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Posted on 31 Oct 2019
Consumer engagement
Patient experience and outcomes
Safety cultures

Losing a baby before or during birth is traumatic for families and the clinicians who care for them, and this is why Safer Care Victoria (SCV) and 19 Victorian health services are partnering to reduce preventable stillbirths.

The second learning session of this work – the Safer baby collaborative - took place in Melbourne recently, and it was here that Julie Wright, Operational Director of Women’s and Children’s Services at Albury Wodonga Health (AWH), told the story of a patient who presented at hospital worried her baby not moving as much in utero.

It was thanks to the strong focus on decreased fetal movements that is part of the work of the Safer baby collaborative that the woman and AWH staff were quick to act.

On examination, a recording of the fetal heart rate showed a “very poor” trace – the baby wasn’t getting enough oxygen. An emergency caesarean was performed and thankfully, after initial concern, this story ends happily with both mum and baby recovering quickly.

However, Julie says, the new mother continued to go over the experience with ‘what ifs?’.

“Her level of shock wasn’t around the early and quick delivery or caesarean, it was around ‘what if I had not come in?’” Julie says. “She kept going back over her story with [nurse manager] Anna and asking ‘what if I didn’t come in?’.”

A well-informed patient who knew her baby’s movements and when to be concerned, together with AWH maternity clinicians who were responsive to the patient’s concerns and able to undertake timely intervention was vital and resulted in a live, healthy baby. This, Julie says, highlights the power and importance of SCV’s Safer baby collaborative.

By participating in the Safer baby collaborative, regional and metropolitan maternity health services from across Victoria have made a commitment to improving outcomes for all women giving birth in Victoria by focusing on reducing avoidable stillbirth rates. And, as is being heard through stories like AWH’s, this work is already having an impact.

Through consumer consultation and research as part of AWH’s Safer baby work, Julie and the team found that in some cases, women concerned about their baby’s movements thought they would have an extended wait at the health service to be seen for monitoring. Alarmingly, some women reported they delayed contacting their care team with concerns about their baby’s movements for up to 24 hours. 

AWH has now implemented day-to-day conversations between clinicians and women about the importance of noticing their baby’s movements along with reinforcing the message that women should contact the maternity unit promptly if they have concerns. 

“We’re now having a lot more women present for decreased fetal movements, and that’s what we want,” Julie says. “We’ve also made improvements in the way women attend for monitoring, relooking at the way we work and having some set appointments. Every half hour, we have time allocated to do monitoring.”

By being able to accommodate drop-in presentations for decreased fetal movement monitoring, the health service is tackling the problem head-on as they spread the message of ‘come in if you notice a change – you won’t have to wait’.

Julie agrees the time was right for her team and health service to join the Safer baby collaborative. And, while she acknowledges it requires a real commitment to keep up momentum, she feels being part of the collaborative is improving the way AWH and the maternity team approach their work.

“Has it created more work? I would say no. It’s really made us think about the way we work. We’ve actually done some fantastic service improvements as part of [the Safer baby collaborative] - it’s given us some impetus to do that.”

For many health services, the appeal of joining a SCV collaborative is that the work incorporates a variety of improvement components including clinical care, engagement of leaders and teams, and taking a different approach to work. By working with the Institute for Healthcare Improvement (IHI) and SCV, participating health services are learning the art and science of improvement. One of the critical components is known as a Plan-Do-Study-Act (PDSA) cycle.

“Through PDSA cycles, we just keep trying things out until we find something that might fit and work for us,” Julie says of AWH’s approach to embracing the collaborative work.

“It’s been great in terms of team work and collaboration. I think if you’ve got an opportunity to do something better and work collaboratively then … maybe it’s what some clinicians need to reinvigorate, re-enthuse, engage your team - and do it together.”

When asked about the improvements and benefits AWH is realising as a result of undertaking the Safer Baby work, Julie says keeping an open mind about improvement work is key.

“I think for clinicians [this work] is hugely important because it’s actually making us really look at things differently, challenge the way maybe we’ve been working and just trying things out,” Julie says.

“It doesn’t matter how long you’ve been a midwife or a doctor or worked in a role like health service management, I think it’s good to keep an open mind and embrace new opportunities.

“If we can make a difference for one woman who doesn’t have the experience of losing a baby, well then it’s been absolutely worth it.”

More information about the Safer baby collaborative.