Hi, this is Makayla with Honest Talk Radio. Honest Talk Radio is a space where we will be sharing the good, the bad, and the ugly in real, raw conversations to try and do our part to reduce the amount of shame, guilt, and judgment so many of us when we face. Our hope is that through these conversations, you will feel supported and encouraged in every aspect of your life. So let's get started.
This episode of Honest Talk Radio is brought to you by U4 at Urbels. Since 2010, Cindy Cohen, a certified herbalist and lactation counselor, has been helping families in their journey to holistic health. Through products such as herbal blends, teas, and zaps. They've reached over 10,000 customers in 58 countries, and that number is growing daily.
Every U4 at Urbels has been handcrafted by Cindy and her excellent team to ensure you get the quality supplements you deserve. Go to www.u4 at Urbels.com for all of your holistic needs. This week on Honest Talk Radio, I'm going to be joined by Dr. Stuart Fishbein.
He is an OB-GYN that truly values and honors a woman's wishes and sees how important it is to have that communication between provider and client. And I'm just so excited for you guys to hear the wonderful words of wisdom that he has. And he is someone that treats v-backs and twin births and breeds births, not as if they are with this crazy, weird thing, but instead a normal variation in birth. And I just can't wait for you to hear what he has to say.
But before we get to that, I have a question for you. Have you ever been told no in any situation in your life? Because I know I have. I know that I have personally been told, oh, you'll never be able to do that.
Or nope, that's not possible. And how does that make you feel? It probably makes you feel pretty darn frustrated, especially when in your heart and in your gut, you know that you can do this or that. So that's what today's show is really about.
We're continuing our conversations around advocating for yourself and what to do when you hear no. And ultimately what it really comes down to is finding the person or people that are going to say yes, creating that team, that support, and finding someone who truly believes in you and your mission and your desires just as much as you do. And again, that's why I'm so honored and excited that Dr. Stu has agreed to come on this show and have a conversation around some of those challenges that we as women face when it comes to birthing her children.
So let's get started. Welcome, Dr. Stu. Thank you so much for taking time out of your very busy schedule and in between delivering babies and all sorts to come on our podcast today.
You're welcome, Michael. I'm delighted to be here, actually. Well, as we get started, I'd love for you to tell the audience just a little bit about yourself and your journey in obstetrics. Okay, well, just briefly, I was trained in medical school at the University of Minnesota.
I ended up doing my residency in Los Angeles at Cedar Sun Medical Center. I spent a lot of time about four months of that residency at LA County USC Hospital when it was the busiest hospital in the country. They were doing about 22,000 per year there, which is about 65 a day. So I was lucky.
I was trained in an era where the skills that make the profession of obstetrics unique were still taught as part of the normal core curriculum. They weren't taught as unusual. They were taught as part of basically normal, which is why I'm so comfortable in the breach in twin world, which so many of my young colleagues now are not. I finished my residency in 1986.
I went into private practice. I practiced in the hospital for 24 years. When I came out of residency, I didn't think at all. I think now I came out thinking like any other well-trained medical doctor would think that some of the things that I do now I would laugh at or I would ridicule.
Even if I didn't do it publicly, I would do it privately. But then over the time, I began to work with midwives. Practice in those days was different than it is now. You had to hustle and build a practice.
I covered five different hospital emergency rooms and I assisted my associates in my office with surgery. I approached my midwives to be a backup physician. I didn't take them on because I thought that the midwifery was the greatest thing since the life of that. I took them on because I wanted to make money.
Fortunately, I was very open-minded about it. My personality was such that I really hooked on with the midwives and I began to attend some of their meetings and I began to see a different way of doing things. Much of what I knew and was educated about normal birth was untrue. I didn't know anything about normal birth.
Frankly, I became a disciple of the midwifery model of care and began to change the way I did things. As I began to change the way I did things, I saw the hospital models becoming more and more rigid about the way they did things and the two began to clash. After 15 years of having a collaborative second practice in Ventura County, California with two midwives and actually at one point we had three midwives and two doctors, the hospital became hostile to the idea of midwives, the idea of v-backs, the idea of breaches or twins. I could not comply.
I was sort of the nail that stood out and generally gets pounded on because I was standing out for what I thought were the ethical and evidence-based choices in the hospital was banning them for really no reason other than economics or, you know, mis-expediency or what they would consider medical legal concerns. So eventually it would be end-hearted ways and for the last eight and a half years I've been working with midwives in a collaborative home-birth practice and doing the things that I've always wanted to do and doing them in having really good statistics and having very little blowback from people, administrators or anything like that because I don't have to deal with them anymore. I'm using good judgment. I'm not a cowboy.
I don't do things that would put my clients in danger, their children in danger or my career in danger or my midwives' careers in danger. I do things because I'm well-educated because I'm well-trained and because I want to offer women options that the hospital should be offering, but they're not. That is exactly where we asked you to come on this show because of, you know, Crystal and I have been following you on social media for some time and really what spoke to us was the fact that you, we could, or we could tell from your social media presence that you advocate for women having a choice and for women being an active participant in their pregnancy and their birth process in the birth process and that is unfortunately getting to be too far in between around the country. You would mention that you are a huge advocate for what would probably most be most likely known in the US as automatic C-section, reasons for an automatic C-section, other places, such as V-BACs, breach and twin births.
What can you tell our listeners who are limited in our options such as small towns, fewer resources? What kind of things do you think they should be looking for or questions they should be asking to be able to get that kind of care? Yeah, well, first of all, I want to say that the things that I do, there's significant evidence in literature that supports the option of V-BAC or breach. As a matter of fact, V-BAC is universally accepted, the fact that it's either banned outright or de facto bans.
A de facto ban is when the hospital doesn't officially ban it but no one in the hospital will do it. So it's like a fake ban, but it's really a ban. Banning V-BAC is unconscionable and unethical and the options of breach and twin delivery, there's still plenty of evidence in literature to support these options. So doing them for me is the norm.
The problem, of course, is that when you are people are not trained to do them. Now, there's no training that's required for V-BAC and there's no logical reason why a hospital would ban V-BAC. It's all an economic decision made by the risk management department or anesthesia department who just doesn't want to deal with that sort of thing. So financially, they have no incentive to lower their C-section rate because ultimately the hospital makes more money if they do more surgeries.
And the fiduciary duty of the people at work at a hospital is not to the women that they're taking care of. It's to the shareholders and the employees of the hospital and to maximize profit. So the whole incentive system is backwards. They could change that in an instant if they were to, insurance companies were to say to hospitals, we're going to pay you twice as much for a vaginal birth and half as much for a C-section.
You find the C-section rate dropping significantly tomorrow. But that, you know, we're a long way off from that sort of thing. So when it comes to breaches and twins, however, it's not kosher or safe to force someone who doesn't know how to do it to do it. So even though it's the ethical choice and it's because it is a reasonable choice and therefore we have the responsibility to support that choice, supporting a small town may not look like I'll help you with your breach birth, but it may look like I can't do your breach birth.
I don't know how, but there's a doctor in CityX, you know, 45 miles from here who you might want to go and have a consult with and see what's happening. So when you say in these small towns, what can you do? Well, first of all, you can fight for feedback. I mean, that's something that the American College will be GYN supports.
There are multiple different avenues to fight for feedback. You can always go to a hospital and you can refuse to have a surgery, you have the right of informed refusal as much as you have the right of informed consent. And so when somebody tells you you can't do a V back in our hospital, they don't have the right to tell you that, but most consumers don't know that. They think that the hospital doesn't allow V back.
Well, that's not for them to choose whether they allowed or not. And it's not something that puts a doctor in a really precarious position because you don't have to know how to do a V back. You just basically have to know how to sit on your hands and do nothing, which is what a V back is. And you need to counsel about the risks and you need to counsel fairly.
And that's something we'll get into later. When it comes to breach and twins, when you live in a small town or you live in a large town that has one hospital like Santa Barbara here and they don't give you that option, you have to consider what are my alternatives. I mean, either I can succumb to that or the possibility of relocating. Getting an Airbnb in a town nearby or something in the last month of pregnancy, it's very inconvenient and it's unfortunate the way it works.
Most of these big institutions in small towns is that it's their way or the highway. And you really don't have a choice. And I wouldn't want to put my colleagues in the position of doing something that they don't know how to do. So the ethical problem really starts in medical school and residency programs where the obligation to teaching these core skills has been lost.
And that's where I put a lot of blame. But that's again, we're not going there today. It's been a lot of time talking about that sort of thing. So for people in small towns, ultimately, V back is something that you can fight for.
Breaches and twins, if there's no one knows how to do them or feels comfortable doing them or says I'll do your twins if they're both head down, but if one of them isn't or blah, blah, blah, then you have to have a C section. Well, that's somebody who's not comfortable in twin techniques and that's not somebody who I'd want you to go to anyway. So you need to possibly move to a place where there's a big center or go to the big city. I remember I spent in my medical school.
I spent three months in Bethel, Alaska as one of my rotations. And in Alaska, I don't know if they still do this, but I think it's sort of, I see both sides of the artmen. They took all the women from the small villages, all the native Alaskans, the Eskimos, and they flew into Anchorage at 36 weeks and they live in a dormitory for 36 weeks until they deliver their babies and then they eventually go back to their villages. I think there's a safety issue there, but there's also a social psychological issue there that's really hard to separate these women from their families for that period of time.
But that's what they used to do. And so if you want to voluntarily do that, I can support that. I think that that's something to do. And we here in Southern California, in my practice, don't have a lot of people that come, but we've had twins come from out of state, we've had V-Backs and breaches come from out of state.
And sometimes I'll stay with family members here. We're big enough town, we're pretty much everyone has a relationship in Southern California. If not, they can rent an Airbnb and they can stay there. And that's one of the options you have.
Absolutely. Yeah, that's, you know, I used to teach the grabbing of the chopper and Margie Hathaway herself was one that she didn't take no for an answer and got on a plane and went and found a doctor that would provide the care that she was looking for. And so it's not impossible. Yeah.
So, the idea is, especially if it's your first pregnancy or early in your reproductive life and you may want more children, then trying to avoid that cesarean section is really important because every time you have a cesarean section, you may lessen your risk slightly for that delivery for that thing, but very, very small amount. But you all you do is you pass the risk on downstream to the next pregnancy, because now you put the next baby at risk of the risks of V-Back and ruptured u-risk and all that other thing. So a lot of people, a lot of breach programs that are a lot, with a few that are there, well, often say, well, we'll do breaches in multiple tips, but we won't do them in primaps. So for me, about 80% of my clientele breaches are first-time moms.
Those are the ones that need it the most. They need to avoid that for c-section the most. And so traveling is pretty much the only option until something happens where we begin to bring this back. And some of us are going around the country and teaching them.
Now there are the midwives that have come to these things. They learn the skill because everyone knows that every now and then you're going to have a surprise breach. But the problem is in many of these states, the law prevents them from actually doing a plan breach. Right.
And so they can't get in a hospital, then the state bans it at home with a midwife. And so it's just counterintuitive to me that if you're not going to let midwives do it at home, then you should certainly support doctors doing it in the hospital. Exactly. So you talked about the fact that you do attend home births and birth center births, which is not a common practice for an OB-GYN.
And you shared a little bit in the beginning of the show about how you got into that. Can you elaborate just a little bit about the home birth, attending home births and birth center births? Yeah. When I was going through the battle with the hospital, it was inevitable that they were not going to renew my privileges.
And so I could have fought them in an administrative battle and probably lost because they're big and I'm small and that's just the way it generally works. And even if I won, I would have won the right to stay at a hospital that wasn't going to let me do what I wanted to do anyway. So fortunately, I had really good relationship with the local midwives and they suggested I come to a couple of home births with them and I sort of laughed initially, even though I'd been backing them for 27 years, the idea of me doing a home birth myself without having an anesthesiologist or a fetal monitor. How would I do that?
How would I know what to do? But I went and fortunately my first five or six births that I was at home were beautiful. They weren't some of the scary ones that I've had since. So I began to practice that way and then I continued to do the things that I like to do, which were breaches and twins because women here have no choices.
There were just no choices for them. And now there are like one or two doctors who do breaches in the hospital setting, but the success rates of hospital births are generally less simply because of the model that you're cared for. And so when a woman comes to see me for these sorts of things, we go over all the options and I don't try to coerce somebody or see my counseling to get them to join my practice. I'm very honest and open with them.
And I want them to choose a home birth because they want it not because they feel like they have to have it or something like that. Right. What would be some of the big differences that you've seen just in front of a woman laboring, like some of the differences on how a woman is laboring at home versus at the hospital? Because I know from as a doula, a lot of my clients' husbands have been scared to entertain the idea of a home birth.
So the woman feels confident with it because her intuition, her gut. But like you said, what am I going to do without anesthesiologist or fetal monitor? So a man's role is generally to provide and to protect. And so a man feels like he wants to protect his woman and therefore he thinks the hospital because our culture believes that the birth is in the hospital is the way it should be done.
It's been that way for almost 100 years now that the American Medical Association sort of ran a campaign against home birthing. And about 100 years ago, 99% of babies were born at home. And now it's a completely opposite direction. But to get to answer to your question, I want to backtrack and talk a little bit about mammalian birth and why and why it's so much what we do is so much more how mammal should behave.
I can't remember the initial part of your question, but I want to just talk about this because it'll come to me as we go along. But what we do to the human female, we would never do to our dog. When our dog goes into labor or a cat or a deer or a horse, they go off by themselves to a quiet place. When they're hungry, they eat, when they're thirsty, they drink.
When they are uncomfortable, they move. They can roll, they can lie down, they can pace, they can stand up, they can go for walk. They can do whatever they need to. They're ready to give birth.
They lie down or they stand up. It's not a sterile procedure. Nobody rushes into the court and nobody ever, ever separates the baby from the mother. It's not done in nature.
And when a predator approaches or little kids run into the bedroom or a mammal that's laboring is anxious or stressed or fearful, he puts out adrenaline and adrenaline stops labor. The animal gets up and wants to flee. That's how nature does it. It would make no sense for nature to do it any other way.
What we do to the human female when we take them to the hospital is we do everything is pretty much antithetical to what I just described. You have to come from your home where you're felt safe, into a hospital emergency room or a triage area of labor and delivery. You have to ask a million questions that have no relevance to what you're there for. Right.
Standard admitting computerized format that they have to do. And meanwhile you're contracting every three minutes and they're asking about how many stairs you have in your house. It's like two to half pairs of how many stairs I have in my house. And then they want you to change into a gown and pee into a cup and sign consent forms about surgery and death.
And then they wrap you down with some monitors on and then they interrupt you constantly for vital signs and then they don't let you eat anything but you're lucky. You can have some ice chips or popsicle. And then you're uncomfortable and you want to go to the bathroom but you have to push a button to wait for the nurse to come to unhook you to go pee. And then you've got your husband and your mom and your aunt Betty sitting in chairs staring at you and we wonder why labor is dysfunctional in the hospital.
So I think your question initially was why, you know, what's the difference between the two and ultimately mammals labor better when they're left to themselves. Sarah Buckley likes to say I think she calls it private safe and unobserved. And the hospital is everything but private and unobserved safety is in the eyes of the beholder. Some people feel safer at the hospital.
That's where they should be. And again, I'm not some hospitals are beginning to come around and letting women ambulates and not necessarily using continuous fetal monitoring or maybe going with telemetry or something so that they can get up and move about and letting them get in the shower and letting them do things that help other mammals to deal with the discomfort and help them move the baby down help respond. The baby's pushing on a nerve on the right leg. You watch a woman naturally labor.
She'll want to put her leg up on a chair and lean on it or lunge or something to get that baby. She's helping that baby move and you're laying there on your side completely and estitized with an epidural. You're not helping your baby anymore. And labor is naturally going to be more dysfunctional.
Yeah, when you were telling that talking about how mammals birth and labor, it reminded me of the story of my second child when I arrived to the hospital. We asked for a wheelchair to meet me because we knew I was pretty far long. My wheelchair was sent to the emergency room and I had to walk down three flights of stairs and across to the other side of the hospital. The nurse would not, my daughter was actually crowning and she was like, I'm sorry, we have to triage you first to make sure you're in labor.
My husband was like, I can see my baby. I know she's in labor. So that brought back all those memories of that uncomfortable. I've seen it a thousand times.
And again, it's a famous quote from Thomas Payne from the Revolutionary War era. He says, I'm abbreviating it. I'm sort of paraphrasing, but he says, the long habit of not thinking something wrong gives it the superficial appearance of being right. And if you ask a nurse, why are we asking all these questions?
These are the same questions you ask if you're coming in with a gunshot wound or an appendicitis. Right. And why are we clamping the cord immediately? Why is the baby going over to the warmer?
Why are you washing off my wife's vulva with iodine for a vaginal birth? They won't have an answer for those sorts of things because it's the way it's always been done and they don't stop to think, why am I doing this? Yeah. Why are we taking a blood pressure on a woman every 30 minutes or something in labor?
Is it really going to change that dramatically? Yeah. Okay. Why do that?
We do that because somebody in administration says you have to chart this every so often. And if a nurse doesn't chart properly, then the nurse gets yelled at. Right. She's a little man.
That's getting... Well, here's a great story about computerized medical records and charting is you probably heard this and you probably talked about this before. I'm sure everybody has is that it takes away eye contact. It takes away the interpersonal relationship when a nurse is busy entering data into the computer.
The ultimate was one time I was doing a C-section and there were some medical students watching and I looked out at the medical students at the foot of the bed and I could see one of them going ghost white. And you know what's going to happen when somebody goes ghost white in the operating room, right? Let's call the nurse Georgia because I can't remember her name and I can say Georgia. No response.
It's not going to be me. We're operating. All right. And Georgia, just a minute, Dr.
Fishbine. Georgia, just a minute, Dr. Fishbine. And meanwhile, the medical student goes boom and hits the floor.
Right. Right. The nurse was so busy entering not essential data that she forgot to be... She forgot the nursing.
This is the kind of thing that goes on at the hospital. Like when I was a chief resident at Cedars, when I did my OV rotation, there was a routine order that every woman on the first post-firm day got a blood... It was called a CBC or a complete blood count, a blood drop. When I became chief, I stopped doing that.
And the first day we were making rounds with the attending, he asked my intern what the woman's team adequate is, and the intern doesn't know. And the attending gets all upset and goes, why don't you know? It's just because we didn't check it. And then he goes, why didn't you check it?
And then she officially looks at me. And so I said, because there's no reason to check it. And he goes, well, don't want to know what her hemoglobin is. No.
Walking. She's not tachycardic. She's not dizzy. She's making urine.
What do I care what her hemoglobin is for? At that time, $87. All right. Why do I care?
I'm going to send her home on iron. I'm not treating a number. I'm treating a person. Or to do things the way they've always been done.
I'll give one more crazy example. And this is not bashing on nurses. I'm bashing on the system that they're forced to work in. There's things called lab values that are called critical lab values.
And they have to be called. And they have to document that they call them in. So one time I admit a woman for a possible autopic pregnancy. And we're watching her overnight because she might be miscuring.
She might have been a topic and we're just waiting. And I get a call at two in the morning from the nurse telling me that she has a critical lab value. And I say, what's the lab value? And I go, she goes, she has a positive pregnancy test.
And I go, well, do you know why she's being admitted? No. All right. But a positive pregnancy test, Dr.
Fishline, is a critical value. And we have to let you know. So I had to be woken up at two in the morning so that let me know that my pregnant lady had a positive pregnancy test. Okay.
This is the kind of thing that maybe these are anecdotes that are rare. I don't think they're that rare. I think there's a lack of thinking. There's lack of critical thinking.
Nurses spend so much time doing busy work that it's very hard to be a nursing. If you've ever talked to doulas who work in the hospital, all right, I must be one of the hardest jobs ever to be a doula in the hospital and watch things being done that you know are detrimental or stupid and you can say nothing. Nothing. You have to watch.
Oh, you and I could have a whole long, long conversation about that as I have been a doula for the past 14 years. And not because you're a doula for the past 14 years, but I will say this plug is that anyone having her first baby, especially if you're going to be in the hospital, but even at home, is you be foolish not to have a doula. Yeah. The chance of you having a successful birth, even unmedicated or even medicated is where the doula is significantly higher in a first pregnancy when you have a doula than without a doula.
You need an advocate who sort of knows what to do, who knows how to, who to her way around the system and knows when things are being done to you that may or may not be being done with proper consent. Right. We're going to do this now and the choice and the doula can say, can we talk about this for a little bit? Can you step out and let us talk about it and then explain to them why they think they need to do this and whether the pros and cons of waiting are and that sort of thing.
That is so important for all of you listeners. Yes. Thank you for saying that. That was actually going to be my next topic, my next question for you.
As a doula and somebody, a birth advocate, you know, having somebody there to kind of remind you as well of what your wishes and desires are through the birth process because many times I've seen fear, you know, be the decision maker and it's really comes down to maybe not understanding what the doctor is saying or what the nurse is saying or what the situation holds. And so it, it fear drives the decision. Well, you could also be picking up on the fear and anxiety of the healthcare practitioner you're talking to. A lot of nurses and doctors are fearful of birth because that's how they were trained.
So yeah, so I agree with you. There's a lot of fear involved in labor and delivery and once again, get back to the melee model, how do mammals deal with fear? They don't labor well when there's another room. Right.
When did you start seeing a shift in, you were taught breach twin birds and when, when did you really start seeing the, the model care shift from that as the teaching, because it's like you said, it's a lot of your younger counterparts, but just. I think even in the eighties, breach birth was already going down the road to extinction. It was codified in 2000 by paper called the term breach trial. There's a documentary that I'm involved in called the heads up the disappearing out of breach delivery that people can look at sort of explains it to a little bit and we do talk about a little bit in our paper, Rick's the reason I published a paper last October on home breach, so those things are available on my website.
You can click on the banner and pull up the sheet, but it was already on the way down. I just happened to train at a program, like I said in the beginning, where USC was, it was, it was a figurative zoo. I mean, like 65 births a day, think about it. Yeah.
Yeah. That's, and there were, I think 12 people on the, on the team doing all the deliveries. The chief did none. He hid in his room.
The seniors did basically the difficult surgeries that you and the, so the interns did most of the deliveries. I was doing on a 24 hour shift, which is how it was in those days. We didn't have short shifts in those days. We had full 24 hour shifts.
I mean, I made, I made you 15 deliveries. Wow. All right. It was, it was, it was, it was cowboy obstetrics, but it was a great place to learn.
Those sorts of laboratory type things don't exist anymore. I mean, patients writes things and stuff. I mean, it's a good thing to some degree, but it's bad for teaching. Right.
Because, you know, so the training has been disappeared even before I, before I finished my residency was disappearing in the country, but in 2000, breach delivery sort of was codified that, that breach should be borne by cesarean section. And within a couple of years, they found that that research was flawed and that that was, it wasn't what should have been recommended, but the damage had been done. Right. Exactly.
And pretty much every training program had taken that out of their training. So it's a problem. Oh, gosh. Well, at Oz Talk, we, we really are actively trying to impact women prenatal birth as well as the postpartum experience.
We hear all too often women say, I had to, or I didn't have a choice. And so we're really trying to change the conversation and change, and help women create a relationship with their provider so that they can have a commun, can effectively communicate. So can you speak to that? Yes, I can.
I would tell people that unless you have a significantly severe medical problem, ideally the ideal practitioner for most pregnant women is a midwife. It is. The availability of such is always not great, but if you have a practice that uses midwives often or a hospital that has certified nurse midwives in their labor unit and stuff like that, you're going to be better off. But there's a basic flaw in the whole obstetrical healthcare system in the United States and it starts with this, okay?
It starts with the idea that pregnancy is not an illness. Pregnancy is wellness and the medical model sees as an illness and they treat it as a disease. And therefore they treat it as a medical problem. And it's more of a emotional psychological event in a woman's life.
Yes. And it's not treated like that. The way medicine works right now for the most part because of economics is that it's become a shift mentality, is that doctors work for a large group and they're on call maybe every eighth night. So you may have somebody that you really love in your practice and you see them for every prenatal visit and then you only have one in eight chance of having them be the one that's going to deliver you.
Or you may go to Kaiser or a system that has a shift medicine where you love the nurse that you've been taking care of you, but it's seven o'clock in the morning and she goes home and now somebody else comes on and she works till seven o'clock at night and then she goes home and it's the same thing with the doctors and that sort of thing. That's not conducive to building that, that's sort of a buckly thing about safe, private and unobserved. I mean, you don't feel safe when you don't have a relationship with the person that's caring for you. In the Midwifery model you develop that relationship and generally the practitioners are sort of dedicated to you.
It's sort of a dinosaur model these days. It was the way obstetrics always was up until probably managed care began to take over in the late 80s and early 90s. And most doctors had their own practices and delivered their own people in some working groups, but you know, it was a small group, maybe two or three people and you got to know all of them and so you sort of got somebody, but now you have to often have somebody walking in who's a complete stranger to you. It's going to be the one that's going to catch your baby, but that person is even giving you the care because the person that's giving you care is the nurse that you never met before, that you happen to, it's a role that dies to the nurse that you get.
One thing that you can do as a consumer is if you go to the hospital and you have a nurse and you don't feel comfortable with that nurse personality wise or whatever, you can ask for a different nurse. You have the right to do that and they will change the nurse for you. I have done, actually my husband did that for me. He was my, he was my do I with my last one.
And but yeah, I rolled in and we're in the military and I never knew. I actually had seen a couple of certified nurse midwives throughout my whole pregnancy and then the day of delivery in Kama and OB-GYN that I've never seen before in my life. Thankfully, I knew how to advocate for myself, my husband knew how to advocate for me and the doctor was extremely willing to listen to my requests. But that's not always the case.
Yeah. And there are advocacy sites that you can go to where you can get documents or just to handouts that inform you of what your rights are when you go to the hospital. And we're not trying to make it an adversarial procedure here. No.
Just because a hospital says they have to do something one way does not mean they have to do something that way. Right. They won't tell you that there are other options because they don't want you to know that because it's inconvenient for them or because they've been told the nurses have been browbeaten that told that if you don't get the patients to do this, then they get the Monday morning quarterback the next following day and yelled at by their charge nurse or their administrator. And so there's a lot of pressure on people that have nothing to do with the mission for which they're there for, which is to give this woman the experience of her life and allow her to have the birth that she is hoped for and honoring.
You know, I mean, when women used to come in with a birth plan, we used to like, see right and then we go in the nurses lounge and we all roll our eyes and say, here's an epidermal in a C section waiting to happen. No, we were sarcastic about it. And that's partly because, you know, it was partly true. And partly because it was our attitude contributed to that to their down.
As a patient or what we call a client and we don't call them patients because they're not sick, but we call them clients. I would strongly recommend that you try to find a practice where there are very few people who are going to be the people that are covering you. If you can find a midwife and she's going to be your person for your whole time, that's the best possible scenario. So continuity of care, trust in your body, trust in your practitioner, right?
These are the ways to go having a doula to help you through it all because that doula will almost definitely be there. So even if the other faces are changing, you've got a friendly knowledgeable face that's going to be with you to help you through that because it is a very difficult time. It's a very emotional time, but it is one of the most memorable times in a woman's life. And sometimes you may have to say, you know, I have the sneaky Blue Cross insurance, but you know what?
I'm going to go to this other person because this other person has a great rep and I'm going to pay a few thousand dollars out of pocket because even though that's going to go on my credit card now and it's going to be a pain, I'm going to get a better experience and two or three years from now, that's three thousand dollars, it will mean anything. Right. I could go out to your own life. Right.
Right. The memory of your, of your breathing of your children will be one of the last memories you ever lose. Yeah, we, we, on this talk are super passionate about the fact that I, we truly believe that a woman's birth experience can shape her for the decisions that she makes for the best of her life. You know, I wish we were teaching this type of stuff in sex education, in our, with our teenagers.
But our team girls, you know, I have two girls. I wish that they, well, I teach them, but I wish in school that they would learn how to respect their bodies and demand respect from even the, you know, their care providers and so that when they get to the phase of life in which they're ready to bear children, they are, they have that confidence going in because I feel like that would be common sense, educational policy, which is pretty much lost. Yeah. Right.
You know, we have a funny, we have a very funny country and I'm not going to, I'm not commenting on whether or not on people who are pro or choice or pro life, but we have a very fervent group of people who think that women should have the right to choose, determine her pregnancy at any point in her, in her, in her pregnant life. Right. But if she wants to keep the baby, we're going to restrict your choices. Exactly.
We, first of all, I say that all the time. Like what? Yeah. If she wants to, if she wants to, I don't want to say the word kill, but I'll say it if she wants to kill her fetus, she has the right to do that.
But if she wants to have the fetus at home, we're going to legislate against that. Right. You want to protect that fetus. Yeah.
Wait a minute. If you want to protect the fetus, then why are we so pro choice? And if we're so pro choice, then why aren't we letting the woman who wants to have a pregnancy the way she wants it, she used to do it the way she wants it. Exactly.
And people have the right, you know, people, we talk about the right to inform consent. And I heard, I don't know if it was for me and he's client or somebody else who said this, but you also have the right to uninform consent and refusal. So you have the right, you have the right, I meant uninform refusal. So even if you think this person doesn't know anything, if this person says, I don't want you to do that to me and you know that if she, if you don't do this or that, that she could die, she has the right to say, I don't want you to do it to me.
Yeah. And we're supposed to honor that, right? Not get court orders, not coerce them by false information. That sort of thing.
As a matter of fact, I mean, even a cog, I don't agree with a lot of the things that they do, but some of the things they say are appropriate. And one of the things is about coercion is never acceptable. Right. So if a doctor tells you that you're an idiot for doing something this way or that, you find another doctor, get out of that practice right away.
If they don't want to answer your questions, if they think your questions are silly, if they got one foot in the door at your prenatal visit and one foot out the door in your prenatal visit, that's not the person that you should be going to. Exactly. They don't deserve you. That's actually a gap that we're trying to bridge is because I do feel like a lot of the times the doctor doesn't necessarily know what you know because they don't take the time to ask.
They don't have the time to ask. I'm going to give them the benefit of the health. The system isn't designed for somebody to be able to spend 45 minutes. Exactly.
Like the midwifery model is. Right. But then they also, as the consumer, you don't, most of the time don't even know what to ask, which is the gap that we're trying to bridge here is, you know, get the information into people's hands so that you do, you do have the knowledge, the background and the education to say, well, what is your C-section rate or what is, you know, how you practice this, this and this. And so that way you can choose a provider that is already practicing.
And remember your physician is a person too. So you have to use that with them too. I mean, everybody has ego. And so you don't want to say something to them like, well, why is it you don't know how to do bridge delivery?
Right. Okay. They may not be happy about hearing, you know, they may not be happy about something reminding them that they're not as adequate as they should, they should be it. And once, of course, once you're out of residency, learning something new in the American medical legal world is not likely going to happen.
So if you don't learn in residency, you're not likely going to be doing it after residency when you're paying your own malpractice premium, you're working for a large corporation that is paying your malpractice and isn't going to let you do things that you're not comfortable with. And we're sure you'd be doing it. So the system, everything about the American obstetrical health care system is backwards. We're not even backwards.
It should just essentially be redesigned. Yeah. And reimbursement should be done differently. And midwives should be used a lot more like they do in England, in the Netherlands.
Low risk women should, which is about 85% of pregnant women should be seeing midwives first. It'll be second. Here it's a turf war. It'll be, you don't want to give it up because financially it hurts them to give it up.
But ultimately midwives do normal birth better than obstetricians do. And obstetricians are experts in abnormal birthing and in that they excel. But their model by which obstetricians are trained doesn't allow for all the things that a normal pregnancy needs, which is essentially leaving them alone. Yeah, exactly.
Because that information isn't always a good thing. Stop over testing. And again, in centers for over testing, people will do it for no reason that 40 weeks and one day they'll do a biophysical profile. And then they find that the fluid is only 9 centimeters.
Okay, well, 9 centimeters is normal. But because it's 9 centimeters, we'll get to check that again in three days. So now you've got a woman going home for the next three days, she's concerned. And she comes back in three days there and now it's only 7.5 and it's over.
The fluid is getting lowish. So now we better induce your labor. And you have this ultrasound or a biophysical for no reason. And now four days later, you're being induced because they did a test probably because they could make money off of it.
All right. Yeah. I know that sounds really skeptical and I know that I could be bashed for that. But I've seen it way, way too often.
If you sit in my shoes and you hear second opinions and you hear people with their second birth, tell you the story of their first birth, you as a dual, you probably hear these stuff. It's far more common than and it deserves to be ridiculed and exposed because there's something wrong with a system that rewards people for doing too much and unnecessary stuff and there's no downside to doing it. The fact that downside is to not doing it because people will yell at you if you didn't. There's a bad outcome and you didn't over test or you didn't do something.
You think you're going to get yelled at. I find that if you have a good relationship with somebody, the likelihood of being sued is far less. Absolutely. But I could go on and on about a story about that.
I was three months premature. Lots of things happened that probably could have been avoided. And my mom loved and trusted the doctor because he was open and honest with her. And so thankfully I'm here today being able to sit here on this interview with you.
But the whole reason why she did not sue was because of that trust and that open communication. It had nothing to do with that. I hate the idea that that drives how we think but it's certainly one of the three main factors that drives the medical community right now which is both that, the legal stuff, the expediency and the economics. And we've forgotten our mission which is to really care.
We have an ethical obligation to support reasonable options. And if a woman chooses a reasonable option that's not what we ourselves would do, our job is to not ridicule that option or not do our job is to support that option which can be a good option unless I said earlier it can look like I'll help you with that or I don't feel comfortable helping with that. But Dr. B over there, why don't you go talk to that person and see if he or she might be a better fit for you.
That sort of thing is very ethical. The opposite is not ethical to tell them that they're you know that they're endangering their baby. The pulling out the proverbial dead baby card is to say once you do that to a pregnant woman you have you have you've stood away other options because now all they hear is... Right.
You basically you you you planted terrible seeds in that woman's mind and you're basically abdicating your own responsibility of keeping those things inside yourself so that you don't... It does it makes it easy to vomit your anxieties onto your patients but it's not the right ethical thing to do. Yeah. You know when I I watch myself on video and and inside my heartbeat is probably 160 and my blood pressure is probably 150 over 110.
But outside I watch myself and I'm talking very calmly and it's like how did I do you know how did I do that and it's just something that's a skill that midwives have it too because people that you know sometimes I think a doctor thinks that the more you scream the more it shows how much you care and your concern. But ultimately you can get much more done by just being calm and reassuring even when people have screwed up or people aren't doing what they're supposed to be doing. If you're calm and reassuring you're much more likely to get everybody to move quicker and do the things that need to be done. Yes for sure.
Absolutely. I did sit here and talk with you and take all your time but I don't want to do that to you as you're a very busy man. I'm going to move you this afternoon. Oh fine.
I think I'm going to go see Captain Marvel. Yeah. My kids really want to see that. Yeah.
It's got to make you use my I'm going to go see it just because it's one of those movies you got to see it. Yeah. So fortunately I know that is I had a busy couple weeks I had a breach and a V back after two C sections yesterday. Yeah.
Great. She's a little tiny Asian woman and she had a nine pound ten ounce baby. Oh so the big baby but that's actually average. Well our first C section was probably not indicated her second one she didn't wasn't given a choice.
It's a classic story of V back of two C sections. Yeah. And then they're looking elsewhere and again that's a supported choice. Many of the things that people think are not supported they're actually supported by ACOG.
All right. Now nothing at home is supported by ACOG. So obviously home birth ACOG doesn't support so clearly breach birth or twin birth at home is an absolute contraindication with the American College of Guyan. And I understand that but that's because there's no data on it.
That's what's called level C recommendations which is basically consensus opinion. There's very little data on it and the data they have is not very accurate data. It's sort of like birth certificate review or case record review. You have no idea whether the woman who was breached was planned or unplanned whether the baby met the criteria for safe breach delivery.
You have no idea on the level of skill of the person that was there delivering them. So you can't really compare that to somebody when they have proper selection criteria and trained people who know what they're doing. And so we're trying to get more data but it's really hard to collect that sort of data and put that out there. But people need to know they have choices and really birth is such an important moment in a woman's life that they shouldn't decide how they're going to do it based on the little insurance card that's in their wallet.
Yes. You should you should you should plan that like you plan your wedding. Right. Well we always you know, Crystal and I was somewhat joke but there's truth to every joke is the fact that you know people will go out and research the car that they're going to buy but they don't research they don't give the same time and effort into their birth experience.
No, there's no there's no car facts for birthing. There's no car facts. Well, my friend my friend and colleague, Liz. I used to say to people that you know the two most important moments in a woman's life in general not always not for everything.
Nothing is always or never in anything. Yes. Her wedding day in the birth of her children. Yeah.
And for the wedding day as you said we plan everything. All right. And we may spend lots and lots of money. And for the birth we take out our insurance card and says okay I got it in a PPL I got to go to this hospital as doctor.
So she was she possibly what if there was such a thing as wedding insurance. And from the time you're 18 to pay $100 a month and when you got married all those wedding expenses were covered. But you can only use these places. That's right.
And you couldn't pick the the necessary food that you wanted. And they invited people to your wedding that you didn't like. And they you know you had to wear this dress and not this dress. Yeah.
Nobody would do that. Right. But for the birth people just like say okay all right I got to go here and oh I have to be induced okay and and maybe has to go to the nursery afterwards and has to have hepatitis vaccine blah blah blah because yeah like you know no no no it doesn't have to do that. You have to go to sites and find out that you have options.
Exactly. And then like listen to your show is a great place to start listening you know reading people's websites joining some of the Facebook groups that are out there. You know coalition for breach birth for breach bombs is a great Facebook page. I can I can is a great choice for every major regional area has an ICANN chapter international society awareness network and for people that have a C section you know it helps them find resources for what to do or even support groups because someone who has a C section it affects them in very very difficult they have a very very difficult time dealing with it because especially in the later in the years when they find out that they were probably avoidable.
Yeah there's actually that's not the word I was going to use but that's a good word. The section was probably avoidable. Right. Well you know we that's one of the reasons why we started the show honest I and called it honest I radio because we want to bring out those conversations and not beat around the bush and not you know we're not here to judge anyone or push shame or guilt as a matter of fact or hope in our desires to pull that way so that you can make decisions if you choose you know a C section that that is a choice because you made it consciously you made it with all the facts and didn't feel pressured or pushed into it.
And so I really really appreciate you coming on today. This has been such an amazing interview and I'm thoroughly thoroughly and very getting to talk to you today. Me too. Can I get some shameless plugs in there?
I was just about to ask you to be back. Okay. First of all you can find me at Burlingincinks.com and that's my website and then there's lots of links on there and the top three links on the top home page are three papers that I put out but there's all kinds of stuff on the resources page. I mean it's mostly for Southern California people but there's all kinds of things that we have an events calendar coming up I teach breach all over the country.
I have a podcast that I do and not on a regular basis probably once or twice a month called Dr. Stu's podcast the link is on the website or you can go to Dr. Stu's podcast.com or Facebook page for that. I also have a book out which came out in 2010 it was the second edition of what we wrote called Fearless Pregnancy, Wisdom and Reassurance from a doctor, midwife and a mom and it's in its second edition.
You can find the link again on website you can buy some used copies on Amazon we don't sell it on Amazon anymore and everything about that book is still very current except the genetics chapter which again was written in 2010 and as you most people know that in the last four or five years genetics has just blown up with all the maternal blood tests and non-vase prenatal testing now that was available in real-time in 2010. So you can rip those pages out of the Fearless Pregnancy book but other than that it's a really good source for people looking to find confidence because some of the books that are out there the more popular ones are often very fear based books and they make people more nervous than anything else. So we wanted to write a book in response to that because we found the midwife that I was working with at Time Joyce Wecklin and I we found that we would spend a good 15 or 20 minutes of every prenatal visit dispelling rumors that people had heard from either reading something or from their friends or family telling them stuff so we wanted to put something out there where people could feel confident. So a lot of times we hear we get our information from TV shows or movies.
Go to the guy she started on online. Yeah you know as an expert in this sort of thing sometimes I'm at a movie and they will do something. Oh I know. You know go oh my god that's that is so wrong.
I mean you must be like the lawyers who watch things like Law and Order where somebody commits a crime and then three days later they're in Superior Court having a trial. It's like no no that would probably take a year and a half and it would you know but it must drive people crazy but it does drive it does watching the technical things and sometimes it really drives me because occasionally there are things that are really accurate like a movie that I just see oh I just watched the birth on Outlander TV series I don't think anybody watches Outlander but Brie was giving birth and it was very short but that was really it was you know they had the slave and the aunt and just the women around her they had a guy pacing outside in the hallway you know and she was screaming and it was just it was just very simple and very accurate. Yeah you know what's going on. I stand up and celebrate when I see that on TV or in the movies I'm like yes they got it right.
I think everybody thinks they call the midwife does a pretty good job with that too. I have a lot of many episodes I've seen some of them. They do. They do pretty good.
They don't get your resources from Dr. Google and don't get your resources from movies. You know go to reliable sources find someone you trust stay calm and pregnancy like mammals are supposed to and your experience is more likely to be a good one even if you end up at a hospital even if you end up with a certain section at least and then you'll probably know that you needed it and you won't have these linker results. Absolutely absolutely and for those of you that are listening if you haven't seen it already go follow Dr.
Stewan social media and see the amazing picture of a breach word that he just attended. Oh yeah you can find me on Instagram at birthing instincts as well right so that's the same as my website's birthing instincts and yeah I just did a breach delivery and it was beautiful. Yeah it's it's well I think the subtitle I wrote down some see fear yes some see normal I think. Yeah right because you know if a doctor saw a baby was out to his head and then hanging there a lot of doctors don't know what to do they would freak and they wouldn't know what to do and that's a shame because that's what makes my specialty unique is the ability to do that sort of thing and I would be really frustrated as an OB if I didn't know how to do those sorts of things yeah if all I could rely on was a scalpel I would be very frustrated I would be mad at the people who trained me.
Exactly. Or anger at our academia right there should be. Right. Right.
Because that's the only way to change the future is to change the next generation of physicians if everybody keeps coming out the same way then it's very unlikely you're ever going to change or have acceptance for alternative viewpoints and it's going to be this battle of them and us. Yeah. Whereas obstetrics sees midwifery as a lesser subset of their profession and midwives see themselves as a separate profession. Right.
And they are a separate profession. They are they shouldn't be run by by doctors. It always amazes me that in like in the medical boards of the states when there's a decision about doctors it's made by doctors when there's a decision about midwives it's made by doctors. Yeah.
Wait a minute. Midwives don't have a saying what doctors do about doctors so why do doctors have a big say in what midwives do with midwives. Why don't midwives decide about midwives? Yeah.
Exactly. Exactly. It's a question that does not have an answer or it ties but don't want to like the answer so. Right.
It's believe it there. It's been a pleasure to be on your show. Thank you so much. I appreciate it.
Thank you for listening to today's show. If you'd like to come on the show and have an honest conversation about connecting, relating, and encouraging women, contact us at hello at honesttalkinternational.com. Also don't forget to subscribe to this podcast so that you can be in tune with all the great avenues. Have a great day.