Fewer stillbirths and reduced perinatal mortality: they are the key findings of the first analysis of the Safer Baby Bundle, Australia's national stillbirth prevention program.
The Safer Baby Bundle is a set of evidence-based clinical guidelines and educational resources developed by the Centre of Research Excellence in Stillbirthfor clinicians and pregnant women to help prevent the tragedy of stillbirth.
In Australia, more than six babies are stillborn every day and a further two die within the first 28 days of life. In 2022, there were over 3,000 perinatal deaths, representing around one percent of all births.
Researchers from Hudson Institute of Medical Research, Monash University and Monash Health have now conducted the first evaluation of the Bundle's impact in Victoria, with very encouraging results.
Impact and equity of Safer Baby Bundle
Across three linked studies published in The Australian and New Zealand Journal of Obstetrics and Gynaecology, Dr Keeth Mayakaduwage and Associate Professor Miranda Davies-Tuck examined whether the Safer Baby Bundle reduced stillbirth and perinatal mortality, changed the causes of perinatal death, and whether its benefits were experienced equitably across population groups.
Dr Mayakaduwage, the primary author of the series, is an obstetrics and gynaecology (O&G) resident medical officer at Monash Health and an adjunct lecturer in the Department of O&G at Monash University. He undertook this work as part of his Honours project at the Hudson Institute of Medical Research, supervised by senior author A/Prof Davies-Tuck, Research Group Head of Epidemiology and Clinical Trials and NHMRC Centre of Research Excellence in Stillbirth investigators.
Dr Mayakaduwage believes the findings provide critical evidence to guide safe, effective, and equitable national implementation.
"We found that implementation of the Safer Baby Bundle in participating Victorian maternity services was associated with a reduction in stillbirth and a statistically significant reduction in overall perinatal mortality, without an increase in unintended harms such as caesarean section, induction of labour, preterm birth, or neonatal intensive care admission," Dr Mayakaduwage said.
"Stillbirths due to unexplained causes and specific perinatal conditions declined in Safer Baby Bundle sites, suggesting improvements in antenatal detection and management of fetal risk," he said. "However, these benefits were not observed across all population groups, with no improvement seen among several migrant groups and an increase in perinatal mortality among Indigenous women during the study period."
Stillbirth reduction is achievable
A/Prof Davies-Tuck added "These findings are significant because they demonstrate that stillbirth reduction is achievable at scale, while also highlighting that universal programs may not benefit all populations equally if they are not culturally tailored."
Australia is one of the safest countries in which to give birth, but progress in reducing stillbirth has been slow and uneven, underscoring the need for effective, evidence-based national prevention programs.
"Certain demographic groups, including migrant and Indigenous populations, experience disproportionately higher risks of stillbirth, reinforcing the need for culturally safe and targeted prevention strategies," A/Prof Davies-Tuck said.
The Centre of Research Excellence in Stillbirth has now adapted the Safer Baby Bundle for Indigenous women and for migrant and refugee communities in Australia. A/Prof Davies-Tuck led the cultural adaptation for migrant and refugee communities, through a co-design process developed in partnership with these communities.
"Families need maternity care that identifies babies at risk earlier, responds appropriately to warning signs, and does so without exposing mothers and babies to unnecessary intervention," she said. "Stillbirth is devastating, yet many cases are potentially preventable with timely, evidence-based antenatal care."
Reducing preventable deaths
Professor Euan Wallace AM, recently appointed Chief Research and Innovation Officer at Monash Health and Dean, Sub-Faculty of Clinical and Molecular Medicine at Monash University, is a co-author on the series. "This research shows that a structured, system-wide approach can reduce preventable deaths while maintaining safety for mothers and newborns. Importantly, it also identifies populations who did not experience these benefits," he said.
Dr Mayakaduwage noted that this evaluation was conducted prior to the rollout of the culturally adapted bundles, and ongoing evaluations will be critical to determine whether these adaptations improve outcomes and equity for these groups.
He also acknowledged Safer Care Victoria and the Consultative Council on Obstetric and Paediatric Mortality and Morbidity for their leadership in rolling out the Safer Baby Bundle across Victoria. Developed by the Centre of Research Excellence in Stillbirth, the bundle forms part of the National Stillbirth Action and Implementation Plan.
