Originally Posted by oliviabolivia
Regarding studies and the like - you will be hard-pressed to find much research on the subject. Most OBs do not support vaginal birth for breech first twins, and it would be almost impossible to find a doctor to support a footling breech first twin birth.
This is, IMO, the crux of the matter. There are a lot of doctors walking around saying, "Can't do. . ." simply because they have no knowledge of it. Sometimes, answers do just leap up in your face, but other times you have to ask the question first
. Unfortunately, there isn't enough "asking" going on about multiple births b/c there are strong social and financial incentives for doctors to stick within their comfort zones and do c-sections.
This doesn't make your decision any easier. Whatever the reason for it, that's the climate we are in and it will be hard/impossible to find a birth attendent to agree to work with you for a vaginal delivery.
Early on in my twin pregnancy, I did a lot of reading about presentations, simply on a "what if" basis. This idea of breech-vertex twins interlocking chins was a top fear mentioned everywhere - and almost nowhere was it quantified
. I looked FOREVER for a number. Finally found one - sorry don't have the online reference. It had been from that famous Obstetric's text (you know, sounds like the surname of a british guy). Anyway the number was so low, that in my personal opinion it was a risk well-worth undertaking to avoid the known complications of c-section for both mom and babe(s).
My twins ended up presenting vertex-footling breech. I got all the same stories about "can't". This included arguing with the doctor at delivery who was saying I was, "making bad choices for my baby" and telling me we had to do a breech delivery a certain way because that was the only way she knew how to do it. I said, "Oh, how many have you done?" Answer: Zero. So much for what she was claiming to know (with such airs of authority)! (As an aside: If anyone is reading between the lines and wondering why I was finding out at delivery that the attending doc had no breech experience, it's b/c it went so quick that I didn't make it to the intended hospital).
The pre-natal and delivery fighting with docs for a vaginal birth was absolutely agonizing. Nice to deal with accusations of being a nihilist and wishing death upon your baby and all that!
If I had been in your shoes, I would have done as I did with my vertex-breech:
1. Planned to birth in a hospital (couldn't get a midwife).
2. Hunted and changed providers to find one with breech experience.
3. Decline her recommendations for epidural, IV, constant monitoring, immediate total breech extraction of Twin B, etc.
4. Bring along 2
support people: to help me emotionally & physically, while
still having help to observe what the medical staff are doing and object/draw my attention to it if necessary.
What I would have changed if mine were breech-vertex (and some of this comes from hindsight):
5: make sure your support person is very familiar with the common interventions in breech delivery and what you do or don't agree with. I would think that if Twin A is breech, they would get that much more jumpy to "get in there" and "facilitate the delivery" in such a way that leads to the common breech birth injuries, even more swiftly than if Twin B is breech (since they are worried about second baby).
6. Relocate closer to the planned hospital so I would be certain to get to the breech-experienced doc even if labour was fast. (but I would NOT go in early in labour unless I thought something was wrong).
Someone said something in one of the early replies in the common sentiment, "doesn't matter how they are delivered, as long as you have healthy mom/babies at the end". I vehemently
disagree: in these sentiments, "healthy" usually means, "Mom will recover physically - eventually. Spiritual health, huh?" and "Babies are out, breathing, possibly recovering from drugs, possibly with injuries from a traumatic birth. Spiritual health? C'mon, it's just a young baby". I think we should be setting our standards of "health" a lot higher.
Good luck with your decision/search etc.