Ep. 90 - Beyond the Hospital: Reclaiming Birth Autonomy with Dr. Stuart Fischbein

Connect with Dr. Stu:

Stuart J. Fischbein MD is a community-based obstetrician and an Associate of the American College of Obstetrics & Gynecology, published author of the book “Fearless Pregnancy, Wisdom & Reassurance from a Doctor, A Midwife and A Mom” and peer-reviewed papers Homebirth with an Obstetrician, A Series of 135 Out of Hospital Births and Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births. After completing his residency at Cedars-Sinai Medical Center in Los Angeles, CA, Dr. Stu spent 24 years assisting women with hospital birthing and, for the last 13 years, has been a home birth obstetrician who works directly with midwives. Since retiring from attending home births in 2022 Dr. Stu has turned his focus to consulting and traveling around the world as a lecturer and advocate for reteaching breech & twin birth skills, respect for the normalcy of birth and honoring informed consent. He hosts a weekly podcast with his co-host Midwife Blyss Young, together they offer hope, reassurance and safe, honest evidence supported choices for those women who understand pregnancy is a normal bodily function not to be feared. 

Visit Dr. Stu’s Website if you would like to connect with him for a consultation. 

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Episode Transcript

Debra Pascali-Bonaro: Do you know the difference between a Midwife and a Doctor and understand how your provider and place of birth impacts you, your baby and your birth? Have you thought about your options to give birth at home versus Hospital? In our conversation today, we’ll unravel the differences, dispel the myths and shed light on a collaborative approach that can lead to positive and pleasurable birth experiences. 

Hi, I’m Debra Pascali-Bonaro, Founder and Director of Orgasmic Birth, and host of the Orgasmic Birth Podcast. I am so honored to welcome Dr. Stuart Fishbein. He is a community based practicing obstetrician and associate of the American College of Obstetrics and Gynaecology. 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 Breech Births at Home: Outcomes of 60 Breech and 109 Cephalic Planned Home and Birth Center Births. This is amazing to everyone who’s listening. After completing his residency at Cedars Sinai Medical Center in Los Angeles. Dr. Stu spent 24 years assisting women with hospital birthing. And for the last 13 years has a home birth obstetrician who works directly with midwives, doctors do travels around the world as your lecturer and advocate for re teaching breech and twin birth skills, respect for the normalcy of birth and honoring informed consent. You can follow him on Instagram @birthinginstincts, and we’ll be putting all these links into the show notes. You can follow his podcast also at Birthing Instincts with Midwife Blyss Young as he offers hope, reassurance, safe, honest evidence and supported choices for those women who understand that pregnancy is a normal bodily function not to be feared. 

So welcome Rd, Stu, I am so honored to have you join us today.

Dr. Stuart Fischbein: Thank you. It’s been a really long time since we’ve seen each other. That was a really sweet introduction. Thank you. I’m a little embarrassed, humbled by it. But I have to tell you that I still remember a screening of Orgasmic Birth years, and years, and years ago when I first met you. And I wasn’t Dr. Stuu in those days. You know, I was Dr. Stuart Fishbein. I was still working in the hospital. I was beginning to evolve. But I was still sort of in the medicalized model, which I trained in. You asked me before we came on a little bit about my origin story, and I’m going to try to keep it relatively short. But it is an interesting story, because I’d never have seen myself doing what I’m doing today if you would have asked me that 30 or 40 years ago. I went to the University of Minnesota Medical School. I’m just a Midwestern boy, and I ended up matching my residency at Cedars Sinai in Los Angeles at that time. We were affiliated with LA County, USC, the University of Southern California’s Women’s Hospital in downtown LA or East LA. And at that time, that hospital was the busiest hospital in the country. They were doing about 22,000 births a year there, which is about 65 babies a day. So I got excellent training, and we just saw things, like all kinds of medical problems. But we also thought things like breeches and twins as just a variation of normal. And we saw them every day so we were exposed to that sort of thing, and we weren’t limited in our ability to take care of them. In The Times, it was indicated that this is just something that you can do. The data supported breech delivery, the data still supports breech delivery, it still supports twin delivery. But I was lucky to get trained in that era. I came out of residency very medicalized, not how I would practice in the last 12, 13 years of my career. 

But in the first 24 years of my career, I started out as a very medicalized physician. I was that guy wearing the hazmat suit sitting at the end of your bed with your legs up stirrup, you flat on your back, putting blue drapes on your legs and washing off your bottom, immediately clamping the cord and showing you this beautiful thing that you just created. And then walking it across the room and setting it down in the warmer. Never really asking why about any of those things, because that’s how it was done. And when you’re a resident, you just keep your head down and you try to get through residency because it’s a trying period of time. But in those days, you didn’t just come out and get a job working for some HMO, get paid a salary and work a shift. You hustled to build your own practice. And one of the things that happened to me was, I was approached by some of the local midwives in Los Angeles and asked to be their home birth transport doctor. And I said, sure. I didn’t say sure, because I thought home birth was a good idea. I didn’t say sure because I thought midwives were a good idea. I didn’t really know much about it. I said sure, because I wanted to make money and taking their transports was just revenue. So I was a mercenary. But that was the first step in the best thing that ever happened to me, which was the transition from a medicalized fear based physician to a much more midwifery model, trusting of nature, understanding that there’s uncertainty in nature and being accepting of it. And knowing that no matter what we do, we’re not going to have perfect outcomes all the time. But living in a world where we support women and their choices, we don’t sort of skew our counseling and funnel them down a path to get them to do what the hospital, or the medical model, or ACOG, or anybody else wants them to do. And that took a long time. 

And after about 10 years of practice, I finally opened a collaborative practice with two certified nurse midwives. We went to Ventura County because Cedars at that time was not allowing midwives to have privileges in the hospital. And for 15 years, we had a really good thing going there. We had a C section rate of about 7%. The midwives took care of all the normal stuff. They did the Well-Woman Exams, the pap smears, the prenatal visits, the normal deliveries. I would come in if somebody needed a colposcopy, or they needed a biopsy, or they needed an ectopic pregnancy surgery, or they needed a C section, or they had a breech or twins, then I would take care of that. And it was really what pregnancy care should be about. Because obese are really good, most of them anyway, at taking care of high risk problems. But the truth is we have very little experience with low risk problems or no risk problems. But 80, 85% of women are really in that category. I learned that we are not the experts for those women. Midwives are the experts for those women. We are the ones who come in when there is a potential problem. And after 24 years, the hospital that I was working at decided that they no longer wanted to have us in their building so they decided not to renew our privileges. And it wasn’t because we had bad outcomes or anything like that. It was sort of the opposite. Actually, I think we were kind of embarrassing some of the other doctors there. We had a 7% C section rate, the next biggest group had a 27% C section rate. So they decided not to renew our privileges. Before that, they banned midwives, they banned VBAC, they banned breech delivery, all these things. Completely unethical things to do, because it’s not their right, in my opinion anyway, to take away these choices from women. And so I was left with the decision to fight them legally. Which is always a loser for everybody. Nobody wins the legal system in America. Or to just go and start doing home births. And that’s what I did. So I was really forced into it. 

Deborah, it wasn’t a choice. And actually, the first few bursts I went to, I was nervous because I had been in a hospital for 28 years. I knew that there was an anesthesiologist down the hall. I knew there was a NICU upstairs backing midwives for all that time. I was still a little bit nervous. But fortunately, they were all beautiful bursts. And then I got bolder, and then I started to support things like breaches, and then twins. And then I said, if somebody is a well controlled diabetic, why does her birth have to be in a hospital? If she’s in labor and her diabetes gets out of control, then okay, we can take her to the hospital. But why does she have to be in the hospital? Same thing with a hypertensive woman. I’m not talking about preeclampsia, or somebody with some real significant medical problem. You mentioned diabetes to an obstetrician and they’re already telling you that well, we’ll have to do an amnio with 37 weeks, which will induce you at 38 weeks. We can’t let you go like that, your baby will get too big, or your baby might get too small. It’s kind of what I call the Goldilocks effect. The babies are never just right. They’re always too big or too small. They’re always looking for a problem. And you can see it because the statistics in our country have not, not even that they haven’t gotten better. They’ve gotten incredibly worse. 50 years ago, the C section rate was 5%. Now, it’s 32%. That’s a 500% increase in the rate of cerebral palsy, or hypoxic ischemic encephalopathy as it’s known. It’s no different. We spend more per capita on maternity care in this country than any other country. And we rank about 40 to 45th in neonatal mortality and maternal mortality. Yet these people that are running the system are telling the homebirth people that they’re the problem. But I can tell everybody listening that the 1.2% of women in the United States that are having home birth are not the cause of a 32% C section rate. It doesn’t work that way. Okay, that’s not how math works. So that’s what I’ve been doing. And then after 40 years, I sort of decided that I couldn’t be on call anymore. I was a solo practitioner for my entire career, and so I carried a pager. I call a pager, it used to be a pager, it used to be pagers, it used to be a pager. I used to have to pull over and find a cell phone like Superman, a payphone whenever we got paged. But I decided that it wasn’t really good for my health anymore to go to bed every night not knowing whether I’m going to be up or not. It causes adrenal fatigue. It certainly causes stress, and it causes damage to relationships. I’m sure that affected some of mine. 

So now, I just consult virtually. I occasionally give birth. I’m licensed in a couple of states where I go around the world and teach breech and twin skills because my colleagues in academic medicine are not, except for very, very few residency programs. They’re not teaching future doctors those couple of skills, which I consider the thing that makes my profession of obstetrics unique. Because if a doctor can’t do breech or twins, will put forceps, there’s very little that an obstetrician can do that some other specialists, or midwife, or nurse practitioner, or family practitioner, or general surgeon, or maternal fetal medicine doctor, or reproductive endocrinologist, or gynecologist can’t do. So I really think that if the academicians running our programs would wake up, they’d realize that they need to revamp their system, or they’re going to create their own obsolescence. And pretty soon, people that hire doctors are going to realize they don’t really need to hire that many OBs. They can hire a few, and then they can do the rest with other specialties. Whether it be midwifery, nurse practitioners, family practitioners, and then have one maternal fetal medicine person on call at a time. And you can save a lot of money because we get paid more than midwives do. And we are longer trained. 

But I’m not saying we’re more skilled. We’re more skilled at certain tasks. Midwives are more skilled in normal. They are well trained. And when you are an expert in normal and know when not to do something, that is a great skill. But you also become very aware when something isn’t normal. If all you see is normal and something isn’t normal, it jumps out at you. The analogy that I use all the time when I talk is if you live in the same apartment for 30 years, or house, and you go out for dinner one night, and you come back to your house and the chair in the hall has moved three inches from where it normally is, you’re immediately going to know something’s wrong. You don’t know what’s wrong. Did the dog get the chair? Was there an earthquake? Did somebody break into my house? You don’t know. But you know something isn’t right because you’re really familiar with what the front hall of your house looks like. Whereas if I were to walk in as a shift medicine doctor coming into your house, I wouldn’t know the chairs are in the wrong place. Because I don’t know anything about your house.

Debra Pascali-Bonaro: Great analogy. I love that. But I have to say too, I love your whole story. And the fact that if someone had told you 30 years ago where you’d be, you would have never believed it. It was by collaborative practice with midwives that so much shifted. I know you kind of said it, but I’m going to ask you just to say, for the person that is still struggling, what’s the difference between a midwife and a doctor? What could you say in a just short statement for people that understand that difference.

Dr. Stuart Fischbein: Well, there’s a blurring of the lines. And before I go into that question, I just want to say that there are some doctors who are amazing, and some that are terrible. And there are some midwives that were amazing, and some that are terrible. So not a black or white thing. But a doctor is trained in medicalized birth. They’re trained in surgical birth. When it comes to obstetrics, I’m not even talking about gynecology and all the other stuff on the other side. I’m just talking about pregnancy related stuff because that’s where we’re going today. So they’re trained in a system that looks at pregnancy as an illness or a problem. A woman comes into the hospital. And from the moment she walks in the door, I’m even talking about the way prenatal care is completely dead. Well, we should talk about that eventually too. But from the moment you walk into the hospital until the moment you put your baby in the car seat to drive home, it’s a very medicalized system. Pretty much everything that’s done to you is antithetical to nature’s design. Because in nature, as Sarah Buckley likes to say, you want to be quiet, safe and unobserved. And that’s not what goes on at the hospital. The hospital is there to get you in, get you delivered, get you out and move you along. Because the hospital’s mission is not the same as yours even though they have a beautiful PR department who puts lovely commercials on the radio. That is not what their interests are. Their fiduciary duty is to financially make the hospital solvent. And that’s by moving things along, ordering things and doing things that generate revenue. That’s a whole nother story. 

But doctors are trained in that. And in some things like that, they’re really good. If you need an emergency surgery, if you need someone to take care of you because you’ve got cold stasis, or you’ve got preeclampsia, you got diabetes, obese and maternal fetal medicine, doctors and collaboration together are really good at taking care of that. Midwives are trained in a different model. They’re trained that pregnancy is a normal function of the human body. It’s wellness that occasionally goes wrong, as opposed to the doctors who think it’s illness that occasionally goes right. And that’s a simplified way of saying it. But actually having lived in both worlds, I can see it more clearly than many. Some people get very angry at me for making this differential because they think they’re saving people. And they are. We talked about 32% C saturate, 40% induction rate. The stats just came out of England, and they have 43% of women in England going into spontaneous labor. 57% of women in England do not experience spontaneous labor. That’s crazy. (inaudible) in England it is 39%. And that doesn’t even come close to places like Armenia, or South Africa, or Brazil where it’s close to 70%. So midwives look at birth as a normal thing. As I said earlier, they’re experts in normal. They can recognize when things start normal, but they also their model often is not insurance based. So they have more time to spend with you. 

A prenatal visit is about an hour long. So they do things like preventative care, they talk about nutrition, they talk about stress reduction, they talk about sleep. They ask you how your relationship is, they develop a relationship with you, they get to know you. Doctors would like to do that, but doctors don’t have the time to do that because doctors generally take insurance. Insurance pays very poorly. So in order to cover the extensive overhead that it costs to run a medical practice, whether it’s an HMO or private practice, they have to generate revenue, and they have to turn people over very quickly. So prenatal visits in that model are going to be 6 to 10 minutes long, if you’re lucky. You can’t possibly do it in 6 to 10 minutes, which you can do in 60. You just can’t. And you’re not necessarily seeing the same person because the medical model also works on the shift mentality. They’ll either have hospitalists or what they call laboris, which are doctors that work 12 or 24 hours in the hospital, and then they go home. Or you’re in a large group of doctors, maybe seven doctors, and so you have one in seven chances of having the doctor that you’ve been seeing as the one on call when you’re in labor. And then also the crazy thing about shift medicine, it’s good for ERs and stuff like that, because it’s intense. But it’s not good for personal relationships. 

So you come in and you’re being taken care of by a perfect stranger nurse and a perfect stranger doctor. And after 9 hours, you may begin to really like that person. But then 7:00 in the morning, or 7:00 at night rolls around, and it changes to a shift. And now, you get a whole new face and a whole new person. And that is not conducive to the mammalian model of birth, which is to be left alone to labor to not be interfered with, in the hospital protocols? Don’t allow that. The nurses have to come in and take your blood pressure every now and then. Why? Because it’s always been done that way. I can talk to people in the medical field, how often when a woman comes into labor with a normal blood pressure? Say 110 over 65. All right, and does her blood pressure ever become a problem for the rest of her labor unless she gets an epidural or something where she gets hypotensive. But yet, hospitals will have policies where they have to document her blood pressure every hour or two. So she’ll be in her zone. And all of a sudden, this thing on her arm will go and it will start to blow up. And it brings you back into your cognitive brain and out of your primitive brain. 

And this is just one of many, many things that hospitals do because hospitals are run on algorithms by people who sit in cubicles who make these decisions. And do I mock them a little bit? Yeah, I do. I do. They train midwives, they train doctors, we go through sometimes hell to get our degree and to get our license. And then we come out and we’re not free to practice the way we want to. So why did we do all that training if we’re coming out only to follow an algorithm set by some arbitrary faceless, actually liability-less person? Doctors are trained to use different medications. But this hospital only has this medication on the formulary. So when you’re giving information to a woman, you have to skew your counseling to conform with what your health organization wants you to do, or you get yelled at.

Debra Pascali-Bonaro: So sad, right? This is important for listeners to really hear because I don’t think the average consumer really understands the constraints that are going on. And I really appreciate you sharing that difference between that midwifery model and physician model. And also stating, I know that we work a lot around the world in places where we don’t have enough midwives that I consider many doctors, MD or midwives in disguise, like people can practice a midwifery model of care, which in some ways you have really stepped into. But I know that people are also thinking this. Let me ask you this, because you’re leaning into it in all different directions. Is (inaudible) safe? Because that’s what I get. People hear this and they go, okay, I hear you. I hear the difference in your cesarean birth rate versus your colleagues. What do you have to say to the people that are on that fence?

Dr. Stuart Fischbein: Well, first of all, safety doesn’t mean the same thing to every person. I could ask you the same question. Are hospital births safe? Is it safe to have a 32% C section rate? Is it safe to be induced with artificial medication? Is that good for your baby? Is it safe to have your baby born in a septic environment and taken into the nursery from skin to skin? If it’s so safe in the hospital, how come newborn intensive care units are filled with babies who came into the hospital inside their mom at eight pounds perfectly normal and ended up in the NICU 17 hours later? So some people think that it’s safe, because you’re close to an operating room. I totally understand that. And some people think that home birth isn’t safe because you’re not. On the other hand, you look at the outcomes and pretty much every outcome category for properly selected moms. I don’t like to use the term low risk or high risk because that means different things to different people like safety, those two. But for properly selected moms, the outcomes and homebirth is safer than a hospital birth. Now, there’s limited things there. If you’re somebody that wants an epidural, you’re not going to get it at home. But then part of the reason you get an epidural at the hospital is because you’re limited in movement, you’re limited in ability to do the things that other mammals would do if they were uncomfortable, like move, or get massaged, or get in the shower, or get in the tub, or get a rebozo, or whatever else to help you deal with these surges that you’re having all the time. So if the hospitals would leave you alone, let you come in and just labor unfettered without all the protocols and stuff? Then it could be considered a possibly safer place in your mind. The problem is two things. One is that you have to get in your car and leave your house when you’re in labor. And that in and of itself is an intervention. And the second thing is the hospital will never leave you alone. They can’t because they have risk managers who decide these policies that say, we can’t leave somebody for hours by herself laboring in a room. We have to check on her. 

But how do we do it at home? Somehow, women labor at home. And by the way, many, many women labor at home for hours, and hours, and hours unfettered until it’s time to go to the hospital. But when they get to the hospital, they’re no longer allowed to labor unfettered anymore. It’s a blockage in the thinking process, Deborah. It’s the long habit of not thinking something wrong, giving it the superficial appearance of being right. And doing something one way for a really long time. I remember one time, I got to speak to some of the residents at a hospital in LA called White Memorial, and I gave a lecture on mammalian birth. Some of the jaws were dropping, and some of the eyes were rolling and stuff like that. But afterwards, we had a good conversation. I said, do you still use a betadine when you have a woman who’s having a vaginal delivery to wash off her vulva? And they go, yeah. I looked at him and I went, why? And they thought about it for a while. And they couldn’t come up with a reason. That’s just because that’s the way it’s done. And then I said, do you still take the babies to the warmer after they’re born? And the nurses would say, yeah, we do. And I go, why? Well, we have to check the baby out. Why? If the baby’s fine, then you don’t have to check the baby out right now. The baby’s not fine, you can actually do some resuscitative things on the mother’s chest. I’m not talking about full on CPR and shit like that. But that’s really, really rare. But they just don’t think about it. And these are good people.

Debra Pascali-Bonaro: We play rituals out of it.

Dr. Stuart Fischbein: Yeah. Nobody goes into this business to just be harmful. I just feel that sometimes when you hear stories of people who are disrespected in the hospital by their caretaker or by their nurse, or they’re just treated gruffly. That to me tells me that the person, the caretaker, is having a bad day or is not a happy person. Because happy people do not treat other people poorly. So I feel for my colleagues that are sort of trapped in that hamster wheel and they can’t get out, that their salary and their life is really dependent on following the rules that are put in place that are one size fits all rules. Every woman that comes into the hospital goes through a ritual when they come in labor. They have them go into the bathroom to pee in a cup, change into a hospital gown. Why? Okay, it’s just a retort. It’s rhetorical. Then they have them get in bed and they put the belts on them. We don’t do this at home. We listen, but we don’t put belts on them. We don’t immobilize them that way. When we have them sign consent forms while they’re contracting every three minutes about death, surgery and stuff. Those consent forms are not meaningful, because they can’t possibly be able to take them in. Plus, by the way, signing a consent form is not informed consent. That’s something your listeners ought to know because you’re not getting informed consent when you sign a consent form. And then they draw your blood and then you ask them, why are you drawing my blood? Well, we have to have a clot in the blood bank, just in case you have a hemorrhage. And they go, well, what do you do when someone comes in with a car accident or a gunshot wound? Well, they get negative blood. Okay, so why do we have to draw blood on every woman that comes in? Well, there’s one reason, and it’s a cynical one. But it’s because they can bill for it. And it’s the long habit of thinking they have to have this blood. 

But then other women give birth at home without any of those things I just described. We don’t make them pee in a cup, or change into a hospital gown, or get on a monitor, or have their blood drawn, or have an IV started. And yet, they still have babies that come out. So it’s just a way of thinking that when you go through eight years of medical school and training, you come out really corrupted in my mind. You only see things one way. And it’s hard getting through those years of training. And so you just put your head down and you go, I talked to many potential OBs across the country who are in college or in early medical school, and they want to do what I did. And they asked me, I want the training, but I don’t want the indoctrination. How do I do that? And it’s very hard because you have to hold your nose for eight years. And it’s very hard to keep your values intact when you’re being stressed out so much for eight years. And this is one of the problems when you talked about that midwifery/doctor difference, where I kind of said there’s a blend because midwifery schools are going more and more these days toward medicalized birth. It’s becoming an issue. The less academic midwifery programs are either closing, or they’re not training enough. But you look at some of the universities and stuff, and they’re becoming more medicalized. They’re following the rules of the American College of nurse midwives with the American College of OB-GYN. So they come out with that medicalized training. And even though they have the title of midwife, that title is kind of like saying ice cream. There are many, many flavors. Ice cream doesn’t tell you what you’re going to get. And the midwife doesn’t also tell you what you’re going to get. An obstetrician doesn’t really either because I’m an obstetrician. My friend, David Hayes is an obstetrician. Henry Adams was an obstetrician, Bradford Bootstaylor. We were a different group of Obstetricians practicing in a different way. But we still have that title. So that’s another analogy.

Debra Pascali-Bonaro: I like that, too. And thank you, this was really helpful. I’m sure everyone is kind of really thinking about and getting some good questions to ask their providers and navigate who their provider is, where they give birth. And of course, I have to end with my question to you, you know that I talk so much about pleasure, joyful and blissful orgasmic births. What’s your think about that? And what would you say would be the way that you would encourage people that want an orgasmic birth to approach birth?

Dr. Stuart Fischbein: I feel like a novice about this when I talk to you about it. What I tell people first of all, I tell families to trust their body. Nature has designed a system over eons that works very well most of the time. Find a practitioner, usually a midwife if you can, and someone that you trust. Do not go to your obstetrician simply because they’re on your insurance plan, or simply because they’ve been doing your pap smear for a decade. That is not a good indication that this person is minded and shares your values. You need to get to know them, and need to ask them certain questions. Blyss and I are putting together a patreon where we will have handouts. So many other ones in our world have done this sort of thing to ask these questions. But this is the most memorable experience of a woman’s life. People say the wedding day and all that stuff. There’s that wedding analogy where you spent fortune on your wedding. And for your birth, you abdicate your responsibility to some third party payer insurance company or something like that, which you would never do for your wedding. But put money aside for this. Save for it. Pay out of pocket if you have to. Cross state lines if you have no choices. If you find out that you’re a VBAC and your hospital isn’t allowing it, or you end up having a breech baby, or you find out at 12 weeks that you’re having twins. Congratulations. Now you’re on a path toward over testing and ultimately induction, or just scheduled cesarean section. It’s hard. I can’t pull myself out like you do where I just talk about the joys of it because I’ve seen both sides. Some of the bursts I’ve witnessed have been glorious, and they make me continue to want to do what I’ve been doing. Nobody can take outcomes where there’s stress or where interventions are either necessary or unnecessary, which leads down this path of this cascade every single day, and that comes out of attained. But it’s not. It’s a beautiful thing. 

I always tell people to watch videos of tranquil births. They’re all over Instagram and Facebook. You just can watch them. Watch how other mammals do it. You don’t see the other cows, or horses, or zebras, or dolphins, they hold space for that female that’s in labor. No one comes in to cut the cord, and no one comes in and separates the mother from the baby. And nobody washes the baby down or anything like that. It’s not designed that way. And somehow, we’ve turned it into this surgical procedure. So finding a good team. I’m not promoting you, but watching videos like yours and other ones that show these beautiful birth stories, there’s so many of them. I don’t want to leave any out so I’m not going to mention them. That can give you an idea, and you don’t have to be thinking that if my birth isn’t like that, that I’ve somehow been unsuccessful. That’s not the case. Every birth is different. And that’s another reason why using an algorithm for birthing that the medical model does is a fool’s errand. That wasn’t a very good answer, but it was a great answer. I just kind of jumped all over the place, but I want the birth of our children to be sacred, to have reverence for it. It’s an amazing thing that your body can do. And to think that your body can grow it, but can’t get it out without medical help. We’ve been conditioned to think that we need a medical system, and we do. This is one of my biggest dilemmas. I’ll just end with this, I would love to see the hospital system as it exists today completely gone. It’s useless, it can’t be fixed. It will not be fixed. The people that are running it are not going to let go of the power and the money that comes with it. But that’s not to say that I want to see hospital birthing gone, because we need hospital birthing. The problem is, if we get all the normal women to give birth in birth centers, or at home, or something like that. Then financially, hospitals will not be viable to take care of the problems that we have. So I haven’t really figured this one out yet. How can we take birth out of the hospital, but yet keep the hospitals there for when we need them? I’m working on that one.

Debra Pascali-Bonaro: Work on that because I’d like to know that too. I often say, we need to have environments that are home births in the hospital. But I also feel that that should be for a select few because we know that birth centers and home births really can provide some of the best environments and best outcomes. I like how you say too for the women that are carefully selected for that. We know that’s the vast majority. Well, I can’t thank you enough for joining us today for sharing so much of your insights, wisdom and analogies that I love. But I know listeners want to know how they can have more. Can you share some of the things you’re offering, and where people can find you?

Dr. Stuart Fischbein: My website is birthinginstincts.com. And from there, there’s links to everything from the papers that I have written on home breech birth on home birth, a case report on twins with entangled heads. (inaudible) and I have a paper that’s in preprint that we’ve submitted for peer review on home twins for 100 sets of twins at home. And we’re going to hopefully get that out. We kind of got jerked around in 2023 by a journal so we’re going to try to do that. Then on my podcast, Birthing Instincts Podcast with my friend and midwife Blyss Young. And then our website for that is we’re not very original, it’s birthinginstinctspodcast.com. You can go there, and then you can reach out to us through the email, the question section on that. We’re putting into Patreon together where we’re going to have added content. We do a podcast once a week, but we’re going to be starting to do extra video content and put it behind like a paywall so we can continue to support ourselves to make this happen. And then on my website, if people are interested in training for breach, there’s the event schedule, and they can look on that and see if I’m coming to an area near them, or if I’m in a country where they want to travel. I was in Ireland in October this year. Last year, I mean. We had people come from Tennessee that wanted to come and spend a week in Ireland, and then they had two days with me. I reteach the skills of breech and twin. I’m not tooting my own horn, but I would tell any residency director right now that if you’re not teaching these skills, look at breach without borders, and look at me to come in and give us your residence for one or two days, and we will teach them to have the skills that they need to know so that they can do breech delivery. They won’t be experts in breach, but they will have the skills to know what to do when that situation happens where someone comes in and dilated with a butt sticking out, and no one knows what to do. So I’ve made it my mission now that I’m not really doing births as much to continue to train as long as my brain continues to work.

Debra Pascali-Bonaro: What a great gift that is, because we need your skills and wisdom to keep training and speaking out, and teaching all those new providers, doctors and midwives in breech and twins.

Dr. Stuart Fischbein: They have to learn when they’re training, Deborah. Because once they’ve been out for 10 or 15 years, and they’ve got a busy practice, and they’re paying malpractice premiums, they’re not going to learn a new skill. They just don’t have the time to go do the training, nor are they going to have the sort of cohonus to want to do it. So it’s got to come in the educational system. And right now, the people that are running the system are, in my opinion, running it into the ground. They’re not serving the women of our country very well because they’re not training future practitioners to have these skills, which are needed to give women the choices that they deserve. Because these skills and these methods of giving birth are all supported in the evidence in the literature as a very reasonable option. And women should be given all reasonable options so that they can make a choice.

Debra Pascali-Bonaro: That they make their own informed choice. Well, a great note to end on for everyone listening, look into the show notes. We’re gonna add all these links. But birthinginstincts.com, I have to say, I can’t wait to read your paper that’s hopefully coming out soon. Again, thank you, it’s such an honor. I love following you and so appreciate the work, the wisdom, the voice that you bring to birth, so thank you for joining us today.

Dr. Stuart Fischbein: Thank you. I feel really good right now.

Debra Pascali-Bonaro: It’s good. That’s the orgasmic energy, right? We can bring joy and pleasure to our life and to birth, so thank you everyone that has listened. Please share your comments, tag us,like and review our podcast. We look forward to having you join us next time on the Orgasmic Birth Podcast.