Sorry it took me so long to see this post. Well, I still don't have a lot of experience, with those scenarios, but I've done a lot of reading, watching videos, attending conferences (Like the International Breech Conference in MD a few years ago.) and learning by the seat of my pants. For example, with my 1st set of twins, I asked the mom to get an US so we'd have a better idea of her particular risk factors. She did. They were both head down, w separate sacs & placentas. We discussed all alternatives & relative risks. I told her I had never done twins at home before. God was good, He made my 1st set easy for me! The twins stayed facing each other, one on each side. so I could easily find both heartbeats the whole time, & they were as low risk as possible. She had one sister who had twins in the hospital & one died. She had another sister who had twins at home (unattended!) & they were fine, so it was easy for her to chose to stay home. Once I had done one set, it was easier to feel confident doing another. I always am straight with my clients, regardless of what risk factors were involved. We go over pros & cons, weighing risks & advantages. I am always clear what my experience with that circumstance is or isn't. Informed consent goes a long way. I serve my clients in whatever way they feel is best for them (with some personal; comfort boundries od course.) But for the most past, I know God won't give me more than I can handle... What He brings me to; He brings me through. This is no guarantee everything will be great. I just step out in faith, going where ever He leads me..