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Multiple birth guidelines ignored.


Hundreds of twins and triplets are dying, or suffering severe disabilities such as cerebral palsy, every year because so few hospitals are following clinical guidelines during their birth, a charity has warned.

The Twins & Multiple Births Association(Tamba) said that “multiples” make up three cent of births each year but account for 7.4 per cent of stillbirths and 18.4 per cent of neonatal deaths, where a baby dies in its first month of life.

More than 500 babies die before, or shortly after, a multiple birth each year. These babies also carry more than six times the risk of cerebral palsy.

Other problems may include premature labour not being recognised by medical staff, or siblings being deprived of oxygen during delivery.

The National Institute for Health and Care Excellence (Nice) tried to reduce the risks with the introduction of new clinical guidelines in 2011.

Under these guidelines, mothers must be attended by a midwife trained and experienced in the delivery of multiple babies, sonographers should be skilled in scanning for twins or more babies and an obstetrician should be available at the birth in case surgery is needed.

However, a study by Tamba shows that fewer than one in five maternity wards have introduced the guidelines, even though the cost was relatively low.

The number of twins and triplets born each year is increasing. There were 10,783 multiple births in 2013 compared with 8,549 about 20 years ago. The increase may be because of mothers giving birth later in life and the use of IVF, where usually two embryos are implanted.

Tamba chief executive, Keith Reed, said that given the increase, services need to improve their care and follow national guidelines.

He said: “Too many units are putting twins, triplets and higher multiples’ lives at risk by failing to follow the latest clinical guidance. By embedding best practice, units can start to reduce the number of families who suffer the terrible heartbreak of losing one or more of their babies.”

Vice-president for clinical quality at the Royal College of Obstetricians and Gynaecologists, Alan Cameron, said that multiple-birth pregnancies were known to pose a higher risk than ‘singleton’ pregnancies, so it was “crucial” that the Nice guidelines were implemented across all UK maternity units.

He said: “Increased monitoring and contact with healthcare professionals is key to ensuring that the mother and her babies receive the best possible care. Additionally, any mother carrying more than one baby must have access to accurate information, including a discussion over delivery method and postnatal wellbeing.

“A multi-disciplinary approach including input from midwives, obstetricians and ultrasonographers will help to ensure any complications are picked up and managed quickly and effectively.

Tamba has written to the Department of Health requesting an urgent meeting with the health secretary after the election.

The letter has been co-signed by the British Maternal & Fetal Medicine Society, the Royal College of Midwives, the Royal College of Nursing, the Royal College of Obstetrics and Gynaecologists and other children’s charities.

From 2005 to 2010 the NHS paid £93m in damages to the families concerned. Multiple births account for one in ten of maternity cases handled by the NHS litigation authority.