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Report card reads “must do better”

12/28/2019

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​The NHMRC funded Stillbirth CRE recently tweeted:
Picture
According to AHPRA there are 744,437 registered health practitioners at 30 June 2019. Obviously not all would be working with pregnant women but you would think a fair chunk of the
  • 33,434 midwives and 2,094 Obstetrician /Gynaecologists would... not to mention
  • Most of the 26,772 GPs who would usually have at least something to do with pregnant women even if its confirming the pregnancy, managing an acute illness during pregnancy, providing advice about quitting smoking, sleeping position or what to do about altered fetal activity, all important opportunities to discuss reducing stillbirth with pregnant women.  
  • Also the students who are currently studying: Midwifery 4065, 248 a dual nursing /midwifery degree and 22,540 studying medicine
So a very rough estimate of “clinicians”  who probably should access and complete the SBB e-learning resource is at least 89,153. So, while it is certainly a great start that 1,100 have completed the resource it represents around 1.2 % of those clinicians who should.
Strategies for increasing clinician engagement with this vital new resource…anyone? 
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Infant mortality on the rise in England

12/25/2019

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In a recent story titled “The biggest story in the UK is not Brexit. It’s life expectancy” published this week in “the Correspondent” author Danny Dorling (Geographer at the University of Oxford) points out that infant mortality is on a slow rise in England and Wales but declining in Scotland he says
There has also been a rise in infant mortality. In England and Wales, this rise was concentrated in those same years of maximum public spending cuts. In 2014, 3.6 babies died for every 1,000 born. That rose to 3.7 in 2015, 3.8 in 2016, and 3.9 in 2017 (which sadly is the latest year for which we have data, as funding for ONS has also been cut).
Though the change appears to be minuscule, according to the ONS, each rise was statistically significant. It means that enough extra babies died to increase that statistic by an amount that almost certainly did not occur by chance. Policy played a part – most importantly, policy concerning the funding of maternity units, the training of midwives, and the social services available to pregnant women. Most of the additional infant deaths each year occurred in the first few days or weeks of the child’s life.
Scotland, by contrast, had the same infant mortality rate as England and Wales in 2014, but by 2018 it had been reduced to 3.2 per 1000 births. This too did not happen by chance. Having decided to invest in mothers and babies, the Scottish government diverted funds from other areas to ensure it did so.”
It is very interesting that he puts the fall in infant mortality down to the Scottish Government “investing” in mothers and babies. One of the investments he is talking about is the establishment of the Maternity and Children Quality Improvement Collaborative (MCQIC), which enacted a quality standard that all maternity care providers have a documented conversation about the importance of fetal movements with pregnant women in the middle of pregnancy and at each antenatal visit thereafter. Supported by this MCQIC, Scotland has achieved a 22.5% improvement in the rate of Stillbirths since 2014.
So, Dorling’s story rang some alarm bells for me because this year the Australian Government has invested a significant amount of money (over 5 million by some accounts) in the NHMRC funded Stillbirth CRE and their “Safer baby bundle” this is loosely modelled on England’s “Safe baby bundle v1”. A strategy that saw up to 20% decrease in stillbirth rate in some of the participating hospitals. Our Government has made this investment in the hope that we will see a similar decline in Stillbirth in hospitals that participate in our bundle. But if the infant mortality rate is slowly rising in England and declining in Scotland at a population level then surely we need to be also looking to what Scotland are doing to make change at a population level? This is particularly because the Scottish drop was NOT due to a bundle of care, that may or may not have been adopted by maternity care providers at the coal face, but a mandated quality and safety initiative enacted at Government level.
Now I am not suggesting for one minute that the Safer baby bundle is not worth the Australian Governments investment. But these figures from the UK surely give us all cause to pause and consider what else needs to be done? These figures indicate that in order to achieve population level change that the SBB should NOT be the only thing the Australian Government does to try to reduce Stillbirth and that alongside the Bundle roll out urgent consideration also needs to be given to enacting Quality and safety standards just as Scotland did, because this seems to have been effective in reducing mortality at a population level rather than only at an individual hospital level. 

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Credit where Credit is Due

12/16/2019

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​Yesterday there was a story in the Herald sun How stillbirth campaign has saved dozens of lives over two decades , a story which was picked up today by Mirage news
 
Basically they have reported that Victoria’s perinatal mortality rate improved from 8.8 per 1000 births in 2017 to 8.6 in 2018, the lowest it has been for 18 years. This means there were 28 less baby deaths.
 
Enhanced training for specialists, monitoring of foetal (sic) growth issues and community education in a concerted statewide campaign by Safer Care Victoria and #movements matter campaigns are being credited for the result.
 
The Victorian Health minister Ms Mikakos weighed in with this:
This is the most comprehensive approach to raise awareness of stillbirth risk factors and improve clinical practice and we are only getting started It is remarkable these efforts are already saving lives
 
It is indeed remarkable but also very unfortunate that the not-for-profit charity StillAware who have been working tirelessly away in Victoria, indeed across Australia has not been “credited” for making any contribution to this drop. This is especially sad because in the years 2014 to present they have delivered:
  • Education sessions to more than 1,316 maternity care providers in Victoria
  • Consumer Education through mother and baby expos of 28,691 Victorian families
  • Overall 886,855 Victorian Consumers reached with their “Your pregnancy brochure and fridge magnet”
 
I call upon those who are claiming credit for this fantastic reduction in stillbirth to immediately and loudly also attribute credit to the amazing efforts of StillAware, who have undoubtably also contributed to this drop AND without a single cent of assistance from the Victorian or Federal Governments.
 
As Mikakos says “Together we’re already saving lives and even before we see the data from our more recent efforts, we know that this too is making a difference.”
 
Yes together we are saving lives and it would be nice for herculean efforts like those made by StillAware to also be recognised


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    Still Talking

    Talking openly about all aspects of stillbirth.

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