There are wide variations in the care provided for multiple births across the NHS in England, according to a new report by the Twins and Multiple Births Association (Tamba) and the National Childbirth Trust (NCT).
In the last 20 years, the number of multiple births has increased. Today, around 3% of all pregnancies in the UK are multiples. However, outcomes for multiple pregnancies compare poorly with outcomes for single births. The Office of National Statistics (ONS) figures show that 7.2% of all stillbirths in the UK in 2014 involved multiples – an increase of 13.6% from the previous year.
Stillbirths are more than twice as likely to occur in multiple births than in single births and neonatal death rates are significantly higher. Around 10% of all stillbirth maternity litigation in England involved multiple births.
In order to reduce the rate of babies from multiple pregnancies that are stillborn or who die while in neonatal care, NICE introduced guidance for multiple pregnancies in 2011 and quality standards in 2013. The joint Tamba and NCT report looks at how well the NICE guidance has been implemented in the last four years.
The report's findings show that only 10-18% of UK maternity units had implemented the NICE guidelines in full. This is despite research that shows that the rate of stillbirths, neonatal death and cerebral palsy falls by up to a third when the NICE guidelines are implemented in full.
The NICE guidelines specify that all women expecting multiple babies should have a named midwife, obstetrician and sonographer with specialist knowledge of multiple pregnancies. However, the survey shows only 28% of parents said they saw a specialist sonographer; only 20% saw a specialist midwife; and nearly a third reported that they did not see a named specialist obstetrician.
The worst care in England was reported in the West Midlands and in the South East where nearly 40% of respondents reported lack of compliance with NICE guidelines for multiple pregnancies. Only 8.6% of women in the South West and 7.6% of women in the East Midlands reported having access to a specialist midwife. The best care was reported in the North East.
The Director of Midwifery at the Royal College of Midwives, Louise Silverton, said: "The wide variation in care and outcomes is extremely worrying. It is crucial that we find out why this is happening and take steps to address it."
Camilla Wonnacott, associate in the Penningtons Manches clinical negligence team, said: “We see the tragic results of lack of proper care for multiple pregnancies. It is unacceptable that, four years after NICE introduced its guidance, so many NHS trusts have yet to comply with best practice.”