Stillbirth prevention — structured oral station (12 minutes)

Opening prompt — "She asks what she can do to reduce her stillbirth risk. What do you say?"

Model response — lead with the bundle, then personalise: ^[1][2]

• "In Australia we use the Safer Baby Bundle, which is five evidence-based things offered to every pregnant woman: support to stop smoking, careful monitoring of your baby's growth, knowing what's normal for your baby's movements and reporting any change straight away, settling to sleep on your side from 28 weeks, and getting the timing of birth right for your individual situation."^[1][2]
• "For you specifically, because you smoke, the most powerful thing you can do is to work with us on stopping — and we will help you with that at every visit."^[6]

Probe 1 — "She asks about sleep position. What is the evidence, and what do you advise?"

• "From 28 weeks, settle to sleep on either side — left or right are both fine — and avoid going to sleep on your back."^[5]
• "The evidence comes from a pooled analysis of five studies: sleeping on your back more than doubled the risk of late stillbirth — an adjusted odds ratio of 2.63 — and we estimate that around 6 percent of late stillbirths could be avoided if every woman slept on her side."^[5]
• "Frame it without blame: it's a simple change that helps, not a cause of guilt."^[5]

Probe 2 — "She asks what to do if her baby's movements change."

• "Know what's normal for your baby. If you notice the movements have reduced, slowed, or stopped, contact us straight away — don't wait."^[1][4]
• "We will see you immediately and put you on a monitor (CTG). If it's a repeat or you have other risk factors, we'll do an ultrasound for growth and fluid as well."^[4]
• "Be honest about the evidence: a big trial (AFFIRM) didn't show that a movements care package reduced stillbirth, but it did increase intervention — so we assess promptly and make a balanced decision, weighing any need to deliver against prematurity."^[4]

Probe 3 — "What about her smoking specifically?"

• "Smoking in pregnancy carries a population attributable risk of 4 to 7 percent for stillbirth — higher in disadvantaged populations — and it also affects fetal growth."^[6]
• "I'd offer a brief intervention at every visit using the 5 A's (Ask, Advise, Assess, Assist, Arrange), an opt-out referral to a specialist quit service, behavioural support, and nicotine replacement therapy where appropriate after a risk-benefit discussion."^[2][6]
• "Non-judgemental framing matters: this is a shared effort, and any reduction helps."^[6]

Probe 4 — "Communication domain: she says she feels responsible for her risk because of her weight and smoking. How do you respond?"

This is a scored domain — demonstrate it out loud, not as an afterthought: ^[1]

• Move to her eye level, acknowledge the feeling, and reframe without blame: "These are common, and they're things we work on together — no one factor causes a stillbirth, and your coming in today is exactly the right thing to do."
• Avoid jargon, avoid a checklist tone, and offer a named follow-up and a written plan.
• Commit to continuity and to a debrief after each visit if she wants one.^[1]

Probe 5 — "What surveillance will you put in place for her pregnancy?"

• Given her BMI and smoking, she is on the increased-risk pathway: serial growth ultrasound with umbilical artery Doppler from 26–28 weeks every 2–4 weeks, and low-dose aspirin 150 mg daily from 12–16 weeks (if still early enough, or document the rationale).^[3][6]
• All five bundle elements, plus an individualised, documented plan for timing of birth.^[1][3]