Birthing Instincts · Dr. Stuart Fischbein + Midwife Blyss Young

#459: Over-Monitoring & Outcomes, How Are We Doing & Who Benefits.

April 1, 2026·1 hr 27 min·6 clips

The US C-section rate increased over 500% from 1970 to 2023 — from 5% to 32.3% — with no statistically significant difference in cerebral palsy, hypoxic ischemic encephalopathy, or neonatal death rates.

1. Birthing Instincts episode 459 features Dr. Stuart Fishbein and co-host Bliss Young discussing over-monitoring in pregnancy — the systematic application of tests and interventions whose outcomes evidence does not justify. 2. Dr. Stuart Fishbein is a hospital and home birth obstetrician with over 40 years of practice, a longtime advocate for birth choices; Bliss Young is a traditional midwife and co-host who is also featured in the documentary film Allowed to Birth. 3. The episode's core thesis is that American obstetrics operates on a model that assumes something is wrong with every pregnancy until tests prove otherwise, and that this model has generated steadily increasing revenue for providers while failing to improve population-level neonatal outcomes. 4. The episode is prompted by a letter from Rebecca, a 40-year-old single mother at 12 weeks who was told she needed a maternal-fetal medicine referral, a fetal echo, and monthly visits she could not afford as a working single parent; Fishbein's written reply calls provider language a 'subtle form of coercion.' 5. Fishbein frames the macro trends: in 1920, 90%+ of births were at home; by 1950, 90%+ were in hospital, following a deliberate campaign that used fear to shift birth practices within 30 years. 6. The C-section rate rose from 5% in 1970 to 32.3% in 2023 (CDC) — a 500%+ increase — with no statistically significant improvement in cerebral palsy, hypoxic ischemic encephalopathy, or neonatal death rates, and no study examining long-term consequences for the one-third of women now having surgical births. 7. Induction of labor rose from 9.6% in 1990 to over 30% in 2025-26 — a tripling — with no corresponding improvement in outcomes; epidural use grew from 22% in 1981 to 80% of first-time mothers by 2024, compared to 10% in the Netherlands. 8. Postpartum hemorrhage has doubled over the last 20 years, which Fishbein attributes partly to active labor management, induction, overuse of synthetic oxytocin, and directed pushing. 9. NICU admissions nearly doubled from 5.6% of US births in 2005 to 9.8% in 2023 (CDC); Fishbein identifies three possible causes — sicker mothers, hospital interventions harming babies, or hospitals admitting babies who don't need NICU care for revenue — and calls the third 'the most sinister.' 10. Ultrasound use rose from 10% of pregnancies in 1970 to more than 95% having at least one, most having three or more; Fishbein asks whether outcomes have improved and answers: no — revenue has. 11. The first prenatal blood tests (repeated pregnancy test, progesterone) cost $100-$300 per draw; Fishbein argues doctors repeat pregnancy tests already confirmed by home tests because the system presumes problems until ruled out, creating a path toward unnecessary supplementation from the first visit. 12. NIPT non-invasive prenatal testing costs $800-$1,200; Fishbein notes it is a screening test not a diagnostic test, that false positives require confirmatory CVS or amniocentesis (which carry their own risks), and that he and Bliss have heard cases of women recommended to terminate who later delivered healthy babies. 13. The PRETRM blood test at $900 list price predicts preterm labor risk at 18-22 weeks; nearly all Google results are manufacturer press releases, the advertised 18% relative risk reduction is misleading in absolute terms, and the measurable benefit is a 0.6-day reduction in NICU stay. 14. The anatomy scan at 20 weeks is billed at $600-$1,500 with Doppler add-ons of $150-$500 each for additional codes; a full anatomy scan can exceed $4,000-$5,000 in billing — more than double the $2,200 a global OB receives for nine months of prenatal care. 15. Color Flow Doppler has become routine at maternal-fetal medicine practices despite Dr. Fishbein saying there is 'almost no indication' for it as a routine screening tool; an MFM guest in a prior episode acknowledged it is overused. 16. Fishbein describes a woman with monochorionic-diamniotic twins at a prestigious medical center who at 35.5 weeks has had 16 ultrasounds with Color Flow Doppler throughout, despite no clinical concern and both babies near the 50th percentile on twin growth curves. 17. Fetal echo following a normal 20-week four-chamber cardiac view costs $500-$1,000 (Medicare pays $330); Fishbein says there is no legitimate indication for it in the face of a normal anatomy scan but it is referred as defensive medicine and revenue generation. 18. Bliss Young adds a personal reflection: after one pregnancy where a finding caused three weeks of anxiety that turned out to be nothing, she chose in subsequent pregnancies not to do routine scanning and to accept whatever outcome came — framing this as a valid individual choice. 19. The tone is informal and conversational with Dr. Fishbein leading data-heavy sections and Bliss Young asking clarifying questions and adding midwifery and personal perspective; the episode is openly critical of mainstream obstetrics. 20. Best for pregnant people or those planning pregnancy who want to critically evaluate routine prenatal monitoring, and for birth workers seeking a systematic critique of standard OB protocols.

As heard by us

A plainspoken look at how prenatal monitoring can create more follow-up than clarity.

Birthing Instincts begins with a personal catch-up, then settles into a skeptical look at prenatal monitoring and the way routine testing can keep creating another round of follow-up.

Read the full review in PlayNext →

Why you'd press play

Want a plainspoken critique of prenatal scans when more testing starts to feel like more monitoring than reassurance?

Read the full recommendation in PlayNext →

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