The Whole Nine Months TAS aims to bring together clinical leaders, the Tasmanian health department, and the community, to safely lower the preterm birth rate in the State. Tasmania was the second state behind Western Australia to officially launch a preterm birth prevention initiative. In conjunction with the Tasmanian Regional Committee of RANZCOG, launch events have been held in the north and south of the state to announce the Initiative and to educate specialists and trainees in Obstetrics and Gynaecology, along with General Practitioners, radiologists, midwives and sonographers, from around the State. These events have successfully raised awareness about the high preterm birth rate in Tasmania, and launched a campaign about the steps that must be taken to safely lower the preterm birth rate in the State.
Key strategies for Tasmania include:
- The provision of appropriate ultrasound services for the accurate measurement and reporting of cervical length at the mid-trimester anatomy scan.
- Face to face meetings with and personal correspondence has been sent to all practicing obstetricians, radiologists and sonographers in the State on the importance of accurately measuring and reporting the length of the cervix at the midtrimester anatomy scan. Women found to have a short cervix are seen promptly by their doctor and prescribed progesterone.
- Subsidised vaginal progesterone is currently available through public hospitals for women at high risk of preterm birth.
- In the South of the State, through the antenatal clinic at the Royal Hobart Hospital (RHH), women with risk factors for preterm birth (short cervix and/or previous preterm delivery before 34 weeks) are identified and referred for cervical surveillance through a dedicated Preterm Birth Prevention clinic. In the North and North West, women also have access to cervical surveillance through radiology practices under the direction of specialist obstetricians.
- State guidelines on the prevention of preterm birth, including the use of progesterone, and the treatment of threatened premature labour are currently being updated. Check back in early 2020 for the final version.
- Encouragement of smoking cessation (especially in women under the age of 20 who have the highest smoking rates; 1 in 3) is an important part of preterm birth prevention.
- Smoking cessation continues to be encouraged throughout the antenatal clinics at each of the maternity hospitals, and the rate of smoking in pregnancy amongst Tasmanian women has decreased from 23% in 2010, to 14% in 2016. However, in comparison to national figures, smoking cessation rates in pregnancy are lowest in Tasmania, with only 1 in 10 women no longer smoking after 20 weeks’ gestation.
- A pilot program on carbon monoxide testing has recently been undertaken at the RHH. This program saw a smoking cessation rate of 35% (more than three times that of previous years), and encouragingly, 65% of women who smoked made at least one attempt to quit during pregnancy. This program will form the basis of future interventions in this area.
- Avoidance of late preterm and early term deliveries without a clear medical or obstetric indication.
- Education continues in both the public and private sector about the benefits of achieving a gestation of 39 weeks, provided it is safe for both mother and baby to do so.
- Support for midwifery-led continuity of care models.
- Midwifery Group Practice (MGP) models of care exist at all public maternity hospitals in the State. The Whole Nine Months TAS supports this model of care being available to women at risk of preterm birth, and at the RHH, recognising the unique challenges that may coexist, women who identify as Aboriginal and/or Torres Strait Islander, have preferential access to this model of care.
- Support for research into the possible causes of high preterm birth rates in Tasmania.
By adapting, modifying and tailoring the successes of the world-first WA Preterm Birth Prevention Initiative to suit our Tasmanian population, we hope to prevent a significant portion of our babies being born too soon. The Whole Nine Months TAS aims to not only bring the preterm birth rate back in line with the national average, but to again be among the lowest in the country. This is an ambitious undertaking, however the health and future wellbeing of the babies of Tasmania, and hence future Tasmanians, are at stake.