Is Hospital Birth Really Safer? | Dr. Stuart Fischbein, MD (Episode 624)

Full Transcript: Episode 624

Lisa Hendrickson-Jack: I’m so excited to be here today with Dr. Stuart Fischbein. Welcome to the show.

Dr. Stuart Fischbein: Thanks, Lisa. Thanks for having me. It’s good to see you again. We really enjoyed having you on — Blyss and I — a few months back on our podcast. I’m grateful whenever I get a chance to talk to an audience that I might not normally reach.

Lisa: It was a pleasure meeting you. It was so much fun being on your show, and you asked some really great questions. I love how direct you are and how you got straight to the point. I’m really excited today to talk to you a little bit about birth. Before I go into asking any questions, I’d love to just hear a brief — how did you get into this field? I’m sure it’s a long story, but what made you specialize and have such a passion and interest in birth?

Dr. Fischbein: It’s funny how your life evolves. Not the way you thought it would have, but the way circumstances kind of channeled you down a path. I was a biology major in college. I had no direction. Literally wanted to be a marine biologist or a park ranger — somebody that worked in the woods. I grew up in Minnesota.

In my third year of undergrad, some of my friends were doing pre-med. I was a biology major, so I’d already taken organic chemistry and calculus and physics and biochemistry. I already had all the pre-med requirements done. I sort of said, oh, well, that sounds like a good idea. Being a doctor back in the late 70s was still what I considered a very noble profession — maybe a little egotistical — but certainly doctors were still captain of their own ships in those days. And I had a Jewish mother. I always tell that story because it really does influence you.

I got into the University of Minnesota Medical School. The first two years are all pretty much classroom and laboratory. The last two years are clinical rotations — some required, like internal medicine, surgery, OBGYN, pediatrics, and some elective. I had just come off a very difficult hematology-oncology rotation, difficult emotionally — seeing children with no hope, some dying. My next rotation serendipitously happened to be OB, and I was up at four in the morning catching a baby.

I was doing all the medicalized things that I sort of mock now, but I still thought it was the greatest thing. Here I am, a third-year medical student, and I’m catching Deborah Smith’s baby named Christopher. I still remember that — my first birth. And it was great.

I started to think, what do I want to get out of medicine? One of the things I really liked about obstetrics was longitudinal care — taking care of a person not only for one medical problem, but through most of their adult life. There are only three specialties that do that: internal medicine, family practice, and OBGYN. Plus, OB had babies, which was a perk. It had some surgery, some psychiatry, some endocrinology, some internal medicine. It seemed to be the thing to do.

I matched in Southern California at Cedars-Sinai Medical Center. I left Minnesota for good and moved to California — I never intended to stay there, but I ended up living there for 40 years. As part of the residency, we were affiliated with LA County USC Women’s Hospital, which at that time in the early 1980s was the busiest hospital in the United States — doing about 22,000 births a year, about 65 babies a day. We were seeing three or four breeches a day, one or two sets of twins a day, all kinds of pathology. It was great training, but it wasn’t great humanity.

I came out of residency very medically trained — cutting episiotomies, cutting cords immediately, taking babies over to the warmer. I did that for the first few years of my practice. In those days, you hung up your shingle and you hustled to build your own practice from scratch. I was approached by two local midwives who had a birthing center and did home birthing in probably late 1986, early 1987, and asked if I would take their home birth transports.

This set me on my whole path. At that point, I had no idea what midwifery was. I just said yes because I saw it as revenue generation. But never did I realize that they would begin to unravel the mess that I had been in — not knowingly — as a medical student and resident. Thinking that pregnancy is a disease, that women’s bodies are broken, that everything is a potential disaster just waiting to happen. They looked at it completely differently.

I began to spend time talking to them. When they brought a patient into the hospital, there’d be hours to sit around and wait. Most came in for non-emergent reasons — they were just tired and needed help. The midwife would always come with the patient. They would ask me, why are you doing that? And my answer would be, I really don’t know. I never thought about it. It’s just the way it’s done.

After about 10 years in solo practice, I started a collaborative midwifery practice with two certified nurse midwives at a hospital in Ventura County, just northwest of Los Angeles. We had a really good thing going for the next 15 years. The midwives took care of all the normal stuff, and I took care of all the problem stuff. Together, we had really good outcomes.

We were never really accepted in the community because we were the outsiders. We were rocking the boat. We would do things like a breech vaginal delivery when all the other OBs would tell the nurses, that’s crazy. After 15 years of giving us a hard time, they finally found a way to get rid of us. First they banned VBAC. Then they banned the midwives from the local hospital. Then they were going to ban breech delivery. I said you can’t do that, and they said it’s our football, we can do whatever we want. Ultimately they just told me they weren’t going to renew my privileges anymore.

I’d made midwife friends over the last 25 years because I was still backing home birthing. They all said, Stu, you’ve got to start doing home birthing. No physician I knew in Los Angeles regularly did home birthing. So I left hospital-based practice and I started doing home birthing. It was a euphoric moment for me because it freed me from all the ridiculousness that goes on in the hospital.

At home, I could give women information. They’d say, we don’t want to do that. I’d say, okay. I would write it in the chart, but I wouldn’t label them noncompliant or high risk because they weren’t following my advice. Because I had a good relationship with most of these women — one-on-one continuity of care — they trusted me.

I ended up in a job that was extremely satisfying. The hours sucked because I was on call for myself for my entire career, which is why I called it quits after 40 years and moved to Utah. Now I just do consulting. I have a podcast. I go around the world and teach breech and twin deliveries, which is my passion now.

Lisa: I really appreciate you taking us through your story. One of the things you alluded to many times — you said that when you were in med school, you learned that pregnancy was an illness. All of these interventions were a necessary thing to prevent this horrible outcome. And then as you went to the other side of birth through your work with midwives and eventually as a home birthing doctor, you saw a completely different side of it. Maybe break down what aspects of your training were not conducive to the type of birthing experience you wanted to provide to your patients.

Dr. Fischbein: In medical school and residency, students and residents are taught by maternal fetal medicine specialists since the 1970s, basically. Prior to 1977, there was no such thing as a maternal fetal medicine specialist. The Society for Maternal Fetal Medicine was founded in 1977.

Somehow, pretty much in every category of wellness and outcomes, we’ve gotten worse — despite the fact that we now have high-risk specialists. Ponder that for a while. Their view of pregnancy is that it’s high risk. The medical model of care sees pregnancy as a potential illness — a medical problem that needs to be managed, needs to be treated. It occasionally gets chaotic, which they don’t like, so they would rather control it.

The American College of OBGYN states in some of their guidelines: pregnancy itself is a high-risk condition. If that’s the prism by which all medical students and residents are learning pregnancy, you can see why they look at it that way. You have a problem list on your prenatal forms. What’s the first problem on every problem list that belongs to an OB? You’re pregnant. That’s the problem list.

Midwifery sees pregnancy as a normal function of the female body — natural biology that occasionally can go wrong. Midwives trust nature’s design to let them know when things are going wrong, not anticipating that everything’s going to go wrong. One of the biggest differences between midwives and doctors is that midwives are accepting of uncertainty and at peace with it. Obstetricians are not. So they’re always intervening, always over-testing.

The incentives in medicine are all backwards. The more testing, the more things that you do, the more money you make. A hospital gets paid two to two and a half times as much money if a woman has a cesarean section than if she has a vaginal delivery. The C-section’s over in 45 minutes, yet the hospital makes two and a half times more money. It takes more skill and patience to do a vaginal delivery. One of the things they don’t teach medical students and residents is the skill of doing nothing — which is a very important skill — and let nature play it out.

Lisa: The best practitioners are the ones that go into the field, see the limitations of what they were taught, and ask what’s next. They fill in that gap with experience, which is what you did. The liberty to do that isn’t available to most of your colleagues stuck in the medical world.

Dr. Fischbein: Especially now. When I first started, I was an independent contractor. My only lords were that I had to have staff privileges and I was licensed by the state. Now doctors, pretty much all of them, are employees. My fiduciary duty, my loyalty was my patient. When you’re an employee, you have a split loyalty — a conflict of interest.

I learned from midwives that pregnant women are clients. They’re not patients. Patient implies that you’re sick. It’s like changing a woman when she comes to the hospital in labor into a hospital gown and starting an IV and drawing blood. Those are all things you do to somebody coming in for surgery or pneumonia — not for something as beautiful as pregnancy.

The way labor rooms are designed with the bed in the center of the room tells you how they think about pregnancy. Why are you in a hospital gown? Why are you in a bed? If you go to a home birth, you almost never find a woman laying in bed. They don’t use the bed. The system is set up incorrectly, and doctors don’t have the liberty to make different decisions because they are captured.

They can’t let a woman go past 41 weeks if the hospital policy says otherwise. They’ve been using coercive language for the last three weeks to try to get the woman so scared that she’ll let them induce her. Even though doctors are employees now and have much less power, they have to know what they’re doing is wrong. They have to know it’s not the only way. And yet they do it anyway.

When we look at outcomes — how are mothers and babies doing in 2025, almost 2026 — compared to how they were doing in the early 70s? The cesarean section rate in 1970 was about 5%. Now we’re bordering on 35%. That’s a 700% increase. If outcomes got commensurally better, you could justify it. But the rate of cerebral palsy, the rate of interpartum death, has not gotten better.

A 700% increase in cesarean section rate. A tripling of the induction rate since 1990 — in 1990 the induction rate was less than 10%, now a third of women are induced. We now have maternal fetal medicine specialists. In the 1970s, about one out of every three women got an ultrasound. Now about 90% of women get at least three ultrasounds. Have our outcomes improved? No.

In the last 15 years, the rate of NICU admissions has gone from just over 5% to almost 10%. How is that possible when in the 1970s we rarely even had them? Fetal growth restriction was redefined five years ago from the third percentile to the 10th percentile. Does anyone believe that 10% of American babies are growth restricted? They’ve just changed the label — suddenly you have a pool of people that you can now do ultrasounds on that went from 3% to 10%.

Lisa: I have three children, ages 3, 10 and 12, and all of them were born in my house. I’ve never had a hospital birth experience. The average woman I speak to in my personal life is absolutely terrified that she would die or that her baby would die. Birthing at home is so outside the realm of what they would even consider. How does the way that women are now viewing birth — how they’ve been so terrified — play into this?

Dr. Fischbein: We’ve had 100 years of fear porn, brought into birth purposely by organized medicine to capture the industry. Birth is an industry — a trillion-dollar industry. Fear is the best way to manipulate people.

I wrote a book called Fearless Pregnancy back in 2004. The opening lines of the poem by William Wordsworth go: What is fear but voices airy, whispering harm where harm is not? When doctors use terms like your baby’s not growing well, your baby seems small, there’s too little fluid, you wouldn’t want a dead baby, would you — that type of language, and the tone in which it’s spoken, is something we are trained to use.

We’re trained in something called motivational interviewing — which is a beautiful term for coercion. One of the basic tenets of medical ethics is that given the same information, it is not reasonable to expect two people to come to the same conclusion. And yet in the medicalized birth model, they want every woman who’s given information to follow the path they want them to follow. When you don’t, you are labeled a troublemaker. A noncompliant patient. A difficult patient. And that’s put in your chart.

This is where it all leads to — using fear to get women to think that the hospital is the safest place. But they’re being misled, because for the most part, it’s not the safest place.

Let’s talk about mammalian birth. Where does a mammal go when she’s in labor? She goes to a quiet place. Nobody goes with her. If she’s hungry, she eats. If she’s thirsty, she drinks. If she’s uncomfortable, she moves. Nobody tells her she can and cannot do that. When she’s ready to give birth, she may stand up, lie down, roll. Baby comes out in dirt, straw, grass — not sterile. Nobody rushes in to cut the cord and nobody ever separates that baby from the mother.

Now look at what we do. If a predator approaches a laboring cat — if kids are staring at her behind the washing machine — what does mom or dad tell the kids? Leave her alone. If the kids won’t leave the cat alone, the cat is going to get up in the middle of labor and find another place. It’s not going to give birth when it’s being disturbed or anxious or fearful. It’s going to delay everything.

What do we do to the human female? Everything that nature’s design provides is antithetical in the medical system. We take a woman from her home and she has to get in a car and drive to the hospital and go through triage and answer questions, pee in a cup, get an IV, get blood drawn, get belts put on her, get in bed. That disrupts her labor. A woman contracting every three minutes at home comes to the hospital, and after all that, the contractions are seven minutes apart — and nobody can figure out why. But it’s simple mammalian birth. She’s now nervous. Maybe she even has high blood pressure. Now they’re labeling her as possibly preeclamptic when all she is is stressed by the whole process.

We have 50 years of fetal monitoring data, and we found that fetal monitoring has done nothing to lower the rate of interpartum death or cerebral palsy. All it has done is raise the C-section rate. It’s probably the primary reason why the C-section rate has gone up that 700%. And yet it’s pretty much standardized practice and no one’s going to get rid of it.

No paper in medicine ever looks at obstetrical care and asks how’s that baby doing when it’s two years old? Does that kid have attention deficit disorder? The way we give birth matters, and that is not something the medicalized birth model considers, nor are practitioners taught it.

Lisa: I experienced an ejection reflex multiple times with my children — meaning that even the pushing wasn’t up to me.

Dr. Fischbein: That’s true. And my point is that like breathing or digestion, your body does these things without thinking about it. However, your higher brain can mess it up. If you have to go to court and you’re nervous beyond belief, you might hyperventilate, feel your heart racing, get an upset stomach. That is your higher brain messing up your bodily functions. The same thing happens in pregnancy. Stress can affect your pregnancy. You’re secreting certain hormones throughout your pregnancy that are probably influencing fetal development — it’s called epigenetics. If you’re bathing your body in oxytocin and dopamine because your life is good, that baby is probably going to have a different experience than a baby born in a war-torn country where there’s starvation and fear.

But we don’t put any credence on that because the medical model can’t measure it. What they care about is getting a live baby out. What happens down the road to that baby, that mom, or that mom’s future babies isn’t their concern.

Lisa: We have this huge problem. What is the solution? Does it start with education of women?

Dr. Fischbein: One of the solutions to stop the fear porn is to change the way we educate our young women and men. We need a revolution in our public education system. We need to teach young women — and young men — about their bodies, about how normal and beautiful the process of conceiving and growing a baby is, and how having sovereignty over your body can set you up for a better life, more self-confidence, more certainty in your decision-making.

If they know these things, when they go to their first OB visit and their OB is traditionally trained in this Western model of fear-based pregnancy, they’re going to look at their doctor and say, that’s not exactly what I’ve learned — maybe you’re not the right doctor for me. Or: explain to me why you don’t let women go past 41 weeks. Or: why don’t you support breech delivery? Or: will you be on call the night I’m in labor?

Once you are indoctrinated with fear, it’s almost impossible to get rid of it. It’s kind of like the movie Inception — don’t think about elephants. Once you plant fear in somebody, you cannot get it out. So we need to stop that from the very beginning.

We also need to change the way reimbursement works. We need to stop paying more money for more things that they do. A vaginal birth requires more skill and time than a cesarean. Let’s pay more for a vaginal birth than we pay for a cesarean birth. Suddenly you might find that VBAC and breech are more accepted. If you say to a hospital, if you have a 20% C-section rate, you get X dollars for every birth; if you have a 30% C-section rate, you get 80% of X dollars — you incentivize them to lower their C-section rate.

Everyone in their right mind has to know that at least half of all C-sections being done in the United States are unnecessary. That’s at least 600,000 unnecessary C-sections every year. What damage are they doing to that mother, to that baby — changing that baby’s birthright, microbiome, rite of passage? Putting that mother at more surgical risk postoperatively: problems with bowel obstructions, adhesions, scar tissue, pain, and problems in all her future pregnancies. Because now she has the VBAC issue and the feared potential of uterine rupture. The problem with potential placenta accreta, where the placenta grows into the scar. What if she wants a second or third or fourth or fifth baby?

Lisa: The big fears when you’re thinking about not giving birth in a hospital are the cord wrapping around the baby’s neck, breech presentation, twins, the baby being too big. Talk us through some of these common fears and the perceived risk versus what the evidence actually shows.

Dr. Fischbein: First of all, the term risk is problematic. The higher chance of something happening doesn’t make it high risk, and yet everything is labeled high risk. If I asked 10 doctors, 10 nurses, 10 civilians to define high risk, I would get 30 different answers. High risk has no definition. High risk is whatever makes your doctor uncomfortable.

They will label a woman who’s diabetic as high risk. If that diabetic is well-controlled, whether on diet or insulin, what are her actual risks any more so than any other woman? Almost none. But what are they going to tell her at 38 weeks? That she needs to be induced. Which is actually higher risk — to be well-controlled with diabetes and wait for labor to occur, or to be induced? I will tell you the higher risk thing is the induction.

According to the Royal College of OBGYN, the risk of a neonatal death with a breech vaginal delivery is two per thousand. The risk with a head-down vaginal delivery is one per thousand. So you’re going to lose one extra baby per thousand breech vaginal deliveries. For that, the medical system wants to section a thousand women to save one baby. What are you doing to the other 998 who didn’t need C-sections? What are you doing to them in their future pregnancies?

Is it higher risk to let a woman deliver vaginally with a breech baby with a skilled practitioner where the baby is properly selected at term? Or is it safer to do a C-section when knowing full well that she wants another baby or two? The answer is it’s higher risk to do a C-section on her — yet the other one will be labeled high risk.

VBAC carries a risk of about 1 in 200 of the scar separating. In about 5% to 16% of those cases where the scar separates, the baby will suffer terribly or possibly die. So the actual risk in any woman with a single low transverse scar of having a very bad outcome is 1 in 6 times 1 in 200 — or 1 in 1,200. Is 1 in 1,200 really high risk? Because that’s the same risk as a woman just under 25 years old of having a baby with Down syndrome. Do we tell 24-year-olds they’re high risk for Down syndrome? No.

When a doctor tells you something is risky, ask them not only what the relative risk is, but: how risky is it exactly? What is the actual risk? If they say it’s twice as risky, that doesn’t mean anything. They need to tell you the actual risk so that you can make an informed decision. Without that, you are being coerced.

Lisa: I think a lot of women would be surprised if they looked at the actual research on ultrasounds and discovered that they don’t significantly improve birth outcomes. The average doctor, I would guess, doesn’t actually know to rattle those numbers off.

Dr. Fischbein: Not doing ultrasound doesn’t generate revenue. Doing ultrasounds generates revenue. Doctors find reasons to do ultrasounds, and on occasion they’ll find some pathology. So there might be some value to a 20-week scan. The problem is MFMs have now gone overboard. At every 20-week scan, they’re looking for things, finding things, using Color Flow Doppler for no particular reason. That leads to finding reasons to do more ultrasounds. And the minute that starts, you begin to scare the woman and her partner.

No two women given the same actual risk should be expected to reach the same conclusion. If I tell you something has a risk of two per thousand, you may say, I don’t want that. Another person will say, well, that’s a 99.8% chance it’s not going to happen — I’ll take that risk. And that’s fine. What an algorithmic medical model doesn’t take into account is every individual woman’s life experience and her own way of analyzing things.

The system doesn’t give the doctor time to get to know the woman and have those conversations. When you are an employee told that you’re going to see six patients an hour, that gives you about eight minutes. You can’t get into a deep conversation about informed consent in eight minutes.

That’s where the midwifery model of care comes in. No midwife is getting rich because midwives see one patient an hour. If that patient needs an hour and a half, they give them an hour and a half. When they come in after two or three visits, they know you. They know your kids’ names. They remember your husband’s name. They remember what you talked about last time.

When you hear the stories about how women were funneled a certain way, how coercive language was used, how when they brought in their birth plan the doctor rolled his eyes — these are not happy people. Happy people don’t talk to other people like that. Happy people don’t threaten people. Happy people are patient and want to communicate.

The quality of care that a patient gets and the quality of life that a physician gets are being put at odds by the people that run the system. They’ve done a great job of dividing the doctor-patient relationship. Patients used to belong to doctors, and doctors brought them to the hospital. Eventually hospitals said, let’s get into managed care, let’s get the patients ourselves and then hire the doctors. And they sold it to us as a good idea because they’re great at propaganda and PR.

Lisa: Everything that you’ve said has really elaborated as to why women feel like we’re a cog in the system. We could only scratch the surface even in almost 90 minutes. Please tell us about your podcast and your work.

Dr. Fischbein: Everything I do is Birthing Instincts. My website is birthinginstincts.com. The podcast is the Birthing Instincts Podcast with my co-host, Blyss Young, traditional midwife. The website for that is birthinginstinctspodcast.com. On Instagram I’m at birthinginstincts.

I’ve written a book called Fearless Pregnancy, Wisdom and Reassurance from a Doctor, a Midwife, and a Mom. It’s available on Amazon or through my website, and also from lulu.com. Part of it’s obsolete because I wrote the initial thing in 2004 — the genetics chapter is completely obsolete — but the wisdom in there is still very valuable.

We have a Patreon group with about 1,100 people — some moms, some birth workers, some OBs, some maternal fetal medicine specialists. We have different tiers and different levels of information. We have a peer review every month, a Q&A every month, Blyss has a village prenatal every month. You can actually see our podcasts on video if you’re on Patreon.

My passion is really my teaching. I go around the world and teach a two-day seminar on twin and breech skills — the biases, common sense, and the psychology of where we’re at in pregnancy so that anybody who attends is better equipped to deal with the medical system. No one leaves that seminar an expert in breech or twin delivery, but no one leaves who couldn’t actually facilitate a breech or twin delivery if they had to.

For birth workers, I have an all-access membership at $1,200 a year — $100 a month — which gives them non-emergent access to me for questions about clients, reviewing labs or ultrasound reports, going over a birth they may feel they could have handled differently. It’s like getting a second opinion.

I do want to write a book — a book on the history of obstetrics during my lifetime. I have letters and things I’ve written since I was a resident in a file in my garage. It would be a fascinating story of history. The best way for us to learn things is not through book learning — it’s through storytelling. I’ll remember when you talked about your births more than if you’d read a book on home birth.

Thank you for the opportunity to be on and speak to your audience. And to see you — that’s always a joy for me.

Lisa: Thank you so much for being here. This was wonderful.