Maternity care during a multiple pregnancy
By the time you read this, you may have booked in with a Lead Maternity Carer (LMC)—a midwife, GP or obstetrician—and found out that you are expecting multiples, and that your maternity care requirements will be different to a singleton pregnancy. Multiple pregnancy is considered high risk, and comes under the “Transfer” category of the guidelines which cover maternity care. Therefore, your midwife or GP must recommend you be referred to a specialist, and the responsibility for your care will be transferred to this specialist. If you already have an obstetrician, there will be no change to your care.
A woman expecting multiples should be referred to an obstetrician as soon as possible, so that potential complications can be considered and assessed. It is very important that the transfer of care happens promptly, so do not accept delays! This is particularly important if you are having monochorionic twins (identical), or triplets, since complications such as Twin-to-Twin Transfusion Syndrome can start as early as 16 weeks. Once referral has occurred, there will be a discussion on your care options for the rest of your pregnancy.
There are several possible options for specialist obstetric care for a multiple pregnancy—the availability of these options may be dependent on where you live in New Zealand. If you are in a provincial area, you may need to travel to a larger centre in order to get appropriate care. Specialist obstetric care options include:
- A hospital obstetrician in the public hospital-based obstetric service, with the hospital’s team of midwives providing antenatal and postnatal care
- A private obstetrician
- Shared care, with your midwife LMC working in partnership with a hospital-based obstetric-led service or private obstetrician.
No matter which service you choose (or is available), you can expect a high standard of care, increased monitoring (scanning) and a partnership approach to ensure that you receive the best care possible.
Often, when a multiple pregnancy is diagnosed, you will have already found an LMC that you feel comfortable with; you may feel upset about your care being transferred to a specialist, and a change in role for your midwife, especially if you have already developed a good relationship with yours. You may feel uncomfortable with the idea of increased monitoring and worried about unnecessary interventions, or that your beliefs and expectations about a “normal” pregnancy and natural childbirth are now not possible.
One of the most important pieces of advice we can give you at this point, is to keep an open mind about the pregnancy and birth, and to always bear in mind that the health professionals providing your maternity care, whether they are obstetricians or midwives, have the same objective: two healthy babies and a healthy mother. As there are many factors that determine the type of pregnancy and birth you will have, taking a flexible approach might save you from having unmet expectations that leave you feeling disappointed or unhappy. So, plan for what you want, but expect the unexpected!
Once you are diagnosed as carrying multiples, your LMC should refer you to an obstetrician, as soon as possible. If you develop serious pregnancy complications, such as TTTS, your obstetrician should refer you to a Maternal Fetal Medicine specialist. This should be done immediately. If you are at a smaller hospital you may be referred onto one of the three Fetal Medicine Units in New Zealand (go to www.nzmfm.health.nz for more information.)
If your babies are born before 35 weeks gestation, your care will be managed by the hospital team (i.e. obstetricians, registrars and midwives), irrespective of who your LMC is. If you have a private specialist, he/she will head the hospital team.
Finally, if you are not happy about your care for any reason, talk to your LMC or obstetrician about your concerns. If you need support with this, phone your local multiple birth club or the Multiples NZ for advice. If you cannot resolve your concerns and are still unhappy with your LMC or obstetrician (and you have the option), change your LMC or obstetrician. Phone your local multiple birth club for the names of midwives or obstetricians that others have found supportive during multiple pregnancy.
Problems finding a specialist or LMC
If you are having problems finding a specialist, your local Hospital must provide care—your GP can refer you to the required service. You can also contact the Ministry of Health to find a local LMC: phone 0800 MUM 2 BE (0800 686 223).
For more information on your maternity care options, click here.
For information on the Legislation governing maternity care for multiple pregnancy, click here.
For more information about talking to your LMC or obstetrician, click here.