26 weeks, still searching for OB. advice wanted!

[withlittlelungs]

We found out at 20 weeks that we were pregnant with twins. We were originally planning on delivering at a birth center, but it is illegal for them to deliver twins there. We can't afford a home birth, so we are on the hunt for an OB.

I did not have a good hospital birth experience with DS, so it is really scary that I'm going to have to deliver in a hospital this time around. Especially because most doctors see twins and think automatic c-section. 
I have set up interviews with 5 OBs in the next few weeks who are all VBAC friendly (I'm not seeking a VBAC but have heard that they are more likely to support natural twin birth as well). 

I'm 1000% flexible if a c-section is medically necessary, and one of the midwives from the birth center is going to be our doula so I feel a lot more confident about delivering in the hospital. However, I still want to find a doctor that will support our birth plan as much as possible. 
I am finding it hard to decide which of my birth preferences I'd be willing to compromise on if need be, and was wondering if you ladies would be able to give me some insight. I'm sure I won't be able to find a doctor 100% on board with everything on my list. Here are my desires for a incident-free birth:

• no IV unless GBS +
• intermittent monitoring
• freedom of movement during labor
• pushing in whatever position I desire 
• allowing labor to begin on its own, continue at its own pace without medication
• minimal vaginal checks
• no epidural during delivery
• no episiotomy
• letting baby B wait until she is ready for delivery 
• spontaneous delivery of placenta
• delayed cord clamping

what would your non-negotiables be? And any other input about interviewing OBs would be incredibly helpful!

[MeepyCat]

I think you're going to find a lot of doctors who are very dubious about this list, not even necessarily because they wouldn't be on board with the things you want, but because they're going to just feel that they can't promise it to you in advance.  What you've described here is a great set of plans that runs on the assumption that nothing will go wrong.  OBs will never, ever assume that, and that may set you up for a lot of tension in advance.

I'd probably let them put in a heplock (not a full IV if avoidable), and monitor the babies during labor, but I'd ask for wireless telemetry unitsso that you can still move around with minimal impediments.  I'd lay out the circumstances in which I was open to induction - sometimes those are medically necessary and useful, when would you be willing to do it?

The time between the delivery of Baby A and Baby B is generally considered potential crisis time, and not without reason.  Once Twin A is out of the uterus, the decrease in uterine size may cause the placenta to begin to abrupt, which can be dangerous for Baby B.  If you're monitoring and can hear that Baby B is fine, they may be okay waiting.  If they don't have that information, expect them to go after Baby B like a commando raid.

I'd also consider some trade-offs - what are your feelings about instrumental delivery and episiotomy vs. c-section?  Where does the balance lie, for you, between "I want to do this naturally" and "I've had enough"?  For example, if it looks like labor is going to be long, would you consider an epidural so that you can rest and conserve energy for the pushing phase?

[Brambleberry]

Almost everything can end up having to be negotiable under the worst-case-scenario circumstances, of course, but I don't think that's what you mean (?).  So I'll use the term non-negotiable here to mean that I would definitely want my OB or FPD to be comfortable with this choice.

• no IV unless GBS +

non-negotiable, but will be considering a hep-lock.  If baby B is breech this may be more negotiable...

• intermittent monitoring

non-negotiable during first stage, my FPD wants CFM during pushing, and I'm o.k. with this.

• freedom of movement during labor

non-negotiable

• pushing in whatever position I desire 

non-negotiable, but I'm willing to be more flexible if baby B is breech and they need to assist.

• allowing labor to begin on its own, continue at its own pace without medication

non-negotiable, assuming no major complications

• minimal vaginal checks

would prefer, but it's not super important to me.

• no epidural during delivery

non-negotiable

• no episiotomy

I would say no episiotomy without cause.  I had to have one with my first, and in those circumstances I would again in a heartbeat.  It was that or c/s, and I consider episiotomies pretty minor interventions.  I would absolutely avoid a physician who is used to doing routine episiotomies.  That may be a good screening question.

• letting baby B wait until she is ready for delivery 

I'd discus this with my caregiver, but I'd want them to be willing to do it under ideal circumstances.

• spontaneous delivery of placenta

Again, I'd discus pros and cons.  With the increased risk of bleeding with a twin-stretched uterus this might not be worth it.  I'm letting it up to my FPD.

• delayed cord clamping

I would want my caregiver to be willing to do this under ideal circumstances.  

[Adaline'sMama]

My OB is okay with all except the delayed cord clamping- Ive found that that is pretty much a no-go in this area though. 

[withlittlelungs]

I really appreciate both of your perspectives! And thank you both for bringing up a point about the episiotomy. I would totally be willing to get one to avoid a c/s!
MeepyCat, I didn't know there was such a thing as wireless monitoring. That is totally something I am going to see about! I really appreciate your input. I think discussing circumstances where I'd be more flexible with some of these terms is going to be helpful when talking to OBs. 

Brambleberry, I am glad to see that a lot of my points would be your non-negotiables as well. Thank you for mentioning discussing pros and cons. I think I am having such a hard time letting go of what I expected to be a peaceful/low intervention birth at a freestanding birth center that I sometimes create tunnel vision when it comes to my birth plan. You have really reminded me to keep a more open mind.