Australia’s mothers and babies 2006

The Australian Institute of Health and Welfare is Australia’s national health and welfare statistics and information agency. The Institute’s mission is better information and statistics for better health and wellbeing.
The AIHW National Perinatal Statistics Unit (NPSU) is a collaborating unit of the AIHW, established in 1979. The NPSU aims to improve the health of Australian mothers and babies through the collection, analysis and reporting of information on reproductive, perinatal and maternal health. It maintains national collections on perinatal health, maternal deaths, congenital anomalies and assisted reproduction technology. The NPSU is located at the Sydney Children’s Hospital and is part of the School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales.

Please note that as with all statistical reports there is the potential for minor revisions of data in this report over its life. Please refer to the online version at <www.npsu.unsw.edu.au>.

Australia’s mothers and babies 2006

Paula Laws
Lisa Hilder
December 2008

© Australian Institute of Health and Welfare 2008

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Australian Institute of Health and Welfare. Requests and enquiries concerning reproduction and rights should be directed to the Head, Media and Communications Unit, Australian Institute of Health and Welfare, GPO Box 570, Canberra ACT 2601.

This publication is part of the AIHW National Perinatal Statistics Unit’s Perinatal statistics series. A complete list of the Institute’s publications is available from the Institute’s website <www.aihw.gov.au>. 

ISSN 1321-8336
ISBN 978 1 74024 865 5

Suggested citation 
Laws PJ & Hilder L 2008. Australia’s mothers and babies 2006. Perinatal statistics series no. 22. 
Cat. no. PER 46. Sydney: AIHW National Perinatal Statistics Unit.
Australian Institute of Health and Welfare 
Board Chair
Hon. Peter Collins, AM, QC

Director 
Penny Allbon

Any enquiries about or comments on this publication should be directed to:
AIHW National Perinatal Statistics Unit
Sydney Children’s Hospital
Level 2, McNevin Dickson Building
Randwick Hospitals Campus
Randwick NSW 2031
AUSTRALIA
Phone: (02) 9382 1014
Fax: (02) 9382 1025
Email: npsu@med.unsw.edu.au
Website: <www.npsu.unsw.edu.au>

Published by the AIHW National Perinatal Statistics Unit
Printed by 

Contents
Acknowledgments
Abbreviations
Key findings
1	Introduction
Purpose of this report
Structure of this report
The Perinatal National Minimum Data Set
The National Perinatal Data Development Committee
National Perinatal Data Collection
Explanatory notes
Data quality
Data presentation
2	Summary data
Women who gave birth and births
Summary measures of perinatal health
3	Mothers
Demographic profile
Maternal characteristics and risk factors
Labour and birth characteristics
Women who gave birth in hospitals
Homebirths
Maternal mortality
4	Babies
Demographic profile
Outcomes
Hospital births
5	Perinatal mortality
Definitions
Fetal deaths
Neonatal deaths
Perinatal deaths
Appendix 1: Data used in figures
Appendix 2: Perinatal National Minimum Data Set items
Appendix 3: State and territory perinatal reports
Appendix 4: State and territory perinatal data collection contacts
Glossary
References
List of tables
List of figures

Acknowledgments
The Australian Institute of Health and Welfare National Perinatal Statistics Unit (NPSU) is a formally affiliated institution of the University of New South Wales (UNSW) and is linked to the School of Women’s and Children’s Health. We would like to acknowledge the support of the NPSU by the School of Women’s and Children’s Health, UNSW and the Sydney Children’s Hospital.
The NPSU values the time, effort and expertise contributed by all states and territories in the collection and provision of the data used in this report. We would like to acknowledge the staff members of the state and territory health authorities who provided data and reviewed the tables for this report: 
Lee Taylor and Kim Lim, Centre for Epidemiology and Research, NSW Department of Health
Merilyn Riley and Odette Taylor, Perinatal Data Collection Unit, and Rosemary Warren, Consultative Council on Obstetric & Paediatric Mortality & Morbidity, Department of Human Services, Victoria
Sue Cornes, Joanne Bunney, Colleen Morris and Vesna Dunne, Health Statistics Centre, Queensland Health
Max Le and Arlene Ernstzen, Maternal and Child Health Unit, Department of Health, Western Australia
Annabelle Chan, Kevin Priest and Joan Scott, Pregnancy Outcome Statistics Unit, Department of Health, South Australia
Peter Mansfield and Helen Galea, Divisional Support Unit, Department of Health and Human Services, Tasmania
Maureen Bourne, Population Health Research Centre, ACT Health
Cheryl McCullough, Hua Zhao and Christine Greenall, Department of Health and Families, Northern Territory.
Within the NPSU, Elizabeth Sullivan assisted with the strategic direction of the report and Jishan Dean assisted in database management. Within the AIHW, John Stegall and Cecilia Burke coordinated the printing and publication process.
Abbreviations
ABS			Australian Bureau of Statistics
ACT			Australian Capital Territory
AIHW			Australian Institute of Health and Welfare
ASCCSS		Australian Standard Classification of Countries for Social Statistics
ASGC			Australian Standard Geographical Classification
g			gram
IPPR			intermittent positive pressure respiration
LMP			first day of the last menstrual period
METeOR		metadata online registry
MMR			maternal mortality ratio
NHDD			National Health Data Dictionary
NHISSC		National Health Information Standards and Statistics Committee
NICU			neonatal intensive care unit
NMDS			National Minimum Data Set
NPDC			National Perinatal Data Collection
NPDDC		National Perinatal Data Development Committee
NPSU 			AIHW National Perinatal Statistics Unit
NSW			New South Wales 
NT			Northern Territory
PSANZ-PDC		Perinatal Society of Australia and New Zealand Perinatal Death 				Classification
Qld			Queensland 
SA			South Australia
SACC			Standard Australian Classification of Countries
SCN			special care nursery
Tas			Tasmania
UNSW			University of New South Wales
Vic			Victoria
WA			Western Australia
WHO			World Health Organization

n.a.			not available
n.p.			not published
Key findings
Australia’s mothers and babies 2006 is the 16th annual report on pregnancy and childbirth in Australia. The report provides national information on women who gave birth in 2006 and the characteristics and outcomes of their babies. The report is based primarily on the National Perinatal Data Collection. 
In 2006, 277,436 women gave birth to 282,169 babies in Australia. This included 280,078 live births and 2,091 fetal deaths. The increase in births continued, with 9,750 more births (3.6%) than reported in 2005. 
Mothers
Of women who gave birth in 2006:
•	their age at the time of birth has increased  
–	the average age was 29.8 years, compared with 28.7 years in 1997 
–	21.4% were aged 35 years or older, up from 15.0% in 1997
–	more had deferred starting a family, with 14.0% of first births being to women aged 35 years or older, compared with 8.3% in 1997 
•	10,183 were of Aboriginal or Torres Strait Islander origin, making up 3.7% of all mothers
•	41.6% gave birth for the first time, with an average age of 28.2 years
•	17.3% reported smoking at all during pregnancy, showing no real change over the previous four years
•	1.7% had a multiple pregnancy, compared with 1.4% in 1997
•	25.1% had their labours induced, the most commonly reported reason being prolonged pregnancy
•	58.1% had a spontaneous vaginal birth, 0.4% had a vaginal breech birth, while deliveries using forceps accounted for 3.5% and vacuum extractions for 7.2%
•	30.8% gave birth by caesarean section, compared with 20.3% in 1997
•	83.5% of those who had previously had a caesarean section had a further caesarean section in 2006
•	the median length of stay in hospital was 3.0 days, and was longer for women who had a caesarean section (5.0 days).
Babies 
Of babies born in 2006:
•	8.2% were preterm (less than 37 weeks gestation), compared with 7.3% in 1997
•	6.4% of liveborn babies were of low birthweight (less than 2,500 grams)
•	14.9% of liveborn babies were admitted to a special care nursery or neonatal intensive care unit
the death rate prior to birth was 7.4 per 1,000 births and the death rate up to 28 days after birth was 3.0 per 1,000 live births, giving a total perinatal death rate of 10.3 per 1,000 births. The most common cause of perinatal death was congenital abnormality. 
1	Introduction
Australia’s mothers and babies 2006 is the 16th in the annual series prepared by the Australian Institute of Health and Welfare’s (AIHW) National Perinatal Statistics Unit (NPSU). The report provides national information on the pregnancy and childbirth of mothers, and the characteristics and outcomes of their babies. It is a collaborative effort of the NPSU and states and territories, and can be used by researchers, academics, students, policy makers and health service planners, and those providing services in reproductive health. The report is based primarily on data from the National Perinatal Data Collection (NPDC). 
Purpose of this report
The purpose of Australia’s mothers and babies 2006 is to provide information on the women who gave birth to liveborn or stillborn babies in 2006, and on their babies. 
This is achieved through: 
•	reporting against the Perinatal National Minimum Data Set
•	providing national information on women who gave birth in 2006, including demographics, risk factors and characteristics relating to the pregnancy, childbirth and puerperium
•	providing national information on the characteristics and perinatal outcomes of babies born in 2006 
•	providing information for state and territory comparison
•	providing information for international comparison.
Structure of this report
This chapter provides background information and describes the data source. 
The remainder of this report is divided into the following chapters:
•	Chapter 2: Summary data
This chapter contains summary data on the number of women who gave birth and the number of babies born in 2006, as well as key perinatal health measures derived from the NPDC. 
•	Chapter 3: Mothers
This chapter contains information on women who gave birth in 2006, including their demographic profile (e.g. maternal age), maternal characteristics (e.g. parity), and characteristics of the labour, birth and puerperium (e.g. onset of labour, method of birth, perineal status).
•	Chapter 4: Babies
This chapter contains information on the characteristics and outcomes of babies born in 2006, including birth status, gestational age, birthweight and sex ratios.
•	
Chapter 5: Perinatal mortality
This chapter includes data from the NPDC on fetal, neonatal and perinatal deaths. It also presents deaths from some jurisdictions classified using the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ-PDC).
Appendix 1 presents the underlying data for the figures in the report. 
The Perinatal National Minimum Data Set
An NMDS is a core set of data elements endorsed by the National Health Information Standards and Statistics Committee (NHISSC) for mandatory collection and reporting at a national level. An NMDS includes agreement on specified data elements as well as the scope of the application of those data elements and the statistical units for collection. Definitions of all data elements that are included in National Minimum Data Sets are included in the AIHW’s online metadata registry, ‘METeOR’.
The Perinatal NMDS is a specification for data collected on all births in Australia in hospitals, birth centres and the community. Data are collected from perinatal administrative and clinical record systems and forwarded regularly to the relevant state or territory health authority. Data for the year ending 31 December are then provided annually to the NPSU for national collation.
The Perinatal NMDS was first specified in 1997. It includes data items relating to the mother, including demographic characteristics and factors relating to the pregnancy, labour and birth, and data items relating to the baby, including birth status, sex and birthweight. A recent evaluation of compliance with the Perinatal NMDS specifications showed an improvement for 2005 data (Laws 2008).
Current definitions are available in the National health data dictionary (NHDD) Version 13 (HDSC 2006) and on METeOR online at <www.meteor.aihw.gov.au>. A list of the current Perinatal NMDS data elements can be found in Appendix 2. Versions 12 and 13 of the NHDD were current at the time of collection of the 2006 data (NHDC 2003; HDSC 2006).
The National Perinatal Data Development Committee
The primary role of the National Perinatal Data Development Committee (NPDDC) is to undertake perinatal data development. New data items and changes to existing items that are endorsed by the Committee are submitted to NHISSC for endorsement for inclusion in METeOR and the Perinatal NMDS. The NPDDC is comprised of representatives from each state and territory health authority, the Australian Bureau of Statistics (ABS) and the NPSU, with temporary members invited on a transitory basis as their expertise is required. The Committee works in consultation with clinical reference groups.
A program of perinatal data development has led to improvements in data provision and reporting. The program of data development involves revision of existing Perinatal NMDS items, data development work on existing perinatal METeOR items and the development of new perinatal items. 

National Perinatal Data Collection
The 2006 national data on births are based on notifications to the perinatal data collection in each state and territory. Midwives and other staff, using information obtained from mothers and from hospital or other records, complete notification forms for each birth in each jurisdiction. Information is included in the NPDC for all live births and stillbirths of at least 400 grams birthweight or at least 20 weeks gestation. Figure 1.1 shows the pathway of perinatal data to the NPSU for national collation.

Figure 1.1: Schematic flowchart of perinatal data collection	

Each state and territory collects more information than is specified on the Perinatal NMDS, and the NPSU requests some of these additional items. The information includes characteristics of the mother, such as previous pregnancies and perineal status after vaginal birth, and characteristics of the baby, such as resuscitation and admission to special care nursery or neonatal intensive care unit. New data items were requested for 2006: main reason for induction of labour and main reason for caesarean section.
The state and territory health authorities undertake data processing, analysis and publication of reports. Each state and territory provided data in an electronic format to the NPSU. Due to data editing and subsequent updates of state and territory databases, the numbers in this report may differ slightly from those in reports published by the states and territories. See Appendix 3 for a list of state and territory reports on the 2006 data and Appendix 4 for state and territory contact details.
Explanatory notes
Tabulated data in this report are based on births in each state and territory in 2006 meeting the criteria for inclusion in the NPDC. Each state and territory has its own form and/or electronic system for collecting perinatal data. Unless otherwise stated, the data in this report relate to the state or territory of occurrence of births in 2006 rather than to the state or territory of usual residence of the mother. 
Data are presented for all states and territories where available. Although the perinatal collections are based on the NMDS, in some jurisdictions the data are collected in different categories. Where data are not available from all states and territories in the required format, this is indicated in the footnotes of tables or figures.  
All states and territories have a data item to record Indigenous status on their perinatal form, although there are some differences among the jurisdictions. According to the NHDD, Indigenous status is a measure of whether a person identifies as being of Aboriginal or Torres Strait Islander origin (NHDC 2003). This separately identifies mothers as those of Aboriginal and Torres Strait Islander origin, and non-Indigenous mothers. No information is collected about the father’s or baby’s Indigenous status. 
The number of babies is marginally higher than the number of mothers because of multiple births. The terms ‘mothers’ or ‘women who gave birth’ have been used in this report when referring to maternal characteristics, whereas ‘births’ refers to babies.
Australian Capital Territory data
The Australian Capital Territory data contain a high proportion of New South Wales residents who gave birth in the Australian Capital Territory. The proportion of non-residents who gave birth in the Australian Capital Territory was 16.3% in 2006. When interpreting the data it is important to note that these births to non-residents are likely to include a greater proportion of high risk and multi-fetal pregnancies associated with poorer perinatal outcomes. Therefore, percentages or rates such as those for preterm birth and perinatal deaths may be inflated for births in the Australian Capital Territory. 
Data quality 
The data received from states and territories are checked for completeness, validity and logical errors. Changes are made as necessary in consultation with the state and territory perinatal data providers. 
Quality of Indigenous status data
All jurisdictions are working towards improving the ascertainment of Indigenous status in their perinatal collections. In 2007, the NPSU, in collaboration with the AIHW’s Aboriginal and Torres Strait Islander Health and Welfare Unit, released a report on Indigenous mothers and their babies. This project included an assessment of Indigenous status data quality (Leeds et al. 2007). 
There are a small number of Aboriginal and Torres Strait Islander mothers who give birth in the Australian Capital Territory, and the proportion fluctuates from year to year, making this jurisdiction less comparable to other jurisdictions. In 2006, 76 of the 105 Aboriginal or Torres Strait Islander women who gave birth in the Australian Capital Territory were Australian Capital Territory residents. 
Data presentation
This report presents perinatal data that can largely be compared with data presented in Australia’s mothers and babies 2005 (Laws et al. 2007). There are three new tables: Tables 3.16, 3.20 and 3.25.
Cell sizes of less than five in state and territory tables have not been published in line with AIHW guidelines for protecting privacy of individuals (SIMC 2007). Exceptions to this are small numbers in ‘Other’ and ‘Not stated’ categories. Where n.p. (not published) has been used to protect confidentiality, the suppressed numbers are included in the totals.
Throughout the report, for totals, percentages may not add up to 100.0, and for subtotals, they may not add up to the sum of the percentages for the categories. This is due to rounding.
For multiple pregnancies, items presented for mothers which may be different for each baby, such as place of birth, are classified according to the characteristics of the first born baby. Where these items are presented for babies, each baby of a multiple birth is assigned the value of the first born baby. The exceptions are gestational age, presentation at birth and method of birth, for which the value for each baby of a multiple birth is presented.
Minor changes to data presentation, including where a jurisdiction has not provided a data item or data have not been published for other reasons, are detailed in the footnotes to the tables.
2	Summary data
Women who gave birth and births
There were 277,436 women who gave birth in 2006 reported to the NPDC, resulting in a total of 282,169 births. Of these, 2,091 were fetal deaths (Table 2.1). This showed an increase of 9,750 births (3.6%) from the 272,419 reported in 2005.
Table 2.1: Women who gave birth and births, by state and territory, 2006
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
Mothers	91,303	68,547	   55,719 	   28,253 	  18,518 	6,053	     5,354 	    3,689 	   277,436 	
										
Fetal deaths	592	626	       391 	       209 	       140 	42	         50 	        41 	       2,091 	
Live births	92,176	69,230	   56,317 	   28,455 	  18,662 	6,101	     5,435 	    3,702 	   280,078 	
All births	92,768	69,856	   56,708 	   28,664 	  18,802 	6,143	     5,485 	    3,743 	   282,169 	

Ten years earlier, in 1997, there were 257,032 births. The number of births has been increasing since 2001, when the lowest number of births was reported (254,326) (Figure 2.1).

Figure 2.1: Number of births, 1997 to 2006
There were 280,078 live births in 2006 reported to the NPDC (Table 2.1). This was 14,129 more than the 265,949 live births registered in Australia in 2006 (ABS 2007). For further information about the differences between these data collections, see Australia’s mothers and babies 2005 (Laws et al. 2007).

Summary measures of perinatal health
Table 2.2 presents summary perinatal health information for Australia derived from the NPDC for births in 2006. Data include measures of pregnancy-related interventions, maternal risk factors and birth outcomes.
Table 2.2: Summary measures of perinatal health for Australia, 2006
Variable	Description of measure	Value	
Maternal age 	Percentage of mothers who were teenagers (less than 20 years) 	4.3	
Maternal age 	Percentage of first-time mothers aged 35 years and older 	14.0	
Smoking	Percentage of women smoking at all during pregnancy(a) 	17.3	
Indigenous status	Percentage of mothers who identified as Aboriginal or Torres Strait Islander	3.7	
Maternal country of birth 	Percentage of mothers born in Australia	76.3	
Hospital sector 	Percentage of women who gave birth in hospital who were in public hospitals	70.1	
Multiple pregnancy 	Multiple pregnancies per 1,000 mothers	16.7	
Spontaneous onset of labour	Percentage of mothers who had a spontaneous onset of labour 	56.6	
Induction of labour	Percentage of mothers who had an induced onset of labour	25.1	
Instrumental vaginal deliveries	Percentage of mothers who had an instrumental (forceps or vacuum extraction) delivery(b) 	10.7	
Caesarean section	Percentage of mothers who had a caesarean section(b) 	30.8	
Previous caesarean section	Percentage of multiparous mothers having had previous caesarean sections	25.8	
Mother’s postnatal stay 	Median length of stay in hospital of birth (days) for those who were discharged home	3.0	
Preterm birth	Percentage of all births that were less than 37 weeks gestation	8.2	
Low birthweight	Percentage of liveborn babies weighing less than 2,500 grams at birth	6.4	
Apgar scores	Percentage of liveborn babies with an Apgar score of less than 7 at 
5 minutes 	1.3	
Assisted reproduction technology	Estimated percentage of births resulting from assisted reproduction technology treatment(c) 	3.1	
Perinatal death rate	Perinatal deaths per 1,000 births	10.3	
(a) 	Excludes Vic.
(b)	For multiple births, the method of birth of the first born baby was used. 
(c) 	The source for the number of babies born following assisted reproduction technology was the Australian and New Zealand Assisted Reproduction Database (ANZARD) held by NPSU.
3	Mothers
Demographic profile
Maternal age
Maternal age is an important risk factor for both obstetric and perinatal outcome. Adverse outcomes are more likely to occur in younger and older mothers (Gortzak-Uzan et al. 2001; Joseph et al. 2005). The age of mothers ranged from less than 15 years to 55 years in 2006. The average age of women who gave birth in Australia has increased gradually in recent years. The mean age in 2006 was 29.8 years, compared with 28.7 years in 1997, while the median age in 2006 was 30.0 years. The trend in delayed childbearing can be attributed to a number of factors including social, educational and economic, and increased access to assisted reproduction technology (Carolan 2003; Cleary-Goldman et al. 2005). 
In 2006, the average age of mothers was higher in Victoria and the Australian Capital Territory (both 30.6 years) and lower in the Northern Territory lower (27.4 years) than the national average (Table 3.1). Nationally, the number of teenage mothers (less than 20 years) dropped from 13,234 in 1997 to 11,977 in 2006, a decline of 9.5% over the decade. The proportion of women who gave birth in 2006 who were teenagers was 4.3%, and ranged from a low of 2.5% in the Australian Capital Territory to 13.3% in the Northern Territory.
The proportion of mothers aged 20–24 years fell from 17.1% in 1997 to 14.6% in 2006 (40,461 mothers). The proportion of older mothers, aged 35 years and over, has continued to increase from 15.0% in 1997 to 21.4% in 2006.

Table 3.1: Women who gave birth by maternal age and state and territory, 2006
Maternal age (years)	NSW	Vic(a)	Qld	WA	SA(b)	Tas	ACT(c)	NT	Australia	
Mean	30.0	30.6	       29.1 	       29.4 	      29.5 	28.5	30.6	      27.4 	         29.8 	
	Number	
Less than 20	     3,470 	      1,964 	     3,076 	     1,514 	       892 	       439 	       133 	       489 	     11,977 	
20–24	   12,683 	      7,825 	     9,739 	     4,635 	     2,920 	     1,234 	       593 	       832 	     40,461 	
25–29	   24,551 	    17,142 	    15,376 	     7,427 	     5,049 	     1,652 	     1,395 	       912 	     73,504 	
30–34	   30,780 	    24,877 	    17,174 	     8,897 	     5,879 	     1,715 	     1,932 	       909 	     92,163 	
35–39	   16,525 	    14,031 	     8,750 	     4,885 	     3,210 	       853 	     1,094 	       454 	     49,802 	
40 and over	     3,236 	      2,700 	     1,604 	        895 	       568 	       160 	       207 	         92 	       9,462 	
Not stated	         58 	            8 	   —  	—	—	—   	—   	           1 	            67 	
Total	   91,303 	    68,547 	    55,719 	    28,253 	   18,518 	     6,053 	     5,354 	     3,689 	   277,436 	
	Per cent	
Less than 20	        3.8 	         2.9 	         5.5 	         5.4 	        4.8 	        7.3 	        2.5 	      13.3 	           4.3 	
20–24	      13.9 	        11.4 	       17.5 	       16.4 	      15.8 	      20.4 	      11.1 	      22.6 	         14.6 	
25–29	      26.9 	        25.0 	       27.6 	       26.3 	      27.3 	      27.3 	      26.1 	      24.7 	         26.5 	
30–34	      33.7 	        36.3 	       30.8 	       31.5 	      31.7 	      28.3 	      36.1 	      24.6 	         33.2 	
35–39	      18.1 	        20.5 	       15.7 	       17.3 	      17.3 	      14.1 	      20.4 	      12.3 	         18.0 	
40 and over	        3.5 	         3.9 	         2.9 	         3.2 	        3.1 	        2.6 	        3.9 	        2.5 	           3.4 	
Not stated	        0.1 	         0.0 	—	—	—	—   	         —   	        0.0 	           0.0 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	       100.0 	
(a)	For Vic, maternal ages presented here may differ from those produced by the Victorian Perinatal Data Collection Unit, due to rounding differences.
(b)       For SA, the mean maternal age presented here may differ from that produced by the Pregnancy Outcome Statistics Unit, that used maternal age to four decimal places for this calculation. The NPDC contains maternal age in completed years.
(c)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages.
Aboriginal and Torres Strait Islander mothers
The data presented on Indigenous status are influenced by the quality and completeness of Indigenous identification, which may vary among jurisdictions. Further detail about the collection and reporting of Indigenous status data are presented in the report Indigenous mothers and their babies, Australia 2001–2004 (Leeds et al. 2007).
In 2006, 10,183 women who identified as being Aboriginal or Torres Strait Islander gave birth in Australia, representing 3.7% of all women who gave birth. Aboriginal or Torres Strait Islander mothers accounted for a much greater proportion of all mothers in the Northern Territory (39.6%) than in other jurisdictions. There were also high proportions of Aboriginal or Torres Strait Islander mothers in Western Australia (6.2%) and Queensland (5.3%). Because of their larger overall populations, there were more Aboriginal or Torres Strait Islander women who gave birth in Queensland (2,937), New South Wales (2,610) and Western Australia (1,741) than in the Northern Territory (1,461) (Table 3.2).

Table 3.2: Women who gave birth by Indigenous status and state and territory, 2006
Indigenous status	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
	Number	
Aboriginal or Torres Strait Islander	     2,610 	        565 	     2,937 	     1,741 	       548 	        216 	       105 	    1,461 	   10,183 	
Non-Indigenous	   88,165 	   67,957 	   52,768 	   26,512 	   17,969 	     5,837 	    5,227 	    2,193 	 266,628 	
Not stated	        528 	          25 	          14 	—	           1 	—   	         22 	         35 	       625 	
Total	   91,303 	  68,547 	   55,719 	   28,253 	   18,518 	     6,053 	    5,354 	    3,689 	 277,436 	
	Per cent	
Aboriginal or Torres Strait Islander	         2.9 	         0.8 	         5.3 	         6.2 	        3.0 	         3.6 	        2.0 	      39.6 	        3.7 	
Non-Indigenous	       96.6 	       99.1 	       94.7 	       93.8 	      97.0 	       96.4 	      97.6 	      59.4 	      96.1 	
Not stated	         0.6 	         0.0 	         0.0 	—	        0.0 	—   	        0.4 	        0.9 	        0.2 	
Total	    100.0 	    100.0 	    100.0 	    100.0 	    100.0 	    100.0	    100.0 	  100.0 	     100.0 	
(a)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, 76 of the 105 Aboriginal or Torres Strait Islander women who gave birth in the ACT in 2006 were ACT residents.  
More Aboriginal or Torres Strait Islander mothers have their babies at a younger age compared with non-Indigenous mothers. The average age of Aboriginal or Torres Strait Islander women who gave birth in 2006 was 25.0 years, compared with 30.0 years for non-Indigenous mothers. More than one in five (20.9%) Aboriginal or Torres Strait Islander mothers were teenagers, compared with 3.7% of non-Indigenous mothers.
Geographical location of the mother’s usual residence
State and territory of the mother’s usual residence
Table 3.3 shows that, of women who gave birth in the Australian Capital Territory, 16.3% lived outside of the Australian Capital Territory (16.2% in New South Wales). For the remaining jurisdictions, the proportion of women who gave birth outside their state or territory of usual residence ranged from 0.1% in both Western Australia and Tasmania to 2.7% in the Northern Territory.

Table 3.3: Women who gave birth by state and territory of usual residence and state and territory of birth, 2006
State/territory of usual residence	State/territory of birth	
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Total	
	Number	
NSW	   90,573 	      1,273 	        437 	           9 	         30 	—   	       870 	         10 	    93,202 	
Vic	         20 	    67,150 	          16 		<5	         35 	<5	<5	<5	    67,229 	
Qld	       550 	n.p. 	   55,200 	<5	           8 	          —   	— 	           5 	    55,793 	
WA	           7 	          16 	           8 	   28,219 	<5	<5	—	         31 	    28,284 	
SA	<5 	          23 	<5	<5	   18,416 	—	<5	         50 	    18,497 	
Tas	<5	          20 	<5	—   	           6 	     6,047 	—	          —   	      6,076 	
ACT	         45 	<5	—	<5	—	—	     4,480 	<5	      4,528 	
NT	<5	            5 	          14 	          10 	         20 	—	<5	     3,587 	      3,640 	
Non-resident(a)	         98 	          30 	          38 	<5	<5	<5	—	          — 	         173 	
Not stated	           4 	—	—	           8 	—	—	—	           2 	           14 	
Total	   91,303 	    68,547 	   55,719 	   28,253 	   18,518 	     6,053 	     5,354 	     3,689 	  277,436 	
	Per cent	
NSW	      99.2 	         1.9 	         0.8 	         0.0 	        0.2 	—   	      16.2 	        0.3 	        33.6 	
Vic	        0.0 	        98.0 	         0.0 	n.p.	        0.2 	n.p.	n.p.	n.p.	        24.2 	
Qld	        0.6 	n.p.	       99.1 	n.p.	        0.0 	—	—   	        0.1 	        20.1 	
WA	        0.0 	         0.0 	         0.0 	       99.9 	n.p.	n.p.	—	        0.8 	        10.2 	
SA	n.p.	         0.0 	n.p.	n.p.	      99.4 	—	n.p.	        1.4 	          6.7 	
Tas	n.p.	         0.0 	n.p.	—   	        0.0 	      99.9 	—	          —   	          2.2 	
ACT	        0.0 	n.p.	—	n.p.	—	—	      83.7 	n.p.	          1.6 	
NT	n.p.	         0.0 	         0.0 	         0.0 	        0.1 	—	n.p.	      97.2 	          1.3 	
Non-resident(a)	        0.1 	         0.0 	         0.1 	n.p.	n.p.	n.p.	—	          —	          0.1 	
Not stated	0.0	—	—	         0.0 	—	—	—	        0.1 	          0.0 	
Total	    100.0 	     100.0 	100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	      100.0 	
(a)	Not usually resident in Australia.
n.p.	Data not published to maintain confidentiality of small numbers.
Remoteness Area of the mother’s usual residence
Data on the geographical location of the usual residence of the mother were provided as state and Statistical Local Area (a small unit within the ABS’s Australian Standard Geographical Classification (ASGC)) and/or postcode. These data have been mapped to levels of remoteness using the ASGC remoteness structure. 
The distribution of Remoteness Area of mothers varied by state and territory of usual residence. In Queensland, 59.4% of women who gave birth resided in major cities compared with around 70.0% in the other populous states. The Northern Territory and Australian Capital Territory presented different profiles of Remoteness Area, with almost all Australian Capital Territory resident mothers giving birth in a major city compared with Northern Territory women who lived in outer regional, remote and very remote areas (Table 3.4). 
Table 3.4: Women who gave birth by Remoteness Area of usual residence and state and territory of usual residence, 2006
Remoteness Area	State/territory of usual residence	
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Total	
	Number	
Major cities	   70,194 	    51,335 	   33,136 	   19,661 	   13,376 	          —   	     4,519 	 —	    192,221 	
Inner regional	   16,785 	    12,925 	   11,313 	     3,329 	     2,144 	     3,981 	           8 	 —	      50,485 	
Outer regional	     5,566 	      2,936 	     8,961 	     2,783 	     2,198 	     1,997 	 —	     1,882 	      26,323 	
Remote	       549 	           28 	     1,444 	     1,556 	       562 	         80 	 —	       820 	        5,039 	
Very remote	         99 	—   	        936 	        936 	       216 	         18 	 —	       928 	        3,133 	
Total	   93,193 	    67,224 	   55,790 	   28,265 	   18,496 	     6,076 	     4,527 	     3,630 	 277,201	
	Per cent	
Major cities	      75.3 	        76.4 	       59.4 	       69.6 	      72.3 	     —  	      99.8 	 —	          69.3 	
Inner regional	      18.0 	        19.2 	       20.3 	       11.8 	      11.6 	      65.5 	        0.2 	 —	          18.2 	
Outer regional	        6.0 	          4.4 	       16.1 	         9.8 	      11.9 	      32.9 	 —	      51.8 	            9.5 	
Remote	        0.6 	          0.0 	         2.6 	         5.5 	        3.0 	        1.3 	 —	      22.6 	            1.8 	
Very remote	        0.1 	          —   	         1.7 	         3.3 	        1.2 	        0.3 	 —	      25.6 	            1.1 	
Total	    100.0 	    100.0 	100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	       100.0 	
Note: Excludes mothers not usually resident in Australia and those whose state or territory of usual residence was ‘Not stated’.
Remoteness Area of mother’s usual residence also varied by Indigenous status. Of non-Indigenous women who gave birth in 2006, 71.0% lived in major cities, followed by 18.2% in inner regional areas. Aboriginal and Torres Strait Islander women were more evenly spread across Remoteness Areas, with 26.5% living in major cities and 26.2% in outer regional areas. Few non-Indigenous women who gave birth lived in very remote areas compared with Indigenous mothers (0.5% compared with 17.7%) (Table 3.5).  

Table 3.5: Women who gave birth by Remoteness Area of usual residence and Indigenous status, 2006
Remoteness Area	Indigenous	Non-Indigenous	Not stated	Total	
	Number	
Major cities	        2,694 	      189,132 	        409 	      192,235 	
Inner regional	        1,878 	        48,478 	        129 	        50,485 	
Outer regional	        2,664 	        23,594 	          68 	        26,326 	
Remote	        1,136 	          3,896 	            8 	          5,040 	
Very remote	        1,802 	          1,328 	            3 	          3,133 	
Total	      10,174 	      266,428 	        617 	      277,219 	
	Per cent	
Major cities	26.5	71.0	66.3	69.3	
Inner regional	18.5	18.2	20.9	18.2	
Outer regional	26.2	8.9	11.0	9.5	
Remote	11.2	1.5	1.3	1.8	
Very remote	17.7	0.5	0.5	1.1	
Total	    100.0 	     100.0 	100.0 	       100.0 	
Note: Excludes mothers not usually resident in Australia.
Maternal country of birth
The country of birth of the mother may be an important risk factor for outcomes such as low birthweight and perinatal mortality. For 2006, seven of the jurisdictions used the four-digit ABS Standard Australian Classification of Countries (SACC) (ABS 1998) to classify countries of birth and one jurisdiction used the ABS Australian Standard Classification of Countries for Social Statistics (ASCCSS).
Of women who gave birth in Australia in 2006, 23.1% were born in countries other than Australia. Mothers born in the United Kingdom constituted 3.0% of all mothers and accounted for a relatively higher proportion of all mothers in Western Australia (7.1%). New Zealand-born mothers constituted 2.7% of all women who gave birth. One in 12 women who gave birth was born in an Asian country (8.6%). Larger proportions of mothers born in non-English speaking countries gave birth in the more populous states, New South Wales and Victoria (Table 3.6). 

Table 3.6: Women who gave birth by country of birth and state and territory, 2006
Country of birth	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
Australia	   65,217 	    51,509 	    46,002 	    20,533 	   15,670 	   5,676 	   4,284 	2,772	  211,663 	
New Zealand	     2,343 	      1,335 	      2,639 	         899 	       200 	       49 	        91 	56	      7,612 	
United Kingdom	     2,334 	      1,762 	      1,333 	      1,998 	       577 	       69 	      115 	62	      8,250 	
Former Yugoslavia	       279 	         537 	          38 	          79 	         27 	—   	n.p. 	<5	         972 	
Other Europe and former USSR	     2,184 	      1,510 	         850 	         716 	411	       41 	      141 	33	      5,886 	
Lebanon	     1,547 	         464 	          30 	          22 	         23 	—	        n.p. 	<5	      2,100 	
Other Middle East and North Africa	     2,166 	      1,777 	         280 	         319 	       186 	       33 	        44 	8	      4,813 	
China and      Hong Kong	     2,125 	         969 	         290 	         170 	         99 	       13 	        60 	7	      3,733 	
India	     1,294 	      1,126 	         170 	         149 	       105 	       n.p. 	        82 	<5	      2,946 	
Philippines	     1,220 	         570 	         473 	         163 	       122 	       20 	        26 	44	      2,638 	
Vietnam	     1,720 	      1,565 	         361 	         299 	       280 	<5	        55 	n.p.	      4,298 	
Other Asia	     4,270 	      2,882 	      1,223 	      1,135 	       422 	       52 	      216 	90	    10,290 	
Northern America	       692 	         395 	         302 	         208 	         92 	       13 	        48 	14	      1,764 	
South and Central America and the Caribbean	       765 	         449 	         206 	         118 	         63 	       n.p. 	        43 	<5	      1,662 	
Africa (excluding North Africa)	     1,100 	      1,151 	         551 	         725 	       192 	       36 	        52 	20	      3,827 	
Other countries	     1,585 	         545 	         950 	          82 	         49 	       17 	        68 	18	      3,314 	
Not stated	       462 	            1 	          21 	         638 	    —  	—	          6 	540	      1,668 	
Total	   91,303 	    51,509 	    55,719 	    28,253 	   18,518 	   6,053 	   5,354 	3,689	  277,436 	
(continued)	

Table 3.6 (continued): Women who gave birth by country of birth and state and territory, 2006
Country of birth	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Per cent	
Australia	      71.4 	        75.1 	        82.6 	        72.7 	      84.6 	     93.8 	     80.0 	      75.1 	        76.3 	
New Zealand	        2.6 	         1.9 	         4.7 	         3.2 	        1.1 	      0.8 	       1.7 	        1.5 	          2.7 	
United Kingdom	        2.6 	         2.6 	         2.4 	         7.1 	        3.1 	      1.1 	       2.1 	        1.7 	          3.0 	
Former Yugoslavia	        0.3 	         0.8 	         0.1 	         0.3 	        0.1 	—	n.p. 	n.p.	          0.4 	
Other Europe and former USSR	        2.4 	         2.2 	         1.5 	         2.5 	        2.2 	      0.7 	       2.6 	        0.9 	          2.1 	
Lebanon	        1.7 	         0.7 	         0.1 	         0.1 	        0.1 	—	n.p.	n.p.	          0.8 	
Other Middle East and North Africa	        2.4 	         2.6 	         0.5 	         1.1 	        1.0 	      0.5 	       0.8 	        0.2 	          1.7 	
China and Hong Kong	        2.3 	         1.4 	         0.5 	         0.6 	        0.5 	      0.2 	       1.1 	        0.2 	          1.3 	
India	        1.4 	         1.6 	         0.3 	         0.5 	        0.6 	n.p.	       1.5 	n.p.	          1.1 	
Philippines	        1.3 	         0.8 	         0.8 	         0.6 	        0.7 	      0.3 	       0.5 	        1.2 	          1.0 	
Vietnam	        1.9 	         2.3 	         0.6 	         1.1 	        1.5 	n.p.	       1.0 	n.p.	          1.5 	
Other Asia	        4.7 	         4.2 	         2.2 	         4.0 	        2.3 	      0.9 	       4.0 	        2.4 	          3.7 	
Northern America	        0.8 	         0.6 	         0.5 	         0.7 	        0.5 	      0.2 	       0.9 	        0.4 	          0.6 	
South and Central America and the Caribbean	        0.8 	         0.7 	         0.4 	         0.4 	        0.3 	n.p.	       0.8 	n.p.	          0.6 	
Africa (excluding North Africa)	        1.2 	         1.7 	         1.0 	         2.6 	        1.0 	      0.6 	       1.0 	        0.5 	          1.4 	
Other countries	        1.7 	         0.8 	         1.7 	         0.3 	        0.3 	      0.3 	       1.3 	        0.5 	          1.2 	
Not stated	        0.5 	         0.0 	         0.0 	         2.3 	—   	—	       0.1 	      14.6 	          0.6 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	
n.p.	Data not published to maintain confidentiality of small numbers.
Maternal characteristics and risk factors
Parity
Parity is the number of a woman’s previous pregnancies that resulted in a birth. In 2006, 41.6% of mothers had their first baby and 33.4% had their second baby. One in six mothers (15.4%) had given birth twice previously and 9.4% had given birth three or more times (Table 3.7).
A parity of three or more was more common in mothers in the Northern Territory than mothers in the other states and the Australian Capital Territory. In the Northern Territory, 8.9% of mothers had given birth three times previously and 7.4% four or more times, compared with 5.6% and 3.8% respectively for Australia (Table 3.7).
In 2006, 30.5% of Aboriginal or Torres Strait Islander mothers were having their first baby and 69.2% had given birth previously. More than one-quarter of Indigenous women had given birth three or more times previously (27.4%).
Table 3.7: Women who gave birth by parity and state and territory, 2006
Parity	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
None	   37,852 	    29,641 	   22,208 	   11,804 	     7,623 	     2,458 	2,357	     1,390 	    115,333 	
One	   30,351 	    23,418 	   18,221 	     9,240 	     6,553 	     1,984 	1,892	     1,075 	     92,734 	
Two	   14,010 	    10,063 	     9,010 	     4,385 	     2,813 	       985 	708	       624 	     42,598 	
Three	     5,166 	      3,351 	     3,603 	     1,630 	       949 	       365 	269	       327 	     15,660 	
Four or more	     3,385 	      2,074 	     2,677 	     1,194 	       580 	       261 	128	       273 	     10,572 	
Not stated	       539 	—   	—  	—	—	—   	—   	—   	          539 	
Total	   91,303 	    68,547 	   55,719 	   28,253 	   18,518 	     6,053 	     5,354 	     3,689 	    277,436 	
	Per cent	
None	      41.5 	        43.2 	       39.9 	       41.8 	      41.2 	      40.6 	      44.0 	      37.7 	         41.6 	
One	      33.2 	        34.2 	       32.7 	       32.7 	      35.4 	      32.8 	      35.3 	      29.1 	         33.4 	
Two	      15.3 	        14.7 	       16.2 	       15.5 	      15.2 	      16.3 	      13.2 	      16.9 	         15.4 	
Three	        5.7 	         4.9 	         6.5 	         5.8 	        5.1 	        6.0 	        5.0 	        8.9 	           5.6 	
Four or more	        3.7 	         3.0 	         4.8 	         4.2 	        3.1 	        4.3 	        2.4 	        7.4 	           3.8 	
Not stated	        0.6 	—	        — 	—	—	—	—   	          —   	           0.2 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	       100.0 	

The average age of first-time mothers increased from 26.8 years in 1997 to 28.2 years in 2006. The median age of first-time mothers was 28.0 years in 2006. Nevertheless, in 2006 more than half of first-time mothers were aged less than 30 years (57.0%).
Figure 3.1 shows the increase in the proportion of first-time mothers in the older age groups between 1997 and 2006. Of women aged 35–39 years, 27.6% were first-time mothers compared with 22.6% in 1997. Of women aged 40 years and over, one-quarter had their first baby in 2006, compared with 20.8% in 1997. Of all first-time mothers, 14.0% were aged 
35 years or older in 2006, compared with 8.4% in 1997. The proportion of mothers who had given birth at least twice previously increased with maternal age from 2.1% for teenagers to 43.4% for mothers aged 40 years and over (Table 3.8). 

 
 Figure 3.1: First-time mothers in each maternal age group, 1997 and 2006 (per cent)	

Table 3.8: Women who gave birth by parity and maternal age, 2006
Parity	Less  than 20	20–24	25–29	30–34	35–39	40 and  over	Not stated	Total	
	Number	
None	      9,783 	    22,143 	    33,818 	    33,463 	    13,725 	        2,370 	          31 	    115,333 	
One	      1,935 	    12,611 	    23,623 	    33,695 	    17,915 	        2,941 	          14 	     92,734 	
Two	         217 	      4,231 	    10,131 	    15,640 	    10,481 	        1,889 	            9 	     42,598 	
Three	          28 	      1,137 	      3,807 	      5,433 	      4,258 	           991 	            6 	     15,660 	
Four or more	            5 	         299 	      2,018 	      3,742 	      3,278 	        1,225 	            5 	     10,572 	
Not stated	            9 	           40 	         107 	         190 	         145 	             46 	            2 	          539 	
Total	    11,977 	    40,461 	    73,504 	    92,163 	    49,802 	        9,462 	          67 	    277,436 	
	Per cent	
None	81.7	54.7	46.0	36.3	27.6	25.0	46.3	41.6	
One	16.2	31.2	32.1	36.6	36.0	31.1	20.9	33.4	
Two	1.8	10.5	13.8	17.0	21.0	20.0	13.4	15.4	
Three	0.2	2.8	5.2	5.9	8.5	10.5	9.0	5.6	
Four or more	0.0	0.7	2.7	4.1	6.6	12.9	7.5	3.8	
Not stated	0.1	0.1	0.1	0.2	0.3	0.5	3.0	0.2	
Total	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	

Previous caesarean sections
In 2006, 25.8% of multiparous women who gave birth in Australia had a history of previous caesarean section. This proportion ranged from 22.6% in the Australian Capital Territory to 29.3% in South Australia (Table 3.9).
Table 3.9: Multiparous women who gave birth by number of previous caesarean sections and state and territory, 2006
Previous caesarean sections	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Total	
	Number	
None	   38,781 	   28,591 	   24,117 	    11,819 	     7,705 	     2,773 	    2,003 	     1,719 	    117,508 	
At least one	   12,047 	   10,315 	     9,393 	     4,630 	     3,190 	       822 	       676 	       580 	     41,653 	
   One	     9,568 	    8,195 	     7,260 	 n.a. 	     2,557 	       636 	       564 	       439 	     29,219 	
   Two	     2,076 	    1,729 	     1,693 	 n.a. 	       523 	       149 	         90 	       102 	       6,362 	
   Three or more	       403 	       391 	       440 	 n.a. 	       110 	         37 	         22 	         39 	       1,442 	
Not stated	     2,084 	—	           1 	—	—	—	       318 	—   	       2,403 	
Total	   52,912 	   38,906 	   33,511 	    16,449 	   10,895 	     3,595 	    2,997 	     2,299 	    161,564 	
	Per cent	
None	      73.3 	      73.5 	      72.0 	       71.9 	      70.7 	      77.1 	      66.8 	      74.8 	         72.7 	
At least one	      22.8 	      26.5 	      28.0 	       28.1 	      29.3 	      22.9 	      22.6 	      25.2 	         25.8 	
   One	      18.1 	      21.1 	      21.7 	 n.a. 	      23.5 	      17.7 	      18.8 	      19.1 	         18.1 	
   Two	        3.9 	        4.4 	        5.1 	 n.a. 	        4.8 	        4.1 	        3.0 	        4.4 	           3.9 	
   Three or more	        0.8 	        1.0 	        1.3 	 n.a. 	        1.0 	        1.0 	        0.7 	        1.7 	           0.9 	
Not stated	        3.9 	—   	        0.0 	—	—	—	      10.6 	—   	           1.5 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	100.0 	100.0	   100.0 	       100.0 	
(a)       Care must be taken when interpreting percentages as 10.6% of data were not stated.
n.a. 	Data not available.
Smoking during pregnancy
Smoking is a risk factor for pregnancy complications, and is associated with poorer perinatal outcomes such as low birthweight, preterm birth, small for gestational age babies and perinatal death (Laws et al. 2006).
For 2006, data were available for seven states and territories: New South Wales, Queensland, Western Australia, South Australia, Tasmania, the Australian Capital Territory and the Northern Territory. The proportion of women who smoked while pregnant ranged from 13.5% in New South Wales to 29.3% in the Northern Territory. Overall, 17.3% of women in these states and territories smoked during pregnancy (Table 3.10). There has been no real change in this proportion over the previous four years.

Table 3.10: Women who gave birth by tobacco smoking status during pregnancy and state and territory, 2006
Smoking status	NSW	Vic	Qld	WA	SA(a)	Tas	ACT	NT(b)	Total	
	Number	
Smoked	   12,302 	 n.a. 	   11,298 	     4,941 	     4,082 	     1,647 	       741 	    1,081 	     36,092 	
Did not smoke	   77,408 	 n.a. 	   44,250 	   23,312 	   14,230 	     4,356 	     4,613 	    2,277 	   170,446 	
Not stated	     1,593 	   n.a. 	       171 	—   	       206 	         50 	—   	       331 	      2,351 	
Total	   91,303 	n.a.    	   55,719 	   28,253 	   18,518 	     6,053 	     5,354 	    3,689 	   208,889 	
	Per cent	
Smoked	      13.5 	 n.a. 	      20.3 	       17.5 	      22.0 	27.2	      13.8 	      29.3 	        17.3 	
Did not smoke	      84.8 	 n.a. 	      79.4 	       82.5 	      76.8 	72.0	      86.2 	      61.7 	        81.6 	
Not stated	        1.7 	   n.a. 	        0.3 	—   	        1.1 	0.8	          —   	       9.0 	          1.1 	
Total	100.0	 n.a. 	100.0	     100.0 	     100.0 	100.0	     100.0 	100.0	       100.0 	
(a)	For SA, ‘Smoked’ includes women who quit before the first antenatal visit.
(b)	For NT, smoking status was recorded at the first antenatal visit.
n.a.	Data not available.
Note: Mother’s tobacco smoking status during pregnancy is self-reported.
The average age of mothers who smoked during pregnancy was 27.0 years compared with 30.1 years for those who did not smoke. Teenage mothers accounted for 11.6% of all mothers who reported smoking during pregnancy, and 42.0% of teenagers reported smoking.
Aboriginal or Torres Strait Islander mothers accounted for 13.9% of mothers who smoked during pregnancy in the jurisdictions which provided smoking data. Over half of the Aboriginal and Torres Strait Islander mothers reported smoking during pregnancy (52.2%), compared with 15.6% of non-Indigenous women who gave birth.
Labour and birth characteristics
Place of birth
Actual place of birth
Most births in Australia occur in hospitals, in conventional labour-ward settings. There were 269,835 women who gave birth in hospitals (97.3%) in 2006 (Table 3.11). A further 5,460 women gave birth in birth centres (2.0%). Planned homebirths and other births, such as those occurring unexpectedly before arrival in hospital or in other settings, were the two categories accounting for the smallest proportion of women who gave birth (2,053 women, 0.7%). 

Table 3.11: Women who gave birth by actual place of birth and state and territory, 2006
Place of birth	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
Hospital	   88,844 	    66,705 	   54,898 	   27,688 	   17,091 	     5,920 	     5,127 	     3,562 	   269,835 	
Birth centre	     1,870 	      1,294 	       472 	       264 	     1,271 	         87 	       202 	—   	      5,460 	
Home	       125 	         197 	         47 	       194 	         86 	         12 	         13 	         34 	         708 	
Other	       385 	         351 	       300 	       107 	         70 	         34 	         12 	         (a)86 	      1,345 	
Not stated	         79 	—   	           2 	—	—	—   	—   	           7 	           88 	
Total	   91,303 	    68,547 	   55,719 	   28,253 	   18,518 	     6,053 	     5,354 	     3,689 	   277,436 	
	Per cent	
Hospital	      97.3 	        97.3 	      98.5 	      98.0 	      92.3 	      97.8 	      95.8 	      96.6 	        97.3 	
Birth centre	        2.0 	         1.9 	        0.8 	        0.9 	        6.9 	        1.4 	        3.8 	          —   	          2.0 	
Home	        0.1 	         0.3 	        0.1 	        0.7 	        0.5 	        0.2 	        0.2 	        0.9 	          0.3 	
Other	        0.4 	         0.5 	        0.5 	        0.4 	        0.4 	        0.6 	        0.2 	        (a)2.3 	          0.5 	
Not stated	        0.1 	—	        0.0 	—   	—	—	—   	        0.2 	          0.0 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	      100.0 	
(a)	The majority of these births occurred in remote community health centres.
Note: For multiple births, the place of birth of the first born baby was used. 
Intended place of birth
The jurisdictions collect intended place of birth at different times during the pregnancy. Victoria, South Australia and Tasmania collect this item at the time of booking, while the remaining states and territories collect the intended place of birth at the onset of labour. Care must be taken when comparing data across the jurisdictions.
In 2006, the intended place of birth was hospital for 96.1% of mothers and birth centres for 3.4%. Only 0.5% intended to give birth at home or in other settings (Table 3.12). 
Around 3.9% of mothers intended to give birth outside of a conventional labour-ward setting in 2006 (Table 3.12). Only 2.7% of mothers actually did so, giving birth in places such as birth centres or at home.  

Table 3.12: Women who gave birth by intended place of birth and state and territory, 2006
Place of birth	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
Hospital	   87,556 	    66,141 	    55,054 	    27,270 	   16,048 	     5,870 	     4,959 	     3,613 	   266,511 	
Birth centre	     3,118 	      2,097 	         571 	        704 	     2,328 	         n.p.  	       379 	<5	      9,368 	
Home	       172 	         230 	          77 	        230 	       102 	        n.p.	         16 	       n.p.	         886 	
Other	       388 	—  	          12 	          48 	         40 	—   	          —   	         (a)11 	         499 	
Not stated	         69 	          79 	            5 	            1 	—   	—	—	         18 	         172 	
Total	   91,303 	    68,547 	    55,719 	    28,253 	   18,518 	     6,053 	     5,354 	     3,689 	   277,436 	
	Per cent	
Hospital	      95.9 	        96.5 	        98.8 	       96.5 	      86.7 	      97.0 	      92.6 	      97.9 	        96.1 	
Birth centre	        3.4 	         3.1 	         1.0 	         2.5 	      12.6 	         n.p.  	        7.1 	         n.p.  	          3.4 	
Home	        0.2 	         0.3 	         0.1 	         0.8 	        0.6 	        n.p.	        0.3 	        n.p.	          0.3 	
Other	        0.4 	—   	         0.0 	         0.2 	        0.2 	—	—   	        (a)0.3 	          0.2 	
Not stated	        0.1 	         0.1 	         0.0 	         0.0 	—	—	—	        0.5 	          0.1 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	      100.0 	
(a)	Includes remote community health centres.
n.p.	Data not published to maintain confidentiality of small numbers.
Note: Intended place of birth at time of booking for Vic, SA and Tas. Intended place of birth at onset of labour for NSW, Qld, WA, ACT and NT.
Duration of pregnancy
Different methods may be used for estimating the duration of a pregnancy, which is reported as the number of completed weeks of gestation. Estimates may be made based on the calculated interval between the first day of the last menstrual period (LMP) and the baby’s date of birth. For the majority of pregnancies, the gestational age derived from the known menstrual dates provides a good estimate of the duration of pregnancy. When the date of LMP is not known or is uncertain, gestational age can be estimated using ultrasound measurements taken in early pregnancy (before the 20th week of gestation). Estimates of gestational age may be revised if there is a discrepancy between gestational ages calculated from dates and ultrasounds, as most pregnant women have at least one ultrasound examination in early pregnancy. 
Preterm birth (less than 37 completed weeks gestation) occurred for 7.4% of all mothers in 2006. The average duration of pregnancy in Australia was 38.9 weeks. A minority of mothers gave birth at 20–27 weeks (0.8%) or 28–31 weeks (0.7%), while 5.8% gave birth at 32–36 weeks. There was a higher incidence of preterm birth in the Northern Territory (11.0%) than elsewhere (Table 3.13). 
Of women who gave birth in 2006, 91.5% gave birth at 37–41 completed weeks of gestation (term) and 1.2% gave birth at 42 or more weeks gestation (post-term). Post-term births were least common in South Australia (0.4%) and most common in New South Wales and the Australian Capital Territory (both 1.6%) (Table 3.13). 
The numbers reported here are based on the duration of pregnancies of mothers, and so differ from the figures on gestational age in Chapter 4, which are based on the gestational age of their babies. The numbers differ because the lower gestational age associated with multiple births is applied once for the duration of pregnancy data, while the gestational age of each individual baby in a multiple birth is used for the data presented in Chapter 4.
Table 3.13: Women who gave birth by duration of pregnancy and state and territory, 2006
Duration of pregnancy (weeks)	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
Mean	39.0	38.9	        38.8 	        38.7 	      38.8 	39.0	38.9	      38.6 	      38.9 	
	Number	
20–27(b)	       596 	       687 	         476 	         234 	       167 	         35 	         56 	         38 	     2,289 	
28–31	       584 	       455 	         436 	         206 	       135 	         38 	         56 	         59 	     1,969 	
32–36	     4,857 	     3,831 	      3,589 	      1,827 	     1,087 	       376 	       321 	       308 	   16,196 	
37–41	   83,757 	   62,609 	    50,870 	    25,805 	   17,046 	     5,544 	     4,837 	     3,255 	 253,723 	
42 and over	     1,498 	       963 	         342 	         181 	         83 	         60 	         84 	         29 	     3,240 	
Not stated	         11 	           2 	             6 	— 	—	—   	          —   	—   	         19 	
Total	   91,303 	   68,547 	    55,719 	    28,253 	   18,518 	     6,053 	     5,354 	     3,689 	 277,436 	
	Per cent	
20–27(b)	        0.7 	        1.0 	          0.9 	         0.8 	        0.9 	        0.6 	        1.0 	        1.0 	        0.8 	
28–31	        0.6 	        0.7 	          0.8 	         0.7 	        0.7 	        0.6 	        1.0 	        1.6 	        0.7 	
32–36	        5.3 	        5.6 	          6.4 	         6.5 	        5.9 	        6.2 	        6.0 	        8.3 	        5.8 	
37–41	      91.7 	      91.3 	        91.3 	        91.3 	      92.1 	      91.6 	      90.3 	      88.2 	      91.5 	
42 and over	        1.6 	        1.4 	          0.6 	         0.6 	        0.4 	        1.0 	        1.6 	        0.8 	        1.2 	
Not stated	        0.0 	        0.0 	          0.0 	—	—	—   	—	          —   	        0.0 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	
(a) 	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, both the percentages of 20–27 weeks and 28–31 weeks for ACT residents who gave birth in the ACT were 0.7%.
(b)	Includes 1 pregnancy of less than 20 weeks duration.	
Note: For multiple births, the gestational age of the first born baby was used. 
Multiple pregnancy
There has been an overall increasing trend in multiple births in the last two decades. This can be attributed largely to the increased use of fertility drugs and assisted reproduction technology, delay in childbearing and the growing number of older mothers (Tough et al. 2000; Tough et al. 2002). 
In the perinatal collections, multiple pregnancies are based on the number of fetuses that remain in utero at 20 weeks gestation and are subsequently delivered. In 2006, there were 4,622 multiple pregnancies (1.7% of all mothers) (Table 3.14), consisting of 4,515 twin pregnancies, 102 triplet pregnancies and five quadruplet pregnancies. 
There were 16.7 multiple pregnancies per 1,000 mothers in 2006. The twinning rate was 16.3 per 1,000 mothers. In 1997, there were 3,719 multiple pregnancies (14.7 per 1,000 mothers), with a twinning rate of 14.2 per 1,000 mothers. Triplet and higher order multiple pregnancies have remained fairly stable with a rate of 0.4 per 1,000 mothers in both 1997 and 2006, dropping to 0.3 per 1,000 mothers from 2002 to 2005.
Table 3.14: Women who gave birth by plurality and state and territory, 2006
Plurality	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
	Number	
Singleton	    89,879 	    67,269 	    54,754 	    27,851 	    18,238 	      5,965 	      5,223 	     3,635 	   272,814 	
Multiple	      1,424 	      1,278 	         965 	         402 	        280 	          88 	        131 	          54 	       4,622 	
Total	    91,303 	    68,547 	    55,719 	    28,253 	    18,518 	      6,053 	      5,354 	     3,689 	   277,436 	
	Per cent	
Singleton	        98.4 	98.1	        98.3 	        98.6 	       98.5 	98.5	       97.6 	       98.5 	         98.3 	
Multiple	         1.6 	1.9	         1.7 	         1.4 	         1.5 	1.5	         2.4 	         1.5 	          1.7 	
Total	      100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	       100.0 	
(a) 	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of multiple pregnancies for ACT residents who gave birth in the ACT was 2.1%.
Onset and type of labour
Onset of labour is categorised as spontaneous, induced or no labour, where a caesarean section was performed before labour had started. In 2006, the onset of labour was spontaneous for 56.6% of all women who gave birth, and there was no labour for 18.3% of mothers. Labour was induced for 25.1% of mothers (Table 3.15).
The proportion of mothers with spontaneous onset of labour was highest in the Northern Territory (62.9%) and lowest in Western Australia (51.0%). Western Australia and Queensland reported the highest proportions of mothers with no labour (21.1% and 20.5% respectively), and Tasmania reported the lowest (13.5%) (Table 3.15). 
The percentage of induced labour was higher in South Australia (28.9%) than in the other states and territories. Overall, combined medical and surgical induction of labour was more common than either type alone. 
Once labour has started it may be necessary to intervene to speed up or augment the labour.  In 2006, labour was augmented for 19.4% of mothers. There was considerable variation among the states and territories in whether labour was augmented, ranging from 15.8% in New South Wales to 26.6% in the Australian Capital Territory (Table 3.15).
Figure 3.2 presents the trends in type of onset of labour over the period from 1997 to 2006. In line with the increase in caesarean sections, spontaneous onset of labour generally decreased during this time, from 64.5% of all women giving birth in 1997 to 56.6% in 2006. The proportion of women giving birth without labour gradually increased, from 11.4% in 1997 to 18.3% in 2006. Induced labour has remained fairly steady over recent years.

Table 3.15: Women who gave birth by onset of labour and state and territory, 2006
Onset of labour/type of augmentation or induction	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
	Number	
Spontaneous	    53,162 	    39,191 	   31,230 	    14,423 	     9,912 	     3,549 	      3,296 	      2,321 	    157,084 	
   No augmentation	    38,661 	    25,570 	   18,577 	      8,621 	     5,928 	     2,416 	      1,871 	      1,286 	    102,930 	
   Medical only(b)	      5,148 	      3,915 	     2,895 	      1,648 	     1,007 	       266 	        427 	        202 	      15,508 	
   Surgical only	      6,316 	      7,324 	     8,421 	      2,831 	     2,400 	       740 	        763 	        395 	      29,190 	
   Combined	      2,998 	      2,382 	     1,335 	      1,317 	       577 	       127 	        235 	        167 	        9,138 	
   Other/not stated	           39 	—   	           2 	            6 	—   	—	—   	        271 	           318 	
Induced	    22,528 	    17,280 	   13,048 	      7,867 	     5,344 	     1,689 	      1,016 	        803 	      69,575 	
   Medical only(b)	      6,641 	      5,486 	     5,013 	      1,500 	     1,718 	       709 	        231 	        277 	      21,575 	
   Surgical only	      1,447 	      1,149 	     1,927 	         516 	       696 	       213 	        101 	          83 	        6,132 	
   Combined	    14,050 	    10,642 	     6,019 	      5,816 	     2,929 	       716 	        684 	        429 	      41,285 	
   Other/not stated	         390 	            3 	         89 	          35 	           1 	         51 	— 	          14 	           583 	
No labour	    15,507 	    12,076 	   11,439 	      5,963 	     3,262 	       815 	      1,042 	        565 	      50,669 	
Not stated	         106 	—	           2 	—	—	—	—	           — 	           108 	
Total	    91,303 	    68,547 	   55,719 	    28,253 	   18,518 	     6,053 	      5,354 	      3,689 	    277,436 	
	Per cent	
Spontaneous	        58.2 	        57.2 	      56.0 	        51.0 	      53.5 	      58.6 	       61.6 	       62.9 	          56.6 	
   No augmentation	        42.3 	        37.3 	      33.3 	        30.5 	      32.0 	      39.9 	       34.9 	       34.9 	          37.1 	
   Medical only(b)	          5.6 	         5.7 	        5.2 	         5.8 	        5.4 	        4.4 	         8.0 	         5.5 	            5.6 	
   Surgical only	          6.9 	        10.7 	      15.1 	        10.0 	      13.0 	      12.2 	       14.3 	       10.7 	          10.5 	
   Combined	          3.3 	         3.5 	        2.4 	         4.7 	        3.1 	        2.1 	         4.4 	         4.5 	            3.3 	
   Other/not stated	          0.0 	—   	        0.0 	         0.0 	—   	—	—	         7.3 	            0.1 	
Induced	        24.7 	        25.2 	      23.4 	        27.8 	      28.9 	      27.9 	       19.0 	       21.8 	          25.1 	
   Medical only(b)	          7.3 	         8.0 	        9.0 	         5.3 	        9.3 	      11.7 	         4.3 	         7.5 	            7.8 	
   Surgical only	          1.6 	         1.7 	        3.5 	         1.8 	        3.8 	        3.5 	         1.9 	         2.2 	            2.2 	
   Combined	        15.4 	        15.5 	      10.8 	        20.6 	      15.8 	      11.8 	       12.8 	       11.6 	          14.9 	
   Other/not stated	          0.4 	         0.0 	        0.2 	         0.1 	        0.0 	        0.8 	         0.0 	         0.4 	            0.2 	
No labour	        17.0 	        17.6 	      20.5 	        21.1 	      17.6 	      13.5 	       19.5 	       15.3 	          18.3 	
Not stated	          0.1 	—	        0.0 	—	—	—	—	           — 	            0.0 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	   100.0 	     100.0 	
(a) 	Multiple sources of data were used in the ACT to identify the types of augmentation and induction and improve ascertainment.
(b)	Includes use of oxytocin and/or prostaglandins.

     Figure 3.2: Onset of labour, all mothers, 1997–2006 (per cent)

The main reason for induction of labour was requested for the first time for 2006. These preliminary data are presented to promote discussion and to assist in development of consistency across jurisdictions, so that in the future more comprehensive information will be available. Table 3.16 shows very similar results for New South Wales, Victoria, Queensland and South Australia. The three specific reasons for labour inductions most commonly reported in each of these jurisdictions were prolonged pregnancy (ranging from 22.5% to 37.9% of inductions), hypertension or pre-eclampsia (ranging from 10.2% to 12.8% of inductions) and premature rupture of membranes (ranging from 6.2% to 11.9% of inductions). The ‘Other’ category accounted for between 15.4% and 49.0% of main reasons given for induction in these jurisdictions. 
It is important when interpreting the data presented in this table that each state and territory is examined independently. Data are not comparable across jurisdictions because of differences in the way they were collected and reported by each of the states and territories. Data were requested using categories presented in Table 3.16. Methods of collection for these data varied. In New South Wales the data were collected using tick boxes. For New South Wales psychosocial reasons was not an option. In Victoria, Queensland and South Australia the information was collected as text. This first review of these data describing the main reason given for induction of labour underlines the need for further work to enable consistent reporting.

Table 3.16: Women who gave birth and had an induction by main reason for induction and state and territory, 2006(a)
Main reason for induction of labour	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	
	Number	
Prolonged pregnancy	    6,984 	    4,387 	   4,945 	n.a.	    1,203 	n.a.	n.a.	n.p.	
Psychosocial	—   	    2,792 	    1,722 	n.a.	—  	n.a.	n.a.	n.p.	
Hypertension/pre-eclampsia	    2,290 	    1,993 	   1,401 	n.a.	       684 	n.a.	n.a.	n.p.	
Premature rupture of membranes	    2,403 	    1,746 	    1,556 	n.a.	       331 	n.a.	n.a.	n.p.	
Diabetes	    1,140 	    1,130 	       675 	n.a.	       269 	n.a.	n.a.	n.p.	
Intrauterine growth restriction 	       870 	       780 	       507 	n.a.	       175 	n.a.	n.a.	n.p.	
Fetal death	       240 	157 	       135 	n.a.	         45 	n.a.	n.a.	n.p.	
Fetal distress	       234 	       400 	60	n.a.	<5	n.a.	n.a.	n.p.	
Isoimmunisation	         37 	         41 	         26 	n.a.	         15 	n.a.	n.a.	n.p.	
Chorioamnionitis	         15 	         23 	       9 	n.a.	<5	n.a.	n.a.	n.p.	
Other	    7,745 	    3,831 	    2,012 	n.a.	 (b)2,616 	n.a.	n.a.	n.p.	
Not stated	570   	—   	—	n.a.	—	n.a.	n.a.	n.p.	
Total	 22,528 	  17,280 	  13,048 	n.a.   	    5,344 	n.a.	n.a.	n.p.	
	Per cent	
Prolonged pregnancy	      31.0 	      25.4 	      37.9 	n.a.	      22.5 	n.a.	n.a.	n.p.	
Psychosocial	—   	      16.2 	      13.2 	n.a.	—	n.a.	n.a.	n.p.	
Hypertension/pre-eclampsia	      10.2 	      11.5 	      10.7 	n.a.	      12.8 	n.a.	n.a.	n.p.	
Premature rupture of membranes	      10.7 	      10.1 	      11.9 	n.a.	        6.2 	n.a.	n.a.	n.p.	
Diabetes	        5.1 	        6.5 	        5.2 	n.a.	        5.0 	n.a.	n.a.	n.p.	
Intrauterine growth restriction 	        3.9 	        4.5 	        3.9 	n.a.	        3.3 	n.a.	n.a.	n.p.	
Fetal death	        1.1 	        0.9 	        1.0 	n.a.	        0.8 	n.a.	n.a.	n.p.	
Fetal distress	        1.0 	        2.3 	       0.5	n.a.	       n.p.  	n.a.	n.a.	n.p.	
Isoimmunisation	        0.2 	        0.2 	        0.2 	n.a.	        0.3 	n.a.	n.a.	n.p.	
Chorioamnionitis	        0.1 	        0.1 	      0.1  	n.a.	       n.p.	n.a.	n.a.	n.p.	
Other	      34.4 	      22.2 	      15.4 	n.a.	   (b)49.0 	n.a.	n.a.	n.p.	
Not stated	        2.5 	—   	—	n.a.	—	n.a.	n.a.	n.p.	
Total	    100.0 	    100.0 	   100.0 	n.a.   	   100.0 	n.a. 	n.a. 	n.p.	
(a)      Because of differences in definitions used and methods of data collection these data are not comparable across jurisdictions.
(b)	Includes psychosocial reasons and prolonged pregnancy where this is less than 41 completed weeks.
n.a. 	Data not available.
n.p.	Tas data not published to maintain confidentiality of small numbers. NT data not published as complete data were not available in the required format. 

Anaesthetic for caesarean section or instrumental vaginal deliveries
The type of anaesthesia used at delivery determines the effectiveness of pain relief, the extent to which a woman is able to actively participate in the birth and her mobility immediately after birth. Table 3.17 presents types of anaesthetic administered in 2006 for forceps, vacuum extraction and caesarean section deliveries. Comparable data were available for seven states and territories. 
For these data, the type of anaesthetic administered is coded hierarchically following the order listed in Table 3.17, with local anaesthetic being the lowest order and general anaesthetic being the highest order. If more than one type of anaesthetic is administered, the highest order type in the hierarchy is coded. Although this data element specifies  anaesthetics administered for the birth, some states and territories may include anaesthetics administered for labour or administered after birth under this item, and this may be reflected in the differences reported among the states and territories.
In 2006, at least 28.7% of women having caesarean section or instrumental vaginal deliveries had an epidural or caudal anaesthetic administered, and at least 53.0% had a spinal anaesthetic. A general anaesthetic was administered for 5.0% of these deliveries (Table 3.17). 
General anaesthetic was used in 6.6% of caesarean section deliveries in 2006, compared with 0.2% of instrumental vaginal deliveries. An epidural or caudal anaesthetic was administered for at least 22.0% of caesarean section deliveries and at least 48.2% of instrumental vaginal deliveries. A spinal anaesthetic was administered in at least 69.7% of caesarean section deliveries, and in only 4.5% of instrumental vaginal deliveries. At least 14.8% of women having an instrumental delivery had a local anaesthetic to the perineum, while at least 6.2% had a pudendal block administered.

Table 3.17: Women who gave birth and had caesarean section or instrumental vaginal deliveries(a) by type of anaesthetic administered and state and territory, 2006
Type of anaesthetic(b)	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Total	
	Number	
None	n.p.	      2,117 	     1,759 	        414 	        298 	        161 	        388 	         79 	      5,216 	
Local anaesthetic to perineum	n.p.	      1,182 	        736 	        445 	        359 	         96 	        158 	         61 	      3,037 	
Pudendal	n.p.	        746 	        122 	        208 	        111 	         33 	         30 	         20 	      1,270 	
Epidural or caudal	n.p.	      8,080 	     5,074 	     5,888 	     2,620 	        395 	        493 	        261 	    22,811 	
Spinal	n.p.	    16,527 	   12,940 	     5,364 	     4,261 	     1,228 	     1,057 	        701 	    42,078 	
General	n.p.	      1,305 	     1,347 	        429 	        432 	        157 	        167 	        105 	      3,942 	
Other(c)	n.p.	            2 	        943 	         36 	           6 	—   	—   	           2 	         989 	
Not stated	n.p.	            1 	—   	—   	—	          —	          — 	        119 	         120 	
Total	n.p. 	    29,960 	   22,921 	   12,784 	     8,087 	     2,070 	     2,293 	     1,348 	    79,463 	
	Per cent	
None	n.p.	         7.1 	        7.7 	        3.2 	        3.7 	        7.8 	       16.9 	        5.9 	          6.6 	
Local anaesthetic to perineum	n.p.	         3.9 	        3.2 	        3.5 	        4.4 	        4.6 	        6.9 	        4.5 	          3.8 	
Pudendal	n.p.	         2.5 	        0.5 	        1.6 	        1.4 	        1.6 	        1.3 	        1.5 	          1.6 	
Epidural or caudal	n.p.	       27.0 	       22.1 	       46.1 	       32.4 	       19.1 	       21.5 	       19.4 	        28.7 	
Spinal	n.p.	       55.2 	       56.5 	       42.0 	       52.7 	       59.3 	       46.1 	       52.0 	        53.0 	
General	n.p.	         4.4 	        5.9 	        3.4 	        5.3 	        7.6 	        7.3 	        7.8 	          5.0 	
Other(c)	n.p.	         0.0 	        4.1 	        0.3 	        0.1 	—   	—   	        0.1 	          1.2 	
Not stated	n.p.	         0.0 	—   	—   	—	—	— 	        8.8 	          0.2 	
Total	n.p.	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	       100.0 	
(a) 	Instrumental vaginal deliveries include forceps and vacuum extraction and exclude breech deliveries.
(b) 	A hierarchical coding system is used for this item, starting with a local anaesthetic, up to a systemic general anaesthetic. If more than one type of anaesthetic was administered, the highest order type in the hierarchy is coded.
(c)	Qld and NT reported that the ‘Other’ category includes the technique of combined spinal-epidural.
n.p. 	Data not published as complete data were not available in the required format.
Presentation at birth
Data are included in this section by mother. Women who gave birth to more than one baby are categorised according to the presentation at birth of the first born baby. Table 4.10 provides the presentation for each individual baby by plurality.
In 2006, the predominant presentation at birth was vertex, where the crown of the baby’s head is the presenting part, occurring for 94.2% of all women who gave birth. Breech presentation, where the baby’s buttocks presents first, occurred for 4.2% of mothers. Face or brow presentation occurred for 0.2% of mothers, while other presentations accounted for 0.6% (Table 3.18). 
Table 3.18: Women who gave birth by presentation at birth and state and territory, 2006
Presentation	NSW	Vic	Qld	WA	SA	Tas(a)	ACT(b)	NT	Australia	
	Number	
Vertex	    86,618 	    64,655 	    52,729 	    26,837 	    17,546 	      4,400 	      5,040 	      3,479 	    261,304 	
Breech	      3,696 	      3,102 	      2,521 	      1,175 	        778 	<5	        246 	n.p.	     11,695 	
Face	        105 	        125 	          65 	          28 	          15 	n.p.	            6 	<5	          351 	
Brow	          76 	        100 	          44 	          38 	          32 	            <5  	            5 	n.p.	          309 	
Other(c)	        467 	        494 	         348 	         175 	        122 	          14 	          57 	          25 	       1,702 	
Not stated	        341 	          71 	          12 	—   	          25 	      1,625 	—   	            1 	       2,075 	
Total	    91,303 	    68,547 	    55,719 	    28,253 	    18,518 	      6,053 	      5,354 	      3,689 	    277,436 	
	Per cent	
Vertex	       94.9 	       94.3 	        94.6 	        95.0 	       94.8 	       72.7 	       94.1 	       94.3 	         94.2 	
Breech	         4.0 	         4.5 	         4.5 	         4.2 	         4.2 	n.p.	         4.6 	n.p.	           4.2 	
Face	         0.1 	         0.2 	         0.1 	         0.1 	         0.1 	n.p.	         0.1 	n.p.	           0.1 	
Brow	         0.1 	         0.1 	         0.1 	         0.1 	         0.2 	n.p.	         0.1 	n.p.	           0.1 	
Other(c)	         0.5 	         0.7 	         0.6 	         0.6 	         0.7 	         0.2 	         1.1 	         0.7 	           0.6 	
Not stated	         0.4 	         0.1 	         0.0 	—	         0.1 	       26.8 	—   	         0.0 	           0.7 	
Total	      100.0 	      100.0 	      100.0 	      100.0 	      100.0 	      100.0 	     100.0 	     100.0 	       100.0 	
(a)	For Tas, presentations were only recorded for vaginal births. Where a caesarean section occurred the presentation was recorded as ‘Not stated’. 
(b)  	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of breech presentation for ACT residents who gave birth in the ACT was 4.4% and 5.6% for non-ACT residents who gave birth in the ACT.
(c)  	Includes shoulder/transverse and compound presentations.
n.p.	Data not published to maintain confidentiality of small numbers.
Note: For multiple births, the presentation of the first born baby was used. 
Method of birth
Data are presented in this section by mother; for multiple births, women are categorised according to the method of birth for the first born baby. Table 4.11 presents method of birth data for each individual baby by plurality.
Vaginal births
Of all women who gave birth in 2006, 58.1% had a spontaneous vaginal birth. The proportion of spontaneous vaginal births ranged from 54.4% in Western Australia to 65.7% in Tasmania (Table 3.19). Vaginal breech births occurred in 0.4% of mothers in 2006, decreasing over the past 10 years from 0.8% in 1997.
Approximately 1 in 9 mothers (10.7%) had an instrumental vaginal delivery where either forceps or vacuum extraction was used. The proportions of these instrumental deliveries varied among the states and territories, from 7.3% in Tasmania to 13.2% in Victoria. Forceps delivery occurred for 3.5% of mothers and was most common in Victoria and the Australian Capital Territory (5.8% and 5.7% respectively). Deliveries by vacuum extraction accounted for 7.2% of women who gave birth nationally, ranging from 6.0% in both Queensland and the Northern Territory to 10.1% in Western Australia (Table 3.19).
Caesarean sections
There were 85,378 caesarean sections performed in 2006, accounting for 30.8% of women who gave birth. Of all women who gave birth, 18.3% had a caesarean section without labour, while 12.5% had a caesarean section with labour. 
The proportion of caesarean section deliveries varied by state and territory, and ranged from 26.9% in Tasmania to 33.2% in Queensland. Three states, Queensland, Western Australia and South Australia, recorded caesarean section rates (percentage) above 32.0% (Table 3.19). 
Table 3.19: Women who gave birth by method of birth and state and territory, 2006
Method of birth	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
	Number	
Spontaneous vaginal	   55,171 	   38,306 	   32,578 	   15,372 	   10,365 	     3,979 	     3,030 	    2,310 	  161,111 	
Forceps	     2,884 	     3,959 	     1,080 	        692 	       693 	n.p.	       305 	n.p.	     9,715 	
Vacuum extraction	     6,331 	     5,095 	     3,334 	     2,856 	     1,297 	       403 	       381 	       220 	   19,917 	
Vaginal breech	       365 	        281 	        211 	          97 	         66 	<5	         31 	n.p.	     1,086 	
Caesarean section	   26,333 	   20,906 	   18,506 	     9,236 	     6,097 	     1,630 	     1,607 	    1,063 	   85,378 	
   Labour	   10,783 	     8,830 	     7,068 	     3,273 	     2,835 	       815 	       565 	       498 	   34,667 	
   No labour	   15,507 	   12,076 	   11,438 	     5,963 	     3,262 	       815 	     1,042 	       565 	   50,668 	
   Not stated	         43 	—	—	—	—	—	—	—	          43 	
Other	—   	—	            8 	—	—	—	—	—	           8 	
Not stated	       219 	—	            2 	—	—	—	—	—	        221 	
Total	   91,303 	   68,547 	   55,719 	   28,253 	   18,518 	     6,053 	     5,354 	    3,689 	  277,436 	
	Per cent	
Spontaneous vaginal	      60.4 	       55.9 	       58.5 	       54.4 	      56.0 	      65.7 	      56.6 	      62.6 	       58.1 	
Forceps	        3.2 	         5.8 	         1.9 	         2.4 	        3.7 	        n.p. 	        5.7 	 n.p. 	         3.5 	
Vacuum extraction	        6.9 	         7.4 	         6.0 	       10.1 	        7.0 	        6.7 	        7.1 	        6.0 	         7.2 	
Vaginal breech	        0.4 	         0.4 	         0.4 	         0.3 	        0.4 	        n.p. 	        0.6 	       n.p. 	         0.4 	
Caesarean section	      28.8 	       30.5 	       33.2 	       32.7 	      32.9 	      26.9 	      30.0 	      28.8 	       30.8 	
   Labour	      11.8 	       12.9 	       12.7 	       11.6 	      15.3 	      13.5 	      10.6 	      13.5 	       12.5 	
   No labour	      17.0 	       17.6 	       20.5 	       21.1 	      17.6 	      13.5 	      19.5 	      15.3 	       18.3 	
   Not stated	        0.0 	—	—	—	—	—	—	—   	         0.0 	
Other	          —   	—	         0.0 	—	—	—	—	         —   	         0.0 	
Not stated	        0.2 	—	         0.0 	—	—	—	—	         —   	         0.1 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	    100.0 	 100.0 	     100.0 	
(a) 	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages.
n.p.	Data not published to maintain confidentiality of small numbers.
Note: For multiple births, the method of birth of the first born baby was used. 
The caesarean section rate in 2006 continues the overall upward trend observed over the last 10 years. The proportion of women having caesarean sections has increased from 20.3% in 1997 to 30.8% in 2006. The percentage increase in the caesarean section rate between 2005 and 2006 (3.4%) was slightly lower than that seen between 2004 and 2005 (3.5%). In contrast, the proportion of instrumental deliveries has remained stable at around 11.0% throughout this period (Figure 3.3).

Figure 3.3: Caesarean section and instrumental deliveries, 1997–2006 (per cent)	

Information about the main reason for carrying out a caesarean section was requested for the first time in 2006. Data are presented in Table 3.20 for five states and territories: Victoria, Queensland, South Australia, Tasmania and the Northern Territory. Data were requested in the categories listed in Table 3.20. The table shows that only Victoria and Queensland were able to provide data for all of the categories and that data were not available or coded to the ‘Other’ category for a substantial proportion of caesarean sections. 
It is important when interpreting the data presented in this table that each state and territory is examined independently. Data are not comparable across jurisdictions since the methods for collecting these data were different in each jurisdiction. The data are presented as a baseline to promote discussion and to assist in development of consistency across jurisdictions, so that in the future more comprehensive information will be available.   

Table 3.20: Women who gave birth by caesarean section by main reason for caesarean section and state and territory, 2006(a)
Main reason for caesarean section	NSW	Vic(b)	Qld	WA	SA	Tas	ACT	NT	
	Number	
Previous caesarean section	n.p.	    7,365 	     6,554 	n.a.	     1,996 	      549 	n.a.	     331 	
Failure to progress/
cephalopelvic           disproportion	n.p.	    3,526 	         2,927 	n.a.	     1,617 	      215 	n.a.	       154 	
Fetal distress	n.p.	    3,009 	     1,914 	n.a.	        807 	      336 	n.a.	     173 	
Malpresentation	n.p.	    2,926 	     2,136 	n.a.	        631 	      146 	n.a.	      154 	
Psychosocial/
elective/patient choice 	n.p.	       536 	        1,197	n.a.	          —  	      270 	n.a.	—   	
Antepartum haemorrhage	n.p.	       698 	        478 	n.a.	        144 	—   	n.a.	       18 	
Hypertension/
pre-eclampsia	n.p.	        585 	            487 	n.a.	            190 	—	n.a.	—	
Multiple pregnancy	n.p.	       437 	        223 	n.a.	          93 	—	n.a.	—	
Intrauterine growth restriction 	n.p.	       207 	        170 	n.a.	          40 	—	n.a.	—	
Other	n.p.	    1,617 	     2,420 	n.a.	      (c)579 	      108 	n.a.	      194 	
Not stated	n.p.	—	—   	n.a.	—	—	n.a.	        39 	
Total	n.p.	  20,906 	   18,506 	n.a.	     6,097 	   1,624 	n.a.	   1,063 	
	Per cent	
Previous caesarean section	n.p.	     35.2 	       35.4 	n.a.	       32.7 	     33.8 	n.a.	     31.1 	
Failure to progress/
cephalopelvic           disproportion (CPD)	n.p.	      16.9 	       15.8 	n.a.	      26.5 	     13.2 	n.a.	    14.5 	
Fetal distress	n.p.	      14.4 	       10.3 	n.a.	      13.2 	     20.7 	n.a.	     16.3 	
Malpresentation	n.p.	      14.0 	       11.5 	n.a.	       10.3 	       9.0 	n.a.	     14.5 	
Psychosocial/
elective/patient choice 	n.p.	        2.6 	         6.5 	n.a.	—	     16.6 	n.a.	—	
Antepartum haemorrhage	n.p.	        3.3 	         2.6 	n.a.	         2.4 	—   	n.a.	       1.7 	
Hypertension/
pre-eclampsia	n.p.	        2.8 	        2.6	n.a.	         3.1 	—	n.a.	—	
Multiple pregnancy	n.p.	        2.1 	         1.2 	n.a.	         1.5 	—	n.a.	—	
Intrauterine growth restriction 	n.p.	        1.0 	         0.9 	n.a.	        0.7 	—	n.a.	—	
Other	n.p.	        7.7 	       13.1 	n.a.	       (c)9.5 	       6.7 	n.a.	     18.3 	
Not stated	n.p.	—	—   	n.a.	—	—	n.a.	       3.7 	
Total	n.p.	    100.0 	     100.0 	n.a. 	     100.0 	   100.0 	n.a.	 100.0 	
(a)      Because of differences in definitions used and methods of data collection these data are not comparable across jurisdictions.
(b)	Vic collects up to four indications for caesarean section. To obtain the main reason, the following hierarchy was used: 1) Previous/repeat caesarean, 2) Malpresentation, 3) Multiple pregnancy, 4) Antepartum haemorrhage, 5) Pre-eclampsia/hypertension, 6) Intrauterine growth retardation, 7) Fetal distress, 8) Cephalopelvic disproportion/failure to progress/obstructed labour and 9) Other. In cases of multiple births the reason refers to the first baby. 'Psychosocial/elective/patient choice represents those who have no specified reason. Patient choice for repeat caesarean is coded under ‘Previous caesarean section’ and not ‘Psychosocial/elective/patient choice’.
(c)      Includes Psychosocial/elective/patient choice. 
n.a. 	Data not available.
n.p.	Data not published as complete data were not available in a comparable format.
Method of birth and maternal age
Table 3.21 presents methods of birth by maternal age groups. Spontaneous vaginal births declined progressively with increasing maternal age. These were most common in women aged less than 20 years (71.6%) and least common in the oldest age group (46.5%). The proportion of instrumental vaginal births was highest in the 25–29 years and 30–34 years age groups (both 11.5%). Vaginal breech births were slightly more common in the youngest and oldest age groups.
Caesarean section rates increase with maternal age. In 2006, caesarean section rates ranged from 17.6% for mothers aged less than 20 years to 44.9% for mothers aged 40 years and older (Table 3.21).
Table 3.21: Method of birth by maternal age, 2006
Method of birth	Less  than 20	20–24	25–29	30–34	35–39	40 and  over	Not stated	Total	
	Number	
Spontaneous vaginal	     8,580 	    27,940 	    44,607 	   50,291 	   25,258 	     4,399 	         36 	   161,111 	
Forceps	       340 	      1,198 	      2,742 	     3,542 	     1,611 	       278 	           4 	       9,715 	
Vacuum extraction	       868 	      2,702 	      5,678 	     7,049 	     3,137 	       477 	           6 	     19,917 	
Vaginal breech	         75 	         177 	         257 	        301 	       228 	         47 	           1 	       1,086 	
Caesarean section	     2,106 	      8,420 	    20,175 	   30,897 	   19,511 	     4,252 	         17 	     85,378 	
Other	          —  	            1 	            3 	            2 	           1 	           1 	         —  	              8 	
Not stated	           8 	           23 	           42 	          81 	         56 	           8 	           3 	          221 	
Total	   11,977 	    40,461 	    73,504 	   92,163 	   49,802 	     9,462 	         67 	   277,436 	
	Per cent	
Spontaneous vaginal	      71.6 	        69.1 	        60.7 	       54.6 	      50.7 	      46.5 	      53.7 	         58.1 	
Forceps	        2.8 	          3.0 	          3.7 	         3.8 	        3.2 	        2.9 	        6.0 	           3.5 	
Vacuum extraction	        7.2 	          6.7 	          7.7 	         7.6 	        6.3 	        5.0 	        9.0 	           7.2 	
Vaginal breech	        0.6 	          0.4 	          0.3 	         0.3 	        0.5 	        0.5 	        1.5 	           0.4 	
Caesarean section	      17.6 	        20.8 	        27.4 	       33.5 	      39.2 	      44.9 	      25.4 	         30.8 	
Other	          —   	          0.0 	          0.0 	         0.0 	        0.0 	        0.0 	         —   	           0.0 	
Not stated	        0.1 	          0.1 	          0.1 	         0.1 	        0.1 	        0.1 	        4.5 	           0.1 	
Total	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	
Note: For multiple births, the method of birth of the first born baby was used. 
Method of birth and Indigenous status
Mothers who identified as being of Aboriginal or Torres Strait Islander origin had a higher proportion of spontaneous vaginal birth compared with non-Indigenous mothers (70.9% compared with 57.6%) and a lower proportion of instrumental vaginal deliveries (forceps or vacuum extraction). Aboriginal or Torres Strait Islander mothers also had a higher rate of vaginal breech births than non-Indigenous mothers (0.8% compared with 0.4%). The caesarean section rate of 23.4% for mothers who identified as Aboriginal or Torres Strait Islander was less than that for non-Indigenous mothers (31.0%) (Table 3.22). This may be explained by the younger age of Indigenous mothers, which averaged 25.0 years. 

Table 3.22: Women who gave birth by Indigenous status, method of birth and state and territory, 2006
Indigenous status(a)/ method of birth	NSW	Vic	Qld	WA	SA	Tas	ACT(b)	NT	Australia	
Indigenous	Number	
Spontaneous vaginal	    1,867 	       404 	    2,112 	    1,243 	       370 	       154 	         70 	       998 	      7,218 	
Assisted vaginal(c)	       130 	        26 	         95 	       110 	n.p. 	         13 	n.p.	         72 	         487 	
Vaginal breech	         17 	          6 	         27 	         14 	         <5	         —   	<5	         17 	           85 	
Caesarean section	       588 	       129 	       703 	       374 	       139 	         49 	         29 	       374 	      2,385 	
Other	          —   	—   	—	—	—	—	—   	—   	—	
Not stated	           8 	—	—	—	—	—	         —   	—	             8 	
Total	    2,610 	       565 	    2,937 	    1,741 	       548 	       216 	       105 	    1,461 	     10,183 	
	Per cent	
Spontaneous vaginal	      71.5 	      71.5 	      71.9 	      71.4 	      67.5 	      71.3 	      66.7 	      68.3 	        70.9 	
Assisted vaginal(c)	        5.0 	       4.6 	        3.2 	        6.3 	n.p.	        6.0 	n.p.	        4.9 	          4.8 	
Vaginal breech	        0.7 	        1.1 	        0.9 	        0.8 	n.p.	         —   	n.p.	        1.2 	          0.8 	
Caesarean section	      22.5 	      22.8 	      23.9 	      21.5 	      25.4 	      22.7 	      27.6 	      25.6 	        23.4 	
Other	—   	—   	—	—	—	—	—   	—	—	
Not stated	        0.3 	—	—	—	—	—	         —   	—	          0.1 	
Total	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0	   100.0 	   100.0 	     100.0 	
										
Non-Indigenous	Number	
Spontaneous vaginal	  53,036 	  37,892 	  30,457 	  14,129 	    9,995 	    3,825 	    2,949 	    1,297 	   153,580 	
Assisted vaginal(c)	    9,040 	    9,021 	    4,318 	    3,438 	    1,954 	       n.p.	       n.p. 	       210 	     29,087 	
Vaginal breech	       345 	       275 	      184 	         83 	         63 	<5	n.p. 	         13 	         997 	
Caesarean section	  25,549 	  20,769 	  17,800 	    8,862 	    5,957 	    1,581 	    1,569 	       673 	     82,760 	
Other	—   	—	           8 	—	—	—	—   	—	             8 	
Not stated	       195 	—	          1 	—	—	—	         —   	—	         196 	
Total	  88,165 	  67,957 	  52,768 	  26,512 	  17,969 	    5,837 	    5,227 	    2,193 	   266,628 	
	Per cent	
Spontaneous vaginal	      60.2 	      55.8 	     57.7 	      53.3 	      55.6 	      65.5 	      56.4 	      59.1 	        57.6 	
Assisted vaginal(c)	      10.3 	      13.3 	        8.2 	      13.0 	      10.9 	       n.p. 	       n.p. 	        9.6 	        10.9 	
Vaginal breech	        0.4 	       0.4 	        0.3 	        0.3 	        0.4 	n.p. 	n.p. 	        0.6 	          0.4 	
Caesarean section	      29.0 	      30.6 	      33.7 	      33.4 	      33.2 	      27.1 	      30.0 	      30.7 	        31.0 	
Other	—   	—   	        0.0 	—	—	—	         —   	—	          0.0 	
Not stated	        0.2 	—	        0.0 	—	—	—	         —   	—	          0.1 	
Total	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0	   100.0 	   100.0 	     100.0 	
(a) 	Indigenous status ‘Not stated’ not included.
(b)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of caesarean sections for Aboriginal or Torres Strait Islander ACT residents who gave birth in the ACT was 21.1%.  
(c)	Assisted vaginal birth includes forceps and vacuum extraction. 
n.p.	Data not published to maintain confidentiality of small numbers.
Note: For multiple births, the method of birth of the first born baby was used. 
Method of birth and previous caesarean section
In 2006, 13.2% of mothers who had ever previously had a caesarean section had a spontaneous vaginal birth, and 3.1% had an instrumental vaginal birth. Repeat caesarean sections occurred for 83.5% of mothers with a history of caesarean section, and ranged from 72.8% in the Northern Territory to 87.8% in Western Australia (Table 3.23).
Table 3.23: Multiparous mothers who have had a previous caesarean section by current method of birth and state and territory, 2006
Method of birth	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
	Number	
Spontaneous vaginal	    1,792 	    1,220 	    1,235 	       439 	       450 	        112 	         97 	     139 	     5,484 	
Assisted vaginal(b)	       408 	       380 	       192 	       113 	       110 	         26 	         27 	       19 	     1,275 	
Caesarean section	    9,802 	    8,689 	    7,940 	    4,063 	    2,623 	        684 	        550 	     422 	   34,773 	
Other(c)	        34 	        26 	        26 	        15 	          7 	—	           2 	—   	        110 	
Not stated	        11 	—	—	—	—	—	—   	        —   	         11 	
Total	  12,047 	  10,315 	    9,393 	    4,630 	    3,190 	        822 	        676 	     580 	   41,653 	
	Per cent	
Spontaneous vaginal	      14.9 	      11.8 	      13.1 	       9.5 	      14.1 	       13.6 	       14.3 	    24.0 	       13.2 	
Assisted vaginal(b)	       3.4 	       3.7 	       2.0 	       2.4 	        3.4 	        3.2 	        4.0 	      3.3 	        3.1 	
Caesarean section	      81.4 	      84.2 	      84.5 	      87.8 	      82.2 	       83.2 	       81.4 	    72.8 	       83.5 	
Other(c)	       0.3 	       0.3 	       0.3 	       0.3 	        0.2 	—	        0.3 	—   	        0.3 	
Not stated	       0.1 	—	—	—	—	—	—   	        —   	        0.0 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0	100.0	     100.0 	       100.0 	
(a) 	Care must be taken when interpreting the ACT percentages as 10.6% of multiparous mothers have been excluded because no information was reported regarding previous caesarean section (See Table 3.9).
(b)	Assisted vaginal birth includes forceps and vacuum extraction.
(c)	Includes vaginal breech and other methods of birth.
Note: For multiple births, the method of birth of the first born baby was used. 
Perineal status after vaginal birth
In 2006, approximately 1 in 3 mothers (35.1%) had an intact perineum following vaginal birth. A first or second degree laceration or graze was reported in 43.6% women after vaginal birth (Table 3.24). In 1 in 100 vaginal births (1.5%), a third or fourth degree laceration of the perineum was reported. This proportion varied among the states and territories, from 1.1% in Queensland to 2.2% in the Australian Capital Territory. An episiotomy was performed for 14.9% of vaginal births, with the highest rate being recorded in Victoria (20.5%). A combined laceration and episiotomy occurred in 1.6% of women who had a vaginal birth, giving a total of 16.6% of women who had a vaginal birth in 2006 having an episiotomy.

Table 3.24: Women who gave birth vaginally by perineal status and state and territory, 2006
Perineal status	NSW	Vic	Qld	WA	SA	Tas(a)	ACT	NT	Australia	
	Number	
Episiotomy	     8,539 	     9,752 	     4,351 	     2,938 	     1,805 	      593 	       429 	       218 	     28,625 	
Intact	   17,326 	   19,664 	   14,361 	     7,543 	     3,836 	   2,224 	    1,239 	     1,190 	     67,383 	
1st degree laceration/    vaginal graze	   16,622 	     6,124 	     7,440 	     3,102 	     3,010 	      688 	       643 	       644 	     38,273 	
2nd degree laceration	   16,428 	   10,693 	     8,208 	     4,139 	     3,227 	      856 	    1,258 	       487 	     45,296 	
3rd/4th degree laceration	     1,125 	       647 	        401 	       277 	       153 	        62 	         82 	         56 	       2,803 	
Combined laceration and episiotomy	     1,058 	       760 	        474 	       367 	       370 	—   	         96 	         14 	       3,139 	
Other	(b)3,526	—	  (c)1,966 	     (c)651 	         19 	—	—   	         13 	       6,175 	
Not stated	       127 	           1 	            2 	—   	           1 	—	         —   	           4 	          135 	
Total	   64,751 	   47,641 	   37,203 	   19,017 	   12,421 	   4,423 	    3,747 	     2,626 	   191,829 	
	Per cent	
Episiotomy	      13.2 	      20.5 	       11.7 	      15.4 	      14.5 	     13.4 	      11.4 	        8.3 	         14.9 	
Intact	      26.8 	      41.3 	       38.6 	      39.7 	      30.9 	     50.3 	      33.1 	      45.3 	         35.1 	
1st degree laceration/    vaginal graze	      25.7 	      12.9 	       20.0 	      16.3 	      24.2 	     15.6 	      17.2 	      24.5 	         20.0 	
2nd degree laceration	      25.4 	      22.4 	       22.1 	      21.8 	      26.0 	     19.4 	      33.6 	      18.5 	         23.6 	
3rd/4th degree laceration	        1.7 	        1.4 	         1.1 	        1.5 	        1.2 	       1.4 	        2.2 	        2.1 	          1.5 	
Combined laceration and episiotomy	        1.6 	        1.6 	         1.3 	        1.9 	        3.0 	—	        2.6 	        0.5 	          1.6 	
Other	      (b)5.4 	—	      (c)5.3 	      (c)3.4 	        0.2 	—	—   	        0.5 	          3.2 	
Not stated	        0.2 	        0.0 	         0.0 	—	        0.0 	—	—	        0.2 	          0.1 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	   100.0	    100.0 	     100.0 	   100.0 	
(a)  	For Tas, cases where both a laceration and episiotomy occurred were coded as Episiotomy.
(b)	Includes unspecified perineal tear and vulval or perineal haematoma.
(c)	Includes cases where the perineum was intact but a graze was reported.
Note: For multiple births, the perineal status after the birth of the first born baby was used. 
Pre-existing and pregnancy-related medical conditions
This section presents state and territory data on selected pre-existing conditions and complications arising in pregnancy. Comprehensive and reliable information on risk factors and complications arising in pregnancy continues to be a challenging area of data development. The development of nationally consistent scope, collection methods and classifications of these conditions and complications is progressing in line with the overall priorities of perinatal data development. 
The following data are presented to promote discussion and to assist in development of consistency across jurisdictions, so that in the future more comprehensive information will be available on these and other conditions. This is being undertaken by the NPDDC as part of its perinatal data development work program.
Table 3.25 provides the numbers and rates of pre-existing medical conditions, selected conditions arising during pregnancy and conditions arising during birth for women who gave birth in each state and territory. It is important when interpreting the data presented in this table that each state and territory is examined independently. Data are not currently comparable across jurisdictions. No national estimates or totals are provided. 
The way in which data are collected varies. Data on these conditions and complications are generally collected using a tick box on the perinatal form of each state and territory. However, for some jurisdictions, a tick box is not available for some of these conditions and complications, so the condition or complication may be recorded using free text. The scope of the selected conditions may vary between jurisdictions—a higher rate may reflect a broader definition of the condition or a lower rate may reflect different practices in collection of the data or different inclusion criteria for the conditions.  
Despite these limitations there was a remarkable homogeneity in the rates of several conditions, notably the pre-existing epilepsy, diabetes mellitus and hypertension, antepartum haemorrhage, gestational diabetes, cord prolapse and retained placenta. For the remaining three conditions the rates varied considerably between jurisdictions. Pregnancy-induced hypertension may be subject to broader definitions in some jurisdictions. Fetal distress in labour and post-partum haemorrhage rates may reflect the relevant definitions as well as variability in the practices and protocols used to assess the conditions.  

Table 3.25: Women who gave birth by selected maternal medical and obstetric conditions and state and territory, 2006(a)
Medical condition or complication	NSW	Vic	Qld	WA	SA	Tas	ACT(b)	NT	
	Number	
Pre-existing medical conditions	
Essential hypertension	804	732	459	233	188	91	80	34	
Diabetes mellitus	541	360	292	170	110	36	79	32	
Epilepsy	n.a.	387	283	158	74	45	22	27	
									
Conditions arising during pregnancy	
Antepartum haemorrhage	n.a.	2,104	1,537	991	619	123	251	44	
   Placenta praevia	n.a.	484	411	162	97	26	53	n.a.	
   Abruptio placenta	n.a.	262	333	96	95	13	33	n.a.	
   Other/not stated	n.a.	1,358	793	733	427	84	165	n.a.	
Pregnancy-induced hypertension	4,436	3,530	3,216	101	1,328	325	102	171	
Gestational diabetes	4,375	3,331	2,837	1,285	835	131	262	270	
									
Conditions arising during labour	
Fetal distress	n.a.	12,490	10,953	3,617	2,239	51	313	354	
Cord prolapse	n.a.	101	82	30	19	<5	5	8	
Postpartum haemorrhage	1,819	7,078	1,992	2,938	1,316	177	344	487	
Retained placenta	n.a.	949	770	363	264	76	58	41	
	Rate per 1,000 women who gave birth	
Pre-existing medical conditions	
Essential hypertension	8.8	10.7	8.2	8.2	10.2	15.0	14.9	9.2	
Diabetes mellitus	5.9	5.3	5.2	6.0	5.9	5.9	14.8	8.7	
Epilepsy	n.a.	5.6	5.1	5.6	4.0	7.4	4.1	7.3	
									
Conditions arising during pregnancy	
Antepartum haemorrhage	n.a.	30.7	27.6	35.1	33.4	20.3	46.9	11.9	
   Placenta praevia	n.a.	7.1	7.4	5.7	5.2	4.3	9.9	n.a.	
   Abruptio placenta	n.a.	3.8	6.0	3.4	5.1	2.1	6.2	n.a.	
   Other/not stated	n.a.	19.8	14.2	25.9	23.1	13.9	30.8	n.a.	
Pregnancy-induced hypertension	48.6	51.5	57.7	3.6	71.7	53.7	19.1	46.4	
Gestational diabetes	47.9	48.6	50.9	45.5	45.1	21.6	48.9	73.2	
									
Conditions arising during labour	
Fetal distress	n.a.	182.2	196.6	128.0	120.9	8.4	58.5	96.0	
Cord prolapse	n.a.	1.5	1.5	1.1	1.0	n.p.	0.9	2.2	
Postpartum haemorrhage	19.9	103.3	35.8	104.0	71.1	29.2	64.3	132.0	
Retained placenta	n.a.	13.8	13.8	12.8	14.3	12.6	10.8	11.1	
(a)       Because of differences in definitions and methods used for data collection these data are not comparable across jurisdictions.
(b)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting rates. The ACT uses broader inclusion criteria for these conditions and data are collected from multiple sources.   
n.a. 	Data not available.
n.p.	Data not published to maintain confidentiality of small numbers.
Women who gave birth in hospitals
Hospitals and birth centres
Hospitals and birth centres were categorised by the number of women who gave birth in them in 2006. The categories vary from those with very few births each year to those with more than 2,000 births, and depend on geographical location, the population of the region and policies regarding maternity services. Table 3.26 presents the number of hospitals or birth centres in each category by state and territory. In 2006, 38.2% of the hospitals or birth centres had 100 or fewer women who gave birth, and 9.9% had in excess of 2,000 women who gave birth (Table 3.26). There has been a decrease in the number of hospitals or birth centres with 1–100 and 101–500 women who gave birth since 2004, when there were 165 and 124 hospitals or birth centres in these groups respectively. 
Table 3.26: Hospitals and birth centres by number of women who gave birth and state and territory, 2006
Number of  women who gave birth	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
1–100	31	         31 	         50 	          17 	         23 	           6 	—   	1	159	
101–500	37	         21 	         22 	          16 	         13 	           1 	          —   	2	112	
501–1,000	17	         11 	           8 	           4 	           5 	           3 	           1 	2	51	
1,001–2,000	17	         14 	         12 	           3 	           2 	           2 	           2 	1	53	
2,001 and over	15	         11 	           9 	           2 	           3 	—	           1 	—	41	
Total	117	         88 	       101 	          42 	         46 	         12 	           4 	6	416	
	Per cent	
1–100	26.5	      35.2 	      49.5 	       40.5 	      50.0 	      50.0 	—   	16.7	38.2	
101–500	31.6	      23.9 	      21.8 	       38.1 	      28.3 	        8.3 	          —   	33.3	26.9	
501–1,000	14.5	      12.5 	        7.9 	         9.5 	      10.9 	      25.0 	      25.0 	33.3	12.3	
1,001–2,000	14.5	      15.9 	      11.9 	         7.1 	        4.3 	      16.7 	      50.0 	16.7	12.7	
2,001 and over	12.8	      12.5 	        8.9 	         4.8 	        6.5 	—   	      25.0 	—	9.9	
Total	 100.0 	    100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	100.0	
Note: In some jurisdictions, a birth centre and co-located hospital labour ward would be considered as one maternity unit.
Hospital sector
‘Hospital sector’ indicates whether a patient was admitted to a public or a private hospital. Of women who gave birth in hospitals in 2006, the proportion in private hospitals was 29.9%, and ranged from 17.9% in the Northern Territory to 39.7% in Western Australia (Table 3.27).

Table 3.27: Women who gave birth in hospital by hospital sector and state and territory, 2006
Hospital sector	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
Public	     66,446 	   46,072 	   37,710 	   16,691 	   12,155 	     4,013 	    3,209 	     2,924 	  189,220 	
Private	     22,396 	   20,633 	   17,188 	   10,997 	     4,936 	     1,905 	    1,918 	        638 	    80,611 	
Not stated	             2 	—	—	—	—	           2 	—   	—	            4 	
Total	     88,844 	   66,705 	   54,898 	   27,688 	   17,091 	     5,920 	    5,127 	     3,562 	  269,835 	
	Per cent	
Public	        74.8 	69.1	       68.7 	       60.3 	       71.1 	67.8	      62.6 	       82.1 	       70.1 	
Private	        25.2 	30.9	       31.3 	       39.7 	       28.9 	32.2	      37.4 	       17.9 	       29.9 	
Not stated	          0.0 	—	—   	—	—	0.0	—   	—	         0.0 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	100.0	100.0	      100.0 	
Admitted patient elected accommodation status
‘Admitted patient elected accommodation status’ is the accommodation chargeable status elected by a patient on admission to hospital. Of women who gave birth in hospitals in 2006, the proportion who elected private status (i.e. elected to be treated as a private patient) was 33.7%, and ranged from 20.4% in the Northern Territory to 40.3% in the Australian Capital Territory (Table 3.28).
Table 3.28: Women who gave birth in hospital by admitted patient elected accommodation status and state and territory, 2006
Admitted patient elected accommodation status	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
Public	     57,874 	   42,346 	   36,416 	   17,561 	   11,161 	     4,253 	    3,061 	     2,834 	  175,506 	
Private	     27,603 	   24,359 	   18,482 	   10,086 	     5,930 	     1,665 	    2,066 	        727 	    90,918 	
Not stated	       3,367 	—   	—	         41 	—	           2 	—   	           1 	      3,411 	
Total	     88,844 	   66,705 	   54,898 	   27,688 	   17,091 	     5,920 	    5,127 	     3,562 	  269,835 	
	Per cent	
Public	        65.1 	63.5	       66.3 	       63.4 	       65.3 	71.9	      59.7 	       79.6 	       65.0 	
Private	        31.1 	36.5	       33.7 	       36.4 	       34.7 	28.1	      40.3 	       20.4 	       33.7 	
Not stated	          3.8 	—	—   	        0.1 	—	—	—   	        0.0 	         1.3 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	100.0	     100.0	      100.0 	
Method of birth and hospital sector
Method of birth for women who gave birth in hospitals was compared by hospital sector and state and territory (Table 3.29). Women who gave birth in public hospitals reported higher levels of spontaneous vaginal birth than those in private hospitals (62.5% compared with 43.9%). Private hospital patients had higher proportions than public hospital patients of vaginal births requiring forceps (5.1% compared with 2.9%) or vacuum extraction (9.6% compared with 6.4%), and lower proportions of vaginal breech births (0.2% compared with 0.5%) (Table 3.29).
Of women who gave birth in public hospitals, the highest rate of forceps deliveries occurred in the Australian Capital Territory (5.5%), and of those in private hospitals, the highest rate of forceps deliveries occurred in Victoria (9.1%). Vacuum extraction was most common for both public and private hospitals in Western Australia.
Of women who gave birth in hospitals in Australia in 2006, 31.6% had a caesarean section delivery. The caesarean section rate of 41.0% for women who were in private hospitals was higher than the rate of 27.6% for those in public hospitals. Of mothers in private hospitals, more than 43.0% had their babies delivered by caesarean section in Western Australia (43.5%), South Australia (43.8%) and Queensland (47.7%) (Table 3.29). 
Caesarean section rates were higher in private hospitals compared with public hospitals across all age groups. Figure 3.4 shows the differences by age group and hospital sector. The caesarean section rate for mothers aged 35–39 years who gave birth in private hospitals was 46.3% compared with 35.5% for those in public hospitals. Of mothers aged 40 years or more, over half in private hospitals had a caesarean section (55.4%) compared with 39.6% of those in public hospitals.

Table 3.29: Women who gave birth in hospital by method of birth, hospital sector and state and territory, 2006
Hospital sector/ method of birth	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
Public	Number	
Spontaneous vaginal	  42,398 	  27,417 	  24,735 	  10,316 	    6,859 	    2,638 	    1,952 	   1,912 	   118,227 	
Forceps	    1,853 	    2,086 	       547 	       450 	       397 	n.p. 	       178 	      n.p. 	       5,574 	
Vacuum extraction	    4,139 	    3,176 	    1,929 	    1,384 	       906 	       265 	       188 	      152 	     12,139 	
Vaginal breech	       314 	       198 	       182 	        88 	         58 	<5	        27 	n.p. 	          896 	
Caesarean section	  17,656 	  13,195 	  10,311 	    4,453 	    3,935 	    1,086 	       864 	      792 	     52,292 	
Other	—   	—   	           6 	—	—	—	—  	        — 	             6 	
Not stated	         86 	—	—	—	—	—	         —   	        —   	            86 	
Total	  66,446 	  46,072 	  37,710 	  16,691 	  12,155 	    4,013 	    3,209 	   2,924 	   189,220 	
	Per cent	
Spontaneous vaginal	      63.8 	      59.5 	      65.6 	      61.8 	      56.4 	      65.7 	      60.8 	     65.4 	         62.5 	
Forceps	       2.8 	        4.5 	        1.5 	       2.7 	        3.3 	       n.p.	       5.5 	       n.p.	           2.9 	
Vacuum extraction	        6.2 	        6.9 	        5.1 	       8.3 	        7.5 	       6.6 	       5.9 	      5.2 	           6.4 	
Vaginal breech	        0.5 	        0.4 	        0.5 	       0.5 	        0.5 	       n.p.	       0.8 	       n.p.	           0.5 	
Caesarean section	      26.6 	      28.6 	      27.3 	      26.7 	      32.4 	      27.1 	      26.9 	     27.1 	         27.6 	
Other	—   	—   	        0.0 	—	—	—	         —   	—   	           0.0 	
Not stated	        0.1 	—	—	—		—	—	         —   	        —   	           0.0 	
Total	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	100.0	100.0	     100.0 	
										
Private	Number	
Spontaneous vaginal	10,390	    9,068 	    7,026 	    4,493 	    2,100 	    1,209 	       852 	      280 	     35,418 	
Forceps	1,030	    1,871 	       533 	       242 	       n.p.	        15 	n.p. 	       23 	       4,135 	
Vacuum extraction	2,172	    1,910 	    1,405 	    1,472 	       376 	       137 	       193 	       66 	       7,731 	
Vaginal breech	31	         73 	         27 	          7 	<5	         —   	<5	—   	          145 	
Caesarean section	8,656	    7,711 	    8,195 	    4,783 	    2,162 	       544 	       743 	      269 	     33,063 	
Other	— 	—   	           2 	—	—	—	—   	        —   	             2 	
Not stated	117	—	—	—	—	—	         —   	        —   	          117 	
Total	  22,396 	  20,633 	  17,188 	  10,997 	    4,936 	    1,905 	    1,918 	      638 	     80,611 	
	Per cent	
Spontaneous vaginal	      46.4 	      43.9 	      40.9 	      40.9 	      42.5 	      63.5 	      44.4 	     43.9 	         43.9 	
Forceps	        4.6 	        9.1 	        3.1 	       2.2 	      n.p. 	       0.8 	       n.p.       	      3.6 	           5.1 	
Vacuum extraction	        9.7 	        9.3 	        8.2 	      13.4 	        7.6 	       7.2 	      10.1 	     10.3 	           9.6 	
Vaginal breech	        0.1 	        0.4 	        0.2 	       0.1 	       n.p.	—	       n.p.	—	           0.2 	
Caesarean section	      38.6 	      37.4 	      47.7 	      43.5 	      43.8 	      28.6 	      38.7 	     42.2 	         41.0 	
Other	—   	—	        0.0 	—	—		—	         —   	—	           0.0 	
Not stated	        0.5 	—	—	—	—	—	         —   	—	           0.1 	
Total	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	100.0	100.0	     100.0 	
(a) 	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. 
n.p.	Data not published to maintain confidentiality of small numbers.
Note: For multiple births, the method of birth of the first born baby was used. 

    Figure 3.4: Caesarean sections by maternal age and hospital sector, 2006 (per cent)	

Length of stay in hospital
Antenatal length of stay
Two-thirds of women (66.7%) gave birth within a day of admission to hospital. The proportion of women who gave birth within two days of admission was 93.6%. Only 0.9% of mothers were hospitalised for seven days or more immediately before giving birth 
(Table 3.30). 

Table 3.30: Women who gave birth in hospital by length of antenatal stay and state and territory, 2006
Length of stay	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
Less than       1 day	   56,821 	   46,641 	   38,023 	   18,340 	   10,640 	     3,962 	     3,223 	     2,288 	  179,938 	
1 day	   24,353 	   16,881 	   14,074 	     7,877 	     5,262 	     1,616 	     1,568 	       942 	    72,573 	
2–6 days	     4,379 	     2,587 	     2,384 	     1,196 	       944 	       306 	       275 	       291 	    12,362 	
7–13 days	       511 	       305 	        268 	       140 	       126 	         21 	         35 	         29 	      1,435 	
14 or more days	       318 	       291 	        149 	         94 	       119 	         15 	         26 	         10 	      1,022 	
Not stated	     2,462 	—   	—	         41 	—	—	—   	           2 	      2,505 	
Total	   88,844 	   66,705 	   54,898 	   27,688 	   17,091 	     5,920 	     5,127 	     3,562 	  269,835 	
	Per cent	
Less than       1 day	      64.0 	      69.9 	       69.3 	      66.2 	      62.3 	      66.9 	      62.9 	      64.2 	       66.7 	
1 day	      27.4 	      25.3 	       25.6 	      28.4 	      30.8 	      27.3 	      30.6 	      26.4 	       26.9 	
2–6 days	        4.9 	        3.9 	         4.3 	        4.3 	        5.5 	        5.2 	        5.4 	        8.2 	         4.6 	
7–13 days	        0.6 	        0.5 	         0.5 	        0.5 	        0.7 	        0.4 	        0.7 	        0.8 	         0.5 	
14 or more days	        0.4 	        0.4 	         0.3 	        0.3 	        0.7 	        0.3 	        0.5 	        0.3 	         0.4 	
Not stated	        2.8 	—   	—	        0.1 	—	—	— 	        0.1 	         0.9 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	

Postnatal length of stay
The length of the mother’s postnatal stay in hospital may be influenced by factors such as the method of birth, maternal medical and obstetric complications, neonatal morbidity and specific hospital policies on early discharge. In 2006, the median postnatal hospital stay for mothers was 3.0 days. Victoria, Western Australia and South Australia reported a longer median length of stay of 4.0 days (Table 3.31).
The trend towards shorter postnatal stays in hospital is reflected by the higher proportion of mothers who were discharged less than five days after giving birth. In 2006, 12.5% of mothers were discharged less than two days after giving birth, and 63.4% of mothers were discharged between two and four days after giving birth. This compares with 9.8% and 51.5% respectively in 1997. Relatively more mothers in Queensland (82.8%) and Victoria (79.3%) had stays of less than five days in 2006. Longer lengths of stay (of five or more days) were relatively more common in Western Australia (34.5%).
Table 3.31: Women who gave birth in hospital(a) by length of postnatal stay and state and territory, 2006
Length of stay	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
Median (days)	3.0	4.0	3.0	4.0 	4.0	3.0	3.0	3.0	3.0	
	Number	
Less than       1 day	     1,933 	       998 	     1,741 	       514 	       411 	       n.p.  	       n.p.  	       190 	       6,082 	
1 day	     9,321 	     4,037 	     8,317 	     2,216 	     1,282 	       526 	       512 	       402 	     26,613 	
2 days	   15,619 	   13,253 	   11,529 	     4,383 	     2,656 	     1,024 	       911 	       604 	     49,979 	
3 days	   17,845 	   13,497 	   11,828 	     5,008 	     3,206 	     1,247 	       944 	       665 	     54,240 	
4 days	   18,886 	   19,477 	   11,371 	     5,586 	     4,085 	     1,115 	     1,053 	       603 	     62,176 	
5 days	   12,171 	   10,243 	     6,363 	     4,287 	     2,859 	       813 	       939 	       478 	     38,153 	
6 days	     4,976 	     1,976 	     1,801 	     2,700 	     1,400 	       361 	       314 	       245 	     13,773 	
7–13 days	     2,708 	     1,107 	     1,120 	     2,278 	       790 	       297 	       161 	       301 	       8,762 	
14 or more days	         88 	         43 	         42 	         49 	         23 	n.p. 	<5	         33 	          301 	
Not stated	     2,388 	—   	—	—	—	—	          —   	—   	       2,388 	
Total	   85,935 	   64,631 	   54,112 	   27,021 	   16,712 	     5,528 	     5,007 	     3,521 	   262,467 	
	Per cent	
Less than       1 day	        2.2 	        1.5 	        3.2 	        1.9 	        2.5 	n.p. 	n.p. 	        5.4 	          2.3 	
1 day	      10.8 	        6.2 	      15.4 	        8.2 	        7.7 	        9.5 	      10.2 	      11.4 	         10.1 	
2 days	      18.2 	      20.5 	      21.3 	      16.2 	      15.9 	      18.5 	      18.2 	      17.2 	         19.0 	
3 days	      20.8 	      20.9 	      21.9 	      18.5 	      19.2 	      22.6 	      18.9 	      18.9 	         20.7 	
4 days	      22.0 	      30.1 	      21.0 	      20.7 	      24.4 	      20.2 	      21.0 	      17.1 	         23.7 	
5 days	      14.2 	      15.8 	      11.8 	      15.9 	      17.1 	      14.7 	      18.8 	      13.6 	         14.5 	
6 days	        5.8 	        3.1 	        3.3 	      10.0 	        8.4 	        6.5 	        6.3 	        7.0 	          5.2 	
7–13 days	        3.2 	        1.7 	        2.1 	        8.4 	        4.7 	        5.4 	        3.2 	        8.5 	          3.3 	
14 or more days	        0.1 	        0.1 	        0.1 	        0.2 	        0.1 	n.p. 	n.p. 	        0.9 	          0.1 	
Not stated	2.8	—   	—	—	—	—	—   	—   	          0.9 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	
(a)	Only includes mothers who were discharged home.
n.p.	Data not published to maintain confidentiality of small numbers.
Note: For multiple births, the length of stay after the birth of the first born baby was used. 

Mothers in private hospitals had a median postnatal length of stay of 4.0 days in 2006, compared with 3.0 days for those in public hospitals. The proportion of women who gave birth in hospital with a postnatal stay of less than five days was 53.4% for those in private hospitals, compared with 82.6% in public hospitals.
Women who had a caesarean section had a longer median length of stay (5.0 days) compared with women who gave birth vaginally. The median length of stay for women who had a spontaneous vaginal birth was 3.0 days, for a vaginal breech delivery the length of stay was 1.0 day, and for instrumental vaginal deliveries 4.0 days. Of women who had a caesarean section, 7.2% had a postnatal length of stay of seven days or longer (Table 3.32). 

Table 3.32: Women who gave birth in hospital(a) by length of postnatal stay and method of birth, 2006
Length of stay	Spontaneous vaginal	Forceps	Vacuum extraction	Vaginal breech	Caesarean section	Other	Not stated	Australia	
Median (days)	              3.0 	        4.0 	           4.0 	          1.0 	            5.0 	        2.0 	 — 	          3.0 	
	Number	
Less than       1 day	          5,582 	         83 	          127 	         214 	             69 	           —  	           7 	      6,082 	
1 day	        24,369 	       329 	        1,090 	         286 	           524 	           3 	         12 	    26,613 	
2 days	        40,496 	     1,348 	        3,311 	         186 	        4,615 	           3 	         20 	    49,979 	
3 days	        34,427 	     2,198 	        4,581 	         110 	      12,895 	         —  	         29 	    54,240 	
4 days	        29,986 	     3,463 	        5,962 	           86 	      22,607 	           2 	         70 	    62,176 	
5 days	          8,693 	     1,278 	        2,488 	           34 	      25,620 	 —	         40 	    38,153 	
6 days	          2,798 	       435 	          971 	           25 	        9,540 	 —	           4 	    13,773 	
7–13 days	          2,055 	       290 	          612 	           24 	        5,776 	 —	           5 	      8,762 	
14 or more days	               69 	         12 	            14 	             7 	           198 	 —	           1 	         301 	
Not stated	          1,196 	         88 	          197 	           12 	           888 	 —	           7 	      2,388 	
Total	      149,671 	     9,524 	      19,353 	         984 	      82,732 	           8 	       195 	  262,467 	
	Per cent	
Less than       1 day	              3.7 	        0.9 	           0.7 	        21.7 	            0.1 	        — 	        3.6 	          2.3 	
1 day	            16.3 	        3.5 	           5.6 	        29.1 	            0.6 	      37.5 	        6.2 	        10.1 	
2 days	            27.1 	      14.2 	         17.1 	        18.9 	            5.6 	      37.5 	      10.3 	        19.0 	
3 days	            23.0 	      23.1 	         23.7 	        11.2 	          15.6 	         —  	      14.9 	        20.7 	
4 days	            20.0 	      36.4 	         30.8 	          8.7 	          27.3 	      25.0 	      35.9 	        23.7 	
5 days	              5.8 	      13.4 	         12.9 	          3.5 	          31.0 	 —	      20.5 	        14.5 	
6 days	              1.9 	        4.6 	           5.0 	          2.5 	          11.5 	 —	        2.1 	          5.2 	
7–13 days	              1.4 	        3.0 	           3.2 	          2.4 	            7.0 	 —	        2.6 	          3.3 	
14 or more days	              0.0 	        0.1 	           0.1 	          0.7 	            0.2 	 —	        0.5 	          0.1 	
Not stated	              0.8 	        0.9 	           1.0 	          1.2 	            1.1 	 —	        3.6 	          0.9 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	
(a)	Only includes mothers who were discharged home.
n.p.	Data not published to maintain confidentiality of small numbers.
Note: For multiple births, the length of stay after the birth of the first born baby and the method of birth of the first born baby was used. 
Mode of separation from hospital
Nearly all women who gave birth in hospital were discharged to their homes (97.3%). Around 2.6% of mothers were transferred to another hospital (Table 3.33). This usually occurs for continuing care in a hospital located nearer to the mother’s place of residence or sometimes for further treatment of complications. These transfers between hospitals occurred more in Tasmania (6.6%) than in the other jurisdictions.
Table 3.33: Women who gave birth in hospital by mode of separation and state and territory, 2006
Mode of separation	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
	Number	
Discharge home	   85,935 	   64,631 	   54,112 	   27,021 	   16,712 	    5,528 	    5,007 	     3,521 	   262,467 	
Transfer to another hospital	     2,784 	     2,071 	       783 	       491 	       378 	       391 	       n.p. 	<5	       7,022 	
Died	n.p. 	n.p.	n.p.	n.p.	n.p.	n.p.	n.p.	n.p.	           12 	
Other(a)	—	— 	—	       135 	—	—	—	         34 	         169 	
Not stated	       121 	—	—	         41 	—	—	—	           3 	         165 	
Total	   88,844 	   66,705 	   54,898 	   27,688 	   17,091 	    5,920 	    5,127 	     3,562 	   269,835 	
	Per cent	
Discharge home	      96.7 	      96.9 	      98.6 	      97.6 	      97.8 	      93.4 	      97.7 	      98.8 	        97.3 	
Transfer to another hospital	        3.1 	        3.1 	        1.4 	        1.8 	        2.2 	        6.6 	n.p. 	n.p.	          2.6 	
Died	n.p. 	n.p.	n.p.	n.p.	n.p.	n.p.	n.p.	n.p.	          0.0 	
Other(a)	—	—   	—	        0.5 	—	—	—	        1.0 	          0.1 	
Not stated	        0.1 	—	—	        0.1 	—	—	—	        0.1 	          0.1 	
Total	     100.0 	     100.0 	     100.0 	     100.0	     100.0 	     100.0 	     100.0 	  100.0 	      100.0 	
(a)	Other includes statistical discharges and transfers to accommodation other than acute hospitals, such as hostels and prisons, and mothers discharged against medical advice.
n.p.	Data not published to maintain confidentiality of small numbers. Note that in this table <5 cells and some blank cells have been presented as ‘n.p.’.
Homebirths
In 2006, 708 planned homebirths, representing 0.3% of all women who gave birth, were reported nationally. The highest proportion of homebirths occurred in the Northern Territory (Table 3.11). It is probable that not all homebirths are reported to the perinatal data collections. 
The mean age of mothers who gave birth at home in 2006 was 32.1 years (Table 3.34). The proportion of mothers aged less than 20 years was 0.7%, and the proportion aged 35 years and over was 33.6%. The proportion of mothers who gave birth at home who identified as being of Aboriginal or Torres Strait Islander origin was 0.7%. The largest proportion of women who had a homebirth lived in major cities (61.9%) (Table 3.34).

Of mothers who gave birth at home, one-quarter had their first baby (25.0%), and 74.4% were multiparous. The method of birth was spontaneous vaginal for 97.5% of women who gave birth at home (Table 3.34), and the presentation was vertex for 97.3% of women who gave birth at home. The average age of first-time mothers who gave birth at home was 30.1 years. 
Of babies born at home in 2006, all were liveborn. The mean birthweight of these liveborn babies was 3,687 grams (Table 3.34). The proportion of liveborn babies of low birthweight born at home was 0.8%, and the proportion of babies born at home that were preterm was 0.7%.
Table 3.34: Selected characteristics of women who gave birth at home, 2006
Characteristic	Number	Per cent	
Women who gave birth	708	— 	
Mean maternal age	32.1	—      	
Parity			
None	           177 	          25.0 	
One	           281 	          39.7 	
Two	           153 	          21.6 	
Three	            60 	            8.5 	
Four or more	            33 	            4.7 	
Remoteness Area of mother’s usual residence(a)			
Major cities	438	61.9	
Inner regional	165	23.3	
Outer regional	74	10.5	
Remote	14	2.0	
Very remote	2	0.3	
Method of birth			
Spontaneous vaginal	           690 	          97.5 	
Other	            10 	            1.4 	
Births	711	— 	
Birth status			
Live births	711	100.0	
Fetal deaths	—	—	
Sex			
Males	           378 	53.2	
Females	           333 	46.8	
Mean birthweight of live births (g)	3,687	—   	
(a) 	Excludes mothers not usually resident in Australia and those whose state or territory of usual residence 
was ‘Not stated’.

Maternal mortality
A maternal death is defined as the death of a woman while pregnant or within 42 days of the termination of the pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (WHO 1992). Maternal deaths occur infrequently in Australia. In the most recent triennial report, for the period 2003–2005, there were 65 maternal deaths reported to the NPSU. These maternal deaths are identified through a number of sources, the primary source being via the state and territory maternal mortality committees. 
Maternal deaths are classified into direct deaths (deaths from pregnancy complications such as embolisms and obstetric haemorrhage) and indirect deaths (deaths from pre-existing diseases exacerbated by pregnancy such as cardiac disease). There were 29 direct maternal deaths and 
36 indirect deaths reported in the 2003–2005 cohort. 
Maternal mortality ratio
The maternal mortality ratio (MMR), calculated using direct and indirect deaths, was 
8.4 deaths per 100,000 women who gave birth. The age-standardised maternal death rate for the 2003–2005 triennium was 0.50 deaths per 100,000 female population. 

Causes of death
The main causes of the 29 direct maternal deaths were amniotic fluid embolism with 
8 deaths, hypertension with 5 deaths, and thrombosis and thromboembolism, also with 5 deaths. The main causes of the 36 indirect maternal deaths were cardiac disease with 10 deaths, psychiatric causes with 6 deaths and non-obstetric haemorrhage, accounting for 5 deaths. 
Aboriginal and Torres Strait Islander women
In 2003–2005, there were 6 Aboriginal and Torres Strait Islander maternal deaths. Indigenous status was not ascertained in 8.0% of the maternal death cohort. The MMR was 21.5 per 100,000 Aboriginal and Torres Strait Islander women who gave birth and 7.9 per 100,000 non-Indigenous women in 2003–2005. 
Complete reporting of maternal deaths is presented in the AIHW report Maternal deaths in Australia 2003–2005 (Sullivan et al. 2008), available at <www.npsu.unsw.edu.au>.

4	Babies
Demographic profile
Birth status
Babies are recorded as liveborn or stillborn (fetal deaths) on perinatal notification forms. A live birth is defined as the complete expulsion or extraction from the mother of a baby which, after such separation, breathes or shows any other evidence of life. A fetal death is defined as a death occurring prior to the complete expulsion or extraction from the mother of a product of conception of 20 or more completed weeks gestation or 400 grams or more birthweight (NHDC 2003). In the NPDC, the same criteria are applied to live births, that is, live births must also be at least 20 weeks gestation or at least 400 grams birthweight.
There were 280,078 live births and 2,091 fetal deaths in Australia in 2006, giving a total of 282,169 births reported to the NPDC (Table 2.1). This equates to a stillbirth rate of 7.4 per 1,000 births.
Sex
Male births exceeded female births in all states and territories, and accounted for 51.5% of all live births nationally in 2006. This proportion was similar across the states and territories. In 2006, the sex ratio for Australia, defined as the number of male liveborn babies per 100 female liveborn babies, was 106.4 (Table 4.1). 
Table 4.1: Live births by sex and state and territory, 2006
Sex	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Australia	
Sex ratio (M:F)	107.1	106.6	     107.8 	     102.2 	     104.1 	107.4	106.8	   103.5 	      106.4 	
	Number	
Males	    47,631 	    35,719 	   29,210 	   14,378 	     9,517 	     3,159 	     2,807 	   1,878 	   144,299 	
Females	    44,457 	    33,509 	   27,105 	   14,075 	     9,145 	     2,942 	     2,628 	   1,814 	   135,675 	
Indeterminate/ not stated	           88 	            2 	           2 	           2 	—   	—   	—	       10 	         104 	
Total	    92,176 	    69,230 	   56,317 	   28,455 	   18,662 	     6,101 	     5,435 	   3,702 	   280,078 	
	Per cent	
Males	        51.7 	51.6	       51.9 	       50.5 	       51.0 	51.8	       51.6 	     50.7 	        51.5 	
Females	        48.2 	48.4	       48.1 	       49.5 	       49.0 	48.2	       48.4 	     49.0 	        48.4 	
Indeterminate/ not stated	          0.1 	0.0	        0.0 	        0.0 	—   	—	—	      0.3 	          0.0 	
Total	     100.0 	     100.0 	     100.0 	    100.0 	     100.0 	     100.0 	     100.0 	  100.0 	      100.0 	

For singleton live births the sex ratio was 106.4 male births per 100 female births. The sex ratio for twins was 106.2 and for other multiple births, 86.4. The sex ratio for all live births was highest in Queensland, at 107.8 male births per 100 female births, and lowest in Western Australia, at 102.2.
Babies of Aboriginal and Torres Strait Islander mothers
The mothers reported to the NPDC for 2006, who identified as being Aboriginal or Torres Strait Islander, gave birth to 10,191 liveborn babies and 121 stillborn babies (fetal deaths). There were 266,628 non-Indigenous mothers who gave birth to 269,264 live births and 1,962 stillbirths (Table 4.2). 
Table 4.2: Births by maternal Indigenous status and state and territory, 2006
Indigenous status(a)	NSW	Vic	Qld	WA	SA	Tas	ACT(b)	NT	Australia	
Aboriginal or Torres Strait Islander	
Fetal deaths	          16 	          5 	          39 	          26 	          6 	<5	<5	        24 	          121 	
Live births	     2,632 	       567 	     2,927 	     1,736 	       553 	n.p. 	n.p.	    1,454 	     10,191 	
All births	     2,648 	       572 	     2,966 	     1,762 	       559 	       218 	       109 	    1,478 	     10,312 	
										
Non-Indigenous									
Fetal deaths	        572 	       618 	        351 	        183 	       134 	        40 	        47 	        17 	       1,962 	
Live births	   89,018 	  68,640 	   53,377 	   26,719 	  18,108 	    5,885 	    5,305 	    2,212 	   269,264 	
All births	   89,590 	  69,258 	   53,728 	   26,902 	  18,242 	    5,925 	    5,352 	    2,229 	   271,226 	
(a) 	Indigenous status ‘Not stated’ not included.
(b) 	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, 77 of the 109 babies were born in the ACT to ACT resident Aboriginal or Torres Strait Islander women in 2006.  
n.p.	Data not published to maintain confidentiality of small numbers.
Outcomes
Gestational age
In 2006, the mean gestational age for all babies was 38.8 weeks. The proportion of babies born at term (37–41 weeks gestation) was 90.6%. 
Preterm birth (before 37 completed weeks gestation) is associated with a higher risk of neonatal problems that cause significant morbidity and mortality in newborn babies. Preterm births were classified according to the criteria of the WHO into groups of 20–27 weeks, 28–31 weeks and 32–36 weeks. Of all babies born in 2006, 8.2% were preterm, with most of the preterm births occurring at a gestational age of 32–36 completed weeks (Figure 4.1; Table 4.3).

    Figure 4.1: Distribution of gestational age, 2006 (per cent)	

The mean gestational age of stillborn babies was 27.6 weeks in 2006 compared with 38.9 weeks for liveborn babies. Preterm birth occurred in 81.8% of stillborn babies, compared with 7.7% of liveborn babies (Table 4.3).
Table 4.3: Births by gestational age and birth status, 2006
Gestational age (weeks)	Live births		Fetal deaths		Total	
	Number	Per cent		Number	Per cent		Number	Per cent	
20–27(a)	     1,289 	        0.5 		     1,229 	      58.8 		     2,518 	        0.9 	
28–31	     2,134 	        0.8 		   188 	        9.0 		     2,322 	    0.8 	
32–36	   18,046 	        6.4 		   294 	      14.1 		   18,340 	    6.5 	
37–41	 255,354 	      91.2 		   375 	      17.9 		 255,729 	  90.6 	
42 and over	     3,239 	        1.2 		       2 	        0.1 		     3,241 	    1.1 	
Not stated	         16 	        0.0 		       3 	        0.1 		         19 	    0.0 	
Total	 280,078 	     100.0 		2,091 	     100.0 		 282,169 	100.0 	
20–36	  21,469 	        7.7 		1,711 	      81.8 		  23,180 	    8.2 	
						
Mean (weeks)	      38.9 		   	27.6	       		      38.8 		
(a)      Includes 1 baby of less than 20 weeks gestation.	

The mean gestational age for all preterm births in 2006 was 33.2 weeks (Table 4.4). Nationally, 0.9% of births were at 20–27 weeks gestation, 0.8% were at 28–31 weeks and 6.5% were at 32–36 weeks. The Northern Territory had the highest proportion of preterm births, at 11.6% of all births, and New South Wales had the lowest, at 7.4% of all births. 
Table 4.4: Preterm births by gestational age and state and territory, 2006
Gestational age (weeks)	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
Mean	33.3	32.9	      33.2 	      33.3 	      33.1 	33.7	32.7	33.0	33.2	
	Number	
20–27(b)	       669 	       747 	       531 	       257 	       177 	         36 	         63 	         38 	      2,518 	
28–31	       675 	       560 	       514 	       236 	       158 	         45 	         67 	         67 	      2,322 	
32–36	     5,490 	     4,396 	     4,081 	     2,042 	     1,210 	       422 	       368 	       331 	    18,340 	
Total	     6,834 	     5,703 	     5,126 	     2,535 	     1,545 	       503 	       498 	       436 	    23,180 	
	Per cent of total births	
20–27(b)	        0.7 	        1.1 	        0.9 	        0.9 	        0.9 	        0.6 	        1.1 	        1.0 	          0.9 	
28–31	        0.7 	        0.8 	        0.9 	        0.8 	        0.8 	        0.7 	        1.2 	        1.8 	          0.8 	
32–36	        5.9 	        6.3 	        7.2 	        7.1 	        6.4 	        6.9 	        6.7 	        8.8 	          6.5 	
Total	        7.4 	        8.2 	        9.0 	        8.8 	        8.2 	        8.2 	        9.1 	      11.6 	          8.2 	
(a)      16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of preterm births among babies of ACT residents who gave birth in the ACT was 7.6%.
(b)	Includes 1 baby of less than 20 weeks gestation.	

In 2006, 13.7% of babies of Aboriginal and Torres Strait Islander mothers were born preterm. This was greater than the proportion of 5.1% in babies of non-Indigenous mothers. 
For singletons, the mean gestational age was 38.9 weeks, compared with 35.2 weeks for twins and 31.4 weeks for higher order multiple births. Preterm birth occurred in 55.5% of twins and in all higher order multiple births, which was much higher than the proportion of 6.5% found among singleton births (Table 4.5). The downward shift in the distributions of gestational age for babies born as multiples compared with singletons dramatically increased for babies of less than 32 weeks gestation, when the risks of subsequent complications are much higher. In 2006, birth before 32 weeks gestation occurred for 11.2% of twin births and 34.3% of other multiple births, but only 1 in 100 (1.4%) singleton births (Table 4.5). 
Only 1.1% of babies were born post-term (at 42 weeks or more gestation). The duration of pregnancy by state and territory is detailed in Table 3.13.

Table 4.5: Births by gestational age and plurality, 2006
Gestational age (weeks)	Singletons	Twins	Other multiple births	Total	
	Number	Per cent  		Number	Per cent		Number	Per cent		Number	Per cent  	
20–27(a)	     2,077 	        0.8 	       394 	        4.4 	         47 	      14.4 	     2,518 	        0.9 	
28–31	     1,641 	        0.6 	       616 	        6.8 	         65 	      19.9 	     2,322 	        0.8 	
32–36	   14,128 	        5.2 	     3,998 	      44.3 	       214 	      65.6 	   18,340 	        6.5 	
37–41	 251,710 	      92.3 	     4,019 	      44.5 	 — 	 — 	 255,729 	      90.6 	
42 and over	     3,239 	        1.2 	           2 	        0.0 	 — 	 — 	     3,241 	        1.1 	
Not stated	         19 	        0.0 	     — 	 — 	 — 	 — 	         19 	        0.0 	
Total	 272,814 	     100.0 	     9,029 	     100.0 	       326 	     100.0 	 282,169 	     100.0 	
20–36	  17,846 	        6.5 	    5,008 	      55.5 	       326 	    100.0 	  23,180 	        8.2 	
					
Mean (weeks)	      38.9 		      35.2 		      31.4 		38.8		
(a)      Includes 1 baby of less than 20 weeks gestation.	
Birthweight
A baby’s birthweight is a key indicator of health status. Babies are defined as low birthweight if their weight at birth is less than 2,500 grams. Within this category, those weighing less than 1,500 grams are defined as very low birthweight and those less than 1,000 grams as extremely low birthweight (WHO 1992).
Low birthweight babies have a greater risk of poor health and dying, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities (Goldenberg & Culhane 2007). A baby may be small due to being born early (preterm), or may be small for its gestational age (intrauterine growth retardation). Some factors contributing to low birthweight include socioeconomic status, size of parents, age of mother, number of babies previously born, mother’s nutritional status, smoking and alcohol intake, and illness during pregnancy (Ashdown-Lambert 2005; Mohsin et al. 2003).
In 2006, 91.8% of liveborn babies had a birthweight in the range 2,500–4,499 grams. The average birthweight of liveborn babies in Australia in 2006 was 3,370 grams and ranged from 3,262 grams in the Northern Territory to 3,407 grams in Tasmania (Table 4.6). 
In 2006, there were 17,954 (6.4%) liveborn babies of low birthweight (Figure 4.2; Table 4.6). The 3,026 very low birthweight babies constituted 1.1% of all live births in 2006, and the 1,305 extremely low birthweight babies constituted 0.5% (Table 4.6).

Table 4.6: Live births by birthweight and state and territory, 2006
Birthweight (g)	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
Mean	3,379	3,371	    3,372 	    3,351 	    3,361 	3,407	3,357	    3,262 	      3,370 	
	Number	
Less than 1,000	       365 	324	     311 	       147 	         94 	        17 	        31 	        16 	      1,305 	
1,000–1,499	       509 	436	       383 	       162 	       109 	        27 	        47 	        48 	      1,721 	
1,500–1,999	    1,117 	904	       797 	       368 	       227 	        86 	        84 	        76 	      3,659 	
2,000–2,499	    3,517 	2,781	    2,350 	    1,149 	       762 	      250 	      238 	      222 	    11,269 	
2,500–2,999	  13,865 	10,472	    8,230 	    4,503 	    2,874 	      897 	      793 	      706 	    42,340 	
3,000–3,499	  33,041 	24,695	  19,665 	  10,421 	    6,751 	    2,039 	    1,885 	    1,287 	    99,784 	
3,500–3,999	  28,679 	21,151	  17,601 	    8,620 	    5,673 	    1,946 	    1,739 	      983 	    86,392 	
4,000–4,499	    9,382 	7,121	    5,969 	    2,635 	    1,869 	      688 	      517 	      306 	    28,487 	
4,500 and over	    1,643 	1,341	    1,002 	       450 	       303 	      151 	      101 	        58 	      5,049 	
Not stated	         58 	5	           9 	—   	—	—   	—   	         — 	           72 	
Total	  92,176 	   69,230 	  56,317 	  28,455 	  18,662 	    6,101 	   5,435 	    3,702 	  280,078 	
Less than 1,500	       874 	        760 	       694 	       309 	       203 	        44 	        78 	        64 	      3,026 	
Less than 2,500	    5,508 	     4,445 	    3,841 	    1,826 	    1,192 	      380 	      400 	      362 	    17,954 	
	Per cent	
Less than 1,000	        0.4 	         0.5 	        0.6 	        0.5 	        0.5 	       0.3 	       0.6 	       0.4 	          0.5 	
1,000–1,499	        0.6 	         0.6 	        0.7 	        0.6 	        0.6 	       0.4 	       0.9 	       1.3 	          0.6 	
1,500–1,999	        1.2 	         1.3 	        1.4 	        1.3 	        1.2 	       1.4 	       1.5 	       2.1 	          1.3 	
2,000–2,499	        3.8 	         4.0 	        4.2 	        4.0 	        4.1 	       4.1 	       4.4 	       6.0 	          4.0 	
2,500–2,999	      15.0 	       15.1 	      14.6 	      15.8 	      15.4 	     14.7 	     14.6 	     19.1 	        15.1 	
3,000–3,499	      35.8 	       35.7 	      34.9 	      36.6 	      36.2 	     33.4 	     34.7 	     34.8 	        35.6 	
3,500–3,999	      31.1 	       30.6 	      31.3 	      30.3 	      30.4 	     31.9 	     32.0 	     26.6 	        30.8 	
4,000–4,499	      10.2 	       10.3 	      10.6 	        9.3 	      10.0 	     11.3 	       9.5 	       8.3 	        10.2 	
4,500 and over	        1.8 	         1.9 	        1.8 	        1.6 	        1.6 	       2.5 	       1.9 	       1.6 	          1.8 	
Not stated	        0.1 	         0.0 	        0.0 	—	—	—   	—	         —	          0.0 	
Total	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	
Less than 1,500	0.9	1.1	        1.2 	        1.1 	       1.1 	0.7	1.4	1.7	1.1	
Less than 2,500	6.0	6.4	        6.8 	        6.4 	       6.4 	6.2	7.4	9.8	6.4	
(a)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of live births of ACT residents who gave birth in the ACT where the birthweight was less than 1,500 grams was 0.8% and where 
the birthweight was less than 2,500 grams the percentage was 4.9%.

 
    Figure 4.2: Live births by birthweight, 2006 (per cent)

The mean birthweight of stillborn babies was 1,209 grams in 2006 compared with 3,370 grams for liveborn babies. Low birthweight occurred in 79.5% of stillborn babies. More than half (60.0%) of the stillborn babies had a birthweight of less than 1,000 grams (Table 4.7).
A smaller proportion of male liveborn babies was low birthweight (5.9%) compared with female babies (6.9%). The average birthweight of liveborn male babies was 3,430 grams, 123 grams higher than that of females (3,307 grams).
Table 4.7: Births by birthweight and birth status, 2006
	Live births		Fetal deaths		Total	
Birthweight (g)	Number	Per cent		Number	Per cent		Number	Per cent	
Less than 1,000	     1,305 	         0.5 		     1,254 	       60.0 		     2,559 	        0.9 	
1,000–1,499	     1,721 	         0.6 		        145 	        6.9 		     1,866 	        0.7 	
1,500–1,999	     3,659 	         1.3 		        130 	        6.2 		     3,789 	        1.3 	
2,000–2,499	   11,269 	         4.0 		        133 	        6.4 		   11,402 	        4.0 	
2,500–2,999	   42,340 	       15.1 		        139 	        6.6 		   42,479 	       15.1 	
3,000–3,499	   99,784 	       35.6 		        125 	        6.0 		   99,909 	       35.4 	
3,500–3,999	   86,392 	       30.8 		         57 	        2.7 		   86,449 	       30.6 	
4,000–4,499	   28,487 	       10.2 		         28 	        1.3 		   28,515 	       10.1 	
4,500 and over	     5,049 	         1.8 		         14 	        0.7 		     5,063 	        1.8 	
Not stated	          72 	         0.0 		         66 	        3.2 		        138 	        0.0 	
Total	 280,078 	     100.0 		     2,091 	     100.0 		 282,169 	     100.0 	
Less than 1,500	    3,026 	        1.1 		    1,399 	      66.9 		    4,425 	        1.6 	
Less than 2,500	   17,954 	        6.4 		    1,662 	      79.5 		   19,616 	        7.0 	
						
Mean (g)	     3,370 			1,209 	 		     3,355 		
For liveborn singletons, the mean birthweight was 3,404 grams, compared with 2,387 grams for twins and 1,648 grams for triplets and other multiple births. Low birthweight occurred in half of all liveborn twins (51.5%) and in almost all higher order multiple births (97.1%), which was markedly higher than the proportion of 4.8% found among singleton births (Table 4.8).

Table 4.8: Live births by birthweight and plurality, 2006
Birthweight (g)	Singletons	Twins	Other multiple births	Total	
	Number	Per cent  		Number	Per cent		Number	Per cent		Number	Per cent  	
Less than 1,000	       960 	        0.4 	       293 	        3.3 	         52 	      16.5 	     1,305 	        0.5 	
1,000–1,499	     1,150 	        0.4 	       515 	        5.8 	         56 	      17.8 	     1,721 	        0.6 	
1,500–1,999	     2,331 	        0.9 	     1,217 	      13.7 	       111 	      35.2 	     3,659 	        1.3 	
2,000–2,499	     8,643 	        3.2 	     2,539 	      28.6 	         87 	      27.6 	   11,269 	        4.0 	
2,500–2,999	   39,279 	      14.5 	     3,052 	      34.4 	           9 	        2.9 	   42,340 	      15.1 	
3,000–3,499	   98,664 	      36.4 	     1,120 	      12.6 	 —	 —	   99,784 	      35.6 	
3,500–3,999	   86,281 	      31.8 	       111 	        1.3 	 —	 —	   86,392 	      30.8 	
4,000–4,499	   28,480 	      10.5 	           7 	        0.1 	 —	 —	   28,487 	      10.2 	
4,500 and over	     5,049 	        1.9 	 —	 —	 —	 —	     5,049 	        1.8 	
Not stated	         62 	        0.0 	         10 	        0.1 	 —	 —	         72 	        0.0 	
Total	 270,899 	     100.0 	     8,864 	     100.0 	       315 	     100.0 	 280,078 	     100.0 	
Less than 1,500	     2,110 	        0.8 	       808 	        9.1 	       108 	      34.3 	     3,026 	        1.1 	
Less than 2,500	   13,084 	        4.8 	     4,564 	      51.5 	       306 	      97.1 	   17,954 	        6.4 	
					
Mean (g)	3,404	     	2,387	     	1,648	     	     3,370 		

In 2006, the average birthweight of liveborn babies of Aboriginal and Torres Strait Islander mothers was 3,169 grams. This was 209 grams lighter than the average of 3,378 grams for liveborn babies of non-Indigenous mothers. The proportion of low birthweight in liveborn babies of Aboriginal and Torres Strait Islander mothers was 12.4% (Table 4.9), twice that of babies of non-Indigenous mothers (6.2%). The mean birthweight of liveborn babies of mothers identified as Aboriginal or Torres Strait Islander, and the proportion with low birthweight, varied markedly among the states and territories. 

Table 4.9: Live births of Aboriginal or Torres Strait Islander mothers by birthweight and state and territory, 2006
Birthweight (g)	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
Mean	3,201	3,179	   3,211 	   3,113 	   3,140 	3,325	2,975	   3,092 	    3,169 	
	Number	
Less than 1,500	        46 	        11 	        60 	        53 	        15 	—   	          6 	        45 	      236 	
1,500–2,499	      268 	        63 	      252 	      194 	        59 	        17 	        14 	      162 	    1,029 	
2,500–2,999	      562 	      131 	      645 	      425 	      129 	        47 	        24 	      377 	    2,340 	
3,000–3,499	      905 	      178 	      993 	      577 	      189 	        65 	        35 	      509 	    3,451 	
3,500–3,999	      617 	      136 	      711 	      359 	      123 	        63 	        20 	      267 	    2,296 	
4,000–4,499	      200 	n.p. 	      223 	        97 	        26 	n.p.        	          7 	        72 	      688 	
4,500 and over	        33 	<5	        43 	        31 	        12 	        n.p. 	—   	        22 	      150 	
Not stated	          1 	—	—   	—	—	—	        —   	—   	          1 	
Total	   2,632 	      567 	   2,927 	   1,736 	      553 	      216 	      106 	   1,454 	  10,191 	
Less than 2,500	      314 	       74 	      312 	      247 	       74 	       17 	       20 	      207 	   1,265 	
	Per cent	
Less than 1,500	       1.7 	       1.9 	       2.0 	       3.1 	       2.7 	—	       5.7 	       3.1 	       2.3 	
1,500–2,499	     10.2 	     11.1 	       8.6 	     11.2 	     10.7 	       7.9 	     13.2 	     11.1 	     10.1 	
2,500–2,999	     21.4 	     23.1 	     22.0 	     24.5 	     23.3 	     21.8 	     22.6 	     25.9 	     23.0 	
3,000–3,499	     34.4 	     31.4 	     33.9 	     33.2 	     34.2 	     30.1 	     33.0 	     35.0 	     33.9 	
3,500–3,999	     23.4 	     24.0 	     24.3 	     20.7 	     22.2 	     29.2 	     18.9 	     18.4 	     22.5 	
4,000–4,499	       7.6 	n.p.        	       7.6 	       5.6 	       4.7 	n.p.        	       6.6 	       5.0 	       6.8 	
4,500 and over	       1.3 	        n.p. 	       1.5 	       1.8 	       2.2 	        n.p. 	        —   	       1.5 	       1.5 	
Not stated	       0.0 	—	—	—	—	—	        —   	       —   	       0.0 	
Total	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0	   100.0 	   100.0 	    100.0 	
Less than 2,500	11.9	13.1	     10.7 	     14.2 	     13.4 	7.9	18.9	14.2	12.4	
(a)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of liveborn babies born in the ACT to ACT resident Aboriginal or Torres Strait Islander women in 2006 where the birthweight was less than 2,500 grams was 10.8%.
n.p.	Data not published to maintain confidentiality of small numbers.
Mothers aged 25–29 years and 30–34 years were the groups with the lowest proportion of low birthweight liveborn babies (both 5.9%). The proportion was higher among babies of younger and older mothers (8.7% for mothers aged less than 20 years and 14.8% for mothers aged 45 years and older).
Of hospital births, the proportion of low birthweight liveborn babies was higher in babies of mothers who gave birth in public hospitals (7.4%) than in babies of mothers who gave birth in private hospitals (4.4%).
Presentation at birth 
In 2006, vertex presentations occurred for 93.6% of all babies. Breech presentation occurred for 4.8% of babies, and other presentations occurred for 0.9% of babies. Almost one-third of twins (32.3%) and 40.8% of higher order multiple babies had non-vertex presentations at birth (Table 4.10).   
Table 4.10: Births by presentation at birth and plurality, 2006
Presentation	Singletons	Twins	Other multiple births	Total	
	Number	Per cent  		Number	Per cent		Number	Per cent		Number	Per cent  	
Vertex	 257,826 	      94.5 	     5,974 	      66.2 	       179 	      54.9 	 263,979 	      93.6 	
Breech	   10,709 	        3.9 	     2,635 	      29.2 	       125 	      38.3 	   13,469 	        4.8 	
Other(a)	     2,272 	        0.8 	       281 	        3.1 	           8 	        2.5 	     2,561 	        0.9 	
Not stated	     2,007 	        0.7 	       139 	        1.5 	         14 	        4.3 	     2,160 	        0.8 	
Total	 272,814 	     100.0 	     9,029 	     100.0 	       326 	     100.0 	 282,169 	     100.0 	
(a) 	Includes face, brow, shoulder/transverse and compound presentations.
Table 3.18 shows the presentation at birth for mothers, where the presentation at birth of the first born baby in multiple births is used.
Method of birth 
Of all births in 2006, 31.5% of babies were delivered by caesarean section and 57.3% of babies had a spontaneous vaginal birth. Approximately 1 in 9 babies was born by an instrumental vaginal delivery (10.6%). Twins had the highest proportion of vaginal breech births (5.6%). 
Two-thirds of all twins were born by caesarean section (69.0%). The majority of higher order multiples were delivered by caesarean section (94.2%), with only 4.3% born by spontaneous vaginal birth (Table 4.11).
Table 3.19 presents data for mothers, where the method of birth of the first born baby in multiple births is used. 
Table 4.11: Births by method of birth and plurality, 2006
Method         of birth	Singletons	Twins	Other multiple births	Total	
	Number	Per cent  		Number	Per cent		Number	Per cent		Number	Per cent  	
Spontaneous vaginal	 160,046 	      58.7 	     1,720 	      19.0 	         14 	        4.3 	 161,780 	      57.3 	
Instrumental vaginal(a)	   29,313 	      10.7 	       561 	        6.2 	           1 	        0.3 	   29,875 	      10.6 	
Vaginal breech	     1,021 	        0.4 	       509 	        5.6 	           4 	        1.2 	     1,534 	        0.5 	
Caesarean section	   82,208 	      30.1 	     6,232 	      69.0 	       307 	      94.2 	   88,747 	      31.5 	
Other	           7 	— 	           1 	        0.0 	—	—	           8 	        0.0 	
Not stated	       219 	        0.1 	           6 	        0.1 	—	—	       225 	        0.1 	
Total	 272,814 	     100.0 	     9,029 	     100.0 	       326 	     100.0 	 282,169 	     100.0 	
(a)	Instrumental vaginal birth includes forceps and vacuum extraction.
Method of birth for babies with breech presentations
Of babies with breech presentations at birth in 2006, 88.4% were born by caesarean section. This ranged from 79.0% in the Northern Territory to 90.7% in South Australia (Table 4.12). The remaining babies were born vaginally, with or without the use of instruments.
Table 4.12: Babies with breech presentations by method of birth and state and territory, 2006
Method of birth	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Total	
	Number	
Vaginal(b)	       501 	456	       279 	       156 	        82 	n.p.	        52 	        41 	     1,567 	
Caesarean section	    3,710 	3,178	    2,633 	    1,178 	       796 	n.p.	       247 	       154 	   11,896 	
Other/not stated	          1 	—	—   	—	—	n.p.	—   	—   	           1 	
Total	    4,212 	3,634	    2,912 	    1,334 	       878 	n.p.	      299 	       195 	   13,464 	
	Per cent	
Vaginal(b)	      11.9 	12.5	       9.6 	      11.7 	       9.3 	n.p.	      17.4 	      21.0 	       11.6 	
Caesarean section	      88.1 	87.5	      90.4 	      88.3 	      90.7 	n.p.	      82.6 	      79.0 	       88.4 	
Other/not stated	       0.0 	—	—   	—	—	n.p.	         —   	—   	        0.0 	
Total	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   n.p. 	   100.0 	   100.0 	    100.0 	
(a)   	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of babies born in the ACT to ACT residents with a breech presentation by a vaginal birth was 15.5%.
(b)	Includes instrumental vaginal births.
n.p.	Data for Tas not published as presentations were only recorded for vaginal births. 
Apgar scores
Apgar scores are clinical indicators of the baby’s condition shortly after birth, based on assessment of the heart rate, breathing, colour, muscle tone and reflex irritability. Between 0 and 2 points are given for each of these five characteristics, and the total score is between 0 and 10. An Apgar score of less than 7 at 5 minutes after birth is considered to be an indicator of complications and of compromise for the baby.
In 2006, 1.3% of liveborn babies had a low Apgar score (between 0 and 6) at 5 minutes. Scores of 0–3 were recorded at 5 minutes in 0.3% of all live births nationally, and scores of 4–6 were recorded in 1.0% of live births (Table 4.13). Among the states and territories, the distribution of low Apgar scores at 5 minutes ranged from 1.1% of all live births in Queensland and Western Australia, to 2.1% in the Northern Territory.

Table 4.13: Live births by Apgar score at 5 minutes and state and territory, 2006
Apgar score	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
	Number	
0–3	        273 	        205 	        192 	          62 	         38 	         17 	         28 	         18 	          833 	
4–6	     1,028 	        713 	        418 	        248 	        186 	         59 	         58 	         58 	       2,768 	
7–10	    90,643 	    68,229 	    55,648 	    28,117 	   18,404 	     6,025 	     5,346 	     3,621 	   276,033 	
Not stated	        232 	          83 	          59 	          28 	         34 	—   	           3 	           5 	          444 	
Total	    92,176 	    69,230 	    56,317 	    28,455 	   18,662 	     6,101 	     5,435 	     3,702 	   280,078 	
	Per cent	
0–3	         0.3 	         0.3 	         0.3 	         0.2 	        0.2 	        0.3 	        0.5 	        0.5 	           0.3 	
4–6	         1.1 	         1.0 	         0.7 	         0.9 	        1.0 	        1.0 	        1.1 	        1.6 	           1.0 	
7–10	       98.3 	       98.6 	       98.8 	       98.8 	       98.6 	       98.8 	       98.4 	       97.8 	         98.6 	
Not stated	         0.3 	         0.1 	         0.1 	         0.1 	        0.2 	—  	        0.1 	        0.1 	           0.2 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	      100.0 	
(a)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. 
Resuscitation at birth
The types of active resuscitation measures given to babies immediately after birth are presented in Table 4.14. For these data, the type of resuscitation used is coded hierarchically, with suction being the lowest order and external cardiac massage and ventilation being the highest order. If more than one type of resuscitation was used, the highest order type in the hierarchy is coded. 
Suction and oxygen therapy were the most common types of resuscitation used. Ventilatory assistance by intermittent positive pressure respiration (IPPR) through a bag and mask or after endotracheal intubation was performed for at least 7.0% of all live births in 2006. External cardiac massage was provided for a small proportion of babies (0.2%).

Table 4.14: Live births by active resuscitation measures at birth and state and territory, 2006
Resuscitation type(a)	NSW	Vic	Qld	WA	SA	Tas	ACT(b)	NT	Australia	
	Number	
None	   56,454 	  48,144 	   27,191 	   18,826 	   11,337 	    4,289 	     3,603 	   2,214 	  172,058 	
Suction	   16,865 	     5,822 	   12,186 	     3,501 	     2,083 	       559 	       782 	      544 	    42,342 	
Oxygen therapy	   12,773 	   10,047 	   12,391 	     3,642 	     3,782 	       823 	       553 	      427 	    44,438 	
IPPR through bag and mask	      5,049 	     4,667 	     3,777 	     1,956 	     1,279 	       404 	       406 	      268 	    17,806 	
Endotracheal intubation and IPPR	        519 	        364 	        507 	        274 	        125 	         15 	         79 	       25 	     1,908 	
External cardiac massage and ventilation	        174 	        143 	        106 	         58 	         36 	         11 	         12 	       19 	        559 	
Other(c)	          25 	            2 	        142 	        198 	         20 	—	—   	          8 	         395 	
Not stated	        317 	          41 	         17 	—  	—	—	—	      197 	         572 	
Total	   92,176 	   69,230 	   56,317 	   28,455 	   18,662 	    6,101 	     5,435 	   3,702 	  280,078 	
	Per cent	
None	       61.2 	       69.5 	       48.3 	       66.2 	       60.7 	      70.3 	      66.3 	     59.8 	        61.4 	
Suction	       18.3 	         8.4 	       21.6 	       12.3 	       11.2 	        9.2 	      14.4 	     14.7 	        15.1 	
Oxygen therapy	       13.9 	       14.5 	       22.0 	       12.8 	       20.3 	      13.5 	      10.2 	     11.5 	        15.9 	
IPPR through bag and mask	         5.5 	         6.7 	        6.7 	        6.9 	      6.9 	        6.6 	        7.5 	      7.2 	          6.4 	
Endotracheal intubation and IPPR	         0.6 	         0.5 	        0.9 	        1.0 	        0.7 	        0.2 	        1.5 	      0.7 	          0.7 	
External cardiac massage and ventilation	         0.2 	         0.2 	        0.2 	        0.2 	        0.2 	        0.2 	        0.2 	       0.5 	          0.2 	
Other(c)	         0.0 	         0.0 	        0.3 	         0.7 	        0.1 	—	—	       0.2 	          0.1 	
Not stated	         0.3 	         0.1 	        0.0 	 —   	—	—	          —  	       5.3 	          0.2 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	    100.0	     100.0 	   100.0 	      100.0 	
(a)	A hierarchical coding system is used for this item, starting with suction, up to external cardiac massage and ventilation. If more than one type of resuscitation was used, the highest order type in the hierarchy is coded.
(b)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of live babies born in the ACT of ACT resident women where the active measure of resuscitation used was endotracheal intubation and IPPR was 1.0%.
(c)	Includes tactile stimulation for NSW and Qld.

Admission to special care nurseries or neonatal intensive care units
Babies are admitted to a special care nursery (SCN) or neonatal intensive care unit (NICU) if they require more specialised medical care and treatment than is available on the postnatal ward (Abeywardana 2006). Of liveborn babies in 2006, 14.9% were admitted to an SCN or NICU. This proportion appears lower in Western Australia because only babies who stayed in an SCN or NICU for one day or more were included. In the other states and territories, this ranged from 11.4% in Tasmania to 16.9% in Queensland (Table 4.15). 
Table 4.15: Live births by admission to special care nursery or neonatal intensive care unit and state and territory, 2006
Admission to    SCN or NICU	NSW	Vic	Qld	WA(a)	SA	Tas	ACT(b)	NT	Australia	
	Number	
Admitted	   14,379 	  10,624 	     9,514 	     2,453 	     2,890 	       693 	        688 	      579 	     41,820 	
Not admitted	   77,793 	   58,606 	   46,803 	   26,002 	   15,772 	    5,408 	     4,747 	   3,123 	   238,254 	
Not stated	            4 	—	—   	—	—	—	—   	—   	             4 	
Total	   92,176 	   69,230 	   56,317 	   28,455 	   18,662 	    6,101 	     5,435 	   3,702 	   280,078 	
	Per cent	
Admitted	       15.6 	15.3	       16.9 	         8.6 	       15.5 	11.4	       12.7 	     15.6 	         14.9 	
Not admitted	       84.4 	84.7	       83.1 	       91.4 	       84.5 	88.6	       87.3 	     84.4 	         85.1 	
Not stated	         0.0 	—	—   	—	—	—	          —   	—   	           0.0 	
Total	     100.0 	     100.0 	     100.0 	     100.0 	     100.0 	    100.0 	     100.0 	   100.0 	      100.0 	
(a)	For WA, babies were recorded as being admitted to an SCN or NICU only if the length of stay was one day or more.
(b) 	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of live babies born in the ACT to ACT resident women where there was an admission to a special care nursery or neonatal intensive care unit was 11.3%. Also, multiple sources were used for 2006 to improve the reporting of special care nursery or neonatal intensive care unit admissions.
Hospital births
Length of stay in hospital of birth
The majority of babies are discharged from hospital at the same time as their mothers, however, some ill babies require longer hospitalisation. A baby’s gestation and birthweight are two factors that influence the duration of hospitalisation. Twins and higher order multiple births usually have longer stays in hospital than singleton babies. 
In 2006, the median length of stay in hospital for babies born in hospital who were discharged home was 4.0 days. The majority of babies remained in their hospital of birth for less than six days (87.2%), and half stayed in hospital for less than four days (49.8%). Relatively more babies born in Queensland had a length of stay of less than four days (58.9%), with a median length of stay of 3.0 days. Babies hospitalised for 28 or more days accounted for 0.8% of babies born in hospital in 2006 (Table 4.16). 

Table 4.16: Babies born in hospital(a) by length of stay and state and territory, 2006
Length of       stay (days)	NSW	Vic	Qld	WA	SA	Tas	ACT(b)	NT	Australia	
Median	4.0	4.0	3.0	4.0	4.0	3.0	4.0	3.0	4.0	
	Number	
Less than 1 day	    1,687 	       656 	    1,528 	       507 	       345 	      123 	      149 	      152 	       5,147 	
1 day	    8,251 	    4,016 	    7,844 	    2,053 	    1,171 	      496 	      482 	      347 	     24,660 	
2 days	  14,739 	  12,716 	  11,010 	    4,114 	    2,524 	   1,000 	      856 	      550 	     47,509 	
3 days	  17,551 	  12,882 	  11,203 	    4,855 	    3,050 	   1,204 	      881 	      577 	     52,203 	
4 days	  19,041 	  18,571 	  10,760 	    5,371 	    3,906 	   1,067 	      988 	      534 	     60,238 	
5 days	  12,451 	    9,831 	    6,044 	    4,223 	    2,727 	      768 	      887 	      391 	     37,322 	
6 days	    5,393 	    2,084 	    1,791 	    2,674 	    1,352 	      338 	      310 	      180 	     14,122 	
7–13 days	    4,004 	    2,140 	    1,892 	    2,431 	       935 	      355 	      251 	      266 	     12,274 	
14–20 days	       849 	       806 	       703 	       218 	       224 	        93 	        70 	        68 	       3,031 	
21–27 days	       380 	       409 	       329 	         73 	       128 	        47 	        20 	        30 	       1,416 	
28 or more days	       580 	       489 	       476 	       184 	       239 	        80 	        27 	        74 	       2,149 	
Not stated	       253 	—   	—	—	—	—	—   	—   	          253 	
Total	  85,179 	  64,600 	  53,580 	  26,703 	  16,601 	   5,571 	   4,921 	   3,169 	   260,324 	
	Per cent	
Less than 1 day	        2.0 	        1.0 	        2.9 	        1.9 	        2.1 	       2.2 	       3.0 	       4.8 	           2.0 	
1 day	        9.7 	        6.2 	      14.6 	        7.7 	        7.1 	       8.9 	       9.8 	     10.9 	           9.5 	
2 days	      17.3 	      19.7 	      20.5 	      15.4 	      15.2 	     18.0 	     17.4 	     17.4 	         18.2 	
3 days	      20.6 	      19.9 	      20.9 	      18.2 	      18.4 	     21.6 	     17.9 	     18.2 	         20.1 	
4 days	      22.4 	      28.7 	      20.1 	      20.1 	      23.5 	     19.2 	     20.1 	     16.9 	         23.1 	
5 days	      14.6 	      15.2 	      11.3 	      15.8 	      16.4 	     13.8 	     18.0 	     12.3 	         14.3 	
6 days	        6.3 	        3.2 	        3.3 	      10.0 	        8.1 	       6.1 	       6.3 	       5.7 	           5.4 	
7–13 days	        4.7 	        3.3 	        3.5 	        9.1 	        5.6 	       6.4 	       5.1 	       8.4 	           4.7 	
14–20 days	        1.0 	        1.2 	        1.3 	        0.8 	        1.3 	       1.7 	       1.4 	       2.1 	           1.2 	
21–27 days	        0.4 	        0.6 	        0.6 	        0.3 	        0.8 	       0.8 	       0.4 	       0.9 	           0.5 	
28 or more days	        0.7 	        0.8 	        0.9 	        0.7 	        1.4 	       1.4 	       0.5 	       2.3 	           0.8 	
Not stated	        0.3 	—   	—	—	—	—	—   	—   	           0.1 	
Total	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	    100.0 	
(a)	Only babies who were discharged home are included. For multiple births, the place of birth of the first born baby was used for all subsequent babies.
(b)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages as more babies of 
non-ACT residents stayed in hospital for 4 days or more, compared with babies of ACT residents (60.4% and 50.4%).
Over the 10-year period from 1997 to 2006, the proportion of hospital-born babies with a length of stay of less than five days increased from 58.2% to 72.9%, while the proportion of babies with a length of stay in hospital of five days or more decreased from 41.8% in 1997 to 27.0% in 2006 (Figure 4.3).

    Figure 4.3: Length of stay of 5 days or more for babies born in hospital, 1997–2006 (per cent)	

Mode of separation from hospital
In 2006, 94.8% of babies born in hospital were discharged home, varying from 87.6% in the Northern Territory to 95.9% in Queensland. A total of 4.0% of babies were transferred to another hospital from their hospital of birth (Table 4.17). 
Babies dying at their hospital of birth accounted for 1.0% of separations. These data do not include babies born outside hospital, and may not include all babies who are transferred to another hospital and die, or babies discharged home who subsequently die. 

Table 4.17: Babies born in hospital(a) by mode of separation and state and territory, 2006
Mode of separation	NSW	Vic	Qld	WA	SA	Tas	ACT(b)	NT	Australia	
	Number	
Discharge home	  85,179 	  64,600 	  53,580 	  26,703 	  16,601 	    5,571 	    4,921 	    3,169 	   260,324 	
Transfer to another hospital(c)	    4,220 	    2,540 	    1,728 	    1,121 	       604 	       398 	       263 	        55 	     10,929 	
Fetal or neonatal death	      801 	       796 	       554 	        249 	       169 	        41 	        74 	        46 	       2,730 	
Other(d)	—   	       (e)75 	         22 	         24 	         —   	—	—   	    (f)330 	          451 	
Not stated	       106 	—	—   	—	—	—	         —   	        16 	          122 	
Total	  90,306 	  68,011 	  55,884 	  28,097 	  17,374 	    6,010 	    5,258 	    3,616 	   274,556 	
	Per cent	
Discharge home	      94.3 	      95.0 	      95.9 	      95.0 	      95.6 	      92.7 	      93.6 	      87.6 	         94.8 	
Transfer to another hospital(c)	        4.7 	        3.7 	        3.1 	        4.0 	       3.5 	       6.6 	       5.0 	       1.5 	           4.0 	
Fetal or neonatal death	        0.9 	        1.2 	        1.0 	        0.9 	       1.0 	       0.7 	       1.4 	       1.3 	           1.0 	
Other(d)	—  	      (e)0.1 	        0.0 	        0.1 	         —   	—	         —   	     (f)9.1 	           0.2 	
Not stated	        0.1 	—	—	—	—	—	         —   	       0.4 	           0.0 	
Total	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	   100.0 	    100.0 	
(a)	For multiple births, the place of birth of the first born baby was used for all subsequent babies.
(b)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting percentages. For example, the percentage of live babies born in the ACT to ACT residents who were transferred to another hospital was 2.9%.
(c)	Includes babies who were transferred to another hospital and died.
(d)	May include statistical discharges, transfers to health care accommodation other than acute hospitals and postneonatal deaths.
(e)	These cases refer to postneonatal deaths (at 28 days or more after birth), regardless of the mode of separation.
(f)	Includes mothers discharged with their babies against medical advice, babies transferred to accommodation hostels and statistical discharges.

5	Perinatal mortality
Definitions
There are different definitions in Australia for reporting and registering perinatal deaths (Figure 5.1). The NHDD specifies a definition of perinatal deaths to include all fetal and neonatal deaths of at least 400 grams birthweight or at least 20 weeks gestation (NHDC 2003). This definition is used in the NPDC. 
In Australia, all fetal and neonatal deaths of at least 400 grams birthweight or, if birthweight is unavailable, a gestational age of at least 20 weeks should be registered (ABS 2008). Further information on these definitions and the issues surrounding the collection of data on perinatal deaths can be found in a previous edition of this report (Laws & Sullivan 2004). 
Figure 5.1: Definitions of perinatal mortality

Figure 5.2 shows the definitions of periods of perinatal and infant deaths used by the NPSU. Neonatal deaths are those occurring in live births up to 28 completed days after birth. Infant deaths are those occurring in live births at less than one year of age. 
Figure 5.2: Perinatal and infant death periods
The ABS definition of a perinatal death includes birthweight of at least 400 grams or, where birthweight is unknown, a gestational age of at least 20 weeks. Deaths where both the birthweight and gestational age are unknown, are included. The data on perinatal deaths published by the ABS are based on the year of registration of the death rather than on the year of birth or death. Data are presented in the Causes of death Australia report (e.g. ABS 2008).
This report presents data on perinatal deaths from the NPDC. For vital statistics, refer to ABS data.

Fetal deaths
As noted previously, fetal deaths are included in the NPDC if the birthweight is at least 400 grams or the gestational age is 20 weeks or more. 
In 2006, there were 2,091 fetal deaths reported to the NPDC, resulting in a fetal death rate of 7.4 per 1,000 births. The state and territory fetal death rates ranged from 6.4 per 1,000 births in New South Wales to 11.0 per 1,000 births in the Northern Territory (Table 5.1).
Table 5.1: Fetal, neonatal and perinatal deaths by state and territory, 2006
	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Australia	
	Number	
Live births(b)	   92,176 	69,230	   56,317 	   28,455 	   18,662 	6,101	     5,435 	    3,702 	  280,078 	
Fetal deaths	        592 	626	        391 	        209 	        140 	42	         50 	         41 	      2,091 	
Neonatal deaths(c)	        223 	228	        223 	         64 	         37 	13	         28 	n.a.	816	
Perinatal deaths	       815 	854	       614 	       273 	       177 	55	         78 	n.a.	2,907	
Total births	   92,768 	69,856	   56,708 	   28,664 	   18,802 	6,143	     5,485 	    3,743 	  282,169 	
	Rate per 1,000 births(d)	
Fetal deaths	        6.4 	        9.0 	        6.9 	        7.3 	        7.4 	        6.8 	        9.1 	11.0	7.4	
Neonatal deaths(c)	        2.4 	        3.3 	        4.0 	        2.2 	        2.0 	        2.1 	        5.2 	n.a.	3.0	
Perinatal deaths	        8.8 	      12.2 	      10.8 	        9.5 	        9.4 	        9.0 	      14.2 	n.a.	10.3	
(a)	16.3% of women who gave birth in the ACT were non-ACT residents. Care must be taken when interpreting rates. For example, for ACT residents who gave birth in the ACT, there were 7.4 fetal deaths per 1,000 births, 3.7 neonatal deaths per 1,000 live births and 11.1 perinatal deaths per 1,000 births.
(b)	Includes neonatal deaths.
(c)	Except in WA and NT, these may exclude neonatal deaths for babies transferred to another hospital or readmitted to hospital and those dying 
at home.
(d)	Fetal and perinatal death rates were calculated using all births (live births and fetal deaths). Neonatal death rates were calculated using all live births. 
n.a. 	Neonatal death data for NT were not available.
There was variation in fetal and perinatal death rates according to maternal age with higher rates reported for teenage mothers. The age-group specific fetal death rates ranged from 6.1 per 1,000 births for babies of mothers aged 30–34 years to 14.6 per 1,000 births for babies of mothers aged less than 20 years (Table 5.2).
The fetal death rate of babies born to Aboriginal or Torres Strait Islander mothers was 11.7 per 1,000 births. The rate was 7.2 per 1,000 births for non-Indigenous mothers. For Australian-born mothers the fetal death rate was 7.1 per 1,000 births, compared with 8.6 per 1,000 births for mothers born overseas (Table 5.2).
Fetal death rates were higher among babies of first-time mothers (8.5 per 1,000 births) than among babies whose mothers had at least one previous birth (6.7 per 1,000 births) (Table 5.2). However, for grand multiparous women (women who have had four or more previous pregnancies resulting in a live birth or stillbirth), the fetal death rate was higher at 11.9 per 1,000 births.
The fetal death rate of twins (18.3 per 1,000 births) and other multiple births (35.9 per 1,000 births) was higher than that of singleton babies (7.0 per 1,000 births). Fetal death rates were higher for babies of mothers who gave birth in public hospitals than in private hospitals (8.2% and 5.5%), and fetal deaths occurred more frequently in the lowest gestational age and birthweight groups (Table 5.2). 
Neonatal deaths
There were 816 neonatal deaths reported to the NPDC for 2006, giving a rate of 3.0 per 1,000 live births. This did not include data from the Northern Territory where information about neonatal deaths was not available (Table 5.1). Ascertainment of neonatal deaths within 28 days of birth is likely to be incomplete. In particular, deaths occurring among babies transferred to another hospital, readmitted to hospital or dying at home may not be known to midwives who collect these data or staff who compile state and territory data. 
Neonatal death rates based on NPDC data varied among the states and territories. The variation in rates may reflect differences in ascertainment practices of deaths by states and territories as well as absolute differences in mortality experienced in the state or territory. The neonatal death rates ranged from 2.0 per 1,000 live births in South Australia to 5.2 per 1,000 live births in the Australian Capital Territory (Table 5.1). 
Note that a significant proportion of women who gave birth in the Australian Capital Territory were New South Wales residents (16.2% in 2006). Many women from southern New South Wales with high-risk pregnancies gave birth in the Australian Capital Territory (Table 3.3), so death rates are likely to appear higher than for those based on births to residents of the Australian Capital Territory.
Higher neonatal death rates were reported for younger mothers. The age-group specific neonatal death rate was 5.2 per 1,000 live births for babies of teenage mothers (aged less than 20 years) and 3.3 per 1,000 live births for babies of mothers aged 20–24 years (Table 5.2).
The neonatal death rate of babies born to Aboriginal or Torres Strait Islander mothers was 7.1 per 1,000 live births for 2006, noting that the data do not include the Northern Territory so the number should be interpreted with caution (Table 5.2). Of all women identifying as Aboriginal or Torres Strait Islander who gave birth in 2006, 14.3% were from the Northern Territory. The neonatal death rate for babies of non-Indigenous mothers was 2.8 per 1,000 live births (Table 5.2).
Neonatal death rates were higher for babies of mothers who gave birth in public hospitals (3.7 per 1,000 live births) than for those of mothers who gave birth in private hospitals (1.2 per 1,000 live births). 

Table 5.2: Rates of fetal, neonatal and perinatal deaths by selected characteristics, 2006
Characteristic	Fetal deaths	Neonatal deaths(a)(b)	Perinatal deaths(a)(b)	
	Rate per 1,000 births(c)	
Maternal age				
Less than 20	              14.6 	5.2	20.3	
20–24	                9.0 	3.3	12.5	
25–29	                6.6 	2.7	9.4	
30–34	                6.1 	2.6	8.8	
35 and over	                7.7 	3.3	11.0	
				
Maternal Indigenous status			
Aboriginal or Torres Strait Islander	11.7	7.1	20.7	
Non-Indigenous	7.2	2.8	10.1	
				
Maternal country of birth			
Australia	7.1	2.9	10.1	
Not Australia	8.6	3.0	11.5	
				
Hospital sector for hospital births			
Public	8.2	3.7	12.0	
Private	5.5	1.2	6.7	
				
Parity				
Primipara	8.5	3.2	11.8	
Multipara	6.7	2.7	9.5	
				
Gestational age				
20–27(d)	488.1	418.3	704.7	
28–31	81.0	23.6	104.7	
32–36	16.0	5.6	21.9	
37 and over	1.5	0.5	2.0	
				
Birthweight				
Less than 1,500	315.0	193.7	451.4	
1,500–2,499	17.0	5.5	22.8	
2,500–2,999	3.3	1.4	4.8	
3,000–3,999	1.0	0.4	1.4	
4,000 and over	1.3	0.3	1.6	
(a)	Numerators exclude neonatal deaths in NT. Denominators exclude live births in NT.
(b) 	Except in WA, these may exclude neonatal deaths within 28 days of birth for babies transferred to another hospital or readmitted to 
hospital, and those dying at home. 
(c)	Fetal and perinatal death rates were calculated using all births (live births and fetal deaths). Neonatal death rates were calculated 
using all live births. 
(d)      Includes 1 baby of less than 20 weeks gestation.	

Neonatal death rates decreased with increasing gestational age, from 418.3 per 1,000 live births for those born at 20–27 weeks gestation, to 0.5 per 1,000 live births for those born at term or post-term. For birthweight, neonatal death rates decreased from 193.7 per 1,000 live births for babies of less than 1,500 grams, to 0.3 per 1,000 live births for babies 4,000 grams or more (Table 5.2).
Perinatal deaths
In the NPDC there were 2,907 reported perinatal deaths in 2006, resulting in a perinatal death rate of 10.3 deaths per 1,000 births (Table 5.1). Of these perinatal deaths, 71.9% were fetal deaths. This did not include data from the Northern Territory where information about neonatal deaths was not available.
Perinatal death rates were highest in babies of teenage mothers (20.3 per 1,000 births), followed by babies of mothers aged 20–24 years (12.5 per 1,000 births). The perinatal death rate of babies born to Aboriginal or Torres Strait Islander mothers (excluding the Northern Territory for neonatal deaths) was 20.7 per 1,000 births. The rate was 10.1 per 1,000 births in babies born to non-Indigenous mothers. Rates were also higher in overseas-born mothers compared with Australian-born mothers (11.5 and 10.1 per 1,000 births respectively) (Table 5.2).
Perinatal death rates were higher among babies of first-time mothers (11.8 per 1,000 births) than among babies whose mothers had at least one previous birth (9.5 per 1,000 births). Perinatal death rates were higher for babies of mothers who gave birth in public hospitals (12.0 per 1,000 births) than for those of mothers who gave birth in private hospitals (6.7 per 1,000 births) (Table 5.2). 
Table 5.2 shows that perinatal death rates were higher for babies in the 20–27 week gestational age group (704.7 per 1,000 births) and lowest at 37 weeks or later (2.0 per 1,000 births). Babies weighing less than 1,500 grams at birth had the highest perinatal death rate (451.4 per 1,000 births) and babies weighing 3,000–3,999 grams had the lowest (1.4 per 1,000 births).
Causes of perinatal deaths
The majority of states and territories have implemented the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ-PDC) to classify causes of perinatal deaths. Further details on these classifications can be found at <www.psanzpnmsig.org/>.
For the 2006 data, five jurisdictions provided causes of death according to the PSANZ-PDC. The main causes of perinatal deaths in these jurisdictions for 2006 were congenital abnormalities (27.8%), spontaneous preterm birth (16.0%) and maternal conditions (13.0%). These three groups of causes accounted for over half of all perinatal deaths in these states (56.9%). The rates per 1,000 births in these jurisdictions were 3.1, 1.8 and 1.5 respectively. Unexplained antepartum death (11.6%) was also a commonly reported cause of perinatal death, with a rate of 1.3 per 1,000 births (Table 5.3). 
Applying these classifications reveals considerable variability by jurisdiction in the leading causes of perinatal death. The largest apparent difference relates to the category of ‘maternal conditions’. This is because this category includes late terminations undertaken for psychosocial indications, the majority of which are undertaken in Victoria. There may also be some differences in the ranking related to jurisdictional differences in applying the classifications and small numbers in some categories.
Table 5.4 presents causes of perinatal deaths by gestational age group for four states. The main cause of perinatal death was congenital abnormalities at 20–21 weeks, 28–31 weeks and 32–36 weeks gestation (47.1%, 22.7% and 26.8% respectively). The leading cause of death at 22–27 weeks gestation was the category of maternal conditions (25.6%). Perinatal deaths of term babies were most commonly due to unexplained antepartum death (26.6%). 
The most common cause of perinatal death in singletons was congenital abnormalities (30.0%). Deaths of twins and higher order multiple births were mostly due to spontaneous preterm birth and specific perinatal conditions (Table 5.5).
Of perinatal deaths to mothers aged less than 20 years, 39.5% were due to maternal conditions. In mothers aged 40 years or over, 42.0% of perinatal deaths were caused by congenital abnormalities (Table 5.6).

Table 5.3: Perinatal deaths by Perinatal Society of Australia and New Zealand Perinatal Death Classification and state and territory, 2006
Cause of death	NSW	Vic	Qld	WA	SA	Tas	ACT(a)	NT	Total	Rate(b) 	
	Number		
Congenital abnormality	 n.a. 	    220 	 n.a. 	      80 	      66 	      13 	      21 	 n.a. 	      400 	3.1	
Perinatal infection	n.a.	      12 	n.a.	      17 	      11 	<5 	<5	 n.a. 	        43 	0.3	
Hypertension	 n.a. 	      23 	 n.a. 	      16 	        6 	<5	<5		 n.a. 	        47 	0.4	
Antepartum haemorrhage (APH)	 n.a. 	      63 	 n.a. 	      11 	        9 	        6 	      10 	 n.a. 	        99 	0.8	
Maternal conditions	 n.a. 	  (c)166 	 n.a. 	      13 	    n.p.	<5	<5	 n.a. 	      187 	1.5	
Specific perinatal conditions	 n.a. 	      65 	 n.a. 	      22 	      16 	8 	      12 	 n.a. 	      123 	1.0	
Hypoxic peripartum death	 n.a. 	      20 	 n.a. 	        9 	<5	<5	<5	 n.a. 	        35 	0.3	
Fetal growth restriction (FGR)	 n.a. 	      43 	 n.a. 	    n.p.	      19 	<5	        7 	 n.a. 	        91 	0.7	
Spontaneous preterm	 n.a. 	    130 	 n.a. 	      55 	      22 	      10 	      13 	 n.a. 	      230 	1.8	
Unexplained antepartum death	 n.a. 	    106 	 n.a. 	      27 	      21 	        6 	        7 	 n.a. 	      167 	1.3	
No obstetric antecedent	 n.a. 	        6 	 n.a. 	<5	—   	—   	<5	 n.a. 	          9 	0.1	
Not stated	 n.a. 	—   	 n.a. 	        3 	—	       —   	        3 	n.a.	          6 	0.0	
Total	 n.a. 	    854 	 n.a. 	    273 	    177 	55	      78 	n.a.	   1,437 	11.1	
	Per cent		
Congenital abnormality	 n.a. 	25.8	 n.a. 	29.3	37.3	23.6	26.9	 n.a. 	27.8	—	
Perinatal infection	n.a.	1.4	n.a.	6.2	6.2	    n.p.	    n.p.	 n.a. 	3.0	—	
Hypertension	 n.a. 	2.7	 n.a. 	5.9	3.4	    n.p.	    n.p.	 n.a. 	3.3	—	
Antepartum haemorrhage (APH)	 n.a. 	7.4	 n.a. 	4.0	5.1	10.9	12.8	 n.a. 	6.9	—	
Maternal conditions	 n.a. 	(c)19.4	 n.a. 	4.8	    n.p.	    n.p.	    n.p.	 n.a. 	13.0	—	
Specific perinatal conditions	 n.a. 	7.6	 n.a. 	8.1	9.0	14.5	15.4	 n.a. 	8.6	—	
Hypoxic peripartum death	 n.a. 	2.3	 n.a. 	3.3	    n.p.	    n.p.	    n.p.	 n.a. 	2.4	—	
Fetal growth restriction (FGR)	 n.a. 	5.0	 n.a. 	6.6	10.7	    n.p.	9.0	 n.a. 	6.3	—	
Spontaneous preterm	 n.a. 	15.2	 n.a. 	20.1	12.4	18.2	16.7	 n.a. 	16.0	—	
Unexplained antepartum death	 n.a. 	12.4	 n.a. 	9.9	11.9	10.9	9.0	 n.a. 	11.6	—	
No obstetric antecedent	 n.a. 	0.7	 n.a. 	    n.p.	—	—	    n.p.	 n.a. 	0.6	—	
Not stated	 n.a. 	—	 n.a. 	1.1	—	—	3.8	n.a.	0.4	—	
Total	 n.a. 	100.0	 n.a. 	100.0	100.0	100.0	100.0	n.a.	100.0	—	
(a)	Includes perinatal deaths to non-ACT residents. Due to the small number of ACT perinatal deaths, large fluctuations can occur in annual percentages. Care must be taken when interpreting rates.
(b)	Rate per 1,000 births in Vic, WA, SA, Tas and ACT. The total number of births in the five jurisdictions was 128,950 in 2006.
(c)	Includes 150 terminations of pregnancy for psychosocial indications.
n.a. 	Data not available. 
n.p.	Data not published to maintain confidentiality of small numbers.
Note: Data are based on state/territory of birth rather than the state/territory of the mother’s usual residence.

Table 5.4: Perinatal deaths by Perinatal Society of Australia and New Zealand Perinatal Death Classification and gestational age, 2006
Cause of death	Gestational age (weeks)	
	20–21	22–27	28–31	32–36	37–41	42 and over	Not stated	Total	
	Number	
Congenital abnormality	156	111	22	42	48	—	—	379	
Perinatal infection	14	15	2	3	8	—	—	42	
Hypertension	2	17	13	10	4	—	—	46	
Antepartum haemorrhage (APH)	12	35	10	18	14	—	—	89	
Maternal conditions	24	139	3	9	11	—	—	186	
Specific perinatal conditions	19	38	17	16	21	—	—	111	
Hypoxic peripartum death	—	—	2	4	27	1	—	34	
Fetal growth restriction (FGR)	4	22	10	20	28	—	—	84	
Spontaneous preterm	82	128	4	3	—	—	—	217	
Unexplained antepartum death	16	39	14	30	61	—	—	160	
No obstetric antecedent	—	—	—	1	7	—	—	8	
Not stated	2	— 	—	1	—	—	—	3	
Total	331	544	97	157	229	1	—	1,359	
	Per cent	
Congenital abnormality	47.1	20.4	22.7	26.8	21.0	—	—	27.9	
Perinatal infection	4.2	2.8	2.1	1.9	3.5	—	—	3.1	
Hypertension	0.6	3.1	13.4	6.4	1.7	—	—	3.4	
Antepartum haemorrhage (APH)	3.6	6.4	10.3	11.5	6.1	—	—	6.5	
Maternal conditions	7.3	25.6	3.1	5.7	4.8	—	—	13.7	
Specific perinatal conditions	5.7	7.0	17.5	10.2	9.2	—	—	8.2	
Hypoxic peripartum death	—	—	2.1	2.5	11.8	100.0	—	2.5	
Fetal growth restriction (FGR)	1.2	4.0	10.3	12.7	12.2	—	—	6.2	
Spontaneous preterm	24.8	23.5	4.1	1.9	—	—	—	16.0	
Unexplained antepartum death	4.8	7.2	14.4	19.1	26.6	—	—	11.8	
No obstetric antecedent	—	—	—	0.6	3.1	—	—	0.6	
Not stated	0.6	—	—	0.6	—	—	—	0.2	
Total	100.0	100.0	100.0	100.0	100.0	100.0	—	100.0	
Notes
1.	Excludes NSW, Qld, ACT and NT. 
2.	The total number of births in the four jurisdictions included in the table was 123,465 in 2006.

Table 5.5: Perinatal deaths by Perinatal Society of Australia and New Zealand Perinatal Death Classification and plurality, 2006
Cause of death	Singletons	Twins	Other multiple births	Total	
	Number	
Congenital abnormality	362	17	—	379	
Perinatal infection	42	—	—	42	
Hypertension	42	4	—	46	
Antepartum haemorrhage (APH)	87	2	—	89	
Maternal conditions	182	4	—	186	
Specific perinatal conditions	58	48	5	111	
Hypoxic peripartum death	32	2	—	34	
Fetal growth restriction (FGR)	80	3	1	84	
Spontaneous preterm	162	46	9	217	
Unexplained antepartum death	151	9	—	160	
No obstetric antecedent	8	—	—	8	
Not stated	1	2	—	3	
Total	1,207	137	15	1,359	
	Per cent	
Congenital abnormality	30.0	12.4	—	27.9	
Perinatal infection	3.5	—	—	3.1	
Hypertension	3.5	2.9	—	3.4	
Antepartum haemorrhage (APH)	7.2	1.5	—	6.5	
Maternal conditions	15.1	2.9	—	13.7	
Specific perinatal conditions	4.8	35.0	33.3	8.2	
Hypoxic peripartum death	2.7	1.5	—	2.5	
Fetal growth restriction (FGR)	6.6	2.2	6.7	6.2	
Spontaneous preterm	13.4	33.6	60.0	16.0	
Unexplained antepartum death	12.5	6.6	—	11.8	
No obstetric antecedent	0.7	—	—	0.6	
Not stated	0.1	1.5	—	0.2	
Total	100.0	100.0	100.0	100.0	
Notes
1.	Excludes NSW, Qld, ACT and NT. 
2.	The total number of births in the four jurisdictions included in the table was 123,465 in 2006.

Table 5.6: Perinatal deaths by Perinatal Society of Australia and New Zealand Perinatal Death Classification and maternal age, 2006
	Maternal age (years)	
Cause of death	Less than 20	20–24	25–29	30–34	35–39	40 and over	Not stated	Total	
	Number	
Congenital abnormality	22	59	88	116	63	29	2	379	
Perinatal infection	1	7	14	13	6	1	—	42	
Hypertension	4	5	12	13	9	3	—	46	
Antepartum haemorrhage (APH)	4	18	21	24	16	6	—	89	
Maternal conditions	49	46	31	30	14	10	6	186	
Specific perinatal conditions	—	13	21	41	33	3	—	111	
Hypoxic peripartum death	3	2	12	10	7	—	—	34	
Fetal growth restriction (FGR)	9	18	17	20	18	2	—	84	
Spontaneous preterm	24	39	51	61	37	5	—	217	
Unexplained antepartum death	7	16	44	50	33	10	—	160	
No obstetric antecedent	1	1	3	3	—	—	—	8	
Not stated	—	2	—	1	—	—	—	3	
Total	124	226	314	382	236	69	8	1,359	
	Per cent	
Congenital abnormality	17.7	26.1	28.0	30.4	26.7	42.0	25.0	27.9	
Perinatal infection	0.8	3.1	4.5	3.4	2.5	1.4	—	3.1	
Hypertension	3.2	2.2	3.8	3.4	3.8	4.3	—	3.4	
Antepartum haemorrhage (APH)	3.2	8.0	6.7	6.3	6.8	8.7	—	6.5	
Maternal conditions	39.5	20.4	9.9	7.9	5.9	14.5	75.0	13.7	
Specific perinatal conditions	—	5.8	6.7	10.7	14.0	4.3	—	8.2	
Hypoxic peripartum death	2.4	0.9	3.8	2.6	3.0	—	—	2.5	
Fetal growth restriction (FGR)	7.3	8.0	5.4	5.2	7.6	2.9	—	6.2	
Spontaneous preterm	19.4	17.3	16.2	16.0	15.7	7.2	—	16.0	
Unexplained antepartum death	5.6	7.1	14.0	13.1	14.0	14.5	—	11.8	
No obstetric antecedent	0.8	0.4	1.0	0.8	—	—	—	0.6	
Not stated	—	0.9	—	0.3	—	—	—	0.2	
Total	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	
Notes
1.	Excludes NSW, Qld, ACT and NT. 
2.	The total number of births in the four jurisdictions included in the table was 123,465 in 2006.

Appendix 1: Data used in figures
Table A1.1: Number of births, 1997–2006
Year	Births	
1997	257,032	
1998	255,325	
1999	257,444	
2000	257,238	
2001	254,326	
2002	255,095	
2003	256,925	
2004	257,205	
2005	272,419	
2006	282,169	
Table A1.2: Primiparous women who gave birth by maternal age, 1997 and 
2006 (per cent)
Maternal age (years)	1997	2006	
Less than 20	81.8	81.7	
20–24	54.4	54.7	
25–29	43.2	46.0	
30–34	30.3	36.3	
35–39	22.6	27.6	
40 and over	20.8	25.0	
Table A1.3: Women who gave birth by onset of labour, 1997–2006 (per cent)
Onset of labour	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	
Spontaneous	64.5	62.6	61.9	61.5	59.0	57.9	57.3	57.6	56.5	56.6	
Induced	24.0	25.5	26.0	25.6	26.7	26.6	26.1	25.3	25.6	25.1	
No labour	11.4	11.8	12.1	12.9	14.3	15.5	16.5	17.1	17.9	18.3	
Table A1.4: Women who gave birth by caesarean section and instrumental birth, 1997–2006 (per cent)
	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	
Caesarean section	20.3	21.1	21.8	23.3	25.4	27.0	28.5	29.4	30.3	30.8	
Instrumental 	11.2	11.2	11.1	11.2	10.9	10.8	10.7	11.0	10.8	10.7	

Table A1.5: Women who gave birth by caesarean section by maternal age and 
hospital sector, 2006 (per cent)
Maternal age (years)	Public	Private	
Less than 20	17.7	23.6	
20–24	20.7	28.9	
25–29	25.8	36.2	
30–34	30.9	40.0	
35–39	35.5	46.3	
40 and over	39.6	55.4	
Table A1.6: Distribution of gestational age, 
2006 (per cent)
Gestational age (weeks)	Per cent	
19	0.0	
20	0.1	
21	0.1	
22	0.1	
23	0.1	
24	0.1	
25	0.1	
26	0.1	
27	0.1	
28	0.2	
29	0.2	
30	0.2	
31	0.3	
32	0.4	
33	0.6	
34	1.0	
35	1.5	
36	3.0	
37	6.4	
38	18.6	
39	23.3	
40	28.4	
41	14.1	
42	1.1	
43	0.1	
44	0.0	
45	0.0	

Table A1.7: Length of stay of 5 days or more for babies born in hospital, 1997–2006 (per cent)
Length of stay	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	
5 days and over 	41.8	39.6	36.6	34.6	33.8	32.6	31.5	30.3	28.2	27.0	
Note: Only babies who were discharged home are included.
Appendix 2: Perinatal National Minimum Data Set items
Data element name	METeOR identifier	
Birth—Apgar score (at 5 minutes), code NN	289360	
Birth—birth order, code N	269992	
Birth—birth status, code N	269949	
Birth—birth weight, total grams NNNN	269938	
Birth event—birth method, code N	295349	
Birth event—birth plurality, code N	269994	
Birth event—birth presentation, code N	299992	
Birth event—labour onset type, code N	269942	
Birth event—setting of birth (actual), code N	269937	
Birth event—state/territory of birth, code N	270151	
Episode of admitted patient care—separation date, DDMMYYYY	270025	
Establishment—organisation identifier (Australian), NNX[X]NNNNN	269973	
Female (pregnant)—estimated gestational age, total weeks NN	269965	
Person—area of usual residence, geographical location code (ASGC 2007) NNNNN	362291	
Person—country of birth, code (SACC 1998) NNNN	270277	
Person—date of birth, DDMMYYYY	287007	
Person—Indigenous status, code N	291036	
Person—person identifier, XXXXXX[X(14)]	290046	
Person—sex, code N	287316	

Appendix 3: State and territory perinatal reports
Individual state and territory health authorities publish reports based on their state or territory perinatal collection either annually or periodically. For the 2006 data, the following state and territory reports have been published:
Victoria
Davey M-A, Taylor O, Oats JJN & Riley M 2008. Births in Victoria, 2005 and 2006. Melbourne: Victorian Department of Human Services.
The Consultative Council on Obstetric and Paediatric Mortality and Morbidity 2008. Annual report for the year 2006, incorporating the 45th Survey of Perinatal Deaths in Victoria. Melbourne: Department of Human Services.
Queensland
Queensland Health 2008. Perinatal statistics Queensland 2006. Brisbane: Queensland Health.
Western Australia
Gee V, Ernstzen A & Le M 2008. Perinatal statistics in Western Australia, 2006: twenty-fourth annual report of the Western Australian Midwives’ Notification System. Perth: Department of Health.  
South Australia
Chan A, Scott J, Nguyen A-M & Sage L 2007. Pregnancy outcome in South Australia 2006. Adelaide: Department of Health.
Maternal, Perinatal and Infant Mortality Committee 2007. Maternal, perinatal and infant mortality in South Australia 2006, including the South Australian protocol for the investigation of stillbirths. Adelaide: Department of Health.
Tasmania
Council of Obstetric and Paediatric Mortality and Morbidity 2008. Annual report 2006. Hobart: Department of Health and Human Services.
Appendix 4: State and territory perinatal data collection contacts
New South Wales
Dr Lee Taylor
Manager
Surveillance Methods
Centre for Epidemiology and Research
NSW Department of Health
Locked Bag No. 961
North Sydney NSW 2059
Phone: 02 9391 9223
Fax: 02 9391 9232
Email: ltayl@doh.health.nsw.gov.au
Website: <http://www.health.nsw.gov.au/public-health/epi/>
Victoria
Ms Merilyn Riley
Senior Research Officer
Perinatal Data Collection Unit
Department of Human Services
GPO Box 4003
Melbourne Vic 3001
Phone: 03 9096 2692
Fax: 03 9096 2700
Email: merilyn.riley@dhs.vic.gov.au
Website: <http://www.health.vic.gov.au/perinatal/>

Queensland
Ms Sue Cornes
Senior Director
Health Statistics Centre 
Queensland Health
GPO Box 48
Brisbane Qld 4001
Phone: 07 3234 0921
Fax: 07 3234 0564
Email: suzanne_cornes@health.qld.gov.au
Website: <http://www.health.qld.gov.au/hic/>
Western Australia
Mr Max Le
Manager
Maternal and Child Health Unit
Data Collection and Analysis
Information Management and Reporting
Department of Health, Western Australia
189 Royal Street
East Perth WA 6004
Phone: 08 9222 2417
Fax: 08 9222 4408
Email: max.le@health.wa.gov.au
Website: <http://www.health.wa.gov.au/>
South Australia
A/Prof Annabelle Chan
Senior Medical Consultant
Pregnancy Outcome Statistics Unit
Department of Health
PO Box 6, Rundle Mall
Adelaide SA 5000
Phone: 08 8226 6357
Fax: 08 8226 6291
Email: annabelle.chan@health.sa.gov.au
Website: <http://www.dh.sa.gov.au/pehs/pregnancyoutcome.htm>
Tasmania
Mr Peter Mansfield
Manager
Clinical Data Services
Resources and Health System Performance 
Health Services 
Department of Health and Human Services
Level 2, 10 Murray Street
Hobart Tas 7000
Phone: 03 6233 2173
Fax: 03 6233 3550
Email: peter.mansfield@dhhs.tas.gov.au
Website: <http://www.dhhs.tas.gov.au/>
Australian Capital Territory
Ms Maureen Bourne
Data Manager
Population Health Research Centre
Population Health
ACT Health
Building 5, Level 1
The Canberra Hospital
PO Box 11
Woden ACT 2606
Phone: 02 6205 2612
Fax: 02 6244 4138 
Email: maureen.bourne@act.gov.au
Website: <http://www.health.act.gov.au/healthinfo/>

Northern Territory
Ms Cheryl McCullough
Perinatal Data Business Analyst
Acute Care Information Systems
Department of Health and Families
Building 6, Royal Darwin Hospital
PO Box 41326
Casuarina NT 0810
Phone: 08 8922 7779
Fax: 08 8922 7787
Email: cheryl.mccullough@nt.gov.au
Website: <http://www.health.nt.gov.au/>
Glossary
Antepartum fetal death: fetal death occurring before the onset of labour.
Apgar score: numerical score used to indicate the baby’s condition at 1 minute and 5 minutes after birth. Between 0 and 2 points are given for each of five characteristics: heart rate, breathing, colour, muscle tone and reflex irritability, and the total score is between 0 and 10.
Augmentation of labour: intervention after the onset of labour to assist the progress of labour.
Baby’s length of stay: number of days between date of birth and date of separation from the hospital of birth (calculated by subtracting the date of birth from the date of separation).
Birth status: status of the baby immediately after birth.
Birthweight: the first weight of the baby (stillborn or liveborn) obtained after birth (usually measured to the nearest 5 grams and obtained within one hour of birth).
Caesarean section: operative birth by surgical incision through the abdominal wall and uterus.
Chorioamnionitis: an inflammation, usually from an infection, of the membranes surrounding the fetus.
Early neonatal death: death of a liveborn baby within seven days of birth.
Epidural: injection of anaesthetic agent into the epidural space of the spinal cord.
Episiotomy: an incision of the perineum and vagina to enlarge the vulval orifice.
Extremely low birthweight: birthweight of less than 1,000 grams.
Fetal death (stillbirth): death prior to the complete expulsion or extraction from its mother of a product of conception of 20 or more completed weeks of gestation or of 400 grams or more birthweight. 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.
Forceps: assisted birth using a metallic obstetric instrument.
Gestational age: the duration of pregnancy in completed weeks calculated from the date of the first day of a woman’s last menstrual period and her baby’s date of birth, or via ultrasound, or derived from clinical assessment during pregnancy or from examination of the baby after birth.
Grand multipara: pregnant woman who has had four or more previous pregnancies resulting in a live birth or stillbirth.
Induction of labour: intervention to stimulate the onset of labour.
Instrumental delivery: vaginal delivery using forceps or vacuum extraction.
Intrapartum fetal death: fetal death occurring during labour.
Intrauterine growth restriction: a fetus whose estimated weight is below the 10th percentile for its gestational age.
Isoimmunisation: development of antibodies directed at the red blood cells of the baby in utero. This occurs when there is an incompatibility between the baby’s blood type and that of its mother.
Late neonatal death: death of a liveborn baby after seven completed days and before 28 completed days.
Live birth: the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered liveborn (WHO definition).
Low birthweight: birthweight of less than 2,500 grams.
Maternal age: mother’s age in completed years at the birth of her baby.
Mode of separation: status at separation of patient (discharge/transfer/death) and place to which patient is released (where applicable).
Mother’s length of stay: number of days between admission date (during the admission resulting in a birth) and separation date (from the hospital where birth occurred). The interval is calculated by subtracting the date of admission from the date of separation.
Multipara: pregnant woman who has had at least one previous pregnancy resulting in a live birth or stillbirth.
Neonatal care levels: Level I care is for normal healthy term babies, some of whom may need short-term observation during the first few hours of life. 
Level II refers to a nursery that generally has babies born at 32–36 weeks gestation weighing around 1,500 to 2,500 grams at birth. It includes care for babies who require intravenous therapy or antibiotics, and/or those who are convalescing after intensive care, and/or those who need their heart rate or breathing monitored, and/or those who need short-term oxygen therapy. 
Level III or intensive care refers to the care of newborn infants who require more specialised care and treatment. It includes most babies born at less than 32 weeks gestation or less than 1,500 grams birthweight, and others who may require such interventions as intravenous feeding, and/or surgery, and/or cardiorespiratory monitoring for management of apnoea or seizures, and/or require assisted ventilation, and/or supplemental oxygen over 40% or 
long-term oxygen (Abeywardana 2006). 
Neonatal death: death of a liveborn baby within 28 days of birth.
Neonatal morbidity: any condition or disease of the baby diagnosed after birth and before separation from care.
Parity: number of previous pregnancies resulting in live births or stillbirths, excluding the current pregnancy.
Perinatal death: a fetal or neonatal death of at least 20 weeks gestation or at least 400 grams birthweight.
Perineal status: status of the perineum after the birth. May involve surgical suturing of perineal laceration or episiotomy incision.
Plurality: the number of births resulting from a pregnancy.
Postneonatal death: death of a liveborn baby after 28 days and within one year of birth.
Post-term birth: birth at 42 or more completed weeks of gestation.
Presentation at birth: presenting part of the fetus at birth.
Preterm birth: birth before 37 completed weeks of gestation.
Primipara: pregnant woman who has had no previous pregnancy resulting in a live birth or stillbirth.
Pudendal: local anaesthetic to block the pudendal nerves.
Resuscitation of baby: active measures taken shortly after birth to assist the baby’s ventilation and heartbeat, or to treat depressed respiratory effort and to correct metabolic disturbances.
Sex ratio: number of male liveborn babies per 100 female liveborn babies. 
Spontaneous vaginal: birth without intervention in which the baby’s head is the presenting part.
Stillbirth: see Fetal death (stillbirth).
Teenage mother: mother aged less than 20 years at the birth of her baby. 
Vacuum extraction: assisted birth using a suction cap applied to the baby’s head.
Vaginal breech: vaginal birth in which the baby’s buttocks is the presenting part.
Very low birthweight: birthweight of less than 1,500 grams.

References
Abeywardana S 2006. Report of the Australian and New Zealand Neonatal Network 2004. Sydney: Australian and New Zealand Neonatal Network. 
ABS (Australian Bureau of Statistics) 1998. Standard Australian Classification of Countries (SACC). Cat. no. 1269.0. Canberra: ABS. 
ABS 2007. Births Australia, 2006. Cat. no. 3301.0. Canberra: ABS. 
ABS 2008. Causes of death Australia, 2006. Cat. no. 3303.0. Canberra: ABS. 
Ashdown-Lambert JR 2005. A review of low birth weight: predictors, precursors and morbidity outcomes. Journal of the Royal Society for the Promotion of Health 125:76–83.
Carolan M 2003. The graying of the obstetric population: implications for the older mother. Journal of Obstetric, Gynecologic, and Neonatal Nursing 32:19–27.
Cleary-Goldman J, Malone FD, Vidaveer J, Ball RH, Nyberg DA, Comstock CH, Saade GR, Eddleman KA, Klugman S, Dugoff L, Timor-Tritsch IE, Craigo SD, Carr SR, Wolfe HM, Bianchi DW & D’Alton M 2005. Impact of maternal age on obstetric outcome. Obstetrics and Gynecology 105(1):983–90.
Goldenberg RL & Culhane JF 2007. Low birth weight in the United States. American Journal of Clinical Nutrition 85:584S–90S.
Gortzak-Uzan L, Hallak M, Press F, Katz M & Shoham-Vardi I 2001. Teenage pregnancy: risk factors for adverse perinatal outcome. Journal of Maternal-Fetal Medicine 10(6):393–7.
HDSC (Health Data Standards Committee) 2006. National health data dictionary, Version 13. AIHW cat. no. HWI 88. Canberra: AIHW.
Joseph KS, Allen AC, Dodds L, Turner LA, Scott H & Liston R 2005. The perinatal effects of delayed childbearing. Obstetrics and Gynecology 105(6):1410–17.
Laws PJ 2008. Perinatal National Minimum Data Set compliance evaluation 2001 to 2005. Perinatal statistics series no. 21. Cat. no. PER 44. Sydney: AIHW National Perinatal Statistics Unit.
Laws PJ, Abeywardana S, Walker J & Sullivan EA 2007. Australia’s mothers and babies 2005. Perinatal statistics series no. 20. Cat. no. PER 40. Sydney: AIHW National Perinatal Statistics Unit.
Laws PJ, Grayson N & Sullivan EA 2006. Smoking and pregnancy. Cat. no. PER 33. Sydney: AIHW National Perinatal Statistics Unit.
Laws PJ & Sullivan EA 2004. Australia’s mothers and babies 2002. Perinatal statistics series no. 15. AIHW cat. no. PER 28. Sydney: AIHW National Perinatal Statistics Unit.
Leeds KL, Gourley M, Laws PJ, Zhang J, Al-Yaman F & Sullivan EA 2007. Indigenous mothers and their babies, Australia 2001–2004. Perinatal statistics series no. 19. Cat. no. PER 38. Canberra: AIHW.
Mohsin M, Wong F, Bauman A & Bai J 2003. Maternal and neonatal factors influencing premature birth and low birth weight in Australia. Journal of Biosocial Science 35(2):161–74.
NHDC (National Health Data Committee) 2003. National health data dictionary, Version 12. 
Cat. no. HWI 43. Canberra: AIHW. 
SIMC (Statistical Information Management Committee) 2007. Guidelines for the use and disclosure of health data for statistical purposes. Available at: <http://www.aihw.gov.au/committees/simc/guidelines_statistical_purposes.doc>
Sullivan EA, Hall B & King JF 2008. Maternal deaths in Australia 2003–2005. Maternal deaths series no. 3. Cat. no. PER 32. Sydney: AIHW National Perinatal Statistics Unit.
Tough S, Greene C, Svenson L & Belik J 2000. Effects of in vitro fertilization on low birth weight, preterm delivery, and multiple birth. Journal of Pediatrics 136(5):618–22.
Tough S, Newburn-Cook C, Johnston D, Svenson L, Rose S & Belik J 2002. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 109(3):399–403.
WHO (World Health Organization) 1992. International statistical classification of diseases and related health problems: 10th revision. Geneva: WHO. 
List of tables 
Table 2.1: Women who gave birth and births, by state and territory, 2006	11
Table 2.2: Summary measures of perinatal health for Australia, 2006	12
Table 3.1: Women who gave birth by maternal age and state and territory, 2006	14
Table 3.2: Women who gave birth by Indigenous status and state and territory, 2006	15
Table 3.3: Women who gave birth by state and territory of usual residence and state and territory of birth, 2006	16
Table 3.4: Women who gave birth by Remoteness Area of usual residence and state and 
territory of usual residence, 2006	17
Table 3.5: Women who gave birth by Remoteness Area of usual residence and 
Indigenous status, 2006	18
Table 3.6: Women who gave birth by country of birth and state and territory, 2006	19
Table 3.7: Women who gave birth by parity and state and territory, 2006	21
Table 3.8: Women who gave birth by parity and maternal age, 2006	22
Table 3.9: Multiparous women who gave birth by number of previous caesarean sections 
and state and territory, 2006	23
Table 3.10: Women who gave birth by tobacco smoking status during pregnancy and 
state and territory, 2006	24
Table 3.11: Women who gave birth by actual place of birth and state and territory, 2006	25
Table 3.12: Women who gave birth by intended place of birth and state and territory, 
2006	26
Table 3.13: Women who gave birth by duration of pregnancy and state and territory, 
2006	27
Table 3.14: Women who gave birth by plurality and state and territory, 2006	28
Table 3.15: Women who gave birth by onset of labour and state and territory, 2006	29
Table 3.16: Women who gave birth and had an induction by main reason for induction 
and state and territory, 2006	31
Table 3.17: Women who gave birth and had caesarean section or instrumental vaginal 
deliveries by type of anaesthetic administered and state and territory, 2006	33
Table 3.18: Women who gave birth by presentation at birth and state and territory, 2006	34
Table 3.19: Women who gave birth by method of birth and state and territory, 2006	35
Table 3.20: Women who gave birth by caesarean section by main reason for caesarean 
section and state and territory, 2006	37
Table 3.21: Method of birth by maternal age, 2006	38
Table 3.22: Women who gave birth by Indigenous status, method of birth and state and territory, 2006	39
Table 3.23: Multiparous mothers who have had a previous caesarean section by current 
method of birth and state and territory, 2006	40
Table 3.24: Women who gave birth vaginally by perineal status and state and territory, 
2006	41
Table 3.25: Women who gave birth by selected maternal medical conditions and obstetric complications and state and territory, 2006	43
Table 3.26: Hospitals and birth centres by number of women who gave birth and state 
and territory, 2006	44
Table 3.27: Women who gave birth in hospital by hospital sector and state and territory, 
2006	45
Table 3.28: Women who gave birth in hospital by admitted patient elected 
accommodation status and state and territory, 2006	45
Table 3.29: Women who gave birth in hospital by method of birth, hospital sector and 
state and territory, 2006	47
Table 3.30: Women who gave birth in hospital by length of antenatal stay and state and territory, 2006	48
Table 3.31: Women who gave birth in hospital by length of postnatal stay and state and territory, 2006	49
Table 3.32: Women who gave birth in hospital by length of postnatal stay and method of 
birth, 2006	50
Table 3.33: Women who gave birth in hospital by mode of separation and state and 
territory, 2006	51
Table 3.34: Selected characteristics of women who gave birth at home, 2006	52
Table 4.1: Live births by sex and state and territory, 2006	54
Table 4.2: Births by maternal Indigenous status and state and territory, 2006	55
Table 4.3: Births by gestational age and birth status, 2006	56
Table 4.4: Preterm births by gestational age and state and territory, 2006	56
Table 4.5: Births by gestational age and plurality, 2006	57
Table 4.6: Live births by birthweight and state and territory, 2006	58
Table 4.7: Births by birthweight and birth status, 2006	59
Table 4.8: Live births by birthweight and plurality, 2006	60
Table 4.9: Live births of Aboriginal or Torres Strait Islander mothers by birthweight and 
state and territory, 2006	61
Table 4.10: Births by presentation at birth and plurality, 2006	62
Table 4.11: Births by method of birth and plurality, 2006	62
Table 4.12: Babies with breech presentations by method of birth and state and territory, 
2006	63
Table 4.13: Live births by Apgar score at 5 minutes and state and territory, 2006	64
Table 4.14: Live births by active resuscitation measures at birth and state and territory, 
2006	65
Table 4.15: Live births by admission to special care nursery or neonatal intensive care 
unit and state and territory, 2006	66
Table 4.16: Babies born in hospital by length of stay and state and territory, 2006	67
Table 4.17: Babies born in hospital by mode of separation and state and territory, 2006	68
Table 5.1: Fetal, neonatal and perinatal deaths by state and territory, 2006	70
Table 5.2: Rates of fetal, neonatal and perinatal deaths by selected characteristics, 2006	72
Table 5.3: Perinatal deaths by Perinatal Society of Australia and New Zealand Perinatal 
Death Classification and state and territory, 2006	75
Table 5.4: Perinatal deaths by Perinatal Society of Australia and New Zealand Perinatal 
Death Classification and gestational age, 2006	76
Table 5.5: Perinatal deaths by Perinatal Society of Australia and New Zealand Perinatal 
Death Classification and plurality, 2006	77
Table 5.6: Perinatal deaths by Perinatal Society of Australia and New Zealand Perinatal 
Death Classification and maternal age, 2006	78
Table A1.1: Number of births, 1997–2006	79
Table A1.2: Primiparous women who gave birth by maternal age, 1997 and 2006 
(per cent)	79
Table A1.3: Women who gave birth by onset of labour, 1997–2006 (per cent)	79
Table A1.4: Women who gave birth by caesarean section and instrumental birth, 
1997–2006 (per cent)	79
Table A1.5: Women who gave birth by caesarean section by maternal age and  hospital 
sector, 2006 (per cent)	80
Table A1.6: Distribution of gestational age, 2006 (per cent)	80
Table A1.7: Length of stay of 5 days or more for term babies born in hospital, 1997–2006 
(per cent)	81

List of figures 
Figure 1.1: Schematic flowchart of perinatal data collection	9
Figure 2.1: Number of births, 1997 to 2006	11
Figure 3.1: First-time mothers in each maternal age group, 1997 and 2006 (per cent)	21
Figure 3.2: Onset of labour, all mothers, 1997–2006 (per cent)	29
Figure 3.3: Caesarean section and instrumental deliveries, 1997–2006 (per cent)	36
Figure 3.4: Caesarean sections by maternal age and hospital sector, 2006 (per cent)	48
Figure 4.1: Distribution of gestational age, 2006 (per cent)	55
Figure 4.2: Live births by birthweight, 2006 (per cent)	58
Figure 4.3: Length of stay of 5 days or more for babies born in hospital, 1997–2006 
(per cent)	68
Figure 5.1: Definitions of perinatal mortality	69
Figure 5.2: Perinatal and infant death periods	69