Disclaimer: The information shared in this post — and in the podcast episode it accompanies — is educational in nature and is not intended as personal medical advice, a diagnosis, or a recommendation to change your care. Always discuss your individual circumstances with your own qualified healthcare provider before making any decisions about your pregnancy or birth.
If you have spent any amount of time in the birth world — as a patient, a provider, or simply a woman trying to make sense of her options — you have probably noticed that a lot of information flows in only one direction.
You are told what the protocol is, what the standard of care says, and are handed a form to sign. That’s typically the extent of it.
What you are far less often given is a complete picture. One that includes both the risks of intervening and the risks of not intervening, the data that supports the recommendation and the data that complicates it, and the understanding that you are the one who gets to make the final call.
That is exactly what this conversation is about.
Meet Dr. Stuart Fischbein
Dr. Stuart Fischbein — known to many as Dr. Stu — is a board-certified OB-GYN, international speaker, and educator who has spent his career doing something very few physicians have done: working inside both worlds of birth. He trained at Cedars-Sinai Medical Center and practiced hospital-based obstetrics for 28 years before spending more than 12 years attending and backing home births alongside midwives in Southern California.
Dr. Stu is the co-host of the Birthing Instincts podcast alongside midwife Bliss Young and is widely respected for his nuanced, evidence-informed perspective on physiological birth, informed consent, and birth autonomy. You can find him at birthinginstincts.com or on Instagram at @birthinginstincts.
Group B Strep: Colonization vs. Infection
Group B streptococcus (GBS) is a normal bacterial colonizer found in the vaginal or rectal flora of many adults. It is not a pathogen in healthy adults — but on rare occasions, babies who pass through a GBS-colonized birth canal can develop what is called early-onset GBS disease, which can be very serious.
The current American standard is to culture all women for GBS at around 36 weeks. If positive, the recommendation is intravenous antibiotics during labor. But Dr. Stu raises important questions that rarely come up in the standard prenatal appointment.
What most providers do not discuss:
- GBS is a transient bacteria. Even if treated and eradicated, it often returns — because it lives in the woman and her partner’s environment.
- Antibiotics come with their own risks. Giving IV antibiotics during labor alters both the mother’s and the baby’s microbiome at a critical developmental window.
- The incidence of GBS disease in babies born to GBS-positive mothers who do not receive antibiotics is approximately 1 in 200 — meaning 99.5% of those babies are unaffected.
- With antibiotics, that risk drops to approximately 1 in 4,000 — but the question of whether antibiotic disruption to the neonatal microbiome causes downstream harm is rarely weighed in the same conversation.
- Most European countries have moved away from routine GBS screening and instead treat symptomatically — addressing fever in labor, prolonged rupture of membranes, or fetal tachycardia as they arise.
The risk factors that may tip the scales toward antibiotic use include: fever in labor, rupture of membranes for more than 18 to 24 hours, premature delivery, or a rising fetal heart rate baseline.
As Dr. Stu noted, GBS positivity does not mean you must deliver in a hospital. Midwives are trained to administer IV antibiotics at home if a woman chooses that option. There may even be a microbiome advantage to being colonized by the healthy bacteria of your own home environment rather than a hospital setting. This blew my mind, but makes so much sense when you pause to think about it!
There is nothing more special than growing ones family; I hope this conversation open discussions with your spouse about what feels best for your growing family. This will look different for each of us! My goal is simply to create space to learn, grow and make the best decision for your family with the information available.
Home Birth Transfers: What the Numbers Actually Mean
One of the most persistent fears around home birth is the idea that a transfer to the hospital is a sign that something went wrong. In reality, the data tells a more nuanced story.
Transfer rates for first-time mothers planning home birth range from roughly 10 to 20% in most studies (with some data suggesting higher numbers for populations not yet accounted for). For women who have previously delivered vaginally, that rate drops significantly — to 1 or 2% in some practices.
The majority of those transfers are non-emergent. They happen for:
- Labor that has stalled or progressed slowly
- Pain that becomes more than the mother wishes to manage without medication
- Exhaustion
- A rising blood pressure that the midwife wants monitored more closely
- A fetal heart rate pattern that warrants observation but is not yet an emergency
This is exactly how the system is designed to work. Skilled midwives are trained to recognize these patterns early, often hours before a situation becomes urgent, and to facilitate a calm, coordinated transition when needed.
Dr. Stu also raised a counterintuitive point: being in the hospital does not automatically mean faster emergency response. Many hospitals cannot get a woman from the labor room to the operating table in under 12 minutes — the window that matters for a baby experiencing a significant bradycardia event.
For context, low-risk women who start labor at home have roughly 40 to 50% lower cesarean rates than comparable low-risk women who start labor in the hospital — simply due to differences in how labor is managed and supported.
Fetal Monitoring: What 50 Years of Data Shows
Continuous electronic fetal monitoring was introduced in the late 1960s and early 1970s with the intention of reducing stillbirth and cerebral palsy. More than 50 years later, the data has not shown that it accomplished that goal.
What it has shown is a strong association with the dramatic rise in cesarean rates. From 5% of births in 1970 to roughly 35% today. Without a commensurate improvement in outcomes for mothers or babies.
Non-stress tests (NSTs) after a due date have similarly not demonstrated improved outcomes in low-risk pregnancies. Dr. Stu pointed to research suggesting that women who receive a routine third-trimester scan for no clinical indication have a roughly 22% higher cesarean rate. Not because anything is medically wrong, but because scans generate findings that generate worry that generates interventions.
None of this means that monitoring is never appropriate. Dr. Stu noted that there is potential benefit for continuous monitoring in a truly growth-restricted baby during labor. And for women who are past 41 to 42 weeks, or who have clinical risk factors like hypertension or diabetes, individualized testing may be warranted.
The principle he returns to repeatedly: testing should have an indication. Order the test only if the result would change your management.
Fun fact: my fourth child was born at home! We did things differently compared to our first three hospital births. You can learn more in this Blog Post!
What Informed Consent Actually Means
One of the most important reframes in this entire conversation is this: doctors give information. You give consent.
True informed consent means receiving complete, balanced information. This includes the potential downsides of both acting and not acting — before agreeing to any intervention. When information is presented selectively, or framed in a way that steers you toward a predetermined outcome, that is not informed consent. It is what Dr. Stu called uninformed consent — or, more plainly, a form of coercion.
He also reminded listeners that hospital policies are not laws. You have the right to:
- Decline routine procedures (including IV placement, continuous monitoring, and GBS antibiotics) with appropriate discussion
- Ask your provider what the evidence base for a recommendation actually is. And, what quality of evidence supports it (note: two-thirds of ACOG guidelines are based on Level C evidence, which is expert consensus rather than high-quality clinical trials)
- Take time to read a consent form before signing, especially if you are admitted for a non-urgent induction
- Seek care elsewhere if your provider’s protocols are not aligned with your values
The best time to have these conversations is before you are in labor. Dr. Stu encourages women to visit their hospital or birth center ahead of time, ask direct questions about how they handle common scenarios, and ensure that their provider knows their priorities while also respecting them.
A Note From Dr. Kayla
I want to be honest with you about why this episode matters to me personally.
I delivered my first three babies within a hospital-based system. During my fourth pregnancy, I spent a lot of time in prayer and research. A significant portion of that research came from listening to the Birthing Instincts podcast! Ultimately, I chose a home birth and had a beautiful, positive experience.
I am not here to tell you that home birth is the right choice for every woman. I am here to tell you that you have choices! More choices than most women are led to believe. These choices deserve to be made with complete information, not under pressure.
If you are pregnant, planning to be, or supporting someone who is, and you want individualized pelvic floor or orthopedic support to help you move through your pregnancy and birth feeling strong and prepared, I would love to help you. See below for my self-paced Holistically Well Pregnancy program and 1:1 Physical Therapy. Our team is truly here to support you creating the best birth experience for you!
This topic goes even deeper on the podcast. Whether you’re a listener, a reader, or a watcher — there’s a version of this conversation waiting for you. Tune in on Apple, Spotify, or YouTube, and if it resonates, a review helps more women find their way here.
[Listen on Apple] | [Watch on Spotify] | [Watch on YouTube]
