Australia`s mothers and babies 2013: in brief

Transcription

Australia’s mothers and babies 2013—in brief presents key statistics
and trends on pregnancy and childbirth of mothers, and the
characteristics and outcomes of their babies. This publication is
designed to accompany the Perinatal data portal available online
at <www.aihw.gov.au/perinatal-data/>.
Australia’s mothers
and babies 2013
in brief
and babies 2013
in brief
The Australian Institute of Health and Welfare is a major national agency
which provides reliable, regular and relevant information and statistics
on Australia’s health and welfare. The Institute’s mission is
authoritative information and statistics to promote better health and wellbeing.
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ISBN 978-1-74249-874-4 (PDF)
ISBN 978-1-74249-875-1 (Print)
ISSN 2205-5134 (PDF)
ISSN 1321-8336 (Print)
Suggested citation
Australian Institute of Health and Welfare 2015. Australia’s mothers and babies 2013—in brief. Perinatal statistics
series no. 31. Cat no. PER 72. Canberra: AIHW.
Australian Institute of Health and Welfare
Board Chair
Dr Mukesh C Haikerwal AO
Any enquiries relating to copyright or comments on this publication should be directed to:
Digital and Media Communications Unit
GPO Box 570
Canberra ACT 2601
Tel: (02) 6244 1000
Email: [email protected]
Published by the Australian Institute of Health and Welfare.
Please note that there is the potential for minor revisions of data in this report.
Please check the online version at <www.aihw.gov.au/> for any amendments.
Contents
1
At a glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Mothers at a glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Babies at a glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ��7
Antenatal care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Smoking during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Maternal health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Place of birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Onset of labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Method of birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Pain relief during labour and operative delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Multiple pregnancies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3Babies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Gestational age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Birthweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Low birthweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Baby presentation and method of birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Apgar scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Resuscitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Hospital births and length of stay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Admission to special care nurseries and neonatal intensive care units. . . . . . . . . 41
Perinatal deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
4
Aboriginal and Torres Strait Islander mothers and their babies . . . . . . . . . . . . . 46
Indigenous mothers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Babies of Indigenous mothers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Australia’s mothers and babies 2013 in brief
5
About the National Perinatal Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Appendixes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
AIHW information on mothers and babies
Australia’s mothers and babies 2013—in brief presents an overview of some of the key statistics
and concepts from the National Perinatal Data Collection and includes links to sources for
further information.
Detailed data tables, including state and territory data, are available online from the AIHW
website <www.aihw.gov.au/publication-detail/?id=60129553770>.
The AIHW online perinatal data portal complements this report and is available at
<www.aihw.gov.au/perinatal-data/>.
The National Core Maternity Indicators data portal also provides further detail on a set of key
indicators endorsed by Australian Government and state and territory health departments and
is available at <www.aihw.gov.au/ncmi/>.
The National Perinatal Data Collection
The National Perinatal Data Collection (NPDC) commenced in 1991 and is a collaborative
effort by the AIHW and the states and territories.
Perinatal data are collected for each birth in each state and territory, most commonly by
midwives. The data are collated by the relevant state or territory health department and a
standard de-identified extract is provided to the AIHW on an annual basis to form the NPDC.
What is included in the NPDC?
The NPDC includes data elements that are mandatory for national reporting (29 data elements
in 2013 that form the Perinatal National Minimum Data Set) as well as additional voluntary
data items.
Which births are counted?
The NPDC includes both live and still births where gestational age is at least 20 weeks or
birthweight is at least 400 grams, except in Western Australia, where births are included if
gestational age is at least 20 weeks, or if gestation is unknown, birthweight is at least
400 grams.
See Section 5 for more information about the NPDC.
1
1
At a glance
a glance
1Mothers
At aatglance
More women are giving birth than a decade ago
• 304,777 women
birth in Australia in 2013—20% more than in 2003 (252,584 women).
Mothers
at agave
glance
• The rate of women giving birth increased from 59 per 1,000 women of reproductive age More
women are giving birth than a decade ago
(15–44 years) in 2003 to 63 per 1,000 in 2013.
• 304,777 women gave birth in Australia in 2013—20% more than in 2003 (252,854 w
• Slightly fewer women gave birth in 2013 than in 2012 (307,474).
•
The rate of women giving birth increased from 59 per 1,000 women of reproductiv
(15–44 years) in 2003 to 63 per 1,000 in 2013.
rate offewer
women
of reproductive
giving
birth,
2003(307,474).
to 2013
• The
Slightly
women
gave birthage
in 2013
than
in 2012
Per 1,000 women aged 15–44
68
66
64
62
60
58
56
54
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Year
The rate of women of reproductive age giving birth, 2003 to 2013
Women are giving birth later in life
• The average age of all women who gave birth was 30.1 years in 2013, compared w
in 2003.
•
The average age has also increased for Indigenous mothers, from 24.7 in 2003 to 25
2013.
•
The proportion of mothers aged 35 and over has increased from 19% in 2003 to 22%
Australia’s
mothers
and24
babies
in brief from319% to
2013, while the proportion of mothers
aged less
than
has2013
decreased
Women are giving birth later in life
• The average age of all women who gave birth was 30.1 years in 2013, compared with 29.5
in 2003.
• The average age has also increased for Aboriginal and Torres Strait Islander mothers, from
24.7 in 2003 to 25.3 in 2013.
• The proportion of mothers aged 35 and over has increased from 19% in 2003 to 22% in 2013, while the proportion of mothers aged less than 24 has decreased from 19% to 17%.
• The average age of first time mothers also increased, from 27.8 years in 2003 to 28.6 in 2013.
29.5
29.9
years
30.1
years
2003
years
2008
2013
Average age of all mothers, 2003 to 2013
Trend in births to younger and older mothers in Australia, 2003–2013
Per cent
Younger than 24
25
35 and over
20
15
10
5
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Year
Trend in births to younger and older mothers in Australia, 2003–2013
Most mothers live in Major cities and were born in Australia
Most mothers lived in Major cities (71%) and most were born in Australia (69%)—similar to
the proportions of all women of reproductive age in the population.
4 1 in Chapter
1: At aare
glance
25 mothers
Aboriginal or Torres Strait Islander
Around 4.1% of all women who gave birth in 2013 were Indigenous, slightly higher than the
Most mothers live in Major cities and were born in Australia
Most mothers lived in Major cities (71%) and most were born in Australia (69%)—similar to the
proportions of all women of reproductive age in the population.
1 in 25 mothers are Aboriginal and/or Torres Strait Islander
Around 4.1% of all women who gave birth in 2013 were Indigenous, slightly higher than the
proportion of Indigenous women of reproductive age in the population (3.3%).
Indigenous mothers were on average younger than non-Indigenous mothers (25.3 years
compared with 30.3).
Characteristics of women giving birth in 2013
Younger than 20
Maternal age
Maternal age
20–24
25–29
30–34
35–39
40 and over
Remoteness
Remoteness
Major cities
Inner regional
Outer regional
Remote
Country of
birthof birth
Country
Indigenous
Indigenous
status
status
Very remote
Indigenous
Non-Indigenous
Australia
Other main Englishspeaking countries
Other countries
0
10
20
30
40
50
60
70
80
90
100
Per cent
Characteristics of women giving birth in 2013
Find out more in the Perinatal data portal: Overview and demographics
5
Babies
ata aglance
glance
Babies at
More
babiesare
are being
being born
More
babies
born
• There were 309,489 babies born in 2013—an increase of 20% from 256,925 in 2003.
• There were 309,489 babies born in 2013—an increase of 20% from 256,925 in 2003.
• 307,277 were live births and 2,191 were stillbirths (less than 1%).
• 307,277 were live births and 2,191 were stillbirths (less than 1%).
• The stillbirth rate of 7 deaths per 1,000 births has not changed substantially since 2003.
• The stillbirth rate of 7 deaths per 1,000 births has not changed substantially since 2003.
Baby boys slightly outnumber baby girls
Baby
boysmore
slightly
outnumber
babythan
girlsfemale (49%). The sex ratio, defined as the
Slightly
babies
were male (51%)
number
ofbabies
male live
per 100
female
live born babies, was 106.0.
Slightly
more
wereborn
malebabies
(51%) than
female
(49%).
51%
The sex ratio, defined as the number of male live born
babies per 100 female live born babies, was 106.0.
49%
1 in 20 babies are Aboriginal and/or Torres Strait Islander
Around 1 in 20 babies (5.2% or 16,149)51%
were Indigenous in 2013 49%
(based on Indigenous status
of the baby).
3 in
4 20
babies
are
to mothers
living
in New
South Wales, Victoria or
1 in
babies
areborn
Aboriginal
or Torres
Straight
Islander
Queensland
Around 1 in 20 babies (5.2% or 16,149) were Aboriginal and/or Torres Strait Islander in 2013
(based
on Indigenous
status
of the
baby).
The
proportion
of babies born
in each
state
and territory closely reflects the distribution of the
total population in 2013 (based on the mother’s state/territory of usual residence).
3 in 4 babies are born to mothers living in New South Wales, Victoria or Queensland
The proportion of babies born in each state and territory closely reflects the distribution of
Babies
state/territory
usualonresidence
of mother,
2013 of usual residence).
the
total by
population
in 2013 of
(based
the mother’s
state/territory
Per cent
35
Babies born
Total population
30
25
20
15
10
5
0
NSW
Vic
Qld
WA
SA
Tas
ACT
State/territory of usual residence of mother
Babies by state/territory of usual residence of mother, 2013
6
Find
out
more in the Perinatal data portal: Overview and demographics
Chapter
1: At
a glance
NT
2
Mothers
Antenatal care
Almost all women attend antenatal care, but only two-thirds attend in the
first trimester
Antenatal care is associated with positive maternal and child health outcomes—the likelihood of
receiving effective health interventions is increased through attending antenatal visits. The World
Health Organization recommends receiving antenatal care at least 4 times during pregnancy. The
Australian Antenatal Guidelines (AHMAC 2012) recommend that the first antenatal visit occur within
the first 10 weeks of pregnancy and that first-time mothers with an uncomplicated pregnancy
attend 10 visits (7 visits for subsequent uncomplicated pregnancies).
Almost all women (99.8%) who gave birth in 2013 had at least 1 antenatal visit (excludes data
from Victoria). The proportion of women decreased as the number of visits increased:
• 95% had 5 or more visits
• 87% had 7 or more visits
• 58% had 10 or more visits.
When very pre-term births (less than 32 weeks gestation) are excluded, the proportions are
only slightly higher.
Regular antenatal care in the first trimester (before 14 weeks gestational age) is associated with
better maternal health in pregnancy, fewer interventions in late pregnancy and positive child
health outcomes. Nationally, in 2013:
• 43% of women attended at least 1 antenatal visit in the first 10 weeks of pregnancy
• 62% of women attended in the first trimester (less than 14 weeks)
• Around 1 in 8 women (13%) did not begin antenatal care until after 20 weeks gestation.
7
Time to first antenatal visit, by gestational age, 2013
Cumulative
percentage
100
90
80
70
60
50
40
30
20
10
0
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
Gestational age (weeks)
Time to first antenatal visit, by gestational age, 2013
Trend information on antenatal care is limited due to the relatively recent standardised
collection
of data:
Trend information
on antenatal care is limited due to the relatively recent standardised
data:
•collection
There has of
been
little change in the proportion of women who attended 5 or more antenatal
visits, from 95.0% in 2011 to 95.5% in 2013 (based on women who gave birth at 32 weeks
• There has been little change in the proportion of women who attended 5 or more
gestation or more from New South Wales, Queensland, South Australia, Tasmania, the
antenatal visits, from 95.0% in 2011 to 95.5% in 2013 (based on women who gave birth at
Australian Capital Territory and the Northern Territory).
32 weeks gestation or more from New South Wales, Queensland, South Australia,
• TheTasmania,
proportion the
of mothers
who had
antenatal
care inand
the the
first Northern
trimester ofTerritory).
pregnancy
Australian
Capital
Territory
decreased, from 69% in 2010 to 62% in 2013 (based on data from all states and territories).
• The proportion of mothers who had antenatal care in the first trimester of pregnancy
decreased, from 69% in 2010 to 62% in 2013 (based on data from all states and
territories).
Find out more in the Perinatal data portal: Antenatal period
8
Chapter 2: Mothers
Antenatal visits in the first trimester vary by socioeconomic status and
Indigenous status
Women living in the lowest socioeconomic status (SES) areas began antenatal care later in
pregnancy—just over half (55%) of women living in the lowest SES areas attended antenatal
care in the first trimester compared with 68% in the highest SES areas.
Antenatal
Antenatalvisits
visitsininthe
thefirst
firsttrimester
trimestervary
varyby
bysocioeconomic
socioeconomicstatus
statusand
and
Indigenous
status
The
proportionstatus
of women attending 5 or more antenatal visits varied only slightly by
Indigenous
remoteness
and
socioeconomic
disadvantage
(data
exclude
Victoria
very pre-term
births):
Women
ininthe
status
(SES)
areas
began
antenatal
care
inin
Womenliving
living
thelowest
lowestsocioeconomic
socioeconomic
status
(SES)
areas
beganand
antenatal
carelater
later
pregnancy—just
over half
(55%)
living
ininthe
lowest SES
areas
attended
(55%)of
ofwomen
women
living
the
areas
attendedantenatal
antenatal
•pregnancy—just
96% of womenover
livinghalf
in Major
cities
compared
with
90%lowest
in VerySES
remote
areas
care
in
the
first
trimester
compared
with
68%
in
the
highest
SES
areas.
care in the first trimester compared with 68% in the highest SES areas.
• 97% of women living in the highest socioeconomic status (SES) areas compared with 94%
The
proportion ofofwomen
attending 5 5orormore
The
moreantenatal
antenatalvisits
visitsvaried
variedonly
onlyslightly
slightlybyby
in proportion
the lowest
SESwomen
areas. attending
remoteness
and
socioeconomic
disadvantage
(data
exclude
Victoria
and
very
remoteness and socioeconomic disadvantage (data exclude Victoria and verypre-term
pre-term
births):
births):
Indigenous women were less likely to attend either an antenatal visit in the first trimester
•(52%
ofofwomen
living
with
ininVery
• 96%
96%
women
living
inMajor
Majorcities
citiescompared
compared
with
90%
Very
areas
compared
with
60%inof
non-Indigenous
women)
or90%
to
attend
5 remote
orremote
moreareas
visits (85%
•compared
living
ininthe
status
compared
with
95%
of non-Indigenous
women)
(age-standardised).
See
Section
4 forwith
more
• 97%
97%ofofwomen
women
living
thehighest
highestsocioeconomic
socioeconomic
status(SES)
(SES)areas
areas
compared
with94%
94%
in
the
lowest
SES
areas.
in the lowest
SES areas.mothers.
information
on Indigenous
Indigenous
Indigenouswomen
womenwere
wereless
lesslikely
likelytotoattend
attendeither
eitherananantenatal
antenatalvisit
visitininthe
thefirst
firsttrimester
trimester
(52%
compared
with
60%
of
non-Indigenous
women)
or
to
attend
5
or
more
visits
(52% compared with 60% of non-Indigenous women) or to attend 5 or more visits(85%
(85%
Antenatal
visits
in
the first trimester
and
5 or more antenatal
visits,
by
compared
with
non-Indigenous
women)
(age-standardised).
See
4 4for
compared
with95%
95%ofof
non-Indigenous
women)
(age-standardised).
SeeSection
Section
formore
more
information
onon
Indigenous
mothers.
selected
maternal
characteristics,
2013
information
Indigenous
mothers.
or
more
visits
55or
more
visits
5 or
more
visits
Major
cities
Major
cities
Inner
regional
Inner
regional
Inner
regional
Inner
regional
Remoteness
Remoteness
Remoteness
Remoteness
Major
cities
Major
cities
Outer
regional
Outer
regional
Remote
Remote
Outer
regional
Outer
regional
Remote
Remote
Very
remote
Very
remote
Lowest
SES
areas
Lowest
SES
areas
Lowest
SES
areas
Lowest
SES
areas
SES
SES
SES
SES
Very
remote
Very
remote
Indigenous
Indigenous
Indigenous
status(a)
Indigenous
status
status(a)
status
Highest
SES
areas
Highest
SES
areas
Highest
SES
areas
Highest
SES
areas
Indigenous
Indigenous
Non-Indigenous
Non-Indigenous
00
2020 4040 6060 8080
Per
cent
Per
cent
Indigenous
Indigenous
Indigenous
status(a)
Indigenous
status
status(a)
status
SES
SES
SES
SES
Remoteness
Remoteness
Remoteness
Remoteness
Antenatal
visit
inin
first
trimester
Antenatal
visit
first
trimester
Antenatal
visit
in
trimester
Indigenous
Indigenous
Non-Indigenous
Non-Indigenous
7575 8080 8585 9090 9595100
100
Per
cent
Per
cent
(a)(a) Age-standardised
percentages.
Age-standardised
percentages.
(a) Age-standardised
percentages.
Note:
Data
onon
5on
or
antenatal
visits
exclude
Victoria
and
very
pre-term
(less
than
3232
weeks).
Note:
Data
5more
or
more
antenatal
visits
exclude
Victoria
and
verybirths
pre-term
births
(less
than 32 weeks).
Note:
Data
5 or
more
antenatal
visits
exclude
Victoria
and
very
pre-term
births
(less
than
weeks).
Antenatal
Antenatalvisits
visitsininthe
thefirst
firsttrimester
trimesterand
and5 5orormore
moreantenatal
antenatalvisits,
visits,bybyselected
selectedmaternal
maternal
characteristics,
2013
characteristics, 2013
9
Attendance at antenatal care varies depending on where mothers live
In 2013, the proportion of mothers attending an antenatal visit in the first trimester of
pregnancy (less than 14 completed weeks’ gestation) varied across the 31 Primary Health
Networks (PHNs)
in Australia.
Thevaries
proportions
rangedon
from
38% mothers
in the South
Attendance
at antenatal
care
depending
where
liveEastern New
South Wales PHN to 86% in Tasmania, with a median of 62%.
In 2013, the proportion of mothers attending an antenatal visit in the first trimester of
pregnancy (less than 14 completed weeks’ gestation) varied across the 31 Primary Health
Networks (PHNs) in Australia. The proportions ranged from 38% in the South Eastern New
South
Wales PHN of
to 86%
in Tasmania,
with a an
median
of 62%. visit in the first trimester
Percentage
mothers
attending
antenatal
(less than 14 weeks), by Primary Health Network of usual residence, 2013
PHN307
PHN701
PHN305
PHN306
PHN503
PHN402
PHN107
PHN501
PHN502
PHN110
76–86%
PHN401
PHN304
PHN301
PHN302
PHN303
PHN109
PHN108
PHN104
PHN103
PHN102
PHN101
PHN105
66–75%
56–65%
50–55%
38–49%
PHN206
PHN201
PHN203
PHN106
PHN801
PHN205
PHN204
Percentage of mothers attending an antenatal visit in the first trimester (lessPHN601
than 14 weeks), by PHN202
Primary Health Network of usual residence, 2013
10
Chapter 2: Mothers
Percentage of mothers attending an antenatal visit in the first trimester
(less than 14 weeks), by Primary Health Network of usual residence, 2013
Tasmania (PHN601 Tas)
86
Adelaide (PHN401 SA)
82
North Coast (PHN109 NSW)
78
Country SA (PHN402 SA)
78
Northern Territory (PHN701 NT)
78
Northern Queensland (PHN307 Qld)
75
Country WA (PHN503 WA)
73
Brisbane North (PHN301 Qld)
72
Darling Downs & West Moreton (PHN304 Qld)
70
Western NSW (PHN107 NSW)
69
Perth South (PHN502 WA)
68
Central & Eastern Sydney (PHN101 NSW)
67
Western Queensland (PHN305 Qld)
65
Gold Coast (PHN303 Qld)
65
Northern Sydney (PHN102 NSW)
63
Perth North (PHN501 WA)
62
Central Qld, Wide Bay, Sunshine Coast (PHN306 Qld)
60
Hunter New England & Central Coast (PHN108 NSW)
60
South Eastern Melbourne (PHN203 Vic)
59
Western Sydney (PHN103 NSW)
58
Eastern Melbourne (PHN202 Vic)
58
South Western Sydney (PHN105 NSW)
55
Brisbane South (PHN302 Qld)
54
Murrumbidgee (PHN110 NSW)
54
Nepean Blue Mountains (PHN104 NSW)
52
Western Victoria (PHN206 Vic)
51
North Western Melbourne (PHN201 Vic)
50
Gippsland (PHN204 Vic)
47
Murray (PHN205 Vic)
42
Australian Capital Territory (PHN801 ACT)
40
South Eastern NSW (PHN106 NSW)
38
0
10
20
30
40
50
60
70
80
90
Per cent
Percentage of mothers attending an antenatal visit in the first trimester (less than 14 weeks), by
11
Smoking during pregnancy
Fewer women are smoking during pregnancy
Tobacco smoking during pregnancy is the most
common preventable risk factor for pregnancy
complications, and is associated with poorer perinatal
outcomes including low birthweight, being small for
gestational age, pre-term birth and perinatal death.
One in 8 women (34,966 or 12%) who gave birth in
2013 smoked at some time during their pregnancy,
a decrease from 15% in 2009.
Rates of smoking were slightly higher in the first 20 weeks of pregnancy (11%) compared with
after 20 weeks of pregnancy (9%).
On average, women who smoked during pregnancy:
• attended their first antenatal visit later in pregnancy (15 weeks) than those who did not smoke (13 weeks)
• had one less antenatal care visit (9 visits) than women who did not smoke (10 visits).
These patterns were present even when considering differences due to socioeconomic status.
Some mothers were more likely than others to smoke in the first 20 weeks of pregnancy.
Proportions were highest among the following women, noting that some may fall in more than
one of these categories:
• younger mothers—more than one-third (34%) of mothers under 20 smoked in the first 20 weeks of pregnancy, a rate which falls to 7% for mothers aged 35–39 but increases slightly to
8% for mothers 40 and over
• mothers living in Remote and Very remote areas—around one-third (37%) of mothers in Very remote and one-fifth (21%) in Remote areas smoked, compared with 9% of women living in Major cities
• mothers living in the lowest socioeconomic status (SES) areas—one-fifth (20%) of mothers living in the lowest SES areas smoked, compared with 4% of mothers in the highest
SES areas
• Indigenous mothers—almost half (47%) of Indigenous mothers smoked, compared with 13% of non-Indigenous mothers (age-standardised percentages).
12
Chapter 2: Mothers
Smoking in the first 20 weeks of pregnancy by selected maternal
characteristics, 2013
(a) Age-standardised percentages.
13
Rates of smoking during pregnancy vary across Primary Health Networks
In 2013, the proportion of women who smoked in the first 20 weeks of pregnancy varied across
the 31 Primary Health Networks (PHNs) in Australia. The proportions ranged from 1.3% in
the Northern Sydney PHN to 25% in Western Queensland, with a median of 14%.
Percentage of mothers smoking during the first 20 weeks of pregnancy, by
Rates of smoking during pregnancy vary across Primary Health Networks
In 2013, the proportion of who smoked in the first 20 weeks of pregnancy varied across the
31 Primary Health Networks (PHNs) in Australia. The proportions ranged from 1.3% in the
Northern Sydney PHN to 25% in Western Queensland, with a median of 14%.
Comment [DE
the legend on th
previous one. T
PHN307
PHN701
PHN701
PHN305
PHN307
PHN306
PHN304
PHN301
PHN302
PHN303
PHN109
PHN301
PHN503
PHN503
PHN402
PHN305
PHN501
PHN502
PHN306
PHN107
PHN302
PHN108
PHN304
PHN402
PHN303
PHN104
PHN109
PHN103
PHN110PHN108
PHN107
PHN501
PHN104
PHN502
PHN401
PHN101
PHN110
PHN401
20–25%
16–19%
12–15%
7–11%
1–<7%
PHN206
PHN105
PHN205
PHN106
PHN206
PHN801
PHN201
PHN201
PHN204
PHN203
PHN203
PHN601
PHN202
PHN601
Percentage of mothers smoking during the first 20 weeks of pregnancy, by Primary Health
Network of usual residence, 2013
14
PHN102
PHN101
PHN103
PHN105
PHN102
Chapter 2: Mothers
PHN106
PHN801
PHN205
PHN204
PHN202
Percentage of mothers smoking during the first 20 weeks of pregnancy, by
25
23
22
22
20
20
Murray (PHN205 Vic)
19
19
19
17
17
17
15
15
14
14
12
12
11
11
10
10
10
9
8
7
7
6
6
3
1
0
5
10
15
20
25
Per cent
Percentage of mothers smoking during the first 20 weeks of pregnancy, by Primary Health
Network of usual residence, 2013
15
1 in 5 smokers quit in pregnancy
Women who stop smoking during pregnancy can reduce the risk of adverse outcomes for themselves
and their babies, and support for smoking cessation is widely available through antenatal clinics.
Of women who gave birth in 2013, around one-fifth (22%) of those who reported smoking
during the first 20 weeks of pregnancy did not continue to smoke after 20 weeks of pregnancy.
On average, mothers who ceased smoking during pregnancy had attended their first antenatal
visit earlier in their pregnancy (by 13.8 weeks) and attended more antenatal visits (9.6 visits),
compared with mothers who reported smoking both before and after 20 weeks of pregnancy
(15.4 weeks and 8.6 visits) (data on the number of antenatal visits excludes Victoria). These
patterns were present even when considering differences due to socioeconomic status.
Some women may continue to smoke before knowing they are pregnant, and cease once
they find out they are pregnant. According to data from the 2013 National Drug Strategy
Household Survey, around 1 in 6 (17%) women smoked before they knew they were pregnant,
and 1 in 10 (11%) continued smoking after they found out they were pregnant (AIHW 2014).
16
Chapter 2: Mothers
Maternal health
1 in 5 mothers are classified as obese
Some mothers may be at an increased risk of complications as a result of their health status
at the start of pregnancy.
Obesity in pregnancy contributes to increased morbidity and mortality for both mother and
baby. Pregnant women who are obese have an increased risk of thromboembolism, gestational
diabetes, pre-eclampsia, post-partum haemorrhage, wound infections and caesarean section,
and their babies have higher rates of congenital anomaly, stillbirth and neonatal death
compared with pregnant women who are not obese (CMACE & RCOG 2010).
Body mass index (BMI) is a ratio of weight and height (kg/m2). A normal range of BMI for
non-pregnant women is 18.5 to 24.9. While increases in BMI are expected in pregnancy, a BMI of
30 or more at the first antenatal visit has been defined as obesity in pregnancy.
Data on maternal BMI was available for mothers in Victoria, Queensland, Western Australia,
South Australia, Tasmania and the Australian Capital Territory in 2013. However, data collection
methods vary considerably between jurisdictions. These data cover around two-thirds of
women who gave birth in 2013.
Among women who gave birth in these jurisdictions:
• one-fifth (19%) were classified as obese (with a BMI of 30 or more)
• one-quarter (24%) were overweight (BMI of 25–29)
• almost half (46%) were in the normal weight range (BMI of 18.5–24.9)
• 3% were underweight.
1 in 5 mothers are obese
A small number of mothers had pre-existing hypertension or pre-existing diabetes in 2013.
This equates to a rate of 8 per 1,000 mothers with pre-existing hypertension and 10 per 1,000
with diabetes (excluding gestational diabetes) (note that data collection methods vary across
jurisdictions and data exclude Western Australia and Victoria).
17
•
half (46%) were in the normal weight range (BMI of 18.5–24.9)
•
3% were underweight.
A small number of mothers had pre-existing hypertension or pre-existing diabetes in 2013.
This equates to a rate of 8 per 1,000 mothers with pre-existing hypertension and 10 per 1,00
with
diabetes
diabetes)
(note
that data
collection
Women
who(excluding
gave birth,gestational
by body mass
index,
selected
states
and methods vary acros
jurisdictions).
territories, 2013
Per cent
50
45
40
35
30
25
20
15
10
5
0
Less than 18.5
18.5–24.9
25–29.9
Underweight
Normal
Overweight
40 and over
30–39.9
Obese
BMI
Note:
BMI data
data were
were available
availablefor
forVictoria,
Victoria,Queensland,
Queensland,Western
WesternAustralia,
Australia,
South
Australia
and Tasmania
were partially collected from t
Note: BMI
South
Australia,
Tasmania
and theand
Australian
Australian
CapitalBMI
Territory.
data and
methods
used forincollection
in territories
states andare
territories
are not uniform.
Capital Territory.
sourceBMI
datasource
and methods
used
for collection
states and
not uniform.
Women who gave birth, by body mass index, selected states and territories, 2013
Australia’s mothers and babies 2013
18
Chapter 2: Mothers
Place of birth
Hospitals are the most common place of birth
Almost all births in Australia occur in hospitals, in conventional labour-ward settings. In 2013,
97% (296,611) of women gave birth in hospitals, while much smaller proportions gave birth
in birth centres (2.0% or 6,085), at home (0.3% or 958) or in other settings including births
occurring before arrival at hospital (0.3% or 984 women).
Of mothers who gave birth in hospital in 2013, most (72%) gave birth in public hospitals, with
28% giving birth in private hospitals. Two-thirds (67%) of women gave birth within 1 day of
admission to hospital and 97% within 2 days of admission. The median length of stay after birth
was 3.0 days.
There has been a trend toward shorter postnatal stays—in 2013, 20% of mothers were
discharged less than 2 days after giving birth and 65% between 2 and 4 days, compared with
11% and 61% in 2003.
Regardless of place of birth, almost all babies were live born (more than 99%). The average
birthweight of live born babies in hospital (3,350 grams) was lower than for those born in birth
centres (3,540 grams) and at home (3,641 grams). The average gestational age was also slightly
lower for babies born in hospital (38.7 weeks) compared with those born in birth centres (39.5)
or at home (39.7). This may be due to the fact that babies who are expected to require a higher
level of care are more likely to be delivered in hospital than in other settings, and are more likely
to be of lower birthweight and pre-term.
Women giving birth at home are older and less likely to be first-time mothers
Women who gave birth in hospitals and birth centres were younger and more likely to be
first-time mothers than those who gave birth at home:
• The average age of mothers who gave birth in birth centres was 29.9 years, with older
average ages for mothers who gave birth in hospitals (30.1) or at home (32.0).
• Nearly half of mothers who gave birth in birth centres (45%) and in hospitals (44%) were aged under 30, compared with only 31% of mothers who gave birth at home.
• One-quarter (25%) of mothers who gave birth at home were first-time mothers, compared
with higher proportions of mothers who gave birth in hospitals and birth centres (44% and
35%, respectively).
Of those who gave birth in hospitals, 21% came from the lowest socioeconomic status areas. By
comparison, women in these areas made up 16% of those who gave birth in birth centres and
12% of those who gave birth at home.
Find out more in the Perinatal data portal: Labour and birth
19
Onset of labour
Onset of labour
Onset of labour
Spontaneous
onset of labour decreases with maternal age
Onset
of labour is categorised
spontaneous
or induced,
or as
no labour (where
Spontaneous
onsetofofaslabour
labour
decreases
with
maternal
age a caesarean
Spontaneous
onset
decreases
with
maternal
age
section was performed before labour started).
Onsetofoflabour
labourisiscategorised
categorisedasasspontaneous
spontaneousororinduced,
induced,ororasasno
nolabour
labour(where
(whereaacaesarea
caesare
Onset
Overall,
just
over
half of women
who
gave birth
in 2013 (53% or 160,526) had a spontaneous
section
was
performed
before
labour
started).
section
was
performed
before
labour
started).
labour, more than one-quarter an induced labour (28% or 84,109) and 1 in 5 had no labour
Overall,just
justover
overhalf
halfofofwomen
womenwho
whogave
gavebirth
birthinin2013
2013(53%
(53%oror160,526)
160,526)had
hadaaspontaneous
spontaneou
Overall,
onset (20% or 60,080).
labour,more
morethan
thanone-quarter
one-quarteran
aninduced
inducedlabour
labour(28%
(28%oror84,109)
84,109)and
and11inin55had
hadno
nolabour
labour
labour,
However,
labour
onset
varied
considerably
by
maternal
age.
Younger
mothers
were
the
most
onset(20%
(20%oror60,080).
60,080).
onset
likely to have spontaneous labour onset (66%) and the least likely to have no labour onset (6%).
However,mothers
labouronset
onset
varied
considerably
bymaternal
maternal
age.
Youngermothers
mothers
werethe
themo
m
However,
labour
varied
considerably
age.
Younger
Conversely,
aged
40
and over
were slightlyby
less
likely to have
spontaneous
labour were
likely
to
have
spontaneous
labour
onset
(66%)
and
the
least
likely
to
have
no
labour
onset
likely
to
have
spontaneous
labour
onset
(66%)
and
the
least
likely
to
have
no
labour
onset
onset than to have no labour onset (35% and 37%). There was little difference in the proportion
(6%).
Conversely,
mothers
aged4040the
and
over
were
slightly
lesslikely
likely
haveaaspontaneous
spontaneous
(6%).
Conversely,
mothers
aged
and
over
were
slightly
less
totohave
of
women
with induced
labour between
age
groups
(ranging
between
26% and
29%).
labouronset
onsetthan
thantotohave
haveno
nolabour
labouronset
onset(35%
(35%and
and37%).
37%).There
Therewas
waslittle
littledifference
differenceininthe
the
labour
There
have
been
small
changes
over
the
decade
to
2013
in
the
type
of
labour
onset—a
slight
proportionofofwomen
womenwith
withinduced
inducedlabour
labouronset
onsetbetween
betweenthe
theage
agegroups
groups(ranging
(rangingbetween
between
proportion
decrease in spontaneous labour (from 57% to 53%) and a corresponding increase in those with
26%and
and29%).
29%).
26%
no labour onset (from 17% to 20%). Induction of labour has remained steady at around 26%
There
havebeen
beensmall
smallchanges
changesover
overthe
thedecade
decadetoto2013
2013ininthe
thetype
typeofoflabour
labouronset—a
onset—aslight
sligh
There
have
of
mothers.
decreaseininspontaneous
spontaneouslabour
labour(from
(from57%
57%toto53%)
53%)and
andaacorresponding
correspondingincrease
increaseininthose
those
decrease
with
no
labour
onset
(from
17%
to
20%).
Induction
of
labour
has
remained
steady
at
aroun
with no labour onset (from 17% to 20%). Induction of labour has remained steady at around
Women
who
gave
birth,
by
onset
of
labour
and
maternal
age,
2013
26%ofofmothers.
mothers.
26%
Percent
cent
Per
100
100
Spontaneous
Spontaneous
Induced
Induced
Nolabour
labour
No
9090
8080
7070
6060
5050
4040
3030
2020
1010
00
Youngerthan
than
Younger
2020
20–24
20–24
25–29
25–29
30–34
30–34
35–39
35–39
andover
over
4040and
Maternalage
age
Maternal
Womenwho
whogave
gavebirth,
birth,by
byonset
onsetofoflabour
labourand
andmaternal
maternalage,
age,2013
2013
Women
Inductiontype
typeand
andreason
reason
Induction
Forwomen
womenwho
whowere
wereinduced,
induced,combined
combinedmedical
medicaland
andsurgical
surgicalinduction
inductionofoflabour
labourwas
wasthe
th
For
mostcommon
commontype
typeofofinduction
induction(data
(dataexcludes
excludesWestern
WesternAustralia).
Australia).
most
Several
jurisdictions
(New South Wales, Queensland, South Australia, Tasmania and the
jurisdictions
20 Several
Chapter
2: Mothers (New South Wales, Queensland, South Australia, Tasmania and the
NorthernTerritory)
Territory)provided
providedfurther
furtherinformation
informationon
onthe
thereason
reasonfor
forinduction
inductionofoflabour.
labour.
Northern
Induction type and reason
For women who were induced, combined medical and surgical induction of labour was the
most common type of induction (data excludes Western Australia).
Several jurisdictions (New South Wales, Queensland, South Australia, Tasmania and the
Northern Territory) provided further information on the reason for induction of labour. Within
these jurisdictions, prolonged pregnancy and premature rupture of membranes were the main
reasons for induction (ranging between 16% and 24% and between 9% and 16%, respectively).
Augmentation of labour
Once labour starts, it may be necessary to intervene to speed up or augment the labour. Labour
was augmented for 15% of all mothers in 2013, which was equivalent to 28% of mothers with
spontaneous onset of labour (data excludes Western Australia).
21
Method of birth
Two-thirds of mothers had vaginal births, one-third had caesareans
In 2013, 204,860 women (67%) had a vaginal birth and 99,862 (33%) had a caesarean section.
Most vaginal births (82%) were non-instrumental. When instrumental delivery was required,
vacuum extraction was more commonly used than forceps (11% and 7% respectively).
The overall rate of primary caesarean section (that is, caesarean sections to women with no
previous history of caesarean sections) was 23%; this rate was higher for first-time mothers
(34%) and lower for mothers who had previously given birth (10%).
The vast majority (85%) of women who had a previous caesarean section had a repeat
caesarean section, while the remainder had a vaginal birth (12% had a non-instrumental
vaginal birth and almost 4% had an instrumental vaginal birth).
Having had a previous caesarean section was the most common main reason for having a
caesarean (based on data from Queensland, South Australia, Tasmania and the Northern Territory).
Perineal status after vaginal birth
Around one-quarter of mothers had an intact perineum after vaginal birth (27%) while almost
half had either a first degree laceration or vaginal graze (23%) or a second degree laceration
(26%). A small proportion of women had a third or fourth degree laceration (2%). Around 1 in 5
women had an episiotomy performed, some of whom also had a laceration.
Caesarean sections are more common among older mothers
The likelihood of vaginal delivery (both non-instrumental and instrumental) and caesarean
section differs by maternal age. Small differences were also evident by remoteness and
socioeconomic status (SES) after accounting for differences in age structure across these areas.
Non-instrumental vaginal delivery decreased with age and increased slightly with each
category of remoteness:
• Non-instrumental vaginal delivery progressively decreased with maternal age (from 69% for teenage mothers to 41% for mothers over 40).
• Fewer mothers living in Major cities had a non-instrumental vaginal delivery (54%) compared with mothers in Very remote areas (60%).
• Mothers living in the highest SES areas were less likely to have a non-instrumental vaginal delivery (52%) than those in the lowest SES areas (59%).
Instrumental vaginal delivery decreased with age (from 13% for teenage mothers to 8% for
mothers over 40) and with increasing remoteness (from 12% in Major cities to 8% in Very remote
areas). Instrumental vaginal delivery was more common among mothers living in the highest
SES areas (14%) compared with the lowest SES areas (9%).
22
Chapter 2: Mothers
highest SES areas (14%) compared with the lowest SES areas (9%).
Caesarean sections increased with age, but differed little by remoteness and SES:
•
Mothers older than 40 were around 3 times as likely to deliver by caesarean section
compared with teenage mothers (51% and 18%).
•
Remoteness of usual residence made little difference to the proportion of mothers giving
birth by caesarean section (34% of those in Major cities compared with 33% of those in
Women
who areas).
gave birth,
bymade
method
birth and
maternal
Very remote
SES also
little of
difference
(34%selected
of women
living in the highest
characteristics,
2013
SES areas and 32% in the lowest SES areas).
Per cent
Non-instrumental vaginal
Instrumental vaginal
Caesarean section
100
80
60
40
20
0
Younger 20–24
than 20
25–29
30–34
Maternal age
Maternal
(a)
35–39
40 and
over
Major
Inner
Outer Remote Very Lowest Highest
cities regional regional
remote SES
SES
areas areas
Remoteness(a)
Remoteness(a)
SES(a)
SES(a)
Age-standardised percentages.
(a) Age-standardised percentages.
Women who gave birth, by method of birth and selected maternal characteristics, 2013
Caesarean sections increased with age, but differed little by remoteness and SES:
• Mothers older than 40 were around 3 times as likely to deliver by caesarean section compared with teenage mothers (51% and 18%).
• Remoteness of usual residence made little difference to the proportion of mothers giving birth by caesarean section (34% of those in Major cities compared with 33% of those in
Very remote areas). SES also made little difference (34% of women living in the highest SES areas and 32% in the lowest SES areas).
19
23
Caesarean sections have increased over time
Since 2003, vaginal non-instrumental delivery has fallen 6 percentage points (decreasing from
61% in 2003 to 55% in 2013) whereas the caesarean section rate has increased by 5 percentage
points (from 28% in 2003 to 33% in 2013). Vaginal delivery with instruments has remained
relatively stable at around 12% throughout this period. These trends remain when changes in
maternal age over time are taken into account.
Internationally, the caesarean section rate has been increasing in most Organisation for
Economic Co-operation and Development (OECD) countries. The OECD average increased
from a rate of 20 per 100 live births in 2000 to 28 per 100 in 2013. Australia’s rate remained
higher than the OECD average over this time and ranked 22nd out of 32 OECD countries in
2013 (when caesarean section rates are ranked from lowest to highest) (OECD 2015).
Women who gave birth, by method of birth, 2003 to 2013
24
Chapter 2: Mothers
Pain relief during labour and operative delivery
Almost 1 in 4 women did not use pain relief during labour
The types of analgesia or anaesthesia used during labour and delivery influence the
effectiveness of pain relief, the extent to which a woman is able to actively participate in the
birth and her mobility immediately after the birth. Analgesia is used to relieve pain during
labour (spontaneous or induced), while anaesthesia is used for operative delivery (caesarean
section or instrumental vaginal birth). More than 1 type of analgesic or anaesthetic may be
administered to each woman.
Of the 244,635 women who had labour onset in 2013, around 3 in 4 received pain relief (77%).
The most common types were nitrous oxide (inhaled) (54%), followed by regional analgesic
(33%) and systemic opioids (20%).
Close to one-quarter (23%) of women who had labour onset did not receive any pain relief
during labour. These women were more likely to be older, to have given birth before, and to
live in the lowest socioeconomic status (SES) areas, compared with women who received
pain relief.
3 in 4 women with labour onset received pain relief
25
Of the 244,635 women who had labour onset in 2013, around 3 in 4 received pain relie
most common types were nitrous oxide (inhaled) (54%), followed by regional analges
(33%) and systemic opioids (20%).
Maternal
Maternal
age
age
Close to one-quarter (23%) of women who had labour onset did not receive any pain r
during labour. These women were more likely to be older, to have given birth before,
Women who went into labour and did not receive pain relief, by selected
live in the
lowest socioeconomic
status (SES) areas, compared with women who receiv
maternal
characteristics,
2013
pain relief.
Younger than 30
30 and over
None
Parity
Parity
One
Two
Three
SES
SES
Four or more
Lowest SES areas
Highest SES areas
0
5
10
15
20
25
30
35
40
45
50
Per cent
Women who went into labour and did not receive pain relief, by selected maternal character
2013 who have a caesarean section receive a type of anaesthetic. In 2013, the vast
All women
majority (95%) of women who had a caesarean section had a regional anaesthetic and 6% had
All women who have a caesarean section receive a type of anaesthetic. In 2013, the vas
a general anaesthetic (note that some women may have had both).
majority (95%) of women who had a caesarean section had a regional anaesthetic and
Mosthad
women
who had
an instrumental
vaginal
deliverywomen
also received
anaesthetic
(87%).
a general
anaesthetic
(note
that some
may an
have
had both).
Among these women, a regional anaesthetic was most common (61%), followed by a local
Most women
who had
an instrumental vaginal delivery also received an anaesthetic (
anaesthetic
to the perineum
(28%).
Among these women, a regional anaesthetic was most common (61%), followed by a l
anaesthetic to the perineum (28%).
26
Chapter 2: Mothers
Multiple pregnancies
Multiple pregnancies increase with maternal age and use of assisted
reproductive technology
Over the decade to 2013, the number of multiple pregnancies increased slightly from 4,259 in
2003 to 4,629 in 2013; however, the rate decreased over this time from 17 per 1,000 mothers
to 15 per 1,000 mothers.
In 2013, this represented 1.5% of all pregnancies. Almost all multiple pregnancies (98%)
were twins, while a small proportion (2%) were other multiples (that is, triplets, quadruplets
or higher).
The proportion of multiple pregnancies increased with maternal age and use of assisted
reproductive technology (ART):
• Less than 1% of mothers aged under 20 gave birth to multiples compared with 2.6% of
mothers aged over 40. This is likely due to a higher use of ART among older mothers—
the average age of women who received ART treatment was 34.3 years compared with
29.9 for women who did not.
• The proportion of multiple pregnancies among mothers who received ART was 7 times
as high as for mothers who did not receive ART treatment (8.4% compared with 1.2%).
Data on whether pregnancy resulted from ART were available for Victoria, Queensland,
Tasmania and the Australian Capital Territory, and 4.4% of women who gave birth in these
jurisdictions in 2013 received ART. Detailed information on the use of ART in Australia is
available from Macaldowie et al. (2014).
17
15
per 1,000
mothers
per 1,000
mothers
2003
2013
27
The proportion of multiple pregnancies increased with maternal age and use of ART:
•
Less than 1% of mothers aged under 20 gave birth to multiples compared with 2.6%
mothers aged over 40. This is likely due to a higher use of ART among older mothers
•
The proportion of multiple pregnancies among mothers who received ART was 6.8 t
as high as for mothers who did not receive ART treatment (8.4% compared with 1.2%
Women
whoongave
multiples,
by selected
characteristics,
2013
based
databirth
fromto
Victoria,
Queensland,
Tasmania
and the Australian
Capital
Territory).
Younger than 20
Maternal age
Maternal age
20–24
25–29
30–34
35–39
ART(a)
ART(a)
40 and over
ART
Not ART
0
1
2
3
4
5
6
7
8
Per cent
(a)
Data available for Victoria, Queensland, Tasmania and the Australian Capital Territory.
(a) Data available for Victoria, Queensland, Tasmania and the Australian Capital Territory.
Women who gave birth to multiples, by selected characteristics, 2013
22
28
Chapter 2: Mothers
9
3
Babies
Gestational age
Most babies are born at term and less than 1 in 10 are pre-term
Gestational age is the duration of pregnancy in completed weeks.
In 2013, the average gestational age for all babies was 38.7 weeks, with the vast majority (91%)
born at term (37–41 weeks).
Average gestational age varied by birth status—38.7 weeks for live born babies, and
considerably lower for stillborn babies (26.9 weeks).
Pre-term birth (before 37 completed weeks’ gestation) is associated with a higher risk of
adverse neonatal outcomes. Overall, 8.6% of babies were born pre-term in 2013, with most
of these births occurring at gestational ages of between 32 and 36 completed weeks. The
average gestational age for all pre-term births was 33.3 weeks.
Most stillbirths were pre-term (84%) but only 8% of live births were pre-term. Conversely, the
vast majority of live births (91% or 280,965) were born at term while only 15% of still births
occurred at term. Less than 1% of all babies were born post-term (42 weeks and over).
Over the decade from 2003 to 2013, the proportion of babies born between 37 and 39 weeks
increased, while the proportion born from 40 weeks onwards decreased.
8.6% pre-term
91% born at term
<1% post-term
Gestational age of babies
29
average gestational age for all pre-term births was 33.3 weeks.
Most stillbirths were pre-term (84%) but only 8% of live births were pre-term. Conversely,
the vast majority of live births (91% or 280,965) were born at term while only 15% of still
births occurred at term. Less than 1% of all babies were born post-term (42 weeks and over).
Over the decade from 2003 to 2013, the proportion of babies born between 37 and 39 weeks
Babies, by gestational age, 2003 and 2013
increased, while the proportion born from 40 weeks onwards decreased.
Per cent
2003
35
2013
30
25
20
15
10
5
0
20–36
37
38
39
Pre-term
Pre-term
40
41
Term
Term
42 and over
Post-term
Post-term
Note: Pre-term births include a small number of births of less than 20 weeks gestation.
Note: Pre-term births include a small number of births of less than 20 weeks gestation.
Babies, by gestational age, 2003 and 2013
Pre-term births are more common to mothers who smoked
Mother’s smoking status was associated with the baby’s gestational age. Babies whose mothers
smoked during pregnancy were 1.5 times as likely to be born pre-term (12%) as those whose
mothers did not smoke during pregnancy (8%).
Other characteristics were also associated with increased likelihood of pre-term birth, noting
that some babies may have more than one of these characteristics. These included:
• babies of Indigenous mothers—14% born pre-term compared with 8% of babies of
non-Indigenous mothers
• babies born in multiple births—around 62% of twins and all (100%) of other multiples
(triplets and higher) were pre-term, compared with 7% of singleton babies
• babies born to mothers usually residing in more remote areas—13% in Very remote areas
compared with 8% in Major cities
• babies of younger (<20) and older (40 and over) mothers—10% and 12% were pre-term,
compared with 8% of babies with mothers aged 20–39.
30
Chapter 3: Babies
2
Birthweight
The vast majority of live born babies are in the normal birthweight range
A baby’s birthweight is a key indicator of infant
health and a determinant of a baby’s chances of
survival and health later in life.
In 2013, the mean birthweight of live born babies
was 3,355 grams, with the vast majority of babies
born in the normal birthweight range (92%);
6.4% (19,597) of babies were low birthweight;
and a small proportion were high birthweight
(1.6% or 4,790).
Birthweight ranges
High: 4,500 grams and over
Normal: 2,500 to 4,499 grams
Low: less than 2,500 grams
(WHO 1992)
Birthweight differed markedly by birth status—the mean birthweight of stillborn babies
(1,131 grams) being far lower than for live born babies (3,355 grams). Around 81% of all stillborn
babies were low birthweight in 2013, and more than half (64%) were extremely low birthweight
(under 1,000 grams).
Babies, by birthweight and birth status, 2013
31
Low birthweight
1 in 16 live born babies are low birthweight
Babies are considered to be of low birthweight when their weight at birth is less than 2,500
grams. This section looks at low birthweight in more detail, and relates to live births only.
In 2013, 6.4% (19,597) of live born babies were of low birthweight. Of these babies:
• 16% or 3,102 were of very low birthweight (less than 1,500 grams)
• 7% or 1,351 were extremely low birthweight (less than 1,000 grams).
6.4%
<2,500 grams
Between 2003 and 2013 there has been little change in the proportion of low birthweight
babies, with the proportion remaining at between 6.1% and 6.4% over this time.
The proportion of low birthweight babies was higher among:
• female babies (6.9%) compared with male babies (5.9%)
• twins (56%) and other multiples (98%) compared with singletons (4.8%)
• babies born in public hospitals (7.0%) compared with private hospitals (4.8%)
• babies with mothers who smoked during pregnancy (12%) compared with babies whose
mothers did not (5.7%)
• babies of Indigenous mothers (12.2%) compared with those of non-Indigenous mothers
(6.1%) (see Section 4 for more information).
32
Chapter 3: Babies
•
twins (56%) and other multiples (98%) compared with singletons (4.8%)
•
babies born in public hospitals (7.0%) compared with private hospitals (4.8%)
•
babies with mothers who smoked during pregnancy (12%) compared with babies
mothers did not (5.7%)
Smoking
Smoking
status
status
• babies
of Indigenous
(12.2%)
compared
with
those of non-Indigenous
mo
Low
birthweight
live bornmothers
babies, by
selected
maternal
characteristics,
2013
(6.1%) (see Section 4 for more information).
Smoked
Did not smoke
Major cities
Remoteness
Remoteness
Inner regional
Outer regional
Remote
Very remote
SES
SES
Lowest SES areas
Indigenous
Indigenous
Indigenous
status
status
status
Highest SES areas
Indigenous mother
Non-Indigenous mother
0
2
4
6
8
10
12
14
Per cent
Low birthweight babies, by selected maternal characteristics, 2013
A baby may be low birthweight due to being born early (pre-term), or may be small for its
A babyage
may
be low
birthweight
due to being
bornrestriction).
early (pre-term),
or mayon
be small fo
gestational
(which
indicates
possible intrauterine
growth
More information
gestational
age
(which
indicates
possible
intrauterine
growth
restriction).
More
inform
these babies is available from the National Core Maternity Indicators data portal.
on these babies is available from the National Core Maternity Indicators dynamic data
Find out more in the National Core Maternity Indicators data portal: Small babies
26
33
Rates of low birthweight babies vary depending on where mothers live
The proportion of live born low birthweight babies increased with remoteness and
disadvantage:
Find out more in the National Core Maternity Indicators data portal: Small babies
• 6.3%
of babies born to mothers living in Major cities were low birthweight, increasing to
10.6% in Very remote areas
Rates of low birthweight live born babies vary by where mothers live
• 5.6% of babies born to mothers living in the highest socioeconomic status (SES) areas were
The proportion of low birthweight babies increased with remoteness and disadvantage:
of low birthweight compared to 7.5% in the lowest SES areas.
•
6.3% of babies born to mothers living in Major cities were low birthweight, increasing to
The proportion
of live
born
babies of low birthweight varied across the 31 Primary Health
10.6% in Very
remote
areas
Networks
inborn
Australia
in 2013.
Theinproportions
ranged from 5.4%
the Northern
• 5.6% (PHNs)
of babies
to mothers
living
the lowest socioeconomic
statusin(SES)
areas
Sydney
PHN
to
8.4%
in
the
Northern
Territory,
with
a
median
of
6.4%.
were of low birthweight compared to 7.5% in the highest SES areas.
The proportionthe
of live
born babies
of low
birthweight
variedinacross
the 31
Health
Internationally,
proportion
of low
birthweight
babies
Australia
in Primary
2012 (6.2%)
was lower
Networks (PHNs) in Australia in 2013. The proportions ranged from 5.4% in the Northern
than the Organisation for Economic Co-operation and Development (OECD) average (6.6%),
Sydney PHN to 8.4% in the Northern Territory, with a median of 6.4%.
with Australia ranked 15th out of 34 OECD countries (OECD 2015).
Internationally, the proportion of low birthweight babies in Australia in 2012 (6.2%) was
lower than the Organisation for Economic Co-operation and Development (OECD) average
Percentage
of live
born15th
low
birthweight
babies,(OECD
by Primary
(6.6%),
with Australia
ranked
out
of 34 OECD countries
2015). Health Network
of mother’s usual residence, 2013
PHN307
PHN701
PHN305
PHN306
PHN503
PHN402
PHN107
PHN501
PHN502
PHN110
7.0–8.5%
PHN401
6.7–6.9%
6.3–6.6%
6.0–6.2%
5.4–5.9%
PHN206
PHN201
PHN203
PHN304
PHN301
PHN302
PHN303
PHN109
PHN108
PHN104
PHN103
PHN102
PHN101
PHN105
PHN106
PHN801
PHN205
PHN204
Percentage of live born low birthweight babies, by Primary Health Network
of mother’s usual
PHN601
PHN202
residence, 2013
34
Chapter 3: Babies
27
Percentage of live born low birthweight babies, by Primary Health Network
of mother’s usual residence, 2013
8.4
8.0
7.2
7.0
7.0
6.8
6.7
6.7
6.7
6.6
6.6
6.6
6.6
6.5
6.5
6.4
6.4
Murray (PHN205 Vic)
6.4
6.4
6.3
6.3
6.2
6.2
6.2
6.1
6.0
6.0
5.9
5.9
5.6
5.4
0
1
2
3
4
5
6
7
8
9
Per cent
Percentage of live born low birthweight babies, by Primary Health Network of mother’s usual
residence, 2013
35
Baby presentation and method of birth
3 in 10 multiple births are non-vertex presentations
Baby presentation
and
of birth
The presentation
of the baby at birth
refersmethod
to the anatomical
part of the baby that is facing
down the birth canal.
3 in 10 multiple births are non-vertex presentations
In 2013, the vast majority of babies (94% or 292,066) were in a vertex presentation at birth, in
The
baby
at the
birth
referscanal.
to the
anatomical
of thehad
baby that is fa
which
thepresentation
top of the headofis the
facing
down
birthing
Small
proportionspart
of babies
down
the birthpresentations:
canal.
different
(non-vertex)
• Around
1 in the
25 babies
(4.4% or 13,617)
were(94%
in a breech
presentation
the baby
exits
In 2013,
vast majority
of babies
or 292,660)
were(where
in a vertex
presentation
at bi
buttocks
feet
first)
whichorthe
top
of the head is facing down the birthing canal. Small proportions of babi
different
(non-vertex)
• Around
1 in 100
babies (1.1%presentations:
or 3,513) were in other presentations including face, brow,
shoulder/transverse
and
compound
presentations.
• Around 1 in 25 babies (4.4%
or 13,617) were in a breech presentation (where the b
In 2013, multiple
births were
than 6 times as likely to be in non-vertex presentation as
exits buttocks
ormore
feet first)
singletons (32% compared with 5%). The proportion was greater for higher-order multiples
• Around 1 in 100 babies (1.1% or 3,513) were in other presentations including face,
(triplets and higher) (37%) than for twins (32%). Non-vertex presentation increased with
shoulder/transverse and compound presentations.
birth order for multiple births, from 23% among babies who were born first to 42% among
In 2013,
multiple births were more than 6 times as likely to be in non-vertex presentat
subsequent
babies.
singletons (32% compared with 5%). The proportion was greater for higher-order mul
(triplets and higher) (37%) than for twins (32%). Non-vertex presentation increased w
Babies,
by presentation
birth and
2013babies who were born first to 42% am
birth order
for multipleatbirths,
fromplurality,
23% among
subsequent babies.
Per cent
Vertex
Breech
Other
100
90
80
70
60
50
40
30
20
10
0
Singletons
Twins
Other multiples
Plurality
Note: ‘Other’ includes face, brow, shoulder/transverse and compound presentations.
Note: ‘Other’ includes face, brow, shoulder/transverse and compound presentations.
Babies, by presentation at birth and plurality, 2013
36
A baby’s presentation at birth can affect the method of birth. Most babies in a vertex
presentation were delivered by vaginal birth (69%), with 31% delivered via caesarean
section.
almost 9 in 10 babies (88%) presenting in breech position were de
Chapter 3:Conversely,
Babies
via caesarean section, with only 12% delivered by vaginal birth.
A baby’s presentation at birth can affect the method of birth. Most babies in a vertex
presentation were delivered by vaginal birth (69%), with 31% delivered via caesarean section.
Conversely, almost 9 in 10 babies (88%) presenting in breech position were delivered via
caesarean section, with only 12% delivered by vaginal birth.
Baby’s method of birth also varies by plurality. The likelihood of vaginal delivery decreases as
plurality increases, from around two-thirds (68%) of singleton babies, to one-third (31%) of
twins and 13% of other multiples. This pattern is reversed for caesarean sections, which are least
common among singletons (32%) and most common among multiple births (69% of twins and
86% of other multiples).
See Section 2 for more information on method of birth for mothers, where the method of birth
of the first-born baby in multiple births is used.
Babies, by method of birth and selected baby characteristics, 2013
Presentation
Presentation
Vaginal
Caesarean section
Not stated
Vertex
Breech
Other
Plurality
Plurality
Singleton
Twins
Other multiples
0
10
20
30
40
50
60
70
80
90
100
Per cent
Note: ‘Other’ presentation includes face, brow, shoulder/transverse and compound presentations.
Note: ‘Other’ presentation includes face, brow, shoulder/transverse and compound presentations.
Babies, by method of birth and selected baby characteristics, 2013
37
Apgar scores
Apgar scores are highest among babies born at term
Apgar scores are clinical indicators of a baby’s condition shortly after birth. The measure is
basedApgar
on the assessment
scoresof 5 characteristics of the baby including skin colour, pulse, breathing,
muscle tone and reflex irritability. Each characteristic is given between 0 and 2 points, with a
total score
between
0 and
10highest
points. among babies born at term
Apgar
scores
are
Apgar
scores
clinical
indicators
a baby’s
condition
shortly
after well
birth.
An Apgar
score
of 7 orare
more
at 5 minutes
afterofbirth
indicates
the baby
is adapting
toThe
the measure is
based
on
the
assessment
of
5
characteristics
of
the
baby
including
skin
colour,
pulse,
environment, while a score of less than 7 indicates complications for the baby.
breathing, muscle tone and reflex activity. Each characteristic is given between 0 and 2
In 2013,
almostwith
all live
born score
babiesbetween
(98%) had
an Apgar
score of 7 or more and 1.8% had an
points,
a total
0 and
10 points.
Apgar score of 0 to 6. Apgar scores of 0–3 were recorded for just 0.3% of all live births and
Apgar
of 7 for
or more
5 minutes
after birth indicates the baby is adapting well to
scoresAn
of 4–6
werescore
recorded
1.5% ofatlive
born babies.
the environment, while a score of less than 7 indicates complications for the baby.
Apgar scores differed by gestational age and birthweight:
In 2013, almost all live born babies (98%) had an Apgar score of 7 or more and 1.8% had an
of babies
born
had an
Apgarofscore
7 orrecorded
more compared
99%
• 92%Apgar
score
of pre-term
0 to 6. Apgar
scores
0–3 of
were
for justwith
0.3%
of of
allbabies
live births and
born
at
term
scores of 4–6 were recorded for 1.5% of live born babies.
• 91% of low birthweight babies (less than 2,500 grams) had an Apgar score of 7 or more
Apgar scores differed by gestational age and birthweight:
compared with 99% of babies weighing 2,500 grams or more.
• 92% of babies born pre-term had an Apgar score of 7 or more compared with 99% of
babies born at term.
Live
Apgar score
of 7 or
more
5 minutes,
by gestational
ageof 7 or more
• born
91%babies,
of low birthweight
babies
(less
thanat2,500
grams) had
an Apgar score
and birthweight,
2013
compared with
99% of babies weighing 2,500 grams or more.
Birthweight
Birthweight
Gestational age
Gestational
(weeks) age
Pre-term (20–36)
Term (37–41)
Post-term (42 and over)
Less than 2,500 grams
(low birthweight)
2,500 grams and over
75
80
85
90
95
100
Per cent
Live born babies, Apgar score of 7 or more at 5 minutes, by gestational age and birthweight, 2013
Find out more in the National Core Maternity Indicators data portal: Apgar score
Find out more in the National Core Maternity Indicators data portal: Apgar score
38
Chapter 3: Babies
Resuscitation
1 in 5 live born babies require active resuscitation
Resuscitation is undertaken to establish independent respiration and heartbeat or to treat
depressed respiratory effect and to correct metabolic disturbances. The types of resuscitation
areResuscitation
hierarchical, with suction being the least severe and external cardiac massage and
ventilation the most extreme. If more than 1 type of resuscitation is performed, the
1 in 5 live born babies require active resuscitation
highest-order type in the hierarchy is the one to be coded.
Resuscitation is undertaken to establish independent respiration and heartbeat or to treat
More than one-fifth (22%) of live born babies required some form of active resuscitation
depressed respiratory effect and to correct metabolic disturbances. The types of resuscitation
immediately after birth in 2013 (excludes data from Western Australia). Around half (47%) of
are hierarchical, with suction being the least severe and external cardiac massage and
those requiring resuscitation received suction or oxygen therapy, and around one-third (36%)
ventilation the most extreme. If more than 1 type of resuscitation is preformed, the highestreceived ventilatory assistance by intermittent positive pressure ventilation (IPPV) through a
order type in the hierarchy is the one to be coded.
bag and mask or via endotracheal incubation. Around 1% of babies who received resuscitation
More than
one-fith
of live
babies required some form of active resuscitation
required
external
cardiac(22%)
massage
andborn
ventilation.
immediately after birth in 2013 (excludes data from Western Australia). Around half (47%) o
those requiring resuscitation received suction or oxygen therapy, and around one-third
(36%) received ventilatory assistance by intermittent positive pressure ventilation (IPPV)
Live born
babies
active resuscitation,
resuscitation
through
a bag
and that
maskreceived
or via endotracheal
incubation.by
Around
1% of live born babies who
measure, 2013
received resuscitation required external cardiac massage and ventilation.
IPPV through bag and mask
Suction
Oxygen therapy
Endotracheal intubation and IPPV
External cardiac massage and ventilation
Other (not further defined)
0
5
10
15
20
25
30
35
Per cent
Note: Excludes data from Western Australia.
Note: Excludes data from Western Australia.
Live born babies that received active resuscitation, by resuscitation measure, 2013
39
Hospital births and length of stay
Twins and other multiples stay in hospital longer
The vast majority of babies are born in hospital (97% babies in 2013), and of these, most are
discharged to home (96% or 256,367 babies in 2013). A small proportion of babies (3%) were
transferred to another hospital and 1% were perinatal deaths (stillbirths or neonatal deaths
occurring in the hospital of birth). Note that all data presented for this topic exclude data from
Western Australia.
Among babies who were discharged to home, the median length of stay was 3 days with
around 92% staying 5 days or less.
A number of factors influence a baby’s length of stay in hospital, including birthweight and
gestational age: low birthweight babies had a median stay of 9 days (compared with 3 days for
normal birthweight babies) and pre-term babies had a median stay of 8 days (compared with
3 days for full-term babies).
As discussed in earlier sections, babies who are part of a multiple birth are more likely to be
of low birthweight and to be born pre-term. This is reflected in the median length of stay
in hospital, which was higher for twins (6 days) and for other multiples (33 days) than for
singletons (3 days).
9 days
8 days
3 days
All babies
Pre-term
babies
Low birthweight
babies
Median length of hospital stay
40
Chapter 3: Babies
Admission to special care nurseries and
neonatal intensive care units
Pre-term babies and multiple births more likely to be admitted to an SCN
or NICU
Some live born babies require more specialised treatment and care than is available on the
postnatal ward. Of all live born babies, 16% (43,159) were admitted to a special care nursery
(SCN) or neonatal intensive care unit (NICU). Note that babies who are transferred between
hospitals (around 3% of all babies) and who are then admitted to an SCN or NICU may not be
included in these data and data also exclude Western Australia and the Northern Territory.
Pre-term babies were more likely to be admitted to an SCN or NICU (75%) than babies delivered
at term (11%) or post-term (13%). Most pre-term babies are of low birthweight, and 76% of low
birthweight babies were admitted compared with 12% of normal birthweight babies and 25%
of those with a high birthweight.
The majority of multiple births are pre-term, and twins and other multiples were therefore
more likely to be admitted than singletons (63% and 95% compared with 15%).
Babies born to Indigenous mothers were 1.5 times as likely to be admitted to an SCN or NICU
as those of non-Indigenous mothers.
Live born babies, by admission to a special care nursery or neonatal
intensive care unit, by selected baby characteristics, 2013
Note: Excludes data from Western Australia and the Northern Territory.
41
Perinatal deaths
Gestational age and birthweight are the biggest predictors of perinatal death
Counting perinatal deaths
There are various definitions used for reporting and registering perinatal deaths in Australia. The
National Perinatal Data Collection defines perinatal deaths as all fetal deaths (stillbirths) and neonatal
deaths (deaths of live born babies aged less than 28 days) of at least 400 grams birthweight or at
least 20 weeks gestation.
Fetal and neonatal deaths include late termination of pregnancy (20 weeks or more gestation) in
Victoria and Western Australia.
Neonatal deaths may not be included for babies transferred to another hospital, re-admitted to
hospital after discharge or who died at home after discharge.
Perinatal and fetal death rates are calculated using all live births and stillbirths in the denominator.
Neonatal death rates are calculated using live births only.
Perinatal and infant death periods used by the National Perinatal
Data Collection
Labour
Birth
7 days
At least 20 weeks or 400 grams
Antepartum fetal
deaths
Intrapartum fetal
deaths
28 days
1 year
0–6 days
7–27 days
28 days–<1 year
Early neonatal deaths
Late neonatal
deaths
Postneonatal deaths
Fetal deaths
Neonatal deaths
Perinatal deaths
Infant deaths
In 2013, there were 10 perinatal deaths for every 1,000 births, a total of 2,998 perinatal deaths.
This included:
• 2,191 fetal deaths or 7 fetal deaths per 1,000 births
• 807 neonatal deaths, a rate of 3 neonatal deaths per 1,000 live births.
42
Chapter 3: Babies
Perinatal death rates decreased dramatically as gestational age and birthweight increased:
• Gestational age—rates were highest among babies born at 20–27 weeks gestation (708 per
1,000 births) and lowest among babies born at term (37–41 weeks) (2 per 1,000 births).
• Birthweight—rates were highest among extremely low birthweight babies (less than 1,000
grams) (700 per 1,000 births) and lowest among babies with birthweight 2,500 grams or
higher (2 per 1,000 births).
Perinatal deaths by gestational age and birthweight, 2013
Deaths per 1,000 births
225
725
200
700
175
675
150
125
100
75
50
25
0
20–27
28–31
32–36
37–41
42 and
over
Less than
1,000
1,000 to
1,499
1,500 to
1,999
2,000 to
2,499
2,500 and
over
Birthweight (grams)
Birthweight (grams)
Other
factorsdeaths
were by
alsogestational
associated
with
rates of
perinatal death (although to a lesser
Perinatal
age
andhigher
birthweight,
2013
extent
than
gestational
ageassociated
and birthweight),
including:
Other
factors
were also
with higher
rates of perinatal death (although to a lesser
extent than
gestationalborn
age and
birthweight),
including:
• maternal
age—babies
to mothers
younger
than 20 and over 40 had the highest rates
maternal
age—babies
born
mothers
younger
than 20Babies
and over
40 had the
highest
of• perinatal
death
(18 and 14
perto1,000
births
respectively).
of mothers
aged
30–34rates
of perinatal
death
(181,000)
and 14 per 1,000 births respectively). Babies of mothers aged 30–34
had the
lowest rate
(8 per
had the lowest rate (8 per 1,000)
• maternal Indigenous status—perinatal death rates were twice as high among babies of
• maternal Indigenous status—perinatal death rates were twice as high among babies of
Indigenous
mothers (18 per 1,000 births) compared with non-Indigenous (9 per 1,000)
Indigenous mothers (18 per 1,000 births) compared with non-Indigenous (9 per 1,000)
(see Section 4 for more information)
(see Section 4 for more information)
• multiple
births—twins
and other
multiples
had perinatal
deathdeath
ratesrates
around
4 and4 10
• multiple
births—twins
and other
multiples
had perinatal
around
andtimes
10
that of
singletons
(34
and
92
deaths
per
1,000
births
compared
with
9).
times that of singletons (34 and 92 deaths per 1,000 births compared with 9).
Patterns
by these
characteristics
were
similar
for both
neonatal
deaths,
noting
Patterns
by these
characteristics
were
similar
for both
fetalfetal
andand
neonatal
deaths,
noting
thatthat
death
rates
were
consistently
higher
than
neonatal
death
rates.
fetalfetal
death
rates
were
consistently
higher
than
neonatal
death
rates.
43
Congenital abnormalities are the leading cause of perinatal deaths
Congenital abnormalities are the leading cause of perinatal deaths
Classifying perinatal deaths
Classifying perinatal deaths
Causes of death for perinatal deaths are classified according to the Perinatal Society of Australia
Causes
death for
perinatal
deaths
are classified
according
to the
Perinatal
Society
of
and
NewofZealand
Clinical
Practice
Guideline
for Perinatal
Mortality
Perinatal
Death
Classification
Australia and New Zealand Clinical Practice Guideline for Perinatal Mortality Perinatal
(PSANZ-PDC).
Death Classification (PSANZ-PDC).
Information about cause of death is based on data for 6 states and territories (Victoria, Queensland,
Information
about
causethe
of death
is based
onTerritory
data forand
6 states
and territories
(Victoria,
South
Australia,
Tasmania,
Australian
Capital
the Northern
Territory).
Queensland, South Australia, Tasmania, the Australian Capital Territory and the Northern
Territory).
The most common cause of all perinatal deaths was congenital abnormalities (anomalies),
The most common
cause
perinatal
deaths
was This
congenital
abnormalities
(anomalies),
accounting
for almost
3 inof
10all
(29%)
perinatal
deaths.
was followed
by spontaneous
accounting
for(16%)
almost
3 in
10 (29%) perinatal
deaths.
This
was followed by spontaneous prepre-term
birth
and
unexplained
antepartum
death
(14%).
term birth (16%) and unexplained antepartum death (14%).
However, the most common causes of death differed between fetal and neonatal deaths. While
However, the
most common
causes
of death
between
fetal and neonatal
deaths.
congenital
abnormality
was the
leading
causediffered
of fetal deaths,
spontaneous
pre-term
birth was
While congenital abnormality was the leading cause of fetal deaths, spontaneous pre-term
the leading cause for neonatal deaths.
birth was the leading cause for neonatal deaths.
Fetal deaths, by cause of death (PSANZ-PDC), 2013
Congenital abnormality
Unexplained antepartum death
Maternal conditions
Spontaneous pre-term
Fetal growth restriction
Specific perinatal conditions
Antepartum haemorrhage
Perinatal infection
Hypertension
Hypoxic peripartum death
Not stated
0
5
10
15
Per cent
Fetal deaths, by cause of death (PSANZ-PDC), 2013
44
Chapter 3: Babies
20
25
30
Neonatal deaths, by cause of death (PSANZ-PDC), 2013
Spontaneous pre-term
Congenital abnormality
Specific perinatal conditions
Antepartum haemorrhage
Hypoxic peripartum death
Perinatal infection
No obstetric antecedent
Hypertension
Maternal conditions
Fetal growth restriction
Not stated
0
5
10
15
20
25
30
35
Per cent
Neonatal deaths, by cause of death (PSANZ-PDC), 2013
These patterns were influenced by gestational age, maternal age and plurality, for example:
These patterns were influenced by gestational age, maternal age and plurality, for example:
• perinatal deaths due to congenital abnormalities increased with increasing maternal age
•
perinatal deaths due to congenital abnormalities increased with increasing maternal age
•
spontaneous pre-term birth decreased with increasing gestational age
• spontaneous pre-term birth decreased with increasing gestational age
of death
among singleton
singleton babies
babies was
was congenital
congenital abnormalities,
abnormalities,
•• the
the most
most common
common cause
cause of
death among
while
whilespontaneous
spontaneouspre-term
pre-termbirth
birthand
andspecific
specificperinatal
perinatalconditions
conditionswere
werethe
themost
mostcommon
causes
of
death
among
twins
and
other
multiples
common causes of death among twins and other multiples
•• most
most perinatal
perinataldeaths
deathsof
ofbabies
babiesborn
bornto
tomothers
mothersyounger
youngerthan
than20
20were
weredue
dueto
tomaternal
maternal
conditionsor
orspontaneous
spontaneouspre-term
pre-termbirth,
birth,while
whilecongenital
congenitalabnormalities
abnormalitieswas
wasthe
themost
most
conditions
common cause
cause of
of perinatal
perinataldeath
death for
forbabies
babieswhose
whosemothers
motherswere
were40
40and
andover.
over.
common
45
4
Aboriginal and Torres Strait
Islander mothers and their babies
Although a range of data by Indigenous status has been presented in earlier sections, this
section provides more in-depth information on Indigenous mothers and their babies.
4.1%
In 2013, there were 12,380 women who gave birth who identified as being Aboriginal and/or
Torres Strait Islander, representing 4.1% of all women who gave birth (based on the Indigenous
status of the mother). Around 1 in 20 babies (5.2% or 16,149) were Aboriginal and/or Torres
Strait Islander (based on the Indigenous status of the baby).
5.2%
In general, Indigenous mothers have fewer interventions during labour and birth compared
with non-Indigenous women. However, the maternal and perinatal outcomes of Indigenous
mothers and their babies have consistently been shown to be poorer than those of
non-Indigenous mothers (AIHW: Leeds et al. 2007).
Nevertheless, most Indigenous mothers and their babies are doing well and there have been
some improvements in recent years. There have been small increases in the proportion of
Indigenous mothers attending an antenatal visit in the first trimester and attending 5 or more
antenatal visits, as well as a small decrease in the rate of smoking among Indigenous mothers
during pregnancy.
46
Chapter 4: Aboriginal and Torres Strait Islander mothers and their babies
Indigenous mothers
Indigenous mothers are more likely to be teenagers, and to live in remote or
disadvantaged areas
Younger maternal age, remoteness and socioeconomic disadvantage are associated with
increased risk of a number of poorer maternal and perinatal outcomes, as discussed in
earlier sections.
Indigenous mothers, compared with non-Indigenous mothers, were:
• almost 7 times as likely to be teenage mothers (18% compared with 3%). Conversely,
only 10% of Indigenous mothers were aged 35 and over compared with 23% of
non-Indigenous mothers
• around 14 times as likely to live in Remote and Very Remote areas as non-Indigenous mothers
(23% compared with 1.7%)
• 2.5 times as likely to live in the lowest socioeconomic status (SES) areas as non-Indigenous
mothers. Around 1 in 2 Indigenous mothers lived in the lowest SES areas compared with
1 in 5 non-Indigenous mothers.
Indigenous mothers receive less antenatal care
On average, in 2013 Indigenous mothers attended 1 less antenatal visit than non-Indigenous
mothers (9 and 10 visits respectively, data exclude Victoria and very pre-term births).
Indigenous women were also more likely to attend antenatal care later in pregnancy than
non-Indigenous women (the average duration of pregnancy at the first antenatal visit was
15 and 13 weeks respectively).
Fewer Indigenous mothers attended their first antenatal visit in the first trimester of pregnancy
(less than 14 completed weeks)—over half (52%) of Indigenous mothers compared with 60% of
non-Indigenous mothers (age-standardised).
The age-standardised proportion of mothers receiving antenatal care in the first trimester
increased with remoteness for both Indigenous and non-Indigenous mothers:
• from 43% of Indigenous mothers in Major cities to 59% in Very remote areas
• from 58% of non-Indigenous mothers in Major cities to 72% in Very remote areas.
The proportion of Indigenous mothers who attended antenatal care in the first trimester
increased slightly between 2010 (50%) and 2013 (52%). In comparison, there has been a
decrease for non-Indigenous mothers over this time from 67% in 2010 to 60% in 2013,
resulting in a narrowing of the gap between Indigenous and non-Indigenous mothers
(age-standardised).
47
•
from 43% of Indigenous mothers in Major cities to 59% in Very remote areas
•
from 58% of non-Indigenous mothers in Major cities to 72% in Very remote areas.
The proportion of Indigenous mothers who attended antenatal care in the first trimeste
increased slightly between 2010 (50%) and 2013 (52%). In comparison, there has been a
decrease for non-Indigenous mothers over this time from 67% in 2010 to 60% in 2013,
resulting
a narrowing
the gap between
and weeks),
non-Indigenous
mothers (
Antenatalinvisit
in the firstoftrimester
(less thanIndigenous
14 completed
by
standardised).
remoteness and Indigenous status (age-standardised), 2013
Per cent
80
Indigenous
Non-Indigenous
70
60
50
40
30
20
10
0
Major cities
Inner regional
Outer regional
Remote
Very remote
Remoteness area
Antenatal visit in the first trimester (less than 14 completed weeks), by remoteness and Indig
status (age-standardised),
2013at 32 weeks or more are also less likely to attend 5 or
Indigenous
mothers who gave birth
more
antenatal visits
than non-Indigenous
mothers:
85% of Indigenous
mothers
had 5likely
or to attend 5 o
Indigenous
mothers
who gave birth
at 32 weeks
or more are
also less
more
visits
compared
with
95%
of
non-Indigenous
mothers
(age-standardised,
excludes
data
more antenatal visits than non-Indigenous mothers: 85% of Indigenous mothers
had 5 o
from
Victoria).
more
visits compared with 95% of non-Indigenous mothers (age-standardised, excludes
Between
2011 and 2013, the proportion of mothers attending 5 or more visits has increased
from Victoria).
slightly for both Indigenous and non-Indigenous mothers (from 84.8% to 86.3% for Indigenous
Between 2011 and 2013, the proportion of mothers attending 5 or more visits has increa
mothers and from 95.1% to 95.5% for non-Indigenous mothers) (age-standardised, excludes
slightly
for both
Indigenous
and non-Indigenous mothers (from 84.8% to 86.3% for
data
from Western
Australia
and Victoria).
Indigenous mothers and from 95.1% to 95.5% for non-Indigenous mothers) (agestandardised,
excludes data
from Western
Australia
and Victoria).
Nearly
half of Indigenous
mothers
smoke during
pregnancy
Indigenous mothers accounted for 17% of mothers who smoked tobacco at any time
Nearly half of Indigenous mothers smoke during pregnancy
during pregnancy in 2013, despite accounting for only around 4% of mothers. Almost 1 in 2
Indigenous
mothers
accounted
for 17%
of mothers
smoked
tobacco
Indigenous
mothers
reported
smoking during
pregnancy
(48% who
compared
with 13%
of at any time du
pregnancy in
2013, [age-standardised]).
despite accounting for only around 4% of mothers. Almost 1 in 2
non-Indigenous
mothers
Indigenous mothers reported smoking during pregnancy (48% compared with 13% of n
The age-standardised proportion of Indigenous women who smoked at any time during
Indigenous
mothersfrom
(age-standardised)).
pregnancy
has decreased
50% in 2009 to 48% in 2013. There has been a similar trend for
non-Indigenous
mothers, with
a decrease in
rate of smoking
fromwho
16% in
2009 to 13%
in time durin
The age-standardised
proportion
ofthe
Indigenous
women
smoked
at any
2013.
Consequently,
rate of smoking
has decreased
all women
between
2013.
pregnancy
has the
decreased
from 50%
in 2009 tofor48%
in 2013.
There2009
has and
been
a similar tren
non-Indigenous mothers, with a decrease in the rate in smoking from 16% in 2009 to 13
2013. Consequently, the rate of smoking has decreased for all women between 2009 and
48
Maternal smoking at any time during pregnancy, by Indigenous status
(age-standardised), 2009 to 2013
Per cent
Indigenous
Non-Indigenous
All women
2011
2012
50
45
40
35
30
25
20
15
10
5
0
2009
2010
2013
Year
Note:
Note:Definitions
Definitionsand
andmethods
methodsused
usedfor
fordata
datacollection
collectiondiffer
differby
bystate
stateand
andterritories.
territories.
Maternal smoking at any time during pregnancy, by Indigenous status (age-standardised), 2
2013
Smoking
cessation rates were lower for Indigenous mothers in pregnancy
The age-standardised rate of smoking cessation during pregnancy among Indigenous
Smoking cessation rates were lower for Indigenous mothers in pregnancy
mothers was 11%, which is less than half that of non-Indigenous mothers (25%) (based on
The age-standardised
rate
cessation
during
pregnancy
among
mothers
who reported smoking
in of
thesmoking
first 20 weeks
of pregnancy
and
not smoking
after Indigenous
mothers
was 11%, which is half that of non-Indigenous mothers (25%) (based on moth
20 weeks
of pregnancy).
who reported smoking in the first 20 weeks of pregnancy and not smoking after 20 we
Indigenous
mothers were more likely to be obese and to have pre-existing
pregnancy).
health conditions
Indigenous
were more likely to be obese and to have pre-existing
Indigenous
mothersmothers
were:
health conditions
• 1.6 times as likely to be obese as non-Indigenous mothers (33% compared with 20%)
Indigenous mothers
were:
(age-standardised,
excludes
data from New South Wales and the Northern Territory)
• almost
3 times
to have
pre-existing
(2.5%)mothers
and almost
4 times
as likely with 20%
• 1.6
timesasaslikely
likely
to be
obese as hypertension
non-Indigenous
(33%
compared
to have
pre-existing diabetesbased
(3.6%)on
compared
with selected
non-Indigenous
(less than 1%
(age-standardised,
data from
states mothers
and territories)
for pre-existing hypertension and 1% for diabetes) (age-standardised, excludes data from
• almost 3 times as likely to have pre-existing hypertension (2.5%) and almost 4 time
Western Australia and Victoria).
likely to have pre-existing diabetes (3.6%) compared with non-Indigenous mothers
than 1% for pre-existing hypertension and 1% for diabetes) (age-standardised).
Indigenous mothers were more likely to have spontaneous labour onset
Spontaneous onset of labour was slightly more common among Indigenous mothers th
non-Indigenous mothers (55% and 52%), while rates of labour induction were the sam
49
both Indigenous and non-Indigenous mothers (28%). Rates of mothers with no labour
therefore lower for Indigenous mothers (17%) than for non-Indigenous mothers (20%)
Indigenous mothers were more likely to have spontaneous labour onset
Spontaneous onset of labour was slightly more common among Indigenous mothers than
non-Indigenous mothers (55% and 52%), while rates of labour induction were the same for
both Indigenous and non-Indigenous mothers (28%). Rates of mothers with no labour were
therefore lower for Indigenous mothers (17%) than for non-Indigenous mothers (20%)
(age-standardised).
Indigenous mothers who had labour onset were slightly less likely to receive pain relief during
labour compared with non-Indigenous women (72% compared with 77%, age-standardised).
Caesarean section rates were slightly lower for Indigenous women
Method of birth is influenced by maternal age, but even when controlling for differences in
age structure between Indigenous and non-Indigenous mothers, some differences remain.
Indigenous mothers were:
• more likely to have a non-instrumental vaginal birth (65%) than non-Indigenous mothers
(55%)
• less likely to have an instrumental vaginal delivery (6%) or caesarean section (29%) than
• more likely
to have
a non-instrumental
vaginal birth (65%) than non-Indigenous m
non-Indigenous
mothers
(12%
and 33%, respectively).
(55%)
• less likely to have an instrumental vaginal delivery (6%) or caesarean section (29%)
Method
of birth by Indigenous
status
non-Indigenous
women (12%
and (age-standardised),
33%, respectively). 2013
Per cent
100
Non-instrumental vaginal
Instrumental vaginal
Caesarean section
90
80
70
60
50
40
30
20
10
0
Indigenous
Non-Indigenous
Indigenous status
Method of birth by Indigenous status (age-standardised), 2013
Find out more in the Perinatal data portal
Find out more in the Perinatal data portal
50
Babies of Indigenous mothers
Babies of Indigenous mothers were 1.7 times as likely to be pre-term
In 2013, the average gestational age of babies of Indigenous mothers was 38.2 weeks, which
was slightly lower than for those of non-Indigenous mothers (38.7 weeks).
Around 1 in 7 babies of Indigenous mothers (14%) were born pre-term, compared with 8% of
babies of non-Indigenous mothers.
Babies of Indigenous mothers who smoked were almost 1.4 times as likely to be born preterm as babies born to non-Indigenous mothers who smoked.
Low birthweight of babies with Indigenous mothers increases with
remoteness
In 2013, the average live born baby of an Indigenous mother weighed 161 grams less than a
baby of a non-Indigenous mother (3,200 grams and 3,361 grams, respectively).
For live born babies with Indigenous mothers, 12.2% (1,507) were of low birthweight,
compared with 6.1% (18,045) of babies with non-Indigenous mothers. Of these babies:
• 17.5% of babies of Indigenous mothers and 15.7% of babies of non-Indigenous mothers
were of very low birthweight (less than 1,500 grams)
• 8.4% of babies of Indigenous mothers and 6.8% of babies of non-Indigenous mothers were
of extremely low birthweight (less than 1,000 grams).
Low birthweight of babies of non-Indigenous mothers varies only slightly by remoteness,
ranging from 5.3% of babies in Remote areas to 6.2% in Major cities. However, for babies of
Indigenous mothers, the difference by remoteness is more noticeable, ranging from 11.6% of
babies in Major cities to 14.2% in Very remote areas.
12.2%
<2,500 grams
51
Low birthweight of live born babies, by Indigenous status of mother and
remoteness, 2013
There has been little change in the proportion of low birthweight babies between 2003 and
2013. The proportion for babies with Indigenous mothers has remained between 11.8% and
13.2%, and the proportion of those with non-Indigenous mothers has remained between 5.9%
and 6.2% over this time.
Babies of Indigenous mothers are more likely to be admitted to SCN or NICU
Apgar scores, use of resuscitation and admission to special care nurseries (SCN) or neonatal
intensive care units (NICU) can give an indication of the health of newborn babies.
Live born babies to Indigenous mothers were more likely to be admitted to an SCN or NICU
(24%) than babies of non-Indigenous mothers (16%) (excludes data from Western Australia and
the Northern Territory).
Similar proportions of babies live born to Indigenous and non-Indigenous mothers:
• had an Apgar score at 5 minutes of 7 or more (97% and 98%, respectively)
• required some form of resuscitation (20% and 22%, respectively, excludes data from
Western Australia).
52
Live born babies to Indigenous mothers were more likely to be admitted to an SCN or NIC
(24%) than babies of non-Indigenous mothers (16%) (excludes data from Western Australia
and the Northern Territory).
Similar proportions of babies live born to Indigenous and non-Indigenous mothers:
Babies of Indigenous mothers, born in hospital and discharged home, had a shorter median
• of
had
score
at 5ofminutes
of 7 or more
(97%
and 98%,
length
stayan(2Apgar
days) than
those
non-Indigenous
mothers
(3 days).
Almostrespectively)
1 in 3 babies of
Indigenous
mothers
(29%)
stayed
for 1 day or less,(20%
compared
withrespectively,
around 1 in 5 babies
(18%)
• required
some
form
of resuscitation
and 22%,
excludes
data from
of non-Indigenous
mothers.
However,
babies
of
Indigenous
mothers
were
1.4
times
as
likely
Western Australia).
as those
of of
non-Indigenous
mothers toborn
stay in
in hospital
6 ordischarged
more days (excludes
dataa from
Babies
Indigenous mothers,
hospitalforand
home, had
shorter median
Western
Australia).
length of stay (2 days) than those of non-Indigenous mothers (3 days). Almost 1 in 3 babies
of Indigenous mothers (29%) stayed for 1 day or less, compared with around 1 in 5 babies
(18%) of non-Indigenous mothers. However, babies of Indigenous mothers were 1.4 times a
Live
babies,
by Indigenousmothers
status oftomother
and selected
birth
likelyborn
as those
of non-Indigenous
stay in hospital
for 6 or
more days (excludes
outcomes,
2013 Australia).
data from Western
Per cent
100
Indigenous
Non-Indigenous
90
80
70
60
50
40
30
20
10
0
Apgar score of 7 or
more
Resuscitation
Stay of 1 day or less
Birth outcome
Admission to
SCN/NICU
Note: Data for admission to SCN/NICU exclude Western Australia and the Northern Territory. Data for resuscitation and length of stay exclude
Western
Australia.
Note: Data
for admission to SCN/NICU exclude Western Australia and the Northern Territory. Data for resuscitation and
length of stay exclude Western Australia.
Live born babies, by Indigenous status of mother and selected birth outcomes, 2013
Higher rates of perinatal death among babies of Indigenous mothers
In 2013,
there
18 perinatal
deaths for
everyof
1,000
births among
babies of Indigenous
Higher
rates
of were
perinatal
death among
babies
Indigenous
mothers
mothers—twice the rate for those of non-Indigenous mothers (9 per 1,000 births).This
In 2013,
there were 18 perinatal deaths for every 1,000 births among babies of Indigenous
included:
mothers—twice the rate for those of non-Indigenous mothers (9 per 1,000 births). This
• 11 fetal deaths per 1,000 births for babies with Indigenous mothers and 7 fetal death
included:
per 1,000 births for those with non-Indigenous mothers
• 11 fetal deaths per 1,000 births for babies with Indigenous mothers and 7 fetal deaths per
7 neonatal
per 1,000 livemothers
births for babies of Indigenous mothers and 2
1,000• births
for thosedeaths
with non-Indigenous
neonatal
deaths
per
1,000
live
births
those with
non-Indigenous
mothers.
• 7 neonatal deaths per 1,000 live births for babies offor
Indigenous
mothers
and 2 neonatal
deaths
percause
1,000 of
livedeath
birthsare
for those
with for
non-Indigenous
mothers. South Australia, Tasmania, t
Data on
available
Victoria, Queensland,
Australian Capital Territory and the Northern Territory. The most notable differences in
cause of death between babies of Indigenous and non-Indigenous mothers in the perinatal
period are for spontaneous pre-term births and congenital abnormalities:
44
53
Data on cause of death are available for Victoria, Queensland, South Australia, Tasmania, the
Australian Capital Territory and the Northern Territory. The most notable differences in cause of
death between babies of Indigenous and non-Indigenous mothers in the perinatal period are
for spontaneous pre-term births and congenital abnormalities:
• Around one-quarter (27%) of perinatal deaths of babies with Indigenous mothers are due to
spontaneous pre-term birth, compared with 16% of babies with non-Indigenous mothers.
• Congenital abnormalities accounted for a smaller proportion of perinatal deaths among
babies of Indigenous mothers (20%) compared with non-Indigenous (30%).
Perinatal deaths, by Indigenous status of mother and cause of death, 2013
Notes
1. ‘Other’ includes ‘specific perinatal conditions’, ‘hypoxic peripartum death’ and ‘no obstetric antecedent’. See Perinatal deaths in Section 3 for more information on the PSANZ-PDC.
2. Includes Victoria, Queensland, South Australia, Tasmania, the Australian Capital Territory and the Northern Territory only.
54
5
About the National Perinatal
Data Collection
The National Perinatal Data Collection (NPDC) commenced in 1991 and collects national
information on the pregnancy and childbirth of mothers, and the characteristics and outcomes
of their babies. The NPDC supports a range of reports and products, including:
• Australia’s mothers and babies annual report
• Perinatal data portal, available at <www.aihw.gov.au/perinatal-data/>
• National core maternity indicators reports and data portal, available at
<www.aihw.gov.au/ncmi/>
• Indigenous mothers and their babies reports
• other specialist reports, indicator-based reports and customised data requests.
Collection of perinatal data by states and territories
Perinatal data are collected after each birth by midwives or other staff from clinical and
administrative records and information systems, including records of antenatal care, the care
provided during labour, and the delivery and care provided after the birth. Each state and
territory has its own form and/or electronic system for collecting data, which are forwarded to
the relevant state and territory health department to form the state or territory perinatal data
collection. See Appendix B for state and territory contact details and the most recent state
and territory perinatal reports, which contain more detailed information about data collection
in each jurisdiction. The Maternity Information Matrix summarises data items from Australian
national and state and territory data collections relevant to maternal and perinatal health, and
is available at <maternitymatrix.aihw.gov.au/Pages/About-the-MIM.aspx>.
Collation of national perinatal data
A standardised extract of electronic data from each state and territory collection is provided to
the AIHW on an annual basis. Records received from states and territories are anonymous: that
is, they do not include any names or addresses, but do include a unique set of identification
numbers so that the source record can be identified. Data are checked for completeness,
validity and logical errors before inclusion in the national collection.
55
56
Chapter 5: About the National Perinatal Data Collection
Maternal
deaths in
Australia
Perinatal
deaths in
Australia
National maternal mortality
& perinatal mortality
databases
Maternal mortality and
perinatal mortality review
committee data
PDC
State/territory health
department collections
Online data
tables
Perinatal
data portal
PDC = Perinatal Data Collection
NMDS = National Minimum Data Set
NHMD = National Hospital Morbidity Database
NCMI = National Core Maternity Indicators
MM = Maternal mortality
MIM = Maternity Information Matrix
MaCCS = Maternity Care Classification System
DSS = Data Set Specification
Australia’s
mothers and
babies
NHMD
National Perinatal Data
Collection
NCMI portal
Reporting
Collections
Metadata
- Specialist
reports
- Indicator reporting
- Customised data
requests
Models of Care collection
(MaCCS) (future)
Overview of maternal and perinatal data collections and national reporting outputs
Metadata: MIM; Perinatal national data standards (NMDS/DSS)
Structure of the National Perinatal Data Collection
Data supplied for the NPDC consist of the Perinatal National Minimum Data Set (NMDS) and
additional data items.
Structure of the NPDC
NPDC
Perinatal NMDS
Additional data items
Mandatory data for
national reporting
Voluntary data for
national reporting
Elements defined in the
National health data
dictionary
Elements defined for
each state or territory
perinatal collection
29 data elements
in 2013
80 data elements
in 2013
The Perinatal NMDS was first specified in 1997 and remains an agreed data set for national
reporting (COAG 2012). An NMDS is an agreed set of standardised data elements for mandatory
supply by states and territories to support national reporting. Standardisation ensures that
there is consistent meaning for data collected at different times or in different places. A list of
the data items supplied for the NPDC from the Perinatal NMDS is at Appendix A. Compliance
of data provided for the Perinatal NMDS is evaluated intermittently to assess data quality and
adherence to standards (Donnolley & Li 2012).
Each state and territory collects more information than is specified in the NMDS, and the
AIHW requests some of these additional items. These data items are at different stages in the
process of standardisation. Some items have had national data standards developed, but have
not yet been included as data elements in the Perinatal NMDS because they could not be
implemented immediately in all jurisdictions.
In contrast, there are other data items—for which there are, as yet, no common definitions or
categories for collecting the data or which are not collected in all jurisdictions—that are also
provided to inform the future development of nationally standardised data.
57
Which births are counted?
This report presents information from the NPDC about births in Australia, including births in
hospitals, in birth centres and in the community. The Australian National health data dictionary
(NHDD) defines a ‘live birth’ as the complete expulsion or extraction from its mother of a baby,
of any gestation, that shows signs of life; and a ‘stillbirth’ is the complete expulsion or extraction
of a baby, of at least 20 weeks gestation or weighing at least 400 grams at birth (the weight
expected of a baby at 20 weeks gestational age), which shows no signs of life.
The Perinatal NMDS and the NPDC require that either the birthweight or the gestational age
conditions are met for both live births and stillbirths. This means that the very small number
of live births occurring before 20 weeks gestation and weighing less than 400 grams are not
included in the NPDC, although they may have been included in jurisdictional perinatal data
collections. Data for babies not weighed at birth and whose gestational age and birthweight
were not recorded are also not included in the NPDC, but may have been included in
jurisdictional perinatal collections. Live births and stillbirths may include termination of
pregnancy after 20 weeks. Stillbirths can include fetus papyraceous and fetus compressus.
In Western Australia, data were included for both live births and stillbirths of at least 20
weeks gestation or, if gestation was unknown, the birthweight was at least 400 grams. In
Victoria, stillbirths were of at least 20 weeks gestation unless gestation was missing and the
baby weighed 400 grams or more. South Australian data may not include all terminations of
pregnancy for psychosocial reasons after 20 weeks gestation.
Care is needed when comparing Australian birth statistics with those from other countries
that have different gestational age or other criteria for defining live births and stillbirths. In
many other countries, pregnancies must continue to 22, 24 or even 28 completed weeks
of gestational age for a fetal death to be counted as a stillbirth. The inclusion in Australia of
more births at lower gestations will affect the distributions of several key baby outcomes—in
particular, rates of perinatal mortality, low birthweight, low Apgar scores (a measure of a baby’s
wellbeing at birth) and admission to a special care nursery or neonatal intensive care unit. For
live births, the Perinatal NMDS and NPDC definition (above) is more restrictive than the World
Health Organization (WHO) definition that specifies a live birth as a baby born showing signs of
life irrespective of gestation (WHO 1992).
National Perinatal Data Development Committee
The National Perinatal Data Development Committee has a key role in improving data quality.
The committee comprises representatives from each state and territory health authority, the
AIHW, the Australian Bureau of Statistics and the National Perinatal Epidemiology and Statistics
Unit, with temporary members invited as their expertise is required. The committee works in
consultation with clinical reference groups. It improves data provision, revises existing Perinatal
National Minimum Data Set items, develops existing perinatal data items in METeOR (AIHW’s
Metadata Online Registry) and contributes to the development of new perinatal data items.
58
Chapter 5: About the National Perinatal Data Collection
Glossary
age-specific rate: a rate for a specific age group. The numerator and denominator relate to
the same age group.
age standardisation: a method of removing the influence of age when comparing
populations with different age structures. This is usually necessary because the rates of many
diseases vary strongly (usually increasing) with age. The age structures of the different
populations are converted to the same ‘standard’ structure, and then the disease rates that
would have occurred with that structure are calculated and compared.
age structure: the relative number of people in each age group in a population.
antenatal: the period covering conception up to the time of birth. Synonymous with prenatal.
antepartum fetal death: fetal death occurring before the onset of labour.
Apgar score: numerical score used to indicate the baby’s condition at 1 minute and at
5 minutes after birth. Between 0 and 2 points are given for each of 5 characteristics: heart rate,
breathing, colour, muscle tone and reflex irritability. The total score is between 0 and 10.
assisted reproductive technology: treatments or procedures that involve the in-vitro
handling of human oocytes (eggs) and sperm or embryos for the purposes of establishing a
pregnancy.
augmentation of labour: intervention after the spontaneous onset of labour to assist the
progress of labour.
baby’s length of stay: number of days between date of birth and date of separation from the
hospital of birth (calculated by subtracting the date of birth from the date of separation).
birth status: status of the baby immediately after birth (stillborn or live born).
birthweight: the first weight of the baby (stillborn or live born) obtained after birth (usually
measured to the nearest 5 grams and obtained within 1 hour of birth).
breech presentation: a fetal presentation in which the buttocks are at the opening of the
womb. In a frank breech, the legs are straight up in front of the body. In a complete breech the
legs are folded, but the feet are above the buttocks. In an incomplete breech, the feet are below
the buttocks.
caesarean section: a method of birth in which a surgical incision is made into the mother’s
womb via the abdomen to directly remove the baby.
59
diabetes (diabetes mellitus): a chronic condition in which the body cannot properly use its
main energy source, the sugar glucose. This is due to a relative or absolute deficiency in insulin.
Insulin, a hormone produced by the pancreas, helps glucose enter the body’s cells from the
bloodstream and then be processed by them. Diabetes is marked by an abnormal build-up of
glucose in the blood and can have serious short- and long-term effects.
early neonatal death: death of a live born baby within 7 days of birth.
episiotomy: an incision of the perineum and vagina to enlarge the vulval orifice.
fetal death (stillbirth): death, before the complete expulsion or extraction from its mother, of
a product of conception of 20 or more completed weeks of gestation or of 400 grams or more
birthweight. Death is indicated by the fact that, after such separation, the fetus does not breathe
or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord,
or definite movement of voluntary muscles.
fetal death rate: number of fetal deaths per 1,000 total births (fetal deaths plus live births).
first degree laceration: graze, laceration, rupture or tear of the perineal skin during delivery
that may be considered to be slight or that involves fourchette, labia, vagina or vulva.
forceps: handheld, hinged obstetric instrument applied to the fetal head to assist birth.
fourth degree laceration: perineal laceration, rupture or tear, as in third degree laceration,
occurring during delivery and also involving anal mucosa or rectal mucosa.
gestational age: the duration of pregnancy in completed weeks, calculated from the date of
the first day of a woman’s last menstrual period and her baby’s date of birth; or via ultrasound; or
derived from clinical assessment during pregnancy or from examination of the baby after birth.
high blood pressure/hypertension: definitions vary but a well-accepted one is from the
World Health Organization: a systolic blood pressure of 140 mmHg or more or a diastolic blood
pressure of 90 mmHg or more, or [the person is] receiving medication for high blood pressure.
Indigenous: a person of Aboriginal and/or Torres Strait Islander descent who identifies as an
Aboriginal and/or Torres Strait Islander.
induction of labour: intervention to stimulate the onset of labour.
instrumental delivery: vaginal delivery using forceps or vacuum extraction.
intrapartum fetal death: fetal death occurring during labour.
intrauterine growth restriction: a fetus whose estimated weight is below the 10th percentile
for its gestational age.
late neonatal death: death of a live born baby after 7 completed days and before 28
completed days.
60
Glossary
live birth: the complete expulsion or extraction from its mother of a product of conception,
irrespective of the duration of the pregnancy, which, after such separation, breathes or shows
any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or
definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the
placenta is attached; each product of such a birth is considered live born (WHO definition).
low birthweight: weight of a baby at birth that is less than 2,500 grams.
maternal age: mother’s age in completed years at the birth of her baby.
mode of separation: status at separation of patient (discharge/transfer/death) and place to
which patient is released (where applicable).
mother’s length of stay: number of days between admission date (during the admission
resulting in a birth) and separation date (from the hospital where birth occurred). The interval is
calculated by subtracting the date of admission from the date of separation.
neonatal death: death of a live born baby within 28 days of birth.
neonatal mortality rate: number of neonatal deaths per 1,000 live births.
non-Indigenous: people who have indicated that they are not of Aboriginal or Torres Strait
Islander descent.
parity: number of previous pregnancies resulting in live births or stillbirths, excluding the
current pregnancy.
perinatal death: a fetal or neonatal death of at least 20 weeks gestation or at least 400 grams
birthweight.
perinatal mortality rate: number of perinatal deaths per 1,000 total births (fetal deaths plus
live births).
perineal status: the state of the perineum following birth. Perineal status is categorised as
intact, first, second, third, or fourth degree laceration, episiotomy, or as another type of perineal
laceration, rupture or tear.
plurality: the number of births resulting from a pregnancy.
postneonatal death: death of a live born baby after 28 days and within 1 year of birth.
post-term birth: birth at 42 or more completed weeks of gestation.
presentation at birth: the part of the fetus that presents first at birth.
pre-term birth: birth before 37 completed weeks of gestation.
primary caesarean section: caesarean section to a mother with no previous history of
caesarean section.
resuscitation of baby: active measures taken shortly after birth to assist the baby’s ventilation
and heartbeat, or to treat depressed respiratory effort and to correct metabolic disturbances.
61
second degree laceration: perineal laceration, rupture or tear, as in first degree laceration,
occurring during delivery and also involving pelvic floor, perineal muscles or vaginal muscles.
spontaneous labour: onset of labour without intervention.
stillbirth: see fetal death (stillbirth).
teenage mother: mother younger than 20 at the birth of her baby.
third degree laceration: perineal laceration, rupture or tear, as in second degree laceration,
occurring during delivery and also involving the anal floor, rectovaginal septum or sphincter
not otherwise specified.
vacuum extraction: assisted birth using traction or rotation on a suction cap applied to the
baby’s head.
62
Glossary
Abbreviations
ACT
Australian Capital Territory
AIHW
BMI
body mass index
IPPV
intermittent positive pressure ventilation
NICU
neonatal intensive care unit
NMDS
national minimum data set
NSW
New South Wales
NT
Northern Territory
OECD
Organisation for Economic Co-operation and Development
PHN
Primary Health Network
PSANZ-PDC Perinatal Society of Australia and New Zealand Clinical Practice Guideline
for Perinatal Mortality Perinatal Death Classification
Qld
Queensland
SA
South Australia
SCN
special care nursery
SES
socioeconomic status
Tas
Tasmania
Vic
Victoria
WA
Western Australia
WHO
World Health Organization
63
References
ABS (Australian Bureau of Statistics) 2013a. Australian Statistical Geography Standard (ASGS):
Volume 5—Remoteness Structure, July 2011. ABS cat. no. 1270.0.55.005. Canberra: ABS.
ABS 2013b. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA),
Australia, 2011. ABS cat. no. 2033.0.55.001. Canberra: ABS.
AIHW (Australian Institute of Health and Welfare): Leeds KL, Gourley M, Laws PJ, Zhang J,
Al-Yaman F & Sullivan EA 2007. Indigenous mothers and their babies, Australia 2001–2004.
AIHW cat. no. PER 38. Perinatal statistics series no. 19. Canberra: AIHW.
AIHW 2014. National Drug Strategy Household Survey detailed report: 2013. Drug statistics
series no. 28. Cat. no. PHE 183. Canberra: AIHW.
AHMAC (Australian Health Ministers’ Advisory Council) 2012. Clinical Practice Guidelines:
Antenatal Care—Module 1. Canberra: Department of Health and Ageing.
CMACE & RCOG (Centre for Maternal and Child Enquiries & Royal College of Obstetricians
and Gynaecologists) 2010. Management of women with obesity in pregnancy. Viewed
19 October 2015, <https://www.rcog.org.uk/globalassets/documents/guidelines/
cmacercogjointguidelinemanagementwomenobesitypregnancya.pdf>.
COAG (Council of Australian Governments) 2012. National Healthcare Agreement 2012.
Intergovernmental agreement on federal financial relations. Viewed 19 October 2015,
<www.federalfinancialrelations.gov.au/content/national_agreements.aspx>.
Donnolley N & Li Z 2012. Perinatal National Minimum Data Set compliance evaluation 2006
to 2009. Perinatal statistics series no. 26. Cat. no. PER 54. Canberra: AIHW National Perinatal
Epidemiology and Statistics Unit.
Hilder L, Zhichao Z, Parker M, Jahan S, Chambers GM 2014. Australia’s mothers and babies 2012.
Perinatal statistics series no. 30. Cat. no. PER 69. Canberra: AIHW.
Macaldowie A, Wang YA, Chughtai AA & Chambers GM 2014. Assisted reproductive technology
in Australia and New Zealand 2012. Sydney: National Perinatal Epidemiology and Statistics Unit,
the University of New South Wales.
OECD (Organisation for Economic Co-operation and Development) 2015. Health at a glance
2015: OECD indicators. Paris: OECD Publishing. Viewed 13 November 2015,
<dx.doi.org/10.1787/health_glance-2015-en>.
SIMC (Statistical Information Management Committee) 2007. Guidelines for the use and
disclosure of health data for statistical purposes. Canberra: AIHW.
WHO (World Health Organization) 1992. International Statistical Classification of Diseases and
Related Health Problems. 10th Revision. Geneva: WHO.
64
References
Acknowledgments
This report was authored by Deanna Eldridge, Deanne Johnson and Kathryn Sedgwick of
the Australian Institute of Health and Welfare (AIHW). The authors gratefully acknowledge
contributions made by the following AIHW staff: Fadwa Al-Yaman, Mary Beneforti, Martin
Edvardsson, Conan Liu, Jude Luzuriaga, Brett Nebe, Geoff Neideck, Deanna Pagnini and
Charlotte Ramage. The authors would also like to thank Associate Professor Sharon Goldfeld for
undertaking an external review of the report.
A large number of stakeholders provided valuable advice and input to the National Perinatal
Data Collection and to this report, including the National Perinatal Epidemiology and Statistics
Unit, the National Perinatal Data Development Committee and, in particular, the following staff
from the state and territory health departments who provided data and reviewed this report:
• Lee Taylor, Tim Harrold and Kim Lim, Centre for Epidemiology and Evidence, NSW Ministry
of Health.
• Vickie Veitch, Kirsty Anderson, Diana Stubbs and Gemma Wills, Clinical Councils Unit, Health
Service Program, Department of Health and Human Services, Victoria.
• Sue Cornes, Joanne Ellerington, Vesna Dunne, Neil Gardiner and Ben Wilkinson, Health
Statistics Unit, Department of Health, Queensland.
• Maureen Hutchinson and Alan Joyce, Maternal and Child Health Unit, Data Integrity
Directorate, Department of Health, Western Australia.
• Wendy Scheil, Kevin Priest, Joan Scott and Britt Catcheside, Epidemiology Branch,
Department of Health, South Australia.
• Peter Mansfield, Peggy Tsang and Cynthia Rogers, Health Information Unit, Department
of Health and Human Services, Tasmania.
• Rosalind Sexton and Wayne Anderson, Epidemiology Section, ACT Health.
• Leanne O’Neil and Shu Qin Li, Health Gains Planning, Department of Health,
Northern Territory.
The AIHW also acknowledges the time, effort and expertise contributed by all maternity staff
in collecting and providing the data for the National Perinatal Data Collection.
65
Appendixes
Appendixes are available for download from the AIHW website on the Australia’s mothers and
babies 2013—in brief web page <www.aihw.gov.au/publication-detail/?id=60129553770>.
• Appendix A: Perinatal National Minimum Data Set items.
• Appendix B: State and territory perinatal data collections.
• Appendix C: Data quality, interpretation and methods.
66
Appendixes
Australia’s mothers and babies 2013—in brief presents key statistics
and trends on pregnancy and childbirth of mothers, and the
characteristics and outcomes of their babies. This publication is
designed to accompany the Perinatal data portal available online
at <www.aihw.gov.au/perinatal-data/>.
and babies 2013
in brief

Australia`s mothers and babies 2013: in brief

Transcription

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