A pioneering project working with mothers of twins, triplets and more has reduced the number of caesarean sections and admissions to hospital during pregnancy.

The Twins, Triplets and Multiple Births Association (Tamba) led a three year maternity engagement project, with Professor Asma Khalil, Consultant Obstetrician at St George’s Hospital, chairing the programme.

The project was launched following excellent results at St George’s after following the NICE (National Institute for Care and Excellence) guidance for the past seven years.

The programme worked with 30 maternity units across England to ensure mums expecting twins, triplets or more are treated in line with the NICE multiple pregnancy guidance. In a year, the programme saw 200 fewer neonatal admissions and 105 fewer emergency caesarean sections in a year.

Based on figures from St George’s, if all maternity units in England followed Tamba’s maternity engagement project and implemented similar changes, within a year neonatal admissions in multiples could be reduced by 1,308 and emergency caesarean sections could be reduced by 634, which would save the NHS £8 million. After five years, across the UK up to 100 stillbirths could be prevented each year.

The programme saw Tamba use twin growth charts to measure the babies’ growth so that twins and multiple babies were not delivered early unless absolutely necessary. Twins tend to be smaller and by having the charts, they take into account that they are twins and so they distinguish whether the twins are small because they are healthy or because they aren’t growing properly. It also trained midwives and sonographers to be multiple birth specialists.

Professor Asma Khalil said: “If we are to successfully implement NICE guidelines, dedicated efforts are needed to overcome the barriers, such as raising awareness, updating knowledge, educating healthcare professionals and ensuring that the required resources are available in all maternity hospitals to provide a consistent high quality service.

“We should strive to reduce stillbirth in multiple pregnancies to levels similar to or even lower than singletons.”

Keith Reed, Tamba CEO, said: “We know, and now have the evidence to prove, that following NICE guidance on multiple pregnancies works. As an independent third party with specialist multiple midwives, staff at the units we worked with were keen to become involved, and the results speak for themselves.”


Click here to watch Professor Asma Khalil on BBC’s Victoria Derbyshire programme (4 April 2019) with mum Michelle and her twin boys George and Tommy on the sofa, while Indre and partner Andy Skyped into the programme from Indre’s bed at St George’s two days after giving birth to Abigaile and Gabriele.

The relevant clip starts at 26 mins.

Further information

Click here to read the full report produced by TAMBA.

Notes to editors

For media enquiries, please contact philippa.harper@stgeorges.nhs.uk