The interview arose because of a “perspective” commentary about the bundle from Wallace and others which was recently published in the MJA
It was a little surprising to me that Wallace would suddenly be expressing concerns that this "stillbirth package could harm healthy babies” because as Swan said when he introduced him, he is “one of the people behind the initiative” specifically he is part of the Executive of the CRE a position he has held well before the Safer baby bundle (SBB) was developed and, in fact, he is a CI on the NHMRC partnership grant, funded to test and evaluate the bundle in a number of hospitals in the Eastern States.
So he is now “sounding the warning” that “Caution is needed so that population‐level reductions in the stillbirth rate are not offset by iatrogenic harm to healthy babies” What does this warning consist of?
I quote from the MJA article:
Foremost, it is to be aware of the potential harm of any intervention and to look for this harm. This is possible with the use of balance performance measures —essentially, measures of unnecessary early delivery such as the proportion of babies delivered for suspected FGR but who were normally grown, or the number of neonatal unit admissions of term babies. Stillbirth programs elsewhere did not embed balance measures as part of their planned evaluation. Benefiting from the lessons learned by others, the Australian Safer Baby Bundle will include (my emphasis) these measures to ensure that strategies designed to reduce stillbirth are targeted towards babies who are at most risk.
So Wallace is warning us that we need to be aware that the bundle may cause intragenic harm and that balance performance measures need to be employed to determine if this harm has occurred. So I return to my earlier question. I am not sure why Euan would be suddenly expressing this concern, because the concerns he mentions are already acknowledged in the study protocol and the measures he recommends are already embedded in the SBB……
So let me finish with a big concern of my own:
Swan asked Wallace: what's the answer here, because you are an obstetrician, the baby is not growing well and the baby has decreased fetal movements, how do you know when to say, well, I think we need to deliver the baby now?
Wallace’s answer started with Ideally what we need are markers to tell us the baby who is in trouble,
Sorry Euan the answer to this question is ALWAYS and ever will be “We need to ask the mother” As long as any of us think that the pregnant woman doesn’t know her body and her baby best and that tests results outweigh her then we will continue to see Stillbirth rates well above what they should be. Searching for tests and ways to measure when a baby is in trouble, MIGHT be useful but they should never, EVER, be used without consulting with and listening to the mum. And that, my friend, is not rocket science !