I saw this the other day, and only now have a few minutes to respond.
I think the key is going into whatever you're doing eyes wide open, and in charge of all the information. Whether you choose a home birth or a hospital birth, you need to be prepared for what you are entering.
With regard to which is better suited to you, much of that is going to depend on your particular situation. First, your pregnancy. Are your twins mono/di, di/di? Is baby A head down (as you approach the final stretch)? Have you had any other complications with the pregnancy? I think a lot of people who don't know anything at all about twins assume all twins are "high risk," and equally so. The fact of the matter is that just as factors like type of incision, reason for primary, prior vaginal births, whether or not you're receiving certain interventions, etc., make VBACs run a HUGE range of risk from catastrophically risky to not risky at all, so too do these things about your particular twin pregnancy make twin vaginal birth run the gamut from higher risk (mo/mo, for example) to not very risky at all (di/di, both vertex, prior vaginal births, etc.). As a nullipara (I'm assuming), you aren't necessarily MORE risky, just a little more unknown, and I know plenty of nullis who have birthed their twins vaginally, at home, in hospitals, and birth centers, without any complications. Like them, you will have many factors that play into your decision of where to have your babies.
Another thing that will play into your decision-- your provider. How much experience does the provider you're considering have with VAGINAL twin birth? If all your provider has ever seen are scheduled cesareans for twins, they are less likely to manage your labor in preparation for a VAGINAL twin birth, as they will likely default to what they know. I was at a twin hospital birth last week where the doctor INSISTED that he's NEVER seen a baby B change position after baby A is out (breech to vertex, or vice versa), that he considers the risks of vaginal delivery of a breech baby B too high to accept, and that he felt an external version for a breech baby B would be unsuccessful if attempted, so he wouldn't even try. I know for a fact that baby Bs flip frequently after births as they have more room to move around, that external or internal versions of baby B are often incredibly successful because of that fact, and that the literature suggests that a vaginal TOL is warranted as long as baby A is vertex. Because the information he had was so far out from what I know to be true (I can read studies, too), I can only assume that he was not up to date on the research regarding twin birth, and that he's never seen many twin vaginal births. He ended up "allowing" the mother to push out her baby A as long as it was in the operating room, and then knocked her out under general to do a cesarean on baby B simply because of B's breech presentation, without attempting a breech "extraction" (much less a birth) or an external version. Moral of this story: make sure you know your provider has attended more than a few vaginal twin births.
This played greatly into my decision of where and with whom to have my babies, by the way. As evidenced by my story above, not many of the doctors in my area have attended many vaginal twin births, as it's so easy to scare most twin moms into unnecessary surgery when you play the "don't you love your baby enough?" card. The provider who attended my birth had attended dozens of vaginal twin births in hospitals before switching to a primarily homebirth based practice, and had attended almost 20 vaginal twin homebirths since then. I knew my care was being handled by someone who knew the research about twin birth, respected mothers' wishes and did her best to carry them out safely, had a TON of education on birth and nursing (the medical and non medical sides), and knew and wasn't afraid of the tricks for managing vaginal delivery of baby B. A lot of the "I/my baby would have died if we had been at home" stories? My provider has likely attended births just like that at home, and managed them well with no complications to mother or baby.
There are providers like that out there, providers in both homes and hospitals. The trick is this-- in the hospital, that provider, no matter how good s/he is, is beholden to hospital policies that may or may not be in yours or your babies' best interests. At home, this is not the case, but surgery is not (as someone has pointed out) 5 minutes away. In many cases in which cesarean is overused or required only because of the negative effects of interventions, that might not be a bad thing. But rarely, it can be. You have to be aware of that, and it needs to play a big role in choosing a homebirth provider. Have you attended births (and approximately how many) where: it was twins? a cord prolapsed? Baby B was breech? Baby A was breech? a mother hemorrhaged? the babies "locked?" How did/would you handle these situations at home? For which ones would you consider transfer to the hospital our best option? Would you be able to transfer with me if we had to? What is your education relative to birth? Are you a: DEM? CPM? CNM? MD? EMT? Paramedic? Certified/licensed in your state?
I know some of those sound silly, but you really want to know what kind of training they have. Do you have hospital backup to ensure continuity of care if we transfer? What kinds of medicines/herbs/supplies do you carry with you to home births? What's the earliest you would attend a twin birth at home? What extra people would you bring to my twin home birth? What if both babies needed resuscitation-- would you be prepared with extra oxygen tanks/masks?
The sad fact is that just as not all doctors are the same, not all midwives are, either. Some are incredibly competent with a somewhat medically-minded approach. Some are incredibly competent with an uber-crunchy holistic approach. And some, medical or otherwise, are simply incompetent and inexperienced. My heart goes out to those mothers who hired a midwife in good faith and with the best of intentions only to find out AFTER the fact that the midwife was not competent. Having no uniform licensing procedure yet (which some might argue is a good thing, but which The Big Push
is trying to remedy) makes asking all of those questions of your homebirth provider REALLY important. Having no guarantees or protections against unnecessary interventions in the hospital makes them equally important to ask of an OB.
I like the idea of keeping OB shadow care during the pregnancy. I did not have that for my own twin pregnancy (for reasons that are more complex than this already-too-long post can address), and I lived in constant fear of going into labor early and ending up in the hands of whatever doctor happened to be on call. Maintaining OB shadow care, while it may be more stressful in some ways, will ensure that you have a reasonably secure backup plan if you go into labor early or need to transfer.
I also like the fact that you put intuition in (what I consider to be) its proper place-- as a part of the process, but not the process itself. That was how my pregnancy was-- I researched my butt off, took what I found out into prayer/meditation, and then made my decisions based upon many dimensions. I wasn't TOO analytical and nerdy, but I definitely wasn't any more woo-woo than was necessary!
Anyway, I'm sorry for writing the novel here, but this is an issue that is close to my heart. As a doula, I think all women deserve to be treated with respect during their births, whether they give birth at home or in a hospital. As a mother of twins, I think we should have those same rights.
Hope your path becomes more clear to you as it progresses.