Episode 146: The Financial Impact of Informed Consent for Birthing Choices with Dr. Stu – Transcript

Episode 146: The Financial Impact of Informed Consent for Birthing Choices with Dr. Stu

Rennie Gabriel  00:10
Hi folks, welcome to Episode 146 of the Wealth On Any Income Podcast. This is where we talk about money tips, techniques, attitudes, information, and provide inspiration around your business and your money. I'm your host, Rennie Gabriel. In past episodes, we spoke about how to understand the numbers from your business, how to measure the level of pleasure based on where you spend your money, how to track your money in 5 to 10 seconds, what determines how close you are to Complete Financial Choice®, and how to run your business without being in your business. Last week, we had Minesh Baxi, a business and financial coach and this week - it may seem a little off topic but it's not - we are having as our guest, Dr. Stuart Fischbein. Dr. Fischbein has been a practicing obstetrician for over 40 years. He's the co-author of the book, Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife, and a Mom, and his peer reviewed papers on home birth and breech birth. Dr. Stu, as he's known, has spent 24 years assisting women with hospital birthing, and for the last 13 years, he has been the only home birth obstetrician in California, who works directly with midwives. He also travels around the world as a lecturer and advocate for reteaching breech and twin birth skills. Respect for the normalcy of birth and honoring informed consent is his focus. Stuart, welcome to the Wealth On Any Income Podcast.

Dr. Stuart Fischbein  02:00
Yeah, this is a podcast, Rennie, that I'd never thought I'd see myself being a guest on. So it's a great story how we actually met. 

Rennie Gabriel  02:08
Yeah, it is. I mean, you know, we met at a wedding. And as you're talking, I'm realizing there are major financial obstacles in terms of having children and the things that you were talking about, I thought were absolutely a fit for the podcast because hospitals, insurance companies, and the money that's spent in those areas definitely have an impact on our lives. Tell me what you do, but I think I covered it in the bio, but you know . . .

Dr. Stuart Fischbein  02:44
Yeah, okay. Thanks. I'll try to keep it relevant to your topic.

Rennie Gabriel  02:47
And important, is why you're doing what you're doing.

Dr. Stuart Fischbein  02:51
Okay. So I am an obstetrician. I'm a member of the American College of OBGYN. I went through the standard training that every OB gets, medical school, residency. I was matched at Cedars Sinai Medical Center in Los Angeles, which is a, you know, has a great reputation. I came out as part of my training, I got to spend four months at LA County USC, Women's Hospital, which in the early 80s, was the busiest hospital in the country doing approximately 22,000 births a year. With if you break that down that 65 babies a day, so you really get exposed to a lot of stuff if you're there for three or four months. So I came out really well trained, but I also came out very medicalized and thinking that pregnancy is an illness and a disease and that it needs to be treated. And that, you know, it's kind of like the Monty Python sketch with John Cleese where he goes, You know, we need more machines that go beep and at one point, the woman says, Doctor, the baby's coming, what should I do? And he says, Nothing dear, you're not qualified. You know, they were funny in the 70s and I got through medical school watching Monty Python, but I will tell you that that stuff didn't sink into me then. It started to sink into me when I went into private practice. And as a mercenary looking to make money, because medicine was different back then, you didn't come out and get a job working for a large HMO like Kaiser or something. You came out and you hung up your shingle and you hustled and you covered emergency rooms and you covered free clinics and you assisted other guys, or covered other guy's call. And by guys. I mean women too, but this is, I'm from the Midwest, so "guys" is just a general term. But I didn't think that home birth was a good idea. I didn't know anything about midwifery. I just backed up their transports because it was revenue for me. But slowly over the next couple of years, I began to realize that the midwives looked at birth a whole different way. I had lots of time to talk with them, sitting around the hospital lounge waiting for their their clients to get further in labor. 

Dr. Stuart Fischbein  04:48
And I realized that their clients were really - by the way I use the word client rather than patient. It's a midwife thing because patients imply that you're sick, and it's a disempowering term kind of like changing a pregnant woman into a hospital gown. You know, why do we do that? You know, we immobilize them, we do all these things to them that disempower them. So we use the word client. But I realized that clients were well educated, very smart, they made a wise decision to do home birthing, pay out of pocket, ignore their insurance, ignore what 95, 97% of people do and go to the hospital. And I began to see that a lot of what I knew was only for about 10 to 15% of pregnant women who have real problems. The other 85% don't have problems. And I was not an expert in a woman that didn't have problems. And yet, I'm taking care of all these women. 

Dr. Stuart Fischbein  05:39
So I began to see a different way of doing things. Then I began, then I opened up a collaborative practice after 10 years, in 1995, I think it was 96, maybe, with two certified nurse midwives in a hospital in Ventura County, and we for 15 years, did really good stuff. The midwives took care of the easy stuff. And the simple stuff, and the well-woman stuff and the pap smears and the normal labors, and I would come in when somebody had cancer or needed surgery or whatever. And so that was a perfect collaboration, because midwives, their style of practice is a lot different. They spend a lot more time with each individual patient than we do. And so they get to know their patients better..

Rennie Gabriel  06:17
or their clients. 

Dr. Stuart Fischbein  06:18
Yeah, well, I'm switching back and forth. But you're right - ,they don't call them patients, they call them clients. And I began to see that that what I was doing was wrong. But the problem was, is that as I began to change the way I practice, the hospitals and the local medical community did not want to go along with us. And they fought us at every turn. And we wanted to do breech delivery. They didn't like midwives, they didn't like breech birth, they didn't like twin birth, they didn't like vaginal birth after cesarean. And slowly but surely, they they did what's called Gunny Sacking or sham peer review. And they started to pick on us. And eventually it reached a point after 15 years where they were not going to renew my privileges, and I would either have to fight them legally, or go and change my course. And I had some very wise people that told me you could fight them legally, but it's an administrative process, you're probably going to lose. And if you win, all you're going to win is the right to stay at a hospital that's going to be looking to get you at every turn. So my midwife colleagues said you should come to a home birth. And I've been practicing now for 25 years. And I'd never been to a home birth, and yet I'd been backing midwives for all that time. So the first couple I went to were beautiful, beautiful births. Nothing like what goes on in the hospital. The women can do what they, really, you know what they want, they can eat, they can move around, they're in their own bedroom, they're naked, if they want to be. They have the people around them that they want. There's no strangers there - there's no change of shift. There's no mandatory IV or mandatory ice chips, or mandatory fetal monitoring, which limits movement, none of those things, and there's great evidence to support that. So that's what I've been doing the last 13 years, I've been going around, and then the skills that I learned like breech and twin delivery and those sorts of things, forceps are not taught anymore. They're the skills that make my profession unique, Rennie, and the average obstetrician doesn't know how to do them. And if I wanted to be an expert in something, I'd want to be an expert in it. And I don't really know how they quite cope with the fact that they don't know that other than some cognitive dissonance to tell these women that they need C-sections, when of course they don't.. So that's in a nutshell, I'm trying right now to break the hold that the medical model has on the mind of the American public.

Rennie Gabriel  08:33
And thank you for that, because I've got an off-topic question that I'm going to ask you. And then I'm going to get to why I think this is a fit for my Wealth On Any Income Podcast. So the off-topic question is, tell me about what you do in terms of giving back. I donate 100% of the profits from the work I do to animal and veteran charities. So all of my guests are people who are giving back in some way and I know you do, so please tell me about it.

Dr. Stuart Fischbein  09:01
I mean, I get paid when I teach. I have been answering people's questions and emails, and writing blogs and all that stuff. And I don't really have a platform. I'm not on Patreon. I'm not you know, I don't charge for those things. I don't have a membership. And I've had a lot of people tell me how stupid I am not to but so I donate those sorts of things. I talk to people, I support women. I support doulas. I support . . . I go to their events. I may speak - there's no fee for that. I mean, I don't . . .

Rennie Gabriel  09:34
And I and I know you support physicians for informed consent as well.

Dr. Stuart Fischbein  09:39
Oh, those, yeah, I'm wearing my T shirt just for you today. Yeah, I mean, charity wise I support FLCCC. Then again, PIC and the American Association of Physicians and Surgeons, or AAPS, they support the private practice of medicine and the idea of informed consent. They're not monolithic, sort of bought off organizations, that one size fits all. And that's, I mean, that's what the AMA is. The AMA does not represent, 85% of physicians don't belong to it. They're a corporate entity. They make most of their money from the coding software that they sell. They are not responsive to their members who are mostly medical students, residents, who are mandated to join, and then academicians. The American College of OBGYN took $11 million from the government to push COVID shots on pregnant women. All right. I mean, the idea that...  That's something that's never been done before with pregnancy, and babies, is give them an experimental medication. And yet my organization was not only promoting it, but they were basically telling us in emails, how to counsel women. And then if women chose not to do it anyway, then we must have counseled them wrong. As opposed to the woman having an independent mind and saying, No, I've done my research, and I think, no I don't really want to do that. I've already had COVID. I'm not really too worried about it. That sort of thing. 

Rennie Gabriel  11:07
Yeah. 

Dr. Stuart Fischbein  11:07
So these companies are corrupt. And they're not there to look after the little guy, either is the hospital. The hospital's mission, the hospital's mission statement is beautiful, but nobody, nobody follows their mission statement. People should go online and read a mission statement of a hospital. You'll start laughing, because it's not what they do. The hospital's fiduciary duty is to be financially solvent. And that means by doing more stuff. You don't get paid to do nothing.

Rennie Gabriel  11:33
Yeah. Well, that leads to some of my other questions, which has to do with I mean, you kind of touched on this, but you know, you didn't talk about specifically the percentage of C-section deliveries in hospitals, let's say now versus 50 years ago. But how has that changed, and why?

Dr. Stuart Fischbein  11:52
Well, I think this is probably what we talked about at the dinner table. But nobody else has heard it except you. Well, in 1970, the C-section rate United States was 5%. And now it's over 30%, which is a 500% increase in the Cesarean section rate. Now, if we had a concomitant improvement in fetal outcome or maternal outcomes, you could maybe justify it in some way, but we have no decrease in the rate of cerebral palsy or neonatal death. As a matter of fact, we're around 40th, give or take some, in the world, in both the neonatal death and maternal mortality.

Rennie Gabriel  12:25
Now, I want to say that it english, from the standpoint of the way I hear it, and the way I would say it, is that as the United States is an industrial country, and compared to other countries in the world, we're at 40th, in the fact that more women suffer here than in other parts of the world.

Dr. Stuart Fischbein  12:48
Yes, and babies. Yes, that's true. So the question is, why did that happen? And there are many reasons why it happened. But there are two main reasons why it happened. And that's what's called stage one thinking. And stage one thinking is where you do something because it sounds like it might do some good or it feels good, but you never ask yourself, the follow up question is, does it actually do good? Or, now what? And those two things were, continuous fetal monitoring, the belts that all women were when they go into the hospital. There's no data after millions of interventions and millions of unnecessary cesarean sections that those things have done anything to decrease the primary outcome, which was to prevent cerebral palsy, and intrapartum death. And the Freidman Curve, which for those people who don't know that, that's a labor curve, where you're supposed to dilate at a certain rate if this is your first baby, or if it's your second or more baby. And in order to know whether you're dilating you have vaginal exams, and vaginal exams are uncomfortable, they're unnecessary, they increase the risk of infection. But you can't plot a curve without points on the curve. So you have to do these. And the idea that all women who are having their first baby should dilate at the same rate doesn't even pass the common sense test. 

Rennie Gabriel  14:09
No. 

Dr. Stuart Fischbein  14:09
I mean, we were all different. 

Rennie Gabriel  14:11
Right. 

Dr. Stuart Fischbein  14:12
And labors are all different, but hospitals work on an algorithm. And everything has to be on the algorithm. And if you fall off the algorithm, Rennie, then they feel like they have to do something, and they intervene. And that's where you get what is famously called the "cascade of interventions", where a woman who's perfectly healthy walks in with a perfectly healthy baby inside of her, and she's being brought in for an induction or maybe an early labor for no particular medical reason, and she ends up with an IV and vag exams, and rupture of membranes, and an epidural, which slows down her labor, and Pitocin, and she can't eat, and the baby starts to get stressed and doesn't like it very much. I got a lot of reasons for that. And finally, they say, You know, your baby's not tolerating labor, you need to a C-section. And the baby's born by C-section. It's got good Apgar scores but because they were worried the baby then goes to the NICU for observation. It's separated from its mother. The mother and father go home in three or four days. And then they would they're told, Geez, you know you had a healthy baby. But think about the experience that they had. 

Rennie Gabriel  15:19
Yeah. 

Dr. Stuart Fischbein  15:20
That baby was perfectly fine three days ago inside mom and now, mom's had a major surgery, all kinds of medications, altered microbiome for the baby, antibiotics, the baby's been separated from the mom for the first 6 to 12 hours. And this is a common occurrence. This is not something that is, that I'm using hyperbole here. It's a very common occurrence in a hospital.

Rennie Gabriel  15:44
Yeah, and, you know, all of those things, from a personal standpoint, are traumatic. Now, one of the things that I want to touch on, that deals with, you know, the focus of my podcast, is the financial implications. So obviously, there are all these health implications. Now, what's the financial implication, or the change if women were adopting a more natural approach to childbirth that's been going on for millennia? 

Dr. Stuart Fischbein  16:17
Well, I'll start with by saying what we need to do is back up, and we need to rethink of how we look at pregnancy and childbearing, not as a medical problem, but as a life event. And if you look at it as a life event, we use this analogy all the time, that two of the most important events in a woman's life are her wedding day and the birth of her children. For your wedding day, you plan everything. You plan the color of the napkins, you pick out your invitation list. You pick out what kind of cake you want. You pick out the venue. You do all these things, you invite people that you love. This is what you do for your wedding, and you spend 10, 20, 30, 100, $150,000, on your wedding, right, whatever. 

Rennie Gabriel  17:02
Yeah. 

Dr. Stuart Fischbein  17:02
For your birth, you got your Medicaid card, or you got your Blue Cross card and you say, 'Ah, this guy has been doing my pap smear for 10 years, I'll just go to him', and you abdicate all these things to a third party who has no interest in your life event. And you're paying a decent amount and the hospitals are expensive. And the birth, the average vaginal delivery, I think it's about 13, $14,000. The average C-section's $25,000. An average, home birth is about $5,000, depending on what state you're in, it's a little bit more in certain states. So the analogy is this, what if someday we invent wedding insurance. And when you're 18 years old, you get, you pay $100 a month, or $50 a month or 10.99 a month. And when you get married, your wedding is covered. But you don't get to pick the venue. You don't get to pick the chicken. You don't get to pick the color of your dress, and they invite people to your wedding you don't like. Okay, nobody's going to do that. 

Rennie Gabriel  18:05
Yeah. 

Dr. Stuart Fischbein  18:06
But that's what we do for our birth of our children, which is, in some ways, the most important life event a woman can ever have. Right? No one ever forgets the day their baby was born. You may get old, you may forget her names and certainly their phone numbers, but you won't forget that. The woman never forgets that day. You ask any grandma, and they remember it vividly. And a lot of them don't have very good memories. So to spend a little money out of pocket, 5 or $6,000, you know, having insurance as a backup is fine. And if you break your leg, or if you're in a car accident, or a heart attack, I mean, insurance is great. But for this life event, people need to look at it differently. They need to think of it not as a medical condition that should be covered by your insurance, because then you're going to get what you pay for.

Rennie Gabriel  18:54
Yeah, and if we use some numbers, and let's say the average is $5,000, for a home birth, or let's say $15,000 for a hospital birth, with no complications, that difference is $10,000. Okay, granted, a lot of that's covered by insurance. So our insurance premiums are higher, because we're paying for that. And if insurance companies weren't involved, the premiums would probably be less. And so based on how many births there are multiplied by 10,000, I don't know how many millions of dollars a year savings would there be?

Dr. Stuart Fischbein  19:36
There'd be quite a few because, you know, there's about 4 million babies born United States every year. 

Rennie Gabriel  19:40
Okay. 

Dr. Stuart Fischbein  19:41
And somebody's paying for that. And you know, some of it is Medicaid or Medicare in California. And, but that's your tax dollars being paid for that. The thing about paying out of pocket for, I mean, some people think insurance companies should cover home birth. The problem with that is that then insurance companies will start to dictate what home birth is worth, and then no midwife is going to want to do it for that anyway, they're not going to take insurance. Like a lot of specialty doctors no longer take insurance anymore, because they don't pay him enough to be able to do a good job. In other words, you have to do volume instead of doing a good job. But if you think about putting out $5,000, or starting a health savings account when you're 18 years old, and putting money away every month, small amounts - 25 bucks. By the time you're 30, 35 years old, you're going to have a lot of money in there. And if you spend $5,000, on a birth, within a year or two, that money won't mean anything. I mean, we spend $5,000, some people spend it on a vacation. 

Rennie Gabriel  20:39
Yeah, oh, more than that. 

Dr. Stuart Fischbein  20:41
It's a down payment on a car, whatever. So and then you don't think about it years down the road, because that's money that was well spent.

Rennie Gabriel  20:49
Exactly. And so, and that's one of the things that I wanted to tie into, not only are we dealing with the health situation of mothers, and the resulting stress in a child, resulting in all of those issues, but there's also the financial impact that I wanted to cover. And so  . . .

Dr. Stuart Fischbein  21:08
Can I just say one more thing? 

Rennie Gabriel  21:09
Yeah, sure. 

Dr. Stuart Fischbein  21:11
There's a unknown or uncalculable, incalculable financial cost to giving birth dramatically at the hospital, not just in emotional cost for the rest of your life, but also in chronic illnesses and diseases. We need to be colonized when we're born by mom's skin and vaginal bacteria. When you're born by a sterile scheduled C-section, because of its convenience, or because, you know, whatever, it's a repeat C-section, those babies are more likely to have some chronic problems as life goes on. And what is that going to cost? 

Rennie Gabriel  21:49
Yeah. 

Dr. Stuart Fischbein  21:50
Those things are not taken into account because, as I like to say, and people who follow me know this, that to the medical model, all that matters is a live baby in the bassinet, and how it gets there and what happens to it later, and what happens to that mother, and what happens to that mother's future pregnancies is not the concern of the medical system. It sounds cold, I'm not condemning the individual people who are stuck in the hamster wheel, I'm condemning the system. The system is broken, it cannot be fixed. People need to think out of the box when it comes to pregnancy and look at alternatives. Have at least have some visits with the midwife and you'll see the difference. You'll know automatically that there's a huge difference in the kind of care you're getting. You're going to feel good when you leave your appointment with a midwife, as opposed to feel like what just happened after your six minute visit with your OB.

Rennie Gabriel  22:40
And thank you and Stuart, I really appreciate that. Now, is there some valuable resource that people can get from you that would support them in learning more about this?

Dr. Stuart Fischbein  22:52
Oh, for sure. I mean, my book, Fearless Pregnancy, is a decent book. It was written, the last edition in 2010, but everything in there still applies, although I wasn't a home birth obstetrician at the time. So it is a little bit different. And the one chapter on genetics is obsolete, because that's all changed. But better than that would be my website, or my podcast, my website is, birthinginstincts.com. And if you click on the little menu at the top, there's something called the blog page. And I wrote a lot of really wise things between 2010 and 2020. I don't write as much on there anymore, because now I have Instagram and my podcast. It's called, The Birthing Instincts Podcast. And I would just tell people, that this is just the tip of the iceberg. But it's a good place to start, to start to learn and invest in it. Just like you would invest in what color invitations you're going to have for your wedding, you go to the place, and you look through a book and you debate it and you talk about it. It's not something that's just blindly picked. Same thing here. When you're pregnant, do some research. There's so many good resources out there, Rennie. But if you go, you could start at my page or my Instagram page at birthinginstincts, and then you'll see all the people that post on there or follow or whatever. And there's some really, really smart people that are posting that I've learned a lot of my stuff from. Lots of great books. Sara Wickham has some great books on pregnancy, that make things that are seemingly high risk, they're really not high risk. And I mean, I'm just mentioning her. There's just a ton of people. I don't want to leave anybody out.  But . . .

Rennie Gabriel  24:28
I get it. Yeah, there's a lot of resources. So I'm going to have the birthinginstincts.com website in the show notes, people can click on it and go right there. And Stuart, thank you for being on the Wealth On Any Income show.

Dr. Stuart Fischbein  24:45
You're welcome. Thank you for having me.

Rennie Gabriel  24:47
You're welcome. And to all those who are listening, if you'd like to know how books, movies and Society programs you to be poor, and what the cure is, then log on to wealthonanyincome.com/TEDx. You'll hear my TEDx talk and can request a free 9-Step Roadmap to Complete Financial Choice® and Philanthropy, and receive a weekly email with tips, techniques, or inspiration around your business or your money. And if you'd like to see how you can increase your wealth, and donate to the causes that touch your heart, please check out our affordable program, Wealth with Purpose, again, on the Wealth On Any Income website. To my listeners, thank you for tuning in. You can listen to the Wealth On Any Income Podcast on your favorite platform. And please rate, review and subscribe. Until next week, be prosperous. Bye bye for now.


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