Experiences of antenatal care practices to reduce stillbirth: surveys of women and healthcare professionals pre-post implementation of the Safer Baby Bundle.

Autor: Andrews C; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia. christine.andrews@mater.uq.edu.au., Boyle FM; 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., Pade A; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia., Middleton P; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.; South Australian Health and Medical Research Institute, Adelaide, Australia.; The University of Adelaide, Adelaide, Australia., Ellwood D; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.; School of Medicine and Dentistry, Griffith University, Queensland, Australia.; Gold Coast University Hospital, Gold Coast, QLD, Australia., Gordon A; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.; School of Medicine, The University of Sydney, Sydney, Australia., Davies-Tuck M; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia., Homer C; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.; Burnet Institute, Melbourne, Australia., Griffin A; QIMR Berghofer Medical Research Institute, Brisbane, Australia., Nicholl M; School of Medicine, The University of Sydney, Sydney, Australia.; Clinical Excellence Commission, NSW Health, Sydney, Australia., Sketcher-Baker K; Clinical Excellence Queensland, Brisbane, Australia., Flenady V; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2024 Aug 01; Vol. 24 (1), pp. 520. Date of Electronic Publication: 2024 Aug 01.
DOI: 10.1186/s12884-024-06712-8
Abstrakt: Background: 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.
Methods: 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.
Results: 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%).
Conclusions: 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.
Trial Registration: The Safer Baby Bundle Study was retrospectively registered on the Australian New Zealand Clinical Trials Registry database, ACTRN12619001777189, date assigned 16/12/2019.
(© 2024. The Author(s).)
Databáze: MEDLINE
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