Maternity units working with multiple birth families at a Lincolnshire hospital trust have seen significant improvements thanks to a groundbreaking project run by the charity, Twins Trust. The project aims to improve adherence to National Institute for Health and Care Excellence (NICE, 2024a, b) guidelines for multiple pregnancies and quality standard 46, improving outcomes for families.
Pilgrim and Lincoln hospitals, part of the United Lincolnshire Hospitals NHS Trust, signed up for the Maternity Engagement Project in February 2023. Following initial audits in February 2023, re-audits were carried out in July 2024. The re-audits consisted of repeating the original audit process and comparing outcomes after changes were implemented. According to Twins Trust, since taking part, Pilgrim unit's NICE adherence has increased from 95.08% to 98.32%, and Lincoln unit's NICE adherence has increased from 67.44% to 95.69%, with both units seeing a reduction in neonatal admissions, and Lincoln's neonatal deaths in multiples reducing from 1.39% to 0.0%.
Both units have introduced a proforma into a multiple pregnancy pack, which is offered to all women with multiples. This clearly defines scan timings and the clinic pathway. Plans are also in place to set up antenatal classes specifically for those pregnant with multiples.
‘United Lincolnshire Hospitals NHS Trust commenced the [Maternity Engagement Project] process in February 2023. I came into post in July 2022, alongside Obstetric Consultant leads for the multiples' service, Vandana Agarwal at Lincoln and Manjusha Sant at Pilgrim. We felt it was sensible that whilst the clinics were in their early stages that we gain support from Twins Trust to ensure early implementation to achieving NICE compliance’.
Abigail Higgins commented that the initial audit gave an indicator of what was already working well, and identified areas for improvement. It also gave advice as to how this could be achieved in the trust. The project allowed for networking with other multiple pregnancy midwives who have completed the project. She noted that ‘this has been invaluable for support and advice from like-minded midwives’.
She also reported that the feedback from families and staff have been positive. Families attend a clinic specialised to their pregnancy, which allows them to feel confident in the care provided. Abigail felt that the staff were more aware of national guidance, which improved knowledge and confidence when providing care.
‘I would encourage other units to sign up to the [Maternity Engagement Project]. The audit process is smooth, and support is available throughout’.
The units have been presented with certificates of recognition to display in the ward.
‘It's heartening that both Pilgrim and Lincoln are passionate about driving change and improving services for families having multiples. The units are one of the top performing units that we have worked with and are offering an exemplary service’.
Twins Trust (2024) released a report, NICE Works II: Transforming Maternity Care for Multiples, that followed on from a 2019 report, the original ‘NICE Works’ (Twins Trust, 2019). The original report showed that when NICE guidelines were followed, those having multiple pregnancies experienced better and safer care.
The new report revealed that 92% (35 out of 36) of maternity units who completed the Maternity Engagement Project improved their adherence to NICE (2024a) guideline 137 and NICE (2024b) quality standard 46. The report also found that there was a statistically significant improvement in overall adherence to NICE (2024b) quality standard 46 of 16.4 percentage points for units who took part in the Maternity Engagement Project.
Three years after starting the project, units, on average, saw their rates of multiple stillbirths and neonatal deaths (in multiple births) both decline by 0.3 percentage points. Their rate of multiple neonatal admissions fell by 10.4 percentage points and their rate of emergency caesarean sections (in multiple births) fell by 6.7 percentage points (Twins Trust, 2024).
‘This research shows the importance of maternity units striving to provide best practice for multiple births. By signing up for our Maternity Engagement Project, all but one unit improved their adherence to the NICE guidelines and we know that this leads to better outcomes for multiple births. We encourage other units to follow suit; it's the wellbeing of the pregnant women and babies that's at stake.’
The Maternity Engagement Project is all about working in partnership with units to create change and make improvements for families expecting multiples. Working with a team of specialist midwives, the year-long process offers units the opportunity to take an in-depth look at their provision and create a service that offers the highest standard of care for families.