Dr. Stuart Fischbein breaks down the truth about 'high risk' pregnancy labels, revealing how the medical system creates unnecessary fear. He explains that high risk has no official definition and often reflects what makes doctors uncomfortable rather than actual statistical danger.
Obstetrics, home birth, collaborative midwifery practice
Key Insights
Actionable Advice
Dr. Fischbein reveals that high risk pregnancy has no official medical definition and often reflects what makes doctors uncomfortable rather than actual statistical danger. The American College of OB GYN considers pregnancy itself a high risk condition, creating unnecessary fear in expectant mothers.
Real statistical analysis shows VBAC complications occur in only 1 in 1200 cases, while continuous fetal monitoring has increased cesarean rates 600% without preventing cerebral palsy. These interventions often create more problems than they solve.
When women are labeled high risk, they spend pregnancy in terror, bathing their babies in stress hormones like cortisol instead of beneficial hormones like oxytocin. This fear-based approach may actually harm the developing baby through chronic stress exposure.
Midwifery care with 30-60 minute visits shows better outcomes than brief doctor appointments, with lower rates of gestational diabetes and hypertension. The relationship-based, preventative model supports healthier pregnancies than fear-based medical management.
“There is no definition for high risk pregnancy. High risk pregnancy means that something is more likely to happen than not.”
— Dr. Stuart Fischbein▶ 2:55
High risk pregnancy has no official medical definition. It's often what makes your obstetrician uncomfortable rather than actual statistical danger. The American College of OB GYN considers pregnancy itself a high risk condition.
“The actual risk of any woman going into, deciding to have a VBAC after a single low transverse cesarean of having a ruptured uterus leading to a really bad outcome is one in six times one in two hundred or one in twelve hundred.”
— Dr. Stuart Fischbein▶ 13:08
The actual risk of serious VBAC complications is 1 in 1200, not the inflated numbers doctors often quote. This is the same risk as having a Down syndrome baby at age 25, which we don't consider high risk.
“Just because you're over thirty five does not make you high risk. Some people with who are over thirty five become high risk.”
— Dr. Stuart Fischbein▶ 10:24
Being over 35 doesn't automatically make you high risk. You have a higher chance of developing complications, but you're not high risk until something actually develops. The label creates unnecessary fear and stress.
“After more than fifty years of continuous fetal monitoring, we have proven that, we cannot prevent cerebral palsy. We have increased the cesarean section rate by probably six hundred percent.”
— Dr. Stuart Fischbein▶ 29:08
Continuous fetal monitoring has no proven benefit and increases cesarean rates by 600%. After 50+ years of use, it hasn't prevented cerebral palsy but has led to millions of unnecessary interventions.
“If you take a similar cohort of women and you give them prenatal care with a midwife, where their prenatal visits are thirty to sixty minutes long, you're gonna find that those the women in them in the, midwifery group are probably gonna have less gestational diabetes, less gestational hypertension.”
— Dr. Stuart Fischbein▶ 20:32
Midwifery prenatal visits are 30-60 minutes focused on relationship and prevention, while doctor visits are 6-8 minutes. Similar cohorts show women with midwifery care have less gestational diabetes and hypertension.
“All this time, the woman is growing a baby inside of her, constantly bathing the baby in the stress hormones of cortisol and adrenaline, and not the dopamine and oxytocin that they should be bathing their babies in.”
— Dr. Stuart Fischbein▶ 22:58
When pregnant women are constantly stressed about being 'high risk,' they bathe their babies in stress hormones like cortisol and adrenaline instead of the beneficial dopamine and oxytocin needed for healthy development.
Steps to advocate for yourself when given a high risk pregnancy diagnosis
Ask for specific statistics
Request the actual numerical risk, not relative risk comparisons. Ask what the baseline risk is and how much your specific situation increases it.
Question routine interventions
Ask if procedures like color flow Doppler at ultrasounds are medically indicated for your specific case or just routine protocol.
Seek relationship-based care
Find practitioners who offer longer visits and know you personally, whether midwives or supportive physicians.
Research evidence
Look up actual studies and outcomes rather than accepting fear-based counseling without question.
Consider second opinions
Especially for major decisions like cesarean sections, seek input from practitioners with different philosophies of care.
High risk pregnancy has no official medical definition and is often what makes your obstetrician uncomfortable rather than actual statistical risk
Dr. Stuart Fischbein explains that the American College of OB GYN considers pregnancy itself a high risk condition, and no single woman makes it through pregnancy without at least one problem on their medical list.
VBAC actual risk is one in twelve hundred for serious complications, not the inflated numbers doctors quote
Dr. Fischbein calculates that scar separation occurs in 1 in 200-333 cases, and only 5-16% of those result in bad outcomes, making the real risk 1 in 1200 - the same as Down syndrome risk at age 25.
Being over 35 or having twins doesn't make you high risk until something actually develops that becomes high risk
Dr. Fischbein explains that labeling women high risk at their first visit based on age or twin pregnancy creates fear and stress hormones that actually harm the developing baby.
Continuous fetal monitoring increases cesarean rates by 600% without preventing cerebral palsy
Dr. Fischbein states that after 50 years of continuous fetal monitoring, there is evidence of non-benefit and no prevention of cerebral palsy, yet it remains mandatory in hospitals.
Standard of care varies by location and doesn't necessarily mean best care
Dr. Fischbein shares how he was considered below standard of care for doing laparoscopic surgery in one community while it was cutting-edge at Cedars Sinai, showing standard of care is just what the average person in that community does.
Midwifery care with 30-60 minute visits creates healthier outcomes than 6-8 minute doctor visits
Dr. Fischbein explains that similar cohorts of women receiving midwifery care have less gestational diabetes and hypertension than those with brief obstetrician visits due to the preventative relationship-based model.
Stress hormones from high risk labeling cross the placenta and affect baby's development
Dr. Fischbein describes how women labeled high risk spend 40 weeks in terror, bathing their babies in cortisol and adrenaline instead of dopamine and oxytocin needed for healthy development.
Induction at 39 weeks carries more risk than waiting until 41+ weeks naturally
Dr. Fischbein states that doctors will tell you induction at 39 weeks is safer than waiting until 41 weeks, but this is not supported by evidence and creates unnecessary intervention cascades.
Pregnancy is labeled as problem number one on every obstetrician's problem list
Dr. Fischbein reveals that the American College of OB GYN considers pregnancy itself a high risk condition, making it the first problem on every pregnant woman's medical chart.
Home birth studies show better outcomes in similar cohorts than hospital births
Dr. Fischbein mentions his published study on 100 sets of twins born at home and references multiple studies showing better outcomes for home birth in appropriate candidates.
Delayed cord clamping and skin-to-skin are natural mammalian processes hospitals interrupt
Dr. Fischbein explains that no other mammal has their cord cut immediately or baby taken away, and when gorillas have c-sections they don't bond because they didn't go through the natural process.
High risk pregnancy has no official medical definition and is often what makes your obstetrician uncomfortable rather than actual statistical risk
▶ 2:45VBAC actual risk is one in twelve hundred for serious complications, not the inflated numbers doctors quote
▶ 12:07Being over 35 or having twins doesn't make you high risk until something actually develops that becomes high risk
▶ 18:33Continuous fetal monitoring increases cesarean rates by 600% without preventing cerebral palsy
▶ 28:58Standard of care varies by location and doesn't necessarily mean best care
▶ 8:31Midwifery care with 30-60 minute visits creates healthier outcomes than 6-8 minute doctor visits
▶ 20:21Stress hormones from high risk labeling cross the placenta and affect baby's development
▶ 22:48Induction at 39 weeks carries more risk than waiting until 41+ weeks naturally
▶ 16:37Pregnancy is labeled as problem number one on every obstetrician's problem list
▶ 5:01Home birth studies show better outcomes in similar cohorts than hospital births
▶ 20:10Delayed cord clamping and skin-to-skin are natural mammalian processes hospitals interrupt
▶ 27:27Scroll for more
“High risk pregnancy means something dangerous is more likely to happen”
CONSIDER: High risk is not a number and often reflects what makes your doctor uncomfortable rather than actual statistical danger
“Being over 35 or having twins automatically makes you high risk”
CONSIDER: Age and twin pregnancy create higher chance of developing problems but don't make you high risk until something actually develops
“Hospital birth with continuous monitoring is safest”
CONSIDER: Continuous fetal monitoring has no proven benefit and increases interventions while midwifery care shows better outcomes
“High risk is something that makes your obstetrician uncomfortable. Period.”
“The term high risk has no meaning. There is no definition for high risk pregnancy.”
“Pregnancy is a problem because the there are lots of benefits from creating a fear based world in which pregnant women in the Western world have been basted for the last fifty to a hundred years.”
“Nature's design is perfect. It doesn't always work. But the design is perfect.”
“High risk is not a number. And this is something that people don't understand.”
EP257 Taking the Fear Out of Birth + Baby Making with Dr. Stu Fischbein, MD
A maverick OB reveals why the medical system fears birth more than women do - and how to reclaim your power during pregnancy.
EP284: From “No Chance” to Baby At 47: Heather’s Story
Discover how Heather defied medical predictions and conceived naturally at 46 after being told she had 'no chance' at 41.
EP231 Endo? PCOS? 1-2% Chance? How Claire Beat Them All
How one woman turned 1-2% odds into a baby at 44 with PCOS and endometriosis—and why she said 'somebody's gotta be in that 1-2%, so it might as well be me.'
Frameworks & Methods
Fecundity (conception rate) in healthy 22-year-old college women is only 20-25% per cycle, meaning it's normal not to get pregnant immediately
Dr. Fischbein explains that even in the most fertile group, after 3 months of unprotected sex, over 50% won't be pregnant - nature designed humans differently than rabbits who have 99% fecundity.
Nature decides it's not wise for a stressed mammal to get pregnant because stress hormones signal famine, predators, or danger - not that you're googling fertility statistics
Dr. Fischbein explains that stress hormones make it less likely to ovulate regularly or prep the uterine lining correctly, as nature can't distinguish between real danger and modern anxiety.
Age-based fertility predictions are often premature and devastating, but not definitive verdicts
Heather was told at 41 she had 'no chance' of having a baby due to her age combined with endometriosis and low AMH, yet conceived naturally at 46 and delivered Emily at 47.
Finding the right medical team that supports your vision is crucial for success
Heather left the first doctor who said she had no chance at 41 and found Dr. Chek's team who embraced her journey and helped her achieve pregnancy at 46.
