Maternity Services and Multiple Births

A joint report by NCT and the Twins and Multiple Births Association (Tamba)

What is this research about?

The joint report by Tamba and NCT describes the findings of the Maternity Services survey completed by 1338 parents of multiples in the UK between April and July 2015. The survey covered a variety of topics including place of birth, quality of antenatal and postnatal care, neonatal care arrangements, feeding support and sleeping arrangements.

Why is this research important?

Multiples make up approximately 3% of pregnancies in UK with numbers rising significantly over the past 20 years due to the increasing use of assisted conception techniques such as IVF. Recent figures from the ONS show that multiples accounted for 7.2% of all stillbirths in the UK in 2014, a 13.6% rise from 2013. Stillbirths occurred in 1.07% of all multiple births, more than twice the rate for singletons. Neonatal death rates are also significantly higher at 11.5 / 1000 live birth in 2013 compared with 2.4 / 1000 for singletons. Infant death rates are 14.5/1000 compared with 3.4/1000 for singletons. Multiple births account for around 10% of all stillbirth maternity litigation claims in England, which cost the NHS £72m between 2005 and 2014. The risk of preterm birth is also considerably higher occurring in at least 50% of twin pregnancies, with twins facing six times the risk of cerebral palsy.

These figures clearly show that outcomes for multiple pregnancies compare poorly to singletons.

NICE antenatal care guidelines and quality standards introduced in 2011 aimed to tackle these inequalities and improve quality of care and outcomes for multiple pregnancies. Studies have shown that stillbirth rates, caesarean rates, late admission to neonatal units and patient safety incidents are all reduced as a result of setting up and delivering services in accordance with the NICE guidance. Unfortunately NICE guidance is still not fully or equally implemented across the UK (only fully implemented in 10-18% of units) and there is no specific guidance for intrapartum care for multiples. Therefore outcomes for multiple pregnancies and patient satisfaction with care remain low. This report seeks to measure parent experiences of maternity care and how well NICE guidelines for multiple pregnancies are being implemented across the UK. In particular it looks at variation by region and home nation of the UK and variations in compliance over time.

Overall the report shows that implementation of NICE guidelines is slowly beginning to address the inequalities of care experienced by parents of multiples and recognise their additional needs, however much further progress is required. Parents generally have good access to screening and advice in preparation for birth, but have further needs in terms of post-natal advice and support and access to a multi-disciplinary team with specialist knowledge of multiple pregnancy, which would improve quality of care, patient safety and outcomes for multiple pregnancies. Wider implementation of NICE guidance and planned extension of NICE guidelines to cover the intrapartum period would also help to ensure continuity of care and improve outcomes for babies and parents during this time.

How is NCT involved?

Rebekah Fox, NCT Senior Research and Evaluation Officer and Sarah McMullen, Head of Knowledge were involved in the analysis of data and writing of the final report on behalf of Tamba and NCT.