Data is important in helping us identify where the greatest risks lie, so that we can find ways to improve our care and reduce those risks for mothers and babies. One of the best data sources for our maternity services is the Victorian Perinatal Services Performance Indicators report. The 2018/19 report shows that our hospitals are performing well and that we are performing better in some areas previously targeted for improvement.
Full term babies (without congenital abnormality) who are considered in poor condition after birth
In 2018/19 the state average for this indicator was 9.7 per cent. Werribee Mercy Hospital (WMH) average was 6 per cent and Mercy Hospital for Women (MHW) average was 7.3 per cent. These results compare well with peer hospitals.
The proportion of babies requiring additional nursery support or born with low Apgar scores (five things used to check a baby’s health at birth: appearance, pulse, grimace, activity and respiration) has fallen at both WMH and MHW over the last three reports and remains at or better than the state average. The perinatal mortality rate as reported also remains at or better than the state average at both WMH and MHW.
Severe fetal growth restriction (FGR)
Sometimes babies do not grow as well as expected during pregnancy. These small babies are described as having fetal growth restriction (FGR).
Doctors and midwives monitor the growth of babies during pregnancy. If the baby is not growing well they should consider the safest time to deliver the baby; this can be before the due date if the baby is severely growth restricted.
In 2018/19 the statewide average was 23 per cent of singleton babies born at 40 or more weeks’ gestation. Both WMH and MHW saw an improvement in this area. WMH rates for FGR reduced from 26.3 per cent during 2017/18 to 25 per cent in 2018/19. MHW rates for FGR reduced from 26.7 per cent in 2017/18 to 9.6 per cent in 2018/19.
Mercy Hospitals Victoria Ltd (MHVL) participated in the Safer Baby Collaborative coordinated by Safer Care Victoria. The collaborative ran from April 2019 until June 2020 and aimed to reduce avoidable stillbirth by 30 per cent. Improvement strategies include promoting smoking cessation and detection and management for FGR.
At MHVL, clinical outcomes are monitored by:
- weekly auditing of all births with special attention paid to babies with FGR and/or low Apgar scores
- an expanded number of indicators are now reviewed by our Adverse Events Committee; for example, all low Apgar scores, all growth restricted babies born past 40 weeks and all reported clinical incidents being reviewed by an expert panel for consideration of further review
- monthly Perinatal Morbidity and Mortality meetings to review births with poor outcomes
- a strong focus on clinician teaching about identification of babies at risk and appropriate timing and management of labour
- ready availability of growth scanning for those at risk of FGR and for those where FGR is suspected.