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

The Safer Baby Bundle (SBB) was introduced in Victoria, Australia, to reduce stillbirth and perinatal mortality. Evaluating its impact is critical to informing its national rollout.

This study assessed the early effect of SBB implementation on stillbirth and perinatal mortality rates in Victoria.

A retrospective population-based cohort study of singleton births ≥ 28 weeks was conducted, comparing outcomes before (January 2014-June 2019) and after (July 2019-December 2020) SBB implementation. Congenital anomalies and terminations were excluded. Interrupted time series analyses and relative risks compared outcomes at SBB and non-SBB sites.

There were 398,273 pre-SBB and 108,024 post-SBB births. In SBB sites, a trend towards reduced stillbirth from 2.08 to 1.64/1000 was observed (RR: 0.79, 95% CI: 0.62-1.00, p = 0.05) along with a significant reduction in perinatal mortality from 2.52 to 2.02/1000 (RR: 0.80, 95% CI: 0.65-0.99, p = 0.041). While in non-SBB sites, rates of stillbirth (p = 0.58) and perinatal mortality (p = 0.53) remained unchanged. Pre-implementation, early term iatrogenic births rose monthly by 0.20% in SBB (p < 0.001) and 0.15% in non-SBB sites (p < 0.001). Post-implementation, monthly trends in SBB sites reduced by 0.14% (p = 0.015) with no further significant increases, while non-SBB sites continued to rise by 0.18% per month (p < 0.001). No significant changes were seen in caesarean section, induction of labour, late preterm birth, neonatal death, or neonatal intensive care unit admission trends in SBB sites.

SBB implementation was associated with reduced perinatal mortality without increasing iatrogenic or neonatal harm. These findings support its national implementation to improve perinatal outcomes in Australia.