0:07
You may have been dreaming about having a home birth when you were first planning your pregnancy. And then when you learn you're having twins that vision may have just gone out the window. Perhaps your doctor told you that delivering twins outside of a hospital is too risky. But is it? What is the real evidence for determining what is safe for you and your babies? Today we're talking with Dr. Victoria Flores, a fully licensed statically trained physician who has attended over 1000 births and about 100 out of hospital and we're going to talk about evidence based considerations for twin home births. This is twin talks. The ultrasound shows your babies to be healthy. What did you say babies? You're huge. Are you having twins? Are they natural? Which one do you like? Better wins? Ha my neighbors cousins, brothers. uncles have twins. So can they read each other's minds? How do you tell them apart? Twins, you got a two for one twins run in your family double trouble. You're not having any more. You just you're not Octomom. If you're pregnant with twins, or you're an experienced twin parent, odds are you've heard it all before. Now it's time to hear from the experts. This is twin talks parenting times to

1:20
Welcome to twin Talks. My name is Christine Stewart-Fitzgerald, and I'm your host. I have identical twin girls who are now in their teens and a singleton girl that's three years younger, and who is firmly stands out on her own. And I personally wanted a less medicalized birth experience for both my pregnancies and I sought out supportive medical providers. But I ended up delivering in a hospital for both occasions. So I'll talk a little bit more about my experience with Dr. Flores in a bit. Now if you haven't already, be sure to hit that subscribe button in your podcast app to make sure you get the latest content. You can also get updates about new episodes from twin talks and other great parenting shows by subscribing to our weekly newsletter at New mommy media.com. And if you're interested in getting an inside look at our show, then check out our membership club called Mighty moms. It's where we chat more about the topics discussed here in the show. And it's a great way to suggest topic ideas or even let us know that you'd like to be a guest on an upcoming episode.

2:22
Well, let's meet our expert today. Dr. Victoria Flores. She is an obstructive really trained physician and has quite an interesting career journey that began with her family roots. So Dr. Flores, could you share with us just a little bit about your story and how you became so passionate about obstetrics and just you know, you bring such a unique perspective. Well, hello there. So hi, Christine, I'm really glad that you brought me on because, you know, we're going to talk about a topic that is so hidden in the shadows almost of the birthing community. It is such a taboo topic in the modernized obstetrical industrial complex. And I was enchanted by birth, as many women are as they're growing up with their baby dolls and their family bringing home new babies. And then going through school during a period of time where women began to acknowledge inequities amongst ourselves as professionals. It made me aspire to doing something for the female community. And I had a personality that was very feminized and wanting to help women as well. And so I remember going home for the first time from college and kind of telling my parents Hey, you know, I've heard about, you know, this thing called obstetrician and delivering babies, you know, I'm thinking I want to deliver babies to and my parents never thinking that I was interested in medicine at that time. Were like, well, you know, you have to become a doctor then I was like, Oh yeah, no big deal. Like that's just like,

4:00
Like no big deal. Like I'm just gonna deliver babies like I'll get the OB get the MD I'll move on right so very unaware of the system that I was trying to overcome and

4:13
So many women that are in midwifery school or that are aspiring to also deliver babies sometimes ask me, Should you go through medical school just to be able to deliver babies and now that I am on the other side of it, and have become and I'm gonna say this and I know it's gonna piss some people off but a little bit more on brainwashed from what the initial teachings were. I am able to say that no, you don't need to become a doctor to know what's necessary to have a safe birth, vaginal birth, you just don't. But the the knowledge in the majority of cases does end at the hospital training and that's just the system because it is to create people that work within it and stay in it, not get beyond it and progress it in any

5:00
Other direction, like it's a it's a, it's a system made for commerce and economy, and it supports many people's positions and jobs and stockholder, you know, values. So it's just it ends there. But I went through school undergraduate school, knowing that I had to become a doctor in order to deliver babies. And so I did, I became a doctor, I went to medical school, I went into residency. And I don't know if you can relate, but there's sometimes like a, a sensation that you get in your life where you realize that your spiritual body is not necessarily aligning with what your physical body is doing, right.

5:51
This logical need to will the body through something that is difficult, and I have always been also a very spiritually aware person, someone who's been a part of the communities that discuss the spiritual body, as well as the physical body. And you know, both things fascinate me, which I thought would be great to become a doctor. And you know, both would be acknowledged, but absolutely not. It's like, you're treated like, like a little robot that needs a little oil here and there. And you'll, you'll get back into gear and start, you know, chugging along as normal as a human being. But that's not the way the body works. But that's how the system treats the body. So I remember getting that feeling of this is weird, I don't understand why we're doing so much for a baby to come out of a mama like this doesn't make sense than intuitive. This is not feel like the way it's supposed to be. And yet I had the education to show me these, quote unquote, dangers of childbirth. And you know, when you don't know what you don't know, you take in what's handed to you? And you say, Yes, and you don't ask for more, because you kind of don't realize that there is more, right, because you don't know what to search for. However, I did have that feeling that it just wasn't right. Some of those indicators were, I just didn't have a lot in common with the people that I was training with. I really have a lot of friends and a lot of really close people in my life that have been there for decades. But I just could not jive with, I would say most of the personalities that were in the l&d Ward, just, it just didn't click and, you know, Maverick, right. I don't know if it's Maverick or not. I mean, there was always some overseeing, attending that would have some excuse for why people didn't, you know, want me to succeed in that realm. And they would say some really, really kind things. And, you know, it's hard because I hate talking about myself, but I would say they would say things like, Oh, you You're, you're just intimidating them or, you know, you come with a different set of knowledge that might, might not make them feel comfortable talking about that, you know, it was just really hard to it's just hard to talk about myself, first of all, and you're making me do that.

8:20
But, but basically, I felt very confident in the things that I was able to do and no, and it was very hard to teach people around you that are in higher hierarchical positions, that they're missing something or maybe they're they're wrong about something or they don't want to hear it. Because that's just not your job to teach up. You only get to teach down stream, right? So there was just a lot of friction. And when things are friction, I've always heard That's like telling you like, maybe this isn't necessarily what you're supposed to do. And so instead of like, initially jumping ship, I was much more like, Okay, let me see what I can learn from this thing, get beyond it, because perhaps that's what the lesson is, I just need to learn something to get through this. And I tried everything. Let me tell you all the things that all the doctors do when they're unhappy in the field, you know, talking to people trying to convince myself that it's better on the other side, hypnotizing myself with, you know, desires of the future and those types of things. And then nothing really got me to the other side, like it just it didn't. So at one point in my fourth year, I did have to just throw up my hands and say, Okay, I am a chief resident, I did a great job. I been at so many numbers, I think I had logged 800 By then, with the ACGME, which is the Medical Council that you have to log your births with. So you can prove that you've done so many vaginal births. Do you think you're supposed to do only 200 before you graduate, and then another 200 or so Syrians or maybe 150? I think it's 200 Syrians I'm sorry, and like, and this was when I was there and about 250 Vaginal, so about equal which shows you the value system of that education is that they value both equally.

10:05
So there was incentive to do c-sections because you should have just as many Syrians on graduation, right. Oh, that's interesting. Yeah, I never even so I mean, we know that sometimes there can be a financial incentive, but even you're saying, even as a resident, it's like, oh, okay, I'm low on my cesarean. So I need to bump up the number. So you do get influenced 100% like that, like, I remember there was this one resident that would put on good luck breech earrings, because anytime a breech would come in, she'd get a C section, and she could knock that. And the goal is to finish your numbers. So you can say you've done them and move on. Right? So. So that is the part of it like, hello, like, there needs to be incentives for everyone to go forward. And that's, that's the token system that they give the residents in training.

10:49
Wow, wow. And so it just sounds like so you were, you know, a little bit I mean, it'll just say, you know, disillusion you're really tuned in to kind of your, your own gut and your own sense of what's right, you know, not just for yourself and your passion and what you wanted to do. But but also for just offering women, you know, expectant mothers different birth choices and knowing Hey, this, this experience that they're having, as, as a patient really shouldn't be like this. This is not it's just not jiving for you as a providers. So I could see that that your that was probably the beginning, early on of wanting something different for them.

11:36
You know, don't don't spend too much time with patients, I have things to do, I need you to see them quickly get here, tell me what's wrong, what you're going to do about it. And then let me leave as your supervisor so that I can do what I have to do. So it's, it's, you know, passed down the pressures of what needs to be done for the day. And I know, every institute is different, I was lucky enough to work with two, because I thought that it was going to be more successful for me to get beyond that friction at another institute. And I just wasn't, it was just a different format. It's funny, it wasn't the the CO residents that I had any issues with, we loved each other. And we still, you know, communicate. But it was more of a systems thing where like, you learn one thing in one hospital, and it doesn't necessarily fit the format at another hospital. So it, I knew that I was fine. And then when I did get out, I got to practice with Dr. Stuart Fishbein. And he thought I was so good and exceptional compared to my peer group, that he basically said, I'm going to teach you how to run this practice. And I'm going to go and you're going to take over because I have full confidence that you're going to be fine. And he's still my partner, and anyone that I decide to bring on or that he decides to bring on, he can vouch for and say that I am doing just what he would do in those situations. We were almost like copies of each other in that regard. So it's I had the validation from the people that mattered. And I was lucky enough to have the insight that I knew whose opinion mattered. And I also had the self confidence and the rebel energy that you're talking about, to kind of put aside any haters that were gonna hate no matter what, right? And I realize that there's many reasons for friction to occur, not necessarily truth, but it could also be spiritual body friction, just like not agreeing with someone's style, or someone's vernacular, or someone's, you know, choice of hair and makeup or whatever. Like, there's so many things that go into what makes someone fit into a culture. And when you see me I definitely look different than some of the obese Not that there's anything wrong. I just I'm just very, very small, petite and girly, as are so many obese. I'm not saying that none of them. I'm just saying that it was hard to get into the culture that I was given. So now fast forward today, I mean, you have just tell us a little bit about your your current practice and who you're serving now. Great. So I currently work in Calabasas, California because that's where Dr. Su finished his practice that so I just took it over. Because a lot of people ask me why I do it there. And it is a wonderfully balanced group of midwives. In one practice as well as me, we all work out at the same office space. And it's mostly what we call the midwife model. And so the midwife model means that every visit isn't like what you would see in the medical model where you check in and you go sit in a waiting room and you wait for your number to be called and then you get sat into a room and then someone who's not your doctor does your vital signs and then someone who's not your doctor, does your initial visit like questions and then hands them off to a doctor who comes in answers the questions that you have, tells you everything's fine maybe does a quick this and that check on your abdomen so that is it.

15:00
Why don't you go read this book to fill in any other missing information and goodbye, and then you get, you know, you've been there for an hour, you've seen your doctor for three minutes, you've been waiting for 30 minutes, we've all had those experiences in the normal system. And then you leave, like, Okay, I can't believe I'm paying $1,000 a month of insurance for my family for me to get this kind of care. And it's just really disheartening. But in the midwife model, and no, it is a little bit more pay out of your pocket and the system that I worked in, but you get a full hour, you get loved on you get tea, when you arrive, you get a living room format, you see the doctor initially upon arriving, and it's your appointment. So there's like no one in the waiting room, it's just you and your family. And you get taken into this beautiful room with a lush cozy couch to sit on. And you feel much more relaxed and at ease when your vitals are being done right in front of the physician. So and if they need to be repeated, the physician will repeat them right there. And, or they'll do them first off the bat. So you're you're being treated by the person who you're choosing to care for you the entire time. Like it's not like you get to see them for a second. Then, after doing you know the initial visit that you would get you think you're getting where we asked all those basic questions of fetal movement, weights, hiney signs of preterm labor, those basic stuff, we also, we have our own education period, in that visit, where we discuss what you should have expected up until this point, it's called anticipatory guidance, what you're going to anticipate for the next visit, what's going to happen between there. And then we also do some emotional work, like, what's going through your mind? What are you feeling about pregnancy? What are you feeling about childbirth, breaking down some of those fears that society has put into you, and empowering the woman to know that this is, this is what she's going to do, and she's going to do great no matter what the outcome is. If she's putting herself in the control seat, she's going to be fine and left without the trauma that you would get if you're just being whisked off and told what to do. And then at the end of the day, there's regrets. Who are you going to blame? You can't blame yourself in that setting, because it wasn't your choice. But in the midwife model. Those are your choices. And we give women the knowledge and the power to make the choices also knowing that complications are very, very rare, especially amongst women that know what to look for, like midwives and myself. And so there's not really as huge of a risk as people would think that there is not the fold that there is. Yeah, yes.

17:45
So Dr. Flores, thanks for sharing your story. I mean, I am so glad to have you here with us today. And so, you know, for our listeners, we're talking with Dr. Victoria Flores, who is here to help us better understand, really about home birth and learn about actual risks versus versus perceived risks and what it's like to have a home birth versus a hospital birth. So let's dive in. And I think for some of our listeners, they may not really know what to expect from from a home birth. And I mean, I think you touched on you're trying to talk about a little bit the midwifery model. And, you know, really, what is that as it applies to a home birth? Like what could twin parents expect from from a home birth? And I mean, like, you know, obviously, it's at home, but But aside from that, how is it different than getting care at a hospital? So

18:42
I would say that the most important part about home birth, or hospital or out of hospital birth, community birth is how we say it, if you're a part of the community, is that we put the mother in the driver's seat. And that's something that not all women want, because we have not been taught taught about childbirth, and child rearing. In our current society, like it's something that's kind of held away from our secular world, like it's just not talked about, because it's considered and feminist, right? It's not a part of that model of society. And so it's a secret and and but there's a curiosity that women have, right, but we kind of just ignore it. But when we get to a point where someone's pregnant, there are a percentage of people that do want to have authority or know what's happening in their body so that they can make decisions because they've either heard of traumatic outcomes in a hospital before, especially in the black community. Women that are of color and black women specifically, are very afraid to birth in a hospital because their rates of maternal death are so much higher.

20:00
It's just women that really want to be in the driver's seat and not be and that want to be heard that don't want to be poo pooed when they make a gesture and say that they feel something, they don't want it to be said, Oh, that's normal, like they want to go down that path of what it could possibly be. And if it's normal, fabulous, but like, let's talk about what it possibly could be to you know, they want that control. Yeah, yeah.

20:37
And so, okay, so thinking in terms of specifically twins, I mean, you know, I think the wealth twins are just overwhelming.

20:48
So does, you know, obviously, we're looking at having the actual birth at home and does the care begin at home? Like, is there prenatal cared? Is that it in a clinical setting or is that in a home setting, like what happens like leading up to the actual birth, so every midwife and myself and stew in any out community practitioners are very different. So some people in doulas too, they they have you come into an office, they have their hour long visit with you, everything is so nice, warm and cozy. And then you'll begin getting a home visit around, you know, the time when you could go into labor, 3738 weeks to get your visit at home. And then you maybe go into labor in the next two weeks. And you don't have to go into the office. But once you have your baby, everyone goes to your home has the baby, you also get your postpartum visits in your own bed. Because that's pretty much yeah, oh my gosh, yeah, I remember up to say, just, you know, coming for that week, you know, the week visit, and like having to bundle up twins in the elephant carriers, and get in the car, and I'm still like, sore everywhere. And just show up just showing up was was it was a huge amount of effort. And I just exhausted, you know, just just to be there, and then you get your maybe 15 minutes if you're lucky. Right? You know, yeah. So oh, that like having postpartum at home like that would that would have sold it for me.

22:18
So just like you're saying, like when you're at home, you get someone to come in to see you at 24 to 48 hours someone to see you maybe at a week, maybe you need extra time to for someone to come and see you on the second week, because there was you know, a little bit more blood loss at your delivery, or they needed to do a vaginal repair or something at the delivery of perennial lacquer laceration repair, and and then you get checked right there without leaving the house. And it is for the comfort of the mother and for her her joy. It really is. And then you also get your breastfeeding recommendations and your education there. There's so much partnership in the community, I think a lot of people don't realize that almost all of us are like friends at some level, like just We are professional friends, but we know each other and we can recommend each other. And we all have an awareness of each other's special skills and strength. And we utilize what's around us to cater to you and to make more of a boutique experience, which is so and so joyful compared to this medical model where no one really is going to know your name. Nobody really is going to be remembered. So they kind of get away with being rude sometimes or even if they aren't nice. It doesn't feel like you get to connect out at a more than superficial level. I know there are some women that don't mind that absolutely. But there are some women that feel unsafe without that rapport. And so to have the continuity of the provider, which is no longer something that really happens in a hospital now. Right with the labor is it's just whoever's on call. Yeah, exactly. But in our model, you know who you're going to get. And you do have to put a little bit more money up front because of that, because that person is going to build their life around your due dates, right? So that they have to be able to tell their whole family that there's a two month period of time where they are not leaving their house or the area at all. So there is so it's a lot. It's more to be given, but it's also so much more joyous for the practitioner. Right. Then, you know, you mentioned when we talked about practitioners and providers. So, you know, we hear a lot of different terms for you know, different birth providers. I mean, we hear doctors, physicians, doulas midwives. So maybe you can explain a little bit what are the different roles that they would be playing in a home birth. Okay, so there so let's began I guess with the physician so the physician would be someone like me or Dr. Su or Dr. Hayes. Dr. Fabbi out in LA with me. There's a few

25:00
Do other practitioners that do occasional homebirths Dr. Crane, he might not be doing those anymore, but he's out in LA to. I know some people that are in Puerto Rico and you know, the rare physician that can be, can be asked to do it so that they go to homebirths. Often they bring in ultrasound, often they bring maybe NST capabilities. So doing continuous fetal monitoring, if they if someone opts for that for a period of time, or if there's a questionable period of whether or not things should continue at home, they can they have access to those monitors, but they're never really needed. Honestly, we can do homebrewers without any of that stuff, but they're available because those people know how to use them. The next degree of person that could be at a home birth is your midwife and the midwife, there's two different types of midwives. There's licensed certified professional midwives.

25:53
Those are what we call apprenticeship trained midwives. So they learned by other midwives, and they have a midwifery school, and they still have to meet certain criteria to take a test and everything but they're learning it in the community model, which is beautiful. And then there's also the certified nurse midwife, which is the ones that are trained in the hospital model. So they become RNs. First, they know how to draw blood first, they know how to basically do all the obstetrical stuff on lnd, because they have to do that rotation in order to finish their RN. And then they decide beyond their RN that they want to learn specifically l&d as a midwife, and then they have to learn how to work with physicians and making decisions. And so it's a hospital based education, not a community based education, but they're still called midwives, because that's what the industry decided they should be called. But it's a different it's a different type of midwife. Okay, so we can't say that all midwives are the same. There's also Yeah, and there's also lay midwives out there, which are even more special, those are midwives that decided that they don't want to go through the licensing route. And they are really valid, beautiful birth workers who are using more ancient Lee governed forms of prenatal care. And it really is care and birth care. So one story I heard is that there there was these doulas that were going to Africa and they wanted to meet the midwives of these African tribes that have done you know, 10s of 1000s of deliveries and have never had a maternal death never had, you know, like anything extreme happen. And they were like so impressed by these women that they wanted these doulas wanted to give them something. And so what they did is they made these prenatal kits that they could give them because they thought that in their western minds that these could benefit these midwives. They had like fundal height tape, they had urine dipsticks, they had blood pressure cuffs they had, you know, scopes like to listen to baby's heart rates and things like that, maybe even little watches. But when the midwives were given those, when they the African midwives, they looked at everything, and we're like, this is hilarious. We don't need any of this, like we use our hands, we know exactly what normal is, we can feel if there's enough fluid, because we can tell by the tightness of the fluid, how the baby's bouncing around in the belly side to side, they can tell how the mom's blood pressure is by just palpating her vessels and seeing it there throbbing looking ology, right?

28:24
They have got their hands, and we have that technology as well. But we should be augmented by the modernists of the measuring machines and components and instruments, right? Like we are not supposed to rely on them. And so it was just a great reminder that there are women out there that are holding these beautiful traditions. And they're practicing a little bit underground, but they are doing a great job, or else they would absolutely be on the front of every newspaper and in jails. And you would hear outcry beyond what we're hearing for, you know, these maternal deaths that are happening in the hospital setting. Yeah, no, I know, there's huge, huge, huge incentives to to really, again, I think to manage it. And, you know, I know, that's the other thing I guess I have to ask is, so when when twin parents, you know, first talk to their doctor, and really I mean, come on, like what 99% of all twin births are in a hospital setting. I mean, I'm sure you have all the statistics, so it's probably it's probably less than 1%, I'm guessing. Yeah. But you know, and even at the hospital setting, I'm sure you've probably got the statistics for twin births. I mean, most of them are probably more medicalized surgical births, or induced. So so few 90% says, Aryans, 90% 90%. Variance. Yes, 90. That's just that's just incredible. So only 10% of all twin births right now are vaginal delivery and nominal in a hospital. Right

30:00
Exactly. And it's and it's not because they they didn't try with more initially, I'm sure there was probably 60% Maybe that were attempting vaginal birth. But you know how easy it is to not know anything about birth and then to be told that something's happening and for the optimal option for cesarean to be offered and for it to be given to with non blinking staring eyes saying, Do you want your babies to live? Right? The threat? Oh, yes. Oh, I heard that. Yeah, yeah.

30:30
Yes, because you don't want the social stigma. And it has nothing to do with the truth of the matter, or the probabilities of the matter, or the balance of your education versus the education of your physician, or the power discrepancy. It's about oh, my god, I can't not do something for me baby moves into the emotional influence in that regard. Well, let's, let's take a break. And when we come back, we're gonna look at what a twin birth might look like, and what are the actual risks that are involved.

31:04
Welcome back to Twin talks. Before the break, we were talking with our twin birth expert, Dr. Victoria Flores, about options for twin births. So we started to talk about some of the risks that the lot of the obstetricians warn us about. So Dr. Flores, can you give us kind of an alternate perspective to what we've been hearing? And I know we weren't even talking about hospital birth right now.

31:29
But just but just in general, I mean, you know, do we have kind of a comparison or what what's you know, if you compare hospital births versus home births, because everybody is gonna say, oh, home births, just it's not an option. It's scary, you know, so what would your response to that be?

31:48
So home birth for twins is pretty much not a viable option, because of the unfortunate case that there's not many twin providers, not because it can't happen, but just because the providers don't exist within practitioners don't exist. But there are and what for us in California, there was a time when midwives did attend homers for twins. And in 2014, there was legislation that was passed to give them access to certain types of homebuyers such as feedback birds, which have a 90% success rate at home and only a 45% success rate in the hospital, that those options would be given to those those midwives in exchange for not accepting to deliver twins at home. And because twins were so rarely delivered at home anyway, it was a loss that the midwives were willing to exchange when they had to come to terms with a bill to pass for their freedom to deliver VBACs at home, which is a much higher percentage of women in the population. So so the politics of it are so real, it's not because the midwife couldn't do it. They had to play the game of politics. That's crazy. And so I know we're talking California, we've got listeners, all around the country and into other countries as well. We are international twin podcast.

33:25
But so I guess what I'm hearing is that the you know, the one of the reasons that we really don't hear much about twin homebirth is just simply because a there aren't very there are very few providers who can either legally do it or who are willing to do it or have the training to do that. Yes, exactly, exactly. And I will tell you that from experience, the training in a community hospital training setting for residents.

33:57
Is there's just not that many twins to go around for everybody. Like if there's a 12 to 20% program. Maybe everyone got maybe four or five twin deliveries during their entire training. And it it's just the way that it is in that community setting. Now if you go to like a more academic setting, there are more twins, but guess what else is in the academic setting? MFM fellowships, so the MFN fellows are the ones that often get those cases and the residents do not get to actually manage the twin labors. So having any OB who's not an MFM does not guarantee that they have experience at all with twins.

34:46
There's so much to it, there's so much to it. And as you know a twin I just remember in all my parent, you know, our prenatal care. It was extremely just data based I mean right related on you know.

35:00
Do you remember going into my my checks and of course, we're measuring for fluid levels, and we're, you know, measuring needle, you know, the fetal monitor heart rates, and we're measuring it was it was all data driven. And I was lucky if I got to see, you know, my, my specialist for, you know, five or 10 minutes. And like you said, there was there was no touching, they didn't they didn't, you know, feel my belly, they didn't, you know, say, you know, what's what's going on? It was just, it was all looking at, okay, we got the data, the data, here's the stats, okay, you're good to go.

35:36
So I, I just totally get you on that. That it's just in dealing with the midwife, it's when you know, there's there's really something about working with a provider who is really using the power of touch. Yeah, has that really intuitive sense. I mean, I know personally, I've worked with other sort of bodywork providers. And it is, it is such an incredible thing. When a provider can you can literally just, you know, touch me and understand there's this, this knowledge going on of what needs to be done.

36:19
And, you know, whether it's, I mean, I've worked with, you know, like, either chiropractors or different kinds of, you know, healing therapists, and it just, I mean, and it's such an really incredible thing, just the healing power of touch.

36:35
So no, to your just, yeah, to your, to your point, it's, it's a different, it's a different function. And I think in the twins world, I mean, we're, we're certainly grateful to have those, the people who are, who understand, you know, what the, the ideal, you know, and what normal levels of, you know, everything with the readings should be what the standards of care should be, but, but I think we also want to have that human connection as well.

37:09
So let me ask you, I mean, right now, probably have, you know, a lot of listeners that are, you know, have had pretty good relationship with their provider, and their providers saying, okay, you know, hey, this is you need to have, you know, the hospital birth or, and maybe, you know, what will allow you to try a natural birth, either meaning vaginally, and or non medicated if that's their choice, but I guess, you know, maybe can you share a little bit about what what should our, you know, twin moms? What kind of conversations can they have with their providers, if they, if they want a more, I don't know, a woman centric approach? Okay, can they ask for? So, okay, so one of the things I had to also learn was the word allow, shouldn't really be in maternal care, like if people shouldn't allow you to do what you want to do, you should be asking for what you want. So you say, You know what my intention is to have a vaginal delivery with these twins? And if they say, Well, we'll see if you're allowed to on that day, you say, no, no, I don't need you to allow me I'm an adult and can make my own decisions, I want you to tell me what the risks and benefits of each choice are, and be honest about them. And perhaps provide literature if I need it in order to believe you are pointing me in the direction to find it. And then I will make the decision and ask you to support me along my path.

38:41
And that's difficult because right, that means that somebody has to be willing to question a person who my society has scripted as the authority in a hospital world. Now, that's not the case in the midwife and the midwife will, it immediately gives women the option to hear the risks, benefits and alternatives of all the options and then decide with whoever they're working with. What's the best for them? Mm hmm. Yeah. Well, so So let me ask you, I mean, that's, that's kind of that's a very brave, bold thing to do. And, you know, I guess, you know, with with, with twins, I mean, we're always told, Well, you know, you're high risk pregnancy, you're high risk, you know, you're you're not, you know, we just we don't know, we want to just you never know, you know, that kind of that thing, like, you know, we want to make sure there's a small chance of X happening and well, we just want to make sure that that's not possible. And so how would you respond to that? Right, nothing's impossible. Nothing's impossible. And there is a risk to every decision that's being made, except that it seems that the system the system has created a priority for one life over the mothers and so there are some people who want to know what the risk is to the mothers

40:00
Well as to their babies, but we always talk about the risk to the babies, mostly honestly. But women that have a lot of babies already at home, they have to get home. And so maybe they need to prioritize their life in a situation so that their family is taken care of no matter what happens to the current pregnancy, right. So it's really, really, really hard to choose martyrdom. And occasionally that does happen like c-sections are the ways are one of the ways that we see people dying in maternal health care that do show up on the news, because they shouldn't have happened, right? Those are the ones that have the clots that were misdiagnosed, and they're not physicians fault, I will say that it's a systems fault. But you have to acknowledge that you're in the system when you're going to choose to have hospital birth. So even if your physician is remarkable, and caring and doing rounds and taking their time, and has a low patient load, if you're in the system, you're reliant on nursing, you're reliant on dietitian, you're reliant on the other people that are in the hospital.

41:03
Yeah, yeah, no, that's, that's just it's just so so challenging. So I guess, because it kind of it since we got to kind of wrap this up here. So let me ask you if if homebirth, you know, really, or not, I mean, what what options do we have? How can families explore different options, different providers? What's the best way to go about and, you know, look at what's available in their area for the type of care that really is more woman and family centered? Well, everyone can have co midwifery care if they still want to include the hospital for the majority of their care as well. So you can always go and find a midwife and say, hey, look, I know you can't deliver twins at home because of the laws. But I still think I would benefit from the knowledge, education and style that you're gonna care for me that, you know, I would rather have experience with than the hospital or I would like to have both or just being able to ask a midwife what they recommend. And you know, some midwives. They know people that do twin numbers, because they're, like I said, there's a community of out of hospital birth workers that know each other and can point you in certain directions. And you can always ask for a few referrals from different clients that they've had in the past. So you can talk to them about those people's experiences, you can always look the medical board up and see if anyone has any thing against them, to see if there's something that you need to worry about. And people usually find people through word of mouth when it comes to twin home birthing. It's like you don't even need to know about that until you get to that wall. And when you get to that wall, you can start your search if that's what your so called to do. If you're ready for that type of birth experience. There's a Instagram page called Twin home birthing. There's currently one of our my friends global midwife, 360 I believe she is a medicine without borders midwife that delivers so many people in disenfranchised areas in Africa. But then half of the year she comes here, she just did a set of triplets at home. And it's not much different than caring for twins, except that she has the guts to have done it because I don't think she's worried about is because when, you know, like I said it's kind of underground. It's just the way it is people know who to go to. There are conferences. There's the twin breach conference where it's mostly homebirth workers that's go that goes on occasionally. This is the second year it's gone on. It's going to happen in Kentucky with Dr. Nathan Riley. I'm holding twin breach conferences. They're spinning babies, they talk about breaches, they talk about twins, but it's kind of like you do have to be in the know, but I set a lot of terms right now that can start people off. So spinning babies. Nathan Riley.

43:52
Laura, what's her last name? Well, she's the global midwife 360 That did triplets. You can Google that. You can look me up Dr. Stu up on birthing instincts. He's my partner.

44:07
And that the Instagram page I was telling you about. And you when you reach out to those mothers individually, or to the people that run those pages, they can usually connect you to the person that they're posting about. Even if they're not giving you a direct link to that person, you can still find a way to get to them.

44:24
Okay, no, that's great. And you know what, we can put the links on our website for this episode. So please, you know, check it out, because I want to make sure that it's easy to find those are all sounds like some really great resources. So that's just really super helpful. So I have to say this has been such an insightful discussion and I really feel like I learned something new every time.

44:47
So yeah, thank you Dr. Flores for for bringing forward just just such great important information and we just don't get it anywhere else. And so for everyone wants to learn more, so please do check out new mommy media.com

45:00
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45:13
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45:53
This is Ben and new mommy media production. The information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of new mommy media and should not be considered facts. Will such information and materials are believed to be accurate. It is not intended to replace or substitute for professional medical advice or care and should not be used for diagnosing or treating health care problem or disease or prescribing any medication. If you have questions or concerns regarding your physical or mental health, or the health of your baby, please seek assistance from a qualified health care provider

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