Dr. Stu's Podcast: Recent Episodes
Dr Stuart Fischbein
Alliterations aside, Blyss is busy birthing so Dr. Stu discusses a tale of two breeches and why all pregnant women and “birthing people”
are not the same. Other topics include Covid-19 updates, more silliness out of the capital and listener letters.
Blyss & Dr. Stu try anti-social distancing and give Zoom a try. Harvard and wisdom may be oxymoronic but wisdom from C.S. Lewis stands the test of time.
Blyss returns to discuss birth and letters from listeners. Another good doctor under fire and America’s maternity care under scrutiny. Dr. Stu and Blyss share insights.
With Blyss at a birth, Dr. Stu goes solo to talk of Twins born early, shared decision making and he takes a deep dive into the malevolent hubris of gunnysacking and gaslighting good people.
Back in the kitchen to discuss Bishop scores and post-date protocols. And WTF happened to the Land of the Free & the Home of the Brave! Blyss & Dr. Stu have their opinions, as usual.
To honor Skye, Dr. Stu declares an early end to 2020. And Blyss joins in to say normalcy begins with how we birth.
Recorded on Facebook and Instagram, October 28, 2020
Link from this podcast: https://www.dailymail.co.uk/femail/article-8834045/Women-France-felt-like-suffocating-forced-wear-face-masks-childbirth.html
(Though Dr. Stu says 12, this is really 13)
Recorded Live on August 21st via Facebook and Instagram
Recorded July 31, 2020 live from Dr. Stu’s Podcast Facebook and Birthing Blyss Midwifery Instagram
Dr. Stu and Blyss live from Facebook and Instagram recorded May 15th
Tune in every Friday at 11a Pacific
Another “not-so- by-the-fire” Fireside Chat session, recorded May 8th. Dr. Stu and Blyss, catch up and share their lates birth related stories and discuss some of today’s important issues.
Dr. Stu and Blyss continue their weekly, “Fireside Chats” (minus the fire). Session 3 recorded, May 1, 2020
During the #Coronavis, Dr. Stu and Blyss are hosting weekly Fireside Chats. Here is session 1 from Friday, March 20th
Birth Center owner & midwife Renee Sicignano (See Chin Yah No) joins our hosts to share her experiences volunteering in Haiti. Blyss and Dr. Stu share in the lessons of gratitude and selflessness.
Links in this podcast:
https://mamababyhaiti.org
https://longreads.com/2020/03/10/criminalization-of-the-american-midwife/
https://www.change.org/p/california-governor-help-best-start-birth-center-keep-coverage-for-medi-cal-clients
A rainy Los Angeles day and a news cycle of panic and TP shortages has Blyss & Dr. Stu addressing listener letters while remembering personal heroes and periwinkle as some of their favorite things.
https://www.cdc.gov/coronavirus/2019-nCoV/index.html
Producer John feeds Blyss’ jigsaw puzzle addiction and Dr. Stu puts on the reading glasses to seek out the holes in another replay of the Amos & Frank Show and their anti-midwife/homebirth crusade to save women from choices.
LINKS: Midwives – Licensees | Medical Board of California
Dr. Stu is reminded what matters by an awesome display in the Alaskan Sky and Blyss chimes in on the little miracles around us. Here’s one, a VBAC in Santa Barbara, OMG!
Links this podcast: Bode and Morgan Miller share ‘incredible’ home birth story of their twins
Method of Birth Should Be a Choice
Catching up on letters from listeners and wisdom from Blyss stimulates Dr. Stu into some thought provoking moments.
Blyss & Dr. Stu take a lesson from The Kansas City Chiefs and rally from a tough stretch to take on 20 babies in January, 2020!
Amos & Frank are at it again. Redefining high risk and continuing to obsess over home birth. Midwives Beth & Blyss react while Dr. Stu obsesses over buns of steel
Morgan & Bode Miller are making a difference. Midwife Beth Cannon joins Blyss & Dr. Stu to discuss the latest news. Cristen Pascucci & Diana Snyder took to the podium with Dr. Stu at the recent New Jersey Symposium on Physiologic Birth. And, breech expert, Dr. Barry Brock, gets hit with a hockey puck.
Picture credit: McCall Miller Photography
Dr. Stu & Blyss welcome photographer, doula & VBAC/Homebirth Cesarean mom, Diana Hinek, to the podcast. Diana shares her story while the team shares opinions on EMR, sleep positions and the optimal cesarean rate.
From L&D rules to road closures, Dr. Stu ponders the absurd. Blyss joins in as the team discuss the origins of worry and life on the road as a solo birth worker.
In annual Halloween tradition, Dr Stu talks with twin parents Linda & Andrew who share the horror of helplessness of having their newborns trapped in baby jail. #twinpregnancy #NICU #babyjail
Sleep deprivation doesn’t stop Blyss and Dr. Stu as they respond to a listener’s questions about the confounding topic of clotting disorders in pregnancy and miscarriage. Dr. Stu shares his 2 seconds of fame.
What’s the deal with placental pathology anyway? From oligohydramnios to home insemination, Blyss & Dr. Stu tackle some really fertile questions.
Links from the Episode
New Jersey Symposium for Physiologic Birth
Madison Breech Conference
The NIH is funding research on vaccine acceptance and counseling techniques rather than safety. Blyss & that right-wing nut, Dr. Stu, are not surprised. Meanwhile, they catch up on cool birthing stuff and recent teaching events.
Even the LA Times gets it. Blyss & Dr. Stu host Birth Photographer and Doula Stephanie Entin of Little Plum Photography in a discussion about the whys and hows of memorializing life as art.
You’re discharged today, see you in 6 weeks.”
Now what? Alyssa Berlin, PsyD joins Blyss & Dr. Stu to discuss starting an Afterbirth Plan well before your due date.
Dr. Stu’s & Blyss discuss his recent blog, the questionable misuse of “directive counseling” and good news from McMaster University.
Blyss & Dr. Stu respond to listener’s questions and discuss birth stories & fun topics from Florence Nightingale to Homer the cat to self care.
Guest Augustine Colebrook joins the team for a wide ranging conversation from birth systems and reaching critical mass to prolonged happy hours and yoga pants!
Blyss & Dr. Stu review a remarkable twin birth tale with a remarkable guest of the podcast, Dr. Emiliano Chavira
Dr. Stu thinks Blyss should open her own mall and the team swallows the uncertainties of labor.
A horseback ride serves as a reminder while birthing topics and letters from listeners keep Blyss and Dr. Stu energized and entertained.
Blyss & Dr. Stu catch up on recent births as they acknowledge a dozen dozen podcasts, discuss some gross behavior at ACOG and welcome Prince Archie.
Dr. Stu is tired of news about no news so he and Blyss discuss fibroids, solo practice and the changing trend in baby names.
The team opines on movie reviews and birth stories before Dr. Stu and Blyss discuss his latest blog on vaccine info.Physicians for Informed Consent (PIC) Annual Workshop Summary 2019
Dr. Stu discusses his recent case report and Blyss joins in to bring some reason to listeners.
Blyss and Dr. Stu team up with Elliot Berlin and the star of the new documentary for an intimate conversation on The Informed Pregnancy Podcast
Dr. Stu and Blyss respond to listeners and then ponder why so much negativity against the 1 percent.
Blyss & Dr. Stu review Dr. Stu’s paper on breech home birth and do what they do best: rock the status quo.
Guest Doula, Karla Leng retells a harrowing horror story while Blyss & Dr. Stu hide behind the chainsaws.
Blyss tells Dr. Stu tales of a busy birth week and the duo celebrate the culmination of some hard work.
ACOG has a new breech guideline emphasizing ECV. Blyss & Dr.Stu sigh, review and comment.
Beyonce sings to Blyss sparing listeners a Dr. Stu rendition of happy birthday while reader questions are answered and research answers are questioned! (Creating More Questions Than Answers)
From hospital closures, to crying babies to generalized rules that make everything more difficult…..or foolish, Dr. Stu and Blyss break it down.
Blyss and Dr. Stu return to share breech and twin stories, stork sightings and a tiny bit of common sense sighting from the 2018 ACOG meeting.
Blyss and Dr. Stu ponder why so many things are made more complicated. From EMR, to PP visits, to 39 is the new 42. And go ahead and eat that placenta, too.
From interlocking twins to using your head wisely, Dr. Stu and Blyss ponder why the brain often gets in the way of common sense. Blyss gets a new nickname.
Blyss and Dr. Stu ponder the definition of post-term, the relevance about being overdue and who owns the Bamboo Inn.
Dr. Stu suffers from Headline headache and gets a dose of Blyss’ tranquility and common sense.
Blyss has some questions about herpes near term and Dr Stu wonders what is happening to joyful traditions.
Blyss and Dr. Stu reunite to discuss informed consent absurdities, good news on home birth and some silly science on placentophagy.
Dr Stu learns a good lesson from three recent VBAC transports and then Blyss chimes in on the revised ACOG Practice Bulletin #184
It’s still the content of your character! Blyss and Dr. Stu recount some unsafe spaces at the recent MANA conference in Long Beach.
Blyss returns with Dr. Stu and explores the undiscovered world of “Private Membership Associations” with midwife and trailblazer, Angee Hock of Nebraska Midwifery Services
Blyss Young of Birthing Blyss joins Dr. Stu to reminisce, vent a little and discuss a home birth quandary.
Canada says up to 30% of all care provided women is of no value and Kim and Dr. Stu wonder how ACOG can be so sure of its vaccine recommendations.
Dr. Stu & Kim catch up on some recent birth stories and renew the call for collaboration and respect in decision making.
Kimberly shares an update on her daughter’s twins. A twin mom stands her ground and Dr. Stu shares an idea for equalizing the consent process.
Consent for a Forced Cesarean Blog
In the shadow of Washington ineptitude Kimberly and Dr. Stu debate the endgame of the ever increasing rolls on Medicaid.
Remaining silent to the BS coming from Dekalb Medical Center and the mistreatment of a fine doctor is not an option. Breech twin moms Becky and Jessica share their insight.
Find out how you can help:
DeKalb Medical Center Protest
Georgia Birth Advocacy Coalition
Kimberly & Dr. Stu continue their discussion from the ACOG convention on the dream of an integrated birthing system and some reasons behind the cesarean epidemic.
https://shutthekaleup.com
Dr. Stu spent the weekend in San Diego with 5000 obstetricians at the annual ACOG meeting and shares some notes with Kimberly and the listeners.
Dr. Stu forgot to throw away his throw away journal.
http://www.mdedge.com/obgmanagement/article/132366/gynecology/it-time-hpv-vaccination-be-considered-part-routine
Kimberly and Dr. Stu dissect the beast that was California SB 457.
http://ca-lm.org/wp-content/uploads/2017/04/SB457-SenBates_Official_04-17-2017.pdf
Dr. Stu & Kim revisit the recurring themes of Breech delivery. One Step Forward and one step backward. With a positive update from The Sheffield Breech Conference by friend of the podcast, Rixa Freeze.
Check out these great links! www.adaywithdrstu.com www.betterbirth360.com
Time sneaks up on us sometimes. Kim and Dr. Stu discuss recent life events and relish a return to the Podcast.
curecervicalcancer.org
Dr. Stu shares his experience of being disrespected by a hospital physician. Kimberly and Dr. Stu discuss better options for collaboration and some exciting news on breech from California Hospital.
Empowered Pregnancy Summit: http://empoweredpregnancysummit.com/Dr-Stuart-Fischbein
Is the AAP helping parents make informed choice on safe infant sleep and do they really know anything about breastfeeding?
http://www.skintoskincontact.com/dr-bergman.aspx
http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938
http://www.aappublications.org/news/2016/10/24/SleepCommentary102416
https://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria
http://cosleeping.nd.edu/
Our Mission
Homepage
http://lact.net
From Obamacare to Micro-aggressions, this political season has Dr. Stu pondering the loss of liberty and personal responsibility.
Dr. Stu has some harsh words for the system while he and Kimberly show their support for Dr. Bob Sears.
Kimberly questions Dr. Stu about the recent Gathering of the LA Birth Community. Surprise!….he has an opinion.
After listening to Dr. Stu & Kim discuss Breech bans and the cost of a hospital birth the metaphor becomes clearer.
Rally Information
ImprovingBirth.org, LA
Kimberly & Dr. Stu discuss the $16 million Alabama judgement.
Please take a moment after you listen to check out today’s podcast links:
Mom Sues for Bait & Switch in Maternity Care
ImprovingBirth.org
Safer Birth In Bama
ACOG says no twin home births. Kimberly and Dr. Stu aren’t buying it.
Dr. Stu’s blog, “Six days was a charm” ACOG opinion #669: Planned Home Birth – ACOG
Folic Acid information: www.thehealthyhomeeconomist.com/folic-acid-making-us-sick/
Dr. Stu’s phone feels inadequate. Kim reassures Dr. Stu as they discuss issues of the day.
Jennifer and baby, Kallysta, again join Dr. Stu as he recalls some of his adventures during the Dr. Stu Podcast Hiatus.
Chiropractor, Midwifery Student and new Mom Jennifer Angell joins Dr. Stu on the couch for some hot new topics and some old wisdom.
Brian queries Dr. Stu on some of the candidates running for president. Surprise! They disagree!!
Dr. Stu welcomes OB Dr. David Ghozland, a leader in bringing Gentle Cesarean to Los Angeles and Cordelia Hanna-Cheruiyot, the face of the Mother Friendly Childbirth Initiative Conference coming this October. A thoughtful discussion ensues.
Dr. Stu and Brian reach into the International mail bag for a question on malpractice insurance.
Dr. Stu and Brian discuss Stu’s new published paper on his first 135 births and share important pregnancy summer time tips.
Read Dr. Stu’s “Home Birth” with an Obstetrician
Back from Scotland, Dr. Stu and Brian catch up on events across the pond and discuss the new breech documentary “Heads Up”
Dr. Stu and Brian welcome CBR‘s Tanya Rabie for a discussion on cord blood stem cells.
1-888-CORD-BLOOD
Founder Dawn Thompson talks to Dr. Stu & Brian about her goal of bringing evidence based care and humanity to childbirth.
ImprovingBirth.org
Learn more about “Kelly’s” story Here
Support “Kelly”‘s Legal Costs Here
image source: humanizebirth.org
Dr Stu and Brian reconvene the court with witnesses Emilee and Kimme.
Dr. Stu welcomes LA Birthkeepers, Emilee Benner & Kimme McGuire who discuss traumatic moments in the delivery room.
improvingbirth.org
humanrightsinchildbirth.org
It’s not the common core curriculum, it ain’t bullying, it’s those dreaded Oreo Cookies!
Dr. Stu is passionate about reteaching breech delivery and Brian urges listeners to help support a new documentary. Support Heads Up Here
Kimberly Durdin rejoins Dr. Stu and Brian for some good old home birth talk. President Clinton chimes in.
Maybe We Should Agree to Disagree
Lactation Specialist and Midwife Student, Kimberly Durdin, IBCLC wows the guys with her wisdom on this important topic.
Human Milk North America
Find a lactation consultant at ILCA.org
Dr. Stu is saddened and maddened with the news of rural Minnesota hospitals closing their OB units.
It’s Dr. Stu’s 2014 Year in Review and they guys discuss the idea of joining Uber and home birth.
Dr. Stu and Brian chat with Ana Paul Markel of Bini Birth on the economics, ethics and evidence based changes of birth.
Dr. Stu & Brian discuss a recent twin home birth and delve into topics from surrogacy to epigenetics to what is a life coach anyway?
Are anti-abortion hospitals making it tougher for some docs and just what does a brand new baby smell like? Dr. Stu answers.
Dr Stu and Brian delve into the epigenetics of Bella, the new Podcast mascot while pondering what price we pay when we keep selling our liberty to lawyers and government.
The Guys welcome Chiropractor Elliot Berlin, a true Renaissance man and they discuss a host of topics including his path to creating the Informed Pregnancy Project to the Berlin Wellness Group to documentary film making to becoming a male Doula.
Much is changing for Dr. Stu and the guys focus on times gone by. Emotional and human thoughts for empty-nesters and so much more!
As Brian listens, Dr. Stu eulogizes his friend and colleague, Dr. Fleiss. “He was a pioneer in bucking the system, allowing people to retain their dignity and choices.”
Dr. Stu and Brian analyze the latest judicial reviews of ObamaCare plus tips for pregnant women to cope with triple digit Summer heat.
Dr. Stu and Brian dissect the Supreme Court’s ruling on the religious freedom of employers and birth control disputes.
From ID theft to the guys discussion on the Wall Street Journal article on changing trends.
A new mom at Staten Island University Hospital tells a shocking story! From the Daily Beast
An important listener email for Dr, Stu – with lots of info – kicks off the show plus a busy home birthing time for Dr. Stu!
Dr. Stu tells Brian about the first time, as a student, that he passed out viewing open heart surgery! Plus some very positive analysis of 40 years of home births!
Brian brings in Louie Anderson so Dr. Stu can play “Family Feud” & we talk high-profile pregnancies!
Dr. Stu, with Brian at his side, fends off another physician’s less than friendly take on homebirthing.
Dr Stu And Brian discuss a study in the The British Medical Journal which casts doubts on the value of mammograms.
Dr. Stu chimes in on the highly sensitive story out of Texas of a hospitalized brain dead pregnant woman.
Dr Stu and Brian discover Atlanta OB Dr Brad Bootstaylor and discuss preserving normalcy in birth
Dr. Stu shocks Brian with a great professional story of a woman who came to the hospital to give birth BUT she WASN’T pregnant
Dr Stu and Brian listen to home birth dad and comic Jim Gaffigan joke about the whole thing
Dr Stu exposes the intellectual dishonesty of academia. Check out his latest blog post!
Dr Stu and Brian are joined by Stephanie and Celeste to discuss some of the major problems with our legal system when it comes to birthing and midwives
Dr Stu and Brian Whitman bring in AM870’s Elisha Krauss to discuss her home birth experience
Dr Stu gets riled up when a very misleading study comes out on the safety of home birthing
Dr Stu and Brian Whitman are back with another podcast full of opinions and stories you’re probably not going to hear at your average dr’s office
Brian And Dr Stu dive deeper into the fears and concerns patients have with their doctors today
Dr Stu and Brian Whitman are back to discuss how ethics play a role in todays medical environment
Stuart James Fischbein, MD was Board Certified in 1989 and became a Fellow of the American College of Obstetrics & Gynecology in 1990. He has been a practicing obstetrician in Southern California since completing his residency. While well trained at Cedars-Sinai Medical Center in the standard medical model of obstetrics he had the respect and vision to support the midwifery model of care and served as a backup consultant to many home and birthing center midwives for 25 years. In 1996 he founded The Woman’s Place for Health, Inc., a collaborative practice of Certified Nurse Midwives and Obstetricians in Camarillo, California.
In 2004, Dr. Fischbein co-authored, “Fearless Pregnancy, Wisdom & Reassurance from a Doctor, a Midwife and a Mom” www.fearlesspregnancy.net . For his efforts he has been awarded the Doulas Association of Southern California (DASC) Physician of the year award twice and was the very first recipient of DASC’s lifetime achievement award in support of pregnant women. He has spoken internationally on breech and vaginal birth after cesarean section and has appeared in many documentaries, including Ricki Lake’s “More Business of Being Born”, and YouTube videos discussing birth choices and respect for patient autonomy and decision making.
Dr Fischbein now works directly with home birthing midwives www.birthinginstincts.com & www.birthsanctuary.com and offers hope for those women who cannot find supportive practitioners for VBAC, twin and breech deliveries. Read more of his thoughts and advocacy for evidenced-based, reasonable choices at www.supportdrfischbein.blogspot.com
Home birthing has its admirers and its detractors. We all know this. There is all too often a lack of respect by overzealous advocates of either side towards the other. My unique experience living in both worlds has shown me that for several reasons, most of them emotional but some of them understandable, those that oppose home birthing want to bully the other side into submission. Through oppression of supportive physicians and self-serving, ethically questionable policies they make it very difficult for the home birth practitioner and client. And once again they are taking their “safety” argument to the legislature to try to mandate physician supervision of licensed midwives even when we all know that most obstetricians are not interested in supervising or are restricted by their malpractice insurance policies from doing so. Thus, many midwives will become illegal in California if this is allowed to become law. Too often there is a blurring of the lines between elective transport and emergency transport. To the on-call obstetrician the knee jerk idea of a homebirth transport is the train wreck. But to most of us in the homebirth world we understand the elective transport is nearly always for the same reasons that patients who plan a hospital birth come in for, only just a bit later in labor. Pain relief, exhaustion and inadequate progress are by far the most common reasons. What makes these women wanting rest, hydration and an epidural more “toxic” and any different from the 90% of women who get these things in the day to day practice of the average obstetrician anyway is simply their preference of home and midwife. Some will say that these patients are unknown to them and therefore high risk. But that argument is specious for most obstetricians practice in large groups these days or they become laborists and so often have no acquaintance or historical relationship to the laboring woman. They will then argue that they can’t be sure these transports had adequate, if any, prenatal care despite records in hand. In reality, most of these women have had better prenatal care from their midwife than any obstetrician can possibly give and my experience tells me they are almost always better educated. But old habits, even misguided ones, are hard to break by those who find no reason to break them. Enter a truly uplifting story of two very different obstetricians and their wonderful deeds of this past week. A testimony to the old adage that truly great men who do extraordinary things will often be despised. Courage is doing the right thing in the face of strong opposition. These two wonderful souls stand out in their compassion, humbleness and willingness to individualize care to patient desires using reasonable choices, true informed consent and sound medical practice. R is a 24 year old, 5’ 9” primipara at 39 weeks who was in active labor for 16 hours. Despite many alternative attempts to rotate her baby he remained occiput posterior. She eventually reached her limit of exhaustion and pain tolerance at 7 cms. My usual back up physician at Cedars-Sinai was away so I put out a few calls to colleagues and was rewarded by two offering to accept her in transport. This may seem a simple thing but I am lucky in that I have choices for back-up when so many of my midwife colleagues are struggling in that arena as discussed above. They drove the 5 minutes over to Cedars while I drove separately. It had been awhile since I have had to transport so I was not quite prepared for the administrative and regulatory onslaught that followed. When I arrived, security would not let me in because R had not yet been admitted. It took a call to the charge nurse to bypass the woman guard with no eye contact to let me in. Upon arriving upstairs R was moaning loudly with every contraction while the nurse was attending to a laundry list of computer data entries, most of which were irrelevant to the medical necessity of an epidural. Admitting wanted the husband to sign all kinds of forms without reading them while R signed a consent form to be treated document between contractions that legally can’t mean anything when a person signs under such duress and pain. Dad refused to sign anything until his wife got her pain relief. A lesser man would have just signed but he knew his rights and pointed out a poster that clearly complied with the EMTALA statues that said “We cannot refuse treatment to anyone!” His point being, treat her first and then we can review documents. And despite much behind the back eye rolling and sighing they actually did. She got her IV and epidural, which still took over an hour, before she had her name band or lab results. Once comfortable, the cascade of interventions began and baby gave all of us a few gray hairs but Dr. C was amazingly patient and trusting of his knowledge of labor and fetal heart patterns. R rested for about 90 minutes and then was feeling a lot of pressure. Dr. C checked her and found the head at plus 2 station but still OP and almost completely dilated. He then used his obstetric skills learned long ago. Putting his hand inside he reduced station, manually rotated the head to transverse and had her start to push. The cervix was reduced and she delivered over an intact perineum after 4 contractions! Baby M weighed in at 6 pounds 15 ounces. That cute little pipsqueak would have easily delivered if not for the persistence of his occiput posterior positioning. Sadly, in most other modern day obstetrician’s hands they may not have been greeted by a wonderfully accepting man and that little pipsqueak would most likely been born by cesarean section. We were all so grateful that there was an experience obstetrician who was trained in a different era in the skills that separate them from today’s obstetric surgeons. J is a 34 year old, 5’ 6” Ventura County primipara at 41 weeks who went into labor the very next day. Her labor was strong and with the support of 2 marvelous doulas, Tracy & Tasha, she was doing great. After about 10 hours of 4 minute strong contractions J asked to be examined. Her sounds were consistent with early transition however her exam was only 2 cm./-1 and 40% effaced and, again, occiput posterior. Over the next 8-10 hours she remained at 4 cm with her cervix getting much more swollen. Despite her heroic effort to this point it was clear to all it was time to transport for an epidural and what follows. Our original backup plan was to go to a LA hospital with supportive backup but they did not want to drive that far and because she worked at the local hospital she knew her previous OB. Dad called and he told them to go to the ER and just tell them to use his name. He said there was no reason to call ahead. So we packed up and all met at the ER. While sitting in the waiting area in a wheelchair the litany of questions began. Now, 2 days in a row for me makes a pattern. It is clear that administration rules the roost as paperwork comes before humanity. One particular question and response from the worker behind the bullet proof glass really stuck with me. It was 5:30 in the morning and J answered that she had ruptured her membranes 6 hours earlier. The woman’s response was so typical of the indoctrination to the one size fits all medical model, “Why did you wait so long to come in?” To those who only see medical birth this is their norm. The question, the timing of it and the tone from the person asking it were so inappropriate and lacking in social skills but we said nothing. In about ten minutes we were on our way up to labor and delivery. Exhausted and in pain with contractions every 3-5 minutes J was, once again, subjected to consent forms and to an even longer laundry list of electronically generated, mostly irrelevant questions unrelated to her immediate need. (Tattoos? LMP? Family History?) And a plethora of questions that were all answered on her prenatal records which I brought with us but which were out at the desk being copied and stamped and posted in the chart but not in the room available to the nurse. I also learned that since I did not ha
ve the actual lab report on her negative Group B Strep that hospital protocol states she has “unknown” Group B strep status and therefore antibiotics were ordered (but could be refused). The hand written results and my presence were obviously not good enough for their risk managers but unnecessary antibiotics were fine. Ouch! Next, the charge nurse came in to tell us that her admitting doctor did not want to take her and was passing her off to the on-call doctor. This was odd to me since they had a relationship and it was 6 AM already but it turned out to be the most fortuitous event of the day. For the doctor that was on call was likely the only one within 30 miles that would have allowed J the wonderful outcome that ensued. But I must digress for one last moment. We arrived at the ER at 5:30AM. She came for exhaustion and pain relief. She got her epidural about 7:20AM. That’s an hour and 50 minutes of pretty obvious suffering due solely to the administrative bureaucracy. She was begging for her epidural and all the wonderful nurses could say was that things were moving as fast as they can. It must be so hard for a caring nurse to watch that day in and day out. Tracy says she sees it 5 times a month. No one raises a stink for fear of retribution. There us little humanity in big institutions and it can only get worse. J got comfortable and moved slowly going from 4 to 5 to 6 cm over the next 10 hours. Baby A was doing great, however, but even so it would be the rarest of obstetricians at a hospital with a nearly 40% c/section rate to allow her to crawl along like this in violation of Friedman’s Curve. Coming on 36 hours of labor and 24 hours of ruptured membranes modern obstetricians would become impatient, label this “dystocia or FTP” and proceed to a surgical birth. But Dr. W so honored this families wishes and followed evidence based medicine combined with knowledge of fetal heart patterns to allow her to labor. Sometime after 1AM the next day she was complete and although almost numb was able to push her baby out in 5 contractions at 8 pounds 7 ounces. Her 40 hour labor ended as it should with good collaboration and obstetric practice and joy all around. Will Dr. W get peer reviewed for going off the reservation? Possibly, but he did the right thing. When I think of where my profession was and now is I get very sad. When I see attempts at bullying women and physicians by special interest groups like ACOG and the CMA I get angry. When my experience and wisdom have taught me that informed choice of options and not restriction of options under the façade of safety or the bias of economics are our right I get motivated. These stories of strong women, educated choice and wonderful support and collaboration deserve our attention. Californians need well trained midwives and these midwives and the women they serve deserve the support of our doctors and lawmakers and not their derision. My greatest admiration, almost to tears, goes out for these two women, their families and to the 2 very special doctors who still remember the humanity of our calling. Dr. F
From curvewire.com: Kim Kardashian Wants C-Section Posted by Johnny Robish on April 10, 2013 – 10:18pm….. “Kim Kardashian Wants C-Section: It’s being reported that pregnant Kim Kardashian wants to give birth by C-section as soon she’s 8-months pregnant because she wants her life back. And since Kanye is a musician, I would assume it’ll most likely be a “Middle-C” section.” ….. I was at a dinner party last night in celebration of the recent homebirth of twins in Santa Barbara, CA. During a lovely evening we discussed a lot of topics and the subject of Ms. Kardashian’s choice came up. This blog is not about bashing her obvious narcissism but her choice did produce a dialogue about labor pain. I have given this subject a lot of thought during my metamorphosis from hospital based to home based practitioner. Since epidurals and narcotics are not available at home we rely on other methods to deal with pain. Movement, water, hypnosis, massage and strong support are beneficial and work well for many laboring women. The key is that these things help cope with the pain but don’t remove it. To understand why coping but not eliminating pain is important we need to ask ourselves why labor is painful in the first place. I mean, if we believe in evolution why wouldn’t the pain of labor evolve away since natural selection usually eliminates those things that are detrimental to the survival of the species. There is, of course, the biblical Garden of Eden explanation but let me put that aside for the moment. Just suppose labor pain is not detrimental but is beneficial. I give credit to my colleague, Aleks Evangelidi, LM, for her insight in this regard…….. Anyone who has ever had a toothache or a kidney stone will argue there is no benefit to the pain other than to let us know something is wrong. Painkillers are a godsend in these circumstances. But labor is not a toothache and it is time to look at the pain of labor in a different light. All mammals have labor and all mammals have labor pains. The onset of labor contractions usually build slowly but eventually become quite painful lasting 40-60 seconds followed by 2-3 minutes of relief. The mammalian body responds to this pain by releasing its own narcotics and neurotransmitters that nature designed just for that purpose. Endorphins and enkephalins are the body’s natural opiates. Oxytocin release produces warmth and attachment responses and adrenaline helps the body cope with stress and possibly spaces out the next contraction allowing time for rest and recovery. And don’t forget Cortisol, which orchestrates all sorts of needed stress responses including blood sugar modulation. It really is a beautiful cocktail that nature has designed just for this purpose………… When a laboring woman is not allowed to cope with pain as nature designed it is easily understood why hospital epidural rates approach 90%. Having to stay flat in bed so continuous fetal monitoring (CFM) can occur does not allow for the natural desire and ability of mammals to move about in labor to diminish discomfort and use their own pain stimulated cocktail. And so, modern obstetrics encourages epidural use to eliminate pain and modern women think this is a good choice because to them: Labor Pain = Toothache…….. It gets back to the saying about the long habit of not thinking something wrong gives it the appearance of being right. Nature is pretty smart. And a toothache does not have a baby inside but a pregnant woman does. And when a woman undergoes the stress of labor so does her baby. Her body’s response to pain releases that cyclical cocktail and those substances certainly cross the placenta. And just maybe all those neurotransmitters and hormones that help mom deal with the pain and stress of labor help her baby cope as well. For after 9 months of sitting comfortably in the womb suddenly everything that baby has ever known is changing. Labor has to be stressful and even painful for the baby and the suddenness of delivery by c-section even more so. Mom’s natural opiates, oxytocin and adrenaline clearly serve a purpose in assisting her baby in this transition. Denying the baby these substances through the commonplace use of epidurals or scheduled c-sections is counter to nature’s design. Babies are little sponges absorbing every experience and forging new and sometimes permanent neural pathways that will be used in the future. Altering labor has to mean altering this process as well. I was never taught this way of thinking in residency and in my 31 years as a physician I have never seen this discussed in a grand rounds or an academic journal and yet it is so common sensical. Modern medicine needs a bit of humbling and as we are beginning to discover when you mess with Mother Nature you inevitably get something not intended……….. The process of labor is painful for a reason and that reason just may be how it benefits the baby’s transition to extra-uterine life. Women are too often told that the pain of labor need not be endured. And while modern anesthesia is also a godsend and epidurals have a place in some labors, obstetricians need to rethink their unconcerned attitude towards its ubiquitous use. Especially in those cases where they scoff at the woman with a birth plan that states an avoidance of pain medicine. Allowing laboring women the freedom to move about and use other pain coping mechanisms might just be doing future generations a favor. Once again it boils down to informed consent. If Ms. Kardashian still wants her unnecessary c-section so she can have her life back after reading this blog then that is her choice and should be respected. I am willing to bet she has never been taught about or thought of birth in this way. Dr. F