Jennifer, you asked <Am I reading this correctly? Isn't he saying that
twins born prematurely have
the best chance of surviving?>

I think he is saying that the twins who got the most prenatal care are
the ones with the best chances of survival, even if they are also
delivered prematurely.

It looks like docs who are "shepherding" the babies carefully in their
intrauterine environments,with the help of more sophisticated prenatal
testing, are more confident that the twins are strong enough to "make it"
safely with the NICU improvements now available.

Obstetricians are then more confident they can control predictable
gambles of premature delivery by elective C. Section under regional
anesthetic.

The alternative is the unpredictable gamble of  complications that are
historically more common in labor and vaginal birth of twins (such as
prolonged, inefficient labor, cord prolapse, entrapment of the
aftercoming head of the second twin etc.)

Those often require an emergency C. Section under general anesthetic for
the second twin. Few doctors now have ever had the experience of
performing either an chancy incision of the cervix, or an internal
version.

(This means using one hand inside the uterus and the other outside the
uterus to try to turn and extract the second baby, hoping it did not
suffer oxygen deprivation or worse.)

This is what U.S.doctors did 4 or 5 decades ago when there was often no
other choice. Many babies were lost or suffered permanent damage, and
many mothers sustained severe gynecological injury during such
procedures.

"I know. I was there" as the saying goes. I worked L&D full time during
the U.S. "baby boom" and watched it many times. Can anyone comment from
countries with less medical technology available?

Jean
**********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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