LINDSAY EDWARDS, ROYAL HOBART HOSPITAL: I'd just like to start with an acknowledgement of country, if I may, and make special mention to the Muwinina people, the traditional custodians of the land of Nipaluna, which we meet on today. I'd like to pay my respects to all Aboriginal and Torres Strait Islanders and recognise elders past, present and emerging as the continuing custodians of the land. And I'd like to also mention that it's Reconciliation Week this week and there's a significant disparity in the health of maternal and child health with First Nations women and children compared to non-Indigenous Australians. And we're here today to speak about pre-term birth or harmful early birth and the disparities occur or they emerge very early in life, with First Nations women having a pre-term birth rate nearly double that as non-Indigenous Australians.
JOURNALIST: Can you give us a bit of an overview on today’s announcement and an explanation of what it will look like for the Tasmanian parents?
EDWARDS: Yes. So here in Tasmania,10 years ago we had the highest pre-term birth rate in the country and we sat at a rate of 11 per cent compared to the national average of about 8 to 9 per cent. Through a continued effort with collaboration between maternity services, primary healthcare doctors, radiologists, sonographers and an intense education campaign, we were able to lower our pre-term birth-rate by 20 per cent after becoming involved with the Australian Preterm Birth Prevention Alliance, and then more recently, the Every Weeks collaboration. So this has all come about, I guess, through an intense education campaign, but also with increased survival length screening, we've reduced our rates of non-indicated- not medically indicated early birth by an increased access to caesarean sections with support from our perioperative services here at the Royal Hobart Hospital, so that babies can now be born on the day that they're supposed to be born and not just seen as access to an elective theatre list. We've also had amazing engagement with our consumers and our women with our lived experience, and we're fortunate to have a few of those here today. So in Tassie back in 2015, 2016, over one in ten babies were born too soon. We've now reduced that rate by 20 per cent, and the fact that we've got ongoing funding from the Commonwealth means that we'll be able to continue that work.
JOURNALIST: Why were those rates so high a decade ago?
EDWARDS: So here in Tasmania, we have an interesting demographic and we have higher rates of obesity and women who are living in larger bodies. We also have higher smoking rates and a lower smoking cessation rate in pregnancy. So despite concerted efforts we’re engaging women for smoking cessation and trying to become smoke free, we still have one of the highest smoking rates in the country and the lowest smoking cessation rates. And we know that those high smoking rates are associated with an increased risk of pre-term birth. We've also been able to safely reduce our late pre-term birth by educating our colleagues and our midwives about babies being safe to stay on the inside. We can monitor these pregnancies and we can usually safely get babies to a gestation that is associated with a much better long-term outcome for their health and well-being.
JOURNALIST: So obviously you've come a long way, but why is ongoing funding something that's important?
EDWARDS: So ongoing funding is so crucial for this work. I mean, we've got Clara here today, and both Helen and Mikaela had early babies with us here at the Royal. And that's what we do this work for at the end of the day. And the fact that we've got a small population here in Tassie, we're a diverse and we're a passionate population in the health service. And so we're striving just to provide the best care possible for every single baby and every woman that we look after. This funding is going to allow us to continue this really important work and so that we can hopefully get out into the primary health sector to engage more of our GPs and also engage our colleagues in private as well.
JOURNALIST: You mentioned the rates for First Nations women were two times higher for pre-term. Is enough work being done in that space and will this funding maybe provide better outcomes?
EDWARDS: Yes, the rating in First Nations women is 1.7 times higher than in non-Indigenous Australians. And as part of the second phase of the collaboration, we've had more focus on First Nations health, and that's going to continue with this additional funding.
JOURNALIST: One of the clinical strategies that stuck out to me was ongoing care with the same midwife can improve outcomes. Can you talk a little bit about that?
EDWARDS: Yeah, so that's being shown to have a significant benefit for women with a known healthcare provider, whether that's a midwife or a private obstetrician. That trust that develops with that one-on-one relationship. And here at the Royal Hobart Hospital, we've had great continuity of care models and we're doing what we can to try and make more of those continuity of care models available to all women, but also with a special focus on our First Nations women.
HELEN PHELAN, MOTHER: Yes. My name is Helen Phelan and I'm mother to Clara Phelan, who was born at 29 weeks and just 500 grams.
MIKAELA DUNN, MOTHER: And I'm Mikaela Dunn and I've got Leonardo Dunn and Raphael Dunn. Leonardo was born at 24 plus 4 weeks at 675 grams. He's now a thriving six-year-old and I was able to go on to have Raphael at 37 plus one weeks after that through all the work which has been done with this collaborative, which is incredible and now he's three.
JOURNALIST: Well we might start with you if that's okay. She's very chatty today. But yeah, I guess do you want to paint us a bit of a picture of what that that was like for you, and I guess it probably put a bit of strain on your family as well?
PHELAN: Yes, it did. Clara was an IVF pregnancy. I have endometriosis so that was an underlying factor to infertility. And we had, since we were a higher risk pregnancy, and when we got to the 20 week scan, anatomy scan we found out that this little one was measuring far too behind in size, so Clara's viability was actually quite low at that point in time, and we sort of didn't think she would make it. But with close monitoring and the expert care of the team here, we managed to carry Clara all the way to 29 weeks. And although she was a tiny dot at just 500 grams, she surpassed all our expectations for survival and she has done incredibly well. So although it was a pretty traumatic journey, we were incredibly well supported by the team here and we're ever so grateful that we were able to bring Clara into the world.
JOURNALIST: What would it have been like for you if you didn't have that support at the time?
PHELAN: I don't think- Clara wouldn’t be here. So, yeah, having access to that level of support is critical for giving pre-term babies a chance of survival.
JOURNALIST: How old is Clara now?
PHELAN: Clara is currently 13 months old.
JOURNALIST: Just tell us a little bit about her. She seems to be pretty happy.
PHELAN: I think that infamous prem baby tenacity has really shown through her spirit. She's been a little fighter from the get-go and she is absolutely thrilled to be here.
JOURNALIST: She's loving the microphone. She's a journalist.
PHELAN: She loves an audience.
JOURNALIST: A politician, maybe.
JOURNALIST: I guess tell us about your journey as well, and just [Indistinct]… looking at briefly about what it was like for you?
DUNN: Yeah. So I went for my 20-week scan. This was my first baby as well. Very normal, healthy, no worries in having a full-term pregnancy at that point. Twenty-week scan, they said that my cervix was actually measuring short. At that point, I had no idea what that actually meant, what that entailed, and was kind of whisked away. They said, take some progesterone we're going to check you in a week, so come back within that time. A day before I was due to get checked up my waters actually broke, full broke. So we were getting in the car ready to come and get checked out, and I was like, this isn't good. I know you can't have a baby at 20 weeks. That's as much as I kind of know you can't do. So I got into the hospital, and they basically said the expectation was that your baby was going to be born within the next kind of 24 hours, 48 hours.
He got through that point and then we kind of reached the part where we were looking at, okay, if we make it to viability what does that actually mean, and that's when I met Lindsay and we talked about what risk factors and what that kind of meant for me staying on bedrest as well. We were fortunate that we got into 24 weeks because the 23 weeks was the viability. So we were hoping to get a bit further along than 24 weeks, but we are incredibly lucky at how it's- again, that prem kind of tenacity that they just have this will to be here and survive. And he's very much in the same boat. He's now a thriving six-year-old.
We had a very kind of typical prem journey, I guess, in the sense of all the kind of normal things that you would experience, nothing too drastic. His biggest thing was oxygen dependency. We were lucky we didn't have to come home on oxygen, thankfully. But yeah, we got him home before his due date which is pretty wonderful as well. And then I was able to go on and have a second pregnancy under Lindsay's close watch, where I think I learnt a lot from my previous experience, kind of going, okay, I know what I need to do to advocate for myself in this time.
Oh, when I had Leonardo, it was also COVID time, which was another kind of added fun stress because you go from being able to have your husband with you at the bedside and then all of a sudden it's like, okay, one person at a time, no family, lockdowns, everything. So we kind of lost all support network. And that's why we did become very heavily reliant on the doctors and the nurses. And yeah, incredible.
JOURNALIST: How much time did you spend in hospital?
DUNN: A hundred and four days with Leonardo. So yeah, just before his due date. I spent my 30th birthday actually rooming in with him. Like, that was like the final couple of nights before we got to come home, so it was pretty special in that respect, so horrible time, timing was like the worst with COVID to have a prem baby. It was the one time you want to be able to have people around you but yeah, we were very fortunate in how it was handled.
JOURNALIST: How big was he when he was first born?
DUNN: He was 675 grams
JOURNALIST: Do you have any advice for anyone who might be experiencing a premature baby?
DUNN: Advocate for yourself, you need to ask your doctors all the appropriate questions. I think that was my problem when I first went into it. I was very in the dark. I didn't know that you could even have a premature baby. So I went in and did my research and I reached out to people who I knew had had premature babies, but leaning in on the doctors and actually asking them and finding out what you can actually do, but yeah, it's just having a good understanding of what is and isn't normal about your body.
I know the second time around I had a much better idea of what felt normal and what didn't feel normal because with Raphael, my waters had actually started leaking at 36 plus four or something. I was far enough along that I was like, oh my gosh, I'm nearly full term at this point, like 24 weeks, 30 weeks surpassed and we were like, we're killing it. But when I reached that point, I went into the- when I went for my check-up with the midwives, I actually said I think I am leaking amniotic fluid, like this feels different, and even they were saying no, this is normal part of this, and I said I actually know there's a test you can do, can we do that test? I know, I was that annoying person. I was like, I know there's a test to test the amniotic fluid, and it was actually positive for that. So then I was able to go in and make sure I was getting the right care to avoid any kind of infection. But that was just through my previous journey and knowing what was available as well.
JOURNALIST: And is it reassuring to know that the government's backing you with this support?
DUNN: Massively. Like, Leonardo wouldn't be here. He wouldn't. And Raph, I don't know if I would have got him as far along if I wasn't able to know that progesterone is something that could help prolong pregnancy as well. So knowing that they're backing it is huge for Tasmania, and mums-to-be. And whether you've- like, I’d had no family who’d had premature babies before. It wasn't something that I was aware of. So coming in from that aspect with no knowledge, and I'm really ashamed to say I didn't even know the NICU existed and when I did my first tour of it, after we spent- 104 days later, before- it was just one of these spaces that you kind of go, wow, that's the reason he's here, It’s so important, all this research.
JOURNALIST: Leonardo and Raphael?
DUNN: Yeah, I’ve got two ninja turtles.
DUNN: So, funny story, Leonardo’s middle name is actually Michael not Michelangelo, but that was my father's name and my husband's father's name as well.
[Laughs].
JOHN NEWNHAM, PROFESSOR OF OBSTETRICS AT UNIVERSITY OF WESTERN AUSTRALIA: Yeah, good morning. My name's John Newnham. I'm Professor of Obstetrics at the University of Western Australia based in Perth and I chair the National Alliance. This program began in 2014 in Western Australia as a proof of concept program. It was shown to work, we lowered the rate of pre-term birth in Western Australia and then we were funded in 2018 through Canberra to roll it out nationally. Please understand- I've lost it again. Australia is now the world's first nation to have a national pre-term birth prevention program and remains the only nation. It is working. We have lowered the rate of pre-term birth in Australia and early-term birth. It is something I think all Australians should be proud of. It is supported by the government through all levels and down through all the levels of our hospitals.
There are 3000 or so Australian healthcare workers involved in this program who are making it work. I'd like to express my grateful appreciation to the Minister, the Assistant Minister, all levels of government and Australia's healthcare workers. But most importantly of all, the 300,000 families, women and babies a year, babies who are born each year in Australia. Thank you all for their support.
But this is only just the beginning. We've built this on seven clinical strategies. We're now introducing an eighth. We now know how to prevent pre-term pre-eclampsia, high blood pressure in pregnancy with a screening program between 11 and 14 weeks. It was worked out not by us but by the people in London, but based on people who live in London. We now need to adapt it to Australia and to work out how to introduce this program across the great diversity of healthcare settings Australia. This program will prevent up to 90 per cent of early pre-term births from pre-term pre-eclampsia. It is profoundly effective and profoundly safe. We now need to work out how to do it. It's recommended that all Australian women be offered this. We're now in the process of putting that in place with help from the Minister.
JOURNALIST: Can you explain what pre-eclampsia is? I feel like I should know, but just in case…
NEWNHAM: No, you shouldn't know. Pre-eclampsia is of unknown origin. It affects about 5 per cent of pregnant women, more likely in your first pregnancy. It is high blood pressure, but also affects many other organs, such as your kidneys when you leak protein in the urine. It progresses, we have no way of stopping it. We can treat the blood pressure but we can't stop the disease progression. The only treatment is to end the pregnancy by delivering the baby. One in seven early pre-term births are due to pre-term pre-eclampsia. It is a very, very severe and dangerous condition if left untreated. In Australia, it is safe because we have the resources to deliver the baby and end the pregnancy. But for the first time in history, we now have the ability to predict it and prevent it.
JOURNALIST: You mentioned since 2018 sort of how much of an improvement that that has. Do you have, like, percentage rates or even the amount of number of babies that's actually equated to?
NEWNHAM: Yes. So, we published in Lancet last December, the outcome of the Australian National program. So we have lowered the rate of pre-term birth by about eight per cent, and that's about 1,400 to 1,700 pre-term births prevented each year - that's a saving to the Federal Government of about $90 million a year. For early term birth, that's the period between 37 and 39 weeks, we've lowered the rate by about 10 per cent - that's about 4,000 being prevented a year. Those early term births are the origin of much of the problems occurring at school age today. Being born just a few weeks early increases the risk of behavioural and learning problems at school age. By lowering that rate, we expect this to translate into better outcomes at school age and, perhaps, less need for the NDIS support.
JOURNALIST: Do you have a goal or a target for the next few years?
NEWNHAM: Our goal is to get the early term birth rate down to about 18 per cent. Up until just recently, one in three Australians was born too early in this early term period. We've got it down to 19 per cent in many Australian hospitals, and many others are on their way. It used to be about 18 per cent, and that's what we should return to.
More questions? Okay, thank you.
WHITE: I just wanted to thank very much both Helen and Clara, of course, and Mikaela for sharing their stories. They're examples of how important it is to support intervention, to support mums as they're going through, arguably, one of the biggest moments of their life, which is pregnancy, to be able to deliver a healthy baby. And I want to thank very much Dr Lindsay Edwards, and Professor John Newnham for joining us here today to speak about the value of this program, not only here in Tasmania but right around the country.
There are thousands of health workers who have been able to improve their knowledge and education, to be able to support mums as they progress through their pregnancy journey to be able to deliver at term. And as we heard from Professor John, this is making an incredible difference to the outcomes for these young people.
Having a baby can be the most extraordinary experience, but if you are facing risks through your pregnancy, knowing that your health professionals have the knowledge to guide you so that you can deliver your baby healthy and at term, just takes a weight off your shoulders. And you can hear from the way Mikaela shared her story where she had a little baby first at 24 plus four, and it was incredibly stressful and hard to then go and have a second pregnancy and deliver at 37 weeks because of the fact, not only she had better knowledge but her health team were able to support her knowing that they could help her deliver a baby a term.
The different interventions that have been able to support women throughout their pregnancies across the country are guided by the evidence of the Alliance and I just want to congratulate them on their work. I first met John last year and he shared with me the work they're doing across the country. I found his knowledge and his passion to be incredibly compelling. And I'm really proud the Federal Government's been able to provide a further $7 million, which will support their work over the next two years.
JOURNALIST: Obviously pre-term birth has an effect on the mum and the bub, but does it also have an effect on the healthcare system and it’s costing a lot of money to hospitals?
WHITE: Yeah. Well, John spoke about that a little bit too. So, we do know that if we're able to help mums deliver their baby at term, they're able to then take their babies home and, obviously, have a higher chance of a healthy pregnancy and a healthy baby. There are obvious costs when you have a premature baby, and that might mean time in the NICU, which is a really important intensive support but it requires a lot of staff and resourcing and it can be quite costly too. So, if we're able to support more mums to be able to deliver their babies later in their term or a full term then it does mean that there's a benefit to them through the health of their baby and the health of the mum, but also it reduces costs in the health system.
JOURNALIST: Can we expect to see- I know some of the funding is for the next two years but I guess looking beyond that, can we expect to see more funding?
WHITE: So the work that we're funding over the next two years continues the work that's already been done, but it looks at two other areas. So, that's the pre-eclampsia work that Professor John spoke about, but also working with our First Nations women. Because we see that the pre-term birth rate in First Nations women across the country is still far too high compared to non-Indigenous women. So, there is work come the way over the next two years for us to gather more evidence and to undertake trials in the Australian setting to understand what we need to do to reduce pre-term births in both of those cohorts. We'll then look at that evaluation and understand what further support might be required.
JOURNALIST: You and Julie Collins sent a letter to the state health minister to reconsider the decision to cut funding from the Cygnet, at the Family Practice, for the afterhours - but that's primary healthcare. I mean, were they stepping in where the Federals should have funded in the first place?
WHITE: So, through our investment to strengthen Medicare we've been able to see an uplift in bulk billing practices right around state, including at Cygnet, at the Family Practice there. So, they are still operational - they're operational Monday to Friday - and they are providing bulk billing services to that community. What the state government had done was fund an initiative for after-hours access. And that was primarily to reduce pressure on the ambulance service and the emergency department - two areas that are the responsibility of the state government to fund and operate.
So, it's really cutting off their nose to spite their face to remove funding from a frontline service like this. Because it will result in people depending on the support from an ambulance or calling into the emergency department, because they won't have those after-hours services in that local community anymore if they do continue on and follow through with this cut.
JOURNALIST: I mean, all primary healthcare is ideally to try and stop people getting to that, sort of, ambulance hospital area, right? So I mean, again, isn't that something that that the Federal should look at funding - that after-hours care, like you have urgent care clinics?
WHITE: We do. We have been funding a range of different initiatives in the primary healthcare space. Tasmanians know there are eight Medicare Urgent Care Clinics operating around the state, including one at Kingston. And we have also seen an uplift in bulk billing rates in Tasmania because of the investment we've made in Medicare. We take our responsibility to fund primary healthcare very seriously, and Tasmanians have seen the result of that. It's the state and the broad government's responsibility to manage the operations of hospitals and the ambulance service, and that's why they've made a particular intervention to provide after-hour care services at Cygnet, because they knew then that would take pressure off those busy services.
I think it's very strange that they've decided to cut funding to a service like that. It has shown proven results that it was reducing an impact on the emergency department and the ambulance service and, unfortunately, what this will now mean is that community members there will have fewer choices. I hope they're able to use the Kingston afterhours clinic through the Medicare Urgent Care Clinic, but if not they will again present to the emergency department and rely on an ambulance service, which will just be another cost to the state government.
JOURNALIST: When do you recognise that the state government has been stepping into the Federal space for a while now? I mean, they've got that Labor TassieDoc rip-off, which is giving doctors money to have more bulk billing; they've got their rapid response, which is when a doctor leaves and someone needs to fill in. I mean, they are putting a lot into the primary healthcare space. Doesn't the Federal Government need to step up?
WHITE: So we recently struck a deal with all governments across the country, including here in
Tasmania, through the National Health Reform Agreement which saw an uplift of funding of about $700 million which will support the operations of the Tasmanian Government as they meet the demand across our community for healthcare. It is important for them to invest that money wisely. And I would argue that, not only should they be using that to fund the operations of the hospital activity, but also looking at how they can take pressure off presentations to the emergency department and support people to access care closer to where they live. Which is exactly what they have been doing in Cygnet, and now they've decided to cut it.
JOURNALIST: Are you disappointed they appeared to suck some of that money back into the budget? Like, it’s not- the health budget hasn't gone up by the amount of money you've funded it by.
WHITE: I think it's an unfortunate circumstance when we've got a Federal Government that's investing very heavily in healthcare - whether that's in primary healthcare or through the National Health Reform Agreement that saw a $700 million uplift for Tasmania, while at the same time the state Liberal Government's handed down a budget that has a $700 million cut for health. Is that a coincidence, or have they simply offed some of their activities behind the line the Federal Government’s funded? The health minister needs to explain the decisions that they’ve made here. Because, at the end of the day, we want Tasmanians to be able to access healthcare that they need, whether that’s walking into a GP or walking in the front door of the emergency department. And what we’re hearing from staff, they feel they’re just being compromised because that hasn’t properly recognised in the recent state budget.