Birthing twins at home is dangerous, right? RIGHT?! Not nearly as dangerous as we've been led to believe...

In part one of this conversation, host Jamie Raisleger begins the dive into the newly published (Dec 2024, PLOS ONE), peer-reviewed paper called Twin home birth: outcomes of 100 sets of twins in the care of a single practitioner with the publication's authors, Dr. Stuart Fischbein and Dr. Rixa Freeze.

Together, they explore the challenges and successes of their study which highlights the high rates of vaginal births in home settings compared to hospitals. The conversation delves into the ethical dilemmas faced by practitioners, the peer review process, and the importance of informed consent in maternity care. Both guests share their personal journeys and motivations for advocating for better birth options for women, emphasizing the need for a supportive environment for twin births. 

About the Paper
This study follows 100 sets of twins attended at home by an obstetrician (Stuart J Fischbein), the first publication looking exclusively at twin home birth. Overall, 91.3% of women gave birth vaginally, compared a national average of 25.2% for twin pregnancies. Most women with twin pregnancies in a hospital setting have few options but cesarean section, even though the evidence shows no benefit to surgery for the majority of cases. This study demonstrates that a home setting that supports physiological birth can yield excellent outcomes and a high vaginal birth rate.

Meet the Guests
Stuart J. Fischbein, MD is a community-based obstetrician and an Associate of the American College of Obstetrics & Gynecology, published author of the book “Fearless Pregnancy, Wisdom & Reassurance from a Doctor, A Midwife and A Mom” and peer-reviewed papers Homebirth with an Obstetrician, A Series of 135 Out of Hospital Births, Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births and Twin home birth: Outcomes of 100 sets of twins in the care of a single practitioner. After completing his residency at Cedars-Sinai Medical Center in Los Angeles, CA, Dr. Stu, as he is known, spent 24 years assisting women with hospital birthing and, for the next 12+ years, was a homebirth obstetrician who worked directly with midwives assisting local Southern California families. Since retiring from attending home births in late 2022, Dr. Stu has turned his focus to traveling around the world as a lecturer and advocate for reteaching breech & twin birth skills, respect for the normalcy of birth and honoring informed consent. He hosts the weekly Birthing Instincts Podcast with co-host Blyss Young and together they offer hope, reassurance and safe, honest evidence supported choices for those women who understand pregnancy is a normal bodily function not to be feared.

Dr. Rixa Freeze has a PhD in American Studies from the University of Iowa. Her doctoral studies focused on the history of healthcare and medicine with specialization in pregnancy, childbirth, and maternity care. Her dissertation examined why women in North America choose unassisted home births. She worked as a visiting assistant professor for 9 years at Wabash College before founding Breech Without Borders in 2018. BWB is a 501(c)3 nonprofit dedicated to breech training, education, and advocacy. She has published about why women choose home birth (JMWH 2009) and attitudes towards home birth in the US (Exp Rev ObGyn 2010). In 2018, she co-authored a study of breech and cephalic home births (BMC Preg Child). The following year, she published an article about outcomes of breech at home, birth centers, and hospitals (Midwifery Today). She co-authored a chapter “Freebirth in the United States” in the 2020 book Birthing Outside the System: The Canary in the Coal Mine. She is the main author of the textbook A Guide to Physiological Breech Birth, now in its 2nd edition. Her analysis of 100 sets of twin home births, co-authored with Stuart Fischbein, was published in December 2024 with PLOS ONE. Current research projects include a video analysis of 207 physiological breech births, a qualitative analysis of the obstacles American physicians face in supporting vaginal breech birth, and a review of the effectiveness of an international vaginal breech training program. She also oversees DNP and bachelor of midwifery research projects relating to breech birth.

Episode Breakdown: 
00:00 Introduction to the Guests and Their Expertise
05:30 Overview of the Twin Home Birth Paper
08:28 The Journey of Collaboration: Dr. Stu and Dr. Rixa
15:55 The Peer Review Process and Its Challenges 1
6:17 Rixa's Personal Journey into Birth Advocacy
23:12 The Genesis of the Twin Home Birth Study
26:39 Challenging Hospital Protocols on Twin Births
29:05 The Evidence vs. Practice in Twin Births
33:43 The Slippery Slope of Cesarean Rates
36:04 Ethics and Hospital Politics in Maternity Care

Find Us on IG:
@birthinginstincts
@rixafreeze
@breechwithoutborders
@triumphant_birth

Links:
Twin Home Birth Paper
www.birthinginstinctspodcast.com
www.birthinginstincts.com
www.breechwithoutborders.org
Rixa's 2009 Interview with Dr. Stu
The book that started it all for Rixa

Thank you for being here, and tune in next week for part 2!