Twin home birth: Outcomes of 100 sets of twins in the care of a single practitioner

by Stuart J. Fischbein, Rixa Freeze

Background

Research on community (home or birth center) twin birth is scarce. This study evaluates outcomes of twin pregnancies entering care with a single community practitioner.

Methods

This is a retrospective observational cohort study of 100 consecutive twin pregnancies planning community births during a 12-year period. Outcomes measured included mode of birth; birth weights; Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; birth interval; blood loss; chorionicity; weight concordance; and other maternal or neonatal morbidity.

Results

31 women (31%) transferred to a hospital-based clinician prior to labor. Of the 69 pregnancies still under the obstetrician’s care when labor began, 79.7% (n = 55) were Dichorionic Diamniotic and 21.3% (n = 14) were Monochorionic Diamniotic. The vaginal birth rate was 91.3% (n = 63): 77.3% for primips and functional primips (no previous vaginal births) and 97.9% for multips. Six mothers (8.7%) had in-labor cesareans (1 multip and 5 primips). Rates of vaginal birth did not vary significantly by chorionicity. There were 8 transports in labor (11.6%): 2 vaginal and 6 cesareans. Average gestational age was 39.0 weeks (range 35–42). Compared to primiparas, multiparas had less perineal trauma and higher rates of vaginal birth and spontaneous vaginal birth. One twin infant and one mother required postpartum hospital transport. Of the babies born in a community setting, there was no serious morbidity requiring hospital treatment.

Conclusions

A community birth can lead to high rates of vaginal birth and good outcomes for both mothers and babies in properly selected twin pregnancies. Community twin birth with midwifery style care under specific protocol guidelines and with a skilled practitioner may be a reasonable choice for women wishing to avoid a cesarean section—especially when there is no option of a hospital vaginal birth. Training all practitioners in vaginal twin and breech birth skills remains an imperative.