December 2021 COPMM newsletter

Highlights from COPMM's latest Annual Report

A list of key Council of Obstetric and Paediatric Mortality and Morbidity (COPMM) recommendations based on the data arising from the review of perinatal, paediatric and maternal death cases reported in 2019 has been highlighted in the Report’s COPMM key recommendations. It is hoped that these will highlight those issues considered by Council to be important and in need of addressing and actioning in the future by relevant statewide organisations. Full Report can be accessed from COPMM’s website.

Highlighted issues based on 2019 data include the following:

• Tasmania’s child death rate was significantly lower than the 2019 national paediatric mortality rate with the number of child deaths reported in Tasmania being overall significantly lower than reported over the last decade. COPMM continues to support the Coroner’s recommendations in relation to youth suicide and reiterates the importance of addressing youth suicide and encouraging appropriate measures to be in place within the community to help young individuals considered to be at risk. COPMM also continues its recommendation for a consistent message about safe sleeping practices.
• An increase in the number of births in all three Tasmanian regions in 2019.
• The Tasmanian perinatal mortality rate per 1 000 births in 2019 was the lowest since 2005 and also less that the 2019 national perinatal rate.
• Overall, the proportion of Tasmanian women who reported that they had smoked tobacco during pregnancy has fallen since year 2010. The proportion of women aged 40 years and over who reported to have consumed alcohol during pregnancy has decreased.
• The proportions of very low birthweight infants and low birthweight infants reported in Tasmania for 2019 has decreased slightly since 2015.
• It is positive to note that there is a downward trend in the number of pregnancies amongst women aged between 15-19 years.
• Mothers that birthed in both public and private facilities in Tasmania were more likely to have a BMI ≥30.0 compared to Australian mothers overall.
• The higher caesarean section rates reported in 2019 in Tasmanian private hospitals is a trend consistent with national findings reported in 2019. Through the work of Professor John Newnham (Preterm Birth Prevention Initiative) and as identified in the 4^th Atlas of Health Care Variation, clear evidence suggests that planned births should be delayed until 39 weeks to optimise the best outcomes for baby’s development, unless there is a medical reason for an earlier birth. A such, Tasmania through its Preterm Birth Initiative and more recently, the Safer Baby Bundle Implementation Programme, are providing steps to encourage both parents and specialists to consider birth plans that are best for both mother and baby.

Safer baby bundle implementation project in Tasmania

Prior to the Covid-19 pandemic, the preterm birth prevention initiative was introduced in Tasmania. In addition to this a complimentary programme known as the Safer Baby Bundle is being rolled out throughout Tasmania in 2021.

• The Stillbirth Centre for Research Excellence (CRE) presented to the Department of Health Clinical Executive on 12 May 2021 with Clinical Executive expressing support for Tasmania to implement the Safer Baby Bundle as a component of the National Stillbirth Action and Implementation Plan.
• On 2 November 2021 Professor Vicki Flenady and Professor David Elwood, Co-Directors of NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE), wrote to the Secretary, Tasmanian Department of Health seeking to formalise a partnership and collaboration with the Department to implement the Safer Baby Bundle across Tasmanian public maternity services.
• The Tasmanian Department of Health implementation of the National Stillbirth Implementation Plan consists of the following:
  • Safer Baby Bundle (SBB) Implementation Project Manager (0.7 FTE) resourced from the Office of the Chief Nurse and Midwifery (OCNM) Officer working in close collaboration with clinical leads across the three regions (commenced 28 June 2021).
  • Co-sponsors for the SBB Implementation project are Professor Anthony Lawler, Deputy Secretary/Chief Medical Officer, and Associate Professor Francine Douce, Chief Nurse and Midwife.
  • Commonwealth funding has been confirmed to support the Tasmanian Department of Health to increase the uptake of stillbirth investigations. The funding will support facilitated ‘face to face’ IMproving Perinatal Mortality Review & Outcomes Via Education (IMPROVE) statewide education for multidisciplinary team members. The training will improve frequency and quality of autopsy and other investigations following stillbirths. This aligns with a key recommendation from COPMM.
  • A representative from the COPMM Maternity/Perinatal Mortality and Morbidity Committee has been requested to participate as a representative on the Safer Baby Bundle Implementation Advisory Group.
  • It is beneficial for the Safer Baby Bundle Implementation Project Advisory Group to stay closely connected with COPMM and to provide regular updates to the Council.
• Across the regions there are varying stages of implementation of evidence-based reforms related to preventing stillbirth, with encouraging trends towards further reducing the Tasmanian stillbirth rate at greater than 28 weeks gestation.
• The Department of Health Safer Baby Bundle Implementation project aims to establish facilitated collaboration and consistency of clinical practice across Tasmania.
• Of the 21 COPMM recommendations from 2019, seven relate directly to the Safer Baby Bundle Implementation project and the National Stillbirth Implementation Plan (current work in progress by OCNM with THS services).

CCYP: Working with and for Tasmanian children and young people

The Commissioner for Children and Young People (CCYP) Annual Report 2020-21 is now available and provides an insight into the CCYP’s work on behalf of, and with Tasmanian children and young people.

The Commissioner, Leanne McLean (also a member of COPMM) notes that there has been a welcomed increase in the number of agencies and organisations, particularly the

Tasmanian Government, wanting to engage with children and young people and to seek their views on some of the big issues that impact upon their lives.

In her Annual Report, the Commissioner includes details of her wellbeing consultations with Tasmanian children and young people, which contributes to the development of the Government’s first whole-of-government child and youth wellbeing strategy. Young participants across the state highlighted a number of gaps in health services across the state as well as access issues (for details of the consultation findings, please view the CCYP Wellbeing Report). The Government’s child and youth wellbeing strategy, It Takes a Village, that has a focus on the first 1,000 days of children’s lives, endeavours to address many of the issues raised through the wellbeing consultations.

Thanks to the strategy, children and young people’s wellbeing was a central theme of the State Budget 2021-22, with substantial additional funding to support children’s wellbeing in the first 1 000 of their lives. Examples include an increase in access to multidisciplinary paediatric services around the State, as well as residential programs to support vulnerable mothers and babies and the delivery of parenting programs to anyone who needs one. The Budget also saw increased funding to children living in Tasmania’s out-of-home care system through prioritised access to health and education supports via the new “SureStart” initiative.

For more details about the Commissioner’s work, please visit www.childcomm.tas.gov.au.

COVID-19 vaccination during pregnancy

The Council of Obstetric and Paediatric Mortality and Morbidity strongly encourages that all women are vaccinated prior to or during pregnancy to provide the best protection for baby and mother.

RANZCOG recommends the following:

• Pregnant women are a priority group for COVID-19 vaccination and should be routinely offered the Pfizer vaccine (Comirnaty) or Spikevax (Moderna) at any stage of pregnancy.
• Pfizer (Comirnaty) and Spikevax (Moderna) are mRNA vaccines.
• Women who are trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination.
• There is no evidence of increased risk of miscarriage or teratogenic risk with mRNA or viral vector vaccines.
• Global evidence has shown that the Pfizer and Moderna vaccines are safe for pregnant women.
• Pregnant women have a higher risk of severe illness from COVID-19.
• 1 in 3 unvaccinated pregnant women who develop COVID will require hospitalisations and 1 in 7 will require ICU admission.
• Their babies also have a higher risk of being born prematurely.
• There is an increased risk (estimated up to 3 times the risk) of stillbirth in women who develop COVID 19.
• COVID-19 vaccination may provide indirect protection to babies by transferring antibodies through the placenta (for pregnant women) or through breastmilk (for breastfeeding women).
• All healthcare workers, including midwives and doctors, are encouraged to be vaccinated, to protect themselves, pregnant women, and their babies. The vaccine does not cause “shedding” and vaccinated people are far less likely to transmit COVID.
• RANZCOG recommends that pregnant women receive booster vaccinations in line with the recommendations for the non-pregnant adult population.

Committees of COPMM

Paediatric Mortality & Morbidity

This Committee continues to be chaired by Dr Michelle Williams and continues to progress the review and classification of reported statewide paediatric death cases.

Perinatal Mortality & Morbidity

The Committee chaired by Professor Dargaville continues to recommend that Tasmania’s private hospitals use PSANZ guidelines to report on perinatal cases to provide COPMM with more comprehensive information on reported stillbirth cases as required. The updated Tasmanian Perinatal Data Collection Form can be accessed via the COPMM’s website. Clinicians are requested to use the Third Edition Version 3.1 for classification of all perinatal deaths from 2019 onwards.

Maternal Mortality & Morbidity

This Committee that is chaired by Associate Professor Amanda Dennis will finalise its review and classification of maternal death cases reported in Tasmania in 2020-2021 as soon as possible. Progress of the Australian Maternity Outcomes Surveillance System (AMOSS Project) will continue to be tracked and its relevance to Tasmania’s reporting assessed etc.

Data management

The Data Management Committee’s Working Group will meet early in 2022 to begin preparations on its next COPMM Annual Report based on available audited 2020 data. It is expected that this report will be tabled in Parliament sometime in October 2022. The Committee continues to monitor national developments in the Congenital Abnormality Registers as well as a national push to improve data timeliness and in-principle support for earlier supply of mortality data to AIHW.

Council news

Council’s Operations Report and latest Annual Report were both tabled in Parliament on 28^th October 2021.

Membership for the current term (May 2019 - May 2022) in accordance with the Terms of Reference includes:

• Dr Michelle Williams (Chair - Paediatrician & RACP rep)
• Professor Peter Dargaville (employed in the delivery of Neonatal Services)
• Dr Anagha Jayakar (UTAS rep)
• Associate Professor Amanda Dennis (UTAS Rep)
• Dr Jill Camier (RACGP rep)
• Ms Kate Cuthbertson, Barrister at Law (Council nomination)
• Ms Sue McBeath (ACMTas rep)
• Dr Tania Hingston (RANZCOG rep)
• Dr Scott McKeown (Department of Health Representative) and
• Ms Leanne McLean (Commissioner for Children and Young People).

The Council website continues to archive newsletters, Annual Reports and other relevant resource information.

Enquiries: To Manager, Dr Jo Jordan; email: [email protected]

Learn more about the Council of Obstetric and Paediatric Mortality and Morbidity (COPMM)