Public Petitions Committee

Meeting date: Thursday, March 15, 2018

Official Report 509KB pdf

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New Petition

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Multiple Births (Support for Families) (PE1683)

I welcome everyone to the third meeting in 2018 of the Public Petitions Committee. I remind members and others in the room to switch phones and other devices to silent.

The first item on the agenda is consideration of a new petition, PE1683, on support for families with multiple births, which was lodged by Jennifer Edmonstone. The petition calls on the Scottish Parliament to urge the Scottish Government to provide better support for multiple-birth families, including both financial and non-financial support.

I welcome to the meeting Jennifer Edmonstone, along with Helen Peck, who is the Scottish co-ordinator of the Twins and Multiple Births Association. Thank you for attending this morning. You have the opportunity to make a brief opening statement of up to five minutes. After that, the committee will ask a few questions to inform our consideration of the petition and to see whether we can tease out some of the issues you have identified.

Thank you so much for taking the time to see us today. I am the Scottish co-ordinator for TAMBA. I am here today to support Jennifer Edmonstone, who is an activist and the secretary for the East Kilbride twins and triplets club. She will outline the background of our petition and give you evidence of the unique challenges that our families face. I will also help along the way by sharing some stories, which may help you to better understand.

From TAMBA’s point of view, it is timely to be here today for three reasons. First, the Government has just announced that £1.6 million is to be set aside to support families in neonatal care. That is especially important to our families, as 50 per cent of them spend time in neonatal care, and it would be great to know how the money will be allocated to multiple-birth families and those who may have to be transferred to units far away from home. The Government has also announced that it is looking to support an initiative to fill the gaps. As a charity that has never had Government funding before but which delivers many services to support multiple-birth families across Scotland, we would like to hear how you could support us. It would also be fantastic if the committee could gather evidence from other departments to see how policies could better support our families.

I now hand over to Jennifer Edmonstone.

As you are aware, the petition refers to a mixture of reserved and devolved powers. Appreciating this, I ask that you please do not lose sight of the bigger picture when considering the devolved matters, as this area is only as great as the sum of its parts.

My aim today is to build on the headline issues in the petition by highlighting what the typical family of multiples is like. I accept that many of the relevant Scottish Government policies, including the new baby boxes, certain grants for those in need and so on, are aimed at families more generally. However, via the petition, I want to show that having a multiple birth is different in many ways and that, therefore, the Government needs to aim some of its relevant policies directly at families with multiples.

I hope that you will understand fully some of the challenges that families of multiples have been facing for years, which lead to pressure physically, emotionally and financially. Forget the glamour and “trophy factor” of celebrity parents with multiples that is portrayed in the media, as that can often undermine the true struggle. Having multiples is undeniably a privilege, but it is full of extreme highs and there are sometimes extreme lows.

What is typical multiple life like? It starts with a high-risk pregnancy and birth. Three per cent of all United Kingdom births are multiples, and life can be hard for that small number of people, with multiples being two times more likely to be stillborn and six times more likely to have cerebral palsy than a singleton birth. Of the multiples that are born alive, 68 per cent of twins and 95 per cent of triplets are born prematurely compared with 7 per cent of all births, and 15 per cent of twins and 42 per cent of triplets are born very prematurely compared with 6 per cent of all births, leading to 52 per cent of twins requiring extra hospital care. However, that does not account for further medical care that is needed after discharge from hospital, which is a common consequence of having premature babies. Extra time spent in hospital can be expensive for a family, with car park charges and so on, and can require extra time off work. It is, therefore, understandable that postnatal depression and relationship breakdown are more prevalent in families with multiples.

Feeding is another issue that I would like to bring to your attention, as 80 per cent of multiple mothers do not breastfeed compared with 60 per cent of singleton mothers. For those who exclusively formula feed, the cost is about £480 per singleton and over double that—£1,060—for twins. That excludes bottles, sterilisers, and electricity costs, which are also doubled. Several factors have been accounted for in that. Fifty per cent of multiples spend extra time in hospital, meaning that they are introduced to more expensive brands of formula. As it is not recommended that parents switch formula, they are often stuck with that. Unlike first-infant milks, follow-on milks are much cheaper and offers are permitted, but using them goes against health visitor advice. Also, as most multiples are born prematurely, they should be weaned later—at seven months at the earliest—meaning more expense is incurred on formula.

Nursery fees are also a big issue for us. As we are aware, childcare is expensive and can push many families into poverty or financial hardship. That is even more prominent in families with multiples. To evidence this, I have compared the cost of sending two children to nursery on a full-time basis when the mother is back at work. For two children who were born two years apart, it was approximately £55,000 over six years. For two children who were born three years apart—that is the national average age gap between first and second children—it was £64,000 over seven years. For twins, the cost was £70,000 over just a five-year period. When broken down, what does that mean? The average salary is £22,000-ish net. When parents who are on the average salary have two children, they will profit every year that they are in work. However, when parents who are on the average salary have twins between the ages of one and three, the nursery fees will exceed one parent’s salary, which often means that one parent chooses not to return to work, as there is no incentive to.

Finally, there is child benefit. The UK is unusual in paying a premium for the first child that is born. The Government recommends that the money should be used for clothes and food, as the arrival of the first child has the largest impact on finances. If multiples are a mother’s first pregnancy, what is not considered is the requirement for multiple items at the same time: car seats, cots, nappies, food, formula, bottles, bedding, clothes and shoes. It has been estimated that twins do not cost double but about 50 per cent more than having one child, and that needs to be accounted for.

I will quickly give you some global comparisons. France offers an additional 18 weeks of maternity leave for twins and 30 weeks for triplets. Ireland offers a grant for families at birth and then at age four, and child benefit is one and a half times and two times that of a singleton for twins and triplets respectively. Australia allows people to pay off their nursery fees over a longer period of time. All those measures could help.

In conclusion, families of multiples are asking for help. The ways in which the Scottish Government could help are as follows: it could increase and match child benefit for each multiple born; it could provide more funding, earlier, for childcare for families with multiples; and it could support improvements in maternity leave, maternity pay and paternity pay by bringing this petition to the attention of Westminster. If improvements such as those are made, it is likely that women will be in a better position to return to work sooner and multiples will be put on an equal footing with singletons.

Thank you very much. That was absolutely fascinating. All the things that you do not think about were presented there. It really captured the issues of the petition.

You were asked what previous actions you had taken, and you said that you had spoken to your MP, who indicated that she would raise with employers’ groups the issue of referring to families with multiple births in employment policies. Can you give us any further information about your engagement with employers’ groups and what responses you have received?

That work started with Kirsten Oswald and, as things changed in my constituency, it was passed on to Jackson Carlaw. Kirsten Oswald was going to approach employers’ groups, but that fell by the wayside. Then I started engaging with Jackson Carlaw and Paul Masterton instead. They took me on a different path, ending up here.

We can think about that, reflecting on the views of employers’ organisations.

As you have acknowledged, some of the laws and policies relating to maternity leave and support for families are reserved to the UK, while others fall to Scotland within the devolved powers. Let us concentrate for the moment on the devolved powers, which include the powers to top up reserved benefits, healthcare services and early learning and childcare. Within those areas, can you expand on your introductory remarks and tell us where you think the further support you are calling for should be prioritised to make the biggest difference to families?

Childcare is one of the biggest areas and is the most problematic for us. It is stopping us from getting back into the workplace, because it is not permitting people to earn enough of a wage to get back. Any form of top-up in that sense would be helpful. Ways and means of getting children into council nursery care would be helpful as well. Do you have anything to say on that, Helen?

Yes. I have a good story that gives an example of that. A few years ago, I dealt with a mother of triplets who lived out in Clackmannan. Her husband worked away from home: he was four months on and back for a month at a time. She was really isolated and finding it really hard. With three babies and no family around her—her parents lived in Ireland—she was finding it a real struggle. We were in frequent contact with her and urged her to contact Home-Start to see whether it could give her some extra support but, sadly, it did not have the resources in her area. Then she got into contact with her local council and said, “I’m really struggling.” By that point, her kids were aged two and were quite a handful, as you can imagine. She had looked at all sorts of options, even trying to get the triplets into a private nursery, but it was outwith the realms of possibility for her because it was far too expensive.

We ended up helping her to contact her local MSP, who then contacted the council. The council was fantastic, because one of the local school nurseries that normally would not take children until the age of three—her girls were, I think, two and three quarters—made an exception to the rule for Isla Malloy for two days a week. It took the girls for two mornings a week, which for her was categorically a lifeline. She had developed quite bad postnatal depression just because she felt so overwhelmed. That happened purely because she told the MSP, “This is a real problem.”

The issue affects not only mothers of triplets but mothers with twins who are in the same situation. Isla Malloy was a nurse, so she was well aware of the signs of postnatal depression. She was also aware that, in order to continue being a nurse, she would have to keep her hours up, although she found that very challenging just because of the magnitude of having triplets. The council gave her the lifeline that she needed.

Thank you for that. As a matter of interest, which council was it?

It was Clackmannanshire Council.

Well done, Clackmannanshire Council.

Good morning, and well done. I thought that you spoke very well. Your petition calls for better financial and non-financial support for families with multiple births. Among the non-financial support, one of the areas identified in the background information in your petition is encouraging healthcare professionals to be mindful of multiple-birth families. On that point, you provide the specific example of providing one prescription/minor ailments treatment per child rather than grouping multiples together. Could you explain what grouping multiples together means in that regard?

It is probably easiest to explain that I have identical twins, so people usually see them as a unit. In a famous high street chain pharmacy, I registered my children—or so I thought—and was given what I thought were two minor ailments prescriptions. I then went back and the pharmacist said, “Only one of yours has been signed up. We need to sign up the other one.” They had given me one prescription for both of my children.

That does not happen across the board, but it is not uncommon. Other people have seen that. Sometimes, people get confused about the fact that they are two separate people who both need help. That is a specific example of where I was going with that.

09:45  

That would seem to be an issue with the pharmacy, because, legally, they have to be treated individually for treatment and prescriptions. That is why I was confused.

Definitely. It is about saying that they are two individuals. It was maybe not the right example to use, but my two quite often get grouped together, and I think that happens more with identical twins than with fraternal twins.

That is about perception and the way in which people react.

It is an example of how everything is portrayed. I have always been treated as though I had one birth and one child, although I had one birth and two children.

Absolutely. On the theme of healthcare practice, in your opening statement you talked about premature birth and the impact of not being able to breastfeed. A significant piece of work that has been working really well in Scotland is the milk donor bank. A huge amount of breast milk is being donated, particularly to the neonatal units, and we have quite an efficient system of supporting that now. Have you come across the milk donor bank? It would obviously be a major way of solving that problem.

I have not used any donor milk myself. I asked about it and was told that I was not allowed to use it, but I think that maybe I was not in the right circumstances.

How old are your children?

My children are a year and a half old, but I asked earlier on. One of my daughters was having an operation and I was hoping to use donor milk because I had no milk by that stage. It would have meant not needing to starve her for eight hours, but I was told that I would not be allowed it for that. That is the only time that I have come across donor milk.

My girls are going to be 14 on Saturday. I have identical twin girls as well.

Donor milk was not there for you.

It definitely was not. I work quite closely with a lot of the neonatal networks, and I know that the milk bank is an amazing scheme—it really is fantastic. We have done a lot of work on it and were involved with Una McFadyen in the early stages of it.

Do you feel that it is now contributing to solving some of the issues?

Partially, yes, but there is a long way to go. The situation is tainted with other issues that go along with it such as mothers not being encouraged to breastfeed in hospitals. We run a lot of antenatal classes and practical preparing for parenthood classes, and we have first-hand contact with the mums. In some hospitals—purely, I think, because the midwives are too busy—breastfeeding has not been encouraged, shall we say, as much as it should be. Some mothers have even been made to feel slightly put down by being told, “You have two—you will never manage that,” when the reality is that, if they want to, there are methods.

There are methods to support that.

There are methods, yes.

We could also look at that and do some work on it.

Yes.

Quite a few infant feeding specialists have been cut in certain areas. I definitely think that, if I had had more support, I would have had a better chance at succeeding in breastfeeding, although I cannot confirm that.

No, but support does help.

Yes.

I am advised by Angus MacDonald, who has been on the Public Petitions Committee for a lot longer than I have, that the national donor milk bank came about as a consequence of a petition to this committee that was closed in April 2015.

From reading your petition and the background material, and from hearing your presentation, we understand that one of the core concerns underpinning the petition is that, for families with multiple births, the issue of financial cost is not just a case of multiplying the costs that apply for most single births, as you have alluded to, but that additional costs arise as a result of circumstances that are more likely with multiple births. As you said, multiple births are more likely to be premature, and there are additional childcare costs. At the risk of making myself shudder, can I ask what other experiences are multiplied? Do you have examples of experiences that are multiplied in the case of multiple births?

The big one for me is shoes. Anyone who is a parent knows that shoes are very expensive.

On a more serious note, it is the start-up equipment: all the car seats—there is no way you can have only one—the cots, and the double buggy. I know that the double buggy is not two things, but it is a more expensive bit of kit. The cost is not doubled, but there is definitely an impact. Helen Peck and I have said that those first five years are crucial. She can give you more of an example about later on in life, but the beginning is the tough time financially.

There are issues even before your babies arrive, or after your babies arrive but before you have them home. For our parents it is commonplace for their babies to arrive particularly early, and I know families that have spent their life savings travelling back and forth to neonatal care because their babies have been in hospital for a long time. Both babies do not necessarily get discharged from hospital at the same time, so the journey can be necessary for even longer.

Most families do not plan to have a multiple pregnancy. When you find out that you are pregnant with two, or three, or four, your idea of the way that life would be is turned upside down. You may have budgeted for things, but you find yourself saying, “I never budgeted to have to buy two of these, or two of those.” If, like me, you do not have other children, you do not have the joy of having anything that you can hand down. The reusable market is not there. I relied very heavily on things such as NCT sales to be able to afford to buy things in the early days, because it was such a massive amount of things. The baby box is fantastic and will contribute to a certain degree, but some of our mothers will not be able to use the stuff inside it at the very beginning, because it is not in teeny-tiny sizes.

As Helen said, it is the buying two of everything that is the problem. I need to dress both children. I had the naive thought that I might have one wardrobe that I could half between the two of them, but that just did not happen.

Helen picked up on the costs when you are in hospital. I was lucky that my children were in the same hospital—although, yes, they were discharged at different times—but to be in a different hospital, with car-parking charges and nothing to eat other than hospital food, you find yourself stuck and in a bit of a robotic way for a while because you are just living day to day. Your partner has had to take time off work, you are taking time off work, you are eating into those holidays and the costs can mount up very quickly, even in the average multiple birth.

I have broken into a cold sweat. [Laughter.]

I am looking at all my friends with twins with a great deal more sympathy. I thought they put the cute quotient very high.

I believe that Mark Griffin MSP has had a campaign to support families in which a child is receiving neonatal care in hospital and to look at the costs associated with that, to which the Scottish Government has responded very positively. Maybe the Government has a sense of that, and perhaps its response could be extrapolated to the issues that you have highlighted.

Continuing the theme of financial support, your petition says that child benefit for the first child is £20.70 and for every child thereafter it is £13.70. Would you like to see all children in multiple births being paid the first-child level of support?

That would be the optimum. I definitely see things differently because, like Helen Peck, my two are my first two and, again, there is no sharing. I read the child benefit policy from the 1990s, which explained why child benefit came about and why the first child got more. Having a multiple birth puts you in a different financial position.

TAMBA is very good at supporting us. Ever since day 1, it told me that my children are the same—they are equal—but when it comes to child benefit, I have to do a calculation for my standing order to put the two child benefit payments together every month and divide the money so that they get the same. I do not understand why that difference of 12 minutes should make a difference. What the amount should be, I am not sure, but the discrepancy is too great. They should be on the same level, whatever that is. Twins or triplets or more should be treated in the same way.

I agree with Jennifer. It should be the same. If someone has two or three babies, 12 or 20 minutes apart, why should there be a discrepancy between them? It is not that you are having one child and a half child. The other child is a child in its own right.

As to what the payment should be, I do not know. That would have to be thought about, but there should be a fairer split or and the payment should recognise that it is financially really challenging for families. Even for families who are middle earners it is financially challenging in the beginning. I remember speaking to Wendy Alexander years ago, when her babies were born. She was fantastic and she had a really good interview with us. She said that she had absolutely no comprehension of how expensive it would be to have twins or of the magnitude of the effect that the whole thing would have on her life. As much as she would not have changed it for the world, there was no getting away from the fact that the first few years would be particularly financially challenging. I would say that that bit lasts five years. When the children go to school, things seem to even out a bit.

I believe that Ireland has a discrepancy in its child benefit—is it one and half times more for those with twins and two times more for those with triplets?—which is really interesting.

You are probably aware that under the new devolved social security powers, the Government is proposing—it has not been settled yet—a £300 payment to parents of multiple-birth children, and thereafter the normal child benefit. What is your opinion on that?

Will that be means tested?

I do not believe so.

Any step in the right direction is a positive, but I would question whether that is enough. I am an okay earner, and I have had to take a career break. I do not think that £300 would have changed that for me. My career break will be two and half years out of my legal career.

However, it could help you with start-up costs.

It could definitely help me with them. It would not help with getting back to work, but, yes, any step in the right direction would be a good step.

I understand that TAMBA was established in 1978 and has been campaigning and providing support for families with multiple births since then—I am horrified to say that it has been 40 years. [Laughter.] Anyway, in that 40-year period, have you seen any overall change in the way that multiple births are understood and supported by Government, healthcare providers, and so on?

You have alluded a couple of times to the pressure on families. A new baby is a huge emotional pressure anyway, but if you are disproportionately likely to be in hospital, have late discharge, have early or premature births and have anxieties to do with those things, what kind of support is available? Is there something that clicks in once it has been identified that you are having a multiple birth? Are there extra supports there? Could more be done in that regard?

10:00  

I would definitely agree that over the past three to four years, our relationship with the Scottish Government has blossomed. We have done quite a good job of making people more aware of the challenges that our families face, and the Government is really supportive of that.

As I said earlier, we try to fill the gaps where people need support that they do not necessarily get from hospital. We have year-long funding from awards for all Scotland, which enables us to provide free midwife-led, day-long antenatal sessions for every family in Scotland. We do them through maternity units. I can honestly say that within 24 to 48 hours of putting it on the website, the session will fill. We take a maximum of 20 people at each session. It is great that a lot of the hospitals support that, because they do not provide those kinds of sessions to the same extent that we do, purely as a result of financial cuts and things like that. We hope that we will be able to provide them for long time to come.

I will give you some examples of other things that we do. Our families go through quite a hard time in the beginning and a lot of people end up with postnatal depression because of the overwhelming nature of their multiple pregnancy. TAMBA operates something called twinline, which is a phone helpline that is run by volunteers. All our volunteers are trained and are parents of multiples—we have all been there and are able to advise. We also have a group of honorary consultants who are specialists in their fields, so if somebody comes to us with a query about their children going to school and whether the children should be separated into different classes, for example, we can give them specialist advice about how they should approach their school. We are there, filling the gaps.

We also offer bereavement support. We understand that there are other bereavement support groups such as SANDS Lothians, which does a marvellous job, but we run our own specialist bereavement support group for families of multiples. As I am sure that you can appreciate, the loss of a twin or both twins, or triplets or one out of three triplets, is very difficult and different from the pain of families who have lost one baby. I am not saying that it is any worse, but it is different, because if you had identical twins, for example, you have the constant daily reminder, as you watch your child grow, that their sibling is not there, and it is very challenging. Also, if the babies are in neonatal care and you have one surviving child in neonatal care, that can be really distressing too, because people see your baby and they treat you as a mum whereas actually, in your heart, you are still a twin mum, because you carried two babies for such a long time.

On a personal level, I want to echo what Helen is saying. I am just a twin mother, not part of TAMBA. TAMBA has been a really great support, particularly through their antenatal classes. I have not tapped into some of the other support that Helen has referred to, but I echo everything that she has said. Any more funding for TAMBA to provide those services would be fantastic.

So there is not just a financial issue; there is an emotional issue in addition to the kinds of pressures that new mums have anyway.

You have focused on childcare, with regard to returning to work and having the freedom to get some breathing space. We have had the policy of 600 hours of free childcare, and the 1,140 hours offer has started to roll out and should be in place for every child by 2020. Are you getting any feedback from your parents on that? Are they able to access and benefit from that? I presume that that should make quite a big difference to multiple-birth families.

Parents are really grateful for the extra hours of childcare that they can get. The one thing that I would say that is pertinent to our families is that the first three years are so financially challenging. Once your maternity leave is finished, you might think, “I might return to work”, but the two-year wait before your state childcare kicks in makes it impossible to return to work—not for everybody but for a lot of our parents—because of the financial challenges you face in the first three years from the babies being born to their going to nursery. I have to say I was delighted when mine went, because at that stage they had upped the offer by half an hour. I thought, “Yes—fantastic! The things you can get done in half an hour.”

I think Helen and I have both been affected by that.

Do you mean in the period from age one to three?

Yes—or zero to three.

Thank you, again, very much. We now have to think about how we want to take the petition forward. Please will you make available to the clerks the statistics that you quoted in your opening statement? That would be really useful in our pursuing the petition.

Do members have suggestions about how we might take this forward?

Can I comment?

Yes, as long as it is not rude.

You know me so well, convener.

Obviously we should be writing to the Scottish and UK Governments to get their views, but I wonder whether there should be a query as well. One thing that popped out in the evidence is free childcare, which is currently for four and five-year-olds and some vulnerable three year-olds—

It is three and four-year-olds and some vulnerable two-year-olds.

That is the one. Perhaps there is possible question about differentiation and an earlier start for childcare for multiple-birth children.

That was one thing that occurred to me. If there is particular pressure on isolated mums, mums without support or families without support, should the category of “vulnerable children” include multiple-birth children, because of the associated pressures? That is a reasonable question to ask.

We should certainly write to the Scottish Government. We have had some representation from TAMBA, but it might want to say something more. Home-Start has been mentioned, and I know it does fantastic work at the local level. I would be interested to know whether Home-Start is aware of this issue.

We should write to the Royal College of Midwives to seek its views on this.

From a health point of view, there are issues around that starting point. The milk donor bank is increasing its work significantly. We could double-check the advice on not using formula, because obviously that would make a huge difference to mums.

We could write to the Child Poverty Action Group.

Yes.

In addition to the Royal College of Midwives, we should write to the Royal College of Nursing and the Multiple Births Foundation.

We could ask the clerks to look at whether there are other child poverty groups or organisations such as Bliss that would be aware of some of the issues with multiple births. It would also be worth while contacting the Convention of Scottish Local Authorities.

The witnesses mentioned what was done in Ireland. Could we ask the clerks to have a look at what the different kinds of offers are to families in other countries, maybe within Europe?

Could we also check the legal requirements for prescriptions? We should clarify that so that TAMBA can advise mothers what to do in situations where things need to be corrected.

Looking at other countries, I think that France also has an interesting approach to the issue.

Today’s session has opened up a series of issues. The financial one is the most challenging, but there are a lot of emotional issues. The figures that were quoted at the beginning show that when someone in is setting out on this journey, things can be quite stark—maybe I should have known about that—in not just financial terms but emotional terms. There is a series of issues that we can raise.

If, on reflection after the committee session, the witnesses decide that there is anything else that they want to provide us with, they should please feel free to do so. Of course, we will contact you once we get submissions back from the other organisations.

Could I make one last point? The other issue is multiple births that are not the first birth. I think it would be worth including TAMBA’s commentary on that. Obviously the financial implications are slightly different in those circumstances, but it would be worth including that, because otherwise we might focus on just the first birth.

I thank the witnesses very much for their attendance. It has been very interesting and useful, and I look forward to the responses that we get. I have never been so grateful to have only had one child at a time. I did not realise how fortunate I was. Thank you very much.

Thank you very much.

Thank you.

10:09 Meeting suspended.  

10:12 On resuming—