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Although the American College of Obstetricians and Gynecologists (ACOG) specified twin birth as having a greater risk of perinatal death and asserted that twin gestation places a candidate at too high a risk for home birth, currently, national standards do not exist in the United States that delineate conditions for which home birth is not advised, and, some midwives are facilitating home and birth center birth with mothers having a twin gestation. Come explore the current climate in regards to twin birth in homes and birth centers, reviewing the literature, both historical and current, of midwife-led care of twin gestation. Then, review the core skill set necessary for midwives to successfully facilitate twin gestation within a home and birth center setting. This text will serve as a beginning point in helping midwives acquire the clinical knowledge and skill set needed to successfully guide appropriate twin gestation within a home and birth center scope of practice; as a contribution to the literature and a call for future studies that inform both safety and practice regarding vaginal twin birth; and as a framework for maternity care providers in critically re-evaluating risk categories for twin gestations.