Demographic Analysis of a National Intervention to Reduce Preventable Stillbirth.

Abstract

Introduction: The Safer Baby Bundle (SBB), an evidence-based bundle of care to reduce stillbirth, implemented across 21 Victorian maternity services in 2019, has been associated with reduced perinatal mortality rates. Aim(s): As Victorian mothers are from diverse backgrounds, some with higher stillbirth risk, this study aims to explore the impact of the SBB across demographic groups. Method(s): Singleton births >=28 weeks' gestation between 2014 and 2020, excluding congenital anomalies, from the Victorian Perinatal Data Collection were analysed. Rates of perinatal mortality, stillbirth risk factors and iatrogenic birth across maternal country of birth and Indigenous status were compared pre-and post-SBB implementation using a chi2 test. Result(s): Perinatal mortality rates reduced from 2.39 to 1.76 per 1000 births(P = 0.04) in Australian-born women and from 2.54 to 1.98 per 1000 births (P = 0.02) in non-Indigenous women. However, perinatal mortality rates did not change in African (5.30 to 5.16 per 1000 births, P = 0.95), Middle Eastern (1.82 to 2.25 per 1000 births, P = 0.75) and South Asian (2.62 to 2.86 per 1000 births, P = 0.73) women and increased from 0.38 to 3.75 per 1000 births (P = 0.01) in Indigenous women. Early term iatrogenic birth trends reduced by 0.16% per month(P = 0.01) in Australian born and 0.13% per month(P = 0.02) in non-Indigenous women but did not improve in Indigenous women or women born in countries outside Australia. Discussion(s): Early insights show that the SBB has improved outcomes in some, but not all, demographic groups. The ongoing cultural adaptation of the SBB may further improve outcomes, however, the identification of other strategies in these groups should be prioritised.