1. Keith Reed - Tamba

2. About The Report Completed - Between August 2013 and February 2014 Responses – 3,728 responses from 6 countries Questions – Birth location & gestation Type of care received based on NICE guidance Quality of information and support (ante and post natal) Support received from their country’s multiple birth association Questions on neonatal care & zygosity not included

3. Survey completed by Mothers of twins 92.8% Mothers of triplets 5.7% Fathers 1.2% 94% had given birth in past 6 years 25% in last 2 years 37% in last year Background Information

4. Respondents from 43% UK 12% USA 10% Canada 11% Ireland 15% Australia 9% New Zealand Background Information

5. Weaknesses Self selecting group (not random) Limited response numbers in certain countries (100s) Experience spread over a number of years Do all patients remember their experience?

6. 79% referred to a specialist within one month of 1 st scan Respondents told about association: 19% USA 30% Canada & Australia 50% UK (69% NI) 60% NZ Antenatal Care

7. Hospital Multiple Specific Parent Education 20% +ve

8. 64% of UK parents completing the survey had used Tamba/MBF (63:1) resources Australia 41% of parents made use of AMBA resources Canada 56% attended a multiples prenatal class 34% of American parents attended a parents of multiples class. 32% UK attend a Tamba class. Antenatal Care 64%

9. Gestation and Delivery Average gestation period = 35.7 weeks Twins (NHS 37) = 32.5 weeks Triplets (NHS 33) 19% 4.5%

10. 48% of births spontaneous (67% resulted in C section) 51% of births elective (75% deliveries by C section) 71% of all respondents delivered by csection 49% of UK multiple births resulted in neonatal care being required Australia has highest level with 65% requiring neonatal care Gestation and Delivery

11. Specialist clinicians 67% Australia to 79% New Zealand Specialist sonographers 28% UK to 63% USA 25% of respondents in NZ didn’t know Named Specialist clinician & sonographer

12. New Zealand leads the way 36% Ireland 25% Australia 20% UK 18% (Audit 10%) USA 4% Named Specialist Midwife

13. Satisfaction Consultant advice on delivery: 84% Ireland – 92% USA Postnatal care: 53% UK – 85% USA (similar for neonatal care) Midwives’ advice on delivery 63% Australia - NZ 77% Caring for babies post discharge 49% UK - 73% NZ

14. Ultrasound & screening Over 92% offered within 14 weeks Frequency: 6 (UK - 16% and Canada - 16%) 10 (Ireland - 23%, USA - 15%, Australia - 16.7% and New Zealand - 14.9%). 20 + scans. USA 27% - most common Over 80% chronicity established 1 st ultrasound Downs screening offered 85% UK – 92% Australia

15. Feeding Breastfeeding is most popular in 5 out of the 6 countries Breastfeeding preferred by 62.2% of mothers in NZ (37.9% UK) 74% NZ received good feeding advice (55.7% UK)

16. 50% given advice on safe sleeping 62% parents co-bedded their multiples 20% of parents co-bed with their babies 25% of multiples in UK remain in same room as parents for 5-6 months Sleeping

17. Less Risky Conclusions? Latest clinical guidance not fully embedded (UK) but improvements over time Clinical teams need to make sure information doesn’t fall through the gaps Patient groups could and do fill in some service delivery gaps (referral delays and patient education) More breastfeeding support appears to create more breastfeeding success (NZ) Greater need for safe sleeping advice (esp parent cobedding)

18. Future questions? Are high no. of scans in USA and neonatal rate in Australia a reflection of practice? Higher satisfaction rates among specialist clinicians helpful for future service models? Is good expert support more important than antenatal education? (NZ) What impact does good advice and support in pregnancy have on later life experience?