#111 | The Obstetric Model of Care vs. the Midwifery Model of Care: Interview with Dr. Stuart Fischbein, MD

July 7, 2021

Are doctors misinforming patients? How can the medical model of birth cause harm to birthing mothers? Why are half of the cesarean births in the United States performed unnecessarily?  Why is one's satisfaction with her own birth experience so low on the priority list?  These are the questions we dive into with Dr. Stu on today's episode.

Stuart James Fischbein, MD, also know as “Dr. Stu” is a Board Certified OBGYN. He has been a practicing obstetrician in Southern California since 1986. In practicing obstetrics, he realized something wasn’t right in the medical model of birth, and he started offering backup support to home and birthing center midwives.

He now practices community based birthing and works directly with home birthing midwives at www.birthinginstincts.com to offer hope for those women who prefer and respect a natural birthing environment and cannot find supportive practitioners for VBAC, twin and breech deliveries. 

He is an outspoken advocate of informed decision making, the midwifery model of care and human rights in childbirth. He joins us on the show today to discuss the  biggest challenges facing birthing mothers today.

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Between episodes, connect with us on Instagram @DownToBirthShow to see behind-the-scenes production clips and join the conversation by responding to our questions and polls related to pregnancy, childbirth and early motherhood. You can reach us at Contact@DownToBirthShow.com or call (802) 438-3696 (802-GET-DOWN). We are always happy to hear from our listeners and appreciate questions for our monthly Q&A episodes. To join our monthly newsletter, text "downtobirth" to 22828.

You can sign up for Cynthia's HypnoBirthing classes as well as online breastfeeding classes and weekly postpartum support groups run by Cynthia & Trisha at HypnoBirthing of Connecticut

Please remember we don’t provide medical advice, and to speak with your licensed medical provider related to all your healthcare matters. Thanks so much for joining in the conversation, and see you next week!

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View Episode Transcript

Satisfaction has to matter. The memory of the event has to matter. It just does. And we were not doing well in the hospital model. And unfortunately, my colleagues that are stuck in it, the need to stand up.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Dr. Stu, it's so awesome to have you on the Don dobro show today you were actually one of the very first people that we wanted to interview on the podcast. And we have now 100 episodes out there and we are finally having you on the show. Yeah, so this is monumental for us. We have listened to many of your podcast episodes, and we know how much valuable information you have to share about the world of birth today, you've been on both sides of it, and you chose to leave obstetrics for the midwifery model of care. Hooray for you. And we want to talk, we want to learn a little bit more about you. We want to talk about why you'd made that choice. And can you just start by giving our listeners a quick introduction on who you are?

Yeah, I'm going to try to make it short over time. But people who want to know more about me can read my bio, or some of my stuff at my website, which is breathing instincts calm. I'm a practicing obstetrician. I finished my residency in 1986, at Cedars Sinai in Los Angeles that came out like every other doctor comes out, very medically oriented, very medically trained thinking pregnancy is an illness, and that it needs to be treated most of the time and, and that women who are pregnant are patients and didn't think twice about the word patients the connotation of what it meant. And I started in my practice, just like in those days was a little different. We didn't just come out and get a job working for somebody, get paid a salary work a shift, you hustled to build a practice. And that was my good fortune. Well, I should say first, my good fortune was in my residency program, I got to spend five months at LA County, USC during my cedars time, and that was the busiest hospital country in those days. And so I was lucky to get the training that I got, which made me able to practice with the skills that I have today, which they're not teaching anymore, which is a shame and a problem. And something maybe we'll get into as we talk a little bit more. So when I get when came out, I was approached by some midwives and asked to be their transport physician or to take their patients, what was used to be called a backup physician, but we really don't call them backup physicians anymore. And I said sure. And I didn't say sure, because I thought it was a good idea. I thought homebirth was stupid. I did it because I was trying to make money. And I thought well, okay, I'll take the transports and I'll get paid with insurance pays me that'll be a way to building my practice along with working in free clinics and, and hustling and ers and covering, you know, assisting other doctors in surgery. And that's how I bought my practice. But over the time, I began to see a different way of doing things. These clients that came in from the midwives were were not poorly educated, they were actually far better educated. They were far. They were a lot of them were professionals, they had made wise choices. They knew a lot more about their bodies and their pregnancies than my own patients did because they they were just that sort of thing. And it changed my whole mind about the homebirth world and I began to attend some of the midwife functions. And I began to spend a lot more time with that sort of thing. And I began to see the other way of doing things after about 10 years in practice. I formed a collaborative practice with two certified nurse midwives. And we worked in a hospital setting. And for 15 years was called the woman's place and we had a really good thing going there. We were never well accepted in community. We were always the outsider we were always sort of picked on. There's something called champion review and Connie sacking. And they they didn't like us there because we did things differently. And we had really good outcomes. And it made other people I think personally made them look bad and it didn't give any business the anesthesiologists and the pediatricians didn't like us because our clients didn't want to have hepatitis vaccine didn't want to have vitamin K and it made people nervous and they wanted to go home for hours after they delivered and that was awkward and inconvenient for the pediatric department. So eventually, we got pushed out of the hospital. And it was the best thing that ever happened to me career wise before though After 24 years of working in the hospital system, I've been 11 years now doing home birth with midwives here in Southern California. And initially, I started out doing just regular birthing, and then I've really taken it to a new level where I'm using the skills that I learned when I was a resident with breaches and twins. And partly because there's no choices for these women in the hospital, they've taken away the choices. Despite the fact that these things that I do are evidence based, there's a lot of good science about them being a very reasonable choice. And if you believe in informed consent, as you and I, as we all do, we need to give people this information. And a fair informed consent process would look like you know, I don't do breech delivery, but it's a reasonable option. So we'll look for someone else, as opposed to saying breeches dangerous, the baby's head will get stuck, and you have to have a C section. And by the way, it should be scheduled at 39 weeks, we don't want you going to labor because the cord might fall out. I mean, these, this is this scare tactic, the skewing of consent. This is rampant in the medical model in the hospital based model. And it violates pretty much every tenant of medical ethics that were taught from the very beginning. So I feel very comfortable doing what I'm doing. I am a bit of a unicorn, there aren't very many of me left. And I hope that the word gets out, I would love to see some young physicians coming out of residency say, you know, this just doesn't seem right. What we're doing doesn't seem right.

doctors do very often my own clients asked me why are doctors, misinforming their clients? Why is this happening? Is it their lack of education? Is it their lack of ethics? Or is it the system that they're working in? or some combination of the three?

You know what, it's all three? I mean, I hate to I hate to be vague like that. But let's talk about that. If you're indoctrinated into one system, and that's all you know, that's all you that's all you practice. I speak English. I don't know Greek. So I can't do anything in Greek. But I can do with something in English. If suddenly Greek became the norm, I would be very, very uncomfortable with that. Right? It would force me to change everything that I knew about my language. And that would be very difficult. It's very difficult for someone who's been practicing or taught to practice a certain way to suddenly realize that what they're doing may not be right, that's almost unthinkable. Because these aren't bad people. I want to reiterate that, again, that gets back to the system, that they really aren't bad people, the system is what forced them into that. I guess, I guess, I have an example that that probably is a better way to say it, the C section where the United States is about 30%, maybe a little higher, let's just say 30. Because it's easy math. The World Health Organization, and a lot of other countries believe that the C section rate ideally should be 10 to 15%, we think it should be lower, but let's just say 15%, because that makes it for easy math as well. So that means that half of all the C sections being done, the United States are probably unnecessary. Right now, there's about 1.3 million c sections done the United States every year. So that means about 700,000 or 650,000. c sections are being done that are unnecessary. If there were 650,000 unnecessary knee surgeries being done every year are unnecessary hysterectomy, or anything else, people would be up in arms about that, but they're not. But here's the irony is that if we admit that six that half the C sections being done are unnecessary, who's doing the unnecessary c sections? Because no doctor goes home at night and says to their spouse, Hey, honey, guess what? I did two unnecessary c sections today. Yet half the C sections are unnecessary. So again, they live in a world of cognitive dissonance because they don't they because it's all they ever know. And that's I was in that world. I was part of that. Well, it takes an awakening it takes sometimes it takes an event that happens. I can't say specifically what it was, for me, I think it was an overtime. But it was being open to observation and open to alternatives. And I think a lot of doctors get into this, as you said the system, which is, you know, low reimbursement, high volume, Monday morning quarterbacking hospital policies, that don't let them individualize care. And if they did try to individualize care, then they're going to get yelled at on Monday from somebody in administration, and they're going to get their livelihood threatened. Or if they work for something where they're on a salary, like here in Southern California, we have Kaiser, if Kaiser wants to induce everybody by 41 weeks, if somebody says I'll let you go longer, and they're and they could get called in and they could eventually potentially lose a bonus or lose their job. And nobody wants to do that. People just want to go home to their family. And they don't really want to fight the system. And so all those things you talked about and then is there some unethical behavior of course there is skewing your counseling to get people to do what you want them to do is unethical and coercion, whether it's subtle or overt, is still coercion. And therefore, when you tell somebody that that's dangerous, when it really isn't dangerous, you just don't want to do it or don't know how to do it. That is coercion.

Can you give our listeners a couple examples of the most common ways that they mothers might be coerced into doing Yeah, woman walks into their 10 week visit and, and she's happens to be 37 years old, and the doctor starts talking already about our age, right? Like planting seeds of doubt and telling her that when she's 36 weeks, we're gonna have to start testing because your placenta might get old. And it might give out And oh, by the way, I do make a little money every time I test you, so that you know that we're gonna do I mean, we're not telling you that, but that's what we're going to do. And in order they actually believe it, which is even worse. I don't know sometimes we don't know whether is it worse that they that they believe what they're saying or that they know what they're saying is wrong, and they do it anyway. It's, it's, it's a toss up. So that's what what breech birth. breech birth is something that I have a strong feeling for. Because it's so beautiful and so easy. If you properly select the clients, and they reached a term and they meet certain criteria, it's really safe. It might be slightly less safe than a head down birth. But it's certainly safer than sectioning all breaches. Because if you section all breaches, then all you do is transfer the little bit of safety, you might have saved that time, to all those woman all that woman's future babies, because now she's got a scarred uterus. So when you tell a woman that a breech birth is dangerous, and nobody does it anymore, either you are ignorant or you're lying. There is no third option. Right? Maybe you believe it, but that's because you're ignorant because you haven't looked into it. And it makes you uncomfortable to be an obstetrician and maybe not have that skill. And maybe it's a little bit embarrassing or a little bit thing that somebody else does that some other doctor over at cedars has that skill or Dr. Fishbein at home has that skill, right, and I don't so I have to tell people that it's dangerous, or he's crazy. Makes me feel better. That's what goes on.

It seems there's not enough education in obstetric school where doctors even have to experience you're laughing at the term obstetrics. Why don't think it's perfectly appropriate term obstetrics school, you know, I mean, I medical school, but I mean, I feel like there's not enough education there because they can graduate without supporting any women through natural births. But a doula can't get their little old credential without attending a minimum of pre natural births. And it's just a little backwards to me. You know, it seems like they're not getting the experience they need just as a baseline.

Well, there's so much wisdom in what you just said there. But what's happening in residency programs, is they're not teaching breech delivery anymore. They're not teaching second twin breech delivery anymore. They're not teaching forceps anymore. These are the skills in my opinion, that make my profession unique. Right that I can do assist a woman with a breech birth or I can reach up and pull out a second twin, if necessary. to not have these skills, I think makes you less than an obstetrician. I don't know how you call yourself an obstetrician. You can come up with another name for yourself. You could be a baby deliver or a pap smear door or whatever. But you're not a obstetrician if you don't have these unique skills, because if you do, all you can do are bachelors and C sections. What makes you different than a surgeon or a midwife? I mean, midwives can do Bachelors of reason they probably do better than most doctors do anyway. And then C sections can be done by the general surgeon. So what do we need obstetrician for and general obstetricians now are are relying or they're taught in the residency. They're conditioned in the residency program to rely on the specialists for everything else. So almost every pregnant woman now, who goes to a normal ob office, at some time during your pregnancy will probably see a maternal fetal medicine specialist. Could be for a 12 week ultrasound could be for a 20 week ultrasound, it could be because she's hypothyroid. And no, God forbid, the OB should manage your thyroid know that I'm going to send her to the endocrinologist. And now for that I don't necessarily blame them. Because when I manage hyper thyroid, hypothyroidism, or diabetes and pregnancy, I don't get paid extra for that. But if I send my diabetic woman to a diabetologist, he gets paid every time she goes in. If I were doing that, I don't get paid. So that's a fault of again, the way our system is set up and it's it sets up so what happens is, is the OB becomes a generalist and every woman who's got a problem if you got a cancer, you go to a GYN oncologist, if you've got a bladder problem, you go to a GYN urologist, if you've got a pregnancy problem, you go to Maternal Fetal Medicine Specialist. If you have problem getting pregnant, you go to the reproductive endocrinologist. What do we do generally ob gyn for anymore? What is the general vo he does your annual exams he writes for options for your hormones. Or maybe you're not up, go to a hormone specialist for that. I'm just saying that if I were a young person wanting to go into ob gyn right now, I would demand that my residency program, teach me how to do a breech delivery. Because even if I'm not going to necessarily see that often, every now and then someone's going to show up in labor and delivery or in the emergency room with a butt sticking out of the vagina, or a foot sticking out of the vagina, and they're no and they're not going to know what to do. And they're going to push it back up inside and do it, you know, and half an hour later, do a certain section and get a baby that's lucky, still alive, when, you know, a couple simple maneuvers, and that baby could be out badly. How do you how do you do that? How do you not keep the skill alive, and the only people that are keeping the skill alive that have interest in it right now seem to be midwives. They're the torchbearers of the profession.

I've told clients for years that as much as we don't want to draw too many generalizations, I do have one I say, if you have the option available to you, and you must birth with an OB, and it must be in a hospital. You are probably in better hands with an older obstetrician, not by virtue of their experience, but because what they've learned is unfortunately, a dying art now,
no. And then people say, Well, you should ask your doctor what their c section rate is. But you hear the truth? Yeah. How do you say that? Right? Well, you said that your doctor had a 50%. c secretary, she admitted that, but I've never had a client who heard some such a thing. I think she was one of a kind and that she openly brazenly says proud of it. She was proud of it. And the and all my clients come to me in the hospitals where I know it's 50% of my doctors is 17. And I'm like, really, because there's never been a law passed, stating they have to be audited, or those numbers have to be revealed, which is unbelievable to me. And it's really interesting to ask your physician again, we don't necessarily going to get an honest answer. But ask your visitors not that question. But ask the patient. How many babies have you delivered? We've done absolutely nothing? That's a good question. Right? Because in our world, you know, in the midwifery world, the home birth world, you know, most of the time we do absolutely nothing. Short of doing nothing is not something that's ever taught to physicians. And and I had another thought back to your other question was about why things are the way they are in the hospital sometimes, is because everybody lives in their own silo, the OBS never have seen a homebirth homebirth midwives. Sometimes, if you don't know what it's like to be a labor and delivery nurse, the labor and delivery nurses don't know what it's like to do this. And so there's no cross, not training. But there should be some sort of grouping together of the breaking of the silos so that a licensed midwife could go spend two months in the labor and delivery Ward, a labor nurse could come to some homebirths, a ob out of there in during the residency program should have to spend three months tailing a midwife around.

That's what true collaborative care looks like

that in countries that have collaborative care, and better and better transition from home to hospital, smoother transition, they have better outcomes. They simply have better outcomes. We're not I mean, we're not doing well. It's kind of like education in our country, we spend more per student than pretty much every other country and we're not doing so well. The same thing in healthcare. We're, you know, we're not doing that. Well. Is it really true that 1/3 of all women have to have a C section. And then now we're trying to analyze whether we should be inducing all women at 39 weeks? Because of the you know, the arrived travel that came out and, and why why are we meddling with all this stuff? Are we really getting better outcomes? Are the neonatal death rate in the cerebral palsy rate falling dramatically because of all these interventions? And the answer is no, it's not. And how is and then, and then when would we ever consider patient satisfaction, right, but we call client satisfaction, not even in the picture, we always say that the number one outcome is a healthy baby. That is by no means the only outcome we're going for, that's the lowest possible bar, everyone's alive at the end, we have to raise the bar a little bit higher than that.

That is the outcome that the hospital looks for baby in the bassinet is all that matters. And as a matter of fact, in the obstetric model, I often think that maybe it's that way, because we don't look at mother baby as a unit as the midwifery model does. Because once that baby's out, it now belongs to the pediatric department. It's not my responsibility anymore. So if I get that baby out a little quicker by a Cesarean section, and I got a crying baby, and I know how to sew somebody up and I don't really worry about what that woman's future is I I asked women who come to me for a console for breech birth. When they've been told by their doctor, they have to have a C section. I asked this 100% I get the same answer every time I asked him Did your doctor ever ask you if you want more babies? And the answer is no. Because that doctor's only concern is getting that baby out in a bassinet without a problem. And they don't care about the woman they want five more children and now has a VBAC issue.

I love your point about how they are not viewing the mother and baby as as a you know solid unit because they are in my as a lactation consultant that is such an important piece of lactation working is that you always see the mom and baby as a two part system. But it's interesting because in birth, it is literally the second that baby comes out of the mother. The obstetrician is that's not my patient anymore. It's it's within seconds. I mean, they go to the the second they go to the warmer, they're no longer responsible for them. How can you have like a holistic care that way? If you don't, then, and then a woman goes home the next day, and the doctor says I'll see you in six weeks. But but but nobody, I mean, you just said, So naturally, I know that you don't believe I know that you think like I do. But you just said the baby goes to the warmer it's like, well, why not? In my world? No, I know, not in our world. But routinely in hospitals. It's big. It's changing a little bit now. But But still, it's way too slow. I mean, there was no reason ever. No man was ever separated from its baby except humans. And the idea that a baby needs to go to the warmer and if you ask a nurse, why are you taking the baby to the warmer? Well, we have to check the baby out why it's crying, why over there, it's breathing. Pink, well, we have to wipe it down why it's good to be covered in shorts. Okay? For next, we have to give it its vaccines, we have to check it out. You know, in the home birth world, when the baby's born, we do a newborn exam on the baby, probably about two hours after it's born. There's no rush to do it unless the baby needs assistance. And then we step in. But you know, we never cut the cord. The baby immediately goes skin to skin. The whole system is designed that way. And every time you do something to a woman laboring or to a baby, that's newborn, that's an intervention in the homebirth. world, we come in quietly, and we put a blood pressure cuff on the woman the first time because we just got there, or we listen, that's an intervention, you're taking a woman out of her where she's at. And she's, she's, you know, she's wondering what's going on. And so her cognitive brain kicks in. It's an intervention, it's a tiny intervention, but it's still an intervention. And it changes everything. So there's no appreciation for the mammalian innate Eon long process of a woman growing a baby and delivering a baby. In the medical model. Everything is looked at as a potential medical problem and therefore needs an intervention or as they say in the in the journal needs managing need to manage that. How are you going to manage that? So like, we manage it by not managing it? Maybe 15% of women need managing, right? Well, that's the problem with the medical model of education and birth or obstetric school, as Cynthia said, it's like, that is what they learn. They don't learn the physiological model that we learn in midwifery school, they learn, they break down pregnancy and birth into all the bits and pieces and you know, write out the protocol with the latest evidence of how to manage it. So that kind of leads me to the question of what is the role of an obstetrician in birth then, like, why would a woman choose an obstetrician? What's the benefit?

Very little for most women, very little. Part of the benefit is the fact that their insurance covers that. And then insurance may not cover a whole birth. So that's an issue.

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One of the analogies that my friend bliss I used to so wisely tell when we used to have these, we used to have Wednesday night meetings when we used to have a birth center. And we would have these parent meetings where the people could come and they could just listen. And we would talk about the periphery model. And she at the head would always talk about the finances. And she would come up with this thing, where she talked about how for women, there are many important things in her life. But probably the two most memorable events in her life are generally her marriage, and the birth of her children, and for her marriage, and I'll summarize briefly because she tells it beautifully, but for marriage, people will send 1000s and 1000s and 1000s of dollars of money in their own pocket, and they'll plan everything. The plan, the invitations, the plan, the dress, the pick the cake, that pick the food, they'll pick who's inviting them, they'll do all this, they'll plan everything they'll spend a lot of money on for their birth, they say, Well, we've been you know, we've got blue shield, we've got Kaiser, we've got Medicaid, or whatever we've got. And you know, it says I got to go to this doctor, or I've been going to this doctor for 10 years, he's been doing my pap smears. So he'll just deliver my baby and not knowing not putting any research into it whatsoever, not looking very carefully at it. So having a good experience in the hospital has to start with early on making sure that the relationship you have with your practitioner is going to get you to the place that you want to be. And if you find that you can't talk to your practitioner or there or you don't know too much about it or you're not comfortable you feel leaving every visit that you feel an empty feeling inside of you. Don't settle for that, you've got to get out of that you've got to make a change, you would never settle for that in your wedding. You wouldn't you know, I don't really like the taste of that fish. But let's serve it anyway. You would never do that. So that is start there. And you've got to work your way and you've got to have confidence in your team. I would also recommend that people have a doula you plan ahead, especially if it's your first baby, you must have a doula, you must have someone who advocates for you so that you don't have to be advocating for yourself. And you need to know what your hospitals policies and procedures are. And if that's not okay for you then look elsewhere. And maybe spend money on it if you have to. Alright, it's a valuable thing. You women remember the birth of their children their entire lives. So it's something that's imprinted. And everything about it is so beautiful. And we we so interrupted, and we pay so little attention to it, it's become the long habit of not thinking something wrong gives it that superficial appearance of being right. And wait, we've managed pregnancy for several generations now in our country makes it why that's why people just go they go to their obstetrician, because they think that's what they're supposed to do. But it's not what you're supposed to do. Right? There's no reason to do that. And hospitals need to wake up. And if we can, if if we really wanted to improve the outcomes in America, for the for the next generation. I mean, there's a lot of ways to do it. But one would be to re reimagine Burling. I hate using that term, because it's such a stupid term is sort of a was mocking it when I said reimagine management. But we need to, we need to get another way of doing it. We need to take normal birth out of the hospital. The hospital doesn't know how to think about things in any way. But but it's the hospital model. When you come into the hospital within labor, you're asked a bunch of questions, the same questions. They're asking you if you were coming in with a gunshot wound, or having your appendix out. You know, how many stairs did you have in your house? or What did you grant? Why do you care? What differences Leave me alone, don't and by the way, if you're going to have your birth at the hospital, because you feel safer there, that's fine. hire somebody to come to your house and keep you at home until the last possible minute. Stay out of the hospital as long as possible because the hospital is anti mammalian. Everything that's done there is at the Medical to nature's design, everything.

You know, you're right that women often hire their obstetricians by default, they put more energy into finding a good real estate agent or owner that are a good plumber. Okay. But the thing when I when I talk to a couple, let's say for the first time who've signed up for my class, I always say, what's your vision for birth, sometimes you're more clear on what you don't want at first than what you do want because our minds have to open up to the possibilities. But when a woman says to me, I really like my obstetrician. My response is always I'm glad you don't dislike your obstetrician, but liking them is not enough. I liked the doctor who I swear if chic the diet doctor I fired. It's almost like she had a mask of niceness and charm, that she was absolutely dangerous for me and my birth, which is why I left her. I ended up having my dream birth with a midwife I really hoped I wouldn't get because she wasn't particularly warm. And I tell women don't be seduced. Don't you know in the finance world, they always said don't fall in love with the stock. Because when it starts going down, you're attached to the company you believe in it. It doesn't mean anything the stock is going down. And when people are with doctors because they quote like their doctor It doesn't mean anything what you need to know is their philosophy, their approach? Are you aligned? Is there a vision of the perfect birth for you your vision of the perfect birth for you? So we don't want you to dislike your doctor. But if you like them, you haven't even begun to evaluate whether they're right for you.

Nice people have done a lot of evil in the world. And you've certainly, and you certainly wouldn't want the pilot who's nice. Okay, you want the pilot who knows how to fly to Plunkett? So yeah, you're right. But But neither is looking nice. This is great. And you want somebody you can communicate with and stuff like that, and feel safe with what it was their skill level? What is a confidence level? Are they are they comfortable with birth? I would tell you that my experience with most obstetricians is that they there's they're scared of birth. It makes them nervous. Alright, and I and I have to tell you that, that I don't know a lot of happy obstetricians. And by the way, when you're in your doctor system, and you love your doctor, and you may love your doctor, you need to find out is that doctor on call every night? And the answer is going to be almost for sure, no. So that means you maybe have a one in five chance of having the person you love being carefree. And by the way, when you have the medical model system, and you have an OB, that one who's really taking care of you when you're in labor, right? The nurse, the nurse, the nurse, you've never the nurse you've never met before, who you may finally start liking but then seven o'clock comes around, and she leaves and then another.

When a woman tells me she loves her doctor, I sometimes say, Does your doctor love you? Does your doctor get choked up longing for you to have your beautiful birth? Maybe? But do you love your doctor? Or do you love your baby? Do you love your doctor? Or do you love your family? I mean, let's just get perspective. We're hiring here. And we need to hire someone not only who's skilled, but who's aligned with your vision of the of the best outcome far beyond that of a healthy outcome.

Yes, and the model by which in which these doctors are submersed. In labor, we talked about it briefly. But the model is such that, that when you're in labor in a hospital, think about how that we think about how that looks generally. Right. You're sort of with strangers, even pre COVID when you can have people in the room it's not always great to have people in the room staring at you like having your mother or your sister or your husband or whatever staring at you. You know, Sarah Buckley likes to say that that, that birds should be safe, quiet and unobserved. And every again, I said everything about the hospital monocles antithetical to that. I mean, you might feel safe there. But it's certainly not quiet. And you're certainly not unobserved. And when you have that model, when you go there, and you have to understand that it interferes with the physiologic processes that trigger labor that make labor go whenever you're nervous, or anxious, or interrupted, you're going to put out adrenaline. Alright, adrenaline stops contractions makes your labor dysfunctional. That's why women who are contracting regularly at home, who then pack their bag, get in their car, drive to the hospital, go through triage signs, and forms change into gown, pee in a cup, get their IV started, get their blood drawn, get put on a monitor, and their contractions are now eight minutes apart. And people are wondering, wow, what happened to my labor? Hmm, where do you go? It's like, Well, duh, you didn't, you're a mammal, you did exactly what a mother Foxx would do. If a predator was approaching you, you'd be like contractions would space out and you'd get if you could, in the hospital, you should get up and run. But you know, people don't do that. But they're, it's very awkward. For most people, they're very uncomfortable. They're they're very nervous there. And the people around them are fairly nervous there. Because I don't know, I guess when you see a bad outcome. You don't you can't help but get a little bit of post traumatic stress when you're a healthcare worker.

Well, especially if you don't see good outcomes day in and day out, you know, to counteract that, like if you occasionally birth has a bad outcome, we all know that it's happens in nature, it happens everywhere. But when you see birth, as normal and natural 99% of the time, you don't have to feel so afraid.

That's very, that's very true. That's very true. Because, you know, we've all every homebirth practitioner has had outcomes that they weren't happy about. And but you have to get back up. You know, you have to pick yourself back up, dust yourself off, and you have to continue. And sometimes you can't, and then it's time to then it's time to move on to a different profession. Many of my colleagues should, should move on, but what we don't know anything else? I mean, what are we going to do? You've been in practice for 15 or 20 years and you really don't like what you're doing, but what are you going to do? Now if you live in a two, two household family, I mean, two income family. Like a lot of like a lot of Obstetricians these days. They do ob for a few years, and then they decide, you know, I don't like the call and I don't like the liability and blah, blah, blah. I'm just gonna do office gynecology, and you can get away with that but Then we need people to deliver babies and who should we be returning to? midwives. That's what we should be turning to.

I reminded me of a story of when I was in school and midwifery school and one of my friends was in medical school to become an obstetrician. And we were having kind of a heated discussion about, you know, I was talking about natural birth and how there's so we caused so many problems in birth with all the interventions, and she looked at me and she was like, she was sort of angry and upset. She's like, well, it's just not fair. Like, why should you as the midwife get to do all the fun verse? Oh, my God. Yeah. And I was like, you can do fun parts to thought about, it's not about it being fun. It's like, you know, I want to support the natural normal process. And that's what I care about, if that's what you care about, maybe you're in the wrong school. That would be all self-serve exactly what I would have said to her, right, maybe if you want to do fun verse, then you shouldn't be practicing in that model. Because they don't allow for when, again, fun birth happens, even despite the hospital model, sometimes it still happens in the hospital. But for the most part, and the idea that that God, you never have to leave your home. And people say, Well, what about the mass? Or what about the cost? Or what about the risk or whatever? What is this bad thing happens? and and the the answer to those most of those questions is that bad things rarely happen. When you leave things alone, at least they rarely happen suddenly. And you can generally if you're experienced, you can see things coming that aren't normal. Because you know what normal is, it's very easy to recognize abnormal, especially midwives are great, because they're experts in normal burden. So if something goes awry, they're going to be able to notice that right away.

And we just need to re emphasize that point, because that's something I always talk about when I would speak with my clients about home birth is that in the world of Obstetrics, they see so little normal birth, that there's their circle of safety for what is okay within birth is so small, compared to a midwife, and especially a home birth midwife who has seen 1000s of normal natural births, her circle of safety is so wide. So it's so much easier to recognize when something is truly varying from the normal.

Again, we need to get back to letting individuals make their own decisions. And if they're wrong, so be it. Right, you can't, if you want to legislate for perfect safety, you'll have no freedom. The Albert canoe, he was a French, I think a French philosopher or something during the Revolutionary War time, has a quote that's on my website someplace. And it's one of my favorite quotes. He says, the welfare of humanity is always the alibi of tyrants. And so you can see that what's going on right now all we have to do it for your safety. And I'm not sure that safety is the same to all people have to build people make their own decisions, some people will want to give birth with an OB in the hospital, that's perfectly reasonable. But it's also perfectly reasonable for a woman to demand that things are different for her because she doesn't think that that their definition of safety is her definition of safety. And if you can't find that in the hospital that she's looking at, you should look at other hospitals or other facilities or birth centers are homebirth. And we need HD to decide for ourselves. And if we're not educated, then we're just going to make blind decisions. We're going to be like lemmings. We're going to follow people, like, you know, wearing masks on the hiking trail. I mean, these sorts of things we just did, because people said to do it, and no one. I mean, there are people like us who thought about it and maybe stuck to it, but then we were reviled for doing it.

And the interesting thing, just to add to that is that it isn't safety is if safety is the number one in childbirth, it's still not even working. It's not getting safer. It's not. So that's the key point, isn't it? Yeah. So not only do you have choice about what feels safe to you, but if you choose the safest option, it's still not safe. It's the illusion of what's safer, the illusion of safe may not be and again, satisfaction has to matter. The memory of the event has to matter. It just does. And we were not doing well in the hospital model. And unfortunately, my colleagues that are stuck in it, they need to stand up. I mean, the change has to come from the consumer, there's no question and somebody will meet the demand if you know supply and demand does work. And if there's a demand for more midwives as a demand for birth center birthing, there's a demand for home birthing will happen. I mean, there was a rise in home birthing during the pandemic but it wasn't very significant. Some people say well, maybe it was 20 or 30% rise, which sounds significant. But when you're talking about 1% of births going up to 1.3% of births, it's still not a lot of change. So but it needs to change because the hospital model is not conducive to good outcomes, satisfaction. Everything about it is wrong. It's financially incentives are all wrong. What you said a while back is It really what needs to happen birth just needs to come out of the hospital, it just needs to be removed from that system and have its own place, whether that's in the home or a birth center, or some other type of building for birth.

It just needs to get out of the hospital, it needs to change sort of like Whole Foods changed the grocery industry, by coming out with organic food. And now every grocery store has organic hospitals, you know, they'll try to make lip service or they'll pay lip service to it by having their mother baby friendly initiatives. And they'll put new curtains in the rooms or foot the nice flooring in the rooms and stuff like that doesn't change the model by which they're practicing. Because you put a nice face on it, it really doesn't. And I don't think that hospitals are going to be able to change because hospitals are not run by caring nurses and physicians anymore. They're run by administrators, businessmen, and risk management lawyers, and they who they're the ones that make the decisions, and their decision, and their priority is not your priority as a pregnant woman. And it never will be. And you see, you see how long it takes even for truly evidence based birth practices to change in hospitals. That takes years it just, if it if it even ever changes, if there's so many barriers, everything that's done in the hospital is done on an algorithm and means that every woman needs to be treated the same. They all need to come in they all need to get their their wristband. So in order to get the wristband, they have to go through this questionnaire, they have to get their blood drawn. Why do why does every pregnant woman in the hospital need blood when no pregnant woman at home needs blood? In case they might hemorrhage and they need to type in type and cross them for a transfusion? We don't stop to ask ourselves what what's the cost of doing that not only in just dollars, but in interrupting their labor by sticking a needle in their arm and potentially giving them a black and blue mark or bruise or paint, you know, whatever in their arm for no reason. Why does a pregnant woman in labor need an IV? Well, she's she's sick. She's really No, she's not sick. Let her drink. Well, what if she needs it? What if she needed general anesthesia suddenly? Well, why would you possibly need to general anesthesia suddenly, and so you're going to starve a 99,999 women, because one might have an emergency. And this is the model by which we're going to put all women through. It's insane. It's you know, it is insane. It's just insane.

And if you try to say no to something as simple as the IV, you get off on the wrong foot with the person caring for you, the nurse and then the whole thing is just, you know, not like I know the patient, the right you have the right knee down is non compliant, they put you down on their job is to serve you know, we don't allow that in our hospital, you know, you know, what is it the Christian Pascucci has the saying, You're not allowed to not allow me. pregnancy is a normal function of your body. All right, it is beautiful. It is something that you waited for all your life. To have to deal with it in fear is crazy. It's it's a normal function like breathing or digestion, right? It happens whether you want it to or not, you grow a baby, you go into labor, you don't have to think about it. As a matter of fact, when you think about it, you can potentially you know, affect it in a negative way. So don't think about it in that way. Enjoy yourself, send your baby while you're pregnant, good hormones, your send them some dopamine, send them some oxytocin, send them some of your level, kiss your partner. Enjoy things. Don't watch the news. Educate yourself but find a reliable sources do not Google do not necessarily look at fear based things on Facebook groups and stuff like that. Be careful, people tend to want to say the sensational, that's the it's the plane that crashes that makes the news not the planes that land safely. So be careful about that sort of thing. And remember, we've been doing this, since the dawn of time, your body knows exactly what to do. And occasionally it goes awry. And when it goes awry, you need to have somebody that you can trust. So every pregnant woman during the pregnancy unless she has some really severe medical problem should interview with a midwife. It may not be that you choose a midwife, but at least you'll learn what the midwifery model of care is like. And then you can compare that to your physician care and you can come up with a plan. And then you can discuss that with your ob if you choose to go that route. And make sure that your ob is on board and if you get an uncomfortable feeling, as I said earlier, then look look for alternatives. You always have alternatives. This is a this is a life event for you. It's beautiful. It's it's enjoyable. Make it make it so three simple things. Hire a doula interview with a midwife. Don't be fearful. Right? It's normal. That's the way things should go.

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It's an incredible thing. It's a lot of work it's men if men were reproducing the species would have died out long ago women are fantastic winter article spectacular. They're fantastic.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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