If you haven’t listened to Part 1 yet, be sure to start there (episode 18) for the full context behind this groundbreaking, peer-reviewd paper (published Dec 2024 in PLOS ONE): Twin Home Birth: Outcomes of 100 Sets of Twins in the Care of a Single Practitioner In part two of this conversation, host Jamie Raisleger, Dr. Stu Fischbein, and Dr. Rixa Freeze dive deeper into the nuances of twin births, the misuse of high-risk labels, and the importance of individualized care. This episode explores how hospital culture, practitioner training, and fear-based protocols continue to shape the twin birth experience—and what needs to change to offer better outcomes and real choice to families expecting multiples. Together, the guests unpack how supportive, personalized care models along with their teaching organizations are leading to successful vaginal twin births both at home and at the hospital. 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 – Selection Criteria for Twin Births 01:26 – The Importance of Individualized Care 06:38 – What Defines High Risk in Pregnancy 08:16 – The Hospital Birth Paradigm vs. Home Birth Experience 10:21 – Understanding the Midwifery Model of Care 12:24 – Challenges in Data Collection for Twin and Breech Births 15:33 – Success Stories in Increasing Vaginal Birth Rates 19:55 – Training the Next Generation of Birth Practitioners 21:48 – Changing Hospital Culture for Better Birth Experiences 24:38 – Empowering Parents to Advocate for Their Birth Choices 29:12 – The Importance of Maternal Confidence and Choice Find Us on IG @birthinginstincts @breechwithoutborders @rixafreeze @triumphant_birth Links: Twin Home Birth Paper Birthing Instincts Podcast https://www.birthinginstincts.com/ https://www.breechwithoutborders.org/ Rixa's 2009 Interview with Dr. Stu The book that started it all for Rixa Thank you for being here!
