is dangerous and high risk now. So how do we know when it's actually a dangerous situation? And that's why.
01:07:59
I'm asking you these questions because I want to give women the information they need to go, oh, these are situations where it truly could be dangerous, where induction is a good idea or I may, I may need to like go to the hospital to transfer, to get medical assistance because we don't want to demonize all medical care. Like you said, there's a time and a place for it and they're really good at handling certain situations. And so we don't want to make it sound like nothing could ever happen or go wrong in pregnancy. But let's talk about those situations where medical intervention.
01:08:29
is necessary or helpful. And I think this is a great conversation to have. And Karen, what women deserve is to be individualized. Yeah. And again, I'm going to reemphasize the fact that the medical model is on an algorithm. And if you have this, then this. It's classic, it's classic, you know, it's deductive logic where you move from one to the other. But that's not how people are. Right. And so what I'm saying here applies to most people, but not all people.
01:08:58
excuse me, women, sorry about that, that slipped out incorrectly. I love that you used women too. I was thinking in general medical terms, but when we're coming to preeclampsia, we're only talking about women. My podcast, we're talking about women. Oh, I don't care about whose podcast. But anyway, I'm just saying that you need to individualize your care and then you have to take into account not only the...
01:09:28
Medical stuff, but you have to take into account the social and emotional history of the of the individual mom The midwifery model allows for that the medical model rarely allows for that. Yeah, so Again people want to know what's safe Well, it's where you feel safest yeah, and I would say that if you're if you don't trust your doctor because we know that we're getting a lot of skewed fearful in fear based information then
01:09:57
You know, get concurrent care during your pregnancy, even if you want to go over to the hospital with an OB, get concurrent care with a midwife. Yeah. Have home visits, you know, every month or so with your midwife so that she can then review the things that the doctor's saying and also do things to help prevent you from having problems that the doctor says are likely to happen because you're over 35. Yeah. I think most women who traditionally have birthed in hospitals or had obstetric care with an OB are usually shocked
01:10:27
pleasantly surprised when they transfer and have care with a midwife because the care is such a higher level of care and they feel like a real person. They feel like the midwife gets to know them, their family, their kids. They feel seen for the first time, not just like a number. It's such a profound difference. And the midwifery model of care is I love midwives and like make sure you find a midwife like Dr. Seuss said, even if you have a condition that requires an obstetric, you know, involvement.
01:10:55
do concurrent care, find someone you truly believe in, like that believes in you and that you trust because you deserve that. Because like you said, like healthcare and prenatal care is not one size fits all. Everybody is unique. Every pregnancy is unique. Every baby and birth is unique and you deserve individualized care. I love that point that you made. And then, you know, we interviewed the Down to Birth podcast people again. It's like podcast people interviewing podcast people,
01:11:25
But there's important data that can come out with that. And we did an interview with them on red flags. And one of the most important ones, that the one that stuck with me the most out of that whole podcast was, how do you feel when you leave your doctor's office? Do you feel better than you felt when you walked in or do you feel worse? Because I can tell you that when you leave your midwife's office, you almost always are going to feel better.
01:11:54
You feel like you've been talking to a friend for an hour. That sort of thing. When you leave the doctor's office, it's often very dissatisfying. I can give you an example. I have had four surgeries on my eye this year. And...
01:12:09
I trust my doctors to be really good surgeons, but they're not really good office doctors. They're in and out of the room in three minutes. I don't feel like I get all my questions answered and some of my anxieties answered. I feel that I'm dismissed easily by they say things like, well, we'll just have to wait and see how that looks next time. Or, you know, that's an unusual finding. We'll have to, you know, we'll know more next week or whatever. That's not very reassuring to me. They don't have any time to really talk about it.
01:12:38
I think they're now remembering me because I've had three surgeries with the same group. But many times they walk in and they would go, they look at the chart and they go, uh, fish bean. This is Dr. Fish, Stuart Fish Bean. No, they wouldn't, they wouldn't know my name. And you leave the office feeling, okay, well, there's that, but I wasn't really feeling good about it. Yeah. So I, yeah, that it's not just, it's not just the prenatal care offices. It's
01:13:07
doctor's office in general, they're on a assembly line. You don't have to see so many people because reimbursement is poor. Yeah, I'm not crying for my eye doctor. So I think they made pretty good living. But you're right, the system is set up in that way. You can't really be successful as a doctor unless you're seeing patients every 15 minutes and and running through them. You can't can't truly care for a woman in pregnancy. Not for what insurance pays you. Right. And and how and how much more
01:13:36
vulnerable is pregnancy than, you know, an eye doctor or, you know, a surgeon, like you, you need to feel deeply cared for and trust your, your provider, your, your, your expert that's caring for you in labor, because birth and pregnancy is so vulnerable. It's, it's not just a medical condition you're going to seek medical care for your, your coming to like, bury your soul and your body and everything and, and you want to know that this
01:14:05
midwife that this provider really has your best interest at mind and knows you and knows what you need, not just on a medical level, but on a physiological level. And that takes skills. I would go even a step further when you said it's really not a medical condition. You're coming in for the doctor, it's different. I'm coming in with an eye problem, that's a medical condition. Right. You're coming in pregnant, that's not a medical condition. That's my point. Right. It's not a medical condition. Right. It's not. So it's more so. So that's why I'm saying
01:14:34
You need a midwife because midwives provide spiritual care, physiological, emotional support, which is what most women deserve in their prenatal care, but you're not going to get that with an OB. No, and another thing bad about the OB model, as if I haven't pigpiled on enough, is that it's very rare in a big center, a big city, for any pregnant woman, even a low
01:15:02
risk normal pregnant woman to make it through her pregnancy without having at least one visit with a high risk specialist, a maternal fetal medicine specialist. Wow. When I was training and stuff, I trained to do ultrasound. I trained to take care of diabetic women, hypothyroid women, preeclampsic women, women with gross restriction. That's what I was trained to do. That's what residency is supposed to train you as an OB to come out to take care of all things obstetric. But what's happened now is that
01:15:30
Obstetricians are now trained by maternal fetal medicine specialists, and I don't know whether it's purposeful or just subconscious, but because maternal fetal medicine specialists see everyone as high risk, because that's what they do. I think what they do is they plant seeds of insecurity in the OBs so that when they come out they need to use the maternal fetal medicine specialist. And I've asked at many of my seminars, did you know any of the women that came into your care?
01:15:58
before they transferred into you, they were seeing an OB that had not yet seen a maternal fetal medicine specialist. And very few, very few. Maternal fetal medicine specialists should be seeing very few women, yet they're seeing the lion's share of the women in consultation. And they have a knack for finding things that don't mean anything and planting seeds of doubt and making you come back for more testing because there's more money in more testing. You don't get paid to do nothing.
01:16:28
And that's a problem with the entire medical system is that it's backwards. I've always, I've always joked that, you know, we have a global fee for obstetrics, you know, and for blue cross, maybe they pay $2,000. I don't know. $2,100. Medi-Medical pay or Medicaid pays probably a thousand dollars, $800 for nine months worth of care. Wow. Right. So how much can you care? Can you give for that? Not much. And what's funny, what's funny about it is because if
01:16:55
The way that they make money is by adding on things, by doing extra testing, doing extra labs, doing extra ultrasounds, doing culture, anything that you can do to increase the revenue. And I understand it from a financial standpoint of view and from your obligation to keep your business afloat, but it's not ethically correct. And so I jokingly say sometimes, what would happen if they had global fees for divorce lawyers? And every divorce was $15,000 for divorce.
01:17:24
Do you know how fast divorces would be over? Very fast. Two weeks it would be over. Right. But when it's fee for service, there's no incentive for the divorce to ever end because that ends the payroll for the lawyers. Yeah. So, you know, there's an absolute, even if it's just the appearance of a conflict of interest. And in our medical model, we have the appearance of conflict of interest, which is an actual conflict of interest as it is in the divorce attorney world.
01:17:54
as well. Yeah. So, you know, when you have that conflict of interest and you have your fiduciary duty pulled in different directions, you're not going to get good care. Midwives don't have that. Yeah. No, they have to respond to their nursing board or their medical board and stuff like that. They have to follow the law. But other than that, they don't have a boss telling them they only have 20 minutes for this visit and that they can't prescribe this or they can't recommend that.
01:18:21
or we don't offer VBAC or the we're not letting anyone go past 40 weeks and six days or, or whatever. They don't have that. They have the stupid laws in their state, but they don't have somebody looking over their shoulder all day long. So they can have your best interest at heart. Yeah. That's why I'm saying at the very beginning that I see the system eventually collapsing under its own weight because people won't tolerate it anymore. Yeah. Women are demanding more. You're absolutely right. And the more we, we
01:18:47
educate them the more they find the information that they need and have that knowledge in their in their power and and learn to take back their power from outsourcing it to everyone around you and believing those seeds of doubt just like you were talking about the more we can recognize those seeds of doubt and go wait a second why does that have to apply to me why do I have to do what you're saying or xyz maybe I can
01:19:11
make my own decision and think for myself and women are taking back our power and families are making different decisions. And, you know, hopefully we hope it has put some, makes a mark and we start to see changes happening. But until they do on a large scale, women have to stand up for themselves and arm themselves with this information. And so thank you for being a pioneer of empowering women, of teaching breach and twin.
01:19:40
you know, vaginal delivery of supporting midwives, supporting women's autonomy and birthrights and all the work that you do, it is truly inspiring. And it is truly making a difference. It may not be making a difference in the system and the giant medical establishments, but you are certainly making a difference in women's lives and in families lives and everyone who tunes into your podcast, everyone where your message spreads your
01:20:09
your expertise and your knowledge is giving so many families confidence and hope that birth can be different and that they can say no, they can get a second opinion, they can trust their intuition, they can trust their body to birth like it's been doing for thousands of years. And so on behalf of all my listeners, I just want to say thank you for continuing to share your knowledge so generously and for coming on this show as well. Thank you.
01:20:39
Well, thanks, Karen. And I just want to say that I appreciate those kind words. I mean, I'm standing on the shoulders of a lot of people that came before me. You know, the Marsden Wagner's of the world, the Michel Odent's of the world, and all of all of the great midwives and all of the midwives that, um, and all their wisdom. And the fact that I want to thank my parents, rest their souls,
01:21:06
for giving me the ability to change midstream, to be open to new ideas and not be narrow-minded. And because I wasn't exposed to anything different than anybody else wasn't exposed early in my career, I just started to listen. Listen to the women. And the midwives. And the midwives, yeah. Who are also women. Right, no, right.
01:21:35
But I'm just saying that that that information is out there. But people are just so closed off to it. And I'm so grateful to those people that came before me that gave me an opportunity. And you're and I, I, it's so important how we give birth. You know, there's a lot of important issues in the world right now. And that one seems to be low down on the list of things, but it's actually should be near the top, should be very close to the top.
01:22:04
It is how we start out in life and how we treat our mothers matters. So much and I think people will begin to see that. And wake up and if we can start to increase the number of people who challenge the medical system, not just in obstetrics and the number of women who choose to birth out of the hospital, if that begins to grow at some point, when you reach about three or four percent of births being in the home,
01:22:35
then the medical model will have to then grant us a seat at the table and they will begin to have to self-reflect. But until, you know, as long as we're 1%, 2% of the birthing world, they can just shut us down. So I'm going to keep going and promoting this option because I think it's the wisest option in so many ways. Yeah, and if it keeps going, everything
01:23:04
and the world keeps going the way it is, I think it won't be too long before we start seeing those numbers. And I'll keep sharing as well too, and giving women the power to choose where they feel the most safe. And that is, as you said, an individual choice and an individual thing. So thank you, Dr. Stu. We really appreciate you coming on and sharing.
01:23:34
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