NHS Maternity Review Report: A Multiples Perspective

The recommendations of the NHS Maternity Report are very exciting for multiple birth families. Now it's time for implementation.

Society is fascinated by twins, triplets and quads. As a mother of twins, I've become accustomed to being asked questions by curious, but well-meaning strangers. This was especially common in the early days, when my double buggy seemed to be a magnet for people. 'Are they twins?' (yes) 'Are they identical?' (I don't know) 'It must be much busier than just having one?' (I'm not sure. I've never had just one) 'How do you cope with two babies crying and not sleeping at the same time?' (with coffee... lots of it).

I've worked as an obstetrician for over 20 years, and during this time I've seen many mothers and families react to the news that they're expecting twins or triplets. One thing many people don't consider is that, whilst finding out you're pregnant with multiples can be very exciting; it can also be very scary. Not only are parents faced with the reality that they will have to cope with not one, but two (or even three or four) babies; but they are also told their pregnancy is high risk.

Improving maternity care is a hot topic at the moment, with the NHS releasing the findings of a year-long maternity review today. This report comes just three months after Health Secretary Jeremy Hunt revealed an ambitious plan to halve the number of stillbirths, neonatal and maternal deaths by 2030. It's especially encouraging to see multiple births, and other complicated pregnancies, mentioned throughout the report. This is ground-breaking, as in previous reports these pregnancies have been overlooked.

But now the hard work begins: ensuring these recommendations are implemented.

If we're to meet Jeremy Hunt's 2030 target, it's vital the recommendations of this report are taken into account. Multiples and other high risk pregnancies make up a disproportionate number of neonatal deaths and stillbirths. Each multiple birth baby is twice as likely to be stillborn as a singleton, and almost five times more likely to die in neonatal care. Sadly, the latest figures from the Office of National Statistics (ONS) show the multiple birth stillbirth rate rose by 11.5% between 2013 and 2014.

In addition, multiple birth parents have expressed high levels of dissatisfaction about the advice they received during their care. In a recent report released by Tamba, nearly a third of parents of multiples described the advice they received from their consultants as poor or very poor, up from 11 per cent in 2012. Likewise, dissatisfaction with the advice given by midwives has doubled amongst parents of multiples since 2012, rising from 16 per cent to 32 per cent.

I find it very distressing to hear that some multiple birth mothers are not receiving the care they need. As a trustee at Tamba, I hear many stories from parents who have had excellent care. However, sadly, the charity also gets many calls from parents who have not felt listened to or respected during their pregnancy. One mum recently told Tamba how her she nearly lost her two boys, because a twin-specific complication wasn't picked up until it was almost too late:

"After we had our 12 week scan we were told we were expecting non-identical twins. I was told this meant I would have less scans as there was less risk of complications [than an identical twin pregnancy], so I went eight weeks without a scan. Then, at our 20 week scan, we discovered that our boys had stage three twin-to-twin-transfusion syndrome, an illness which only affects identical twins who share a placenta. We were lucky that our boys both survived!"

Cases like this highlight what can go wrong when multiples do not have the specialist care they need, and this must change. In the past, multiples and other high risk groups have been overlooked when it comes to pregnancy care. Only 1.5% of maternities result in a multiple birth, yet twin and higher multiple babies account for 7% of all stillbirths and 13% of neonatal deaths.

The recommendations of the NHS Maternity Report are very exciting for multiple birth families. Now it's time for implementation.

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