On day two of International Multiple Birth Awareness Week, we consider safe care during pregnancy. In this blog, Research Fellow for the EBMBC, Lorna Hibberd explains the importance of multidisciplinary guidance and the role of the multiple birth midwife.
Families expecting twins, triplets or higher-order multiples often face a very different pregnancy journey from those expecting a single baby. Multiple pregnancies are associated with increased risks, including preterm birth, pre-eclampsia and neonatal admission. In light of these increased risks, national guidance recommends access to specialist care. The NICE Twin And Triplet Pregnancy Guideline (NG137) recommends that women with twin and triplet pregnancies receive care from a dedicated multidisciplinary team, including specialist obstetricians, specialist midwives and sonographers with expertise in multiple pregnancy.
The Multiple Birth Midwife Standard developed by the Royal College of Nursing (RCN) outlines the role and the important contribution of the Specialist Multiple Birth Midwife (MBM). While obstetric or fetal medicine consultant expertise is undoubtedly essential in managing the clinical complexities and risks associated with multiple pregnancy, the role of the MBM offers something different. The Multiple Birth Midwife Standard emphasises that the MBM role includes care coordination, continuity, family advocacy, education, psychosocial support and service development, functions that extend beyond the management of clinical risk. As evidence shows that multiple birth families face varying levels of support quality when it comes to addressing their psychosocial support needs, specialist midwives are uniquely positioned to bridge these gaps, ensuring that care remains family-centred as well as clinically focused.
Originally published in 2021, the EBMBC contributed to the standard's 2024 update and provided a review of its initial distribution and implementation in 2022. This review found that although implementation was inconsistent and faced multiple barriers, where a MBM role had been successfully implemented, services reported improved care coordination, continuity of care, personalised support, stronger multidisciplinary working and more positive experiences for multiple birth families.
The findings highlight the ongoing importance of the role of the Multiple Birth Midwife. Professional standards help define the knowledge, leadership and expertise required to support multiple birth families and provide a framework for consistent, high-quality care. Across our published and ongoing work we know of examples of excellent and innovative practice, demonstrating what is possible when specialist roles are embedded within maternity services. The challenge now is ensuring that all families expecting multiples, regardless of where they live, have equitable access to the specialist expertise and support that national guidance recommends.