World-first preterm birth prevention program has lowered the rate of early births by about 4,000 a year

Thousands of early births have been avoided with improved outcomes for women and babies, according to analysis of a world-first Australian initiative. 

A study recently published in The Lancet Obstetrics, Gynaecology, & Women's Health, examined the impact of a national preterm birth prevention program introduced in Australia in 2018.

It found since the prevention measures were introduced, the rate of preterm and early term births — a major cause of death and disability — had lowered by between 7 and 10 per cent, or about 4,000 fewer early births a year.

University of Western Australia Professor of Obstetrics and Chair of the Australian Preterm Birth Prevention Alliance, John Newnham, spearheaded the preterm birth prevention program and was lead author of the study, which examined nearly 2 million Australian births.

He said the lessons learned would significantly change the lives of many Australian families.

"No-one in the world has ever been able to lower their rate of pre-term birth across the nation, and Australia's rate, like all similar countries, has been rising dramatically in recent years," Professor Newnham said.

"We set out to form a national program to lower Australia's rate of pre-term birth, funded by the federal government, but with support all the way down through to individual hospitals, and we were successful."

Preterm birth — which is defined as birth between 20 and 37 weeks of pregnancy — is the leading cause of death and one of the major causes of disability in children across the world. Early term birth is defined as between 37 and 39 weeks of pregnancy.

Professor Newnham said while 37 weeks used to be considered full-term, there was evidence to suggest planned births between 37 and 39 weeks — without medical justification — put babies at additional risk of having issues like having respiratory problems or needing neonatal care.

The six-year program was run in two three-year phases.

The first phase saw the rate of preterm births fall by 8 per cent, the equivalent of 1,342 cases each year.

While the second phase looked at the rate of early term births, showing a reduction of 10 per cent over a 16-month period, which equated to about 5,300 fewer cases.

The initiative involved implementing seven clinical strategies, including avoiding births being planned before 39 weeks without medical justification.

"There are medical reasons such as high blood pressure, but in the absence of those reasons, babies should be left where they belong until at least 39 weeks," Professor Newnham said.

The clinical strategies also include measuring the length of the cervix during pregnancy scans and using vaginal progesterone — which can help prevent the uterine contractions that can lead to early birth — for women with a short cervix or a history of preterm birth.

Health professionals were also encouraged to help women who smoke to quit and provide expectant parents with access to continuity of care — where they see the same health professional during their pregnancy.

"Australia for many years has been a very safe place for women to have babies. This program has made it even safer," he said.

Baby born 'the size of a tub of butter'

For Perth mother Yasmine Phillips, the research has been "truly life saving".

Her eldest daughter Ava, now five, was born via an emergency caesarean at 25 weeks after Ms Phillips developed a severe form of life-threatening pre-eclampsia.

"I was quite unwell and the future was really unknown for Ava at that point as well," Ms Phillips said.

"[Ava] only weighed 580 grams when she was born, which is basically the size of a tub of butter that you might have in your fridge at home."

Ava spent 101 days in the neonatal intensive care unit. While her lungs will never be as strong as a child born at full term, she is now a "happy and healthy" little girl, Ms Phillips said.

When Ms Phillips and her husband Chris Robinson decided to try for a second baby, Australian research into preventing preterm births gave doctors clear guidance on how to reduce the chance of another premature birth.

"We managed to make it safely to 37 weeks … that was all thanks to the knowledge that has come out of this world-first initiative," Ms Phillips said.

She believed the research was a game changer for her second daughter Sage.

"It's genuinely life saving work and we are so lucky to have these teams of people working together not only on the research side but with hospitals all over Australia to ensure that the life saving work that they are coming up with is being enacted in real life."

Doctors are now implementing the strategies

Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Nisha Khot said doctors were already implementing the strategies.

"Looking at the length of the cervix every time you do a morphology scan at 20 to 22 weeks is something that has now pretty much become routine across the country," Dr Khot said.

"Doctors will definitely take a lot out of this … and already I see doctors have changed practice.

"I think the other really important thing that obstetricians have taken from this is that we must not plan to deliver babies before 39 weeks if there isn't a good reason to do it."

Dr Khot said while she was "very excited" about the study's success, more work was needed to prevent births of babies prior to 32 weeks gestation.

"We know that babies that are born at less than 32 weeks are more likely to have … physical disability, learning difficulties, other issues throughout their lifetime."

Professor Newnham said he would keep working to continue to reduce harmful early births, saying he first started the work as an obstetrician in Perth in the 1980s.

"This has been my career-long project and I started it and I still run it, but I'm surrounded by wonderful people all over the country who really have put their shoulder to the wheel to make it work," he said.