The Safer Baby Bundle national rollout

The Safer Baby Bundle (SBB) was initially implemented by the health departments across Victoria, Queensland and New South Wales. Educational programs for health care providers were developed including the SBB eLearning program . All resources are based on the best available evidence as summarised in the position statements and guidelines.

Through additional MRFF funding, the SBB was up scaled nationally. Formal partnerships with jurisdictional Health Departments to implement the Safer Baby Bundle (SBB) were obtained across all Australian States and Territories. All states and territories have representation on the National Stillbirth Evidence and Implementation Operational and Steering Committees, enabling high-level collaboration between jurisdictions and cohesive approaches towards implementation and evaluation. Delays with launching implementation programs and disruptions to programs caused by the COVID pandemic were extensive. Thus, timelines and implementation approaches have varied.

The SBB has successfully decreased the gap between what is known and what is done in maternity care to both prevent stillbirth and allow women to have safer pregnancies. For parents, consistent and clear messaging has improved awareness and understanding of three important actions pregnant women can utilise to help reduce the risk of stillbirth; go to sleep on your side after 28 weeks of pregnancy; be aware of your baby’s movements and contact your maternity care professional immediately if movements change; and if you smoke, stop and avoid being around other people’s cigarette smoke.

A focus of the initiative was to optimise care for all women by improving access to high-quality and culturally safe care. Despite substantial disruptions posed by the COVID pandemic, our evaluation shows that maternity healthcare professionals across Australia have engaged well with the SBB initiative and improved their practices for monitoring and detecting if a baby is not growing well enough (a key strategy to prevent stillbirth). Reassuringly, the changes in practice as a result of the SBB did not appear to increase obstetric intervention or preterm birth rates.

Exceptional outcomes in Victoria, the first jurisdiction to implement the program, demonstrated the initiative was able to safely reduce the number of women experiencing late gestation stillbirth by 21%. Nationally, a reduction in the late gestation stillbirth rate is not yet observed, however, all components of the SBB are yet to be fully embedded into standard care across maternity services. Also, the impact of COVID in potentially raising stillbirth rates may have mitigated the reductions in other jurisdictions that commenced later than Victoria. 

Strong collaboration with Departments of Health across all states and territories to implement the Safer Baby Bundle was crucial to ensuring the high visibility, acceptability, and feasibility of the national rollout.

Key demonstrated outcomes of the SBB:

• A multi-faceted national clinical education program receiving overwhelmingly positive feedback and gaining impressive national multi-disciplinary reach (including rural and remote and indigenous settings).
• Co-designed and accessible parent-facing resources (translated into 23 languages) and key messages shared widely and amplified by partnering organisations.
• Appropriateness and acceptability of the initiative were high, demonstrated through published evaluations of education programs, aligning public awareness campaigns, and consultations with women and HCPs.
• New approaches for monitoring and comparing key performance indicators at a national level (for strategies to reduce stillbirth) were established and have also been integrated into clinical dashboards, sustaining change with the provision of real-time data (e.g. in NSW, WA and QLD).
• Victorian services saw a 21% reduction in the rate of late gestation stillbirth.

Through analysis of routinely collected national data, the impact of the SBB on stillbirth rates and other important clinical outcomes remains the focus of the Stillbirth CRE’s ongoing program of work. It is anticipated that these data will be available from data custodians late 2024, for analysis and publication mid-2025.

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03401-0