Every year in WA, 3000 babies are born too early. While many of these children may go on to live a normal and fulfilling life, for many others their early birth will forever prevent them from achieving the health and wellbeing that should have been their birth right.
Rates of such harmful early birth have been rising in recent decades across Australia and all similar countries.
But it does not need to be this way. WA has led the way showing that rates of preterm birth can be safely reduced. This work has led to development of a world-first national program and is a story of which all in our State can be proud.
Preterm birth is defined as birth before 37 completed weeks of pregnancy. It is the single greatest cause of death and disability in young children. This definition we now know is quite misleading.
Many unborn babies are actually not fully mature until 39 weeks of pregnancy and the 14-day period from 37 to 39 weeks is now known as early term birth.
Rates of early term birth have also been rising dramatically, with one in three Australian children now born in this two week period.
Early term birth predisposes to learning and behavioural problems at school age and the dramatic increase in these early births over the past 10-20 years is believed to be one of the factors underpinning some of the problems being seen in our primary schools.
In 2014, a program was launched across WA as a world-first attempt to safely lower rates of harmful early birth.
The program included a package of clinical strategies, each of which had been shown individually in research studies to be effective but had not previously been combined as a population-based program.
These strategies included education of the general public and the healthcare workforce to avoid birth before 39 completed weeks of pregnancy unless there was a medical reason; ultrasound measurement of the length of the cervix at the routine mid-pregnancy scan as a shortened neck of womb predicts preterm labour; use of a natural hormone treatment called progesterone to be prescribed for women at risk; support for programs aiming to discourage smoking; and a dedicated new preterm birth prevention clinic at King Edward Memorial Hospital.
The program was shown to be effective. Rates of preterm birth across WA were reduced, with a 20 per cent reduction at KEMH which is the major referral centre.
This success soon led to support from the Commonwealth Government to roll out the WA program across Australia as a whole. The national program was launched in June 2018, badged as the Australian Preterm Birth Prevention Alliance, and consists of 28 lead clinicians and scientists across Australia.
Success was soon evident in some regions of Australia, but not all. It was clear that a better method of implementing the program was required.
In May 2021, the Commonwealth provided funds to roll the program out more effectively across the nation. A methodology known as a Breakthrough Collaborative was employed.
This model was originally developed in Boston, USA by the Institute for Healthcare Improvement and that organisation was chosen to be a key collaborator in the Australian program.
The alliance also partnered with Women’s Healthcare Australasia which is a not-for-profit organisation based in Canberra that collects data from our maternity services and then feeds the information back for benchmarking purposes.
Essentially, the Breakthrough Collaborative is designed to produce rapid and enduring improvements in clinical practice across healthcare facilities by defining the overall aim and then supporting participating organisations to test how the strategies can best be implemented in their own healthcare environment. Consumer representatives are embedded throughout the process.
Sixty-three Australian maternity services were included in the first round, representing 54 per cent of Australia’s annual public births.
The first Collaborative commenced in October 2022 and concluded in March 2024. More than 600 sub-projects were conducted in these hospitals, providing great insight into how our maternity services can be improved to provide safer and more effective healthcare for pregnant women and their unborn babies.
The program has been highly effective and final outcome data will be forthcoming in the coming months.
We are now planning the next stages of the national program. An eighth clinical strategy will be considered for implementation, based on successful research trials.
This strategy involves screening of women at 11 -14 weeks of pregnancy to predict those cases of preeclampsia (high blood pressure of pregnancy) that will lead to early preterm birth.
About 10 per cent of early preterm births are due to preeclampsia and identification of those cases at risk enables prescription of a treatment that will prevent about 60 per cent of cases.
The Australian National Preterm Birth Prevention initiative is the world’s first such national program. It was conceived and developed in WA, shown to be effective in our population, and then rolled out across Australia’s other seven States and Territories. As a result, Australia is on track to become the world’s first nation to strategically and safely lower its rate of harmful early birth.
The national program was built on a legacy provided by several decades of research conducted at KEMH and continues to be led from the Women and Newborns Health Service and Department of Obstetrics of The University of Western Australia.
The success of this program will positively impact the families of WA for generations to come.
Professor John Newnham is the chair of the Australian Preterm Birth Prevention Alliance