#476: Questioning the 2 cm Placenta Rule & A Remarkable Breech Twin Birth with Fadwah Halaby

This week, Dr. Stu welcomes Florida midwife Fadwah Halaby for an inspiring conversation about evidence, autonomy, and trusting physiological birth. Before diving into an unforgettable breech twin home birth, Stu takes a deep dive into another one of obstetrics' commonly accepted practices, the "2-centimeter rule" for low-lying placenta, and uncovers the surprisingly weak evidence behind it.

Together, Stu and Fadwah explore how outdated conventions become hospital policy, why individualized care matters, and what happens when skilled providers support families instead of protocols. From twin growth charts to cord prolapse, patient autonomy, and the realities of home birth, this episode challenges assumptions while celebrating the art and science of physiological birth.

About Fadwah

Fadwah has worked as a nurse since 1992 (34 years) in various areas such as home health, ER, and L&D. For the past 20 years she has worked as a Nurse Practitioner, Certified Nurse Midwife - 8 years in a busy OB practice facilitating hospital birth and office gynecology, and 12 years in her independent home birth practice. She has assisted over 2000 babies to be born with about 700 of those in the community birth setting. She has been offering breech and twin birth in her practice for several years, more often in the past few years since completing formal training through Spinning Babies and Breech Without Borders. The first birth she ever witnessed live (other than her own) was a breech birth, in 1986.

She is a divorced mother of 6 grown children with 5 granddaughters. Currently living in Palm Beach County, south Florida where she has her office and home birth practice, Midwife360. She is currently back to working in a solo practice with back up from various other home birth midwives in the area. She is limiting her practice to 4 births per month and willing to take on breech births from the community whenever she is able as there are no options for breech for most women. She is a licensed autonomous APRN in Florida.

In 2023, she decided to exit the insurance game completely, after offering in-network provision of care through most insurance companies, both private and public. The reasons for this are numerous, but mainly financial and emotional. To help offset the difficulty some families have in affording home birth midwifery (a concierge service to be sure) she started a non profit - Birth Equity Resource. A 501(c)3 designed to attract donors wanting to help those more financially challenged to be able to choose home birth midwifery.

Website: midwife360.com

Non-Profit: birthequityresource.org

Instagram: @midwife360

References:

Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia

https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.2003.02491.x

Vaginal delivery in women with a low-lying placenta: a systematic review and meta-analysis

https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15622

Fetal Imaging: Executive Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop

Placenta previa: distance to internal os and mode of delivery

https://www.ajog.org/article/S0002-9378%2809%2900629-2/fulltext

Birthing Instincts Podcast 378: The Cost of Homebirth, Navigating Insurance in Midwifery, with Fadwah Halaby

A maneuver for head entanglement in term breech/vertex twin labor, by Dr. Stu Fischbein

https://static1.squarespace.com/static/52ca1028e4b05c5f2d7b157d/t/62e02090874eae67b683bc67/1658855570428/A+Maneuver+for+Head+Entanglement+Published.pdf

Discussed in This Episode

• Where the 2-centimeter low-lying placenta guideline actually came from
• Counseling families about twin pregnancy beyond fear-based statistics
• Fadwah's pathway from hospital midwifery to independent home birth practice
• Preparing for a planned breech twin home birth
• Managing cord prolapse in a breech presentation
• Home birth emergency preparedness and neonatal resuscitation
• The importance of individualized risk assessment over blanket policies

Podcast Produced by: Raquel Hernandez, Pride and Joy Doula Care

This show is supported by

• LMNT | Got to drinklmnt.com/birthinginstincts to get a free sample pack with any order
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• Restorative Roots | Go to restorativeroots.com and use code BIRTHINGINSTINCTS to get $20 off
• Girls Who Know | Go to girlswhoknow.com and use  code INSTINCTS for 15% off

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