13103.1-Pregnancy Outcomes Report-FINAL

Pregnancy
Outcome
in South Australia

2011
September 2013
Pregnancy Outcome Unit,
SA Health
September 2013
Pregnancy Outcome in South Australia 2011
SA Health
Address:
Pregnancy Outcome (Statistics) Unit
Epidemiology Branch
SA Health, Government of South Australia
Citi Centre Building
11 Hindmarsh Square
Adelaide 5000
South Australia
Postal Address:
Citi Centre Building,
11 Hindmarsh Square Adelaide 5000
South Australia
Telephone: (08) 8226-6382
Fax: (08) 8226-6291
Web: www.sahealth.sa.gov.au/pregnancyoutcomes
E-mail: Pregnancy.Stats@health.sa.gov.au
ISSN 0819-3835
Suggested citation: Scheil W, Scott J, Catcheside B, Sage L, Kennare R. Pregnancy Outcome in South Australia 2011. Adelaide:
Pregnancy Outcome Unit, SA Health, Government of South Australia, 2013.
Pregnancy Outcome in
South Australia 2011
Wendy Scheil
Joan Scott
Britt Catcheside
Leonie Sage
Robyn Kennare
September 2013
Pregnancy Outcome Unit

SA Health
Acknowledgements
Staff
Wendy Scheil
Head/Senior medical consultant
Joan Scott
Senior midwife
Leonie Sage
Senior midwife, Abortion statistics
Maureen Fisher
Administrative officer
Judith Thompson
Administrative officer
Kerry Jolly
Midwife
Robyn Kennare

Senior midwife, Maternal,

Perinatal & Infant Mortality Committee
Acknowledgements
We would like to thank all midwives and nurses in South Australia who completed and submitted the Supplementary
Birth Records on which the perinatal data collection is based. We thank them also for responding so efficiently to our
queries.
We would also like to express our sincere thanks to the following:
>> doctors who notified births with congenital abnormalities and those who notified terminations of pregnancy;
>> the pathology departments of teaching hospitals for autopsy information;
>> the Cytogenetics and Molecular Genetics Unit, Womens and Childrens Hospital, for cytogenetics reports;
>> the Births, Deaths and Marriages Registration Division for data and perinatal death certificates;
>> the Coroners Office for Coroners findings and autopsy reports;
>> Kevin Priest of the Health Statistics Unit for his assistance in programming and provision of perinatal data to the
National Perinatal Statistics Unit and in data linkage;
>> Graeme Tucker, Britt Catcheside and Anh Minh Nguyen of the Health Statistics Unit for assistance with responding
to data requests and in data linkage;
>> Alison Scott for assisting with data entry: and
>> Maureen Fisher and the Media and Communications Branch of SA Health for the graphics.
page 2
Contents
Contents
Acknowledgements...................................................................................................... 2
Executive Summary..................................................................................................... 10
1. Numbers and fertility rates................................................................................................................... 10
2. Place of birth....................................................................................................................................... 10
3. Teenage women.................................................................................................................................. 10
4 . Older women and first time mothers.................................................................................................... 10
5. Country of birth and race..................................................................................................................... 10
6.
Smoking during pregnancy and Body Mass Index................................................................................. 10
7. Antenatal care and length of stay......................................................................................................... 11

8.
Aboriginal women............................................................................................................................... 11
9. Procedures........................................................................................................................................... 11
10. Method of birth................................................................................................................................... 11
11. Multiple births..................................................................................................................................... 11
12. Abortions............................................................................................................................................. 11
13. Perinatal mortality................................................................................................................................ 12
14. Congenital Anomalies.......................................................................................................................... 12
I Introduction.......................................................................................................... 13
1. The Perinatal Statistics Collection......................................................................................................... 13
2. The Abortion Statistics Collection......................................................................................................... 13
II Mothers And Babies: Characteristics & Outcomes.............................................. 14

1. Place of residence of mother................................................................................................................ 14
2. Place of birth of baby........................................................................................................................... 15
3. Maternal race...................................................................................................................................... 20
4. Maternal age....................................................................................................................................... 21
5. Country of birth................................................................................................................................... 22
6. Marital status and type of patient........................................................................................................ 24
7. Occupation of father and mother......................................................................................................... 25
8. Previous pregnancy outcomes.............................................................................................................. 26
9a. Gestation at first antenatal visit............................................................................................................ 27
9b. Body Mass Index (BMI)......................................................................................................................... 27
9c. Antenatal visits.................................................................................................................................... 28
9d. Type of antenatal care.......................................................................................................................... 28
10. Smoking.............................................................................................................................................. 29
11. Medical conditions............................................................................................................................... 30
12. Obstetric complications........................................................................................................................ 30
13. Procedures performed in current pregnancy......................................................................................... 31
14a. Onset of labour.................................................................................................................................... 31
page 3
Contents
14b. Reasons for induction of labour........................................................................................................... 32

15a. Presentation and method of birth......................................................................................................... 33
15b. Reason for caesarean section............................................................................................................... 35
16. Complications of labour and birth and perineal status after birth.......................................................... 36
17. Fetal monitoring during labour............................................................................................................. 37
18. Analgesia for labour and anaesthesia for birth..................................................................................... 37
19. Postnatal length of stay of women....................................................................................................... 38
20. Sex of baby.......................................................................................................................................... 39
21. Birthweight and gestation.................................................................................................................... 39
22. Birth injuries......................................................................................................................................... 40
23. Treatment given in neonatal period...................................................................................................... 40
24. Level of care utilised............................................................................................................................. 40
25. Length of stay of babies....................................................................................................................... 41
26. Congenital anomalies.......................................................................................................................... 41
27. Multiple births..................................................................................................................................... 42
28. Perinatal mortality................................................................................................................................ 44
29. Home births......................................................................................................................................... 46
30. Birthing unit births............................................................................................................................... 47
III Terminations of Pregnancy................................................................................... 50

1.
Numbers and rates............................................................................................................................... 50
2.
Age of women..................................................................................................................................... 51
3.
Place of residence and place where termination performed.................................................................. 53
4.
The reason for termination................................................................................................................... 54
5.
Gestation, method and complications.................................................................................................. 54
6.

Previous terminations. Total termination of pregnancy rate and total first termination
of pregnancy rate................................................................................................................................. 56
IV Obstetric Profiles By Hospital Category............................................................... 58

V Clinical and Maternity Performance Indicators................................................... 67
1. Clinical indicators................................................................................................................................. 67
1: Outcome of selected primiparae...................................................................................................... 67
2: Vaginal birth following caesarean section (VBAC)............................................................................. 68
3: Major perineal tears & surgical repair of the perineum - selected primiparae with an intact perineum...68
4: General anaesthesia for caesarean section........................................................................................ 68
5: Antibiotic prophylaxis & caesarean section....................................................................................... 68
6: Pharmacological thromboprophylaxis & caesarean section................................................................ 68
7: Postpartum haemorrhage / blood transfusion................................................................................... 69
8: Intrauterine growth restriction (IUGR)............................................................................................... 69
9: Apgar score..................................................................................................................................... 69
10: Term babies transferred or admitted to a neonatal intensive care unit for reasons other than
congenital abnormality................................................................................................................. 70
page 4
Tables
2.
Maternity performance indicators, hospitals with at least 500 births per year....................................... 70
VI Trends in Perinatal Statistics in South Australia, 1981-2011............................... 74

Trends in Perinatal Statistics in South Australia (SA), 1981 2011................................................................ 77
VII Summary Statistics for 2011................................................................................. 80

1. Number of births................................................................................................................................. 80
2. Place of birth....................................................................................................................................... 80
3. Sex...................................................................................................................................................... 80
4. Plurality and condition at birth............................................................................................................. 80
5.
Race of women.................................................................................................................................... 80
6. Obstetric interventions in 20,043 women who gave birth.................................................................... 81

7. Low birthweight (<2,500g).................................................................................................................. 81
8. Congenital abnormalities..................................................................................................................... 81
9. Perinatal mortality rates (numbers of deaths in parentheses)................................................................. 81
10. Terminations of pregnancy................................................................................................................... 81
References................................................................................................................... 82
Publications................................................................................................................. 82
Annual Reports............................................................................................................................................ 82
Other reports/papers.................................................................................................................................... 83
1 Birth defects.................................................................................................................................... 83
2 Termination of pregnancy................................................................................................................. 85
3 Perinatal epidemiology..................................................................................................................... 85
4 Perinatal mortality............................................................................................................................ 88
5 Caesarean section............................................................................................................................ 88
Appendix 1: Definitions.............................................................................................. 89
Appendix 2: 2011 Supplementary Birth Record Form............................................... 93
Appendix 3: Congenital Abnormality Form.............................................................. 94
Tables
Table 1:
Births and crude birth rate by CURB regions................................................................................. 14
Table 2: Total births notified in 2011, by place of birth and plurality, South Australia................................. 15
Table 3a: Hospital births by category of hospital.......................................................................................... 18
Table 3b: Hospital births by race and hospital.............................................................................................. 19
Table 4a: Race of women who gave birth.................................................................................................... 20
Table 4b: Race and birthplace category of women who gave birth.............................................................. 21
Table 4c: Age and race of women who gave birth...................................................................................... 21
page 5
Tables
Table 4d: Age-specific fertility rates............................................................................................................. 22

Table 5a: Country of birth, major groups..................................................................................................... 23
Table 5b: Specified country of birth............................................................................................................. 23
Table 6a: Marital status and age.................................................................................................................. 24
Table 6b: Type of patient and marital status................................................................................................. 24
Table 7:
Occupation of father and mother................................................................................................. 25
Table 8a: Parity by race, women who gave birth.......................................................................................... 26

Table 8b: Previous pregnancy outcomes (multigravidae only)....................................................................... 26
Table 9a: Gestation at first antenatal visit.................................................................................................... 27
Table 9b: BMI of women who gave birth..................................................................................................... 27
Table 9c: Antenatal visits by race, women who gave birth........................................................................... 28
Table 9d: Type of antenatal care.................................................................................................................. 28
Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women................. 29
Table 10b: Average number of tobacco cigarettes smoked per day in the second half of pregnancy,
non-Aboriginal and Aboriginal women......................................................................................... 29
Table 11: Medical conditions in current pregnancy...................................................................................... 30
Table 12: Frequency of some obstetric complications................................................................................... 30
Table 13: Procedures performed in current pregnancy................................................................................. 31
Table 14a: Onset of labour............................................................................................................................ 31
Table 14b: Method of induction of labour..................................................................................................... 31
Table 14c: Augmentation of labour after spontaneous onset........................................................................ 32
Table 15a: Method of birth........................................................................................................................... 34
Table 15b: Method of birth by presentation.................................................................................................. 34
Table 15c: Method of birth in breech presentation, by plurality..................................................................... 34
Table 16: Frequency of some complications of labour and birth................................................................... 36
Table 17a: CTG performed during labour...................................................................................................... 37
Table 17b: Fetal scalp pH taken during labour............................................................................................... 37
Table 18a: Analgesia for labour..................................................................................................................... 37
Table 18b: Anaesthesia for birth.................................................................................................................... 38
Table 19a: Postnatal length of stay by type of patient.................................................................................... 38
Table 19b: Average postnatal length of stay by type of patient & type of birth.............................................. 39
Table 20: Sex of baby.................................................................................................................................. 39
Table 21: Birthweight distribution of all births............................................................................................. 39
Table 22: Birth injuries................................................................................................................................. 40
Table 23: Neonatal treatment given, all live births........................................................................................ 40
Table 24: Level of nursery care utilised by birthweight, all live births............................................................ 41
Table 25: Length of stay of liveborn babies in hospital................................................................................. 41
Table 26: Selected congenital abnormalities notified to the perinatal statistics collection.............................. 42
Table 27a: Birthweight by plurality................................................................................................................ 43
page 6
Tables
Table 27b: Gestation at birth by plurality....................................................................................................... 43

Table 27c: Perinatal outcome by plurality...................................................................................................... 43
Table 28a: Perinatal mortality by birthweight................................................................................................. 44
Table 28b: Perinatal mortality by gestational age at birth............................................................................... 45
Table 28c: Perinatal mortality (all births of specified birthweight/gestation)................................................... 45
Table 28d: Perinatal mortality by race, all births............................................................................................. 46
Table 29: Planned home births by age of women........................................................................................ 46
Table 30: Method of birth in planned home births....................................................................................... 46
Table 31: Birthweight distribution of planned home births........................................................................... 47
Table 32: Perinatal outcome in planned home births................................................................................... 47
Table 33: Planned birthing unit births by age of women.............................................................................. 48
Table 34: Method of birth in planned birthing unit births............................................................................ 48
Table 35: Birthweight distribution of planned birthing unit births................................................................ 48
Table 36: Perinatal outcome in planned birthing unit births......................................................................... 49
Table 37: Termination of pregnancy rate per 1,000 women aged 15-44 years, 1970-201............................ 50
Table 38: Terminations of pregnancy by age................................................................................................ 51
Table 39: Termination of pregnancy and live birth rates and termination of pregnancy proportions by age... 52
Table 40: Terminations by place of residence............................................................................................... 53
Table 41: Terminations by hospital category................................................................................................. 53
Table 42: Terminations by category of doctor.............................................................................................. 54
Table 43: Reason for termination for fetal reasons....................................................................................... 54
Table 44a: Women with previous terminations by age................................................................................... 55
Table 44b: Calculation of total induced abortion rate (TAR)........................................................................... 55
Table 45a: Women with previous terminations by age................................................................................... 56
Table 45b: Calculation of total induced abortion rate (TAR)........................................................................... 56
Table 45c: Calculation of total first induced abortion rate (TFAR) .................................................................. 57
Table 46: Obstetric profiles by hospital category, South Australia, 2011: live births and stillbirths
of >=400g or >=20 weeks gestation........................................................................................... 60
Table 47: Socio-demographic aspects of perinatal statistics, 1981 and 2002 2011.................................... 75
Table 48: Obstetric aspects of perinatal statistics, 1981 and 2002 2011.................................................... 76
Figures
Figure 1a: Map showing SA hospitals with obstetric beds in 2011.............................................................. 16
Figure 1b: Map showing Central Regions of SA.......................................................................................... 17
Figure 2:
Distribution of hospital births by hospital category..................................................................... 18
Figure 3:
Age and race of women who gave birth.................................................................................... 22
Figure 4:
Reasons for induction of labour................................................................................................. 32
Figure 5a: Method of birth, women who gave birth................................................................................... 33
page 7
Figures
Figure 5b: Reason for caesarean section..................................................................................................... 35

Figure 5c: Reason for elective caesarean section......................................................................................... 35
Figure 5d: Reason for emergency caesarean section................................................................................... 36
Figure 6:
Perinatal mortality rate by birthweight, all births........................................................................ 44
Figure 7:
Termination of pregnancy rate in South Australia, 1970-2011.................................................... 50
Figure 8a: Termination of pregnancy and live births by age......................................................................... 52

Figure 8b: Teenage pregnancy, termination of pregnancy and birth rates, South Australia, 1970-2011....... 53
Figure 9:
Percentage of Aboriginal women by hospital category............................................................... 61
Figure 10: Percentage of women with <7 antenatal visits by hospital category........................................... 61
Figure 11: Percentage of teenage women by hospital category................................................................... 61
Figure 12: Percentage of women 35 years or more by hospital category..................................................... 61
Figure 13: Percentage of single women by hospital category...................................................................... 62
Figure 14: Percentage of women with 4 or more prior livebirths by hospital category................................. 62
Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category...................... 62
Figure 16: Percentage of women with obstetric complications by hospital category.................................... 63
Figure 17: Percentage of women with complications during labour or birth by hospital category................ 63
Figure 18: Percentage of women with induction of labour by hospital category.......................................... 63
Figure 19: Percentage of women having epidural analgesia by hospital category........................................ 64
Figure 20: Percentage of breech births by hospital category........................................................................ 64
Figure 21: Percentage of emergency caesarean sections by hospital category............................................. 64
Figure 22: Percentage of elective caesarean sections by hospital category................................................... 64
Figure 23: Percentage of total caesarean sections by hospital category....................................................... 65
Figure 24: Percentage of births with birthweight below 2,500g by hospital category.................................. 65
Figure 25: Percentage of births with gestation less than 37 weeks by hospital category.............................. 65
Figure 26: Percentage of births with prolonged hospitalisation by hospital category................................... 66
Figure 27: Percentage of live births requiring neonatal intensive care by hospital category.......................... 66
Figure 28: Percentage of births with birth defects by hospital category....................................................... 66
Figure 29a: Induction of labour for selected primiparae, SA hospitals with >=500 births per year................. 71
Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with >=500 births per year............ 72
Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first)
caesarean section & no intervening births, SA hospitals with >=500 births per year.................... 72
Figure 29d: Proportion of selected primiparae with an intact perineum after a vaginal birth, SA

hospitals with >=500 births per year.......................................................................................... 72
Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital
abnormality, SA hospitals with >=500 births per year................................................................. 73
Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births

per year,.................................................................................................................................... 73
Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births

per year, 2007-2011.................................................................................................................. 73
Figure 30.1 Percentage of teenage women among women giving birth in SA............................................... 77
page 8
Figures
Figure 30.2: Percentage of women aged 35 years and over among women giving birth in SA....................... 77
Figure 30.3: Percentage of primiparous women aged 35 years and over in SA............................................... 77
Figure 30.4: Percentage of Aboriginal women and Asian women among women giving birth in SA.............. 78
Figure 30.5: Percentage of women never married and with no de facto partner among women giving
birth in SA................................................................................................................................ 78
Figure 30.6: Percentage of multiple births among births in SA....................................................................... 78
Figure 30.7: Percentage of low birthweight babies among births in SA.......................................................... 79
Figure 30.8: SA standardised perinatal mortality ratio (SPMR)........................................................................ 79
page 9
Executive Summary
Executive Summary
This report on pregnancy outcome in South Australia for 2011 provides statistics derived mainly from the South
Australian perinatal statistics collection of births. These are notified by hospital and homebirth midwives and neonatal
nurses. For a more complete picture of pregnancy outcome, some statistics from the abortion statistics collection
are also included. More statistics on abortions in the state in 2011 are available in the Ninth Annual Report of the
Abortion Reporting Committee. Comparisons of selected pregnancy characteristics and outcomes are provided for
six different hospital categories in the state. Individual hospital reports (Pregnancy and Neonatal Care Bulletins) with
these comparisons made in greater detail are provided to hospitals in the state with at least 100 births per year. Group
reports are provided for hospitals with smaller numbers of births. Comparisons of maternity performance indicators
are also provided for hospitals with at least 500 births per year.
1. Numbers and fertility rates

The number of births notified in South Australia in 2011 was 20,344, which was 342 more than the previous year.
The number of women who gave birth was 20,043. The total fertility rate was 1.89 live births per woman, compared
with 1.84 in 2010 and 1.91 in 2007 and 2008, which were the highest rates over the past decade. The fertility rate
increased in all age groupings other than the 20-24 years age grouping which remained stable.
2. Place of birth
Compared to 2010, the numbers of births increased at all metropolitan teaching hospitals. Births increased at two
of the metropolitan private hospitals while they decreased at two with one remaining steady. Six percent of women
(1,235 women) gave birth in birthing units in teaching hospitals and 87 women (0.5%) had planned home births.
3. Teenage women
803 teenage women gave birth, accounting for 4.0% of women who gave birth, and 871 teenage women had
terminations of pregnancy, accounting for 17.2% of terminations. In 2011, the proportion of known pregnancies
terminated was 49% for teenagers compared with 20% for women of all ages. The teenage pregnancy rate declined
in the 1970s and 1980s, but increased in the early 1990s. It declined again after 1996. The teenage pregnancy rate of
30.6 per 1,000 women in 2011 was the lowest rate recorded since 1970.
4. Older women and first time mothers

The mean age of women giving birth increased from 26.6 years in 1981 to 29.7 years in 2011, and, among first time
mothers, from 24.4 years to 27.9 years. The proportion of women aged 35 years or more increased from 4.6% in
1981 to a high of 21.1% in 2009 and was 20.6% in 2011. Among first time mothers, this proportion increased from
1.2% to 12.8% in 2009 and was 12.0% in 2011. As in the previous nine years, more women gave birth in the 30-34
years than in the 25-29 years age group.
5. Country of birth and race

Seventy - eight percent of women who gave birth in 2011 were Australian-born. Of women born overseas who gave
birth, the largest proportions came from India (3.6% of women), the United Kingdom and Ireland (2.5%), China
(1.7%), Vietnam (1.3%), the Philippines (1.0%), New Zealand (0.9%) and Sudan, Afghanistan and Cambodia (0.7%).
Of the women who gave birth in the state in 2011, 11.1% (2,229 women) were Asian, compared with 2% in 1981.
They gave birth mainly in teaching hospitals.
6. Smoking during pregnancy and Body Mass Index

The proportion of women smoking at the first antenatal visit has declined steadily from 25% in 1998 to 13.1% in
2011. About 4% each year quit smoking before the first antenatal visit.
While statistics on Body Mass Index were available only for 75% of women who gave birth in 2011 (an improvement
from 42% in 2007), and must be interpreted with caution, these show that 38.4% of all women giving birth were
overweight and 18.3% were obese, including 7.9% who were severely or morbidly obese.
page 10
Executive Summary
7. Antenatal care and length of stay

Week of gestation at the first antenatal visit was reported for only for 93% of women who gave birth. These show
that 79% of women attended for antenatal care within the first 14 weeks of pregnancy. Ninety-one percent of women
attended at least seven antenatal visits and although many women had more than one type of antenatal care, the
most common types used were hospital clinics (48%), obstetricians in private practice (30%) and general practitioners
(15%). Twenty-nine percent of women were private patients. The median length of stay of women after a birth was
three days; it was two days for those who had a vaginal birth and four days for those who had a caesarean section. It
was two days longer among private patients for vaginal births and one day longer for caesarean births.
8. Aboriginal women
693 Aboriginal women gave birth in South Australia in 2011, accounting for 3.5% of all women who gave birth in
the state. Eighteen percent of Aboriginal women were teenagers (compared with 3.6% of non-Aboriginal women).
Fifty four percent of Aboriginal women attended for antenatal care within the first 14 weeks of pregnancy (compared
with 80% of non-Aboriginal women) and 63% attended at least seven antenatal visits during pregnancy (compared
with 87% of non-Aboriginal women). In 2011, at the first antenatal visit, 53.4% of Aboriginal women reported that
they smoked, while in Non-Aboriginal women this proportion dropped to 11.7%. In 2011 the proportion of preterm
births (<37 weeks gestation), and low birthweight births (<2,500g) were twice as high for Aboriginal women as for
non-Aboriginal births. The perinatal mortality rate of babies of Aboriginal women was twice that of non-Aboriginal
women (19.9 compared with 9.2 per 1,000 births).
9. Procedures
Ninety-nine percent of women who gave birth had an ultrasound examination; 31% had labour induced while
another 20% had spontaneous labour augmented; epidurals were used for pain relief during labour for 32% of
women, and 12% had an episiotomy (18% of women who gave birth vaginally). The main reasons for induction of
labour were prolonged pregnancy (18%), hypertension (14%), diabetes or gestational diabetes (8.0%), poor fetal
growth and premature rupture of membranes (7%). Fifty-one percent of inductions of labour were performed for
other than defined indications.
10. Method of birth

Fifty-five percent of women had normal spontaneous vaginal births. Six percent gave birth by ventouse and forceps
(compared with 1% and 15% respectively in 1981). In 2011 the proportion of women giving birth by caesarean
section was 33%, a proportion which has been relatively stable for four years. Of those who had previously given
birth, 30% had previously had a caesarean section. Only 17% of women had a vaginal birth following a previous first
caesarean without intervening births, compared with 30% in 1998. The main reasons given for caesarean section
were previous caesarean section (37%), failure to progress in labour or cephalopelvic disproportion (28%), fetal
distress (16%) and malpresentation (12%).
11. Multiple births

Multiple births accounted for 2.9% of births; women with twins or triplets accounted for 1.5% of women who gave
birth in 2011. These proportions increased in the 1980s and 1990s as a result of the use of assisted conception and
the increasing proportion of older women, who have higher rates of multiple pregnancies than younger women. The
peak proportion of multiple births was recorded in 2002 and 2003 (3.6%). The subsequent decline in the proportion
of multiple births was probably related to the increasing use of single embryo transfer in assisted conception practice.
12. Abortions
5,010 terminations of pregnancy were notified, thirty-eight fewer than in 2010. The induced abortion rate was 15.5 per
1,000 women aged 15-44 years. This figure has remained stable for 2010 and 2011. It has declined significantly since
2001, when it was 17.7 per 1,000 women. Approximately 95% of terminations were performed in metropolitan public
hospitals, including the Pregnancy Advisory Centre, and 79% were performed by doctors in family advisory clinics in
these hospitals. Ninety-two percent of terminations were performed within the first 14 weeks of pregnancy and 1.9%
(95) were performed at or after 20 weeks gestation. Fifty-two percent of terminations performed at or after 20 weeks
gestation were for fetal reasons. Approximately 20% of reported pregnancies ended as terminations in 2011.
page 11
Executive Summary
13. Perinatal mortality

The perinatal mortality rate for all births in 2011 was 9.5 per 1,000 births, the stillbirth rate 7.4 per 1,000 births and
the neonatal mortality rate 2.2 per 1,000 live births. For international comparison, the World Health Organisation
recommends including only stillbirths of at least 1,000g birthweight (or 28 weeks gestation if birthweight unavailable)
and early neonatal deaths within the first 7 days of life (instead of 28 days) in calculating the perinatal mortality rate.
This rate for international comparison for South Australia for 2011 was 3.5 per 1,000 births, with an early neonatal
mortality rate of 0.6 per 1,000 live births.
14. Congenital Anomalies

In 2011 there were 606 births (3.0%) notified at birth with congenital anomalies, compared with an average of 2.5%
over the past decade. In 2011 there were 6 cases of spina bifida reported at birth, a decrease from the 11 cases
reported in 2010 and 18 in 2009. Spina bifida is a type of neural tube defect. Formal review of the increased case
numbers in 2009 and 2010 showed a greater than expected number of neural tube defects in babies born to African
and Middle East born women, but this did not completely explain the observed increase, which was most likely on
account of random fluctuation due to the small numbers involved.
page 12
Introduction
I. Introduction
This report summarises the statistics for 2011 from the South Australian Perinatal Statistics Collection and the South
Australian Abortion Statistics Collection, both of which are held in the Pregnancy Outcome Unit. Some definitions
used by the Unit are provided in Appendix 1. Guidelines1 with some of these definitions are issued to all South
Australian obstetric units to promote the uniform completion of forms.
1. The Perinatal Statistics Collection

This collection utilises notifications of births in South Australia made by hospital and homebirth midwives and hospital
neonatal nurses on the Supplementary Birth Record (SBR - Appendix 2). The SBRs are checked manually for completeness
and data discrepancies and then go through a series of automated validation procedures during data entry.
Information on congenital abnormalities detected at birth or in the neonatal period (within 28 days of birth) is
provided by doctors using the Congenital Abnormality Form (Appendix 3). Few statistics on birth defects are included
in this report as these are reported annually by the South Australian Birth Defects Register at the Womens and
Childrens Hospital.2 The Register complements statistics on birth defects from the perinatal and abortion statistics
collections with statistics on birth defects detected and notified after discharge from the birth hospital up to the
childs fifth birthday.
Perinatal data are provided under legislation, the South Australian Health Care Regulations 2008, Part 5 Pregnancy
outcome data and statistics. The South Australian Perinatal Statistics Collection includes all births occurring in South
Australia, including those to women who normally reside interstate, mainly in New South Wales near the South
Australian border and in the Northern Territory. Births of South Australian residents which occur in other states are not
included. The perinatal data have been collected since 1981, but there have been changes in the data items collected
over the years.
Perinatal death certificates are obtained from the Births, Deaths and Marriages Registration Division, chromosome
analysis reports from the Cytogenetics and Molecular Genetics Unit at Womens and Childrens Hospital, autopsy
reports from pathology departments and Coroners autopsy reports and findings from the Coroners Office. All these
are linked with the SBRs to provide more complete information on births and deaths. All maternal, perinatal and
infant deaths in the state are reviewed by the Maternal, Perinatal and Infant Mortality Committee and details of
these are reported in the annual report of the Committee entitled Maternal, Perinatal and Infant Mortality in South
Australia 2011.3
2. The Abortion Statistics Collection

Notifications made by doctors of medical terminations of pregnancy under the Criminal Law Consolidation (Medical
Termination of Pregnancy) Regulations 2011, are included in this collection. It commenced in 1970, when specific
abortion legislation was introduced under the Criminal Law Consolidation Act. Termination of pregnancy became
legal in the state if performed in a prescribed hospital by a medical practitioner for a woman who has been resident
at least two months in the state. The practitioner and another medical practitioner must have examined the woman
and formed the opinion that the continuation of the pregnancy would involve greater risk to her life or greater risk of
injury to her physical or mental health than if the pregnancy were terminated; or that there is a substantial risk that
if the pregnancy were not terminated and the child were born, the child would suffer from such physical or mental
abnormalities as to be seriously handicapped. A termination may not be performed on a woman who is pregnant
with a child capable of being born alive unless it is performed to save the womans life. The legislation states that
evidence that a woman has been pregnant for a period of 28 weeks or more is prima facie proof that she was
pregnant with a child that was capable of being born alive.
page 13
Mothers and Babies
II. Mothers And Babies: Characteristics & Outcomes

The births in 2011 in South Australia described in this report include live births, stillbirths and terminations of
pregnancy of at least 400g birthweight or 20 weeks gestation. There were two births of unknown birthweight. Forty
four births of less than 400g birthweight have been included, consisting of 40 stillbirths and four live births. The four
live births were born at 20-24 weeks gestation and all but a growth restricted baby died in the neonatal period. SBRs
were received for all 20,344 births reported by hospital and home birth midwives in their monthly notification lists.
These comprised 20,194 live births and 150 stillbirths. The number of women who gave birth was 20,043, 376 more
women than in 2010. Findings relating to Aboriginal women and babies in the text of this report have been italicised
for easy identification, in accordance with the request of the Aboriginal Health Council.
1. Place of residence of mother

This table previously presented in CURB Regions, has been updated to reflect the ABS Statistical Geographical
Boundaries (ASGS 2011), using SA4 boundaries for the four Adelaide Metropolitan Regions, and SA3 boundaries
to present the nine non metropolitan components in South Australia. The distribution of births according to the
mothers place of residence by Regions is provided in Table 1 together with the estimated resident population and
crude birth rate. The crude birth rate in 2011 for South Australia was 12.4 per 1,000 population. It was lowest in the
Fleurieu Kangaroo Island, Adelaide Central and Hills, and Yorke Peninsula Regions. It was highest in the Adelaide
North Region and was also high in the Eyre Peninsula and South West, and Outback North and East Regions.
Table 1: Births and crude birth rate by ABS Statistical Geographical Boundaries (ASGS 2011) regions, South
Australia, 2011
Total births
Live births
Estimated resident
population, June
30, 2011+
Number
Percent
Number
Number
Adelaide - Central and Hills
2,857
14.0
2,839
287,592
9.9
Adelaide - North
5,975
29.4
5,921
401,687
14.9
Adelaide - South
4,198
20.6
4,175
349,768
12.0
Adelaide - West
2,711
13.3
2,687
223,893
12.1
Barossa
400
2.0
400
33,590
11.9
Lower North
256
1.3
256
22,318
11.5
Mid North
297
1.5
294
27,673
10.7
Yorke Peninsula
239
1.2
238
24,258
9.9
Eyre Peninsula and South West
821
4.0
817
57,817
14.2
Outback - North and East
411
2.0
407
29,509
13.9
Fleurieu - Kangaroo Island
406
2.0
404
47,092
8.6
Limestone Coast
846
4.2
843
64,105
13.2
Murray and Mallee
773
3.8
766
68,930
11.2
Interstate
154
0.8
147
na
na
20,344
100.0
20,194
1,638,232
12.4
ASGS 2011
(Mothers residence)
Total
Crude birth
rate per 1,000
population
+ Australian Bureau of Statistics. Population estimates by age and sex, South Australia, 2011. Canberra: ABS, 2012
(Catalogue No 3235.0).
na: not applicable
page 14
Mothers and Babies
2. Place of birth of baby

Of the 20,344 births in 2011, 96 (0.5%) were home births and of those 87 were planned homebirths. The remaining
20,248 births occurred in hospitals or in 79 cases, before arrival at hospitals into which the women had been booked.
These 79 Born Before Arrival (BBA) births have been included in the statistics for those hospitals. The distribution of
births by place of birth (home or hospital) and plurality is provided in Table 2. Locations of South Australian hospitals
with obstetric beds in 2011 are provided in Figures 1a and 1b.
Table 2: Total births notified in 2011, by place of birth and plurality, South Australia
Condition
at birth
Home births
Hospital births
Total
Singleton
Twin
Singleton
Twin
Triplet
Quad
Live birth
93
19,513
578
20,194
Stillbirth
138
150
95
19,651
585
12
20,344
Total births
Of the 20,248 hospital births, 80.3% occurred in metropolitan hospitals (teaching and private) and 19.7% in country
hospitals. This distribution is summarised in Table 3a and Figure 2. Table 3b provides the numbers of births and
women by race in individual hospitals. Metropolitan hospitals are listed in order of number of births and country
hospitals in alphabetic order within their category of number of births. Fifty-six percent of hospital births in South
Australia in 2011 occurred in metropolitan teaching hospitals. Maternity and neonatal services at SA hospitals are
delineated according to six levels of service, as defined in the policy, Standards for Maternal and Neonatal Services
in SA 20104. The Womens and Childrens Hospital is defined as providing Level 5 maternity services and Level 6
neonatal services, as it provides a high risk pregnancy service and neonatal intensive care, but has no maternity
intensive care facility on site. The Lyell McEwin Hospital provides Level 6 maternity services and Level 5 neonatal
services with maternity intensive care services and special care neonatal services. Flinders Medical Centre provides
Level 6 maternity and neonatal services with both maternity and neonatal intensive care services.
Compared with 2010, births increased at the three metropolitan teaching hospitals. The total number of births
in metropolitan private hospitals decreased slightly, with Ashford showing an increase. Births at North Eastern
Community Hospital remained constant, while births at Burnside, Calvary and Flinders Private showed small decreases.
The total number of births in country hospitals increased overall by 133. In the Level 4:4 country centres, births
increased at Mount Gambier and Port Augusta. Increases occurred at some hospitals with more than 100 births per
year, eg Gawler Health Service, Port Lincoln, Port Pirie, South Coast District (Victor Harbor) and the Northern Yorke
Peninsula Regional Health Service (Wallaroo). Numbers remained relatively constant at Barossa Health (Tanunda),
Lower North Health (Clare), Mount Barker, and Naracoorte. Decreases were seen at Murray Bridge and the Riverland
Regional (Berri). At smaller country centres with <100 births per year, births remained relatively constant at Ceduna,
Mid North Health (Jamestown), Kangaroo Island, Loxton and Waikerie. Decreases were seen at Kapunda and Millicent.
page 15
Mothers and Babies
Figure 1a: South Australian hospitals with obstetric beds in 2011
page 16
Mothers and Babies
Figure 1b: Hospitals with obstetric beds in 2011, Central Region of SA
page 17
Mothers and Babies
Table 3a: Hospital births by Perinatal Service Delineation, South Australia, 2011
Hospital category
Number of births
Percent hospital births
11,327
55.9
Womens & Childrens Hospital (W&CH)
(5,013)
(24.8)
Lyell McEwin Hospital (LMH)#
(3,292)
(16.3)
Flinders Medical Centre (FMC)
(3,014)
(14.9)
Metropolitan private
4,923
24.3
Country
3,998
19.7
(890)
(4.4)
Level 3:3>100 births per annum
(2,737)
(13.5)
Level 3:3<100 births per annum
(371)
(1.8)
20,248
100.0
Metropolitan teaching
Level 4:4
Total
Figure 2: Distribution of hospital births by hospital category, South Australia, 2011 (n=20,248)
W&CH
LMHS
16.3%
24.8%
u v w x
10
FMC
55.9%
a Ashford 7.4%
b Burnside 6.0%
c Calvary 4.2%
d Flinders Private 3.1%
e North Eastern Community 3.6%
24.3%
r Mt Gambier 2.9%
s Port Augusta 1.4%
t Gawler 2.4%
u Mount Barker 1.8%
v Port Lincoln 1.8%
w Murray Bridge 1.2%
x Whyalla 1.4%
y Other country hospitals with >100 births per year 5.0%
z Hospitals with <100 births per year 1.8%
19.7%
20
14.9%
30
40
50
60
Percentage of hospital births
page 18
Mothers and Babies
Table 3b: Hospital births in South Australia in 2011 by race and hospital
Hospital
Metropolitan teaching
Caucasian
n
Aboriginal
Asian
n
Other
n
Total number of
women who gave
birth
Total births
n
Womens & Childrens Hospital

(W&CH)
3,084
209
1,290
430
5,013
4,892
Lyell McEwin Hospital (LMH)#
2,559
118
386
229
3,292
3,256
Flinders Medical Centre (FMC)
2,556
78
219
161
3,014
2,961
Noarlunga Health Service
Modbury Public Hospital
TQEH
Total
8,205
406
1,896
820
11,327
11,117
Ashford#
1,411
68
17
1,499
1,474
Burnside War Memorial (BWMH)#
1,108
85
14
1,210
1,188
Calvary#
783
57
11
855
839
Flinders Private#
592
25
11
632
618
North Eastern Community (NECH)#
689
27
727
721
4,583
16
262
62
4,923
4,840
Mt. Gambier#
550
18
17
12
597
592
Pt Augusta
174
104
293
293
Subtotal
724
122
24
20
890
885
Barossa Health (Tanunda Centre)
138
142
142
Gawler Health Service
473
491
491
99
100
100
Total
Country
Level 4:4* Country
Level 3:3* Country 100 births
Lower North Health Centre (Clare)

Mt. Barker
351
366
366
Murray Bridge Soldiers Memorial
185
22
21
234
234
Naracoorte
153
12
172
170
Pt. Lincoln
323
24
356
356
Pt. Pirie
151
10
164
163
Riverland Regional (Berri)
142
15
12
177
177
South Coast District (Victor Harbor)
126
133
133
Northern Yorke Peninsula Regional

Health Service (Wallaroo)
107
118
118
Whyalla
233
32
10
284
284
2,481
123
65
68
2,737
2,734
Subtotal
* Perinatal Service Delineation
# These hospitals have neonatal special care nurseries.

This is a metropolitan hospital situated at the metropolitan/country boundary; it has the characteristics of a country hospital and has been included as such.
Table 3b continued
page 19
Mothers and Babies
Caucasian
Aboriginal
Asian
Other
Total births
Total women who

gave birth
Ceduna
21
18
39
39
Kangaroo Island
31
33
33
Kapunda
39
40
40
Loxton District
73
80
80
Mid North Health (Jamestown)
30
32
32
Millicent
38
40
40
Peterborough
Quorn
48
51
51
Waikerie
27
38
38
Subtotal
320
32
367
367
Coober Pedy
Cummins
Ernabella Clinic
Subtotal
3,528
278
95
97
3,998
3,990
16,316
700
2,253
979
20,248
19,947
Hospital
Level 3:3* Country <100 births
1-99 births per annum
Southern Flinders Health Service

(Crystal Brook)
Southern Yorke Peninsula
(Yorketown)
Other Country
Total (country)
Grand total
* Perinatal Service Delineation
3. Maternal race
The distribution of women who gave birth, by race is provided in Table 4a and also by category of birthplace in Table
4b. In these tables and all others where distribution by race is shown, Aboriginal includes Aboriginal (669 women),
Torres Strait Islander (8 women) and those who are Aboriginal and Torres Strait Islander (16 women). Aboriginal
women accounted for 3.5% of women and gave birth mainly in metropolitan teaching hospitals and country
hospitals. Asian women accounted for 11.1% of women, and gave birth mainly in metropolitan teaching hospitals,
but 11.6% gave birth in private hospitals.
Table 4a: Race of women who gave birth, South Australia, 2011
Race
Number of women
% Women
Caucasian
16,153
80.6
Aboriginal
693
3.5
Asian
2,229
11.1
Other
968
4.8
Total
20,043
100.0
page 20
Mothers and Babies
Table 4b: Race and birthplace category of women who gave birth, South Australia, 2011
Race of women
Birthplace
Caucasian
Asian
Aboriginal
Other
Total
Number
Number
Number
Number
Number
Metropolitan
teaching
hospital
8,039
49.8
396
57.1
1,873
84.0
809
83.6
11,117
55.5
Metropolitan
private
hospital
4,504
27.9
16
2.3
258
11.6
62
6.4
4,840
24.1
Country
hospital
3,520
21.8
278
40.1
95
4.3
97
10.0
3,990
19.9
Home
90
0.6
0.4
0.1
0.0
96
0.5
Total
16,153
100.0
693
100.0
2,229
100.0
968
100.0
20,043
100.0
4. Maternal age
Among the five-year age groups the largest number of women who gave birth was in the 30-34 years age group
(Table 4c). The proportion of women in this age group (31.1%) has exceeded that of the 25-29 years age group
(29.7%) since 2001. Teenage women accounted for 4.0% of women who gave birth and older women aged 35
years or more accounted for 20.6% (Table 4c and Figure 3). Aboriginal women were generally younger than nonAboriginal women: 17.7% were teenagers and only 7.6% were 35 years or older. Among Asian women, on the other
hand, only 0.8% were teenagers but 19.0% were 35 years or older.
The age-specific fertility rates have remained steady in the 20-24 age group and increased in the teenage, 25-29,
35-39 and 40+ age groups, when compared with 2010 (Table 4d). The rate was highest in the age group 30-34 years
(124.3 per 1,000 women), followed by the 25-29 years age group (108.6 per 1,000 women). The general fertility
rate (see Appendix 1) was 62.4 per 1,000 women aged 15-44 years, up from 60.8 in 2010. The total fertility rate
(see Appendix 1) was 1.89 live births per woman, higher than 2010 (1.85) down from 1.91 in 2008, which was the
highest for more than a decade, but still below replacement level (2.1).
Table 4c: Age and race of women who gave birth, South Australia, 2011
Age
(years)
Caucasian
Asian
Aboriginal
Other
Total
Number
Number
Number
Number
Number
0.0
0.3
0.0
0.1
0.0
15-19
639
4.0
121
17.5
18
0.8
24
2.5
802
4.0
20-24
2,239
13.9
244
35.2
201
9.0
239
24.7
2,923
14.6
25-29
4,710
29.2
174
25.1
784
35.2
291
30.1
5,959
29.7
30-34
5,082
31.5
99
14.3
802
36.0
246
25.4
6,229
31.1
35-39
2,775
17.2
40
5.8
355
15.9
136
14.0
3,306
16.5
40-44
673
4.2
13
1.9
66
3.0
30
3.1
782
3.9
31
0.2
0.0
0.1
0.1
35
0.2
16,153
(80.6)
693
(3.5)
2,229
(11.1)
968
(4.8)
20,043
(100.0)
<15
45+
Total
page 21
Mothers and Babies
Figure 3: Age and race of women who gave birth, 2011 (n=20,043)
Percentage of women
100%
80%
60%
40%
20%
0%
Caucasian
n=16,153
14-19
Aboriginal n=693 Asian n=2,229
20-24
25-29
Other n=968
30-34
Total n=20,043
35+
Age (years)
Table 4d: Age-specific fertility rates, South Australia, 2011

Number of live births
Estimated resident female

population*
Age-specific fertility rate per 1,000

women (ASFR)
na
na
15-19
796#
51,684
15.5#
20-24
2,930
55,821
52.5
25-29
6,003
55,253
108.6
30-34
6,275
50,502
124.3
35-39
3,353
53,149
63.1
40-44
790#
57,092
14.5#
37
na
na
20191
323501
62.4
Age (years)
<15
45+
Total
* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2011. Canberra: ABS, 2012 (Catalogue No 3235.0).
# the number of live births and fertility rate for women aged 15-19 years include live births for younger ages, and the number and rate for women
aged 40-44 years include live births for older ages, while the total number and rate (general fertility rate) include all live births. Live births in this table
exclude terminations of pregnancy.
Sum of 5-year ASFRs = 378.5 per 1,000 women. Total fertility rate = 378.5 x 5 = 1,892.5 live births per 1,000 women = 1.89 live births per woman.
5. Country of birth
The distribution of women by country of birth is provided in Table 5a by major group, and in Table 5b by specified
countries of birth that had 40 or more women who gave birth. Of the 22.3% of women born outside Australia, the
largest proportion was born in India (3.6% of women). Other countries contributing relatively large proportions of
migrant women were the United Kingdom and Ireland (2.5%), China (1.7%), Vietnam (1.3%) the Philippines (1.0%),
New Zealand (0.9%) Afghanistan, Cambodia and Sudan, (0.6%) each, Malaysia (0.5%), South Africa and Thailand
(0.4%), Canada, Indonesia, Iran, Iraq, Japan, Pakistan, South Korea, Sri Lanka, and the United States of America
(0.3%), and Germany and Poland (0.2% each).
page 22
Mothers and Babies
Table 5a: Country of birth, major groups,* women who gave birth, South Australia, 2011
Country of birth
Number
15,792
78.8
Oceania and Antarctica
Europe and the USSR
914
4.6
The Middle East and North Africa
346
1.7
Southeast Asia
886
4.4
Northeast Asia
517
2.6
Southern Asia
1,036
5.2
Northern America
113
0.6
South America, Central America and the Caribbean
98
0.5
Africa (excluding North Africa)
341
1.7
20,043
100.0
Total
* Australian Bureau of Statistics. Australian Standard Classification of Countries for Social Statistics (ASCCSS). Canberra: ABS, 1990
(Catalogue No 1269.0).
Table 5b: Specified country of birth,* women who gave birth, South Australia, 2011
Specified country of birth
Number
% of women
% of migrant women who gave

birth (n=4,475)
1100
Australia
15,568
77.7
na
6104
India
722
3.6
16.1
2101-2107
UK & Ireland
507
2.5
11.3
5101
China
338
1.7
7.6
4110
Vietnam
255
1.3
5.7
4107
Philippines
210
1.0
4.7
1301
New Zealand
182
0.9
4.1
3207
Sudan
123
0.6
2.7
6101
Afghanistan
117
0.6
2.6
4102
Cambodia
113
0.6
2.5
4105
Malaysia
96
0.5
2.1
9220
South Africa
84
0.4
1.9
4109
Thailand
78
0.4
1.7
5105
South Korea
68
0.3
1.5
6108
Sri Lanka
62
0.3
1.4
7104
USA
62
0.3
1.4
4103
Indonesia
57
0.3
1.3
6107
Pakistan
56
0.3
1.3
3103
Iran
55
0.3
1.2
5103
Japan
55
0.3
1.2
7102
Canada
51
0.3
1.1
3104
Iraq
51
0.3
1.1
2504
Poland
50
0.2
1.1
2305
Germany
47
0.2
1.1
1,036
5.2
23.2
20,043
100.0
100.0
All other countries

Total
* ASCCSS, Australian Bureau of Statistics
page 23
Mothers and Babies
6. Marital status and type of patient

While 89.8% women who gave birth in 2011 were married or in a de facto relationship, 10.2% were single (9.2%
were never married and 1.0% were widowed, separated or divorced, Table 6a). Of never married women, a fifth
were teenagers and a third were in the early twenties age group. Relatively more single women were hospital/public
patients than married women and women in de facto relationships (91.5% v 68.5%, Table 6b). Twenty-nine percent
of all women were private patients.
Table 6a: Marital status and age, women who gave birth, South Australia, 2011
Marital status of women
Age
(years)
Never married
Married/de facto
Widowed/
separated/divorced
Unknown
Total
Number
Number
Number
Number
Number
<20
391
21.2
416
2.3
0.5
100.0
809
4.0
20-24
550
29.8
2,333
13.0
40
20.4
0.0
2,923
14.6
25-29
445
24.1
5,457
30.3
57
29.1
0.0
5,959
29.7
30-34
281
15.2
5,900
32.8
48
24.5
0.0
6,229
31.1
35-39
135
7.3
3,132
17.4
39
19.9
0.0
3,306
16.5
40-44
39
2.1
732
4.1
11
5.6
0.0
782
3.9
0.2
31
0.2
0.0
0.0
35
0.2
1,845
9.2
18,001
89.8
196
1.0
0.0
20,043
100.0
45+
Total
Table 6b: Type of patient and marital status, women who gave birth, South Australia, 2011
Marital status of women
Type of
patient
Hospital/
public
Private
Total
page 24
Never married
Married/de facto
Widowed/
separated/divorced
Unknown
Total
Number
Number
Number
Number
Number
1,688
91.5
12,338
68.5
184
93.9
100.0
14,211
70.9
157
8.5
5,663
31.5
12
6.1
0.0
5,832
29.1
1,845
9.2
18,001
89.8
196
1.0
0.0
20,043
100.0
Mothers and Babies
7. Occupation of father and mother

This categorisation is based on the Australian Statistical Classification of Occupations (ASCO) of the Australian Bureau
of Statistics and is provided in Table 7. Unclassified occupations have been assigned a separate category (Category 9).
A much larger proportion of mothers than fathers (24.4 v 0.4%) was included in the occupation home duties. Larger
proportions were also found for the groups of clerks and salespeople and personal service workers. More fathers were
managers and administrators, tradespeople, plant and machine operators and labourers. Occupation was unknown
for 10.3% of fathers and 3.6% of mothers.
Table 7: Occupation* of father and mother, women who gave birth, South Australia, 2011
Father
Occupation
Mother
Number
Number
Managers and administrators
2,938
14.7
1,413
7.0
Professionals
3,101
15.5
3,220
16.1
Para professionals
955
4.8
1,307
6.5
Tradespersons
3,537
17.6
617
3.1
Clerks
580
2.9
2,373
11.8
Salespersons and personal service workers
1,191
5.9
3,017
15.1
Plant and machine operators and drivers
1,239
6.2
69
0.3
Labourers and related workers
2,642
13.2
576
2.9
Students
495
2.5
872
4.4
Pensioners
119
0.6
42
0.2
Home duties
88
0.4
4,898
24.4
Unemployed
872
4.4
786
3.9
Other
212
1.1
137
0.7
2,074
10.3
716
3.6
20,043
100.0
20,043
100.0
Unknown
Total
* Australian Bureau of Statistics. ASCO. First Edition. Occupation Definitions. Canberra: ABS,1990. (Catalogue No. 1223.0).
page 25
Mothers and Babies
8. Previous pregnancy outcomes

Forty-two percent of women had no previous birth and 31.4% were pregnant for the first time. Among Aboriginal
women and those of other races, these proportions were lower, with 34.3% and 37.7% respectively giving birth for
the first time. The proportion of women giving birth for the first time was the highest among Asian women (55.5%).
The proportion of women of parity 4 or greater was much higher among Aboriginal women (12.3%) and women of
other races (9.1%), than among Caucasian women (2.8%) and Asian women (1.4%) (Table 8a).
Table 8a: Parity by race, women who gave birth, South Australia, 2011
Race of women
Caucasian
Parity
Asian
Aboriginal
Other
Total
Number
Number
Number
Number
0-primigravida
4,913
30.4
188
27.1
902
40.5
284
29.3
6,287
31.4
0-multigravida
1,803
11.2
50
7.2
325
14.6
81
8.4
2,259
11.3
5,814
36.0
193
27.8
710
31.9
283
29.2
7,000
34.9
2,413
14.9
108
15.6
203
9.1
154
15.9
2,878
14.4
762
4.7
69
10.0
57
2.6
78
8.1
966
4.8
270
1.7
42
6.1
18
.8
34
3.5
364
1.8
178
1.1
43
6.2
14
.6
54
5.6
289
1.4
16,153
(80.6)
693
(3.5)
2,229
(11.1)
968
(4.8)
20,043
(100.0)
Total
Number
Among women with previous pregnancies (multigravid women), the proportions who had previous specified adverse
pregnancy outcomes are shown in Table 8b. Just over a third of the women had a previous miscarriage and a fifth had
a previous termination of pregnancy.
Table 8b: Previous pregnancy outcomes, women who gave birth, South Australia, 2011
(multigravidae only, n= 13,756)
Previous pregnancy outcome
Number
Miscarriage
4,734
34.4
Termination of pregnancy
2,695
19.6
186
1.4
88
0.6
314
2.3
Stillbirth
Neonatal death
Ectopic pregnancy
Of the 11,497 women who had previously given birth, 3,483 (30.3%) had had a previous caesarean section.
page 26
Mothers and Babies
9a. Gestation at first antenatal visit

In 2011 gestation at the first antenatal visit was reported as unknown for 7.3% of women (Table 9a). If these
women with an unknown number of visits are excluded, among the remaining women, 78.6% attended within
the first 14 weeks. This proportion was much lower for Aboriginal women (54.6%) than for non-Aboriginal women
(79.5%).
Table 9a: Gestation at first antenatal visit, women who gave birth, by race, South Australia, 2011 (n=20,043)
Race of women
Non-Aboriginal
Total
Aboriginal
Gestation
at first
antenatal
visit
Number
Adjusted %
(excluding
unknown)
(n=17,965)
Number
Adjusted %
(excluding
unknown)
(n=615)
Number
Adjusted %
(excluding
unknown)
(n=18,580)
<14 weeks
gestation
14,277
73.8
79.5
336
48.5
54.6
14,613
72.9
78.6
14 weeks or
greater*
3688
19.1
20.5
279
40.3
45.4
3,967
19.8
21.4
Unknown
1385
7.2
78
11.3
1,463
7.3
19,350
96.5
693
3.5
20,043
100.0
Total
100.0
100.0
100.0
* includes 39 women with no antenatal care
9b. Body Mass Index (BMI)

Reported height and weight at the first antenatal visit were used to calculate the Body Mass Index (BMI, see Appendix
1) for women who gave birth. This was considered valid only for women who attended the first antenatal visit before
20 weeks gestation. Among these 17,472 women (87.2%) of all women who gave birth, height and weight were
not reported for 2,402 women (13.7%), so that BMI could only be calculated for 15,070 women who gave birth in
2011 (75.2%). Table 9b shows that 7,701 women recorded a BMI >=25.0 (38.4% of all women giving birth), 3,658
(18.3%) had a BMI >=30.0, and 1,590 (7.9%) had a BMI >=35.0.
Table 9b: BMI of women who gave birth, South Australia, 2011
BMI
(based on height and weight at first antenatal visit where gestation
at first antenatal visit was <20 weeks)
Number
Adjusted %
(excluding unknown
(n=15,070)
<18.5 (underweight)
444
2.5
2.9
18.5 24.9 (normal)
6925
39.6
46.0
25.0 29.9 (overweight)
4043
23.1
26.8
30.0 34.9 (obese)
2068
11.8
13.7
35.0 39.9 (severely obese)
972
5.6
6.4
40 or more (morbidly obese)
618
3.5
4.1
2402
13.8
17472
100.0
Unknown
Total
page 27
Mothers and Babies
9c. Antenatal visits

Women who gave birth are grouped in Table 9c according to the number of reported antenatal visits: no visits, 1 - 6
visits, 7 or more visits. However, for 5.1% of women (8.2% of Aboriginal women), the number of antenatal visits
attended was not reported. If women for whom the number of antenatal visits was not reported are excluded, 31.0%
of Aboriginal women compared with 7.5% of Caucasian women were reported to have made fewer than 7 visits.
Among Asian women this proportion was 11.2%. A low frequency of antenatal visits may be taken, particularly in
term births, as an indication of inadequate antenatal care. Although the exact number of antenatal visits was reported
for 19,015 (94.9%) women, (99.8%) women report having attended at least one antenatal visit.
Table 9c: Antenatal visits by race, women who gave birth, South Australia, 2011
Race of women
Caucasian
Antenatal visits
Asian
Aboriginal
Other
Total
Number
Number
Number
Number
Number
21
0.1
15
2.2
0.0
0.2
39
0.2
1-6
1,125
7.0
182
26.3
236
10.6
135
13.9
1,678
8.4
14,200
87.9
439
63.3
1,873
84.0
786
81.2
17,298
86.3
807
5.0
57
8.2
119
5.3
45
4.6
1,028
5.1
16,153
80.6
693
3.5
2,229
11.1
968
4.8
20,043
100.0
None
Not reported
Total
9d. Type of antenatal care

Table 9d shows that the main types of antenatal care used were hospital clinics (48.2%), obstetricians in private
practice (29.8%), general practitioners (14.9%) and birth centres (8.4%). Individual women may have used more than
one type of antenatal care. There were 39 women (0.2%) who had no antenatal care.
Table 9d: Type of antenatal care, women who gave birth, South Australia, 2011 (n = 20,043)
Type of care
Number
39
0.2
Hospital clinic
9,663
48.2
Obstetrician in private practice
5,978
29.8
General practitioner (GP)
2,996
14.9
Birth centre
1,686
8.4
GP/midwife (shared care)
1,571
7.8
Midwifery Group Practice (W&CH)
955
4.8
Obstetrician/midwife (shared care) in private practice
368
1.8
77
0.4
153
0.8
77
0.4
151
0.8
ABBP (Abu Bingi Family Birthing program Pt Augusta)
80
0.4
RFBP (Regional Family Birthing Program at Whyalla)
38
0.2
AMIC (Metropolitan Aboriginal Family Birthing Program)
71
0.4
Other
31
0.2
Not stated
21
0.1
No antenatal care
Home birth midwife

Northern Womens Community Health Centre (NWCHC)
Team midwifery Pt Pirie
Midwifery group practice Gawler
page 28
Mothers and Babies
10. Smoking
Table 10a shows that 13.1% of all women were reported to be smokers at their first antenatal visit, and 3.6% had
quit smoking before their first visit. Smoking status was unknown for 1.3% of women. The proportion of all women
smoking during pregnancy has been declining in the state, from 25% in 1998 to 13.1% in 2011.
The proportion of Aboriginal women who reported that they smoked at the first antenatal visit (53.4%) up slightly
from 2010 (52.8%).The highest rate in the last decade was (61.2%) reported in 2005. However, this was considerably
higher than non-Aboriginal women (11.7%). Additionally, 5.5% of Aboriginal women reported that they quit
smoking in pregnancy prior to their first antenatal visit, compared with 3.6% of non-Aboriginal women.
Among age groups, the highest rates of smoking were among teenagers (32.3%) and women aged 20-24 years
(22.9%). Smoking rates were high among all age groups of Aboriginal women varying from 42.3% among teenage
women to 54.1% among those aged 20-24 years.
In the second half of pregnancy (Table 10b), 11.5% of women (2,303 women) were reported to be smokers and
0.4% (88 women) smoked more than 20 cigarettes per day, but the number of cigarettes smoked was not known
for 1.9% of women. In the second half of pregnancy, 48.3% of Aboriginal women smoked, compared with 10.2%
of non-Aboriginal women. A higher proportion of Aboriginal women (2.3% compared with 0.4%) also smoked more
than 20 cigarettes per day, but the number of cigarettes smoked was not known for 6.2% of Aboriginal women and
1.7% of non-Aboriginal women.
Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women who gave
birth, South Australia, 2011
Non-Aboriginal
Smoking status
Smoker
Quit before 1 visit
st
Non-smoker
Unknown smoking status
Total
Total
Aboriginal
Number
Number
Number
2,263
11.7
370
53.4
2,633
13.1
687
3.6
38
5.5
725
3.6
16,153
83.5
267
38.5
16,420
81.9
247
1.3
18
2.6
265
1.3
19,350
96.5
693
3.5
20,043
100.0
Table 10b: Average number of tobacco cigarettes smoked per day in the second half of pregnancy, nonAboriginal and Aboriginal women who gave birth, South Australia, 2011
Average number of tobacco
cigarettes smoked per day
Non-Aboriginal
Total
Aboriginal
Number
Number
Number
17,044
88.1
315
45.5
17,359
86.6
50
.3
.6
54
.3
1,387
7.2
241
34.8
1,628
8.1
11-20
459
2.4
74
10.7
533
2.7
21-30
61
.3
14
2.0
75
.4
31-40
.0
.3
10
.0
None
Occasional (<1)
1-10
41+
Unknown
Total
.0
.0
.0
338
1.7
43
6.2
381
1.9
19,350
96.5
693
3.5
20,043
100.0
page 29
Mothers and Babies
11. Medical conditions

Medical conditions were recorded in the current pregnancy for 7,926 women (39.5%). The frequencies of specified
medical conditions are provided in Table 11. Up to four conditions can be reported for each pregnancy.
Table 11: Medical conditions in current pregnancy, women who gave birth, South Australia, 2011
Medical condition
Number
% of women (n = 20,043)
12,117
60.5
1,356
6.8
None
Anaemia
Urinary tract infection
543
2.7
Hypertension (pre-existing)
237
1.2
Diabetes (pre-existing)
139
0.7
Epilepsy
108
0.5
Asthma
1,314
6.6
Other
5,852
29.2
12. Obstetric complications

Obstetric complications were recorded for 7,269 women who gave birth (36.3%). The reported frequencies of the
more common complications are presented in Table 12. Up to four complications can be reported for each pregnancy.
There were two maternal deaths in 2011, one direct death and one incidental death (see definition in Appendix 1)
notified to the Maternal, Perinatal and Infant Mortality Committee in 2010.3
Table 12: Frequency of some obstetric complications, women who gave birth, South Australia, 2011
Obstetric complication
Number
% of women (n= 20,043)
12,774
63.7
Threatened miscarriage
313
1.6
Antepartum haemorrhage (APH) - Abruption
101
0.5
APH - Placenta praevia
111
0.6
APH Other & unknown causes
462
2.3
1,456
7.3
872
4.4
Gestational diabetes
1,393
7.0
Other complications (including 4 women with impaired glucose tolerance)
4,218
21.0
No complication
Pregnancy hypertension
Intrauterine growth restriction (suspected)
page 30
Mothers and Babies
13. Procedures performed in current pregnancy

Procedures performed are listed as reported in Table 13. At least one ultrasound examination was performed for
99.3% of women, amniocentesis for 3.7% and chorion villus sampling for 0.9%.
For a proportion of women, it was not known whether a specific procedure had been performed, eg 1.4% for
maternal serum alpha feto-protein (MSAFP) screening. It is hoped that the increasing use of the Pregnancy Record
will reduce the number of unknown entries. The listing of procedures on the Supplementary Birth Record will also be
improved, eg to distinguish first from second trimester Down syndrome screening.
Table 13: Procedures performed in current pregnancy, women who gave birth, South Australia, 2011
Procedure
Yes
No
Unknown
Number
Number
Number
4,181
20.9
15,579
77.7
283
1.4
Triple/Quadruple screen (Down syndrome etc)
13,917
69.4
5,884
29.4
242
1.2
Ultrasound
19,905
99.3
103
0.5
35
0.2
Chorion villus sampling
184
0.9
19,839
99.0
20
0.1
Amniocentesis
733
3.7
19,291
96.2
19
0.1
Cordocentesis
0.0
20,021
99.9
20
0.1
98
0.5
19,945
99.5
0.0
MSAFP (Neural tube defect screen etc)
Other surgical procedure
14a. Onset of labour

Labour occurred spontaneously in 50.8% of women who gave birth (Table 14a). It was induced in 31.2%, and the
methods of induction used were artificial rupture of membranes (ARM) in 68.1% of inductions, prostaglandins in
58.0% and oxytocics in 53.0% (Table 14b). In many cases more than one method was used.
Table 14a: Onset of labour, women who gave birth, South Australia, 2011
Onset of labour
Number
10,185
50.8
No labour caesarean section
3,609
18.0
Induction
6,249
31.2
20,043
100.0
Spontaneous
Total
Table 14b: Method of induction of labour, women who gave birth, South Australia, 2011
Number
% of women
(n =20,043)
% of inductions
(n =6,249)
13,794
69.0
ARM
4,230
21.1
68.1
Oxytocics
3,292
16.5
53.0
Prostaglandins
3,601
18.0
58.0
Method of induction
No induction
page 31
Mothers and Babies
14b. Reasons for induction of labour

Up to two reasons could be provided for induction. These reasons for induction of labour are defined (see page 55) in
The Australian Council on Healthcare Standards Obstetrics Indicators - Clinical Indicator Users Manual Version 5 for
use in 2007.
Figure 4 demonstrates that 18.0% of women were induced for prolonged pregnancy (41 or more completed weeks),
13.7% for hypertension, 6.8% for diabetes (including gestational diabetes and glucose intolerance), 7.2% for
intrauterine growth restriction (IUGR) and 6.8% for premature rupture of membranes (PROM). Other defined reasons
accounted for smaller proportions. Other than defined reasons accounted for 50.8%.
Figure 4: Reasons for induction of labour, SA, 2011 (n=6,249)
Diabetes*
PROM
Hypertensive disorders
IUGR
Isoimmunisation
Fetal distress
Fetal death
Chorioamnionitis
Prolonged pregnancy
Other
0
10
20
30
40
50
60
Percentage
*includes diabetes mellitus, gestational diabetes and glucose intolerance
The proportion of women giving birth who had labour augmented was 20.5%. Of the 10,185 women who went into
spontaneous labour, augmentation was used for 4,101 (40.3%). Methods used in augmentation were artificial rupture
of membranes (ARM) (74.4%), oxytocics (40.0%) and prostaglandins (0.4%). More than one method may be used. It
should be noted that prostaglandins are not recommended by the manufacturers as a method of augmenting labour.
Table 14c: Augmentation of labour after spontaneous onset, women who gave birth, South Australia, 2011
Method of augmentation
Number
% of women (n=20,043)
% of augmentations (n=4,101)
Any augmentation
4,101
20.5
100.0
ARM
3,052
15.2
74.4
Oxytocics
1,640
8.2
40.0
Prostaglandins
16
0.1
0.4
page 32
Mothers and Babies
15a. Presentation and method of birth

Of the women who gave birth, 54.7% had normal spontaneous vaginal births (Table 15a and Figure 5a). Caesarean
section was performed for 33.2% of women, with 16.1% of women having elective sections; forceps were utilised
for 5.7%, ventouse for 5.9% and breech birth for the remaining 0.5%. The method of birth given for women who
had multiple births is that for the first birth. The method of birth by presentation for all births is provided in Table 15b.
Breech presentation occurred in 4.8% of births and caesarean section was the method of birth for 88.8% of breech
presentations. Caesarean section was utilised for 89.2% of breech presentations in singletons (Table 15c).
Table 15a: Method of birth, women who gave birth, South Australia, 2011
Method of birth
Number
10,965
54.7
1,150
5.7
Assisted breech (no forceps)
28
0.1
Caesarean section (elective)
3,175
15.8
Caesarean section (emergency)
3,471
17.3
Ventouse
1,189
5.9
0.0
58
0.3
Assisted breech (with forceps for head)
0.0
Unknown
0.0
20,043
100.0
Normal spontaneous vaginal

Forceps
Breech extraction
Breech spontaneous
Total
Figure 5a: Method of birth, women who gave birth, South Australia, 2011 (n = 20,043)
Forceps (5.7%)
Breech delivery (0.4%)
Caesarean section
(33.2%)
Normal
spontaneous
vaginal (54.7%)
Ventouse (5.9%)
page 33
Mothers and Babies
Table 15b: Method of birth by presentation, all births, South Australian 2011 (n=20,344)
Presentation
Vertex
Method of birth
Breech
Other
Unknown
Total
Number
Number
Number
Number
Number
10,968
57.3
0.0
37
19.9
14
35.0
11,019
54.2
1,144
6.0
0.0
11
5.9
7.5
1,158
5.7
0.0
34
3.5
0.0
0.0
34
0.2
Elective caesarean
2,699
14.1
537
54.5
32
17.2
14
35.0
3,282
16.1
Emergency
caesarean
3,126
16.3
338
34.3
99
53.2
15.0
3,569
17.5
Ventouse
1,196
6.3
0.0
2.2
0.0
1,200
5.9
Breech extraction
0.0
15
1.5
0.5
0.0
16
0.1
Breech
spontaneous
0.0
58
5.9
1.1
2.5
61
0.3
Assisted breech
(forceps)
0.0
0.3
0.0
0.0
0.0
Unknown
0.0
0.0
0.0
5.0
0.0
19,133
94.0
985
4.8
186
0.9
40
0.2
20,344
100.0
Normal
spontaneous
Forceps
Assisted breech
(no forceps)
Total
Table 15c: Method of birth in breech presentation, by plurality, all births, South Australia, 2011(n = 985)
Plurality
Assisted*
breech
Elective
caesarean
Emergency
caesarean
Breech
extraction
Breech
spontaneous
Total
Singleton
28
445
256
54
786
Twins
89
81
12
194
Triplets
37
537
338
15
58
985
Total
* in one of the assisted breech births forceps were applied to the head.
page 34
Mothers and Babies
15b. Reason for caesarean section

Up to two reasons may be provided on the Supplementary Birth Record for caesarean section, and these have been
collated in Figure 5b (all caesarean sections), Figure 5c (elective caesarean sections only) and Figure 5d (emergency
caesarean sections only). The main reasons given for all caesarean sections were previous caesarean section (37.3%),
failure to progress/cephalopelvic disproportion (CPD) (28.0%), fetal distress (15.6%) and malpresentation (11.5%).
The main reasons for elective sections were previous caesarean section (65.8%), malpresentation (13.7%) and
multiple pregnancy (3.0%), and the main reasons given for emergency sections were failure to progress or CPD
(51.5%), fetal distress (29.7%), previous caesarean section (11.3%) and malpresentation (9.4%).
Figure 5b: Reason for caesarean section, 2011 (n=6,646)
CPD/Failure to progress
Previous caesarean
Fetal distress
Malpresentation
Pregnancy
hypertension/hypertension
APH
Multiple pregnancy
IUGR
Other
10
20
30
40
50
60
Percentage
Figure 5c: Reason for elective caesarean section, 2011 (n=3,175)

CPD
Previous caesarean
Fetal distress
Malpresentation
Pregnancy hypertension/hypertension
APH
Multiple pregnancy
IUGR
Other
10
20
30
40
50
60
70
Percentage
page 35
Mothers and Babies
Figure 5d: Reason for emergency caesarean section, 2011 (n=3,471)
CPD/Failure to progress
Previous caesarean
Fetal distress
Malpresentation
Pregnancy hypertension/hypertension
APH
Multiple pregnancy
IUGR
Other
10
20
30
40
50
60
Percentage
16. Complications of labour and birth and perineal status after birth
Complications of labour or birth were recorded for 7,480 women who gave birth (37.3%). Up to four complications
can be recorded. The reported frequency of some complications is presented in Table 16. Among all 20,043 women
who gave birth, episiotomy was performed for 2,463 (12.3%). Among the 13,397 women who gave birth vaginally,
3,630 (27.1%) had an intact perineum after birth, 5,465 (40.8%) had a repair of a perineal tear, of whom 452 (3.4%)
had a third or a fourth degree tear; 18.3% had an episiotomy.
Table 16: Frequency of some complications of labour and birth, women who gave birth, South Australia, 2011
Complication of labour
Number of women
% of women (n=20,043)
12,563
62.7
38
0.2
1,476
7.4
887
4.4
2,198
11.0
Retained placenta
268
1.3
Prolonged labour
159
0.8
Cord prolapse
33
0.2
Wound infection
26
0.1
452
2.3
Failure to progress
2,578
12.9
Other
4,823
24.1
None
Post-partum haemorrhage (PPH) primary (amount not specified)
PPH - 600-999ml
PPH 1,000 ml or more
Fetal distress
Third degree tear (391) or fourth degree tear (31)
page 36
Mothers and Babies
17. Fetal monitoring during labour

Cardiotocography (CTG) was performed during labour for 64.0% of women who gave birth. The majority of these
(51.5% of women) were external CTGs (Table 17a) while a scalp clip was used for 12.4%.
A fetal scalp pH was taken during labour in 155 women who gave birth (0.8%, Table 17b).
Table 17a: CTG performed during labour, women who gave birth, South Australia, 2011
CTG during labour
Number of women
% of women (n=20,043)
7,225
36.0
None
External
10,329
51.5
Scalp clip
2,489
12.4
Table 17b: Fetal scalp pH taken during labour, women who gave birth, South Australia, 2011
Fetal scalp pH taken
Number of women
% of women (n=20,043)
No
19,888
99.2
Yes
155
0.8
18. Analgesia for labour and anaesthesia for birth

These distributions are provided in Tables 18a and 18b. Epidurals were used for analgesia in labour for 31.7% and
for anaesthesia for birth for 27.7% of women. The proportion of women who had an epidural for either was 32.8%
(6,567 women). The proportion of women who had a spinal anaesthetic increased between 1991 and 2011 from
0.2% to 0.8% for analgesia and from 0.5% to 24.2% for anaesthesia. General anaesthesia was used for 2.2% of
births. It was used in 6.7% of caesarean sections. Approximately 36% of women who gave birth received none of the
specified methods for analgesia during labour.
Table 18a: Analgesia for labour,* women who gave birth, South Australia, 2011
Analgesia
Number
% of women
None
7,264
36.2
Nitrous oxide and oxygen
8,075
40.3
Narcotic (parenteral)
3,580
17.9
Epidural (lumbar/caudal)
6,361
31.7
Spinal
154
0.8
Other
347
1.7
Combined spinal-epidural
0.0
* more than one method may be used for each woman
page 37
Mothers and Babies
Table 18b: Anaesthesia for birth,* women who gave birth, South Australia, 2011
Anaesthesia
Number
% of women
None
7,195
35.9
Local anaesthesia
2,074
10.3
Pudendal
199
1.0
5,546
27.7
Spinal
4,854
24.2
General anaesthesia
450
2.2
Other
174
0.9
69
0.3
* more than one method may be used for each woman
19. Postnatal length of stay of women

The distribution of length of stay of women who gave birth in hospitals is presented in Table 19a for public and
private patients. The median duration for all women was three days. It was two days for vaginal births and four days
for caesarean section births (Table 19b). The median duration of stay was two days longer for private patients for
vaginal and one day longer for caesarean births (four and five days respectively for private patients compared with
two and four days respectively for public patients).
Table 19a: Postnatal length of stay by type of patient, women who gave birth in South Australian hospitals, 2011
Postnatal length of stay (days)
Public
Private
Total
Number
Number
Number
<1
819
5.8
26
0.4
845
4.2
2,475
17.5
68
1.2
2,543
12.7
3,531
25.0
198
3.4
3,729
18.7
3,490
24.7
680
11.7
4,170
20.9
2,183
15.4
2,283
39.3
4,466
22.4
1,081
7.6
1,731
29.8
2,812
14.1
304
2.1
570
9.8
874
4.4
7 or more
259
1.8
249
4.3
508
2.5
14,142
100.0
5,805
100.0
19,947
100.0
Total
page 38
Mothers and Babies
Table 19b: Average postnatal length of stay by type of patient & type of birth, women who gave birth in
South Australian hospitals, 2011
Public
Average length
of stay
Total
Vaginal
(n=9,915)
Caesarean
(n=4,227)
Total
(n=14,142)
Vaginal
(n=3,386)
Caesarean
(n=2,419)
Total
(n=5,805)
Vaginal
(n=13,301)
Caesarean
(n=6,646)
Total
(n=19,947)
2.17
3.98
2.71
3.88
5.19
4.42
2.60
4.42
3.21
(1.46)
(1.69)
(1.75)
(1.17)
(1.15)
(1.33)
(1.58)
(1.63)
(1.81)
Mean number
of days
(SD)
Private
Median number
of days
20. Sex of baby

The sex distribution of babies is provided in Table 20; the male:female sex ratio was 1.05:1.
Table 20: Sex of baby, all births, South Australia, 2011
Sex of baby
Male
Female
Total
Number
10,432
51.3
9,912
48.7
20,344
100.0
21. Birthweight and gestation

The birthweight distribution of all births is presented in Table 21. The percentage of low birthweight babies (<2,500g)
was 7.5%, and that of very low birthweight babies (<1,500g) was 1.6%. The mean birthweight was 3,324g (SD
622.0g), with birthweights ranging from 55g to 5656g. The proportion of low birthweight babies was 16.2% among
babies of Aboriginal women compared with 7.2% among babies of non-Aboriginal women. Among live born babies,
these proportions were 15.2% and 6.6% respectively.
Table 21: Birthweight distribution of all births, South Australia, 2011
Birthweight (g)
Number of births
Percentage of births
<400
44
0.2
400-499
37
0.2
500-749
68
0.3
750-999
53
0.3
1,000-1,499
117
0.6
1,500-1,999
274
1.3
2,000-2,499
933
4.6
2,500-2,999
3319
16.3
3,000-3,499
7261
35.7
3,500-3,999
6018
29.6
4,000-4,499
1927
9.5
291
1.4
0.0
20344
100.0
4,500+
Unknown
Total
page 39
Mothers and Babies
In 2011, 1,526 babies (7.5%) were of low birthweight and 1,876 (9.2%) were preterm (<37 weeks gestation). The
proportion of preterm births was 17.1% among babies of Aboriginal women compared with 9.0% among babies of
non-Aboriginal women.
22. Birth injuries

Birth injuries were reported in 178 live births (0.9%). The most common injury reported was cephalhaematoma.
Fracture and nerve injury occurred less frequently (Table 22).
Table 22: Birth injuries* in 19,883 live births, South Australia, 2011
Birth injury
Number of live births
% of live births
20,016
99.1
15
0.1
Dislocation
0.0
Nerve Injury
12
0.1
109
0.5
48
0.2
None
Fracture
Cephalhaematoma
Other
* more than one injury may be reported for each birth
23. Treatment given in neonatal period

The proportions of live births who received specified treatments in the neonatal period are provided in Table 23, which
shows that 84.5% of neonates did not receive any of these treatments.
Table 23: Neonatal treatment given, all live births, South Australia, 2011
Neonatal treatment
Number
% of live births
17,056
84.5
895
4.4
Phototherapy for jaundice
1,354
6.7
Gavage feeding more than once
1,628
8.1
Any intravenous therapy
2,041
10.1
None of the treatments listed below

Oxygen therapy for more than 4 hours
24. Level of care utilised

Table 24 shows that 83.6% of neonates utilised Level I care only. Level II care was used by 16.2% of neonates, Level
III care at the Womens and Childrens Hospital or Flinders Medical Centre by 2.6% and paediatric intensive care at
the Womens and Childrens Hospital by 0.2% of neonates. As would be expected, with decreasing birthweight, an
increasing percentage of babies required Level II and Level III care.
page 40
Mothers and Babies
Table 24: Level of nursery care utilised by birthweight, all live births, South Australia, 2011
Birthweight (g)
Level of care utilised
<1,500
(n=210)
1,500-2,499
(n=1,191)
2,500+
(n=18,791)
Unknown
(n=2)
Total
(n=20,194)
Number
Number
Number
Number
Number
17
8.1
244
20.5
16,623
88.5
100.0
16,886
83.6
Level II
183
87.1
939
78.8
2,150
11.4
0.0
3,272
16.2
Level III (W&CH & FMC)
179
85.2
184
15.4
170
0.9
0.0
533
2.6
2.9
11
0.9
33
0.2
0.0
50
0.2
Level I only
Level III (W&CH

Paediatric intensive care)
25. Length of stay of babies

Table 25 shows the distribution of length of stay of liveborn babies in hospital for preterm (<37 weeks gestation) and
term births (37 weeks gestation). The mean duration of stay for all liveborn babies was 5.0 days (SD 10.49) and
the median duration 3 days. The mean duration was 3.4 days (SD 4.39) for term births and 21.7 days (SD 27.58) for
preterm births, while the median durations were 3 and 13 days respectively.
Table 25: Length of stay of liveborn babies in hospital, South Australia, 2011
Length of stay (days)
Preterm births
Term births
Total
Number
Number
Number
<1
21
1.2
774
4.2
795
4.0
27
1.5
2,360
12.9
2,387
11.9
53
3.0
3,391
18.5
3,444
17.1
90
5.2
3,787
20.6
3,877
19.3
126
7.2
4,129
22.5
4,255
21.2
128
7.3
2,556
13.9
2,684
13.4
103
5.9
751
4.1
854
4.2
7-13
328
18.8
481
2.6
809
4.0
14-20
289
16.6
62
.3
351
1.7
21-27
192
11.0
22
.1
214
1.1
28 or more
388
22.2
42
.2
430
2.1
1,745
100.0
18,355
100.0
20,100
100.0
Total
26. Congenital anomalies

Among the 20,344 births in 2011 there were 606 births (3.0%) notified with congenital anomalies, compared with
an average of 2.5% over the past decade.; 567 (2.8%) of these births had abnormalities notified in the congenital
anomalies range 74000-75999 of the British Paediatric Association (BPA) Classification of Diseases. This is a 5-digit
extension of the 4-digit classification of the ICD-9 (International Classification of Diseases. Manual of the International
Statistical Classification of Diseases, Injuries and Causes of Death, 1975 Revision. Geneva: World Health Organisation,
1977). Table 26 includes births with the more readily identifiable defects used for international monitoring (sentinel
defects) notified to the perinatal statistics collection in 2001-2011.
Terminations of pregnancy are not included in this table unless they meet a criterion for inclusion in the perinatal data
collection, ie at least 400g birthweight or 20 weeks gestation. Notifications of births with birth defects identified after
discharge from the hospital of birth but within the first five years of life are made to the South Australian Birth Defects
Register at the Womens and Childrens Hospital, and more complete statistics on birth defects in South Australia are
available from the Registers Annual Report.2
page 41
Mothers and Babies
In 2011 there were 6 cases of spina bifida reported at birth, a decrease from the 11 cases reported in 2010 and 18 in
2009. Spina bifida is a type of neural tube defect, and following a statewide campaign to promote periconceptional
folate in 1994 and 1995 the use of folate supplementation in pregnancy increased, and rates of neural tube defects
decreased. Formal review of the increased case numbers in 2009 and 2010 showed a greater than expected number
of neural tube defects in babies born to African and Middle East born women, but this did not completely explain the
observed increase, which was most likely on account of random fluctuation due to the small numbers involved. Due
to the small numbers involved it was not possible to determine whether folate supplementation played a role. None
the less, it is important to ensure that all women continue to use supplementary folate periconceptually.
Table 26: Selected congenital abnormalities notified to the perinatal statistics collection, 2001-2011, South Australia
Congenital abnormality
BPA* CODE
Number of births =
Year
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
17,704 17,745 17,844 17,522 18,196 18,803 19,757 19,970 19,901 20,002 20,344
74000-74029 Anencephalus
74100-74199 Spina bifida
18
11
74200-74209 Encephalocele
74230-74239 Hydrocephalus
10
12
11
14
74900-74909 Cleft palate
14
17
10
15
11
12
11
12
11
74910-74929 Cleft lip and palate

(Total cleft lip)
15
16
14
17
16
30
28
25
18
13
75030-75038 Tracheooesophageal fistula, oesophageal

atresia and stenosis
10
12
75120-75124 Atresia and stenosis

of large intestine, rectum and
anal canal
12
10
40
42
34
41
38
29
41
40
39
44
43
75300-75301 Renal agenesis and

dysgenesis
10
12
11
12
75520-75549 Limb reduction

defects
13
18
13
75660-75669 Anomalies of
diaphragm
12
75670-75679 Anomalies of
abdominal wall
13
10
13
12
10
17
15
75800-75809 Down syndrome
21
19
13
14
19
17
17
21
22
14
16
75260-75261 Hypospadias and

epispadias
* British Paediatric Association Classification of Diseases. London: The British Paediatric Association, 1979.
27. Multiple births

Among women who gave birth there were 293 twin and 4 triplet pregnancies compared with 19,746 singleton
ones in 2011. Thus there was one twin pregnancy in every 68 pregnancies and one triplet pregnancy in every 5,010
pregnancies among women who gave birth. Women who gave birth with twins and triplets comprised 1.7% of all
women who gave birth. The total number of multiple births was 598 (2.9% of total births).
A comparison of multiple births with singleton ones shows that multiple births were of lower birthweight (with
51.8% being of low birthweight compared with 6.2% for singletons, Table 27a), and gestation (with 61.5% being
preterm births compared with 7.6% for singletons, Table 27b). The proportion of live births in hospital at 28 days was
19.7% for multiple births compared with 1.6% for singletons. The perinatal death rate for multiple births was 31.8
compared with 8.9 deaths per 1,000 births for singletons, Table 27c).
page 42
Mothers and Babies
Table 27a: Birthweight by plurality, all births, South Australia, 2011

Singleton births
Birthweight (g)
Multiple births
Number
Number
<400
43
0.2
0.2
400-499
31
0.2
1.0
500-749
51
0.3
17
2.8
750-999
41
0.2
12
2.0
1,000-1,499
71
0.4
46
7.7
1,500-1,999
209
1.1
65
10.9
2,000-2,499
770
3.9
163
27.3
2,500-2,999
3,085
15.6
234
39.1
3,000-3,499
7,209
36.5
52
8.7
3,500-3,999
6,017
30.5
0.2
4,000-4,499
1,927
9.8
0.0
291
1.5
0.0
0.0
0.2
19,746
100.0
598
100.0
4,500+
Unknown
Total
Table 27b: Gestation at birth by plurality all births, South Australia, 2011
Gestation (weeks)
Singleton births
Multiple births
Number
Number
Total
%
Number
<24
92
0.5
1.0
98
0.5
24-27
64
0.3
27
4.5
91
0.4
28-31
109
0.6
54
9.0
163
0.8
32-36
1,243
6.3
281
47.0
1,524
7.5
37-41
18,184
92.1
230
38.5
18,414
90.5
54
0.3
0.0
54
0.3
19,746
100.0
598
100.0
20,344
100.0
42+
Total
Table 27c: Perinatal outcome by plurality, all births, South Australia, 2011
Perinatal outcome
Stillbirth
Discharged within 28 days
In hospital at 28 days
Neonatal death
Total
Singleton births
Multiple births
Total
Number
Number
Number
140
0.7
10
1.7
150
0.7
19,251
97.5
461
77.1
19,712
96.9
320
1.6
118
19.7
438
2.2
35
0.2
1.5
44
0.2
19,746
100.0
598
100.0
20,344
100.0
page 43
Mothers and Babies

High crude perinatal mortality rates were associated with low birthweight births (Table 28a), low gestation births
(Table 28b) and multiple births (Table 27c). The perinatal mortality rate for all births (livebirths of any gestation and
stillbirths of at least 400g birthweight/20 weeks gestation) in 2011 was 9.5 per 1,000 births. The stillbirth rate was
7.4 per 1,000 births and the neonatal mortality rate was 2.2 per 1,000 live births.
The relationship between perinatal mortality and birthweight is demonstrated in Table 28a and Figure 6. The highest
perinatal mortality rate was observed for the lowest birthweight group weighing <500g (985.5 per 1,000). The
lowest perinatal mortality rate of 0.5 per 1,000 births was observed for births weighing 4,000-4,499g. The perinatal
mortality rate for the birthweight group 3,5003,999g was 1.0 per 1,000 births, and the 4,500+g birthweight group
was 6.9 per 1000 births. The perinatal mortality rate for babies of normal birthweight (2,500g or more) was 1.9 per
1,000 births. The decline in perinatal mortality with increasing gestational age is demonstrated in Table 28b.
Table 28a: Perinatal mortality by birthweight, all births, South Australia, 2011
Stillbirths
Neonatal deaths
Number
Deaths
per 1,000
births
40
37
10
500-749
68
750-999
Perinatal deaths
Number
Deaths
per 1,000
live births
Number
Deaths
per 1,000
births
909.1
750.0
43
977.3
27
729.7
700.0
34
918.9
44
24
352.9
12
272.7
36
529.4
53
46
132.1
65.2
10
188.7
1,000-1,499
117
106
11
94.0
9.4
12
102.6
1,500-1,999
274
267
25.5
7.5
32.8
2,000-2,499
933
924
9.6
6.5
15
16.1
2,500-2,999
3,319
3,308
11
3.3
0.9
14
4.2
3,000-3,499
7,261
7,253
1.1
0.6
12
1.7
3,500-3,999
6,018
6,015
0.5
0.5
1.0
4,000-4,499
1,927
1,926
0.5
0.0
0.5
291
289
6.9
0.0
6.9
0.0
0.0
0.0
20,344
20,194
150
7.4
44
2.2
194
9.5
Birthweight
(g)
Total
births
Live
births
<400
44
400-499
4,500+
Unknown
Total
Figure 6: Perinatal mortality rate by birthweight, all births, South Australia, 2011
Perinatal deaths per 1,000 births

(logarithmic scale)
1000
100
10
0.1
00
<5
0-
50
0-
75
00
10
00
15
00
20
00
25
00
30
00
35
00
40
00
45
Birthweight (g)
page 44
Mothers and Babies
Table 28b: Perinatal mortality by gestational age at birth, South Australia, 2011
Stillbirths
Gestational
age at birth
(weeks)
Neonatal deaths
Number
Deaths
per 1,000
births
19
79
91
77
28-31
163
32-36
37-41
Number
Deaths
per 1,000
live births
Number
Deaths
per 1,000
births
806.1
16
842.1
95
969.4
14
153.8
10
129.9
24
263.7
153
10
61.3
0.0
10
61.3
1,524
1,497
27
17.7
10
6.7
37
24.3
18,414
18,394
20
1.1
0.4
28
1.5
54
54
0.0
0.0
0.0
20,344
20,194
150
7.4
44
2.2
194
9.5
Total
births
Live
births
<24
98
24-27
42+
Total
Perinatal deaths
The perinatal mortality rates for other specified minimum birthweights or gestational ages (where birthweight was
unavailable) are provided in Table 28c. The perinatal mortality rate recommended by the World Health Organisation
(WHO) for use in international comparison refers only to stillbirths of at least 1,000g birthweight (or, if birthweight
is unavailable, 28 weeks gestation) and to (early) neonatal deaths within the first 7 days of life. This rate was 3.5 per
1,000 births in 2011, with a stillbirth rate of 2.6 per 1,000 births and an early neonatal mortality rate of 0.6 per 1,000
live births. The perinatal mortality rate for births to Aboriginal women was 19.9 per 1,000 births in 2011 compared
with 9.2 per 1,000 births for births to non-Aboriginal women (Table 28d).
Table 28c: Perinatal mortality, South Australia, 2011 (all births of specified birthweight/gestation)
Total
births
Specified
birthweight/
gestation
Live
births
Stillbirths
Neonatal deaths
Perinatal deaths
Number
Number
Number
Deaths
per 1,000
births
400g/20 weeks*
20,300
20,190
110
5.4
41
2.0
151
7.4
500g/22 weeks
20,263
20,180
83
4.1
34
1.7
117
5.8
24
1.2
107
5.3
20,142
20,090
52
2.6
19
0.9
71
3.5
12
0.6
64
3.2
(WHO National
Statistics)
1,000g/28 weeks
(WHO International
Statistics)
Number
Deaths
per 1,000
live births
Number
Deaths
per 1,000
births
* There were 44 births of birthweight <400g

# only neonatal deaths within the first 7 days of life are included
page 45
Mothers and Babies
Table 28d: Perinatal mortality by race, all births, South Australia, 2011
Total births
Stillbirths
Neonatal deaths
Alive at 28 days
Perinatal deaths
Number
Number
Number
Number
Number
Deaths
per 1,000
births
Caucasian
16,406
111
34
16,261
145
8.8
Aboriginal
703
10
689
14
19.9
Asian
2,256
19
2,231
25
11.1
Other
979
10
969
10
10.2
Total
20,344
150
44
20,150
194
9.5
Race
29. Home births

Supplementary Birth Records were received from home birth midwives regarding planned home births for 87 women
which occurred at home in 2011. There were nine unplanned home births in South Australia in 2011 which have been
excluded from the planned home birth statistics. Seven of these nine women received antenatal care with the Midwifery
Group Practice at the Womens and Childrens Hospital or the Northern Womens Community Health Centre, private
obstetrician or an Independent Midwife. Two of these women had no antenatal care. Ascertainment of planned home
births occurring at home in South Australia for the year 2011 is estimated to be 64.4% (87 out of an estimated 135
home births). This estimate has been derived from a comparison with data from the Births, Deaths and Marriages
Registration Division on births registered, which did not occur in hospital (and were not BBAs - babies born before arrival
at the hospital into which the woman had been booked). This was considerably lower than previous years, and was
likely due to birthing women not being attended by a registered midwife or doctor, who have legislated responsibilities
to report perinatal information. In addition, 27 women who planned to birth at home were transferred to hospital care
before birth. Statistics for all 114 planned home births in 2011 are provided in Tables 29-32, by place of birth.
Table 29: Planned home births by age of women, South Australia, 2011
Birthed at home
Age (years)
Birthed in hospital
Total
Number
Number
Number
<20
1.1
3.7
1.8
20-24
10.3
11.1
12
10.5
25-29
20
23.0
11
40.7
31
27.2
30-34
35
40.2
14.8
39
34.2
35-39
16
18.4
29.6
24
21.1
40-44
6.9
0.0
5.3
Total
87
100.0
27
100.0
114
100.0
Table 30: Method of birth in planned home births, South Australia, 2011
Birthed at home
Method of birth
Birthed in hospital
Total
Number
Number
Number
84
96.6
11
40.7
95
83.3
Forceps
0.0
7.4
1.8
Assisted Breech
0.0
3.7
0.9
Elective caesarean section
0.0
12
44.4
12
10.5
Emergency caesarean section
0.0
3.7
0.9
Ventouse
3.4
0.0
2.6
87
100.0
27
100.0
114
100.0
Total
page 46
Mothers and Babies
Table 31: Birthweight distribution of planned home births, South Australia, 2011
Birthed at home
Birthweight (g)
Birthed in hospital
Total
Number
Number
Number
1,500-1,999
0.0
3.6
0.9
2,000-2,499
1.1
3.6
1.7
2,500-2,999
8.0
17.9
12
10.4
3,000-3,499
20
23.0
32.1
29
25.2
3,500-3,999
32
36.8
25.0
39
33.9
4,000-4,499
17
19.5
17.9
22
19.1
4,500+
9.2
0.0
7.0
Unknown
2.3
0.0
1.7
87
100.0
28
100.0
115
100.0
Total
Table 32: Perinatal outcome in planned home births, South Australia, 2011
Birthed at home
Perinatal outcome
Stillbirth
Total
Birthed in hospital
Total
Number
Number
Number
0.0
3.6
0.9
87
100.0
26
92.9
113
98.3
0.0
3.6
0.9
87
100.0
28
100.0
115
100.0
30. Birthing unit births

Statistics presented for births in birthing units in South Australia (Tables 33-36) relate to the birthing units at the
Womens and Childrens Hospital, the Lyell McEwin Hospital and Flinders Medical Centre. The units at the Womens and
Childrens Hospital and the Lyell McEwin Hospital were established in 1992 and 1993 respectively under the Alternative
Birthing Services Programme. In October 1996 the birthing unit at Flinders Medical Centre commenced a birthing
service. These statistics relate to all 2,448 women for whom it was reported that birthing unit was their intended
place of birth. Of these women, 1,235 gave birth in the birthing units while 1,213 women (49.6%) gave birth in labour
wards. Some of these women were transferred to labour wards because of medical or obstetric complications. With the
commencement of the Midwifery Group Practice model of care at Womens and Childrens Hospital in 2004, more of
these women who gave birth in labour wards than previously did so because the birthing unit was not available at the
time. Among the women who gave birth in labour wards, 29.8% had caesarean sections and 16.7% had instrumental
births. These statistics have also been included in the statistics for the respective hospitals. Seventy-three babies (3.0%)
were of low birthweight and there were ten perinatal deaths (perinatal mortality rate 4.1 per 1,000 births).
page 47
Mothers and Babies
Table 33: Planned birthing unit births by age of women, South Australia, 2011
Birthed in birthing unit
Age (years)
Birthed in labour ward
Total
Number
Number
Number
68
5.5
76
6.3
144
5.9
20-24
254
20.6
210
17.3
464
19.0
25-29
420
34.0
391
32.2
811
33.1
30-34
324
26.2
347
28.6
671
27.4
35-39
138
11.2
148
12.2
286
11.7
40-44
31
2.5
39
3.2
70
2.9
0.0
0.2
0.1
1,235
100.0
1,213
100.0
2,448
100.0
<20
45+
Total
Table 34: Method of birth in planned birthing unit births, South Australia, 2011
Method of birth
Total
Number
Number
Number
1,190
96.4
642
52.9
1,832
74.8
12
1.0
119
9.8
131
5.4
0.1
0.3
0.2
Caesarean section (elective)
0.0
55
4.5
55
2.2
Caesarean section (emergency)
0.0
306
25.2
306
12.5
31
2.5
83
6.8
114
4.7
Breech spontaneous
0.1
0.2
0.2
Assisted breech (forceps)
0.0
0.1
0.0
1,235
100.0
1,213
100.0
2,448
100.0

Forceps
Ventouse
Total
Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2011
Birthweight (g)
<1,500
Total
Number
Number
Number
0.0
0.4
0.2
1,500-1,999
0.2
0.5
0.3
2,000-2,499
0.6
53
4.4
60
2.4
2,500-2,999
130
10.5
199
16.3
329
13.4
3,000-3,499
459
37.1
416
34.2
875
35.7
3,500-3,999
459
37.1
358
29.4
817
33.3
4,000-4,499
152
12.3
152
12.5
304
12.4
27
2.2
29
2.4
56
2.3
1,236
100.0
1,218
100.0
2,454
100.0
4,500+
Total
page 48
Mothers and Babies
Table 36: Perinatal outcome in planned birthing unit births, South Australia, 2011
Perinatal outcome
Total
Number
Number
Number
0.0
0.7
0.3
1,236
100.0
1,203
98.8
2,439
99.4
Prolonged hospitalisation (in hospital at

28 days)
0.0
0.4
0.2
Neonatal death
0.0
0.2
0.1
1,236
100.0
1,218
100.0
2,454
100.0
Stillbirth
Total
page 49
Termination of Pregnancy
III. Terminations of Pregnancy

1. Numbers and rates
There were 5,010 terminations of pregnancy notified in South Australia in 2011, 38 fewer than in 2010. There were
15.5 terminations of pregnancy per 1,000 women aged 15-44 years. Following the introduction of specific legislation
in 1970, the pregnancy termination rate rose to a peak of 13.9 in 1980, followed by a period of relative stability in
the 1980s, with another increase commencing in 1991 which reached a peak of 17.9 in 1999 (Table 37 and Figure 7).
The rate declined considerably from 17.7 in 2001 to 15.3 in 2005, since then it has remained relatively stable.
Table 37: Number* of pregnancy terminations, and rate per 1,000 women aged 15-44 years, South
Australia, 1970-2011
Year
Number
Rate
Year
Number
Rate
1970
1,440
6.0
1991
4,696
14.1
1971
2,409
9.6
1992
4,717
14.2
1972
2,692
10.6
1993
4,959
15.0
1973
2,847
11.1
1994
5,140
15.7
1974
2,867
10.9
1995
5,475
16.9
1975
3,000
11.1
1996
5,545
17.2
1976
3,289
11.9
1997
5,609
17.5
1977
3,494
12.4
1998
5,488
17.2
1978
3,895
13.6
1999
5,679
17.9
1979
3,880
13.3
2000
5,580
17.6
1980
4,081
13.9
2001
5,579
17.7
1981
4,096
13.7
2002
5,467
17.5
1982
4,061
13.4
2003
5,216
16.7
1983
4,036
13.1
2004
4,931
15.9
1984
4,091
13.1
2005
4,715
15.3
1985
4,079
12.9
2006
4,889
15.5
1986
4,327
13.5
2007
4,885
15.4
1987
4,229
13.1
2008
5,101
16.0
1988
4,263
13.0
2009
5,057
15.6
1989
4,342
13.2
2010
5,048
15.5
1990
4,463
13.4
2011
5,010
15.5
* The corrected total numbers of pregnancy terminations notified for the years 1970 to 2010 are shown in Table 37
Figure 7: Pregnancy termination rate per 1,000 women aged 15-44 years, South Australia, 1970-2011
20
16
12
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
0
Year
page 50
2. Age of women
The age distribution of women who had pregnancies terminated is shown in Table 38. Among the five- year age
groups (Table 39), the highest pregnancy termination rate was among women aged 20-24 years (26.6 per 1,000
women) followed by women aged 25-29 years (20.4 per 1,000 women). Pregnancy termination rates continue to fall
for teenage women, from 16.1 in 2010 to 15.0 per 1,000 women in 2011. The teenage pregnancy rate (including live
births, induced abortions and stillbirths) continues to decline, and in 2011 was the lowest on record for the state at
30.5 per 1,000 women aged 15-19 years compared with 31.7 in 2010. The abortion proportion (induced abortion
as a proportion of induced abortions and live births) was 0.20; it was highest among teenagers (0.49), and was also
high among women aged 20-24 years (0.34) and older women aged over 45 years (0.31). This indicated that about
49% of known teenage pregnancies were terminated. This proportion was highest for younger teenagers (0.7 for
those aged <15 years).
Table 38: Terminations of pregnancy by age, South Australia, 2011
Age (years)
Number
12
0.0
13
0.0
14
13
0.3
15
44
0.9
16
90
1.8
17
133
2.7
18
240
4.8
19
251
5.0
Subtotal (<20 years)
774
15.4
20-24
1,483
29.6
25-29
1,129
22.5
30-34
824
16.4
35-39
585
11.7
40-44
198
4.0
17
0.3
5,010
100.0
45+
Total
The distribution of pregnancy terminations and live births by age in South Australia in 2011 (Table 39 and Figure 8a)
demonstrated that the largest proportion of pregnancy terminations occurred in the age group 20-24 years while the
largest proportion of live births occurred among those 30-34 years, who had the highest fertility (live birth) rate of
121.1 per 1,000 women. Teenagers accounted for 15.4% of the termination of pregnancy and 4.0% of the live births
in South Australia in 2010. The teenage pregnancy rate continued to decline and was associated with a decline in
both the teenage birth and teenage pregnancy termination rate (Figure 8b). The teenage pregnancy rate in 2011 was
30.5 per 1,000 women aged 15-19 years, and was the lowest rate recorded since 1970.
page 51
Table 39: Termination of pregnancy and live birth rates and termination of pregnancy proportions by age,
South Australia, 2011
Number of
termination
of
pregnancy
Estimated resident
female population
August 4 2011*
Termination
of pregnancy
rate per
1,000 women
Number of
live births#
Fertility rate
per 1,000
women
Termination
of
pregnancy
+ live births
Termination
of
pregnancy
proportion
16
na
na
na
16
0.70
15-19
758
5,1684
15.0
796
15.5
1561
0.49
20-24
1,483
5,5821
26.6
2,930
52.5
4413
0.34
25-29
1,129
5,5253
20.4
6,003
108.6
7132
0.16
30-34
824
5,0502
16.3
6,275
124.3
7099
0.12
35-39
585
5,3149
11.0
3,353
63.1
3938
0.15
40-44
198
5,7092
3.8
790
14.5
1025
0.20
17
na
na
37
na
17
0.31
5,010
323501
15.5
19,883
62.4
25,201
0.20
Age
(years)
<15
45+
Total
* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2010. Canberra: ABS, 2011 (Catalogue No 3235.0).
# Terminations of pregnancy are excluded from the numbers of live births.
The termination of pregnancy and live birth rates for women aged 15-19 years include terminations and live births at younger ages, and the rates for
women aged 40-44 years include terminations and live births at older ages, while the total rates include all terminations and live births.
Figure 8a: Termination of pregnancy and live births by age, South Australia, 2011
Percentage of women
100%
80%
60%
40%
20%
0%
Abortions
n=5,010
<20
20-24
Live births
n=20,191
25-29
Abortions & Live births

n=25,201
30-34
35-39
40+
Age (years)
page 52
Figure 8b: Teenage pregnancy, termination of pregnancy and birth rates, South Australia, 1970-2011
Rate per 1,000 women aged 15-19 years
60
50
40
30
20
10
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1990
1991
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
Year
Abortion rate*
Birth rate*
Pregnancy rate*
*Abortions and births to women aged less than 15 years are included in the numerator
3. Place of residence and place where termination performed

The proportion of women who were country residents (18.6%) was similar to previous years. As in previous years,
the proportion of pregnancy terminations performed in country hospitals (1.1%) was lower relative to the proportion
of country residents having terminations, indicating that the majority of country residents have their terminations in
metropolitan hospitals (Table 40).
Table 40: Terminations by place of residence, South Australia, 2011
Residence of women
Metropolitan
Country
Total
Number
4,075
81.4
935
18.6
5,010
100.0
As in previous years, the vast majority of terminations (95.5%) were performed in metropolitan public hospitals,
including 60.9% (2,915) at the Pregnancy Advisory Centre (Table 41).
Table 41: Terminations by hospital category, South Australia, 2011
Hospital where termination performed
Metropolitan public
Country
Total
Number
4,783
95.5
170
3.4
57
1.1
5,010
100.0
Doctors in family advisory clinics in teaching hospitals and the Pregnancy Advisory Centre performed 79.4% of
the terminations. Elsewhere, obstetricians and trainee obstetricians performed 18.8%, while general practitioners
performed 1.8%.
page 53
Table 42: Terminations by category of doctor, South Australia, 2010

Category of doctor performing termination
Number
Obstetrician/gynaecologist
837
16.7
Trainee obstetrician/gynaecologist
107
2.1
3,978
79.4
88
1.8
5,010
100.0
Medical practitioner in family advisory clinic

General practitioner
Total
4. The reason for termination

The pattern of reasons for terminations of pregnancy remained similar to previous years, with 96.2% being performed
for the womans mental health (including three terminations for pre-existing psychiatric disorders), 3.3% for serious
handicap of the fetus and 0.4% for specified medical conditions. Of the 166 terminations for fetal reasons, 81 were
for chromosomal abnormalities and 81 for other fetal abnormalities detected or suspected prenatally. Four were
performed for exposure during pregnancy to drugs, which may cause fetal abnormalities (Table 43).
Table 43: Reason for termination for fetal reasons, South Australia, 2010
Reason for termination
Number
Identified chromosomal abnormality
81
48.8
Other identified fetal abnormality
81
48.8
Possibility of damage from drugs
2.4
Possibility of hereditory disease
0.0
166
100.0
Total
5. Gestation, method and complications

The majority of terminations (91.8%) were performed within the first 14 weeks of pregnancy and most frequently (in
66.7% of cases) by vacuum aspiration. There were 94 terminations performed at 20 weeks gestation or later: 52.1%
of these were performed for fetal reasons.
Tables 44a and 44b report complications by the number of termination procedures performed (5012), which included
two failed procedures.
Seventy-two complications (1.4%) of termination procedures were identified. Eighteen of these (25%) were reported
on the abortion notification form, and 54 (75%) were identified through comparison with statistics from the South
Australian hospital morbidity collection, using codes for pregnancy termination. The abortion notification form is
usually completed about the time of discharge from the hospital where the procedure has been performed, allowing
identification and notification of more immediate complications.2
The main complication reported was retained products of conception (60 cases). Of the 36 complications reported
following terminations with mifepristone +/- misoprostol, 33 (91.6%) were due to retained products.
page 54
Table 44a: Complications of termination procedures, South Australia, 2011

Number of complications
Validation
Form
% of complications
% of all termination
procedures
Haemorrhageintra-operative
1.4
0.0
Haemorrhagepost-operative
2.9
0.0
Perforation/ trauma to uterus
0.0
0.0
Hysterotomy/hysterectomy
5.8
0.1
50
10
82.6
1.2
Failed procedure
2.9
0.0
Infection
4.3
0.1
Other
0.0
0.0
Total
54
18
100.0
1.4
Complication
Retained products of conception
Table 44b: Complications by method of termination procedure, South Australia, 2011

Number* of women with
complications
% of termination
procedure with
complications by
method
Validation
Form
Total
Number of
termination
procedures
10
15
3,073
0.5
Dilatation and curettage
360
2.2
Hysterotomy
66.7
Dilatation and evacuation
396
0.0
Cervagem
41
14.6
Misoprostol Cervagem
39
12.8
33
36
1,085
3.3
Other
15
0.0
Total
54
18
72
5,012
1.4
Method of termination
Vacuum aspiration
Mifepristone +/- Misoprostol
page 55
6. Previous terminations. Total termination of pregnancy rate and total first

termination of pregnancy rate
Of the 5,010 women who had terminations, 1,898 (37.9%) had undergone a previous termination (Table 13a).
Among the teenagers 14.8% had a previous termination; 34.1% of women aged 20-24 years and 49.2% of women
aged 30-34 years had undergone a previous termination.
The total induced abortion rate (TAR) is the sum of pregnancy termination rates for each of the five-year age groups
multiplied by five. This can be calculated using the rates in Table 2 and in 2011 was 465.5 per 1,000 women aged
15-44. This represents the number of induced abortions 1,000 women would have during their lifetime if they
experienced the induced abortion rates of the different age groups for 2011.
A woman may have more than one termination of pregnancy in her lifetime, and to estimate how prevalent
termination of pregnancy is at these age-specific induced abortion rates, a total first induced abortion rate (TFAR,
Table 13c) may be calculated after excluding women with repeat terminations. The TFAR for 2011 was 289.2 per
1,000 women aged 15-44 years. This suggests that 28.9% of women would have a termination of pregnancy in their
lifetime if they experienced the termination of pregnancy rates of the different age groups for 2011.
Table 45a: Women with previous terminations by age, South Australia, 2011
Age (years)
Number
% of age group
% of all terminations
0.0
0.0
15 - 19
112
14.8
2.2
20 - 24
506
34.1
10.1
25 - 29
512
45.3
10.2
30 - 34
405
49.2
8.1
35 - 39
268
45.8
5.3
95
44.2
1.9
1,898
37.9
37.9
< 15
40+
Total
Further details of termination of pregnancy in South Australia in 2011 may be obtained from the Eighth Annual
Report of the South Australian Termination of pregnancy Reporting Committee for the year 2011.6
Table 45b: Calculation of total induced abortion rate (TAR) for 2010 for South Australia*
Age
(years)
Number of women who had

terminations
Estimated female resident

population 4th August 2011
Termination of pregnancy rate

per 1,000 women
15-19*
774
51,684
15.0*
20-24
1,483
55,821
26.6
25-29
1,129
55,253
20.4
30-34
824
50,502
16.3
35-39
585
53,149
11.0
40-44*
215
57,092
3.8
5,010
323,501
na
Total
* In these calculations, termination of pregnancy for women under 15 years are included in the age group 15-19 yrs and termination of pregnancy for
women aged 45 years or more are included in the age group 40-44 years, as is traditional.
Total induced abortion rate (TAR) = sum of termination of pregnancy rates for 5-year age groups x 5 = 93.1 x 5 = 465.3 per 1,000 women aged 15-44 years.
page 56
Obstetric Profiles by Hospital Category
Table 45c: Calculation of total first induced abortion rate (TFAR) for 2011 for South Australia
Number of
women who had
terminations (A)
Number of women
who had previous
terminations (B)
Number of women
who had first
termination (A) (B)
Estimated
female resident
population
30 June 2011*
First termination
of pregnancy rate
per 1,000 women
15-19
774
112
662
51,684
12.8
20-24
1,483
506
977
55,821
17.5
25-29
1,129
512
617
55,253
11.2
30-34
824
405
419
50,502
8.3
35-39
585
268
317
53,149
6.0
40-44
215
95
120
57,092
2.1
Total
5,010
1,898
3,112
323,501
9.6
Age
(years)
* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 30 June 2011. Canberra: ABS, 2011 (Catalogue No 3235.0).
In these calculations, termination of pregnancy for women under 15 years are included in the age group 15-19 yrs and termination of pregnancy for
women aged 45 years or more are included in the age group 40-44 years.
Total first induced abortion rate (TFAR) = sum of first termination of pregnancy rates for 5-year age groups x 5 = 57.8 x 5 = 289.2 per 1,000 women
aged 15-44 yrs.
page 57
IV. Obstetric Profiles By Hospital Category

Obstetric profiles for the three major metropolitan public hospitals and three hospital categories for 2011 are provided
in Table 46 and Figures 9-28. They were also reported for hospital categories and individual hospitals in the Pregnancy
and Neonatal Care Bulletins.
These hospital categories as determined by their Perinatal Service Delineation are:
1. The Womens & Childrens Hospital,
2. Flinders Medical Centre, (both the Womens and Childrens Hospital and Flinders Medical Centre have neonatal
intensive care facilities)
3. The Lyell McEwin Hospital,
4. Metropolitan private hospitals,
5. The two Level 4:4 country hospitals (Mount Gambier and Port Augusta) and
6. Other country hospitals (Perinatal Service Delineation of 3:3).
Eight mothers who gave birth at Modbury Hospital, the Queen Elizabeth Hospital and Noarlunga Health Service have
been excluded from these hospital category statistics.
A list of maternal and baby factors identified either as risk factors for poor perinatal outcome in earlier analyses,7 or
of general interest, is provided with means for all state hospital births as well as proportions for the six hospital
categories.
The mean is the proportion for women who gave birth in all state hospitals (for maternal factors) or births in all
state hospitals (for baby factors),
e.g. % Aboriginal women
Number of Aboriginal women who gave birth in state hospitals
Total number of women who gave birth in state hospitals
x100
Where indicated (+) in Table 46, it is the mean (number of women who gave birth, or births) for the 23 hospitals
or groups of hospitals for which obstetric profiles have been provided, and which have also been included in the
provision of the 10th and 90th percentile values. These are as follows:
1.
Womens & Childrens Hospital
2.
Flinders Medical Centre
3.
Lyell McEwin Hospital
4.
Ashford Hospital
5.
Burnside War Memorial Hospital Inc
6.
Calvary Healthcare Adelaide
7.
Flinders Private Hospital
8.
North Eastern Community Hospital
9.
Mount Gambier & District Health Service Inc
10.
Port Augusta Hospital & Regional Health Service Inc
11.
Barossa Health (Tanunda Centre)
12.
Gawler Health Service
13.
Lower North Health Centre (Clare)
14.
Mount Barker District Soldiers Memorial Hospital Inc
15.
Murray Bridge Soldiers Memorial Hospital Inc
page 58
16.
Naracoorte Health Service Inc
17.
Northern Yorke Peninsula Regional Health Service (Wallaroo)
18.
Port Lincoln Health Service Inc
19.
Port Pirie Regional Health Service Inc
20.
Riverland Regional Health Service (Berri)
21
South Coast District Hospital Inc (Victor Harbor)
22.
The Whyalla Hospital & Health Services Inc
23.
Country hospitals with <100 births per year
The 10th percentile is the proportion below which 10% of the 23 hospital proportions, ie the two lowest hospital
proportions, would be found if the 23 proportions were ranked from highest to lowest. The 90th percentile is the
proportion above which 10% of the 23 hospital proportions, ie the two highest proportions, would be found if the
23 proportions were ranked from highest to lowest. As the two Level III hospitals which account for 40.0% of hospital
births have proportions of some factors (such as prolonged hospitalisation and use of neonatal intensive care) which
are much greater than for the other 21 hospitals, occasionally the mean for all hospitals will be seen to be higher than
the 90th percentile.
The table and figures provide obstetric profiles for the three major metropolitan public hospitals and three hospital
categories. These have been provided since 1986 to hospitals with 100 or more births per year, together with their
individual hospital profiles, including crude and standardized perinatal mortality ratios,8 the latter with exclusion of
perinatal deaths from congenital abnormalities3 and terminations of pregnancy. For country hospitals with less than
100 births per year, a group report has been provided.
Each hospitals statistics for each factor may be compared with those for state hospitals and for categories of
hospitals, eg whether a hospitals proportion for any factor falls within the range of the more common proportions
prevailing in hospitals in the state (ie between the 10th and the 90th percentiles).
page 59
Table 46: Obstetric profiles by hospital category, South Australia, 2011: live births and stillbirths of >=400g
or >=20 weeks gestation#
All state hospitals
Metropolitan hospitals
Country hospitals
Mean
10th
percentile
90th
percentile
W&CH
FMC
LMH
Private
Level
4:4
Other
867+
133
1188
4,892
2,961
3,256
4,840
885
3,105
% Aboriginal women
3.5
0.2
9.4
4.1
2.6
3.6
0.3
13.8
5.0
% Antenatal visits <7*
9.0
0.8
13.5
13.6
14.2
13.5
0.8
8.7
4.9
% Teenage women
4.0
0.3
7.6
3.5
4.7
7.6
0.2
9.0
5.1
% Women 35 years
20.5
10.4
31.5
21.7
18.1
13.7
31.3
12.5
13.7
% Single women
10.2
2.3
15.3
15.1
10.5
13.0
2.5
11.6
10.9
% 4+ prior live births
3.0
0.4
6.8
3.2
2.7
5.5
0.5
5.6
3.5
% 1+ prior perinatal
deaths
1.4
0.4
2.6
1.8
1.4
1.7
0.7
1.5
1.3
% Obstetric complications
36.4
18.8
42.4
42.4
49.7
39.3
28.3
37.4
23.5
% Labour complications
37.4
21.5
48.7
48.8
48.7
36.6
26.3
30.5
29.2
% Induction
31.3
22.6
35.1
34.5
29.0
27.6
33.9
33.9
27.7
% Emergency caesarean
17.4
9.8
21.5
17.7
21.4
16.3
17.4
13.7
15.2
% Elective caesarean
15.9
10.7
25.5
11.7
16.5
12.6
25.0
12.9
12.2
% Total caesarean
33.3
20.9
40.6
29.4
38.0
28.9
42.5
26.6
27.4
% Ultrasound
examination*
99.5
98.9
100.0
99.4
99.5
99.6
99.8
99.2
99.5
3.7
0.8
5.3
5.3
2.5
2.9
4.9
1.9
1.6
% Episiotomy
12.4
3.1
17.3
14.1
9.3
12.1
16.4
7.7
7.9
% Repair of perineal tear
27.4
18.6
33.4
33.4
25.2
22.5
27.9
23.7
25.4
% Epidural analgesia
31.9
9.2
45.9
38.0
25.4
25.8
43.1
23.3
19.9
% Spinal analgesia
0.8
0.2
1.4
0.2
0.6
1.2
0.9
0.6
1.4
% Private patients
29.1
1.8
100.0
8.3
1.2
1.8
100.0
17.6
10.0
% Primiparous women
42.8
33.1
46.8
46.8
45.0
38.6
45.0
39.4
36.0
% Previous caesarean
17.4
12.1
21.8
15.3
17.9
16.0
21.8
16.4
15.4
% PPH
12.0
4.0
13.6
19.9
13.6
11.7
5.1
9.5
9.9
880+
133
3,014
5,013
3,014
3,292
4,923
890
3,108
% Birthweight <2,500g
7.5
1.2
6.5
12.9
9.5
7.6
4.2
7.2
2.1
% Gestational age <37

weeks at birth
9.2
1.2
9.5
14.3
11.8
9.6
6.5
10.1
2.2
% Prolonged
hospitalisation (>27 days)
2.2
0.0
1.1
4.4
4.6
0.6
0.7
1.1
0.3
% Neonatal intensive
care (Level III or W&CH
paediatric intensive care)
2.7
0.3
1.4
5.5
5.3
1.1
0.9
1.6
0.7
% Birth defect
3.0
0.4
2.5
4.9
3.4
3.2
1.8
2.2
1.2
Factors
Maternal factors
Women (n=19,939)
% Amniocentesis*
Baby factors
Births (n=20,240)
* adjusted for missing values

+ mean number of women who gave birth, or mean number of births for the 23 hospitals or groups of hospitals
# 8 mothers who gave birth at the TQEH, Modbury hospital and Noarlunga Health Service have been excluded from this table
page 60
Percentage
Figure 9: Percentage of Aboriginal women by hospital category

16
14
12
10
8
6
4
2
0
90th percentile
Mean
10th percentile
Hospital category
Percentage
Figure 10: Percentage of women with <7 antenatal visits by hospital category
14
12
90th percentile
10
8
Mean
6
4
2
0
10th percentile
Hospital category
Figure 11: Percentage of teenage women by hospital category
10
Percentage
90th percentile
6
Mean
4
2
10th percentile
0
1
Hospital category
Percentage
Figure 12: Percentage of women 35 years or more by hospital category

35
30
25
20
15
10
5
0
90th percentile
Mean
10th percentile
Hospital category
page 61
Percentage
Figure 13: Percentage of single women by hospital category

18
16
14
12
10
90th percentile
Mean
8
6
4
10th percentile
2
0
1
Hospital category
Percentage
Figure 14: Percentage of women with 4 or more prior livebirths by hospital category
8
7
6
5
4
3
2
1
0
90th percentile
Mean
10th percentile
Hospital category
Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category
3
90th percentile
Percentage
2.5
2
1.5
Mean
1
0.5
10th percentile
0
1
Hospital category
page 62
Figure 16: Percentage of women with obstetric complications by hospital category

50
90th percentile
Mean
Percentage
40
30
20
10th percentile
10
0
1
Hospital category
Figure 17: Percentage of women with complications during labour or birth by hospital category
60
Percentage
50
90th percentile
40
Mean
30
10th percentile
20
10
0
1
Hospital category
Figure 18: Percentage of women with induction of labour by hospital category

40
Percentage
90th percentile
30
Mean
20
10th percentile
10
0
1
Hospital category
page 63
Figure 19: Percentage of women having epidural analgesia by hospital category

50
90th percentile
Percentage
40
Mean
30
20
10
10th percentile
0
1
Hospital category
Figure 20: Percentage of breech births by hospital category
0.8
Percentage
90th percentile
0.6
0.4
Mean
0.2
10th percentile
0
1
Hospital category
Figure 21: Percentage of emergency caesarean sections by hospital category
Percentage
25
90th percentile
20
Mean
15
10th percentile
10
5
0
1
Hospital category
Figure 22: Percentage of elective caesarean sections by hospital category

30
90th percentile
Percentage
25
20
15
Mean
10
10th percentile
5
0
1
Hospital category
page 64
Percentage
Figure 23: Percentage of total caesarean sections by hospital category
45
40
35
30
25
20
15
10
5
0
90th percentile
Mean
10th percentile
Hospital category
Percentage
Figure 24: Percentage of births with birthweight below 2,500g by hospital category
14
12
10
8
6
4
2
0
90th percentile
Mean
10th percentile
Hospital category
Percentage
Figure 25: Percentage of births with gestation less than 37 weeks by hospital category
16
14
12
10
8
6
4
2
0
90th percentile
Mean
10th percentile
Hospital category
page 65
Figure 26: Percentage of births with prolonged hospitalisation by hospital category
Percentage
5
4
3
Mean
90th percentile
2
1
10th percentile
0
1
Hospital category
Figure 27: Percentage of live births requiring neonatal intensive care by hospital category
6
Percentage
5
4
3
Mean
90th percentile
10th percentile
0
1
Hospital category
Figure 28: Percentage of births with birth defects by hospital category

6
Percentage
5
4
90th percentile
Mean
3
2
1
10th percentile
0
1
Hospital category
page 66
Clinical and Maternity Performance Indicators
V. Clinical and Maternity Performance Indicators

1. Clinical indicators
These clinical indicators were selected from The Australian Council on Healthcare Standards (ACHS) Clinical Indicator
Users Manual Version 2010. They were also reported for hospital categories and individual hospitals in the Pregnancy
and Neonatal Care Bulletin 2011.
Some data informing these clinical indicators were not collected on the Supplementary Birth Record and the indicator
is not able to be calculated.
For the purpose of Indicators 1.1 1.4; 3.1 - 3.6 selected primipara was defined as:
>> a woman who was 20-34 years of age at the time of giving birth
>> giving birth for the first time at 20 weeks of gestation
>> singleton pregnancy
>> cephalic presentation
>> at 370 to 410 weeks gestation.
Indicator 1: Outcome of selected primiparae

Rationale:
The selected primiparae represented an uncomplicated pregnancy whereby intervention and

complication rates should be low and consistent across hospitals. Use of the selected primiparae
(rather than all women giving birth) as the basis for inter-hospital comparison of maternity care
controlled for differences in case mix and increased the validity of those comparisons.
For the purpose of Indicators 1.1 1.4 the denominator was total number of selected primiparae who gave birth. (n=5,886)
>> Clinical indicator 1.1: Total number of selected primiparae who had a spontaneous vaginal birth.
Clinical indicator 1.1 =
2,776 x 100
5,886
= 47.2% (95%CI 45.9%-48.4%).
>> Clinical indicator 1.2: Total number of selected primiparae who underwent induction of labour.
2,384 x 100
5,886
= 40.5% (95%CI 39.3%-41.8%).
>> Clinical indicator 1.3: Total number of selected primiparae who underwent an instrumental vaginal birth
which was defined by the use of forceps or vacuum extraction.
1,411 x 100
5,886
= 24.0% (95%CI 22.9%-25.1%).
>> Clinical indicator 1.4: Total number of selected primiparae undergoing caesarean section.
1,699 x 100
5,886
= 28.9% (95%CI 27.7%-30.0%).
page 67
Indicator 2: Vaginal birth following caesarean section (VBAC)

Rationale:
This indicator related to those women giving birth vaginally following a previous primary (first)
caesarean section and having NO intervening pregnancies greater than 20 weeks gestation.
>> Clinical indicator 2.1: Rate of vaginal birth following primary caesarean section
Numerator:
Total number of women giving birth vaginally following a previous primary caesarean section.
(n=409).
Denominator:
Total number of women giving birth who have had a previous primary caesarean section and NO
intervening pregnancies greater than 20 weeks gestation. (n=2,420).
Clinical indicator 2.1 = 409 x 100 = 16.9% (95%CI 15.5%-18.4%).

2,420
Indicator 3: Major perineal tears & surgical repair of the perineum selected primiparae with an intact
perineum
Rationale:
This indicator has been included because a high incidence of an intact perineum is considered a
desirable outcome.
>> Clinical indicator 3.1: Total number of selected primiparae who gave birth vaginally and had an intact perineum
Numerator:
Total number of selected primiparae with an intact perineum. (n=368)
Denominator:
Total number of selected primiparae giving birth vaginally. (n=4,187)
Indicator 4:
Rationale:
368 x 100
4,187
= 8.8% (95% CI 8.0%-9.7%).
General anaesthesia for caesarean section

This indicator monitored the number of women who had a caesarean section performed under
general anaesthesia. General anaesthetic included women undergoing a primary general
anaesthetic and included conversions from regional to general anaesthetic where intubation was
required to control the airway.
>> Clinical indicator 4.1: General anaesthesia for caesarean section

Numerator:
Total number of women having a general anaesthetic for a caesarean section (n=444).
Denominator:
Total number of women having a caesarean section (n=6,646).
Clinical indicator 4.1 = 444 x 100 = 6.7% (95% CI 6.1%-7.3%).

6,646
Indicator 5: Antibiotic prophylaxis & caesarean section
Antibiotic prophylaxis was not collected on the Supplementary Birth Record and this indicator was not able to be
calculated.
Indicator 6: Pharmacological thromboprophylaxis & caesarean section

Pharmacological thromboprophylaxis was not collected on the Supplementary Birth Record and this indicator was not
able to be calculated.
page 68
Indicator 7: Postpartum haemorrhage / blood transfusion

Rationale:
Postpartum haemorrhage (PPH) is a potentially life threatening complication of birth that occurs
in about 3-5% of vaginal births. The condition remains a leading cause of maternal morbidity
and mortality.
Blood transfusion is required following massive blood loss of equal to/or more than 1000mL or in
response to a postpartum haemoglobin level of less than 80g/L.
*Blood transfusion was not collected on the Supplementary Birth Record and this indicator was
calculated from reports of postpartum haemorrhage equal to/or more than 1000mL .
>> Clinical indicator 7.1*: Incidence of postpartum haemorrhage 1000mL (Vaginal Births).
Numerator:
Total number of women who give birth vaginally who were reported to experience a postpartum
haemorrhage of 1000mL or more (n=478).
Denominator:
Total number of women who give birth vaginally (n=13,397).
478 x 100
13,397
= 3.6% (95% CI 3.3%-3.9%).
>> Clinical indicator 7.2*: Incidence of postpartum haemorrhage 1000mL. (LSCS)

Numerator:
Total number of women who give birth by caesarean section who were reported to experience a
postpartum haemorrhage of 1000mL or more (n=409).
Denominator:
Total number of women who give birth by caesarean section (n=6,646).
409 x 100
6,646
= 6.2% (95% CI 5.6%-6.8%).
Indicator 8: Intrauterine growth restriction (IUGR)

Rationale:
Profound IUGR is a major cause of perinatal mortality and morbidity with mortality increasing
with IUGR in late pregnancy. This indicator aimed to identify undiagnosed IUGR for babies born at
term.
>> Clinical indicator 8.1: Incidence of IUGR at 40 weeks gestation.

Numerator:
Total number of births with birth weight less than 2750g at 40 weeks gestation or beyond
(n=133).
Denominator:
The total number of babies born at 400 weeks gestation or beyond (n=7,784).
133 x 100
= 1.7% (95%CI 1.4%-2.0%).
7,784
Indicator 9: Apgar score

Rationale:
This indicator has been included as a measure of the outcome of labour, with particular emphasis
on the assessment of baby well-being.
>> Clinical indicator 9.1: Apgar score of 6 or below at five minutes after birth among all babies except
antepartum fetal deaths
Numerator:
The number of babies born with an Apgar score of 6 or below at five minutes post birth (n=324).
Denominator:
The total number of babies born (excluding fetal deaths in utero diagnosed prior to
commencement of labour) (n=20,268).
Clinical indicator 9.1 = 324 x 100 = 1.6%

20,268
(95%CI 1.4%-1.8%).
page 69
Indicator 10: Term babies transferred or admitted to a neonatal Intensive Care Unit for reasons other
than congenital abnormality
Rationale:
This indicator has been included as an index of the overall management of labour in terms of
outcome.
>> Clinical indicator 10.1: Term babies transferred or admitted to a neonatal intensive care unit for reasons
other than congenital abnormality
Numerator:
The number of term babies (37 weeks gestation or later) transferred/admitted to a neonatal
intensive care unit for reasons other than congenital abnormality (n=87).
Denominator:
The total number of term live babies born (n=18,448).
87 x 100
= 0.5%
18,448
(95%CI 0.4%-0.6%).
2. Maternity performance indicators, hospitals with at least 500 births per year
Six clinical indicators are presented. Five are selected from The Australian Council on Healthcare Standards (ACHS
Clinical Indicator Users Manual Version 2010) and are presented for hospitals with at least 500 births per year.
Additionally, the sixth indicator presents the standardized perinatal mortality ratio.
These six indicators are as follows:
1. Proportion of selected primiparae who underwent induction of labour
This was as defined for Clinical indicator 1.2 and was 40.5% for the state in 2011 (and 40.6% for state hospitals) in
2011.
2. Caesarean section rate for selected primiparae
This was as defined for Clinical indicator 1.4 and was 28.9% for the state (as well as state hospitals) for 2011.
3. VBAC: proportion of women who gave birth vaginally following a previous primary (first) caesarean
section and no intervening births.
This was as defined for Clinical indicator 2.1 and was 16.9% for the state (as well as for state hospitals) for 2011.
4. Proportion of selected primiparae with an intact perineum following vaginal birth.
This was as defined for Clinical indicator 3.1 and was 8.8% for the state in 2011 (and 8.7% for state hospitals) in
2011.
5. TERM NICU: proportion of term babies admitted to neonatal intensive care (NICU) for reasons other than
congenital abnormality.
This was as defined for Clinical indicator 10.1 and was 0.5% for the state (as well as for state hospitals) for 2011.
6. SPMR: Standardized perinatal mortality ratio for all births.
This is as defined8 in the Pregnancy and Neonatal Care Bulletin 2011. It adjusts for the difference between the
distribution of births by birthweight between the hospital and state hospital births. As perinatal mortality is much
higher in babies of low birthweight, this adjustment ensures that a hospital is directly comparable with other
hospitals and state hospitals as a whole if it has a higher proportion of low birthweight babies than state hospital
births.
SPMR =
page 70
Observed number of deaths

Expected number of deaths
X 100
To obtain the expected number of deaths for a hospital, the state hospital perinatal mortality rate for 2011 for each
of the birthweight groups in Table 28a is applied to the number of births in each corresponding birthweight group for
the hospital. This gives an expected number of deaths in each birthweight group. These expected deaths are then
totalled to give a total number of expected deaths for the hospital.
SPMRs provided in this report exclude deaths attributed to congenital abnormalities (as determined by the Maternal,
Perinatal and Infant Mortality Committee3), which are the least preventable, as well as terminations of pregnancy.
An SPMR above 100 means that after adjustment for birthweight differences and deaths attributed to congenital
abnormalities and terminations of pregnancy, perinatal mortality for that hospital is higher than that for state hospital
births eg an adjusted SPMR of 120 means that it is 20% higher.
A 95% confidence interval (CI) which includes the value 100 in its range means that the hospitals perinatal mortality
is not (statistically) significantly different from that for state hospital births for 2008. The SPMRs and 95%CIs for
individual hospitals and categories of hospitals have been programmed using indirect standardization methods.11
Statistics for the six maternity performance indicators for 2011 are provided in Figures 29A 29F for the ten hospitals,
A J, with at least 500 births in 2011. SPMRs for the preceding five years combined, 2007-2011, are provided in
Figure 29G. Metropolitan teaching hospitals and Mount Gambier Hospital have been named with their permission
and are as follows:
A. Womens and Childrens
B. Flinders Medical Centre
C. Lyell McEwin Hospital
D. Mt Gambier Hospital
None of the elevations in the SPMR for the individual hospitals for 2011 or for the last five-year period 2007-2011 (Fig
29G) was statistically significant.
Figure 29a: Induction of labour proportion for selected primiparae, SA hospitals with >=500 births per year, 2011
50
40
30
20
10
0
A
Hospital
Induction of labour %
*SA hospitals = 40.6%
page 71
Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with >=500 births per year, 2011
60
50
%
40
30
20
10
0
A
Hospital
Caesarean section %
Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first)
caesarean section & no intervening births, SA hospitals with >=500 births per year, 2011
40
30
20
10
0
A
Hospital
VBAC %
Figure 29d: Proportion of selected primiparae with an intact perineum after a vaginal birth, SA hospitals
with >=500 births per year, 2011
40
30
20
10
0
A
Hospital
Primip no repair %
*SA Hospitals = 8.7%
page 72
Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital
abnormality, SA hospitals with >=500 births per year, 2011
1.2
1
%
0.8
0.6
0.4
0.2
0
A
Hospital
Term NICU %
Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births per
year, 2011
300
250
200
150
100
50
0
A
Hospital
SPMR
*SA hospitals
Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births per
year, 2007-2011
200
150
100
50
0
A
Hospital
SPMR
*SA hospitals
page 73
VI. Trends in Perinatal Statistics in South Australia, 1981-2010

Perinatal statistics are presented in Tables 47 and 48 for both socio-demographic and obstetric aspects for each
year from 2001-2011, as well as for 1981, when the perinatal data collection was commenced. Some features are
illustrated in Fig 30.1 30.8 for the years 1985-2011. The trends noted between 1981 and 2011 are as follows:
1 The total fertility rate was 1.89 live births per woman, following a steady increase from 1.71 in 2000 to 1.91 live
births per woman in 2008 and 2009.
2 The increase in the proportion of Asian women from 1.8% in 1981 to 11.1% in 2011 and of Aboriginal women
from 1.5% in 1981 to 3.5% in 2011.
3 The decrease in the proportion of teenage women giving birth from 7.8% in 1981 to 4.0% in 2011. Over the
past decade, there has been a general decline in both the teenage birth and abortion rate. The teenage pregnancy
rate in 2011 of 30.6 per 1,000 women was the lowest recorded since 1970, when abortion statistics were first
collected, enabling calculation of a pregnancy rate.
4 The increase in the age of women giving birth. The proportion of women who gave birth who were 35 years or
older increased from 4.6% in 1981 to 20.6% in 2011, following a peak of 21.1% in 2008 and 2009. Amongst
primiparous women the proportion in 1981 was 1.2%, and in 2011 12.0%. (It was 12.8% in 2009). The mean
age among women giving birth increased from 26.55 years to 30.14 years in 2010, and in 2011 it was 29.69
years. The mean age among primiparous women went from 24.42 years to 28.34 years in 2010, with this figure
being 27.92 years in 2011.
5 The proportion of single women giving birth peaked in 1996 at 14.9%, since which time there has been a gradual
decrease to 10.2% in 2011, which is the lowest in the past two decades.
6 In the last decade, the proportion of births in country hospitals, especially in small country hospitals, has gradually
declined from 24.9% in 1997 to 19.3% in 2010 and 19.7% in 2011. The proportion of births in teaching
hospitals peaked in 2000 at 54.6%, and following a low of 49.6% in 2000, has gradually increased to 54.3 in
2010, with it being at its highest in 2011 with 55.7%. In 2011 metropolitan private hospitals accounted for
24.2% of births. The number of births in birthing units in teaching hospitals increased from 125 (0.6%) in 1992
to 1,235(6.1%) in 2011. Home births increased from 44 (0.2%) in 1997 to 144 (0.7%) in 2010, but in 2011 only
87 (64.4%) out of an estimated 135 home births were reported to the Unit. There was a decrease in the reporting
of homebirths in 2011and was likely to be due to birthing women not being attended by a registered midwife or
doctor, who have legislated responsibilities to report perinatal information.
7 The increase in the proportion of multiple births, related to assisted conception pregnancies, and the older age of
women, from 2.0% in 1981 to a peak of 3.6% in 2002 and 2003. After that the proportion declined to 3.0% in
2008 and 2009, but rose to 3.3% in 2010. In 2011 this proportion was 2.9%.
8 The induction rate increased from 22.1% in 1981 to 29.3% in 2002, after which it declined slightly. It was 32.2%
in 2011. Fifty percent of inductions in 2011 were performed for other than defined indications.
9 The fall in the proportion of normal spontaneous vaginal births (from 66.1% in 1981 to 54.7% in 2011, but
stable for the last five years), breech births (from 1.1% to 0.5%) and forceps births (from 15.2% to 5.7%). The
proportion delivered by ventouse increased from 0.7% to 6.9% in 2010, decreasing to 5.9% in 2011, and by
caesarean section, from 16.9% in 1981 to 33.2% in 2010. The caesarean section rate has been relatively stable
for the last five years.
10 The gradual increase in the proportion of low birthweight births from 5.8% in 1981 to a peak of 7.6% in 2005.
This proportion has been around 7.0% in the last five years (7.5% in 2011). The proportion of preterm births also
increased from 5.5% in 1981 to 9.2% in 2011.
11 The proportion of births with congenital abnormalities identified before discharge from hospital after birth has
been relatively stable at 2.3%-2.8% during the last decade (2.7% in 2008 and 2009). In 2011 it was 3.0%.
12 The increase in the proportion of babies utilising Level II care from 6.7% in 1982 to 16.6% in 2002 and 2003,
followed by a decline to 15.3% in 2009. In 2011this proportion was 16.2%.
13 The proportion of babies utilising neonatal intensive care has decreased from 3.0% in 2000 to 2.6% in 2011,
while the proportion using paediatric intensive care remained at 0.2%-0.3%. The proportion in hospital at 28 days
has been between 2.0% and 2.5% (2.2% in 2011).
page 74
Trends in Perinatal Statistics in South Australia
14 The considerable fall in the perinatal mortality rate, despite the increasing proportion of preterm births. The perinatal
mortality rate for national statistics (for babies of at least 500g birthweight or 22 weeks gestation if birthweight
unavailable) has fallen from 11.6 in 1981 to 5.3 per 1,000 births in 2011, while the rate for international statistics
(for births of 1,000g or 28 weeks if birthweight unavailable) has fallen from 7.2 to 3.5 per 1,000 births during the
same period. The fall in this neonatal mortality rate (for early neonatal deaths) has been particularly outstanding,
reaching 0.6 per 1000 live births in 2007 and 2008, the lowest recorded in the state. This figure was 1.2 per 1,000
livebirths in 2011. The fall in perinatal mortality is reflected in the standardized perinatal mortality ratio which has
been calculated in Table 48 for each year utilising perinatal mortality rates for 500g birthweight groups for the years
1981-1989 combined as the standard. It was 52.8 in 2011 compared with 117.6 in 1981.
Table 47: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 2002 2011
Year
Characteristic
1981
2002
2003
2004
2005
2006
2007
1 Total births
19,052
17,745
17,844
17,522
18,196
18,803
2 Live births
18,905
17,623
17,710
17,409
18,067
3 Women who gave

birth
18,857
17,421
17,517
17,229
4 Total fertility rate

per woman
1.75
1.73
1.75
Teaching hospital
52.2%
49.6%
Private hospital
19.7%
Country hospital
2008
2009
2010
2011
19,757
19,970 19,901
20,002
20,344
18,663
19,624
19,819 19,761
19,883
20,194
17,897
18,519
19,471
19,672 19,604
19,667
20,043
1.74
1.82
1.82
1.91
1.87
1.84
1.89
50.6%
49.9%
51.6%
52.1%
52.6%
53.2% 53.7%
54.3%
55.5%
27.9%
28.1%
27.2%
26.5%
26.7%
26.6%
26.5% 25.7%
25.6%
24.1%
27.8%
22.2%
21.3%
22.5%
21.6%
20.8%
20.2%
20.3% 19.9%
19.3%
19.9%
0.3%
0.3%
0.3%
0.4%
0.3%
0.5%
0.5%
0.5%
0.7%
0.7%
0.5%
(65)
(48)
(60)
(67)
(63)
(87)
(107)
(101)
(134)
(144)
(96)
Aboriginal
1.5%
2.5%
2.7%
2.8%
2.7%
3.0%
3.0%
3.2%
3.1%
3.2%
3.5%
(Women who gave

birth)
(277)
(445)
(468)
(484)
(487)
(548)
(578)
(624)
(607)
(625)
(693)
(Births)
(280)
(452)
(473)
(491)
(492)
(559)
(590)
(637)
(618)
(630)
(703)
Asian
1.8%
4.8%
4.7%
4.8%
5.3%
5.1%
6.2%
7.0%
8.1%
9.6%
11.1%
Mean age (years)
26.55
29.62
29.77
29.81
29.86
30.01
30.05
30.11
30.14
30.14
29.69
Teenage (%)
7.8%
5.6%
5.4%
5.3%
5.2%
4.8%
4.6%
4.5%
4.1%
4.0%
4.0%
35 years (%)
4.6%
17.0%
17.6%
17.9%
18.7%
20.4%
20.2%
21.1% 21.1%
20.5%
20.6%
Never married
7.6%
12.3%
11.9%
11.8%
12.5%
11.7%
11.0%
10.7% 10.0%
9.6%
9.2%
Widowed/divorced/
separated (%)
2.0%
1.6%
1.5%
1.3%
1.3%
1.3%
1.4%
1.3%
1.0%
1.91
5 Place of birth (%)
Domiciliary*
6 Race (%)
7 Age
8 Marital status (%)
(Single)
1.2%
1.2%
(9.6%) (13.9%) (13.3%) (13.0%) (13.8%) (13.0%) (12.5%) (11.9%) (11.2%) (10.9%) (10.2%)
9 Primiparae
Mean age (years)
Teenage
35 years
24.42
27.77
27.91
28.13
28.02
28.20
28.30
28.24
28.27
28.34
27.92
15.4%
11.3%
10.9%
10.0%
10.1%
9.5%
8.9%
8.8%
8.4%
7.8%
7.8%
1.2%
9.9%
10.6%
11.0%
11.4%
12.6%
12.5%
12.7% 12.8%
12.2%
12.0%
* includes unplanned home births
page 75
Table 48: Obstetric aspects of perinatal statistics, South Australia, 1981 and 2002 2011
Year
Characteristic
1981
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Multiple births (%)
2.0%
3.6%
3.6%
3.3%
3.3%
3.0%
2.9%
3.0%
3.0%
3.3%
2.9%
Twins
(363)
(632)
(626)
(578)
(570)
(552)
(544)
(592)
(578)
(644)
(586)
(21)
(12)
(21)
(6)
(21)
(12)
(21)
(3)
(12)
(15)
(12)
(0)
(0)
(0)
(0)
(0)
(0)
(0)
(0)
(0)
(4)
(0)
22.1%
29.3%
29.0%
27.9%
28.3%
28.9%
29.8%
28.6%
29.4%
29.6%
31.2%
66.1%
58.7%
57.8%
55.9%
55.8%
56.0%
56.0%
56.0%
55.4%
55.2%
54.7%
Elective caesarean
8.2%
12.6%
13.3%
14.0%
14.6%
15.5%
15.3%
15.4%
15.7%
15.5%
15.8%
Emerg caesarean
8.7%
16.6%
16.7%
17.6%
17.6%
17.4%
17.1%
16.8%
16.7%
16.7%
17.3%
Forceps
15.2%
5.9%
4.8%
5.0%
4.2%
3.7%
4.1%
4.2%
4.6%
5.4%
5.7%
Breech
1.1%
0.4%
0.4%
0.4%
0.4%
0.4%
0.4%
0.5%
0.4%
0.3%
0.5%
Ventouse
0.7%
5.9%
6.9%
7.1%
7.3%
7.0%
7.1%
7.1%
7.2%
6.9%
5.9%
1 Plurality
Triplets
Quadruplets
2 Induction of labour
(%)
3 Method of birth
Normal
spontaneous
Total caesarean
4 Birthweight <2,500g
(16.9%) (29.2%) (30.0%) (31.5%) (32.3%) (32.9%) (32.3%) (32.2%) (32.4%) (32.2%) (33.2%)
5.8%
7.1%
7.0%
7.0%
7.6%
7.0%
6.9%
7.0%
7.3%
7.2%
7.5%
Singletons
4.9%
5.4%
5.3%
5.3%
5.9%
5.5%
5.5%
5.5%
5.7%
5.6%
6.2%
Multiples
52.1%
50.5%
53.0%
55.8%
57.7%
53.4%
53.6%
53.4%
59.8%
54.1%
51.9%
5.5%
8.3%
8.4%
8.7%
9.0%
8.2%
8.5%
8.6%
9.0%
8.9%
9.2%
Singletons
4.8%
6.6%
6.7%
7.0%
7.3%
6.8%
7.1%
7.0%
7.2%
7.2%
7.5%
Multiples
41.1%
52.2%
54.6%
58.4%
58.4%
54.4%
57.2%
59.3%
67.5%
58.4%
61.5%
6 Congenital
abnormalities
3.4%
2.4%
2.3%
2.5%
2.5%
2.3%
2.6%
2.7%
2.7%
2.8%
3.0%
7 Level II care
Na
15.8%
16.6%
16.6%
16.2%
15.3%
16.1%
15.4%
15.3%
16.0%
16.2%
8 Level III care
3.3%
2.8%
2.7%
2.9%
2.9%
2.5%
2.3%
2.5%
2.9%
2.5%
2.6%
Na
0.2%
0.2%
0.2%
0.3%
0.2%
0.3%
0.3%
0.3%
0.2%
0.2%
4.2%
2.2%
2.2%
2.3%
2.4%
2.0%
2.1%
2.2%
2.2%
2.0%
2.2%
5 Gestational age <37

weeks
9 W&CH ICU care

10 Hospitalisation for
28 days or more
11 Neonatal deaths
96
54
42
52
63
38
55
51
49
44
44
12 Stillbirths
147
122
134
113
129
140
132
151
140
119
150
13 Perinatal deaths
243
176
176
165
192
178
188+
202
189
163
194
400g/20 weeks
12.8
9.9
9.9
9.4
10.6
9.5
9.5
10.1
9.5
8.1
7.4
500g/22 weeks*
11.6
6.8
6.5
5.7
6.2
4.9
5.2
5.3
4.9
4.4
5.8
7.2
4.0
3.9
3.5
3.7
3.1
2.6
3.4
3.5
3.2
3.5
117.6
70.3
68.1
66.9
66.5
63.0
65.1
67.3
65.2
57.6
52.8
14 Perinatal mortality
rate per 1,000 births
1,000g/28 weeks*
15 Standardized
perinatal mortality
ratio
* only neonatal deaths within the first 7 days of life are included, as recommended by the World Health Organisation for national and international
statistics.
page 76
Trends in Perinatal Statistics in South Australia (SA), 1985 2011

Figure 30.1: Percentage of teenage women among women giving birth in SA
8
Percentage
6
4
2
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
Figure 30.2: Percentage of women aged 35 years and over among women giving birth in SA
24
Percentage
20
16
12
8
4
2005
2006
2007
2008
2009
2010
2011
2005
2006
2007
2008
2009
2010
2011
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
Figure 30.3: Percentage of primiparous women aged 35 years and over in SA
Percentage
15
10
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
page 77
Figure 30.4: Percentage of Aboriginal women and Asian women among women giving birth in SA
12
10
Percentage
8
6
4
2
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
Asian
Aboriginal
Figure 30.5: Percentage of women never married and with no de facto partner among women giving birth in SA
15
Percentage
12
9
6
3
2011
2010
2009
2007
2007
2008
2006
2003
2006
2003
2002
2005
2002
2001
2005
2001
2000
2004
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
Figure 30.6: Percentage of multiple births among births in SA

4
Percentage
3
2
1
2011
2010
2009
2008
2004
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
page 78
Figure 30.7 Percentage of low birthweight babies among births in SA

8
Percentage
2011
2010
2005
2004
2009
2004
2003
2008
2003
2002
2007
2002
2006
2001
2001
2000
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
Figure 30.8: SA standardised perinatal mortality ratio (SPMR)

150
SPMR
100
50
2011
2010
2009
2008
2007
2006
2005
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
Year
page 79
Summary Statistics for 2011
VII. Summary Statistics for 2011

These statistics refer to all live births as well as stillbirths of at least 400g birthweight or 20 weeks gestation. Forty-four
babies of less than 400g birthweight have been included.
1 Number of births
Reported number of births (from monthly notifications): 20,344
Notified births with Supplementary Birth Records: 20,344
Notified women who gave birth with SBRs: 20,043
Crude birth rate: 12.4 live births per 1,000 population.
Total fertility rate: 1.89 live births per woman
2 Place of birth
Home births: 96 home births in all (0.5%), of which 87 were planned home births (0.5% of births in the state).
Metropolitan teaching hospitals: 11,327 (55.7%)
Metropolitan private hospitals: 4,923 (24.2%)
Country hospitals: 3,998 (19.7%)
3 Sex
Males 10,432, Females 9,912. Male: Female sex ratio = 1.05:1
4 Plurality and condition at birth
Plurality
Condition at birth
Live birth
Stillbirth
Total
Singleton
Twins
Triplets
Total
19,606
579
20,194
140
150
19,746
586
12
20,344
5 Race of women
Race
Number of women
Caucasian
16,153
80.6
Aboriginal
693
3.5
Asian
2,229
11.1
Other
968
4.8
Total
20,043
100.0
page 80
Summary Statistics for 2011
6 Obstetric interventions in 20,043 women who gave birth

Induction of labour was performed for 6,249 women (31.2%) and labour was augmented for another 4,101 women
(20.5%) who gave birth.
Forceps were utilised for 1,150 women (5.7%), ventouse in 1,189 (5.9%) and episiotomy was performed for 2,445
women who gave birth (12.2%, or 18.3% of women who gave birth vaginally).
Caesarean section was performed in 6,646 women who gave birth (33.2%), of which 3,175 (15.8%) were elective,
and 3,471 (17.3%) emergency operations.
7 Low birthweight (<2,500g)
Number of singleton births of low birthweight =1,216 (6.2% of singleton births).
Number of multiple births of low birthweight =310 (51.8% of multiple births).
Number of all births of low birthweight =1,5262 (7.5% of all births).
8 Congenital abnormalities
Births notified with congenital abnormalities: 606 (3.0%).
9 Perinatal mortality rates (numbers of deaths in parentheses)
Birthweight/Gestation
1
400g/20 weeks
2
3
Stillbirth rate per

1,000 births
Neonatal death rate per

1,000 live births
Perinatal mortality rate

per 1,000 births
(150)
7.4
(44)
2.2
(194)
9.5
500g/22 weeks if birthweight

unavailable (WHO National Statistics*)
(83)
4.1
(24)
1.2*
(107)
5.3*
1,000g/28 weeks if birthweight

unavailable (WHO International/
Standard Statistics*)
(52)
2.6
(12)
0.6*
(64)
3.2*
* Only neonatal deaths within the first 7 days of life are included.
10 Terminations of pregnancy
Total number of terminations notified: 5,101
Induced abortion rate per 1,000 women (15-44 years): 15.5
Total induced abortion rate per 1,000 women (15-44 years): 465.5
Total first induced abortion rate per 1,000 women (15-44 years): 289.2
Induced abortion proportion: 0.20
page 81
References
References
1. Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record.
Adelaide: Pregnancy Outcome Statistics Unit , South Australian Department of Health, 2006.
2. The South Australian Birth Defects Register. 2006 Annual Report. Adelaide: Womens and Childrens Hospital,
Children, Youth and Womens Health Service, 2009.
3. Maternal, Perinatal and Infant Mortality Committee. Maternal, Perinatal and Infant Mortality in South Australia
2008. Adelaide: SA Health, Government of South Australia, 2009.
4. Statewide Service Strategy Division. Standards for Maternal and Neonatal Services in SA 2010. Adelaide:
Department of Health, 2010.
5. South Australian Health Commission. Report of the South Australian Birthing Services Working Group. Adelaide:
Social Health and Policy Development Branch, South Australian Health Commission, 1994.
6. South Australian Abortion Reporting Committee. Ninth Annual Report - For the Year 2011. Adelaide: SA Health,
Government of South Australia, 2013.
7. South Australian Health Commission Epidemiology Branch. Risk factors for adverse perinatal outcome:
determination from a perinatal statistics collection. Adelaide: South Australian Health Commission, December
1986.
8. Mallett R, Knox EG. Standardized perinatal mortality ratios: technique, utility and interpretation. Community
Med 1979; 1: 6-13.
9. Roberts CL, Lancaster PAL. Australian national birthweight percentiles by gestational age. MJA 1999;170:114-8.
10. Womens Hospitals Australasia. Supporting Excellence in Maternity Care. The Core Maternity Indicators Project.
Turner, Australian Capital Territory: Womens Hospitals Australasia, 2007.
11. Breslow NE, Day NE. Statistical methods in cancer research Vol II. The design and analysis of cohort studies. Lyon:
International Agency for Research on Cancer, 1987.
Publications
The following is a list of publications from 1985 from the Pregnancy Outcome Unit or which utilised data from the Unit.
Annual Reports
1. Pregnancy Outcome in South Australia (from 1985), website: www.sahealth.sa.gov.au
2. Maternal, Perinatal and Infant Mortality in South Australia. Annual Report of the Maternal, Perinatal & Infant
Mortality Committee (from 1985), website: www.sahealth.sa.gov.au
3. Committee appointed to examine and report on abortions notified in South Australia Annual Report (from 1985
to 2002). South Australian Abortion Reporting Committee Annual Report (from 2003).
4. Pregnancy and Neonatal Care Bulletin (from 1985): for individual hospitals.
The Unit provides birth defects data to the South Australian Birth Defects Register at the Womens and Childrens
Hospital and perinatal and birth defects data to the Australian Institute of Health and Welfare National Perinatal
Statistics Unit in Sydney for their reports.
page 82
References
These reports are as follows:

1.
The South Australian Birth Defects Register Annual Report (from 1986).
South Australian Birth Defects Register, Public Health Research Unit, Womens and Childrens Hospital, Children,
Youth and Womens Health Service, 72 King William Road, North Adelaide, South Australia 5006.
Telephone (08) 81616518
Website: www.wch.sa.gov.au/services/az/other/phru/birthdefect.html
2.
Australias Mothers and Babies (from 1991)
3.
Congenital anomalies in Australia (from 1981)

AIHW National Perinatal Statistics Unit, Sydney Childrens Hospital, Level 2, McNevin Dickson Building, Randwick
Hospital Campus, Randwick NSW 2031.
Telephone (02) 9382 1014
Website: www.npsu.unsw.edu.au
Other reports/papers
1. Birth defects
1.
Jonas O, Stern LM, Macharper T. A South Australian Study of Pregnancy and Birth Risk Factors associated with
Cerebral Palsy. Int J Rehab Research 1989; 12 (2): 159-166.
2.
Chan A, Robertson EF, Haan EA, Keane RJ, Ranieri E, Carney A. Prevalence of neural tube defects in South
Australia, 1966 91: effectiveness and impact of prenatal diagnosis. BMJ 1993; 307: 703-6.
3.
Bower C, Norwood F, Knowles S, Chambers H, Haan E, Chan A. Amniotic band syndrome: a population-based
study in two Australian States. Paediatr Perinat Epidemiol 1993; 7: 395-403.
4.
Chan A, Robertson E, Haan E, Ranieri E, Keane R. The sensitivity of ultrasound and serum alpha-fetoprotein
in population-based antenatal screening for neural tube defects in South Australia 1986-1991. Br J Obstet
Gynaecol 1995; 102 :370-376.
5.
Chan A, Keane RJ, Hanna M, Abbott M. Terminations of pregnancy for exposure to oral retinoids in South
Australia, 1985-1993. Aust NZ J Obstet Gynaecol. 1995; 35 : 422-426.
6.
Byron-Scott R, Chan A, Haan EA, Bower C, Scott H, Clark K. A population-based study of abdominal wall defects
in South Australia and Western Australia. Proceedings, 14th Annual Congress Australian Perinatal Society,
Adelaide, March 1996, P82.
7.
Chan A, Hanna M, Abbott M, Keane RJ. Oral retinoids and pregnancy. MJA 1996;165: 164-167.
8.
Chan A, McCaul KA, Cundy P, Haan EA, Byron-Scott R. Perinatal risk factors for developmental dysplasia of the
hip. Arch Dis Child 1997; 76 : F94 F100.
9.
Yiv BC, Saidin R, Cundy PJ, Tgetgel JD, Aguilar J, McCaul KA, Keane RJ, Chan A, Scott H. Developmental
dysplasia of the hip in South Australia in 1991: Prevalence and risk factors. J. Paediatr Child Health 1997; 33:
151-6.
10. Cheffins T, Chan A, Keane RJ. The effects of rubella immunisation in South Australia. Proceedings, Rights to
Health 29th Annual Conference, Public Health Association of Australia Inc., Melbourne, 5-8 October 1997.
11. Byron-Scott R, Haan E, Chan A, Bower C, Scott H, Clark K. A population-based study of abdominal wall defects
in South Australia and Western Australia. Paediatr Perinat Epidemiol. 1998; 12: 136-151.
12. Cheffins T, Chan A, Keane RJ, Hann EA, Hall R. The impact of rubella immunisation on the incidence of rubella,
congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia. Br J Obstet
Gynaecol 1998; 105: 998-1004.
13. Chan A, McCaul K, Keane RJ, Haan EA. Effect of parity, gravidity, previous miscarriage, and age on the risk of
Downs syndrome : population-based study. BMJ 1998; 317: 923-4.
14. Byron-Scott R. et al. A validation study of congenital heart defects in South Australia. Proceedings, Australian
Birth Defects Society. Annual Scientific Meeting. Sydney 1998.
page 83
References
15. Byron-Scott R. et al. A comparison of selected birth defects in Aboriginal and non-Aboriginal babies in South
Australia. Proceedings, Australian Birth Defects Society. Annual Scientific Meeting, Sydney 1998.
16. Byron-Scott R. Richardson M, Hiller J, Chan A, Haan E, Knight B, Adams P. The prevalence and validation of
congenital heart defects in South Australia, 1986-94. Proceedings of the 3rd Annual Congress of the Perinatal
Society of Australia and New Zealand, Melbourne, 1999. P153.
17. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Late diagnosis of congenital dislocation of the hip and
presence of a screening programme. South Australian population-based study. Lancet 1999;354:1514-17.
18. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Screening for congenital dislocation of the hip (letter).
Lancet 2000;355:232-33.
19. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ. Folate before pregnancy: the
impact of a South Australian health promotion campaign on women and health professionals. Western
Australian Birth Defects Registry Twentieth Anniversary Scientific Symposium April 27-28, 2000. Perth, Western
Australia. Teratology 2000;62: 365.
20. Cheffins T, Chan A, Haan EA, Ranieri E, Ryall RG, Keane RJ, Byron-Scott R, Scott H, Gjerde EM, Nguyen A-M,
Ford JH, Sykes S. The impact of maternal serum screening on the birth revalence of Downs syndrome and the
use of amniocentesis and chorionic villus sampling in South Australia. Br J Obstet Gynaecol 2000;107:1453-9.
21. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ. Folate before pregnancy:the impact
on women and health professionals of a population-based health promotion campaign in South Australia. MJA
2001; 174:631-636.
22. Chan A, Foster BK, Cundy PJ. Invited commentary. Problems in the diagnosis of neonatal hip instablity. Acta
Paediatr 2001;90:836-9.
23. Metz MP, Ranieri E, Gerace RL, Priest KR, Luke CG, Chan A. Newborn screening in South Australia: is it universal?
MJA 2003;179:412-415.
24. Chan A. Invited commentary: Parity and the risk of Down syndrome caution in interpretation. Am J Epidemiol
2003;158:509-511.
25. Gibson CS, MacLennan AH, Hague WM, Rudzki Z, Sharpe P, Chan A, Dekker GA. Fetal thrombophilic
polymorphisms are not a risk factor for cerebral palsy. Perinatal Society of Australia and New Zealand 8th Annual
Congress, Convention Centre, Darling Harbour, Sydney, Australia, 15th-18th March 2004, A41.
26. Gibson CS, MacLennan AH, Rudzki Z, Hague WM, Haan EA, Sharpe P, Priest K, Chan A, Dekker GA for the South
Australian Cerebral Palsy Research Group. The prevalence of inherited thrombophilias in a Caucasian Australian
population. Pathology 2005;37:160-163.
27. Byron-Scott R, Sharpe P, Hasler C, Cundy P, Hirte C, Chan A, Scott H, Baghurst PB, Haan E. A South Australian
population-based study of congenital talipes equivarus. Paediatr Perinat Epidemiol 2005;19:227-237.
28. Gibson CS, MacLennan AH, Hague WM, Haan E, Priest K, Chan A, Dekker GA for the South Australian Cerebral
Palsy Research Group. Associations between inherited thrombophilias, gestational age and cerebral palsy. Am J
Obstet Gynecol 2005;193:1437.e1-1437.e12.
29. Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in South Australia 19862000: a population-based cohort study. Birth Defects Research Part A Clin Mol Teratol 2005:73;605-611.
30. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral Palsy
Research Group. Neurotropic viruses and cerebral palsy: a population bases case-control study. BMJ ,doi:10.1136/
bmj.38668.616806.3A (published 6 January 2006).
31. Sharpe PB, Mulpuri K, Chan A, Cundy P. Differences in risk factors between early and late diagnosed DDH. Arch
Dis Child 2006;91:F158-162.
Research Group. The association between inherited cytokine polymorphisms and cerebral palsy. Am J Obstet
Gynecol 2006;194: 674.e1-674.e11.
33. Gibson CS, MacLennan AH, Janssen NG, Kist WJ, Hague WM, Haan EA, Goldwater PN, Priest K, Dekker GA for
the South Australian Cerebral Palsy Research Group. Associations between fetal inherited thrombophilia and
adverse pregnancy outcomes. Am J Obstet Gynecol 2006; 194: 947.e1-947.e10.
page 84
References
34. Gibson CS, MacLennan AH, Dekker GA, Goldwater PN, Dambrosia JM, Munroe DJ, Tsang S, Stewart C, Nelson
KB. Genetic polymorphisms and spontaneous preterm birth. Obstet Gynecol 2007;109:384-391.
35. Muller PR, Cocciolone R, Haan EA, Wilkinson C, Scott H, Sage L, Bird R, Hutchinson R, Chan A. Trends in state/
population-based Down syndrome screening and invasive prenatal testing with the introduction of first-trimester
combined Down syndrome screening, South Australia, 1995-2005. Am J Obstet Gynecol 2007;196:315.e1-315.e7.
Research Group. Mannose-binding lectin haplotypes may be associated with cerebral palsy only after perinatal
viral exposure. Am J Obstet Gynecol 2008;198:509.e1-509.e8.
37. Khoo NS, van Essen P, Richardson M, Robertson T. Effectiveness of prenatal diagnosis of congenital heart defects
in South Australia: a population analysis 1999-2003. Aust NZ J Obstet Gynaecol 2008;48:559-563.
38. Chan AC, van Essen P, Scott H, Haan EA, Sage L, Scott J, Gill TK, Nguyen A-M T. Folate awareness and the
prevalence of neural tube defects in South Australia, 1966-2007. MJA 2008;189: 566-569.
39. Djukic M, Gibson CS, MacLennan AH, Goldwater PN, Haan EA, McMichael G et al. Genetic susceptibility to viral
exposure may increase the risk of cerebral palsy. Aust NZ J Obstet Gynaecol 2009: 49:247-253.
40. De Souza, Halliday J, Chan A, Bower C, Morris JK. Recurrence risks for trisomies 13,18, and 21. Am J Med Genet
Part A 149A:27162722.
41. Davies MJ, Moore VM, Willson KJ, Van Essen P, Priest K, Scott H, et al. Reproductive technologies and the risk of
birth defects. N Engl J Med. 2012 May 10;366(19):1803-13. PubMed PMID: 22559061.
42. Flood L, Scheil W, Nguyen A, Sage L, Scott J. An increase in neural tube defect notifications, South Australia,
20092010. Western Pacific Surveillance and Response Journal, 2013, 4 (2). doi:10.5365/wpsar.2012.3.3.006
2. Termination of pregnancy
1.
Hart G, Macharper T. Medical termination of pregnancy in South Australia 1970-1984. Adelaide: South
Australian Health Commission, 1986.
2.
Chan A, Taylor A. Medical Termination of Pregnancy in South Australia - The First 20 Years 1970-1989. Adelaide:
Pregnancy Outcome Unit, South Australian Health Commission, December 1991.
3.
Chan A, McColl M, Versteeg J, Gameau B, Scanlan C, Pridmore B. A South Australian Study on Contraception
and Abortion. Public and Environmental Health Service, South Australian Health Commission and Department of
Obstetrics and Gynaecology, The Queen Elizabeth Hospital, Adelaide, March 1994.
4.
Hart G, Macharper T. Clinical aspects of induced abortion in South Australia from 1970-1984. Aust. NZ J Obstet
Gynaecol 1986; 26: 219-224.
5.
Hart G, Macharper T. Induced abortion trends in South Australia. Am J Public Health 1987; 77: 200-202.
6.
Chan A, Keane RJ. Prevalence of induced abortion in a reproductive lifetime. Am J Epidemiol 2004;159:475-480.
7.
Chan A, Sage LC. Estimating Australias abortion rates 1985-2003. MJA 2005;182:447-452.
3. Perinatal epidemiology
1.
Connon AF, Macharper T. Teenage pregnancies in South Australia. Adelaide: South Australian Health
Commission, September 1986.
2.
South Australian Health Commission, Epidemiology Branch: Characteristics of pregnancies and births among
migrant women in South Australia. Adelaide : South Australian Health Commission, October 1986.
3.
South Australian Health Commission, Epidemiology Branch. Risk factors for adverse perinatal outcome: determination
from a perinatal statistics collection. Adelaide: South Australian Health Commission, December 1986.
4.
South Australian Health Commission, Epidemiology Branch. Variation in perinatal risk by place of residence of
mother in South Australia. Adelaide: South Australian Health Commission, December 1986.
5.
South Australian Health Commission, Epidemiology Branch. Variations in Perinatal Risk by Hospital of Birth in
South Australia. Adelaide: South Australian Health Commission, January 1987.
6.
South Australian Health Commission, Epidemiology Branch. Aboriginal Births in South Australia, 1981-1986: An
Analysis of Perinatal Outcomes, Adelaide: South Australian Health Commission, May 1988.
page 85
References
7.
South Australian Health Commission, Epidemiology Branch: Pregnancy Outcome Attributes by Postcode: South
Australia 1981-1986. South Australian Health Commission, Adelaide: August 1988.
8.
Jonas O, Scott J, Chan A, Macharper T, Lister J. A validation study of the 1986 perinatal data collection form.
Adelaide: Pregnancy Outcome Unit, South Australian Health Commission, 1991.
9.
South Australian Cancer Registry. Associations between perinatal characteristics and risk of childhood cancer:
South Australian cancer cases born in 1981-1993. In: Epidemiology of Cancer in South Australia. Incidence,
Mortality and Survival 1977 to 1994. Adelaide South Australian Health Commission, 1995.
10. Taylor A, Twisk A-M, Chan A. Perinatal risk factors by postcode in South Australia 1989-1992. Epidemiology
Branch, South Australian Health Commission, Adelaide: June 1995.
11. Pregnancy Outcome Unit. Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record.
Adelaide: South Australian Health Commission, December 1997.
12. McLean A, Scott J, Keane RJ, Sage L, Chan A. Validation of the 1994 South Australian perinatal data collection
form. Adelaide: Pregnancy Outcome Unit, Department of Human Services, 2001.
13. Hart G, MacHarper T, Moore D, Roder D. Aboriginal pregnancies and births in South Australia. MJA 1985; 143:
S54-56.
14. Chan A, Roder D, Macharper, T. Obstetric Profiles of Immigrant Women from Non-English Speaking Countries in
South Australia, 1981-83. Aust NZ J Obstet Gynaecol 1988; 28: 90-95.
15. Jonas O, Roder D, Esterman A, Macharper T, Chan A. Pregnancy and Birth Risk Factors for Intellectual Disability
in South Australia. Eur J Epidemiol 1989; 5: 322-327.
16. Jonas O, Chan A, Macharper T, Roder D. Pregnancy and Perinatal Factors associated with persistently low Apgar
scores: an analysis of the birth records of infants born in South Australia. Eur J Epidemiol 1990; 6: 136-141.
17. Crotty M, Ramsay AT, Smart R, Chan A. Planned Homebirths in South Australia 1976-1987 MJA 1990; 153: 664-671.
18. Jonas O, Chan A, Roder D, Macharper T. Pregnancy Outcomes in primigravid women aged 35 years and over in
South Australia, 1986-1988. MJA 1991; 154: 246-249.
19. Zhang B, Chan A. Teenage Pregnancy in South Australia, 1986-1988. Aust. NZ J Obstet Gynaecol 1991; 31: 291-298.
20. Jonas O, Roder D, Chan A. The Association of Maternal and Socioeconomic Characteristics in Metropolitan
Adelaide with Medical, Obstetric and Labour Complications and Pregnancy Outcomes. Aust NZ J Obstet
Gynaecol 1992; 32: 1-5.
21. Chan A, Roder D, Priest K, Esterman A. A perinatal perspective on South Australia in the 1980s. MJA 1992; 157:
515-518.
22. Jonas O, Roder D, Chan A. The association of low socio-economic status in Metropolitan Adelaide with maternal
demographic and obstetric characteristics and pregnancy outcome. Eur J Epidemiol 1992; 8:708.
23. Jonas O, Roder D. Breech Presentation in South Australia, 1987-1989. Aust NZ J Obstet Gynaecol 1993; 33: 1721.
24. Scott J, Chan A. Planned birthing unit deliveries in South Australia. Proceedings, 14th Annual Congress Australian
Perinatal Society, Adelaide, March 1996, P21.
25. Dal Grande E, Chan A, Keane R. Asian, but different: Obstetric characteristics of women born in Vietnam
and Philippines who delivered in South Australia in 1991-1994. Proceedings, 14th Annual Congress Australian
Perinatal Society, Adelaide, March 1996, P22.
26. Keane R, Dal Grande E, Chan A, McCaul K. Episiotomy a decline in the cutting edge. Proceedings, 14th Annual
Congress Australian Perinatal Society, Adelaide, March 1996, P75.
27. Chan A, McPhee AJ. A safer leap into this dangerous world. Lancet 1996; 348 (suppl II) :12.
28. Carter JR, Hiller JE, Ryan P, Chan A. The Association between maternal age and preterm births to primiparous
women in South Australia, 1991-1993, Proceedings, First Annual Congress, Perinatal Society of Australia and
New Zealand, Fremantle, Western Australia, 16-24 March 1997.
29. Zhang B, Hiller JE, Chan A. Asthma in pregnancy in South Australia. Proceedings, First Annual Congress,
Perinatal Society of Australia and New Zealand, Fremantle, Western Australia, 16-24 March 1997.
page 86
References
30. Roder D, Nguyen A-M, Chan A. Trends in perinatal characteristics in South Australia, 1981 to 1994, by place of
residence of mother. Aust NZ J Public Health 1997; 21: 483-8.
31. Zhang B, Hiller JE, Chan A. Asthma in pregnancy: Association with Spontaneous Preterm Birth. Proceedings of
the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand, Melbourne, 1999, A113.
32. McLean AP, Hiller JE, Chan A. Maternal epilepsy and fetal outcomes in South Australia. Perinatal Society of
Australia and New Zealand 4th Annual Congress. Brisbane Convention and Exhibition Centre, Brisbane, Australia,
12-15 March 2000, P192.
33. Chan A, Keane RJ, Robinson JS. The contribution of maternal smoking to preterm birth, small for gestational age
and low birthweight among Aboriginal and non-Aboriginal births in South Australia. MJA 2001;174: 389-93.
34. van der Klis KAM, Westenberg L, Chan A, Dekker G, Keane RJ. Teenage pregnancy: trends,characteristics and
outcomes in South Australia and Australia. Aust N Z J Public Health 2002; 26: 125-31.
35. Westenberg L, van der Klis KAM, Chan A, Dekker G, Keane RJ. Aboriginal teenage pregnancies compared with
non-Aboriginal in South Australia 1995-1999. Aust N Z J Obstet Gynaecol 2002;42: 187-191.
36. Wang JX, Knottnerus A-M, Schuit G, Norman RJ, Chan A, Dekker GA. Surgically obtained sperm and risk of
gestational hypertension and pre-eclampsia. Lancet 2002;359: 673-4.
37. Jacobs DJ, Vreeburg SA, Dekker GA, Heard AR, Priest KR, Chan A. Risk factors for hypertension during
pregnancy in South Australia. Aust NZ J Obstet Gynaecol 2003; 3: 421-428.
38. Heard AR, Dekker GA, Chan A, Jacobs DJ, Vreeburg SA, Priest KR. Hypertension during pregnancy in South
Australia, Part 1: Pregnancy outcomes. Aust NZ J Obstet Gynaecol 2004; 44: 404-409.
39. Vreeburg SA, Jacobs DJ, Dekker GA, Heard AR, Priest KR, Chan A. Hypertension during pregnancy in South
Australia, Part 2: Risk factors for adverse maternal and/or perinatal outcome results of multivariable analysis.
Aust NZ J Obstet Gynaecol 2004;44: 410-418.
40. Leahy K, Elliot E, Kennare R, Chan A. Characteristics and pregnancy outcomes of first time mothers aged 35
years and over compared to younger first time mothers in South Australia 1991-2002. Before and Beyond Birth.
Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual Congress. Adelaide Convention Centre,
Adelaide, South Australia, 13-16 March 2005, A144.
41. Kennare R, Heard A, Chan A. Substance use during pregnancy: risk factors and obstetric and perinatal outcomes
in South Australia. Aust NZ J Obstet Gynaecol 2005;45:220-225.
42. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of spontaneous preterm birth. Perinatal
Society of Australia and New Zealand 10th Annual Congress. Perth Convention Exhibition Centre, Perth, Western
Australia, 3-6 April 2006, FC17.1, p 165.
43. Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record.
Adelaide: Pregnancy Outcome Statistics Unit, South Australian Department of Health, 2006.
44. Budde MP, De Lange TE, Dekker GA, Chan A, Nguyen AM. Risk factors for placental abruption in a socioeconomically disadvantaged region. J Matern Fetal Neonat Med 2007 Sep; 20(9):687-93.
45. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of pre-term birth: a population study. J
Matern-Fetal Neonat Med 2009;22(1):1-7.
46. Kennare R, Keirse M, Tucker G, Chan A. Planned home and hospital births in South Australia, 19912006:
differences in outcomes. MJA 2010; 192: 7680.
47. Dodd J, Grivell R, Nguyen AM, Chan A, Robinson J. Maternal and perinatal health outcomes by body mass index
category. ANZJOG 2011: 51,2: 136140.
48. Grivell RM, Reilly AJ, Oakey H, Chan AC, Dodd JM. Maternal and neonatal outcomes following induction of
labor: a cohort study. Acta Obstet Gynecol Scand 2012; 91:198203.
49. Ludford I, Scheil W, Tucker G, Grivell R. Pregnancy outcomes for nulliparous women of advanced maternal
age in South Australia, 1998-2008. The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2012
Jun;52(3):235-41. PubMed PMID: 22553967.
50. Dodd JM, Catcheside B, Scheil W. Can shoulder dystocia be reliably predicted? The Australian & New Zealand
Journal of Obstetrics & Gynaecology. 2012 Jun;52(3):248-52. PubMed PMID: 22428758.
page 87
References
1.
Roder D, Chan A, Esterman A. Birthweight specific trends in perinatal mortality by hospital category in South
Australia, 1985 1990. MJA 1993; 158: 664-667.
2.
Connon AF, Chan A on behalf of the Postneonatal Subcommittee, maternal, perinatal and Inmfant
Mortality Committee. Accidental deaths of babies in the postneonatal period in South Australia (letter). MJA
1994;161:397.
3.
Roder D, Chan A, Priest K. Perinatal mortality trends among South Australian Aboriginal births 1981-92. J
Paediatr Child Health 1995; 31: 446-450.
4.
Haslam R, McPhee A, Chan A, Keane R. Neonatal mortality a system of classification and trends in South
Australia. Proceedings of the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand,
Melbourne, 1999. P86.
5.
Robson S, Chan A, Keane RJ, Luke CG. Subsequent birth outcomes after an unexplained stillbirth: preliminary
population-based retrospective cohort study. Aust NZ J Obstet Gynaecol 2001;41: 29-35.
6.
Flenady V, Chan A, Haslam R, King J, Tudehope D, McCowan L. Cause specific perinatal mortality in Australia and
New Zealand using a new clinical classification system (ANZACPM and ANZNDC). Perinatal Society of Australia and
New Zealand 7th Annual Congress, Hotel Grand Chancellor, Hobart, Tasmania, March 9th-12th 2003, A87.
7.
Dodd JM, Robinson JS, Crowther CA, Chan A. Stillbirth and neonatal outcomes in South Australia, 1991-2000.
Am J Obstet Gynecol 2003;189: 1731-1736.
8.
Chan A, King JF, Flenady V, Haslam RH, Tudehope DI. Classification of perinatal deaths: Development of the
Australian and New Zealand classifications. J Paediatr Child Health 2004;40: 340-347.
9.
Flenady V, King J, Chan A, McCowan L, Tudehope D, Haslam R, Charles A, Roberts C for the Perinatal Mortality
Audit Guidelines Working Party of the PSANZ Perinatal Mortality Special Interest Group. Development of Clinical
Practice Guideline for Perinatal Mortality Audit incorporating psychological and social aspects of perinatal
bereavement. Before and Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th
Annual Congress, Adelaide Convention Centre, Adelaide, South Australia, 13-16 March 2005, P58.
10. De Lange TE, Budde MP, Heard AR, Tucker G, Kennare R, Dekker GA. Avoidable risk factors in perinatal deaths: a
perinatal audit in South Australia. Aust NZ J Obs Gynaecol 2008;48:50-57.
5. Caesarean section
1.
Jonas O, Chan A, Macharper T. Caesarean Section in South Australia, 1986. Aust NZ J Obstet Gynaecol 1989;
29: 99-106.
2.
Chan A. Epidemiology of the rising Caesarean section rate. Proceedings, 14th Annual Congress Australian
Perinatal Society, Adelaide, March 1996, A70.
3.
Chan A, Keane RJ, Scott J. Elective Caesarean section and child deprivation (letter). Lancet 1996; 347: 1196.
4.
Kennare, R. Why is the caesarean section rate rising? MIDIRS Midwifery Digest 2003; 13 (4): 503-508.
5.
Kennare R, Heard A, Chan A. Is caesarean section in the first birth a problem for women in the next birth?
Before and Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual Congress.
Ade;laide Convention Centre, Adelaide, South Australia, March 13-16 2005, A 127.
6.
Kennare R, Tucker G, Heard A, Chan A. Risks of adverse outcomes in the next birth after caesarean delivery.
Obstet Gynecol 2007;109:270-276.
7.
Dekker G, Chan A, Luke C, Priest K, Riley M, Halliday J, King J, Gee V, ONeill M, Snell M, Cull V, Cornes S. Risk
of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective
population-based cohort study. BJOG 2010;117:13581365.
page 88
Appendix
Appendix 1: Definitions
Abortion rate:
Number of induced abortions in a group of women in a year

Estimated resident population of same group in the same year
x 1,000
The abortion rate per 1,000 women in the reproductive age group 15-44 years has been calculated in this report
using as the numerator all abortions; the denominator used has been the estimated resident population for women
aged 15-44 years in that year.
Abortion proportion:
=
Abortions
Abortions + live births
This is often called the abortion ratio, which is strictly:
Abortion
Live births
Apgar score: A numerical scoring system applied after birth (usually at 1 minute and again at 5 minutes) to evaluate
the condition of the baby, as specified below:
Score
Sign
Heart rate
Absent
Slow (below 100)
Over 100
Respiratory effort
Absent
Slow, irregular
Good, crying
Muscle tone
Reflex irritability
Flaccid
Some flexion of extremities
Active motion
No response
Grimace
Vigorous cry
Blue, pale
Body pink, extremities blue
Completely pink
Colour
Birthweight: The first weight of a fetus or newborn obtained after birth. This is preferably measured within the first
hour of life before significant post-natal weight loss has occurred.
Low birthweight: Birthweight of less than 2,500g.
Very low birthweight: Birthweight of less than 1,500g.
Body Mass Index (BMI): weight (in kg) height2 (in metres).
This is used as a standard for recording obesity statistics and also as a measure of underweight. However the
categories do not take into account factors such as frame size, muscularity, varying proportions of components such
as fat, bone, cartilage and water, and may be misleading in athletes, children and some ethnic groups. The categories
for describing weight using BMI are:
BMI category Name

<18.5 Underweight
18.5 to < 25
Normal
25 to < 30
Overweight
30 to < 35
Obese
35 to < 40
Severely obese
40 or greater
Morbidly obese.
page 89
Appendix
Caesarean section: Birth of a child by an abdominal operation.

Elective caesarean section: One which takes place as a planned procedure before the spontaneous onset
of labour.
Emergency caesarean section: One which is undertaken for a complication:
(a) before the onset of labour or
(b) during labour, whether that labour is of spontaneous onset or following induction of labour.
Fertility rates:
Age-specific fertility rate:
Number of live births to women in an age group in a year
Estimated resident population of women of that age group in the same year
x 1,000
General fertility rate:

Total number of live births in a year
Estimated resident population of women aged 15-44 years in the same year
x 1,000
Total fertility rate (TFR): The sum of age-specific fertility rates (live births at each age of women per female
population of that age). It represents the number of children a woman would bear during her lifetime if she
experienced current age-specific fertility rates at each age of her reproductive life.
Gestational age: The duration of pregnancy in completed weeks determined by the best obstetric estimate, using
ultrasonography and the first day of the last normal menstrual period.
Induction of labour: An intervention undertaken to stimulate the onset of labour by pharmacological or other
means.
Live birth: The complete expulsion or extraction from its mother of a product of conception, irrespective of the
duration of 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.
Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy
or its management but not from accidental or incidental causes.1
Maternal deaths are divided into two groups:
1. Direct obstetric deaths: those resulting from obstetric complications of the pregnant state (pregnancy, labour and
puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of
the above.
2. Indirect obstetric deaths: those resulting from previous existing disease or disease that developed during
pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of
pregnancy.
As an extension of the WHO definition, accidental and incidental deaths occurring in pregnant women are also
reviewed by the Maternal, Perinatal and Infant Mortality Committee so as to avoid missing indirect deaths which may
be difficult to distinguish from incidental deaths. Examples of incidental deaths are deaths from drowning and road
accidents, where the pregnancy is unlikely to have contributed significantly to the death, although it may be possible
to postulate a remote association.
Multigravida: A woman who has been pregnant more than once.
Parity: The total number of previous pregnancies resulting in live births or stillbirths.
1 World Health Organisation. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision.
Volume 2. Geneva: WHO, 1993, p 134.
page 90
Appendix
Perinatal deaths:
Early fetal death: Death in a fetus of less than 400g birthweight, and of less than 20 weeks gestation. A
miscarriage is a spontaneous early fetal death.
Fetal death: Death prior to the complete expulsion or extraction from a woman of a product of conception,
irrespective of the duration of pregnancy; the 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.
Late fetal death or stillbirth: Death in a fetus of at least 400g birthweight, or of at least 20 weeks
gestation.
Late fetal death rate or stillbirth rate:
=
Number of late fetal deaths or stillbirths in any year
x 1,000
Number of live births and stillbirths in that year

Neonatal death: Death of a liveborn infant within 28 days of birth.
Neonatal death rate:
=
Number of neonatal deaths in any year

Number of live births in that year
x 1,000
Perinatal death: Includes late fetal death (stillbirth) and neonatal death.
Perinatal mortality rate (PMR):
= Number of stillbirths and neonatal deaths
Number of stillbirths and live births
x 1,000
For South Australian statistics, the rate refers to live births and stillbirths of at least 400g birthweight or 20
weeks gestation.
For national statistics, the rate refers to all births of at least 20 weeks gestation or 400g birthweight, and
neonatal deaths occurring within 28 days of birth.
For international comparison, the rate refers to all births of at least 1,000g birthweight or, when birthweight
is unavailable, of at least 28 weeks gestation and neonatal deaths occurring within seven days of birth (as
recommended by WHO).
Preterm: less than 37 completed weeks gestation.
Primigravida: A woman pregnant for the first time.
Primipara: A pregnant woman who has had no previous pregnancy resulting in a live birth or stillbirth.
Race
1. Caucasian: individuals of European descent.
2. Aboriginal: this includes part-Aboriginals as well as full blood Aboriginals. An Aboriginal is a person of
Aboriginal descent who identifies as an Aboriginal and is accepted as such by the community in which he or she
lives.
3. Asian: (exclude Asia Minor) - In this category, include women originating from all Asian countries, including the
Indian subcontinent (India, Bangladesh, Pakistan, Nepal, Sri Lanka), who were formerly listed as Other race.
4. Torres Strait Islander (TSI): A Torres Strait Islander is a person of Torres Strait Islander descent who identifies as a
Torres Strait Islander and is accepted as such by the community in which he or she lives.
5. Aboriginal & TSI: persons of both Aboriginal and Torres Strait Islander descent.
6. Other: Races other than (1) - (5). Include women from the Middle East and Africa.
page 91
Appendix
Guidelines for use regarding Indigenous Status - categories (2), (4) and (5).
There are three components to the definition:
>> descent
>> self identification
>> community acceptance
It is not possible to collect the three components of the definition in a single question. The Australian Bureau
of Statistics (ABS) proposes that the focus of a single question should be the descent, the first component
of the definition. The ABS therefore proposes the use of the following alternative questions, depending on
whether the person is present or not.
Where the person is present : Are you of Aboriginal or Torres Strait Islander origin?;
OR
where the person is not present and someone who knows the person well responds for him/her: Is the
person of Aboriginal or Torres Strait Islander origin?
If the response is Yes, then clarify whether the person is of Aboriginal origin (2), Torres Strait Islander
origin (4) or both Aboriginal and Torres Strait Islander origin (5).
Self reporting of descent is not equivalent to self reporting of identity but because of the absence of a
second identity question some respondents will interpret the origin question to mean both descent and
identification. What identification in the context of the variable Indigenous Status should measure is an
individuals self assessed historical and cultural affiliation.
Termination of pregnancy: (synonym induced abortion) The removal or expulsion of a pregnancy from the uterus
via surgical or medical intervention, performed by a medical practitioner in a prescribed hospital in South Australia,
on specified grounds under the Criminal Law Consolidation Act and notified under the Criminal Law Consolidation
(Medical Termination of Pregnancy) Regulations 1996. Terminations of pregnancy at gestations of 20 weeks or later or
where the fetus weighs at least 400g, performed by induction of labour resulting in a birth are included in the South
Australian perinatal data collection. These are usually for congenital abnormalities or medical reasons.
Total abortion rate = the sum of the five-year age-specific induced abortion rates multiplied by 5.
This represents the number of induced abortions 1,000 women would have during their lifetime if they experienced
the rates of the year shown.
page 92
Appendix
Appendix 2: 2011 Supplementary Birth Record Form

2011 SUPPLEMENTARY BIRTH RECORD
FOR COMPLETION BY MIDWIVES AND NEONATAL NURSES
Mothers name .............................................................................................................................

Surname
Given Names
Childs surname (if different) ........................................................................................................
Hospital/Place of birth.........................................................
Mothers address .........................................................................................................................
Mothers Case Record Number ..........................................
..................................................................................................... Postcode
Plurality (1=single, 2=twin, 3=triplet, 4=quad)
Personal information above this line is confidential
For multiple births, please complete a separate baby form for each baby.
MOTHER S I N FO R MATIO N
1 Mothers date of birth

day
2 Race
1.
2.
3.
4.
5.
6.
month
year
Caucasian
Aboriginal
Asian
Torres Strait Islander (TSI)
Aboriginal & TSI
Other
1.
2.
3.
4.
5.
6.
7.

No antenatal care

Hospital clinic

Obstetrician in private practice

General practitioner

Birth centre

Home birth midwife

Obstetrician/midwife
(shared care) in private practice
8.
GP/midwife (shared care)
9.
Other (specify)............................................
18 Tobacco smoking status at first visit
....................................................................
4 Type of patient
1. Hospital/Public
2. Private
1.
2.
3.
4.
Never married
Married/De facto
Widowed
Divorced
Separated
Smoker
Quit in pregnancy before first visit
Non smoker
Unknown smoking status

None

Number per day = ............................................

<1 (occasional)

Unknown number
20 Medical conditions present in this

pregnancy
OCCUPATION
6 Babys father
....................................................................
Babys mother
....................................................................
PREVIOUS PREGNANCY OUTCOMES
7 Number of previous pregnancies
8 Number of previous pregnancies resulting

in births >20 weeks (parity)
9 Number of previous outcomes
Singleton
Multiple
Livebirths, not neonatal deaths

Livebirths, neonatal deaths
Stillbirths
Miscarriages
Ectopic pregnancies
Terminations of pregnancy
1.
None
2.
Anaemia
3.
Urinary tract
infection
4. Hypertension
(pre-existing)
5.
Diabetes
(pre-existing)
6.
Epilepsy
7.
Asthma
8.
Other (specify)............................................
21 Obstetric complications
1. None
2. Threatened
miscarriage
3. APH - Abruption
4. APH - Placenta
praevia
5. APH - Other &
unknown cause
6. Pregnancy hypertension (all types)
7. Suspected IUGR
8. Gestational diabetes
9. Other (specify, including impaired
glucose tolerance)
...................................................................
22 Date of admission prior to delivery
10 Outcome of last pregnancy

....................................................................
11 Date of delivery/termination of last

pregnancy
month
12 Method of delivery in last birth
Tick if Yes
year
THIS PREGNANCY
14 Date of last menstrual period
24 Onset of labour
year
16a Number of antenatal visits

16b First antenatal visit
1. Spontaneous
2. No labour (LSCS)
3. Induction (excluding augmentation)
Give reason/s for induction
(If postdates, state T+ .............. days)
....................................................................
6.
7.
8.
9.
10.
Height (cm)
Please return top copy to:

Pregnancy Outcome Unit, PO Box 6,
Rundle Mall, Adelaide SA 5000
1.
2.
3.
4.

ARM

Oxytocics

Prostaglandins

Other (specify)............................................
1.
2.
3.
4.
5.
6.
Vertex
Breech
Face
Brow
Other
Unknown
26 Presentation prior to delivery
Normal spontaneous
Forceps
LSCS (elective)
LSCS (emergency)
If LSCS state reason/s:
...................................................................
Ventouse
Breech extraction
Breech spontaneous
Unknown
Assisted breech (with forceps for head)
1. None
2. PPH (Primary)
600 - 999ml
1000ml or more
3. Fetal distress
4. Retained placenta
5. Prolonged labour
(>18 hrs)
6. Cord prolapse
7. Wound infection
8. Failure to progress (specify)
...................................................................
9. Other (specify)
...................................................................
29 Perineal status after delivery
Tick tear, repair & episiotomy if all

1.
Intact
2.
1st degree tear/vaginal graze
3.
2nd degree tear
4.
3rd degree tear
5.
4th degree tear
6.
Repair of tear
7.
Episiotomy
8.
Other (specify) ...........................................
9.
Not stated
30 CTG performed during labour
4 Hour of birth
(24 hour clock)
5 Sex
1. Male
2. Female
3. Indeterminate
6 Birthweight (grams)
7 Gestation at birth
(best clinical estimate in weeks)
CONDITION AT BIRTH
8 Apgar Score
1 minute
5 minute
9 Time to establish regular

breathing (to nearest minute)
10 Resuscitation at delivery
1. None
2. Aspiration
3. Oxygen
4. IPPV - bag & mask
5. IPPV - intubation
6. Narcotic antagonist
7. Sodium bicarbonate
8. Ext. cardiac massage
9. Other (specify)
...................................................................
11 Condition occurring during birth

1. None
2. Fracture
3. Dislocation
4. Nerve injury
5. Other (specify)
...................................................................
12 Congenital abnormalities
1.
Nil apparent
2.
Yes (specify)
....................................................................
1. None
2. External
3. Scalp clip
....................................................................
31 Fetal scalp pH taken during labour
....................................................................
1. No
2. Yes
....................................................................
32 Analgesia for labour

1.
2.
3.
4.
5.
6.
7.

None

Nitrous oxide and oxygen

Narcotic (parenteral)


Spinal

Other (specify)............................................

1.
2.
3.
4.
5.
6.
7.
8.

None

Local anaesthesia to perineum

Pudendal


Spinal

General anaesthesia

Other (specify)............................................

33 Anaesthesia for delivery
34 Mothers outcome for birth hospital/

home birth
1.
Discharged
2.
Transferred
3.
Died
Transferred to ........................................................
on
day
month
year
35 MOTHERS FINAL DISCHARGE/DEATH
Date
day
....................................................................
25 If induction, or augmentation after

spontaneous onset, specify method/s
Gestation (weeks)
BMI
Tick if Unknown
LABOUR AND DELIVERY
1. Hospital
2. Birth centre
3. Home
4. Other (specify) ..................................................
5. Not booked
Weight (kg)
year
1.
MSAFP (NTD etc)
2.
Triple/Quadruple screen
(Downs etc)
3.
Ultrasound examination
4.
Chorion villus sampling
5.
Amniocentesis
6.
Cordocentesis
7.
Other surgical procedures (specify)
...................................................................
13 Number of previous caesareans
15 Intended place of birth
month
23 Procedures performed in this pregnancy
0. No previous birth
1. Vaginal
2. Caesarean
9. Not known
month
day
1.
2.
3.
4.
5.
28 Complications of labour, delivery and

puerperium
19 Average number of tobacco cigarettes

smoked per day in 2nd half of pregnancy
5 Marital status
day
27 Method of delivery
17 Type of antenatal care
10.
Not stated
3 Country of birth
1.
2.
3.
4.
5.
SLA
month
year
BABY DE TAILS
1 Case record number
....................................................................
....................................................................
13 Treatment given
1.
2.
3.
4.
5.

None of the treatments below

Oxygen therapy > 4 hours

Phototherapy for jaundice

Gavage feeding more than once

Any intravenous therapy
14 Nursery care required
1.
Level 1 only
2.
Special nursery (Level 2)
Number of days .......................

3.
Neonatal Intensive Care Unit (NICU)
- FMC/WCH (Level 3)
Number of days .......................
4.
Paediatric Intensive Care Unit (PICU)
- WCH
Number of days .......................
15 Was transfer to NICU/PICU for a

congenital abnormality?
Yes
No
OUTCOME OF BABY
16 Outcome of baby
1.
2.
3.
4.
Fetal death
Discharged
Neonatal death
17 Baby transferred to
2 Place of birth
1.
2.
3.
4.
....................................................................
on
Hospital
BBA
Domicilary
Birthing unit/centre
day
day
month
year
18 Date of final discharge (or death)
3 Date of delivery
month
year
day
month
year
page 93
Appendix
Appendix 3: Congenital Abnormality Form
page 94
For more information

Epidemiology Branch
Citi Centre Building
11 Hindmarsh Square
Adelaide 5000 South Australia
Postal Address
Citi Centre Building,
11 Hindmarsh Square
Adelaide 5000 South Australia
Telephone: (08) 8226-6382
Fax: (08) 8226-6291
Web: www.sahealth.sa.gov.au/pregnancyoutcomes
E-mail: Pregnancy.Stats@health.sa.gov.au
If you do not speak English, request an interpreter from SA Health
and the Department will make every effort to provide you with
an interpreter in your language.
www.ausgoal.gov.au/creative-commons
Department for Health and Ageing, Government of South Australia.
All rights reserved. ISSN: 0819-3835
FIS: 12065.1. Printed September 2013.

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Pregnancy

Pregnancy Outcome Unit

Head/Senior medical consultant

Senior midwife, Abortion statistics

Senior midwife, Maternal,

Pregnancy Outcome in South Australia 2011

Smoking during pregnancy and Body Mass Index................................................................................. 10

7. Antenatal care and length of stay......................................................................................................... 11

II Mothers And Babies: Characteristics & Outcomes.............................................. 14

Pregnancy Outcome in South Australia 2011

14b. Reasons for induction of labour........................................................................................................... 32

III Terminations of Pregnancy................................................................................... 50

Numbers and rates............................................................................................................................... 50

Place of residence and place where termination performed.................................................................. 53

The reason for termination................................................................................................................... 54

Gestation, method and complications.................................................................................................. 54

IV Obstetric Profiles By Hospital Category............................................................... 58

Pregnancy Outcome in South Australia 2011

VI Trends in Perinatal Statistics in South Australia, 1981-2011............................... 74

VII Summary Statistics for 2011................................................................................. 80

6. Obstetric interventions in 20,043 women who gave birth.................................................................... 81

Births and crude birth rate by CURB regions................................................................................. 14

Pregnancy Outcome in South Australia 2011

Table 4d: Age-specific fertility rates............................................................................................................. 22

Occupation of father and mother................................................................................................. 25

Table 8a: Parity by race, women who gave birth.......................................................................................... 26

Pregnancy Outcome in South Australia 2011

Table 27b: Gestation at birth by plurality....................................................................................................... 43

Distribution of hospital births by hospital category..................................................................... 18

Age and race of women who gave birth.................................................................................... 22

Reasons for induction of labour................................................................................................. 32

Figure 5a: Method of birth, women who gave birth................................................................................... 33

Pregnancy Outcome in South Australia 2011

Figure 5b: Reason for caesarean section..................................................................................................... 35

Perinatal mortality rate by birthweight, all births........................................................................ 44

Termination of pregnancy rate in South Australia, 1970-2011.................................................... 50

Figure 8a: Termination of pregnancy and live births by age......................................................................... 52

Percentage of Aboriginal women by hospital category............................................................... 61

Pregnancy Outcome in South Australia 2011

Pregnancy Outcome in South Australia 2011

1. Numbers and fertility rates

4. Older women and first time mothers

5. Country of birth and race

6. Smoking during pregnancy and Body Mass Index

Pregnancy Outcome in South Australia 2011

7. Antenatal care and length of stay

10. Method of birth

11. Multiple births

Pregnancy Outcome in South Australia 2011

13. Perinatal mortality

14. Congenital Anomalies

Pregnancy Outcome in South Australia 2011

1. The Perinatal Statistics Collection

2. The Abortion Statistics Collection

Pregnancy Outcome in South Australia 2011

Mothers and Babies

II. Mothers And Babies: Characteristics & Outcomes

1. Place of residence of mother

Adelaide - Central and Hills

Eyre Peninsula and South West

Outback - North and East

Fleurieu - Kangaroo Island

Murray and Mallee