The Resource Doula

Dr. Stu Talks Breech, VBAC, Twin Home Birth, and More!

June 22, 2023 Natalie Headdings Episode 33
The Resource Doula
Dr. Stu Talks Breech, VBAC, Twin Home Birth, and More!
Show Notes Transcript Chapter Markers

Show Notes

On this episode of the podcast I chat with Dr. Stu about twin birth, breech vaginal birth, and what the difference is in the care you receive at a hospital versus a midwifery setting. He provides insight from over 40 years in the birth world. This discussion is such an important one, so grab your favorite drink and enjoy listening or watch on YouTube @resourcedoula!

Follow him on Instagram @birthinginstincts and at The Birthing Instincts Podcast with midwife Blyss Young as he offers hope, reassurance and safe, honest evidence-supported choices for those women who understand pregnancy is a normal bodily function not to be feared. His website is www.birthinginstincts.com.


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Please remember that that what you hear on this podcast is not medical advice, but remember to always be an active participant in your care, and talk to your healthcare team before making important decisions. If you found this podcast helpful, please consider writing a positive review in your favorite podcast app or on YouTube! Thanks so much for listening. I’ll catch you next time!

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Natalie:

On today's podcast, I chat with Dr. Stu about twin birth breach vaginal birth, and what the difference is in the care you receive at a hospital versus a midwifery setting. He provides insight from over 40 years in the birth world. This discussion is such an important one, so grab your favorite drink and enjoy listening. Welcome to the Resource Doula podcast. I'm Natalie, your host, and my goal is to equip you with the tools and information you need to make informed healthcare decisions while having some fun along the way. Through engaging interviews with experts, personal stories, and insightful commentary. I'll save you the time and effort of sifting through countless sources on the internet. Consider me your personal resource dealer because if I don't know the answer, I can connect you with someone who probably does. So whether you're a seasoned health guru or just starting your journey, I hope this show inspires and encourages you every step of the way. I have the pleasure of introducing Dr. Stu for today's episode. Dr. Stewart Fishbein has been a practicing obstetrician for over 40 years. He is co-author of the book, fearless Pregnancy Wisdom and Reassurance from a Doctor, a Midwife, and a Mom, and Peer Reviewed papers on Home Birth, Andre Birth. Dr. Stu as he is known by, spent 24 years assisting women with hospital birthing, and for the last 13 years has been a home birth obstetrician who works directly with midwives. He travels around the world as a lecturer and advocate for reteaching, breach and twin birth skills, respect for the normalcy of birth, and honoring informed consent. You can follow him on Instagram at birthing instincts and listen to the Birthing Instincts Podcast Midwife Bliss Young as he offers hope, reassurance, and safe, honest evidence supported choices. For those women who understand pregnancy is a normal bodily function not to be feared, his website is birthing instincts.com. dr. Stu, welcome to the Resource Doula podcast. Thanks so much for being here today. I feel

Dr. Stu:

like I've been here before. This might be take three. Yes, take three. Uh, Natalie, thank you for having me, uh, in your studio and the opportunity to speak to your, uh, listeners because, uh, I always love the opportunity to do what I think is spreading truth and spreading wisdom, uh, on the idea that birth is something that, that. It, it's so, it needs to be so much different than the way we treat it now. So, uh, we're working on it. We're working on it. You're helping. Yeah. Yeah. I appreciate that. Right.

Natalie:

I, I would also be remiss if I didn't say, just use this platform to say thank you for everything that you're doing too, because it's, it can be easy to just not say anything and stay in your own bubble. Right. But it's really, you're doing, you're doing massive work around the world. So I appreciate it and I, I know that I speak on behalf of my listeners as well to say thank you. So, um, I wanted to start out just asking you what led you to women's health in general in the beginning and then how you transitioned from that hospital setting? The conventional setting to the more the midwifery model of care

Dr. Stu:

in home birth. Okay. Um, unlike a lot of fellow travelers that we, you and I both have, Who may have had an epiphany, it may have been they saw their sister give birth or maybe they, they had a bad experience at the hospital or whatever that inspired them to do something. That wasn't the case for me. It was, it was a gradual process, um, with a lot of evolution that required exposure to the right things at the right time and having an open mind. Um, I have very strong opinions, but I'm also open-minded enough to know that, you know, a lot of my thoughts and opinions and things I thought were true or not. So I started out, um, I went to college and in the seventies, everybody that goes to, well, everyone who graduates high school went to college. That's just what you did. And, um, at least in our, my circle of friends and stuff like that. So, um, and then, uh, my third year as a junior in college, I decided that I would go pre-med. Because a bunch of my friends were doing it, and I was sort of aimless. I was a biology major. I wanted to be a forest ranger or marine biologist, but I don't know, there wasn't a whole lot of feeling about anything then. It was a different time and different era. People have to really understand that the seventies were a completely different era than we are in 2023. Uh, things were, world was a completely different place. And so I, I went pre-med. I got into medical school at the University of Minnesota, and then in the first two years of medical school, it's pretty much all didactic. You're spending a lot of time in the classroom and in the lab. And the second two years, uh, you're do a lot of rotations on different specialties to try to figure out what you want to do. And unfortunately you have to make this decision, you know, three years into medical training and really not knowing anything, being very naive about. Options and, and where things are gonna go. And ob obviously being idealistic. And I had just come off a hematology oncology rotation where I'd spent time dealing with very sick kids, uh, with cancer and fungal infections. And was, it was, it was depressing for me. And then my next rotation was OB g y n, where I was up at three in the morning, uh, catching a baby instead of up dealing with a seizure and a child. So I really liked it. And then I took a deeper dive into it and I realized that I really liked longitudinal care, which is taking care of people over time. And in the, in obstetrics in those days, that's what you did. It was, there was no shift mentality. There was no being on at seven, off at seven type thing. You took care of somebody and they were your client and you took care of them. Of course, we didn't call'em clients then. They called them patients, of course. Mm-hmm. Um, And so, uh, and then you get to do a little psychiatry, a little surgery, a little internal medicine, a little endocrinology. So you get a lot of different things in one specialty. And I really liked that. And of course, you don't think about hours and liability and being on call and being up in the middle of the night when you're young and naive. So I matched at Cedar Sinai in Los Angeles, where I did my residency for four years in the early eighties. And I was affiliated with, uh, LA County U S C at the time, which was, that's the University of Southern California, um, the busiest hospital in the country in the early eighties doing about 22,000 births a year. Wow. Which is about 65 babies a day. So you're gonna see a lot of stuff when you're there for three or four months. Mm-hmm. And so that's where I got my training, Andre in twins. And it was all considered normal forceps. We, we got really good training. That kind of training isn't available anymore. And I finished my residency program and I came out very medicalized thinking that I knew everything about women's health because. I, that's what I was trained to do. Mm-hmm. And as part of building a practice, in those days you didn't come out and get a job working for somebody and get paid a salary, you hustled to build a practice. So I covered emergency rooms, I covered free clinics, I assisted other people in surgery. I took call for other guys who wanted to take less call and I was approached by a couple midwives and asked if I would take their home birth transports. And I said, sure. But unlike I would say now, back then I thought home birth was stupid and I had no, nothing about midwifery. I just said yes because it was revenue. For me, it was, I was a mercenary and I was looking to make money. Uh, fortunate that that happened because when a woman would be transferred from home, it would was almost never for an emergency. There were a few that were real emergencies, but most of'em was, were just the kind of things that we all know about where the woman is exhausted or labor has stalled out or. Whatever. Mm-hmm. And it's non-emergent. They come in by car and they just need an epidural and Pitocin. And so there'd be a lot of time downtime once they got settled in the hospital. And I'd be sitting in the lounge with a midwife and, um, we would just be talking and I would begin to hear a different way of doing things. And the, the, the women they brought in were actually quite intelligent and they were actually more well-informed about their bodies than about pregnancy than my patients by far. And I realized that there was a, I was doing something wrong and it was a slow process. Over 10 years, I think about 10 years later, I started a collaborative mid midwife midwifery practice with two midwives in Ventura County. Cedars wouldn't allow midwives to have privileges in those days, and so we started a collaborative practice and I thought that this was going to be great because. Midwives could take care of all the normal stuff, the well-woman exams, the normal pregnancies, the, all that stuff. And I could do the colposcopies and the biopsies and the surgeries and the forceps and the twins and the breaches. And, uh, so it was really a nice collaboration. We had really good results. We had a 7% C-section rate. We took all comers, um, but we were never accepted in the community. Mm-hmm. The, uh, ob, other obs, the pediatricians and the anesthesiologists were all picking on us, uh, doing what's called SHA peer review and gunny sacking, and you can look these terms up and, and, uh, they made it very difficult for us. But we survived for about 15 years there. And finally it came to a point where, um, they said that they were not gonna renew my privileges. They had canceled, they had, uh, canceled the midwives privileges. They had canceled vbac, they had banned breach. Uh, no bad outcomes, just. Made the anesthesiologist and the pediatricians nervous. Yeah. And the nurse and the nurses were nervous because they were getting all their information from the old, old bees who just didn't wanna do any of that stuff. When I first came to that community, no one was doing laparoscopic surgery. If you had an ectopic pregnancy, you had a laparotomy. Wow. Um, I was the first one to do laparoscopic surgery cuz I was trained in that. Um, and that caused us a, a minor stir because they didn't, you know, they weren't used to it. Mm-hmm. Now standard of care is this weird, uh, phrase, which is really open to interpretation of who sets the standards. And if people who don't know anything are setting the standards, then you have lousy standards of care. So, right. That was what's going on. So they weren't gonna renew my privileges, so I had a choice of fighting them legally, which is a pain. Mm-hmm. And you're probably gonna lose because of the way the system works or leaving. And I was approached by some midwives that I had known for years and they said, Stu, come to some home births. You know, and I, and after 25 years in practice, Natalie, I'd still never been to a home birth. Wow. Wow. Right. And, uh, I said, okay. Unfortunately, I went, uh, I had several, several women I had in my practice who were pregnant at that time, who were due after the date that my privileges were not gonna be renewed. Um, they said to me, we'll, we'll go, we'll just stay home. You come to our house. So between the, between the women and the midwives in the community, I, I went and fortunately those births were just smooth and beautiful. And, and then the rest is sort of history. So I got into it sort of by a fluke of the way my rotations were in medical school, uh, in, um, in medical school. And then I ended up in midwifery simply because, and home birthing, simply because I was open to the fact that everything that I, almost everything that I learned in residency program only applied to about 10% of women. And I knew nothing about other, the 90% of women that I was still taking care of and treating them as if medi as, as if pregnancy was a, a problem. Mm. And not a natural, normal function of their body. And the midwives have taught me so much more, and then I've taken it to the next level. And I've started to do breaches at home and twins at home, and diabetics at home, and hypertensives at home. All just thinking a little bit outside the box and saying, well, you know, if she's diabetic and she has a, a meter inside her body and a pump, and she can just look at her phone and know what her blood sugar is, and if it starts to go outta whack, we can drive to the hospital. But why should she have to be reduced at 38 or 39 weeks in a medicalized system, which is going to give her IVs and no food and immobilize her and have people around her, she, and then take the baby to the nicu? Because the hospital has a protocol that says all infants of diabetic mothers need to be observed. Not observed on the mother's chest, but observed in the nicu. I mean, separately. Yeah. Right. So we could spend the whole hour talking about the absurdities that go on in prenatal care and, and labor and delivery, and that would be the whole podcast, but I don't think that's where you wanna go. So I answered the best I can so people can understand sort of how I evolved. And fortunately I was just open enough to, um, to hear what these other people were saying. I didn't shut myself off as so many of my colleagues do.

Natalie:

Yeah. Yeah. Wow. Well, thank you for going into that. I know that a lot of my listeners are kind of lean towards more of the holistic, like crunchy side of things anyways. Um, but there were some questions on like, what would you say is the biggest predictor of a successful home birth now that you've seen it, you've gone through with all of the Yeah. More complicated deliveries.

Dr. Stu:

Well, if I had to sum it into one thing, I'd say there are two things. What is having the right mindset? And surrounding yourself with supportive people. Mm. That's it. Yep. It's a physiologic thing. It's like, it's like, how do I digest my dinner? What's the best way to digest my dinner? Is to leave it alone. Mm-hmm. And not worry about it. Not think about it. It's the same thing here. Yeah. It's a primitive brain function. And when your cognitive brain, or your higher brain or your neocortex gets involved, um, it can only really screw it up. So you wanna, you wanna be surrounded by people that keep you safe and that you trust. Yeah. That's it. And then everything else will fall into place. If you end up having a problem that's medical that really requires hospital care, your team is gonna know that. Mm-hmm. And it's very rare for something to suddenly happen in labor when you're not meddling with labor. The reason we see so many emergency, I love that term, C-sections in the hospital setting is because of the way the hospital manages labor. It just is. And, and people say, well, how can you say that? And I say, because I lived in that world for 20, I don't know, 28 years. Mm-hmm. Count my residency 28 years I was in the hospital setting. And then I've, for the last 13 years I've been out of the hospital. And so I, I have that unique perspective of having lived in both places. And so I can speak to both, whereas most people live in one or the other and really, really don't know. There's no, there's no breaking of the silos. Right. Ob ob residents don't come and spend a rotation for a month with a home birth midwife. Wouldn't that

Natalie:

be amazing if they did? Oh

Dr. Stu:

man. Wouldn't it be amazing if they had to spend a month as a labor and delivery nurse too? Yeah. Right. Yeah. And then having home birth midwives come in and, and spend a month in the hospital setting. To see what goes on in the hospital so that they can better deal with it. I can't even imagine being a doula right now, or even a labor and delivery nurse and watching every day some of the stuff that goes on. I, we've talked about this on our podcast and, and with so many people that I've talked to about how it's, they, they, they, they quit. They can't take it anymore because they're watching malfeasance go on every single day. Mm-hmm. Yeah.

Natalie:

Yeah. No, it's, it's rough out there. It's surprising that it's continued this long. I think, I feel like there's a breaking point coming. I don't know, that's just my, maybe wishful thinking, but I feel like the word is spreading that physiologic birth is normal and pe more people are pursuing home birth. Um, so we'll see. I dunno, it's, it's

Dr. Stu:

climbing, it's certainly not climbing fast enough for your liking or my liking, but, but it is, the, the problem of course is the, the, is the value that we put on it. We still, as long as we continue to think of pregnancy as a medical condition, then we're gonna expect our insurance to take care of it. Our insurance is not gonna pay well for it. Uh, they're gonna mandate that you go to this doctor or this hospital and you can have this medicine or this procedure, or you can, and, and when we, when we give, when we surrender that to a third party, the third party's ethical and fiduciary responsibility is not to me, it's to their company or their, or their business. Right. And so the, the people need to change the way they value, they need to put money into it and effort into it. Like they would, as we use the analogy as you would your wedding. Mm-hmm. You would never let some third party decide what you can have at your wedding and who you can invite and where you can have it. You would just wouldn't do that. Mm-hmm. And so, uh, but we do it. And so until we change the mindset of people that it has value, Then people will begin to invest in it more and will make more demands on the system. And the system will either break or which, uh, it, it is already broken, but, or, or they'll have to adapt. Mm-hmm. Um, or a new system will rise up and that's what will happen to the people who are looking. But they'll have to find a, you know, the, it's, it's, it's a long process because the old system is not gonna just say, you know, we, we suck, we're going away. Right. They're not gonna do that. Right, right.

Natalie:

Yeah. Uh, okay. Let's transition to twins cuz we had some twin questions. So could you give us kind of some definitions of like the ti the different types of twins and maybe some considerations for each type and how that birth, that birth might play out or what you might watch for with, with each

Dr. Stu:

type? Yeah. Well there are, there are. Essentially three types of twins if we, unless we get into real rare things, which we won't get into, and that would be based on the ity. The ity is the number of membranes around the twins. So, um, there's diamniotic dichotic, twins, which would, would everybody would call non-identical twins or fraternal twins, where they're two separate eggs that the woman ovulated that both get fertilized and they both implant, um, on rare. Again, I don't want to get into the weeds, so I'm not even gonna go off to the rare occasion where they're identical, but in two separate sac. So they each have their own amnio, their own corion, their placenta are separate. They never, they can be fused, but they never communicate with each other. You don't have to worry about this rarer condition called twin, twin transfusion syndrome, or again, a weed thing called taps or traps or all kinds of different things. But, um, and then there's monody twins where the twins are iden. We call'em identical twins. They're in the same corion, but they each have their own amnio. So those are monochorionic diamniotic twins. And there's about a 15 to 17% chance that those twins will end up with a problem with their blood flow between the two of them, which can, which can be quite serious. Um, if that doesn't occur, however, then, then there's really no significant increased risk for monody twins than there is for die, die twins as far as allowing them to go to term and go into labor. And then there's the rare case where you have what's called mono mono twins, which are two twins in the same sack. Okay. And that has the high morbidity rate because of, of the placental, uh, perfusion issue as well as cord entanglement because the Quin, the Quinns, tie themselves into knots when they're little. So, um, that's very, that's something that you wouldn't be do thinking about doing outside of the hospital, and that's something that would need to be dealt with earlier. So we're really dealing with d d dye twins and mono die twins outside of the ho. Uh, if we're talking about twins in general, and, and I'm assuming that because that's what I do is, is doing them at home. Right. Um, mono die twins are probably 15 to 20% of twins, and dai dye twins are probably 80, 75 to 80% of twins. Oh, wow. Okay.

Natalie:

Okay. Yeah, that's higher than I thought.

Dr. Stu:

At least, at least, at least that's in my practice. Okay. And then I may, I may have a selection bias and my numbers aren't big enough to reach statistical significance, so, but it really doesn't matter. I mean, when we talk percentages, percentages are, are, are population based. Yeah. It's either you have mono die, or you have die die. You don't have a 80% d you know, it doesn't work like that. So statistics are often used, uh, and misconstrued, so. Mm-hmm. We talk about actual risk, relative risk a lot, and we'll talk, maybe we'll even have an example of that later on today. Cool.

Natalie:

Okay. So when twins, like you got baby ba, baby A and baby B, right? And they position themselves in order to be born, um, oftentimes people worry about the transverse lie or a breach presentation or all of, can you just go into that a little bit more and, um, how you approach those kinds of

Dr. Stu:

births? Yeah. Early in the pregnancy, almost always, there's a small percentage where a and B don't actually declare themselves, but usually early on a will become a and a will stay a the whole time, and a's the one that's closer to the exit of the uterus, which is called the, uh, internal Os of the uterus. And that almost always stays the same. And then they could be in multiple positions. The most common is Vertex. Vertex, all right. Which is about 44. About 44% of twins will be Vertex. Vertex. Okay. About 27% will be Vertex breach, and about 13% will be breach vertex or breach. Breach. And that leaves about two or 3% for things like transverse lie or, or the cord presenting first or placenta previa or some other weird thing which we're not gonna talk about today. So if you add that up, it actually turns out that over 50% of twins have at least one twin that is breach. Hmm. Whether it's the first twin, the second twin, or both twins. So this is something that I've talked about recently a lot, and I'll just mention it here because it's so powerful for me, is that if you have a practitioner who's uncomfortable with a breach baby and you have twins, and you know that more than half the time you're gonna have at least one twin that's breach, then that practitioner should not be the one taking care of you. Mm-hmm. You should find someone who's comfortable with breach. They will tell you that breach is dangerous, that breaches need c-section that brought can't deliver a breach for his twin. That's all not true. They may have been trained that way, or they may be stuck in their box and they may not wanna look outside their box to see that that's not true because no one likes to admit that they don't know so something, or that they've been doing something wrong for their entire career. Right. That's, there's cognitive dissonance there and it's very difficult to do that, and I understand it, but the confident person is not afraid to say they don't know something. Mm-hmm. And the insecure person is the one that tells you, you know, that talks in certainty. So there's old saying that says, it's not my skepticism that should bother you, it's your certainty that should, so yes, it's their c it's their certainty. So, um, yeah. So, um, breach is a very common presentation. It breaches a very normal presentation up until the late. Eighties, early nineties breach was just considered a variation of normal. And then it, for whatever reason, the medical people running the programs, they decided that they didn't really wanna do it anymore. And they, they said, let's get a paper that shows that we can don't have to do it anymore. And they, and that's what they did. It's almost as if they said, we don't want to do breach. Or the same thing too. We, we think all women should be induced at 39 weeks. Let's get a paper that says that. And so out comes the Arrive trial, right? It's the, it's the same sort of thing. Even though lots of papers say it's not a good idea, they choose to glom onto the one paper that says it's a good idea. And with Breach First Twins in the same year that the term breach trial came out, which kind of killed breach in most training programs in most hospitals. There was a paper that came out that actually had the same numbers of, of, of women in it. That said that, uh, breach first twins weighing more than 1500 grams. There's no increased morbidity with those twins, and there's no reason to section them. And that paper was completely ignored. Wow. And there's a, there's a, there's a many places in the history of medicine where conflicting papers came out, and confirmation bias may cause people to choose the paper that supported their position and ignore the paper that didn't support their position. That's problematic. That's, that's the, that's the human condition. That's, that's we're all human in the, and we tend to want to kind of gravitate toward things that make us feel good and avoid those things that make us feel like we're doing something that's not okay. Right. Or just

Natalie:

nervous in general. I think a lot of providers are just nervous about it.

Dr. Stu:

Well, they're trained in a fear-based world. I mean, everything about obstetrics that's taught to, to medical students and residents is taught by people who look at pregnancy as, as danger and fear. Um, Maternal fetal medicine. Doctors. Doctors or the doctors that are teaching. Most residents, they run the programs, they're the directors of the programs, almost always. And maternal fetal medicine doctors are specialists in what problems? Very rare things. Yeah. Yeah. High risk problems. Yeah. So they look at every woman as a potential problem. I don't know that there's any woman who goes through the obstetric model of, of pregnancy and comes out without at least one diagnosis of something that's wrong with them. And having that seed of fear planted in them early on turns out to be nothing. Your hips are too small. Your baby's too big. Your baby's too small. You know, your're too old. Uh, your placenta looks old. Um, you know, uh, your, your thyroid's outta whack, whatever. All these things are just the analogy that I use all the time. If people, a lot of your. People who are listening probably saw the movie Inception and they're sitting around one time early in the movie and they say something like, well, can't we just tell them? Can't we just put the idea in their head and no, cuz they'll know where it came from. And they give an example, they say, okay, don't think about elephants.

Natalie:

Right?

Dr. Stu:

So the rest, the only thing you think about the rest of the pregnancy, a woman's thinking about elephants. If they're, if they're told at 10 weeks that, you know, you're 35, that means your placenta is, we're gonna have to watch you a little closer, maybe talk about induction later on. Then for 30 weeks you've got, you've just planted seeds into a woman that, that is completely unnecessary. Yeah. But that's the model by which they're trained. They think they're doing the right thing because that's all they see. They've never seen anybody do it differently and they don't know it and they don't wanna know it.

Natalie:

Yeah, it's like the, if you have a hammer in your hand, everything looks like a nail kind of illustration. Yeah.

Dr. Stu:

Um, you wanna hear a really funny side story? Can I just tell you a really funny story? Yes, of course. Okay. So, um, my sister married a man named Bruce Hammer and my wi my former wife's maiden name was Nail. Oh my gosh. So my sister married a hammer and I married a nail. Is that funny or

Natalie:

what? That's hilarious. Yeah. How did you guys, I'm sure it wasn't planned, but that's, it didn't even,

Dr. Stu:

you know, it didn't even occur to me until years later that, that was, that, that, that was funny cuz she doesn't go by that name. Right. When I married her, she had another, another last name, but, okay. Her, her ma, her maiden name, if we still use that term Yeah. Is, uh, is was Neil. So that was pretty funny. Anyway, when you. I couldn't resist. Sorry.

Natalie:

No, that's a good story. Um, someone did ask, like, can you talk about the risk of a, just a cesarean versus a, a breach vaginal birth, and it could be singleton or twins, whichever. That's like a relative versus absolute risk. Okay. Conversation. Well,

Dr. Stu:

if you take one pregnancy and you look at the risk, right, and you only look at the risk that the medical model uses as their gold standard, which is neonatal death. All right? Then you have then the royal college of ob g gyn has the best numbers and the risk of a neonatal death if you do a C-section at term for breach is about one in 2000. Okay? And the risk for vaginal delivery is about one in 500. So the relative risk is four times greater with a vaginal birth for that one baby. Okay? But the chance of it not happening to that baby, Is 99.95% with a cesarean and 99.8% with a vaginal delivery. And before I go on to talk about long-term risks, the risk of a neonatal death with a head down baby is one in a thousand or just twice. So the breach birth is only twice as risky as a head down baby. Okay? So it's 99.8 versus 99.9 versus 99.95. If you ask the person what's, is there a significant difference between those numbers? Most people are gonna say no, right? They're almo, they're all, all of them are very small risks, okay? So if you wanna convince somebody, you use relative risk. You say, oh, it's four times riskier and blah, blah, blah. But if you do a C-section for that baby, then there's problems with that baby. Potentially more likely to have an altered microbiome, which can affect the baby for its entire life and cause chronic illnesses and things like adult onset diabetes and childhood asthma, and that sort of thing. You could have more bonding issues. More breastfeeding issues cuz the baby's separated from the mother. Um, I, I, I mentioned the microbiome. You have more, more risk to the mother, um, in this pregnancy. And then what you've done in, if the mother wants more children is then you, everything that you've saved and risked to this one baby, that little four times risk that we talked about. Right? You've now transferred to all her future babies cuz now she has the VBA issue and the scarred uterus. So people that say it's safer to do a c-section for breach, they're, they're, they're, they're talking with blinders on. And I can tell you why I know this, because when I see a consult for breach and it say it's their first pregnancy and they're 37 weeks and they're coming in for the first time to see me and they say, my doctor says I need to c-section to schedule it, I'm gonna schedule it in a week or two and blah, blah, blah. And the, I I will ask the woman, And her husband. Did the doctor ever ask you if you want more children? And the answer is universally no. Hmm. Because all that matters to that obstetrician is that one baby being live in the bassinet. Right. And what happens to that mother and that mother's future babies and even that baby that they delivered by cesarean and electively scheduled rather than waiting for labor? Um, because it's inconvenient. Um, that doesn't matter to them because we have a crying baby in a bassinet. Right. And we're happy about that. And so again, it's stage one thinking. We're not thinking long term. We're not thinking down the road what's, what's, what's the overall greater risk? And cesarean section is not benign. It's a major operation. Right. And there are complications with that, including like simple, like I'd say simple things like wound infection, but. Future. You could have adhesions, you could have pain, you could have bowel obstruction, you could have injury to your bladder. You could have all kinds of things down the future. And you could have the risk of ruptured uterus. Again, small risk, but if you're gonna emphasize small risk to a vaginal breach birth, then we should be equally, we should treat the risks of, uh, future, um, deliveries after a cesarean section with the same, um, respect. Right. Or disrespect never.

Natalie:

Right. Yeah. Yeah. Okay. Well, this, this goes right into another question that somebody had. Um, somebody was asking, what would you look for with an hvac, so home birth after cesarean, um, in order to have a successful deli vaginal delivery and maybe signs to look out for for things going

Dr. Stu:

south? Well, there are no signs really. What, um, if you wanna have a successful vaginal birth after cesarean, you're better off doing it at home. Mm-hmm. By far. Yep. By far it's well known that the success rate for VBAC at home is over 90%. The success rate for VBAC in the hospital is somewhere between 60 and 70%. And that's simply by the, because of the model by which you're cared for. And that's true with a woman who just walks in the hospital, um, a first time mom who walks in the hospital, to have a baby has a 25% chance of having a C-section. So high in the midwifery world, it's somewhere between two and 7% depending on the, which practice. Yeah. And it's only because of the model by which you're cared for. So there's, you know, your midwife in your home birth situation is trained to watch for certain things. Now, ruptured uterus, which is something we all fear, is a scary term. And it implies, it, it gives you the image of a tire sort of exploding on the freeway or something that's not normally what happens. Usually the scar begins to separate and there are most often there will be some symptoms and it'll fetal heart rate or mothers. Uh, subjective feelings of discomfort or whatever, not always, but only a small percentage of scars that separate lead to a really bad outcome. And so when you're giving people information, you have to give them honest, informed consent with, um, actual risk, not relative risk, that sort of thing. So your midwife knows what to watch for, but it's really, really rare to have a problem with a VBAC where you're not immobilized, anesthetized, and on Pitocin. Right? If you're just laboring at home, you're not going to generally see those same types of problems. Are you gonna have a perfect outcome? No, of course not. No matter what venue you're in, you're not gonna have a perfect outcome, and you're gonna have a tragedy every now and then. Mm-hmm. That's the human condition. Right. And that's just the way it works in life and death.

Natalie:

Yeah. Yeah. No, that's, it's good to feel that. And,

Dr. Stu:

and, and, and by the way, Natalie midwives accept that they're trusting of the process, and they're accepting the fact that they can't control everything. Doctors don't accept that, so they want to control everything. And in the process of controlling everything, they, they screwed up. They do. Mm-hmm. They create their own chaos, but it's chaos that they feel comfortable with because it's their chaos. They don't want random chaos. Right, right, right.

Natalie:

Controlled chaos, I suppose

Dr. Stu:

they want controlled chaos. Huh? I mean, look at the model. Look at what they've done. They've taken a c-section rate of 5% 50 years ago and made it over 30% now. Right. Overall, and, and that's a 500% increase with no decrease in the rate of cerebral palsy or the outcomes that you, that you want to try to prevent has not decreased at all, but your morbidity and mortality to your mother's has gone up. And they're the ones in control of the profession. They're the ones telling us home birth people. We home birth people telling us, no, US home birth people, us my mother was an English teacher, so I gotta get this right. Um, that we're the ones that are doing things wrong and they don't take a look at their own outcomes. Yeah. You know, we have, we have a rising chronic illness rate in children now that's multifactorial. It could be nutrition, it could be vaccines, but it could be the microbiome exposure at birth. It could be lots of things. Yeah. Um, but we're not looking at it, you know, the problems we have with birth in America are not because 1% of women are giving birth at home. Yeah.

Natalie:

Is it really only 1%

Dr. Stu:

overall? About 1.6%. Some states are higher, but some states are lower. Yeah. But it went from about 1.2% to about 1.6% in during the covid years. Which sounds like nothing. I mean, it is like a 35% increase. Yeah. It's, it's not, it's certainly not satisfying to me. I'd like to see it rise much faster. Yeah. Right. Yeah. What we need is more midwives, though. We can't, we can't handle the more home births right now because we don't have enough midwives out there practicing. And then when we do try to get more midwives, what happens is the state legislatures, after being lobbied by medical societies, will make it more difficult for midwives to practice. And as my co-host, bliss likes to say, we end up, um, medicalizing midwifery. Right. And we're gonna end up with becoming in midwifery what we really didn't want to become, because everybody wants to be legislated and licensed. Uh, well, not everybody wants it, but that's where we're headed. Yeah. And even the organizations like Meac and Nam, they, they, apparently, there's a new thing now. They want you to take N R P, which is. Neo, the Neo Neal Resuscitation program that we all take, but they, they're gonna adopt the, now that you have to take the American Academy of Pediatrics model of N R P, which includes all the hospital based stuff, not home birth intubation and about using drugs and all that stuff. That's not something that we would do. And so they're gonna make it more and more difficult for the average midwife to practice like a traditional midwife practice because they want to control. It gets back to that whole thing about the medical model does not like individuals making decisions. It does not like individual chaos. It wants to put everybody on an algorithm, not realizing how stupid that is, that we're not the same, that we all don't dilate at 1.5 centimeters an hour.

Natalie:

Okay. Really? Uh, do you feel like the, was it correlated where the breach births went down and c-sections went up? Like was that kind of the turning point for the c-section rate in America is breach? Oh, no, it started,

Dr. Stu:

started long before that. The turning point, I believe, was in the seventies when they came up with an, uh, continuous fetal monitoring. Okay. And when and when, uh, Manuel Friedman came out with his Friedman labor curve, I think those were the two biggest things to see arise because it was 5% in the seventies. By 1990 it was 20 some percent. Um, and by, and, and the, uh, so I don't, I don't think it was anything other than those two things. And then cuz the banning of breach and stuff like that didn't occur till 2000. And we're talking three, we're talking 3% of term pregnancies. So 3% of term pregnancies can't make your C-section rate go up. That's 20 or 30%. Right. It doesn't work like that. So same thing with twins. Yeah. Okay. Twins are about 3% of the population too. Okay. Used to be one in 80. Now it's about one in 32 or something like that. I

Natalie:

feel like it's going up. I don't know, this is just like circumstantial data up. It's, but it's

Dr. Stu:

going up mainly cuz of I v F, but also possibly because of, uh, older women, um, giving birth. And there's slightly greater risk of, of, I guess I wouldn't call it a risk of twinning. That's a terrible term. Right. Possibility of twinning. Okay. Yeah. I hate, I I, the language we use is really important. Mm-hmm. And a lot of times we use words that like mal presentation for breach. Okay. Sounds terrible. Terrible. Does ma what does mal mean in Latin? Bad. Bad. Yeah. Right. I hate that. Mm-hmm. But we just, with these things roll off our tongue all the time. We, we say things like incompetent cervix. Yeah. That

Natalie:

one gets me. Or the geriatric pregnancy. That also gets me. Yeah. Yeah, yeah. Right. I don't know, it seems like all of my friends are having twins right now, so I know so many people having twins. Maybe it's,

Dr. Stu:

are they spontaneous? Are your friends spontaneous twining?

Natalie:

Yeah. Yep. All of them.

Dr. Stu:

So, yeah. Mm-hmm. Well, maybe the world know, maybe the world knows that the pop, we need more babies. Yeah. So they're saying less women are getting pregnant, so we better get, we better have more women have twins.

Natalie:

Oh, man. I don't know

Dr. Stu:

that that makes No, that makes no sense. But it's as good as a good explanation as anything else. I, I

Natalie:

agree. Yeah. Okay. So when you're re-teaching BRE and you're training midwives and obstetricians, hopefully, um, what does that look like? You're doing workshops and then like if hospitals, if, if providers are still in hospitals that are saying no to breach, like how does, how does that work?

Dr. Stu:

Um,

Natalie:

Well, it doesn't,

Dr. Stu:

yeah, it doesn't work. Uh, yeah, I have a reteach breach seminar that I go around and teach, and then my friends, rre, David Hayes and Christine Loria, um, have the, uh, breach Without Borders group. And they, they go around, they, they go more locally and worldwide, and they have an online course. I, I am a old fashioned doc. I like face-to-face. I like interaction. I like having those, that's that style. They do all their didactic teaching online and then the, and then David or Christina goes around and does the seminars with it. Whatever it is, it's great. But almost all the seminars attended mostly by midwives and other birth workers. We rarely get obs to come. Yeah. Um, this year I've had a couple of obs and I had one MFM in Kansas City, much to her credit. Wow. But other than that, um, doctors don't come. Uh, RZA is an academician, so she's working harder to get in her foot in the door of academic training programs. We're gonna be in Chicago the first week in August teaching at, uh, I can't remember if it's Northwestern or some place. So we're gonna get a chance to speak to some residents, which I'm really excited about because I really like to reach them. Um, unfortunately there's a proprietary ego thing that goes on with people that run training programs of residents, and they don't want people like David Hayes or me, you know, coming in and doing that. I just, I, you know, that's my perception of it. Maybe I'm wrong. Maybe there's another reason, but I, I have yet to find one that they, they wouldn't want the residents and I think that residents, like I said earlier, were, were young and and enthusiastic. They wanna know these skills. Yeah. If I finished my OB residency program, not knowing how to do a breach delivery or put on forceps, I'd be pissed at my residency program. Because I may not be practicing in an institution where c-section is readily available, nor may I wanna be doing C-sections and ev all these women. I may decide I wanna go to a rural community, or I wanna do something. I need the skills that make my profession unique and you're not training me. And you are the porch bearers of my profession. Yeah. And you're not training me to be my, uh, uh, professional obstetrician, you know, any, any well-trained chimpanzee can do a c-section. I know. Not literally. Not literally. Oh, take me literally. Alright. Okay. But, but they can, I mean, it's, it's a general surgeon can do it. A family practice doctor can do it. You know, they don't, you don't need to be an obstetrician to do a C-section. It's a turf battle. And, uh, surgeons don't wanna touch it because during their training they're taught that, oh, we don't want a too with pregnant women. You know, that's why we still have dentists and other people, you know, asking the woman who needs dental work to get a note from their obstetrician that it's okay to give you antibiotics. Mm-hmm. I mean, you went to dental, dental school for god's sakes. You didn't learn about how to take care of teeth of pregnant women. Right. Of course you did. You just want someone to cover your ass. Yeah. That's what we have going on throughout. Yeah. I don't know how I went off on that tangent,

Natalie:

but that's okay. I see that also in the fitness world, like I specialize in pre and postnatal exercise and a lot of other trainers or exercise physiologists kind of like, ugh. They, they worry and they don't wanna touch them, and they just do, you know, the quote unquote safe exercises, which, if we're not loading pregnant women, like they need to lift heavy, they, their lives are like strength workouts, essentially. The car seat and the diaper bag and the baby's growing. Like, there's a lot of things that they need to train for, and we're underdosing them chronically for exercise-wise. So, I mean, yeah.

Dr. Stu:

Yeah. There's just a, there's just a lot of, again, it's the fear that permeates everything about pregnancy and our culture. And what's really interesting, if you look at other cultures where maybe even their outcomes, they may even have more maternal deaths than we do, um, like say Central America or, or even the Amish population where they're not, where they're not based in fear, where pregnancy is a life event. Um, they, they enjoy their pregnancies much more than American women do.

Natalie:

Yeah. Yeah. I believe it. Hmm. Yeah. Yeah. Wow. Okay. Um, I have a, a good question from one of my audience members. Um, what's your, all,

Dr. Stu:

all the questions have been good, by the

Natalie:

way. Oh, good. I'm glad. This one is a, this one's a pivotal one. What is your opinion on

Dr. Stu:

free birth? Okay. Um, you know, as a, as a medical professional, even though I'm No, no, I'm certainly not like most obstetricians, it's not, it's not great for me to su to say that I com completely support free birth. But I completely support free birth. Hmm. Yeah. Okay. Depending on what your choices are, I mean, I think it's smarter to have somebody that's trained on your team, even if they're sitting downstairs while you're upstairs with your partner just laboring and having the baby, just in case. Um, certainly having some prenatal care that's valuable. Not the kind of prenatal care that you get in an obstetrician's office, but kind of prenatal care that you get in a midwifery model where you learn about certain things. Uh, but ultimately, and I think Michelle Odont would agree with me that free birthing is probably the way we're designed. Um, and we should be prepared for things to go wrong. And that's why having a skilled person there, and that's why it's hard for me as a medical professional to really endorse it. Right. But I'm endorsing it. Mm-hmm. Um, if you have no other choices and the, and the, and I would strongly take free birth over, over hospital birthing. For, for women that are properly selected. Again, I'm not talking about somebody with preeclampsia Right. Or something like that. I'm talking about perfectly healthy women with generally singleton pregnancies. I've, you know, I know that there are some that birth twins at home and they do fine. Mm-hmm. But there are potential, more potential problems and that's why having access to a trained professional with their, with their birth bag, with them, with all their potential meds and stuff that they may need, or, you know, giving birth in a, in a location where you're close enough, where 9 1 1 is close. That makes perfect sense. But other than that, um, you know, I really, the more I watch what goes on in the hospital and the more I've been around midwifery care, I think that, that women are capable of doing this. Mm-hmm. And we've just lost faith in that because we've been so indoctrinated to believe that that birth is a medical condition. Yeah. And it's not. And

Natalie:

we outsource. Yeah, we outsource our health a lot of times. Not even just in pregnancy, but in the rest of life as well. We worry about whatever it may be. Like, oh, I got sick, call the doctor. I got whatever, call the doctor. And it's kind of like an automatic response rather than, let me see if I can like, wait this out. Trust my body to heal itself. Right. As long as there's no, you know, no like immediate concerns. I think just, yeah. We tend

Dr. Stu:

to, yeah. I've learned a lot. I've learned a lot in the last decade or so from, from midwives and from smart people reading about like fever. Mm-hmm. You know, when you have a fever, unless it's like really high, you shouldn't be trying to break the fever. Right. The fever is your body responding properly. Um, and you know, this is, this is controversial in, not in our circles, but you know, when you have well children, why do they go to the pediatrician at all? Mm-hmm. If they're, well, why are they going? That's a great question. They're going because there's a vaccine schedule. Mm-hmm. And if you are not on the vaccine schedule, if you choose to not follow that, many people should. Um, then why are you going in for well, child exams? Um, you know, you could have a midwife, a naturopathic person. If you just, somebody you know, or you, you as a parent, you can sort of tell if your kid's thriving or not. Mm-hmm. The whole, the whole idea that we have these well, uh, person exams, you know, in, in my profession, we had the annual pap smear mm-hmm. And the annual mammogram. And I just went along with that. And then I started to realize like, like what are we, why are we, what's the, what's the advantage of doing all this screening? Is it, is it leading to, to better outcomes, worse outcomes, more unnecessary, and worrying more unnecessary biopsies and interventions? And the answer is in my, my research is, yeah. Yeah. Unless you have high risk behavior, um, getting an annual pap smear for a woman in a monogamous relationship after she's, you know, Dr. She, she reaches when she, when she's married, something like that. It, it, that, that's unnecessary. Mm. And yet, and yet the, in the industrial lobbies that are called acog or, or the American Radiology Association, or whatever they call themselves, um, you know, they would go, they'd go nuts because that's the revenue generation, right? It's people in the door. We always have to look at no. One of the ways, one of the ways that I, people say, well, how do you decide which evidence to trust and which evidence not to trust? It's very difficult though, because science is totally corrupted. Totally corrupted by money. Yeah. And by big pharma. Which is the same thing. And so one of my, one of the things I use is, is reliable sources. But the thing that I'm talking about here is if some paper recommends you do less, that makes sense to me. Mm-hmm. Probably true because there's no money in doing less. Right? Exactly. Exactly. There's no money in not taking a medication for the rest of your life. Mm-hmm. A statin, an S S R I, uh, you know, a blood thinner, whatever, you know, once you're on those medications, thyroid birth control, you know, we're not trying to fix the underlying problem. We're just treating the problem with a medicine that you will take for the rest of your life and you'll have to refill it every 90 days. And it's an annuity for the pharmaceutical companies. And we, we, you know, have they done great things? Sure. They have created some great medicines that have saved lots of lives, but the idea that, that they, uh, have your best interest at heart is so naive. Yeah. We've seen that now, we've, now it's now been exposed. The, you know, they used Covid to their advantage to, to take more control over the world. But it also gave us a real good, clear insight into, into how that all works. And if people are paying attention, then they know that, and that's been going on in obstetrics, you know, for a hundred years. The gaslighting of people. Yeah. And tell them they need to do it this way and they need to do that. And this is safer. Well, safer is what, what does safety mean? Safety doesn't mean the same, it's not like, it's like the Friedman curve. Everybody's safety is exactly the same. No, it's not the case. Not true.

Natalie:

Yeah. Right. Yeah. I feel like I could have a lot of other questions off of that, but I'm gonna stick on track. Um, somebody else, I think this is probably the last one of our Instagram submitted questions. Somebody else was asking, um, couple people actually. What would be your idea of a safe time safe? I guess it segues in safety of between twins. So how long would you wait, um, after, you know, first baby's born, before like, I don't know, transfer or getting worried Sure. Or something like

Dr. Stu:

that. Yeah. Yeah. Ricks and I have a paper coming out, um, probably next month I'm hoping, or maybe oh, yay, really soon. I keep, I've been saying this for about a year now, so it's, hopefully it's coming out soon. Um, the twin to twin interval is what we call that. What's the difference? The difference in time or the di distance in time between twins in the hospital, twin pregnancy vaginally delivered. They're usually like five minutes or less because the first twin comes out. They immediately go up and rupture the membranes of the second twin, and they have the woman push the baby out, whether she can feel it or not. Wow. Um, that's the way we were all trained. Okay? We all thought that that was the way it should be, but I realize now, the reason that they do it that way is mainly because they've got 10 people waiting in the, in the delivery room. They've got the, the pediatric teams there, they got the anesthesiologists there. You got a bunch of nurses there. They can't have people standing around for an hour and a half, um, doing nothing. Waiting. Yeah, waiting. So that's wrong right now the question is how long is too long? And that's an interesting question. And there is some world literature that talks about the longer the twin to twin interval goes, the more likely you are to get an acidotic. Baby B an acidotic baby B translates into a baby B that's probably got lower Apgar scores and may or may not need more respiratory assistance. Okay? So they don't give any time limit. They're just saying that the longer you go, the more the pH of that baby's gonna be dropping more. All right? And I have found. Again, not statistically significant cuz my numbers don't reach that. That the longer you go, the more likely you are to have a postpartum hemorrhage. Hmm. Now you could go two hours and have no postpartum hemorrhage and you could have a postpartum hemorrhage with a five minute twin to twin interval. So it isn't a direct correlation, but it is a, a correlation nonetheless. Okay. So I have, since that information has been collated by myself and Rx, I have decided that I think that about 30 to 45 minutes is a reasonable time to do absolutely nothing except L you know, let, as long as baby B is fine inside with a heartbeat. Yeah. So baby A, if you get the cords long enough, you can leave the, pull the baby up to mom and Mom can bond with baby A and you can have skin to skin time and then you can, if the contractions are still spaced out a little bit, you can get baby A to latch and that may help bring down oxytocin, which then will make your uterus contract more and get things going with baby B. But if after 30, 45 minutes it's not, and I have this discussion with my twin moms, um, in the prenatal period, it's not, we're not talking about it right then and there. We'll talk about it and some will say, no, I don't want you to intervene. And others will say, fine, you can go ahead and rupture membranes. And so then normally that's what we would do is rupture membranes at that point. And that usually jumpstarts things pretty quickly. Mm-hmm. And then, and then you get that baby out and then, um, uh, you're less likely to have a baby with a low, low Apgar score. So, um, there is no, I don't like to have algorithms and I don't like to tell people what they should do, but I think, uh, a reasonable and nature, most of the time will, will solve the problem without me having to intervene because it will be less than four 30 minutes or so before the things start to heat up again. Okay. But sometimes it can be a long time, and we've had people go four hours, six hours in between twins. I, I know part, part of me is also the person that can't sit there and wait that long. Yeah. Right. I I, I go nuts. Mm-hmm. I mean, you can, you can take the doctor outta the hospital, but you can't take all of the doctor outta the doctor. And I, you know, I can't sit around for that long. I know that I hear stories from some of my saintly midwife colleagues who say, yeah, we had one baby born 12 hours after the other one or something, and we didn't have a postpartum hemorrhage. And that's great. Yeah. But I'm just saying that, that ultimately I think a reasonable time period of 30 to 45 minutes between twins is between starting up and trying to get, be moving. Makes sense. Okay. And that is purely subjective on my part. And is

Natalie:

that primarily with die, die twins then? No.

Dr. Stu:

Okay. It doesn't matter. No. There the, if you reach term with mono die twins, there's no reason that you can't delay cord clamping. They're not all of a sudden gonna develop a shunt that wasn't there for nine months. Right. So if, if, if die, die, if mono die twins make determine in labor. I try. I don't treat them any differently at all. Okay.

Natalie:

Right. So with Die Die twins, this might be a dumb question from me personally. So Baby A comes out, does the placenta stay or does it also come out and then the whole next birth happens?

Dr. Stu:

Well, that's a funny story too, because I always thought they all came out after twin B until it happened to me once where after Twin A came out, there was a gush of blood and I wasn't thinking because it was so routine for me. Yeah. So I'm worried a little bit. So I, I examined, all I can feel is placenta at the in, in the opening and I'm thinking, well, she can't have a placenta Previa Baby A just came out of there and then I realized, oh, it's baby. A's placenta was just sitting at the, you know, the internal loss. And so Right. Just, you know, just a small. Gentle tug on the cord and out came baby's place. But then baby B actually there was more bleeding than I liked and so we expedited baby B by rupturing membranes and getting baby B out. But that's only happened one time to me in 40 years. Wow. To practice where the ace placenta came out before B, right? Almost always. Both because ultimately the uterus has to contract generally enough for the placenta to shear off Right. And right. Even though one twin comes out, it's very rare that the uterus contracts enough cuz there's still another 5, 6, 7, 8 pound baby in there. Mm-hmm. For the uterus to contract enough to cause the placenta to shear off. Okay. So that's an oddity. Most of the time they both placenta will come out after baby B comes out. Okay.

Natalie:

And then, um, in call birth for twins, is that like somewhat common if you're, or I guess for baby a potentially

Dr. Stu:

no more common or less common for me than, than in call singletons. Okay. Nothing I've seen. You know that, that way, I mean, baby B maybe even more likely with baby B to be on call. Okay. Um, but again, I don't, you know, I know on-call is cool, but I'm not sure that it has, I mean, maybe I'll get yelled at for this, but you maybe can tell me what, what, what's the significance of a baby being on call versus rupturing and then coming out like 30 seconds later or five minutes later or whatever? I, I'm not sure. I think it's one of those magical, mystical cauldron things that midwives love, so that might be it. Yeah. I mean, we never had oncall bursts in the hospital when I was training because everybody got a Right.

Natalie:

Right. Yeah. Hmm. It's one of those things, I guess you probably see more in home birth, obviously.

Dr. Stu:

Oh, ob you absolutely, you absolutely see more in home birth and you know what? It's obviously very nice. It's if, if it comes out that way, then nature designed it to come out that way. But, but nature also designed RUP membranes to rupture before labor even starts, and then Yeah, that happens too. So it, it, it's, it's a random thing, but I think it's one of those things like a, like a blood moon or a, you know, or a lunar eclipse. It's kind of a cool thing that happens once in a while. And so we give it a little more emphasis maybe than it needs. Yeah.

Natalie:

Yeah. That's fair. So I wanna ask you what your favorite resources are, and you can totally push your own podcast as well. I want people to listen to it, but like, books, any Instagram accounts, films, all of that. What, what would you recommend

Dr. Stu:

for people? You're gonna get me in trouble here. I don't know that I can really answer this question very well. Ok. Cause because there are so many good resources for women who are looking for. Information, not indoctrination, but information to give them insight. Mm-hmm. And, you know, I mean, there are some great podcasts, but if I name a couple, then I'm gonna leave out a bunch and I don't really want to do that same thing with books. Okay. Um, you know, on my, on my website I have a resource page, but, you know, I haven't updated that thing in like five years. So, um, because, because I, you know, I just, I, it's not important to me at this point. I think, um, what's important to do is, is to read about things about your children. And that's why I think books like the Vaccine Friendly Plan and reading, um, dissolving Illusions or turtles all the way down about vaccines because you know, you're gonna give birth and it's gonna be, you know, however you want it. I mean, I would tell you better than any book would be to, to, for every woman, whether she wants a hospital birth or not, to have prenatal care with a midwife. Um, because the midwives will then be their resource and then they can refer them to the books and the podcasts and the, and the blogs and things that they think are, are most valuable. Mm-hmm. Um, rather than putting me on the spot

like

Natalie:

that, that's okay. Right. No, that's, I think

Dr. Stu:

that's a great answer. Look, there are so many good. I have, you know, I've, I on my, um, my podcast feed from iTunes, uh, apple Podcasts, uh, I can't keep up with them all. There's so many good podcasts out there. And not every topic is something that people wanna listen to, which is why they should go through and they should pick out the topics that seem to be interesting to them. Listen, and I try to do topics. She likes to do topics. I like to just talk

Natalie:

and, you know, you guys are a good team that

Dr. Stu:

way. I think. I think we are. I, I do think we are. I think that we bring each other, bring Audi, each other our best. Um, uh, but we do topics like we recently did, so. The umbilical cord, or we did low lying placenta, which I think is a real good one because, um, people are freaked out about low lying placenta. You know, when you have your 20 week scan, doctors will sometimes find a low lying placenta, and I found research that showed that when you have a low lying placenta at 20 weeks and it's anterior 100% of those resolve. Hmm. Yet for the next eight weeks or so, you're gonna be worried. Yeah. Because they found a low line present. They're not gonna tell you that it's gonna resolve. They're gonna tell you they want you to come back in four to six weeks to take a look at it. Of course. That, that's the cha-ching, cha-ching, uh, thing that maternal fetal medicine doctors do. Mm-hmm. Again, they don't make money by not seeing you. It's a great point. And I know there's an, I know there's an supposed to be an ethical wall there, but that ethical wall is long. It's got, it's like Swiss cheese. Mm. We, we, we, it's very, very difficult. Every one of us. Skews our counseling, you know, every, every midwife. We don't have the time, most of us, to give full informed consent on everything. It's really interesting. At the last seminar I did just up in, um, post Falls Idaho a couple weeks ago, uh, we were talking about informed consent, and I talked about full infor true informed consent, and I said, you can't possibly give it. And then, and then when the Wi Midwife said, well, I do, and I go, oh, okay. Do you give lidocaine when you repair a thing? Yes. Do you tell a woman that she can die from that? Yes. And I look at her and I go, you do, right? I mean, like, would you read the package insert to her? I mean, I mean, do you understand that every medicine, everything that we do has a laundry list of things that are so rare, right. That you can't possibly give a, but sh she says she does. So I, well far be it from me. So she may be right that she can do that. But no more normal people can't give. True informed consent. So they, we skew it, but the the system skews it terribly. They funnel you to funnel you down the path they want you to take. Right?

Natalie:

Yeah. Yeah. No, that's a, a whole nother reason why it's really crucial to see a midwife and to read things yourself and do a lot of research prior to the

Dr. Stu:

whole process. Right? No, and, and, and not everybody listening to your podcast, well, probably everybody listening to your podcast is gonna feel like we do, but, but not everybody is gonna agree with everything that I'm saying. I wouldn't expect them to. Yeah, but I wouldn't, I wouldn't expect them to just outright dismiss what I'm saying either. But that's what will happen because what I'm saying makes a lot of people uncomfortable. Yeah. It makes a lot of my professional colleagues uncomfortable. It makes a lot of women who follow the medical advice, uncomfortable women who have the cascade of interventions. This is not to diminish anybody's birth experience, but. Birth should be this wonderful life event. It shouldn't be this, it shouldn't go into it with this fearful process. Sometimes it goes wrong. Yeah. And then you need medical attention, but most of the time the medical attention is actually detrimental Yeah. To the process and the having the life experience. Right?

Natalie:

Mm-hmm. Yeah. And I, I like to say that too, like there's no guilt or shame in past experiences when you weren't as informed as you could have been. Like, and as you know, you know

Dr. Stu:

better. You No, not for the individual. Yes. There's guilt. I, I, I'm, I'm guilting and shaming my colleagues. Mm-hmm. Yeah. Because they should wake up. But the individual woman who ends up falling into that trap, it's not their fault. Right. How are you supposed to know? Yeah. I mean, I, I was part, I was part of that trap. Mm-hmm. I was the guy wearing the hazmat suit with the immediate cord clamping who showed you your baby, and then walked it across the room and put it down in the warmer. That was me. Oh

Natalie:

man. That's so like foreign to think about.

Dr. Stu:

But yeah, it still goes on in a lot of places. But that's how, if you know, if that's how you're trained and that's all you know, that's all you know. And that's all you know. I mean, if you only, if you live in a box and you never look outside the box, you only know what's in the box. Yeah, agreed. Like my cat has never been outside except when I carry her from, you know, house to house or whatever, but Yeah. But you know, I, she doesn't know what it's like outside and it's a good thing because she probably wouldn't last a day where I live now. Yeah. And my colleagues live in, they live in the box that they're trained and they, some, some of them never get out of it. And in order for them to feel good about what they're doing, they either have to ignore what people like me say, or they have to ridicule what people like me say. Yeah. That's how it works. Hmm. That's the solution for cognitive dissonance. That's how we all deal with it. Oh man. Yeah. You know, I wish I, I will, I will tell you right off the bat, I really do wish that there was a way I could speak about these things with total glee and positivity, but yeah, no, I don't blame you at all. I can't. Yeah. I mean, when you, if you read my inbox every day from what people write to me and tell me their story about how they just had a glorious VBAC after two C-section home birth, because they listen to the podcast and then they go on and tell me about their first c-section was for no reason whatsoever, and their second one was just a schedule or, or whatever, or, or they've had two vaginal deliveries and then they had a third baby that was a C-section for macros, somia. Oh, yeah. And, and, and these doctors. You know, I didn't get into it and I don't want to, but have you heard my thing about the C-section rate and about cognitive dissonance? Cuz it's, it's a great little analogy. Think maybe, but yeah. The C-section rate in the United States is 30%, let's just say it's 30%. And say the World Health Organization says it should be 10 to 15%. So let's say 15% and say every year in the United States there's about 1.4 million C-sections being done. Maybe less, but let's just say 1.4. It's by far the biggest operation being performed anywhere. The most common operation. Wow. But according to the World Health Organization, half of all C-sections are necessary. So that means there's about 700,000 unnecessary surgeries being done on women every year in the United States. And no one says a peep about it. Right. Not even the insurance companies who are paying for it. Which is odd because if you had 700,000 unnecessary knee surgeries or gallbladder surgeries, the people would, the insurance companies be up in arms about it, right? Yeah. But here's the really scary part is if you have 700,000 unnecessary C-sections, who's doing them? No doctor goes home at night and says to their spouse, Hey honey, guess what? I did two unnecessary C-sections today. Right? Every C-section a doctor does is necessary, yet half are unnecessary. So how do you live with that? And that's where cognitive dissonance comes in. Cuz they'll have to say, well, it's the other guy that's doing the unnecessary ones, but the other guy's saying it's you that's doing the unnecessary one. Yeah. And nobody takes responsibility for it. They're just ignoring it. Yet, 700,000 women are what?

Natalie:

What? They're just ignoring it. They're ignoring the fact that they're doing the unnecessary and

Dr. Stu:

700,000 women are having unnecessary surgeries affecting them. Their current baby and all their future babies. Yeah. And no one says anything. Oh yeah.

Natalie:

No, I don't,

Dr. Stu:

I don't quite understand the silence about that and the acceptance of that as being the norm. I think it

Natalie:

probably, well, somewhat has to do with just people worrying about like, I mean, it's fear-based, obviously, but it's a baby and, and they don't touch pregnant women or they don't do studies on babies or pregnant women as much as they should or could because it's a ethical liability. And in their eyes it's like, well, if it was unnecessary but the baby still lived, then I guess it was still fine and good. Right? Like,

Dr. Stu:

I don't know. Yeah. Well they all, well, you what you got, like you said, all that matters is live baby and the BestNet. But here's the interesting thing. If, if insurance companies would suddenly say to a hospital, we're gonna pay you half as much for a cesarean as we do for vaginal delivery, they would go way down. The C-section rate would drop by 10 15 by, by by 50%. Yeah. Um, in a matter of months. Yeah. Because they'd put in new policies that say, you know, breach delivery, vbac. Um, you know, stop these inductions that are leading to these pri c-sections. Stop. We not, you're not allowed to introduce somebody for or do a c-section for suspected macro somia. You're not allowed would, they would, it's so stupid. They would find reasons to, to get rid of cesarean section, but as long as the system is designed to reward you for bad behavior, you'll get more bad behavior. That's just standard economics 1 0 1. Right, right. Yeah, because again, it's not a, it's not a lighthearted subject. It's one of my, another heavy subject, but it, it, it just shows you how crazy the current system is. Mm-hmm. That nobody's speaking up about this, and that those people that run this system are criticizing midwives for how they practice. Jesus.

Natalie:

It doesn't make sense.

Dr. Stu:

No. And then the, the, and then the, and then them wanting to you to be grateful for how they saved your baby. Right.

Natalie:

All that matters is a healthy mom, healthy baby.

Dr. Stu:

Right? They, they, they hold this whole cascade of interventions leads to a cesarean section and they say, thank God you were here. Not realizing how stupid that is. Right. It's like a fireman starting a fire and then you calling them to come put it out, and then expecting you to say, thank you for putting out the fire that you started. I mean, no one would do that. Yeah. But for this, they do. Mm-hmm. Yeah.

Natalie:

Yeah. I, I mean, I think it has to be heavy, like it can't be lighthearted because if it's lighthearted, then we're not putting enough emphasis or, you know, like, well, there, I mean,

Dr. Stu:

but it, no, but it, it is. It's a beautiful moment in a person's, in a woman's in a family's life. And when I see these videos of women having home water births with their little kids around, and then little kids climb in the pool afterwards and stuff like, those children will never look at birth with the same fears. Yeah. That most children, we've sterilized birth. Mm-hmm. And we've sterilized death. Most people lived their entire life. Never seeing a person born, never seeing a person die. Yeah. I was, so, a hundred years ago, a hundred years ago, no one lived their life without seeing a person born and without seeing a person die. Yeah. We've

turned

Natalie:

it over. Usually it was in the same room. Right. Like they had a birthing room. A dying

Dr. Stu:

room. Yeah. No, no. Grandma died in bed and, and, and mom gave birth in the same room.

Natalie:

Yeah. Right. Yeah. Okay. I'm taking it a little bit less heavy. I want to know what, first of all, what your number one piece of advice for our listeners is. What do you want every single person

Dr. Stu:

to know? You mean who's pregnant? Yes. Or in life in general. I mean,

Natalie:

I guess you could do either, you could do two if you want one for

Dr. Stu:

pregnancy. No, I'm not. I can't tell people in life, in, in pregnancy. Uh, I would tell everyone to hire a midwife and a doula, but, but, but look at the midwifery model of care before you settle on the, uh, medical model of care. Nice. Just look at it. Yeah. And if you're gonna, and if you are somebody that really wants a hospital birth because you feel safer there, that's 100% fine. But your prenatal care is still something that you should consider getting with a midwife. What we call concurrent care or, or collaborative care. Mm-hmm. Um, at the same time, even though you're gonna go with your OB and you're gonna do it in the hospital, and you may want an epidural as a life-saving bridge because the, the idea of pain and labor is just too much for you. That is absolutely fine as long as you're informed. But, but you can't really get informed in the obstetric model. You get groomed Yeah. Not informed. So that would, I mean, I mean, number one advice for a pregnant person is realize that you're not sick and that midwifery model looks at your pregnancy as part of a, just a natural function. And so look at it that way. And if you can find a great collaborative situation, that's great too. That's, that's it. I mean, all the other stuff is, you know, is, is too specific for each individual thing. But the whole idea is the philosophy of not worrying, bathe your baby in oxytocin and dopamine during your pregnancy, not. Adrenaline and cortisol not be worried all the time. Yeah. Trust that your body got you, your body got you pregnant. It can do that. It's growing a baby, it knows what to do if you just trust it. And of course you wanna bathe your baby in whatever you can to make your baby's epigenetics better. Yep. We don't really understand that what, what fear can do to a developing brain in our, in our womb. Hmm. But it can't be good. Yeah. It can't be, it can't be good. Maybe it's neutral, but it's not good. Yeah.

Natalie:

Right. I love that. Okay. My next question I ask everybody is, what is your favorite wellness habit that you're incorporating into your daily

Dr. Stu:

life right now? Me? Right now? Yeah. Oh, I, I, I, I drink green stuff in the morning. Nice. Nice. That's new, that's new for me. I used to be like bagels or cereal and bananas or strawberries, you know, that kind of a breakfast. Um, now I think that, um, I take more supplements. I take a lot of things that I've learned. You know, I take a probiotic, I take choline, I take zinc, I take vitamin D, vitamin C, you know, all the protect yourself against covid stuff. Yeah. And, um, and then I started drinking. You know, we have a, um, couple of sponsors that help sponsor us and, um, uh, well, they don't sponsor us, but they're, you know, they like Athletic Greens is one. And then there's this other company that I, you know, I, I, you know, we get ads in our Instagram all the time and we ignore them completely. Sometimes they hit the, hit you on the right day at the right time and, oh yeah, go on. And you spend, you spend$200 on, on. Supplements. So that I think has been helpful for me to keep. Cause as we get older, you know, our bodies do give out and we, you know, men tend to get a gut and women tend to get a butt. And that's just the way it works. And you know, if you can stay physically active and physically fit. And I think that, so that's one thing that I do. And I, and I also try to stay as active as I can. I've got some orthopedic problems and as you know, I had the eye issue. I'm still recovering from that, so I'm not really doing as much as I normally do. But I have a, a electric bike, which has been a godsend for me. Awesome. Uh, I can explore places I could never have gone before, cuz I've had two knee operations and I have a bad knee and I just don't have the strength to pedal uphill that much anymore. But now it's like, you know, when you have pedal assist, it's great. Yeah. And being outside. And now that I have a homestead in southern Utah, I can walk in the grass and I can, I can connect and I have a garden. And I'm gardening of growing vegetables and flowers and I am, uh, I think that these are the things that are keep gonna keep me healthy and happy till the, the day I don't wake up. Yeah. And that, and that will happen at some point, hopefully not for about another 30 years. Yeah. We want

Natalie:

you around for longer.

Dr. Stu:

Yeah. Well, yeah. But that's, that's the, the key is to, is to not, I know. I don't watch the news anymore. I get enough crappy news on Instagram and stuff. They can't help it. Yeah. So I I, I, you can't because you, this last hour with me, you've heard me, you said get heavy. It's gets heavy. Mm-hmm. Because, because I'm so passionate about trying to point out the flaws in what, what we consider to be our traditional medical system as it comes to obstetrics. And it can be, it can be, it can wear on you and, you know, and I, and I read incessantly and so I, you know, I have to have a way to get rid of that. Aggravation Yeah. That I get from reading my journals that just, you know, they just won't, they won't, they won't, they don't see the light and they just continue to try to find new ways to intervene in, in nature's design. Yeah. So exercise, you know, drinking green stuff. Sorry. Um, uh, I don't, it doesn't have to be green. Just, you know, it's a healthier mixture of, of things that I think are good for your body. Do I feel any different? No, not really. I don't know. Maybe I feel worse if I didn't, but mentally I feel better. That's, that's

Natalie:

valid.

Dr. Stu:

That's worth it there. Well, that's what we talked about at the very beginning. I think the very first question was tru having, you know, trust your body mm-hmm. And allow your body to do what your body's designed to do and stop messing with it all the time. Yeah. You know, don't take regular medications if you, you know, unless you. Clearly have to, but try to solve the under underlying problem. I mean, I, I had, um, cholesterol that was slightly high, and my internist, who I'd been with for 30 years wanted to put me on a statin. And I said, how about if I just change my diet and then lose a little bit of weight? And I did. And, and you know, if I tired of taking a statin, I'd be on that drug for the rest of my life. Yep. With all the costs and the side effects from that. Mm-hmm. And we're finding out, and we will find out more and more that statins are horrible. There are so many side effects. I have a lot of, a lot of doctor friends who, who swear by them, but they, you know what we swore by a lot of medications and, and, you know, thalidomide and d e s and Vioxx and, and r i vaccines, we swore by those too, and they turned out to be horrible. So, uh, so yeah. You, you know, let your body do what it's designed to do. Yeah. Um, no, there's certain things I can't help, like, like my orthopedic issues. I mean, I, I, I'm resisting getting an artificial. Joined. Don't really want one. Yeah. But at some point I'm, I'll, I'll probably do it and then I'll kick myself for not have done it 10 years earlier. That's what everybody, everybody who gets one says, I wish I would've done this earlier, and yet I'm just still don't wanna do that. Yeah.

Natalie:

Yeah. I've had a lot of clients echo that same, same thing. It's, it can be very beneficial. It can get you back to where you want to be as far as movement

Dr. Stu:

wise. You know what, like artificial hips and knees. Exactly.

Natalie:

Yeah, yeah, yeah. Not the shoulder. Right. I wouldn't recommend the shoulder.

Dr. Stu:

Yeah. Well, we're getting outside. I think I'm getting really outside my expertise. You just asked for what, you know, some things that I do. Yeah. And I tell you that, that finding a homestead finally and getting out of Los Angeles was huge for me. Um, the last few years, even though, I mean, my kids are all grown, but the last few years living in LA I just, I watched my city go downhill and I just, I watched, um, me fighting some losing battles and I just decided that, That, you know, I can't, I can't continue. I did it for 40 years. I can't, I can't continue to, to do that. Yeah. And so I needed, I needed a change and now I'm re-energized to do other things like teach advocate, consult with people. I have a consulting service, um, bliss and I are working on probably doing some sort of Patreon type thing coming up where people can then have direct contact with us. Subscription type thing. Yeah. Something cuz I obviously I need to make an income. Yeah. Um, so that, we'll figure that out. But I want to do, uh, things that are not as physically and emotionally stressful and being on call to all my midwife colleagues out there and all my birth worker colleagues out there, doulas, lactation, consult, being on call. It takes its toll. Mm-hmm. And you need to take breaks. You need to do this in a, in a time of your life where you're, where you're, you're not bound by dealing with your babies and your toddlers and your children and you need to take breaks. So, so work for six months and then take three months where you take no clients and rejuvenate your body. Cuz being on call will wear you out. Yeah. Um, and you'd never wanna lose that spark of enthusiasm that we all have for birth. I mean, we are birth geeks. Yep. Hundred percent. Um, yeah, but what's better? Hockey maybe?

Natalie:

Can't think of anything that's better. Oh, so that. Subscription hopefully soon. But otherwise, services you have, um, a way that people can get in contact with you through your website, right? Birthing instincts.com and your podcast, birth Birthing Instincts podcast

Dr. Stu:

and Instagram is birthing and Instagram perfect. Right. And my, my website has, um, has testimonials in it. It has guidelines in it, it has blogs, things I've written. I just was reading some stuff that I wrote back in 20 13, 20 14, and stuff like that. I, I was like pretty, I was pretty on it right then. And unfortunately nothing has really changed in the last seven or eight, nine years. But, but, um, it's really interesting to read that stuff. And then I have a link at the very top. I'd like it to be in a bigger banner, but it's a tiny little banner that says, become a member. People can sign up for membership or they can sign up to have a consult virtual, just like this. Okay. Um, one-on-one, that sort of thing. Um, and I, uh, and look, I, I think. First thing that people need to do is have decide to put, like we said at the beginning, put value on this process. Mm-hmm. If you don't value giving birth, if you don't think it has value, you won't wanna spend any money on it or any time on it. And, uh, that's so true. True. Then you get what you pay for. Yeah. It, it, the way we give birth to our children has immense value because it will be with you the rest of your life. You'll remember it more than you'll remember just about anything else. And we like to give you, um, happy memories. Yeah. Um, and the medical model isn't doing that for the most part. Yeah. Right.

Natalie:

Yeah. Well said. Well said. Well, Dr. Stu, thank you. Thank you. Thank you for everything that you do and for being here today. I, I truly appreciate

Dr. Stu:

it, Natalie. Thank again, thanks for having me on, and thanks for the patience of the technical glitches at the beginning. Oh, we're, we're good. Yeah, we're all good. Awesome.

Natalie:

I really enjoyed my conversation with Dr. Stu about birth and his perspectives on all the things. I hope this really piqued your interest. To learn more about physiologic birth and to do some research of your own, you'll find all the links for the resources he mentioned as well as his site and social pages for you to follow in the show notes for this episode. Please remember that what you hear on this podcast is not medical advice, but remember to always be an active participant in your care and talk to your healthcare team before making important decisions. If you found this podcast helpful, please consider leaving a five star rating on Spotify or writing a review on Apple Podcasts as this really helps other people find the show. Thanks so much for listening. I'll catch you next time.

Interview Start
Twins
HBAC
No Money in Doing Less
Cognitive Dissonance & C-Section Rate
Wrap Up Questions
Stress Less
Outro