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Best Practice Example

Emmeline Horne, Leeds, LGI & St James’

Questions regarding continuity of care and caring for multiple birth pregnancies

1. What is the team called?

The Twins and Multiple Births Team. We have 3 community midwives Kath Harper, Tracey Campey and Gemma Miller. They are all Band 6 community. We also have Karla Gibson, Maternity support worker and Emmeline Horne who oversees the specialist midwives.

2. How many of them are there?

There are three midwives who make up 1.6 WTE and Karla who works 0.8 WTE.

3. How many mothers do they see overall and how many of these are expecting multiples?

As a team we specialise in women experiencing a multiple pregnancy. There are currently (Jan 2017) 102 women on their case files. This equates to about 120 women per year.

4. What other populations do they focus on?

The team focus only on women experiencing a multiple pregnancy. We provide a full caseload antenatal and postnatal care. We also work with other specialist teams to provide a package of care for women with other health needs, for example the diabetes and mental health team.  Tracey is also a community midwife, so hers is a dual role. It’s hoped eventually all her hours will be for multiple births.

5. Did the team exist already?

The team was formed after the NICE guidelines were updated in 2011 (CG129). It was first launched in its original form in 2013 after one of the midwives had a twin pregnancy herself. She identified a need for having a specialist midwife to give advice and support to multiple birth families. It was originally started on a trial basis at one hospital. Ladies would come in for a clinic appointment and receive advice from her. From there it has evolved and now the team has a full case load of care throughout Leeds Teaching Hospitals where a woman is offered antenatal and postnatal in the hospital setting and at home. The only part of the care not currently provided by the team is intrapartum care. However, this is something that can be offered if and when needed.

6. What did they do to identify the needs of multiple birth mothers? And how did you bring about a change?

Because we had a midwife who went through a multiple pregnancy herself we were able to combine her experience with the NICE guidance. The increased needs of the women including consultant care, extra support with mental wellbeing and access to the right support and resources, such as Tamba. We asked women for feedback via a questionnaire and they wanted more consistency with their midwife and less visits between hospital and community. As the team grew and expanded we began to see all the women around their scan or consultant appointments and where possible we see them when they come to see other speciality doctors as well. We also visit women at home at least once during pregnancy and provide peer support infant feeding classes and antenatal classes during pregnancy with a reunion meet up postnatal.  We’re now doing another audit about what care the women want and their experience of the service. This will be a more formal questionnaire and anonymous. Collecting this feedback will mean we can show the trust we are a valued service and we can use the feedback to develop the service further. It’s still in its infancy as it was only launched in December 2016 

We keep reviewing our service all the time. This week in fact we have a reunion of mums who will come back, having had their babies. They’ll come and talk about their experiences and we make sure we use this feedback to evaluate our service. Our Team Leader Emmeline also attends where possible to get some feedback to take to senior management and CCG’s. There is also a Facebook group for multiple pregnancies in Leeds that the women can access for support and we get some retrospective feedback on there too.

We get a lot of feedback about the antenatal classes. I think what often happens, especially when the women have had children before, is that they hear the words “antenatal class” and they aren’t really that interested. But once they’ve been on one they feel converted! We do lots of participation and physical tasks and I think they are friendlier than some classes where you’re “talked at”. We also do fun things like put piccalilli and marmite in the nappies so they’re realistic when it comes to practising changing the babies. We also show partners how to bath the babies – but this isn’t just about bathing the babies it’s a participation activity. They do it as a group and it gives the partners chance to talk with others expectant parents to share some excitements or anxiety. During this time we are promoting bonding with the baby, and talking about expectations of life with a new born. Ensuring they know it’s important to give mum a break especially if she has had the twins at home all day on her own. It’s not just about the bathing it’s about supporting your partner and helping her. We also talk about how to bond with the baby during pregnancy by feeling the movements, playing music or reading to the baby, helping to build the parent infant relationship.

7. Does mum see one midwife throughout her pregnancy, birth and postnatally?

For pregnancy and postnatal, yes. We provide caseloading care as much a possible so you will see the same midwife for your home visits, antenatal care and postnatal care. All our midwives attend the antenatal classes so if they can’t see their named midwife throughout (for example, if they’re on holiday) they can be confident the other midwives on the team know about mum’s circumstances. But we do make sure they have consistency wherever possible.

However the birth is different, we don’t currently provide a specialist intrapartum service. The woman will have an experienced midwife and consultant available during her delivery who are experienced and trained in the delivery of multiple pregnancy. Everyone also meets Karla (the maternity support worker) so she bridges any potential gaps. The families know she will go with them and provide that continuity if needed.

8. Does mum see one clinician throughout the same period?

Our consultants try maintaining continuity also. We have our multiples clinics on a Monday so the same consultants are in attendance.  They will also provide continuity of care through the birth if they are in during the birth.

9. What choices are parents given in terms of where and how they receive their antenatal care, intrapartum care and postnatal care?

For antenatal care, the choices are a little bit limited in that you’re either at Leeds General Infirmary or St James’ Hospital. The majority of care will be at St James’ but some women are seen at LGI. We also provide some of the care in the home setting.

During intrapartum care there is a lot more choice, we don’t have a midwife-led unit at Leeds but we have midwife-led suites too.

Postnatally, the midwife team will see families on the ward and support with feeding. Once home if they need a visit every day, or they just want the basics, that’s up to them. There is lots of choice about postnatal care.

10. What is the feedback they have received from parents on the service?

We tend to get really good feedback – they all appreciate the continuity of care, especially the ladies who have had babies before and had different care in hospital and community, Our midwives work with all other teams to ensure the care is continuous and the women is central to her care. There is a lot of continuity in the care we provide and that’s what people tend to comment on a lot.

When we did have questionnaires, we had a lot of feedback, and on our Facebook group Twins in Leeds. (We don’t moderate the group, as it isn’t run by us, but we do get a lot of feedback on there). We get a lot of ladies coming to us to say thank you for the wonderful service. I had a letter recently from a mum. It said how much they had really loved the service we provided and they appreciated it and she was really pleased. We often get feedback in letters or cards, they write some lovely things. We share them on our closed staff Facebook group.

We were recently nominated and won the Leeds teaching Hospitals Time to Shine Team of the year which was very competitive. The most special part of this award was we were nominated by the patients. We received over 20 different nominations with women saying how supportive and caring we were and how we went above and beyond. They also praised the charity work we do as a team arranging fundraising events, our last event raised over £1600 for the lullaby trust. All the team were also nominated by the patients for either midwife or maternity support worker of the year which is very rewarding.

11. Has anyone else in your maternity network (or beyond) express an interest in learning more about the service you provide? / copying your model?

We’re a very busy unit and have over 1% of deliveries that are multiple births, probably more.

There have been some questions from other trusts and they ask us what we do. We’re hoping as time moves on they will look at doing it themselves.

The implementation of it is quite easy. I think trusts will need to look at doing things differently for these ladies. We ensured that services and staffing are focused in the areas they are required and ensure no overlapping of appointments to enhance women’s care but also improve efficiency.  



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