Groundbreaking Monash University Study on Stillbirth Prevention

Recent research led by Monash University academics has delivered promising news for maternal and fetal health in Australia. The study reveals that the Safer Baby Bundle, a targeted intervention program, achieved a notable 20 percent reduction in stillbirth rates across participating Victorian hospitals. This initiative, rooted in evidence-based practices, marks a significant step forward in addressing one of the most heartbreaking challenges in obstetrics.

Conducted by a team from Monash University's Department of Obstetrics and Gynaecology, in collaboration with the Hudson Institute of Medical Research and Monash Health, the evaluation underscores the power of structured clinical guidelines. By focusing on late-gestation pregnancies from 28 weeks onward, where many stillbirths are preventable, the bundle addresses critical gaps in antenatal care. This work not only validates the program's effectiveness but also highlights the vital contributions of university-led research to public health outcomes.

What is the Safer Baby Bundle?

The Safer Baby Bundle (SBB) is a nationally coordinated set of clinical guidelines and educational resources designed specifically to lower stillbirth rates in Australia. Developed by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Stillbirth (Stillbirth CRE), it targets five key modifiable risk factors identified through extensive epidemiological analysis.

Launched initially in states like Victoria, New South Wales, and Queensland, the bundle promotes standardized care pathways for maternity services. Unlike isolated interventions, it integrates multiple strategies into a cohesive 'bundle' approach, proven effective in similar programs overseas, such as the UK's Saving Babies' Lives Care Bundle, which saw comparable reductions.

This holistic framework ensures that healthcare providers deliver consistent, high-quality advice and monitoring, empowering pregnant women with actionable knowledge to safeguard their babies.

The Persistent Challenge of Stillbirths in Australia

Despite Australia's reputation for world-class healthcare, stillbirth remains a stubborn issue. Each year, more than 2,100 babies are stillborn after 20 weeks' gestation, equating to over six per day—surpassing the national road toll. The late-gestation stillbirth rate hovers around 2.0 to 2.5 per 1,000 births from 28 weeks, with up to one-third deemed preventable through better antenatal practices.

In Victoria specifically, pre-implementation rates stood at approximately 2.08 stillbirths per 1,000 births in bundle sites. Nationally, progress has been glacial, with only a 1.4 percent annual decline since 2000, lagging behind comparable high-income countries. Factors like smoking, suboptimal fetal monitoring, and sleep positioning contribute disproportionately, particularly among vulnerable groups such as Indigenous women and certain migrant communities.

Monash researchers emphasize that while Australia boasts low overall perinatal risks, targeted interventions like the Safer Baby Bundle are essential to close these gaps and align with global benchmarks.

Unpacking the Monash-Led Research Methodology

The pivotal study, published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, employed a robust retrospective population-based cohort design. Led by Dr. Keeth Mayakaduwage, an adjunct lecturer at Monash and obstetrics resident at Monash Health, it analyzed over 500,000 singleton births from 28 weeks in Victoria between January 2014 and December 2020.

Researchers compared pre-bundle (2014–June 2019) and post-implementation (July 2019–December 2020) periods across Safer Baby Bundle (SBB) sites and non-SBB controls. Interrupted time series analyses and relative risk calculations provided causal insights, controlling for trends in interventions like inductions.

A/Prof. Miranda Davies-Tuck, senior author and Research Group Head at Hudson Institute (affiliated with Monash), oversaw the project, ensuring rigorous statistical modeling. Prof. Euan Wallace, Dean at Monash's Sub-Faculty of Clinical and Molecular Medicine, contributed strategic oversight. This multidisciplinary effort exemplifies how university research translates data into policy impact.

Detailed Results: A 20 Percent Drop in Stillbirths

The findings are compelling. In SBB sites, stillbirth rates fell from 2.08 to 1.64 per 1,000 births—a 21 percent relative reduction (RR 0.79, 95% CI 0.62–1.00, p=0.05). Perinatal mortality dropped from 2.52 to 2.02 per 1,000 (20 percent reduction, RR 0.80, 95% CI 0.65–0.99, p=0.041). Crucially, non-SBB sites showed no such changes.

Declines were linked to fewer unexplained stillbirths and conditions like fetal growth restriction, signaling enhanced detection. Importantly, no uptick occurred in adverse outcomes: caesarean rates, inductions, preterm births, neonatal deaths, or NICU admissions remained stable. Trends in early-term iatrogenic births even reversed in SBB sites, averting potential over-intervention.

These results, from early implementation phases, affirm the bundle's safety and efficacy, providing a blueprint for scaling.

The Five Core Elements of the Safer Baby Bundle

Success hinges on five interconnected elements, each backed by peer-reviewed evidence:

• Supporting smoking cessation: Smoking doubles stillbirth risk; the bundle offers tailored counseling and resources to quit, addressing a key preventable factor affecting 10-15 percent of pregnancies.
• Improving fetal growth restriction (FGR) management: FGR accounts for 20-30 percent of stillbirths; standardized ultrasound protocols from 26-28 weeks enable timely intervention.
• Raising awareness of decreased fetal movements (DFM): Women learn to monitor movements from 28 weeks; prompt clinical assessment upon reduction prevents 50 percent of associated stillbirths.
• Promoting optimal maternal sleep position: Avoiding back-sleeping reduces risk by 2-4 times via improved placental flow; simple advice integrates into antenatal visits.
• Building community awareness: Public campaigns demystify stillbirth risks, encouraging early help-seeking and clinician vigilance.

These steps-by-step protocols ensure comprehensive coverage, with e-learning modules and handbooks aiding adoption.

For deeper dives into clinical research roles supporting such innovations, explore research jobs in higher education.

Victorian Hospitals' Implementation Journey

Victoria pioneered SBB rollout in June 2019 via Safer Care Victoria, phasing it across 22 maternity sites by 2021. Monash Health led championing efforts, integrating bundle training into workflows. Multidisciplinary teams—midwives, obstetricians, GPs—used quality improvement cycles to embed practices.

Challenges like COVID-19 disruptions were navigated through virtual training, achieving high compliance. Preliminary 2020-21 data showed 21 percent stillbirth drops, aligning with study outcomes. This state-wide success, supported by the Consultative Council on Obstetric and Paediatric Mortality, paves the way for national adoption.

Read the full Monash announcement.

Equity Concerns and Population-Specific Impacts

While overall gains are clear, equity gaps persist. No stillbirth reductions occurred in several migrant groups, and perinatal mortality rose among Aboriginal and Torres Strait Islander women during the study. These disparities reflect higher baseline risks—up to double for some demographics—necessitating cultural adaptations.

Stillbirth CRE responded with 'Stronger Bubba Born' for First Nations and 'Growing a Healthy Baby' for migrants, co-designed with communities. A/Prof. Davies-Tuck led migrant tailoring, emphasizing trust-building. Ongoing evaluations will track progress, underscoring research's role in inclusive health.

Monash University's Leadership in Public Health Research

Monash's involvement exemplifies translational research excellence. Through its School of Clinical Sciences at Monash Health and partnerships like Hudson Institute, the university bridges lab-to-bedside. Dr. Mayakaduwage's Honours project evolved into landmark publications, mentored by global experts.

Such endeavors attract top talent; aspiring researchers can find opportunities via career advice for research assistants in Australia or Australian university jobs. Monash's model inspires other institutions to prioritize impactful obstetrics studies.

Voices from the Experts

Dr. Mayakaduwage noted, 'Stillbirths due to unexplained causes declined, suggesting better fetal risk management—without added harms.' A/Prof. Davies-Tuck added, 'Universal programs need cultural tailoring for equity; stillbirth is preventable with timely care.'

Prof. Wallace affirmed, 'A system-wide approach reduces deaths safely.' These insights, drawn from real-world data, guide clinicians nationwide.

Explore Stillbirth CRE resources.

National Rollout and Future Outlook

SBB now spans all jurisdictions, integrated into the National Stillbirth Action Plan. Victoria's proof-of-concept supports expansion, with economic evaluations underway via BMJ Open protocols. Projections: up to 400 preventable stillbirths annually if fully realized.

Future focuses include AI-enhanced monitoring, longitudinal equity studies, and GP integration. Monash commits to follow-ups, potentially revolutionizing perinatal care.

Photo by Fara on Unsplash

Career Implications in Higher Education and Healthcare

This research spotlights demand for experts in epidemiology, obstetrics, and public health. Universities like Monash drive policy via evidence, creating roles in trials and implementation. Professionals eyeing academia can leverage such successes for advancement.

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