Quality statement 8: Preparation for birth

Quality statement

Women with a multiple pregnancy have a discussion by 28 weeks with one or more members of the multidisciplinary core team about the timing of birth and possible modes of delivery so that a birth plan can be agreed.

Rationale

Most women with multiple pregnancies deliver by 37 weeks either spontaneously or electively. This discussion should include the risks and benefits of different modes of birth and how they are managed to enable women to make an informed decision about their birth preference. Women should also be informed that a preterm birth is associated with an increased risk of admission to a neonatal unit.

Quality measures

Structure

Evidence of local arrangements to ensure that women with a multiple pregnancy have a discussion with one or more members of the multidisciplinary core team by 28 weeks about the timing of birth and possible modes of delivery so that a birth plan can be agreed.

Data source: Local data collection.

Process

The proportion of women with a multiple pregnancy who have a discussion with one or more members of the multidisciplinary core team by 28 weeks about the timing of birth and possible modes of delivery.

Numerator – the number of women in the denominator who have had a discussion with one or more members of the multidisciplinary core team by 28 weeks about the timing of birth and possible modes of delivery.

Denominator – the number of women with a multiple pregnancy of 28 weeks or more.

Data source: Local data collection.

Outcome

Women feel well informed and able to make decisions that reflect what is important to them about the options for delivery.

Data source: Local data collection. The Maternity Services Data Set collects data on delivery method (global number 2016160) and gestational age at birth (global number 17206120). Data will also be collected against NHS Outcomes Framework 2013/14: indicator 4.5 'Women's experience of maternity services'.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women with a multiple pregnancy to have a discussion with one or more members of the multidisciplinary core team by 28 weeks about the timing of birth and possible modes of delivery so that a birth plan can be agreed.

Healthcare practitioners from the multidisciplinary core team ensure that the timing of birth and possible modes of delivery are discussed with women with a multiple pregnancy by 28 weeks so that a birth plan can be agreed.

Commissioners ensure that they commission services so that women with a multiple pregnancy have a discussion with one or more members of the multidisciplinary core team by 28 weeks about the timing of birth and possible modes of delivery so that a birth plan can be agreed.

Women who are pregnant with twins or triplets (referred to as a multiple pregnancy) have a discussion with one or more members of their healthcare team about the timing of the birth and how they want their babies to be delivered. This discussion needs to take place by 28 weeks of their pregnancy and include agreement of their birth plan.

Source guidance

Twin and triplet pregnancy (2019) NICE guideline NG137, recommendation 1.8.2

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.

[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]

Equality and diversity considerations

Information on the timing of birth and possible modes of delivery should be understood by all women to enable them to make informed decisions. Information should be provided in an accessible format (particularly for women with physical, sensory or learning disabilities, and women who do not speak or read English).