Improving multiple birth care is a priority. Recent reports have identified failings in effective care and demonstrated that the gap in stillbirth rates between singleton and multiple births is widening (Ockenden 2022, Draper 2022). The NICE guidelines recommend a core team, including a Multiple Birth Midwife, to provide multiple pregnancy care (NICE, 2019).
Researchers
- Lorna Hibberd, Research Assistant, Elizabeth Bryan Multiple Births Centre, Birmingham City University, lorna.hibberd@bcu.ac.uk
- Martha Burlingham, Research Assistant, Elizabeth Bryan Multiple Births Centre, Birmingham City University, martha.burlingham@bcu.ac.uk
- Jane Denton, CBE, F RCN, Co-lead Elizabeth Bryan Multiple Births Centre & Director Multiple Births Foundation jane.denton@bcu.ac.uk
- Nathalie Turville, Deputy Director, Elizabeth Bryan Multiple Births Centre, Birmingham City University, Nathalie.turville@bcu.ac.uk
- Carmel Bagness, RCN Professional Lead Midwifery & Women’s Health, carmel.bagness@rcn.org.uk
- Elizabeth Bailey, Director, Elizabeth Bryan Multiple Births Centre, Birmingham City University elizabeth.bailey@bcu.ac.uk
Research background
Improving multiple birth care is a priority. Recent reports have identified failings in effective care and demonstrated that the gap in stillbirth rates between singleton and multiple births is widening (Ockenden 2022, Draper 2022). The NICE guidelines recommend a core team, including a Multiple Birth Midwife, to provide multiple pregnancy care (NICE, 2019). However, the specialist role remained undefined. Supported by the Multiple Births Foundation (MBF), the Royal College of Nursing (RCN) created the Multiple Births Midwife Standard (MBMS) to set a role standard. In 2022, the MBF and Birmingham City University’s Elizabeth Bryan Multiple Births Centre (EBMBC), with RCN collaboration, reviewed the distribution and implementation of the Standard, to make recommendations for maternity services.
Research aim
To evaluate the distribution, awareness and implementation of the Multiple Births Midwife Standard in UK maternity services and, based on this, make recommendations for implementation uptake.
Research methods and approach
An anonymous online survey was distributed to Directors/Heads of Midwifery for each UK maternity service, where snowball sampling ensured the survey reached the most appropriate respondents within organisations. The survey was developed using an Appreciative Inquiry (AI) approach, asking about what worked well and what could be improved. Through highlighting examples of successful implementation and actively involving practitioners, the evaluation sought to encourage organisations to improve implementation practices. A realist view aided in identifying potential implementation barriers and explored opportunities for optimal real-world use.
Simple statistics were used to describe the outcomes (percentages, ratios etc) from quantitative and categorical data responses. Specific relationships between data points were not anticipated to contribute to the interpretation of the findings, and so statistical analysis was not performed.
An emergent, or flexible, analysis approach was undertaken to identify themes from the qualitative data, which varied in breadth and depth. Thematic analysis (Braun and Clarke, 2006) facilitated an understanding of the findings through an AI lens, answering ‘what is working well?’ and ‘what could be improved?’. Thematic analysis involves reading and re-reading survey text data and coding for common themes. Partial and complete quotes that support the themes and findings can be found in the supplementary material.
Project outcomes
This report has highlighted significant shortcomings in the implementation of the MBMS across services, whilst celebrating successes and producing recommendations to improve implementations for all. Ultimately, actions need to be taken by organisations to implement MBM roles and to meet the National Institute of Health and Clinical Excellence (NICE) guideline [NG137] Twin and Triplet pregnancy (2019).