The Australian Institute of Health and Welfare just released their National Core Maternity Indicators (NCMI).  These indicators are a measure of perinatal clinical activity and outcomes from births in the nation of Australia.  The data are meant to be used as baselines, applied to quality improvement efforts and improving best practice.  Information is collated from 2004 through 2018, the most recent year of published results.  There are 12 indicators that are tracked and the information is summarized for the antenatal period, labor and birth and finally birth outcomes.

While Australia is a very large country land-mass wise, their population totals  just 25.5 million people.  There were approximately 300,000 births in 2018.  The NCMI tracks and examines 12 indicators

Antenatal indicators

• Tobacco smoking in pregnancy
• Antenatal care in the first trimester

Labor and birth indicators

• Induction of labor for first time parents
• Cesarean section rate for first time parents
• Non-instrumental vaginal birth for first time parents
• Instrumental vaginal birth for first time parents
• Episiotomy rate for people having their first baby and birthing vaginally with and without instruments
• Rate of general anesthesia for people giving birth by cesarean section
• VBAC rate after first birth was a cesarean

Birth outcome indicators

• Apgar score of less than 7 at 5 minutes for term babies
• Small for gestational age babies at or after 40 weeks of gestation
• Third and fourth degree tears for both nulls and multips who gave birth vaginally

Smoking during pregnancy

Smoking in pregnancy is not an insignificant problem.  Approximately 10 percent of pregnant people in Australia smoked in the first 20 weeks of pregnancy.  While this number has been decreasing over time, it is still a concern as smoking during pregnancy can cause low birth weight babies, preterm birth, placental complications and an increased risk of perinatal death.  Supporting pregnant people who smoke with cessation programs is important.  Unfortunately, 75 percent of the people who reported smoking during the first 20 weeks, continued to smoke in the second half of pregnancy as well.

First trimester antenatal care

Nearly 75 percent of pregnant people received prenatal care in the first trimester.  This number has very slowly been increasing over time.  Early prenatal care is associated with improved outcomes and it is important to work toward the goal of all pregnant people starting care before the second trimester begins.  Programs that encourage people to seek out care earlier in pregnancy have only been moderately successful.

Nullip inductions

45.3% of people birthing for the first time were induced.  This number has been steadily increasing year over year since 2004, when the number was 31%

Instrumental/operative vaginal birth

The rate of vacuum and/or forceps deliveries has increased over time.  In 2018, 56.2% of first time (NTSV) birthers who  gave birth vaginally did so with the help the vacuum or forceps.  In  2004, this number was 48.1%.

Episiotomy

In 2018, more than one in five NTSV people giving birth without vacuum/forceps did so with an episiotomy.  If vacuum or forceps were used, almost 80 percent of the time, they also received an episiotomy.  Both of these episiotomy rates have been rising steadily since 2004 despite decades of data that indicate routine episiotomy causes more harm than benefits and should be avoided.

Cesarean delivery

The cesarean section rate for NTSV parents was 30.1%, which is also an increase from 25.3% in 2004. NTSV are parents giving birth for the first time at term, with a single baby in the vertex position - considered to be a low risk population with reduced labor complications and better birth outcomes.

Vaginal birth after cesarean

The VBAC rate in 2018 was 12.1%.  If people gave birth  again after a cesarean, around 1 in 8 of them did so vaginally.  The remainder had a repeat cesarean.  Surprisingly this number has remained fairly steady over the time period of 2004 through 2018.

General anesthetic for cesarean delivery

6.0% of people who gave birth by cesarean did so while under general anesthesia as opposed to regional spinal or epidural pain medication.  This number has been very consistent for the past decade and a half.

5 minute APGAR score of less than 7 for full term babies

Approximately 1.3% of full term newborns had an APGAR less than 7 at five minutes after birth.  This is up from 0.9% in 2004.  A baby with an APGAR score of less than 7 at five minutes may need some additional help transitioning to life on the outside.

Small for gestation age birth weights

The number of babies being born at low birth weights who were full term has gone down to 1.3%.  In 2004 it was 2.1%.  Birthweight is a key indicator of infant health and can be a predicator for outcomes throughout the infant’s lifetime.

Third or fourth degree perineal tears

5.0% of people giving birth vaginally for the first time resulted in a third or fourth degree tear to the perineum.  When examining all people who gave birth vaginally, this rate drops to 2.9%.  This rate has been stable during the data collection period.

Summary

Solid tracking of perinatal indicators is the first step in any quality improvement program.  Australia has almost two decades of information that can be used to identify opportunities for better birth outcomes.  There are many indicators that demonstrate that evidence-based care and best practice is not routinely applied  Similarly to the United States, Australia has some significant work to do if the tracked indicators are to be improved.

You can find the entire report here and the summary report that accompanies it here.  The material is also available to download as a pdf.

Resources

Australian Institute of Health and Welfare. (2020). National Core Maternity Indicators. Retrieved from https://www.aihw.gov.au/reports/mothers-babies/ncmi-data-visualisations

Published: November 24, 2020

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