We have seen a huge increase in the use of fertility treatment over the past 20 years, resulting in a significant rise in the number of multiple pregnancies. Multiple pregnancies make up approximately 3% of pregnancies in the UK. They have a much higher neonatal death rate and a higher risk of poor health and disability after birth. The latest figures show stillbirth rates for multiple births rose by 13.6% between 2013 and 2014.
According to a recent report prepared by Twins and Multiple Birth Association (TAMBA) and the National Childbirth Trust (NCT), women expecting multiple births are experiencing “shocking variations” of antenatal care depending on whereabouts in the country they live.
In addition to variation across the UK, rates of patient satisfaction also vary across the regions of England, showing a “postcode lottery” in access to care. The North East have the best performing regions with overall 71.5% satisfaction, whilst the South East and West Midlands are the worst, both with 61.1%
Guidelines set out in 2011, by The National Institute for Health and Care Excellence (NICE), sought to improve the quality of care and outcomes for multiple pregnancies. The guidelines recommend that all women expecting multiple babies should have a named midwife, obstetrician and sonographer with specialist knowledge of 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.
However, NICE guidance is only implemented in 10-18% of units across the UK. Therefore, outcomes for multiple pregnancies and patient satisfaction with care remain low.
It is worrying that so many women expecting twins or triplets are still not receiving the specialist care they need, and that there is such a variation in the standard of care received across the country. The NICE guidelines have clearly made a difference where implemented and if applied across the country, are likely to have a significant impact on stillbirth rates for multiple births.