Help for multiple births

Multiple births have increased significantly over the past 30 years, and with them a growing need among families for specialist support services that have previously not been widely available. Mothers of twins and triplets and their babies face greater health risks and challenges.

We need to ensure that multiple birth families have the care they need to help minimise the risk of problems arising and intervene early where needed.

The Multiple Births Foundation, a charity that has already built up a great deal of evidence and experience over almost 30 years of working directly with families with twins, triplets and more has collaborated with BCU, which has a national reputation in the education and professional development of healthcare professionals, to establish a new centre.

The Elizabeth Bryan Multiple Births Centre, based at Birmingham City University (BCU), is an exciting innovation aimed at improving the care of multiple birth families through research into all aspects of multiple births, providing education and professional development programmes for healthcare and allied professionals and working with practice-based partners in the West Midlands to develop services, which can be replicated nationally and internationally.

There were more than 12,000 twin maternities and 189 triplets in the UK in 2015, compared with 7,600 twin and 105 triplet maternities in 1985.

The main reason for this is treatment for infertility, but advances in obstetric and neonatal care have also contributed to more multiple birth babies surviving. Although twins, triplets and more can bring great joy to many families, the reality is usually quite different to the parents’ expectations, and the practical, emotional and financial challenges of caring for two or more babies can be very daunting.

RISKS AND SUPPORT

Few people realise that twin pregnancies are associated with higher risks for the mother. These include miscarriage, high blood pressure, pre-eclampsia and haemorrhage, and delivery by Caesarean section is more likely.

Preterm birth is the greatest risk for the babies, with over 50 per cent of twins born before 37 weeks gestation and 10 per cent before 32 weeks, compared with about 1 per cent of singletons. These babies are more likely to die or have a disability.

Despite these medical risks, many twins and triplets will be healthy, but parents still need good information and help.

From the diagnosis of a multiple pregnancy onwards, mothers and their partners need specific and consistent information about how the pregnancy will be managed, why they may be referred to a foetal medicine specialist if complications arise, and what will happen if the babies are born early.

After delivery, mothers need help from midwives and maternity support workers with experience of multiple births to help them establish and maintain breast-feeding. Research shows that many mothers of twins give up breast feeding earlier than mothers of singletons due to lack of help.

When the family gets home, advice about managing the practicalities of care and how to establish a sleeping routine, including whether the babies sleep together or apart, is essential for harmony in the family.

SPECIALIST ADVICE

One of the greatest challenges is relating to more than one child at a time and treating each one as an individual. Most twins and triplets, even those who are monozygotic (genetically identical) are quite different in personality, interests and abilities – and parents, the wider family and all health and social care professionals as well as teachers need to understand this.

Helping bereaved parents who may be grieving for one or more babies who have died while caring for the survivor is another important part of our work requiring specialist knowledge.

Now the centre is open we are very excited about the prospects of integrating modules on multiples into all courses and offering online education for healthcare and allied professionals.

Research is already under way into the experiences of multiple birth families and those with preterm babies. We will also be working with a whole range of professionals including midwives, health visitors, neonatal nurses and staff in the community to pilot and evaluate services such as specialist clinics.

If you are interested in joining our Multiple Births Special Interest Group to keep updated with the work of the centre, hear about the latest research and educational opportunities or need advice about care for or support for families, email multiple.births@bcu.ac.uk or telephone 0121 331 5185.

Jane Denton CBE is director, Multiple Births Foundation, and Dr Merryl Harvey is reader in nursing, Department for Children and Young People’s Health, Birmingham City University.