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Health: Multiple Pregnancy

Volume 764: debated on Monday 13 July 2015

Question

Asked by

To ask Her Majesty’s Government what plans they have to improve care and deliver better outcomes for mothers and children in cases of multiple pregnancy.

My Lords, all women should receive excellent maternity care that focuses on the best outcome for them and their babies. The Department of Health is working with key partners, including Sands, NHS England and the royal colleges to deliver a programme to prevent stillbirths and neonatal deaths, which are a significant risk in multiple pregnancies. Furthermore, the independent national maternity review will assess current provision and consider how services should be safely developed to meet women’s needs.

The Twins & Multiple Births Association, Tamba, states that multiple pregnancies make up 3% of all births but account for more than 7% of stillbirths and 14% of neonatal deaths. Clinical guidance and quality standards have been published by NICE in recent years, but Tamba has found that fewer than 20% of maternity units have implemented the guidance in full. A particular concern is that only 18% of units have specialist midwives as recommended. Although there are figures on neonatal death and stillbirth, there are no figures on damage in multiple births, which I expect will be much higher. As we know, just a small interruption in oxygen supply can adversely affect children in the long term. Considering that since 2005 the number of reported patient safety incidents has risen by 419%, does the Minister agree that this is a worrying trend? What is being done to address this?

My Lords, the level of stillbirths in England is too high, whether from multiple or single births. The MBRRACE-UK report indicates that if we had the same rates as in Sweden or Norway, many more children would survive in this country. One of the problems that the noble Baroness puts her finger on is that the tariff system may discourage some neonatal units from referring cases to specialist referral units.

My Lords, the large number of multiple births in this country is very largely due—probably half due—to the practice of in vitro fertilisation. A very large number of patients are coming into this country having been referred to clinics overseas that do not accept the regulations on limiting embryo transfer. Does the Minister have figures on this and is there something that the Government can do to stop this practice, which is seriously increasing the cost of perinatal care and the tragedy for mothers?

The Government may have figures on this. I do not have figures here today, but I shall certainly endeavour to find them as soon as I can and perhaps follow it up with the noble Lord in a meeting outside this House.

My Lords, given that mothers expecting multiple births need the expert care of qualified midwives and yet we have quite a shortage, and given that the Government are considering giving golden hellos to GPs, what about midwives?

My Lords, we are not considering golden hellos to midwives. There are, I think, some 6,400 extra midwives in training at the moment and some 2,100 more midwives today than there were in 2010.

My Lords, does the Minister accept that multiple births can sometimes require additional emotional support for mothers? Will he therefore ensure that some of the extra resources allocated to child mental health services are targeted at perinatal healthcare to ensure that all maternity services have access to a perinatal mental health professional as recommended by NICE guidelines?

The NICE guidelines for mothers expecting twins or more have an enhanced pathway as well, in which there will be a specialist named obstetrician and a mental health specialist. The Government have committed an extra £75 million over the next five years to increase the availability of mental health expertise to women who have multiple births.

Does not the Minister take pride in the fact that his Government—or the coalition Government—were so successful in recruiting many more health visitors, so that vulnerable families such as these get the support that they need?

Yes, I believe that under the coalition Government an extra 4,000 health visitors were recruited, and they are very important.