On 15 October the Safer Baby Bundle Handbook and Resource Guide was officially launched at a parliamentary briefing. Last year, there was a Select Committee Inquiry into the Future of Stillbirth Research and Education and the Safer Baby Bundle is one tangible outcome that came out of the recommendations to the inquiry. The National Rural Health Alliance provided a submission to the Select Committee Inquiry and presented as a witness at the senate committee hearing.
Stillbirth remains a significant issue for women and their families in rural and particularly remote Australia. The Australian Institute of Health and Welfare (AIHW) data also shows that the further away women are from a major city the higher the rate of stillbirth. In 2013-2014, there were 4,419 stillbirths reported which equates to a rate of 7.1 deaths per 1,000 births in Australia (AIHW 2018). Approximately 33% of stillbirths (1481 stillbirths) are to women from rural and remote areas of Australia.
In addition to the known risk factors for stillbirth such as smoking in pregnancy, maternal overweight and obesity, advanced maternal age (>35 years), primiparity, pre-existing disease such as diabetes and hypertension, women in rural areas have additional risk factors. These additional risk factors relate to access to maternal health care. Closures of small maternity units have had a negative impact on maternal health and wellbeing, resulting in an increased number of women not reporting they are pregnant and delaying or avoiding antenatal care. As a result they are not engaged with the health care system and present late for care, consequently risks to maternal and fetal health can be missed. There are also increased numbers of unplanned out of hospital births.
The Safer Baby Bundle covers other known risk factors for stillbirth and it is hoped that the new guidelines will reduce the rate of stillbirths by 20%. However, the issue of timely and culturally appropriate maternal health care remains unchanged. Future work around reducing stillbirth in rural and remote Australia needs to include how the Safer Baby Bundle will be implemented, how the rural and remote health workforce can be supported to undertake the eLearning training. In addition to how health services and health professionals will be supported to implement the guidelines into their practice. For example, what strategies will be put in place to assist a rural midwife who is assessing a woman reporting decreased fetal movements.
The guideline indicates an ultrasound scan is one tool that should be used to confirm the presence of a fetal heart beat. However, in some rural and remote areas accessing an ultrasound scan is problematic because the service is not available or there are no staff available to provide the service. A submission to the Senate Inquiry into the availability and Accessibility of diagnostic imaging equipment around Australia by the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT), the peak national body, supports this.
In addition, given that there are higher rates of stillbirth outside of major cities, a tailored education and awareness program needs to be implemented to raise awareness of stillbirth risks and provide local solutions for women and their families to prevent stillbirth and to provide immediate support in the event of stillbirth occurring.
The Safer Baby Bundle has been developed by integrating the evidence base on what is known to date about factors that can prevent stillbirth with knowledge gained from lived experiences from bereaved parents and their families. The eLearning package, guidelines and resources from a suite of informational support for maternity healthcare professionals. The e-learning modules are free and are accredited CPD training. For more information go to the Safer Baby Bundle website.