#466: Update On The Use Of TXA (Tranexamic Acid)
Birthing Instincts
Dr. Stuart Fischbein + Midwife Blyss Young
4.8 • 691 Ratings
🗓️ 20 May 2026
⏱️ 87 minutes
🧾️ Download transcript
Summary
What happens when a medication designed to stop hemorrhage quietly starts creeping into routine birth care?
This week, Dr. Stu and Midwife Blyss take on TXA (tranexamic acid), what it is, when it actually makes sense, and why they’re increasingly concerned about how it’s being used in modern maternity care.
From postpartum hemorrhage protocols to the growing push for prophylactic use during cesareans and even BEFORE birth, this conversation digs into the science, the politics, and the unintended consequences nobody seems willing to talk about.
Along the way, they tackle the bigger issue underneath it all: Who gets to define “safe” birth care? Hospital systems? Bureaucrats? International organizations? Or the people actually attending births?
References:
Evidence Based Birth Podcast Episode 396 - Inequities in VBAC Access with Dr. Nicholas Rubashkin, MD, PhD
Mom who sued the State of Nebraska in home birth case delivers baby
Home births to resume after safety concerns
https://www.yahoo.com/news/articles/home-births-resumed-safety-concerns-183648374.html
Practice Bulletin No. 183: Postpartum Hemorrhage: https://journals.lww.com/greenjournal/abstract/2017/10000/practice_bulletin_no__183__postpartum_hemorrhage.56.aspx
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum hemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial:
https://pubmed.ncbi.nlm.nih.gov/28456509/
Efficacy of prophylactic tranexamic acid among parturient at increased risk for postpartum hemorrhage undergoing cesarean delivery: A systematic review and meta-analyses of randomized controlled trials
https://pubmed.ncbi.nlm.nih.gov/41066405/
Discussed in This Episode
The Momnibus Act & the Future of Midwifery
TXA Enters the Midwifery World
What TXA Actually Does in the Body
The Evidence Behind TXA for Hemorrhage
Why Routine Prophylactic TXA Raises Concerns
Does TXA Cross the Placenta?
Four Ts of Postpartum Hemorrhage
Why Timing Matters in Hemorrhage Care
Defining “High Risk” in Birth
Use of Oral and Intermuscular TXA
Podcast Produced by: Raquel Hernandez, Pride and Joy Doula Care
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Transcript
Click on a timestamp to play from that location
| 0:00.0 | Welcome to the Burthing Instincts podcast. |
| 0:05.0 | I'm Dr. Stewart Fishbein, a hospital and home birth obstetrician for over 40 years, and a long-time advocate for birth choices. |
| 0:12.0 | And I'm Bliss Young, a traditional midwife. |
| 0:15.0 | Join us in our conversational style podcast where we talk about everything births. |
| 0:20.0 | Sometimes we laugh, sometimes we cry, but we're happy |
| 0:22.7 | that you're here. So here we go. Well, good morning to you and everyone else. Good morning, good |
| 0:32.2 | afternoon, good evening, good middle of the night, as always. Have I got a show for you today, |
| 0:36.1 | Bliss? Okay. I'm excited. So you guys, |
| 0:40.5 | we're going to be talking about TXA today. I'm part of a online Facebook group that ranges from |
| 0:47.0 | everything to student midwives, birthkeepers. I don't know how many birthkeepers are on there, |
| 0:51.9 | but I think so. And then CNMs who practice in the hospital. |
| 0:56.0 | So there's a wide range of kind of questions and information that come through there. |
| 1:01.0 | And I've been hearing a lot about TXA given in a lot of different modalities. |
| 1:07.2 | So I asked you if we could talk about that because I think a lot of people, TXA is a pretty new one for us to be using at home as midwives. |
| 1:15.7 | And so I think there's some confusion about the best way to utilize it and why we're utilizing it. |
| 1:21.2 | And if you're a mom or a family that's planning homebirds, this might be something that's interesting to you to think |
| 1:28.9 | about and talk to your midwife about. And I have a very strange coincidence that I'll get to |
| 1:34.0 | when we start talking about TXA, that you'll be shocked. It'll blow you out of the water. Okay. |
| 1:40.4 | But before we do that, I have quite a few things that I need to get to. Okay. |
| 1:45.2 | Out of my mind. |
| 1:47.0 | Out of my mind. |
| 1:47.0 | Some of them are serious. |
... |
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