08/18/2025
As I was working to catch up on my reading and podcasts that I go through, I came across some very exciting news.
Dr. Stu Fischbein OBGYN of Reteach Breech and Birthing Instincts, alongside Rixa Freeze of Breech Without Borders successfully published a Twin Homebirth Study in a peer reviewed journal. This is a huge deal as there has never been a study done like this, and the parameters and outcomes of this study are incredible. To get into some of the statistics discovered in this study-
Twin Homebirths: Outcomes of 100 sets of twins in the care of a single practitioner.
Transfers prior to labor- 31. 1 true cholestasis, 1 true IUGR, 4 cases of twin-to-twin transfusion syndrome (TTTS) of the 21 mono-di pregnancies, and some preterm labor and pprom (waters breaking preterm pre-labor) cases.
69 sets of twins went into labor at home. 8 transferred during labor, resulting in 6 cesarean deliveries and 2 vaginal births.
91.3% of twin births resulted in a successful vaginal birth. Vaginal birth of twins for multips (mothers of one or more children) was 97.9%. Vaginal birth of twins for Primips (first time mothers) delivering twins was 77.3%. In this study, mothers with no previous vaginal births having a VBAC with twins were included in the primip category, despite having 1 or more previous cesarean deliveries.
61 sets of twins were born at home with 1 maternal postpartum transfer and 1 neonatal postpartum transfer. This included 5 twin VBACs with no previous vaginal deliveries and 1 twin VBAC with at least one prior vaginal delivery.
The single newborn transfer was due to Transient Tachypnea of the Newborn (TTN), a benign condition that resolved without treatment. The average delivery was 39 weeks 0 days, range 35-42wks. On average, Twin A had an APGAR of 8 and Twin B an APGAR of 7 at 1 minute. There were no statistical differences in APGAR scores based on birth interval, the time between baby A and baby B is born. The rate of maternal blood loss did increase with the birth interval (40+min).
There was only one emergent transfer during labor, indicated by intense maternal uterine pain. This can be a sign of uterine rupture, so the team decided on hospital transfer by ambulance. During surgery (indicated for suspected uterine rupture) there was no uterine window or rupture detected and the cause of the intense pain was unknown.
63.9% of the mothers with successful births at home had an intact perineum with no tearing, 27.9% had a first degree tear, 6.6% (4 women) had a 2nd degree tear, and 1 woman who was also a primip had a third degree tear (1.6%). There were no episiotomies. There were no neonatal deaths. There were no maternal deaths.
25% of hospital twins are born vaginally in the hospital setting, leaving a 75% rate of cesarean for twins born at the hospital. This study had a cesarean rate of 8.7%. The current USA overall cesarean rate is 34%. The World Health Organization states that a cesarean rate above 15% is concerning, as only about 10% of women should medically need a cesarean. Women deserve information and opportunity to make an informed decision that is right for them. As it stands, if a provider has not had breech vaginal training, about 1 in 20 of their patients will be an automatic cesarean. About 5.5% of pregnancies will have a breech twin or breech singleton. That is 1 in 20 clients that they can not serve, but can only offer a cesarean.
Below is linked the recently published study, as well as the podcast where Dr. Stu and Rixa Freeze discuss the study.
Twin Home Birth study:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0313941
Rixa joins at 14 minutes and goes through her background and the process of peer review. At 42 minutes, the discussion of the study begins.
https://redcircle.com/shows/93749277-4626-4bd4-8469-ed3c1c1bf4d2/episodes/f175751e-d0ac-40f8-bdfb-1da6d200ddcf
