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Postcode Lottery of Multiple Birth Antenatal Care Putting Babies’ Lives at Risk

Women expecting twins, triplets or more are experiencing “shocking variations” of antenatal care depending on whereabouts they live in England, according to a joint report from the Twins and Multiple Births Association (TAMBA) and the NCT.

Multiple pregnancies account for three per cent of all pregnancies in the UK, but according to the latest figures, between 2013 and 2014, stillbirth rates for multiple births rose by 13.6 per cent.

Following a survey of more than 1,300 mothers who gave birth to twins or triplets, the TAMBA and NCT report reveals that patients in the South East and West Midlands receive the worst standards of antenatal care, while those in the North East receive the best.

According to the study, the National Institute for Health and Care Excellence (NICE) guidelines on antenatal care are being implemented in only 10-18 per cent of UK units.

NICE introduced guidance for multiple pregnancies in 2011 - and quality standards in 2013 - in an effort to transform the care of women expecting twins and triplets, reduce the number of multiples stillborn and dying in neonatal care and give providers of maternity services clear, evidence-based guidance on how to care for women with multiple pregnancies.

Research shows that when the guidelines are implemented in full, the rate of stillbirths, neonatal deaths and Caesarean sections is reduced by up to a third.

The guidelines state a number of requirements that include:

  • all women expecting multiple babies should have a multidisciplinary team to include a skilled midwife, obstetrician and sonographer, with expertise in multiple pregnancies;
  • mothers should receive guidance on when referrals to a fetal medicine specialist is required and,
  • antenatal education to prepare them and their partners for the arrival of two or more babies.

The main findings of the TAMBA and NCT survey included:

  • around one in three mothers of twins and triplets did not have access to a specialist obstetrician trained in caring for multiple pregnancies;
  • only 20 per cent saw a specialist midwife and just 28 per cent saw a specialist sonographer. In the East Midlands, just 7.8 per cent of patients saw a specialist midwife, compared with 48 per cent in the North East;
  • twins or triplets are twice as likely to be born stillborn, than single babies, and almost five times more likely to die in neonatal care.

Specialist multi-disciplinary teams are extremely important during the antenatal period because this is often the time when problems can arise for women expecting twins, triplets or more.

The scale of the differences in the standard of multiple-pregnancy care across the country is concerning and it is vital that the NHS England maternity review addresses the reasons behind the discrepancies as a matter of urgency to prevent more babies from dying.

It is very disappointing that so many women expecting twins or triplets are still not receiving the specialist care they need. The fact that as many as 40 per cent of patients in the South East and West Midlands are not receiving care in compliance with the NICE guidelines is simply unacceptable.

One of my former clients lived in the South East and she very sadly lost one of her twins as a result of the mismanagement of her labour. The guidelines for the management of twin and triplet pregnancies exist for a reason and research has shown time and again that if they are implemented in full, they can make a significant impact on stillbirth rates for multiple births.

If nothing is done to reverse the shocking 80 plus per cent of English NHS Trusts that are failing to provide proper care for couples expecting twins or multiples, babies’ lives will continue to be at risk.

Lauren Tully is a clinical negligence lawyer at Slater and Gordon in Manchester.

The clinical negligence solicitors at Slater and Gordon help families who have had to deal with devastating birth injuries in a sensitive and supportive manner. We understand the complex legal and medical issues involved, and the importance of supporting you through this most difficult time.

If your baby was injured during pregnancy or child birth due to medical negligence call us for a free consultation any time of day on 0800 916 9049 or contact us online. We can provide immediate representation anywhere in the UK.

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