Multiple births and women's experience of maternity care
Maggie Redshaw (NPEU (Former member))
Jane Henderson (NPEU (Former Member)), Jenny Kurinczuk (NPEU)
Multiple births, Women's experience of maternity care
Department of Health, Multiple Births Foundation, Twins and Multiple Births Association
Using data from the 2006 survey of women's experience of maternity care, published as 'Recorded Delivery' (2007) and from Hospital Trust based surveys of women carried out in 2007 as part of the Healthcare Commission maternity review, published as 'Towards Better Births' (2008), the aim was to describe the experience of maternity care of women having twins or triplets and to compare this with that of women having singleton births.
As little is recently known of women's experience of care during pregnancy, labour and birth and postnatally, in relation to multiple birth, these national data provide some baseline information on this important topic. They describe the care provided during pregnancy and afterwards for women having a multiple birth, make comparisons with the care provided for mothers having a single baby and describe women’s views of the care they received.
Mothers of multiples were more likely to be having their first baby and those having twins or triplets were more likely to by over 35 years of age.
Mothers of singletons and twins on average first saw a health professional about their pregnancy at 7 weeks gestation and the timing of the ‘booking’ appointment was similar, booking at an average of 11 weeks gestation.
The number of antenatal checks varied with plurality: mothers of multiples had an average of 13 checks compared with 9 for mothers of singletons;they were twice as likely to have between 15 and 19 checks, with a small proportion (6%) having 20 or more antenatal checks.
A higher proportion of women with a multiple pregnancy were not offered Down’s Syndrome screening (15%, compared with 4% for singleton pregnancies).
Women with a multiple pregnancy had more ultrasound scans (8 compared with 3 scans).
Women with multiple pregnancies were significantly more likely to experience antenatal problems such as nausea and carpal tunnel syndrome, but rates of other symptoms were similar.
Women with a multiple pregnancy had more antenatal admissions to hospital and overnight stays (37%compared with 18%).
More women expecting a multiple birth indicated that for medical reasons there was no choice about where to give birth (17% compared with 7%).
Labour and birth care
More women with multiple pregnancies were worried about not knowing when labour would start, getting to the hospital in time, and needing to give birth by caesarean section.
Women having a multiple birth who went into labour were more likely to be induced than mothers of singletons (43% compared with 25%).
Mothers of twins who laboured were twice as likely to have an epidural(56% compared 28%) and less likely to have pethidine as an analgesic in labour (18% compared with 33%).
Caesarean delivery was nearly three times more common for multiple births as for singletons (62% compared with 23%) and was more likely tobe a planned procedure.
Of women who gave birth vaginally, more mothers of multiples had an episiotomy (38% compared with 23%).
The use of the lithotomy position for delivery and episiotomy were associated with the use of forceps or ventouse for delivery of at least one of the babies.
During labour and birth women having multiples were more likely to be more midwives (36% compared with 22% had 4 or more midwives).
Almost all singleton infants born to women in the study were delivered at term (mean, 39.5 weeks) compared with twins (mean 36.4 weeks) and triplets (mean 33.3 weeks) who were more likely to be born early.
Following a multiple birth, babies were twice as likely to have an NNU stay of between 15 and 30 days compared to singletons, and to stay for a month or more.
After birth mothers of multiples stayed in hospital for longer (over 60% stayed 4 days or more compared with 18% of mothers of singletons).
Fewer mothers of multiples were visited at home by a midwife after leaving (89% compared with 97% which was associated with their babies' admission to a neonatal unit.
Mothers of singletons and twins who saw a midwife at home had a similar number of contacts (average 4 visits) and one in 5 similarly would have liked more home visits.
The length of time over which home visits were carried out was quite variable, with 10% of multiples and 5% of singleton last seen by the midwife at one month or more.
Fewer mothers with more than one baby exclusively breast-fed their infants in the first few days (32% compared with 58%), however a similar proportion were feeding some breast milk at this time compared with mothers of singletons (73% compared with 75%).
Mothers of multiples were only slightly more likely to report having received practical help (75% compared with 71%)with infant feeding.
In terms of overall physical health at three months or more after the birth there were no significant differences reported by women who had given birth to a single infant and those who had given birth to twins or triplets: two-thirds of both groups reported their current health as ‘excellent’ or’ ‘very good’ at this time.
Following a multiple birth 20% of women would have liked more information about their own recovery and health compared with 16% of mothers of singletons.
The quality of antenatal care during pregnancy was generally highly rated,however, mothers of multiples appear slightly less likely to be as positive as mothers of singletons.
Only a third of women expecting multiples had met staff prior to labour, though this was higher than for singletons (34% compared 21%).
Mothers of multiples were more likely to say they were not left alone and not worried at all (83%)during labour and birth compared with mothers of singletons (74%).
The quality of interpersonal aspects of care during labour and birth was little different for the the groups and perceptions of postnatal care was similar, though a bit more critical.
In summary, as might be expected mothers of multiples received more care, particularly during the antenatal period, more labour and birth interventions and to some extent more flexible postnatal care, though some would have liked more visits and could have benefitted from more support, particularly with infant feeding.