Jerm: "Dr Stu, if I'm following you correctly, you're suggesting that there's an overmedicalization of childbirth and it's also driven by a combination of profit and fear. Is that correct?"
Dr Stu: "That would be exactly correct. Those are the two most powerful motives for why we have a system that is the way it is. If we could remove both of those from the system, and we rewarded NOT doing something. If we could bill for NOT giving a hepatitis vaccine then hospitals would probably back off on demanding women get a hepatitis vaccine for their baby.
"If we paid more for a vaginal birth than we did for a Caesaerean birth, if we paid less for induction than we did for someone in natural labor, maybe we'd see more natural labors and vaginal births. When the system pays more for more interventions you're going to see more interventions.
"And how do you drive a woman to be intervened upon? You scare her. You tell her stupid stuff. 'Oh my God, you're over 35.' At the very first visit, they're 10 weeks pregnant. At the very first visit, and the doctor is talking about their age, and being how high risk this could be, and your placenta might give out.
"I don't think the doctors realize this. I think there's a lack of self-awareness in the words that come out of their mouth. Because there's no reason at 10 weeks pregnant to tell a woman, 'God, you have narrow hips. There's a chance your baby may not fit through your pelvis.' Why are you telling her that? Because you're projecting your anxieties upon the women that you're caring for. That's what you're doing. You don't even know you're doing it.
"And you think that that's giving information so they can make informed consent. It's not, because they only tell them that the downsides of, say, a breech vaginal delivery. But they don't tell the downsides of a Caesarean section. They tell them the benefits of an epidural, they don't tell them the downsides of an epidural.
"So they skew their counseling. This is coercion of a subtle form. There's overt coercion, pulling out the 'Your baby will die if you don't do this' card. But there's very subtle coercion. And it goes on in every doctor's office all the time. Some of it is motivated by fear, fear in the doctor as much as in the woman.
"And a lot of it is motivated by profit margin. The more hospitals do, the more money they make. So why would they do less? If I were the chief financial officer of a hospital, why would I want to lower my C-section rate? Because I'm a good person? Well, screw that. Your fiduciary duty is to your hospital entity that you work for."
Dr Stuart Fischbein with Jerm @ 16:18—18:42 (recorded in 2024, posted 2025-03-06) https://podbay.fm/p/jerm-warfare-the-battle-of-ideas/e/1741328385?t=978