Comment on “Reducing Perinatal Mortality in Victoria, Australia: Early Insights From the Safer Baby Bundle Implementation”

In Australia, 6 babies are born stillborn each day. Yet, up to 30% of stillbirths can be prevented with improved antenatal care. In 2019, the Safer Baby Bundle (SBB) was implemented in Victoria, Australia, to target 5 areas to prevent stillbirth in high-risk pregnancies: smoking cessation, fetal growth restriction (FGR) detection, care for decreased fetal movement (DFM), safe maternal sleep position, and optimal timing of birth. The aim of this study was to examine the early impact of the SBB on perinatal outcomes in Victoria, Australia.

This was a retrospective, population-based cohort study, based on data extracted from a statewide database of births ≥20 weeks of gestation. Included in this cohort were singleton births ≥28 weeks from January 2014 through December 2020. Excluded were births with congenital anomalies. Pre-SBB implementation outcomes (January 2014 to June 2019) were compared with those of post-SBB implementation (July 2019 to December 2020). All maternity services in Victoria—representing metropolitan, rural, public, and private hospitals—were invited to participate, with 21 serving as SBB sites and 47 as non-SBB sites. The primary outcomes were stillbirth and perinatal mortality, defined as stillbirth and neonatal death.

The analysis included 398,273 births preimplementation of SBB and 108,024 births postimplementation. At SBB sites, stillbirth decreased from 2.08 to 1.64 per 1000 births [relative risk (RR), 0.79; 95% CI, 0.62-1.00; P =0.05] and perinatal mortality significantly decreased from 2.52 to 2.02 per 1000 births (RR, 0.80; 95% CI, 0.65-0.99; P =0.041). No significant changes were observed for the primary outcomes at non-SBB sites. At SBB sites, increases were observed in smoking cessation (RR, 1.16, P <0.001), antenatal DFM reporting (RR, 2.48; P <0.001), and iatrogenic FGR delivery (RR, 1.29; P <0.001) with a decrease in undelivered severe FGR (RR, 0.65; P <0.001).

Interrupted time series analyses showed postimplementation increases in smoking cessation rose by 0.23% per month ( P =0.032) at SBB sites and 0.60% per month ( P =0.012) at non-SBB sites. Antenatal reporting of DFM also rose significantly by 0.15% per month ( P =0.001) at SBB sites, with no significant change at non-SBB sites ( P =0.21). Postimplementation, trends showed no significant changes for cesarean delivery, induction of labor, late preterm and early-term births, and admission to the neonatal intensive care unit. However, early-term iatrogenic birth trends decreased significantly by 0.14% per month ( P =0.015) at SBB sites but continued to rise by 0.18% per month ( P <0.001) at non-SBB sites.

In conclusion, SBB implementation in Victoria, Australia, was associated with reduced perinatal mortality and lower early-term iatrogenic birth trends without increasing obstetric or neonatal harm.

(Summarized from Mayakaduwage KLB, Farrell T, Selvaratnam RJ, et al. Reducing perinatal mortality in Victoria, Australia: early insights from the Safer Baby Bundle implementation. Aust NZ J Obstet Gynaecol . 2026; 66:e70082. doi:10.1111/ajo.70082).