Quality statement 3: Composition of the multidisciplinary core team

Quality statement

Women with a multiple pregnancy are cared for by a multidisciplinary core team.

Rationale

Women with a multiple pregnancy should have their clinical care provided by a multidisciplinary core team because of the increased risks and complications associated with multiple births. Members of this team will have the expertise needed to provide high-quality care for women with a multiple pregnancy. It may be appropriate for the multidisciplinary core team to refer women to the community midwifery team for some of their additional antenatal appointments.

Quality measures

Structure

Evidence of local arrangements to ensure that women with a multiple pregnancy are cared for by a multidisciplinary core team.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women with a multiple pregnancy to be cared for by a multidisciplinary core team.

Healthcare practitioners ensure that women with a multiple pregnancy are cared for by a multidisciplinary core team.

Commissioners ensure that they commission services for women with a multiple pregnancy to be cared for by a multidisciplinary core team.

Women who are pregnant with twins or triplets (referred to as a multiple pregnancy) are cared for by a team of healthcare professionals with different skills and roles (for example, specialist doctors, specialist midwives and ultrasound operators).

Source guidance

Twin and triplet pregnancy (2019) NICE guideline NG137, recommendation 1.3.1

Definitions of terms used in this quality statement

Multiple pregnancy

A multiple pregnancy is defined as a twin or triplet pregnancy.

[Expert opinion]

Multidisciplinary core team

A multidisciplinary core team of named specialists consists of specialist obstetricians, specialist midwives and ultrasonographers, all of whom have experience and knowledge of managing twin and triplet pregnancies.

A specialist obstetrician is an obstetrician with a special interest, experience and knowledge of managing multiple pregnancy, and who works regularly with women with a multiple pregnancy.

A specialist midwife is a midwife with a special interest, experience and knowledge of managing multiple pregnancy, and who works regularly with women with a multiple pregnancy.

An ultrasonographer is a healthcare professional with a postgraduate certificate in the performance and interpretation of obstetric ultrasound examinations.

The multidisciplinary core team should coordinate clinical care for women with twin and triplet pregnancies to:

  • minimise the number of hospital visits

  • provide care as close to the woman's home as possible

  • provide continuity of care within and between hospitals and the community; the community includes GPs in primary care, and community midwives and health visitors.

The multidisciplinary core team should offer information and emotional support specific to twin and triplet pregnancies at their first contact with the woman and provide ongoing opportunities for further discussion and advice including:

  • antenatal and postnatal mental health and wellbeing

  • antenatal nutrition

  • the risks, symptoms and signs of preterm labour and the potential need for corticosteroids for fetal lung maturation

  • likely timing and possible modes of delivery

  • breastfeeding

  • parenting.

[Adapted from NICE's guideline on twin and triplet pregnancy, recommendations 1.3.1, 1.3.4, 1.3.5 and terms used in this guideline]