Interview with Dr. Stuart Fischbein
From Fear to Freedom: Rethinking Childbirth
I went to a birth center and they turned me away because of my C-section, too. I called all of the birth centers in the area, same thing. There is a big financial interest in preventing midwives from existing (look at the Birthing Instincts podcast and Dr Stu Fischbein, he’d be a good interview!! - Dani
Over the last year, I’ve been particularly interested in the medicalization of childbirth by Cartel Medicine. The most natural part of being human has been turned into a disease.
As always, fear is the fuel that sustains this “industry,” designed to diminish a woman’s belief in her own ability and power, steering her towards reliance on the Church of Modern Medicine.
I’m glad Dani (above) pointed me towards Dr. Fischbein, and I’m very grateful he agreed to this wonderful interview.
With thanks to Dr. Stuart Fischbein.
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19-minute discussion titled "10 Things Your Typical Obstetrician Is Unlikely to Tell You About Childbirth," a synthesis of insights drawn from the four related posts above and this interview. Your feedback is appreciated.
1. Dr. Fischbein, can you share the journey that led you to specialize in home births, breech, and twin deliveries, and what inspired you to challenge the conventional medical model of childbirth?
I was trained in the conventional medicalized model of pregnancy. After completing my residency, I went into private practice at a time when obstetricians were still often self-employed in solo practice. I practiced a very medicalized model of office and hospital-based care following the ACOG guidelines with little awareness of any other model of care. To build a practice, I chose to cover free clinics, emergency rooms and labor wards, other established doctors’ practices when they needed coverage and assist in surgery. Early on I was approached by some local home birth midwives and asked if I would accept their transfers and transports. I said sure but not because I had any idea about midwifery care. I did so simply to generate revenue. It was during these years that I began to hear about another model of care which made a lot of sense and my evolution began.
2. Over the years, how has your perspective on hospital births evolved?
As I learned more about midwifery care and a mammalian model of birthing, I came to see the hospital protocols as mostly unnecessary interventions designed to generate revenue and, supposedly, lower liability all under a canard of safety. One only must look at the worsening outcomes and rising rates of induction and caesarean section with not only no evidence of benefit for most women but strong evidence of non-benefit.
3. What are the most significant misconceptions about home births that you encounter?
Since our culture has been indoctrinated to believe that pregnancy and birth are dangerous, it is not unexpected that this fear carries over to the “what ifs” of homebirth. What if she hemorrhages? What if baby is in distress? How do you birth without anesthesia? What is not understood is when healthy women go to term and are left alone in labor as nature intended without all the interruptions and interventions then things rarely go wrong and when they do the home birth midwife is trained to see them coming and can offer shared, individualized decision making.
4. You’ve spoken about the over-medicalisation of childbirth. What are the most critical issues arising from this trend?
When you intervene in Nature’s design a basic tenet is you must show that the intervention is safe. For many of the things done in modern medical obstetrics this is ignored. We see the overuse of unproven technology leading to medicalized intervention but poorer outcomes. There is little consideration from obstetricians about interfering in the labor process because they are not taught about the design of mammalian birth, the microbiome, and the importance of the mother-baby dyad. They see birth as a disease that requires treatment. In the last 50 years this has led to a 600% increase in caesarean section, an induction of labor rate around 1/3 of all pregnancies, a rising rate of postpartum depression among many other downsides with no improvement in neonatal mortality
5. Can you explain the risks and benefits of home births compared to hospital births?
For cohorts of healthy mothers (I hesitate to use the term “low risk” or “high risk” as no one really can define what that means. See Birthing Instincts Podcast #387) there is good and mounting evidence that those birthing at home have better outcomes. Lower rates of induction, use of anesthesia, caesarean, infection, episiotomy, and NICU admission. Higher rates of breast-feeding success and mother satisfaction. While in any birth at either location there is a chance of a poor outcome, overall, the benefits to home birthing for many women are clear. The hospital is certainly necessary for a small percentage of pregnancies and both options should be available and supported.
6. In your experience, how do medical interventions during hospital births impact long-term outcomes for mothers and babies?
We have a rising chronic health care crisis in children around the globe to where it is reported that more than 50% of children have a medical condition, often auto-immune. While correlation does not equal causation and there are plenty of variables such as heavy metals, glyphosate, 5G, GMO foods and additives, this crisis parallels the rise in use of caesarean birth, antibiotics, and synthetic oxytocin for induction. Nature designed us to be born after navigating the birth canal in labor and exposure to a mother’s vaginal flora. These alterations of the microbiome and innate fetal reflexes can not be dismissed as a cause of chronic disease. On the maternal side we have seen a rise in pathologic placentation such as placenta accreta directly correlated to the rising caesarean rate and an alarming rise in the rates of postpartum depression. Maternal confidence in their ability to give birth naturally is falling while dependency on medical intervention is being promoted by those that control our birth industry.
7. Your podcast and website, Birthing Instincts, advocate for informed decision-making. Why do you think this is often lacking in mainstream obstetrics?
Obstetricians are trained in a fear-based model by High-Risk specialists called Maternal-Fetal Medicine doctors who are experts in problems and, therefore, see pregnancy through this prism. When pregnancy is seen as medical problem the tendency is to believe it needs to be fixed. And who better than those who devote a decade of their life in training to decide what should be the standard of care. There is an arrogance, or what is called the authoritative gaze, that has captured obstetrics into thinking they know best and so are uncomfortable hearing from a patient who might differ from them. So, whether overtly or subliminally, they skew their counselling to funnel the woman down the path they most support. To them, being risk averse does not mean choosing the less risky path. It means choosing the path they are most comfortable with. Sharing that decision making process makes the doctor uncomfortable.
8. Can you elaborate on the importance of respecting patient autonomy in childbirth decisions?
Supporting the idea of bodily autonomy through giving the best unbiased information is the goal. Patients have the absolute right of giving or refusing consent.
9. Breech births are often considered high-risk. What has your experience taught you about safely managing them outside of hospitals?
I was sort of forced into supporting home breech birth. While properly selected breech vaginal delivery is a solidly evidence supported option it began to fall out of favor in the late 1980’s. This culminated in the publication of a poorly written peer-reviewed paper call the Term Breech Trial in 2000 which, effectively, shut down breech vaginal birth training and delivery. I had assisted women in breech birth for most of my hospital career because I the good fortune of training in an era where it was just considered to be a variation of normal. Outcomes were quite similar to head down vaginal birth. When the hospital I was admitting to passed a policy banning breech in 2010 and had previously banned midwives and VBAC (vaginal birth after caesarean section) my ability to honor my patients’ choices was cut off. Since fighting the hospital legally would have been extremely difficult, I was encouraged by the local home birth community to continue supporting breech and twins in that setting. Turns out success rates and safety of home breech birth with a skilled attendant is better than an equal cohort of women in the hospital. I have since published several papers on home breech and twin birthing.
10. VBAC (Vaginal Birth After Cesarean) remains a controversial topic. What do you believe are the biggest barriers to its acceptance?
The biggest barriers are unreasonable fear and financial incentives. Although the chance of a poor outcome with a VBAC is quite small there is fear of litigation which can be devastating to medical personnel whether there is negligence or not. And then the incentives in my specialty are all backwards. Supporting vaginal birth requires more time and effort than scheduling a caesarean. Yet, the reimbursement from third party payors is the same for the physician. However, the hospital makes more than twice the amount for a caesarean birth as they do for a vaginal birth. In fact, the more testing and procedures done the higher the reimbursement. And it costs money to run a practice or to keep the hospital financially solvent. So, what is the incentive for supporting VBAC? There should be an ethical obligation to support choices such as VBAC and breech. That they don’t gives us a view as to one of the many flaws in the current medicalized birth model.
11. Twin pregnancies pose unique challenges. How does your approach differ from the standard medical model?
Our model individualizes care. The standard medical model runs on an algorithm. They label all twins as high risk. While some are, many are not and the evidence in the literature supports offering options other than the intervention filled approach that is rigidly adhered to. Caring for twins in a midwifery style of supporting options and intervening only when indicated is quite reasonable. Again, all one must do is look at outcomes to see that.
12. How do you see fear influencing the decisions women make about childbirth, and how can this be mitigated?
I think we have covered this well. I would add that the innate process of all mammalian birth prefers the environment to be safe, quiet, and unobserved. When a mammal in labor experiences fear their labor stops and they flee. And only when it is safe will labor ensue. In this way Nature ensures the best chance of survival. I think obstetricians have lost their way and are not even aware of this basic physiology. And as I said earlier, they are trained in a fear-based model, see everything as a potential problem and project these anxieties onto the women of our countries. Mitigation will rely on training physicians in a new paradigm, changing the culture surrounding birth, putting practical legal safeguards in place and changing financial incentives.
13. Your advocacy for midwifery care has been a hallmark of your career. What role do midwives play in improving childbirth outcomes?
Midwives have been and are currently the torchbearers of maternity care. The continuity of care over profit model serves women better. They, not OBs, are the experts in normal birthing. They are the curious ones about training in the skills, such as breech and twin vaginal birth, because they want to serve mothers as their first priority. Without my accidental exposure to them early in my career I may very well still be practicing as most of my colleagues and failing the current and future generations.
14. What projects or initiatives are you currently focused on, and how can readers stay connected with your work?
On December 13th, 2024 my paper on Twin Home Birthing was published. ( https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0313941 )
In 2025, I am hopeful to contribute to a changing emphasis on health in America by working in some capacity with the new administration and the MAHA movement.
I will be traveling again starting in March, 2025 and teaching my 2-day seminar on hands-on breech and twin skills. https://www.birthinginstincts.com/events
My website is www.birthinginstincts.com
IG @birthinginstincts
I will continue my weekly podcast with my co-host, midwife Blyss Young.
Birthing Instincts Podcast
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Many years ago, Dr. Babnick was a home birth doctor in Portland, Oregon. He did not fear breech or twins. He taught many naturopathic doctors about natural home birth. Then we used a simple fetoscope to listen to the babies heart. Now, unfortunately, there is so much reliance on Doppler and Ultrasound.
For perspective here’s an old friend, Midwife Sarah Taylor’s blog
http://sarahsojourner.blogspot.com/2015/03/
Thank you for this wonderful interview with Dr Stuart Fischbein, and for covering the topic of childbirth. I have a daughter and daughter-in-law, both of who recently chose birthing centers in hospitals to give birth to their first child, and they were pressured hard (but thankfully declined) to take vaccines and did end up getting coerced into numerous ultrasounds. Expectant mothers experience so much scaremongering, even in a "birthing center", that it's mind boggling.