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Premature twins defy the odds thanks to expert care at the RVI's Top Rated Maternity Unit

When identical twins Leon Andrew and David John Plummer were born at the Newcastle’s Royal Victoria Infirmary (RVI) on Wednesday 30th April 2008, they arrived 3 months early and weighed less than 2lbs each – about a third of the normal weight for a newborn twin. Being born so prematurely means that their lungs, brains and other vital organs were not properly developed and so specially trained staff were ready and waiting for their early arrival into the world at the RVI’s Maternity Unit - recently rated by government health watchdog, the NHSLA, as the top rated unit in the North East and one of the very best in the country achieving the highest assessment level possible (CNST Level 3) for a second time in a row. The RVI’s expert team have been caring for the twins ever since birth.  

Their proud parents Clare, 33 and John, 39 from Gosforth, Newcastle first became aware that there might be something wrong during the twins’ pregnancy when Clare started bleeding at just 11 weeks. She had an ultrasound scan at the RVI which was when they found out that the babies had Twin to Twin Transfusion Syndrome – a life-threatening condition which affects the blood supply being shared by twins in the placenta with one  receiving not enough and the other too much blood. This news was devastating for Clare and John but they were reassured that they were already in the very best hands at the RVI with access to nationally renowned experts in caring for babies.  Clare was quickly referred to the expert care of Dr Stephen Sturgiss, a Consultant in Fetal Medicine who has specialist knowledge and experience of this rare syndrome which affects around 10% of all identical twin pregnancies.

Dr Sturgiss recalls “When Clare came into our care we confirmed there was more fluid than usual around one of the twins, and less fluid than usual around the other and we decided to carry out ultrasound scans every week to monitor their progress. By 17 weeks into the pregnancy it was clear that the situation was not improving and in order to give the twins the best possible chance of survival, it was decided that Clare should have a highly specialist “keyhole” laser operation in her tummy to stop any further blood flow between the babies”.

The operation was successful and things seemed to have settled down when all of a sudden, 22 weeks into her pregnancy Clare's waters broke while she was shopping in Asda - she went straight to the RVI where doctors were concerned that she might be about to go into labour. 

Sandra Bosman, the very first midwife In the UK dedicated to looking after mums with multiple births, has looked after Clare and John throughout their rollercoaster of a journey and says "Some babies have survived when born at 22 weeks but it's very touch and go and so this was a very stressful time for Clare and John." Thankfully Clare didn't go into labour and she was allowed home to rest and wait, continuing to be closely monitored at the RVI twice a week. 

When Clare took a turn for the worse and became very ill with an infection at 26 weeks, the doctors decided to perform an emergency caesarean section. The powerful treatment Clare needed to fight off the infection could have harmed the twins and they could not stay in the womb any longer as they were in danger of contracting the infection themselves. So on Wednesday 30th April 2008 at 2:36pm Leon Andrew was born weighing just 1lb 7oz and his brother David John followed just one minute later weighing 1lb 11oz. The tiny new arrivals were taken straight to the Special Care Baby Unit where they were met by a team of expert doctors and nurses, specially trained to provide the intensive and complex care they needed to help them breathe with special ventilators.

Clare was looked after on one of the postnatal wards after the birth and a few days later was well enough to go home but she found it really hard to be discharged without being able to take them home with her.  "I feel like I've missed and  I found it hard not bonding with my children - I sometimes feel like I'm not their mother", says Clare.

Sandra Bosman adds "It is a very common problem for parents who have premature babies to have to deal with and we work extremely closely with them to make sure they get all the support they need to help them cope. Clare and John havev been on a very emotional journey - one minute the twins are doing beautifully and the next they are not so well again" adds Sandra.".

"On top of all this we have three other children who need our care and attention as well", says John "so I would be coming into hospital to see Clare and the twins, go home to make sure the other kids had their tea and then we’d go back to the hospital. It's been a long hard journey."

Clare and John's other children, Connor (9), Abby (5) and Piper (3) have been to visit their new twin brothers.  "They keep asking why they are not coming home though" says Clare, "They don't understand".

The twins are expected to stay at the RVI for a little while yet. Leon recently had an operation for a bowel complication that affects around 1% of premature babies, because it had not been able to develop properly. He will need to stay in hospital to allow the bowel to heal and then will be able to go home using nappies like any other baby.

Dr Martin Ward Platt, one of the Consultant Paediatricians looking after the twins, commented: "We are very pleased with their progress.  They are still some way off getting home, but once they do we will follow them up carefully to make sure all is well."

Clare and John, who also has a daughter called Caitlin (9) have only been able to cuddle their new additions to the family about half a dozen times and feel like they have been on a terrible rollercoaster. "It's so hard", says John "you don't know what you're going to come into from day to day. But right the way through from the first scan onwards all the staff have been absolutely marvellous."

“Now all we need is a larger car” jokes Clare “as we’ve got quite a size of a family now our little car just won’t cope!”.

Notes to editors:

• Since 2000 the number of babies born at the Royal Victoria Infirmary has increased by 25%.  6,400 births this year will be a record for the hospital and we expect there will be more.
• The RVI’s Maternity Unit is the only unit of its size, volume and complex activity in the country to have been rated as “Best Performing” by the government health watchdog Healthcare Commission and been awarded CNST Level 3 status twice in a row. This is the highest possible level for assessment by the NHS Litigation Authority which supports hospital Trusts to reduce legal claims by improving their services and demonstrates exceptionally high standards in its risk management and health & safety approach in the care of women in childbirth and newborns.
• The Level 3 rating is also excellent news for pregnant women in the area, who can be reassured that by choosing to give birth at the RVI they are opting for extremely high quality maternity care.
• The NHSLA Assessment for Maternity Services cover eight areas:

(i)   Ensuring the maternity service is organised in a way that embeds risk management into everyday culture as an integral part of good clinical practice

(ii)  Learning from experience by proactively involving women and their families to constantly evaluate and improve care provided.

(iii) Communicating clearly and fully so parents always know their care and treatment choices and what is going on at all times. Also ensuring clear communication channels between all staff at all times.

(iv)  Providing the very best clinical care for mums and their babies.

(v)   Ensuring comprehensive induction, training and competency assessments for all staff so we know their practice is the best and safest possible.

(vi)  Completing complete and accurate health records.

(vii)  Implementing high standards of clinical risk management so that staff have a thorough understanding of risks facing mums and their babies to act accordingly in their best interests.

(viii)  Making sure there are adequate staffing levels at all times with more consultants and midwives than ever before.