Understanding the Safer Baby Bundle and Its Origins

The Safer Baby Bundle (SBB) represents a pivotal advancement in maternal and fetal health care, developed through collaborative efforts by Australia's leading researchers in stillbirth prevention. Originating from the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Stillbirth (Stillbirth CRE), the bundle comprises five evidence-based elements designed specifically to address modifiable risk factors for late-gestation stillbirths, those occurring from 28 weeks onwards. These elements include supporting smoking cessation during pregnancy, improving detection and management of fetal growth restriction, raising awareness and timely response to decreased fetal movements, promoting side-sleeping to avoid supine position from 28 weeks, and facilitating informed discussions on the timing of birth.

In Australia, where stillbirth rates have hovered stubbornly between 6.7 and 7.7 per 1,000 births for over two decades, such interventions are crucial. Each year, more than six babies are stillborn daily, equating to over 2,000 tragedies annually, with late-gestation cases comprising a significant portion. The SBB was rolled out nationally starting around 2020, building on successful models from the UK and Scotland that achieved 20% reductions in stillbirth rates.

Monash University's involvement underscores its leadership in translational medical research, partnering with institutions like the Hudson Institute of Medical Research and Monash Health to bridge the gap between evidence and practice. This initiative aligns with the National Stillbirth Action and Implementation Plan, aiming for a 20% national reduction by embedding standardized care pathways into maternity services.

Monash Researchers Lead Groundbreaking Evaluation Study

Led by Dr. Keeth L.B. Mayakaduwage, an adjunct lecturer in the Department of Obstetrics and Gynaecology at Monash University and resident medical officer at Monash Health, the pivotal evaluation was conducted as part of his Honours project at the Hudson Institute. Supervised by Associate Professor Miranda Davies-Tuck, Research Group Head of Epidemiology and Clinical Trials, and involving Professor Euan Wallace AM, Dean of Clinical and Molecular Medicine at Monash, the research culminated in three linked papers published in December 2025 in the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG).

The studies utilized a retrospective population-based cohort of over 506,000 singleton births at or beyond 28 weeks in Victoria from 2014 to 2020, excluding anomalies and terminations. Interrupted time series analyses compared pre-SBB (January 2014–June 2019) and post-SBB (July 2019–December 2020) periods across 28 participating public maternity services (SBB sites) versus non-participating ones. This rigorous methodology provided early insights into real-world implementation effectiveness.

Dr. Mayakaduwage emphasized, “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.” This work highlights the career trajectory for early-career researchers at Monash, from Honours projects to high-impact publications influencing national policy.

Key Findings: Significant Reductions Without Added Risks

In SBB sites, stillbirth rates trended downward from 2.08 to 1.64 per 1,000 births (relative risk [RR] 0.79, 95% CI 0.62–1.00, p=0.05), approximating a 21% reduction. Perinatal mortality—encompassing stillbirths and neonatal deaths within 28 days—dropped significantly from 2.52 to 2.02 per 1,000 (RR 0.80, 95% CI 0.65–0.99, p=0.041). No such changes occurred in non-SBB sites, underscoring the bundle's attributable impact.

• Decline in unexplained stillbirths and those due to specific perinatal conditions (e.g., from 0.26 to 0.08/1,000 for certain causes, RR 0.30, p=0.015).
• No rise in caesarean sections, inductions, preterm births, neonatal deaths, or NICU admissions.
• Reversal of rising early-term iatrogenic births trend post-SBB (monthly decrease of 0.14%, p=0.015).

These outcomes suggest enhanced antenatal surveillance and risk management, preventing fetal compromise without over-medicalization. For aspiring researchers, this demonstrates how epidemiological studies at universities like Monash can drive clinical change. Explore research assistant roles in maternal health to contribute similarly.

Disparities in Impact: The Need for Culturally Tailored Approaches

While promising, equity remains a challenge. Benefits were uneven: Australian-born women saw stillbirth reductions (1.96 to 1.46/1,000, p=0.08), but several migrant groups showed no improvement, and perinatal mortality rose among Indigenous women. A/Prof Davies-Tuck noted, “Universal programs may not benefit all populations equally if they are not culturally tailored.”

Monash-led co-design has produced adaptations like 'Stronger Bubba Born' for First Nations women and 'Growing a Healthy Baby' in multiple languages (e.g., Arabic, Dari). Ongoing evaluations will assess these. This highlights interdisciplinary research at Monash, integrating epidemiology, community engagement, and policy. For academics, such work exemplifies grant-funded Centres of Excellence driving equity in health outcomes.

Learn more via Stillbirth CRE resources.

Implementation Challenges and Success Factors in Victoria

Victoria's rollout, led by Safer Care Victoria, covered 28 public services by late 2020, amid COVID-19 pressures. Success factors included clinician training via accredited e-learning, handbooks, and masterclasses; multidisciplinary buy-in; and data-driven monitoring via perinatal registries. Barriers like resource constraints were mitigated through partnerships.

Monash Health's championship role, integrating SBB into protocols, exemplifies university-hospital synergies. Prof Wallace stated, “A structured, system-wide approach can reduce preventable deaths while maintaining safety.” This model offers lessons for national scaling, relevant for research jobs in public health implementation science.

Broader Implications for Australian Maternal Health Research

The SBB's success validates bundle care—simplified, evidence-packaged interventions—for complex issues. Australia's stagnant stillbirth rate (7.6/1,000 in 2024) contrasts with potential 20% drops, potentially saving 400+ lives yearly. Monash's contributions position it as a hub for perinatal epidemiology, fostering PhD/postdoc opportunities in big data and trials.

Stakeholders, from midwives to policymakers, praise the non-harmful risk reduction. Future: nationwide equity via adaptations, AI-enhanced monitoring. Aspiring lecturers? Check lecturer jobs in obstetrics at Australian unis.

Expert Perspectives and Stakeholder Reactions

Dr. Mayakaduwage: “Improvements in antenatal detection suggest better fetal risk management.” A/Prof Davies-Tuck: “Stillbirth is devastating, yet preventable with evidence-based care.” Reactions from Stillbirth Foundation Australia and PSANZ endorse expansion.

Indigenous leaders call for Stronger Bubba Born prioritization. This multi-perspective approach enriches Monash's research ecosystem, blending clinical, epidemiological, and cultural lenses.

Future Directions and Opportunities in Stillbirth Research

Ongoing trials, genomic studies, and tech integration (e.g., fetal movement apps) build on SBB. Monash's Hudson Institute pioneers biological insights alongside population studies. National goals by 2025 may extend, with funding via NHMRC.

• Equity-focused RCTs for adaptations.
• Cost-effectiveness analyses.
• Integration with digital health records.

For postdocs, postdoc positions in maternal-fetal medicine abound. Monash exemplifies how university research translates to lives saved.

Photo by Francesca Runza on Unsplash

Actionable Insights for Clinicians, Parents, and Researchers

Clinicians: Audit SBB uptake, train via CRE modules. Parents: Report movements, sleep on side, quit smoking. Researchers: Leverage Victorian Perinatal Data Collection for studies.

In conclusion, Monash's SBB evaluation marks a milestone in higher education-driven public health. Explore Rate My Professor, higher ed jobs, career advice, university jobs, and Australian academic opportunities to join this vital field.