Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
Institute for Social Science Research, The University of Queensland, Brisbane, Australia.
BMC Pregnancy Childbirth. 2024 Aug 1;24(1):520. doi: 10.1186/s12884-024-06712-8.
The Safer Baby Bundle (SBB) aimed to reduce stillbirth rates in Australia through improving pregnancy care across five elements; smoking cessation, fetal growth restriction (FGR), decreased fetal movements (DFM), side sleeping in late pregnancy and decision making around timing of birth. We assessed experiences of women and healthcare professionals (HCPs) with antenatal care practices around the five elements.
A pre-post study design using online surveys was employed to assess change in HCPs awareness, knowledge, and frequency of performing recommended practices (22 in total) and women's experiences of care received related to reducing their chance of stillbirth. Women who had received antenatal care and HCPs (midwives and doctors) at services participating in the SBB implementation program in two Australian states were invited to participate. Surveys were distributed over January to July 2020 (pre) and August to December 2022 (post). Comparison of pre-post responses was undertaken using Fisher's exact, Pearson's chi-squared or Wilcoxon rank-sum tests.
1,225 women (pre-1096/post-129) and 1,415 HCPs (pre-1148/post-267, ≥ 83% midwives) completed the surveys. The frequency of HCPs performing best practice 'all the time' significantly improved post-SBB implementation across all elements including providing advice to women on side sleeping (20.4-79.4%, p < 0.001) and benefits of smoking cessation (54.5-74.5%, p < 0.001), provision of DFM brochure (43.2-85.1%, p < 0.001), risk assessments for FGR (59.2-84.1%, p < 0.001) and stillbirth (44.5-73.2%, p < 0.001). Practices around smoking cessation in general showed less improvement e.g. using the 'Ask, Advise and Help' brief advice model at each visit (15.6-20.3%, p = 0.088). Post-implementation more women recalled conversations about stillbirth and risk reduction (32.2-50.4%, p < 0.001) and most HCPs reported including these conversations in their routine care (35.1-83.0%, p < 0.001). Most HCPs agreed that the SBB had become part of their routine practice (85.0%).
Implementation of the SBB was associated with improvements in practice across all targeted elements of care in stillbirth prevention including conversations with women around stillbirth risk reduction. Further consideration is needed around strategies to increase uptake of practices that were more resistant to change such as smoking cessation support.
The Safer Baby Bundle Study was retrospectively registered on the Australian New Zealand Clinical Trials Registry database, ACTRN12619001777189, date assigned 16/12/2019.
Safe Baby Bundle（SBB）旨在通过改善五个要素的妊娠护理来降低澳大利亚的死产率；戒烟、胎儿生长受限（FGR）、胎动减少（DFM）、妊娠晚期侧卧位睡眠以及分娩时机的决策。我们评估了女性和医疗保健专业人员（HCP）对五个要素的产前护理实践的经验。
采用在线调查的预-后研究设计，评估 HCP 对建议实践的意识、知识和执行频率（共 22 项）的变化，以及女性对降低死产风险的护理体验。邀请在澳大利亚两个州参与 SBB 实施计划的服务中接受产前护理和 HCP（助产士和医生）的女性和 HCP 参加。调查于 2020 年 1 月至 7 月（前）和 2022 年 8 月至 12 月（后）分发。使用 Fisher 的精确检验、Pearson 的卡方检验或 Wilcoxon 秩和检验比较前后的反应。
1225 名女性（前 1096/后 129）和 1415 名 HCP（前 1148/后 267，≥83%助产士）完成了调查。在 SBB 实施后，所有要素的 HCP 执行最佳实践的频率“一直”显著提高，包括向女性提供有关侧卧位睡眠的建议（20.4-79.4%，p<0.001）和戒烟的益处（54.5-74.5%，p<0.001），提供 DFM 手册（43.2-85.1%，p<0.001），对 FGR（59.2-84.1%，p<0.001）和死产（44.5-73.2%，p<0.001）的风险评估。一般来说，戒烟方面的实践改善较少，例如在每次就诊时使用“询问、建议和帮助”简短咨询模式（15.6-20.3%，p=0.088）。实施后，更多的女性回忆起有关死产和风险降低的对话（32.2-50.4%，p<0.001），大多数 HCP 报告在常规护理中包括这些对话（35.1-83.0%，p<0.001）。大多数 HCP 同意 SBB 已成为他们常规实践的一部分（85.0%）。
实施 SBB 与预防死产的所有目标护理要素的实践改进相关，包括与女性就死产风险降低进行的对话。需要进一步考虑增加对更难改变的实践（如戒烟支持）的采用率的策略。
Safe Baby Bundle 研究在澳大利亚和新西兰临床试验注册数据库中进行了回顾性注册，ACTRN12619001777189，日期为 2019 年 12 月 16 日分配。
