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June 2011

Pregnancy Outcome Unit,  
Epidemiology Branch, SA Health

Pregnancy 
Outcome

in South Australia
  2009



June 2011 
Pregnancy Outcome in South Australia 2009 
  SA Health

Address: 
Pregnancy Outcome (Statistics) Unit 
Epidemiology Branch 
SA Health, Government of South Australia 
Citi Centre Building
11 Hindmarsh Square   
Adelaide 5000 
South Australia

Postal Address: 
Pregnancy Outcome (Statistics) Unit 
SA Health, Government of South Australia  
PO Box 6, Rundle Mall,  
Adelaide  5000 
South Australia

Telephone:  (08) 8226-6382 
Fax:  (08) 8226-6291

Web:  www.health.sa.gov.au/pehs/pregnancyoutcome.htm 
  www.dh.sa.gov.au/pehs/pregnancyoutcome.htm

E-mail:  Pregnancy.Stats@health.sa.gov.au

ISSN 0819-3835

Suggested citation: Chan A, Scheil W, Scott J, Nguyen A-M, Sage L. Pregnancy Outcome in South Australia 2009.  
Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2011.






Pregnancy Outcome in  
South Australia 2009

Annabelle Chan 
Wendy Scheil

Joan Scott
Anh-Minh Nguyen

Leonie Sage

June 2011

Pregnancy Outcome Unit 
SA Health



Staff

Annabelle Chan  Head/Senior medical consultant to July 2010 
    Clinical Associate Professor, Discipline of Obstetrics and 
    Gynaecology, University of Adelaide

Wendy Scheil  Acting Head/Senior medical consultant from August 2010

Joan Scott  Senior midwife

Leonie Sage  Senior midwife, Abortion statistics 

Maureen Fisher  Administrative officer

Judith Thompson  Administrative officer

Kerry Jolly  Midwife

Robyn Kennare  Senior midwife, 
    Maternal, Perinatal &amp; Infant Mortality Committee

Acknowledgements 

We would like to thank all midwives and nurses in South Australia who completed and submitted the Supplementary Birth 
Records on which the perinatal data collection is based. We thank them also for responding so efficiently to our queries.

We would like to congratulate Associate Professor Annabelle Chan on her retirement and thank her most sincerely for 
her many years of dedicated work with the Pregnancy Outcome Unit since 1986.

We would also like to express our sincere thanks to the following:

doctors who notified births with congenital abnormalities and those who notified terminations of pregnancy; &gt;

the pathology departments of teaching hospitals for autopsy information; &gt;

the Cytogenetics and Molecular Genetics Unit, Women s and Children s Hospital, for cytogenetics reports; &gt;

the Births, Deaths and Marriages Registration Division for data and perinatal death certificates; &gt;

the Coroner s Office for Coroner s findings and autopsy reports; &gt;

Kevin Priest of the Health Statistics Unit for his assistance in programming and provision of perinatal data to the  &gt;
National Perinatal Statistics Unit and in data linkage;

Ann-Marie Twisk, Graeme Tucker and Britt Catcheside of the Health Statistics Unit for assistance with responding to  &gt;
data requests and in data linkage;

Alison Scott for assisting with data entry: and &gt;

Maureen Fisher and the Communications Division of SA Health for the graphics. &gt;

Pregnancy Outcome in South Australia 2009page 2

Acknowledgements



Contents

Acknowledgements  2

Executive Summary 10
1. Numbers and fertility rates ............................................................................................................................. 10

2. Place of birth .................................................................................................................................................. 10

3. Teenage women ............................................................................................................................................. 10

4. Older women and first time mothers .............................................................................................................. 10

5. Country of birth and race ............................................................................................................................... 10

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

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

8. Aboriginal women ........................................................................................................................................ 11i

9. Procedures ..................................................................................................................................................... 11

10. Method of birth ........................................................................................................................................... 11

11. Multiple births .............................................................................................................................................. 11

12. Abortions ..................................................................................................................................................... 12

13. Perinatal mortality ........................................................................................................................................ 12

14. Congenital Anomalies .................................................................................................................................. 12

I. Introduction 13
1. The Perinatal Statistics Collection ................................................................................................................... 13

2. The Abortion Statistics Collection ................................................................................................................... 13

II. Mothers and Babies: Characteristics and Outcomes 14
1. Place of residence of mother .......................................................................................................................... 14

2. Place of birth of baby ..................................................................................................................................... 15

3. Maternal race................................................................................................................................................. 20

4. Maternal age ................................................................................................................................................. 21

5. Country of birth ............................................................................................................................................. 23

6. Marital status and type of patient ................................................................................................................... 24

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

8. Previous pregnancy outcomes ........................................................................................................................ 26

9a. Gestation at first antenatal visit .................................................................................................................... 27

9b. Body Mass Index (BMI) ................................................................................................................................. 27

9c. Antenatal visits ............................................................................................................................................. 28

9d. Type of antenatal care .................................................................................................................................. 28

10. Smoking ...................................................................................................................................................... 29

11. Medical conditions ....................................................................................................................................... 30

12. Obstetric complications ................................................................................................................................ 30

13. Procedures performed in current pregnancy ................................................................................................. 31

14a. Onset of labour .......................................................................................................................................... 31

Pregnancy Outcome in South Australia 2009 page  3

Contents



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

15a. Presentation and method of birth ............................................................................................................... 33

15b. Reason for caesarean section ..................................................................................................................... 34

16. Complications of labour and birth and perineal status after birth .................................................................. 36

17. Fetal monitoring during labour ..................................................................................................................... 36

18. Analgesia for labour and anaesthesia for birth .............................................................................................. 37

19. Postnatal length of stay of women ............................................................................................................... 38

20. Sex of baby .................................................................................................................................................. 39

21. Birthweight and gestation ............................................................................................................................ 39

22. Birth injuries ................................................................................................................................................. 40

23. Treatment given in neonatal period .............................................................................................................. 40

24. Level of care utilised ..................................................................................................................................... 41

25. Length of stay of babies ............................................................................................................................... 41

26. Congenital anomalies ................................................................................................................................... 42

27. Multiple births .............................................................................................................................................. 43

28. Perinatal mortality ........................................................................................................................................ 44

29. Home births ................................................................................................................................................. 46

30. Birthing unit births ....................................................................................................................................... 48

III. Terminations of Pregnancy 50
1. Numbers and rates ......................................................................................................................................... 50

2. Age of women ............................................................................................................................................... 51

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

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

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

6. Previous terminations. Total abortion rate and Total first abortion rate ............................................................ 55

IV. Obstetric Profiles by Hospital Category 57

V. Clinical and Maternity Performance Indicators 67
1. Clinical indicators ........................................................................................................................................... 67

2. Maternity performance indicators, hospitals with at least 500 births per year ................................................. 70

VI. Trends in Perinatal Statistics in South Australia,1981 2009 74
Trends in Perinatal Statistics in South Australia (SA), 1985   2009 ....................................................................... 74

VII. Summary statistics for 2009 80
1. Number of births ............................................................................................................................................ 80

2. Place of birth .................................................................................................................................................. 80

3. Sex ................................................................................................................................................................. 80

4. Plurality and condition at birth ....................................................................................................................... 80

5. Race of women .............................................................................................................................................. 80

Pregnancy Outcome in South Australia 2009page 4

Contents



6. Obstetric interventions in 19,604 women who gave birth ............................................................................... 81

7. Low birthweight (&lt;2,500g) ............................................................................................................................ 81

8. Congenital abnormalities ............................................................................................................................... 81

9. Perinatal morality rates (numbers of deaths in parentheses) ............................................................................ 81

10. Terminations of pregnancy ........................................................................................................................... 81

References 82

Publications 82
 Annual Reports ................................................................................................................................................. 82

Other reports/papers .......................................................................................................................................... 83

Appendix 1: Definitions 89

Appendix 2: 2009 Supplementary Birth Record Form 93

Appendix 3: Congenital Abnormality Form 94

Tables

Table 1:  Births and crude birth rate by CURB regions, South Australia, 2009 ........................................ 14

Table 2:  Total births notified in 2009, by place of birth and plurality, South Australia ......................... 15

Table 3a:  Hospital births by category of hospital, South Australia, 2009 ................................................. 17

Table 3b:  Hospital births in South Australia in 2009 by race and hospital ...........................................18-19

Table 4a:  Race of women who gave birth, South Australia, 2009 ............................................................. 20

Table 4b:   Race and birthplace category of women who gave birth, South Australia, 2009 ................... 20

Table 4c:  Age and race of women who gave birth, South Australia, 2009 .............................................. 21

Table 4d:  Age-specific fertility rates, South Australia, 2009 ...................................................................... 22

Table 5a:  Country of birth, major groups,* women who gave birth, South Australia, 2009 .................. 23

Table 5b:  Specified country of birth,* women who gave birth, South Australia, 2009 ........................... 23

Table 6a:  Marital status and age, women who gave birth, South Australia, 2009 .................................. 24

Table 6b:  Type of patient and marital status, women who gave birth, South Australia, 2009 ............... 24

Table 7:  Occupation* of father and mother, women who gave birth, South Australia, 2009 .............. 25

Table 8a:  Parity by race, women who gave birth, South Australia, 2009 ................................................. 26

Table 8b:  Previous pregnancy outcomes, women who gave birth, South Australia, 2009  
 (multigravidae only, n= 13,712) ................................................................................................... 26

Table 9a:  Gestation at first antenatal visit, women who gave birth, by race, South Australia, 2009  
 (n=19,604) ..................................................................................................................................... 27

Table 9b: BMI of women who gave birth, South Australia, 2009 .............................................................. 27

Pregnancy Outcome in South Australia 2009 page  5

Tables



Table 9c:  Antenatal visits by race, women who gave birth, South Australia, 2009 ................................. 28

Table 9d:  Type of antenatal care, women who gave birth, South Australia, 2009 (n = 19,604) .............. 28

Table 10a:  Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women  
 who gave birth, South Australia, 2009 ........................................................................................ 29

Table 10b:  Average number of tobacco cigarettes smoked per day in the second half of pregnancy,  
 non-Aboriginal and Aboriginal women who gave birth, South Australia, 2009 ..................... 29

Table 11:  Medical conditions in current pregnancy, women who gave birth, South Australia, 2009 ..... 30

Table 12:  Frequency of some obstetric complications, women who gave birth, South Australia, 2009 ....30

Table 13:  Procedures performed in current pregnancy, women who gave birth, South Australia, 2009 ..31

Table 14a: Onset of labour, women who gave birth, South Australia, 2009 .............................................. 31

Table 14b:  Method of induction of labour, women who gave birth, South Australia, 2009 ..................... 31

Table 14c:  Augmentation of labour after spontaneous onset, women who gave birth,  
 South Australia, 2009 ................................................................................................................... 32

Table 15a:  Method of birth, women who gave birth, South Australia, 2009 ............................................. 33

Table 15b:  Method of birth by presentation, all births, South Australian 2009 (n=19,901) ...................... 34

Table 15c:  Method of birth in breech presentation, by plurality, all births, South Australia,  
 2009 (n = 941) ............................................................................................................................... 34

Table 16:  Frequency of some complications of labour and birth, women who gave birth,  
 South Australia, 2009 ................................................................................................................... 36

Table 17a:  CTG performed during labour, women who gave birth, South Australia, 2009 ...................... 36

Table 17b:  Fetal scalp pH taken during labour, women who gave birth, South Australia, 2009 .............. 36

Table 18a:  Analgesia for labour,* women who gave birth, South Australia, 2009 .................................... 37

Table 18b:  Anaesthesia for birth,* women who gave birth, South Australia, 2009 ................................... 37

Table 19a:  Postnatal length of stay by type of patient, women who gave birth in South Australian  
 hospitals, 2009 .............................................................................................................................. 38

Table 19b:  Average postnatal length of stay by type of patient &amp; type of birth, women who gave  
 birth in South Australian hospitals, 2009 .................................................................................... 38

Table 20: Sex of baby, all births, South Australia, 2009 ............................................................................. 39

Table 21:  Birthweight distribution of all births, South Australia, 2009 .................................................... 39

Table 22:  Birth injuries* in 19,761 live births, South Australia, 2009 ........................................................ 40

Table 23:  Neonatal treatment given, all live births, South Australia, 2009 .............................................. 40

Table 24:  Level of nursery care utilised by birthweight, all live births, South Australia, 2009 ................ 41

Table 25:  Length of stay of liveborn babies in hospital, South Australia, 2009 ....................................... 41

Table 26:  Selected congenital abnormalities notified to the perinatal statistics collection, 
  1999-2009, South Australia ......................................................................................................... 42

Table 27a: Birthweight by plurality, all births, South Australia, 2009 ......................................................... 43

Table 27b: Gestation at birth by plurality all births, South Australia, 2009 ................................................ 43

Pregnancy Outcome in South Australia 2009page 6

Tables



Table 27c:  Perinatal outcome by plurality, all births, South Australia, 2009 .............................................. 44

Table 28a:  Perinatal mortality by birthweight, all births, South Australia, 2009 ....................................... 44

Table 28b: Perinatal mortality by gestational age at birth, South Australia, 2009 .................................... 45

Table 28c:  Perinatal mortality, South Australia, 2009 (all births of specified birthweight/gestation) ...... 46

Table 28d:  Perinatal mortality by race, all births, South Australia, 2009 .................................................... 46

Table 29:  Planned home births by age of women, South Australia, 2009 ................................................ 47

Table 30:  Method of birth in planned home births, South Australia, 2009 .............................................. 47

Table 31:  Birthweight distribution of planned home births, South Australia, 2009 ................................ 47

Table 32:  Perinatal outcome in planned home births, South Australia, 2009 .......................................... 47

Table 33: Planned birthing unit births by age of women, South Australia, 2009 .................................... 48

Table 34: Method of birth in planned birthing unit births, South Australia, 2009 .................................. 48

Table 35:  Birthweight distribution of planned birthing unit births, South Australia, 2009 .................... 49

Table 36: Perinatal outcome in planned birthing unit births, South Australia, 2009 .............................. 49

Table 37:  Abortion rate per 1,000 women aged 15-44 years, South Australia, 1970-2009 ...................... 50

Table 38:  Terminations of pregnancy by age, South Australia, 2009 ........................................................ 51

Table 39:  Abortion and live birth rates and abortion proportions by age, South Australia, 2009 ......... 52

Table 40:  Terminations by place of residence, South Australia, 2009 ....................................................... 53

Table 41:  Terminations by hospital category, South Australia, 2009 ......................................................... 53

Table 42:  Terminations by category of doctor, South Australia, 2009 ....................................................... 53

Table 43:  Reason for termination for fetal reasons, South Australia, 2009 .............................................. 54

Table 44:  Complications of terminations, South Australia, 2009 ............................................................... 54

Table 45a:  Women with previous terminations by age, South Australia, 2009 .......................................... 55

Table 45b:  Calculation of total abortion rate (TAR) for 2009 for South Australia* ................................... 56

Table 45c:  Calculation of total first abortion rate (TFAR) for 2009 for South Australia* .......................... 56

Table 46:  Obstetric profiles by hospital category, South Australia, 2009: live births of any gestation  
 and stillbirths of &gt;=400g or &gt;=20 weeks gestation .................................................................... 59

Table 47: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 2000   2009 ....75

Table 48:  Obstetric aspects of perinatal statistics, South Australia, 1981 and 2000   2009 ..................... 76

Pregnancy Outcome in South Australia 2009 page  7

Tables



Figures

Figure 1a: Map showing SA hospitals with obstetric beds in 2009 ............................................................ 15

Figure 1b: Map showing Central Regions of SA .......................................................................................... 16

Figure 2: Distribution of hospital births by hospital category, South Australia, 2009 (n=19,766) ......... 17

Figure 3: Age and race of women who gave birth, 2009 (n=19,604) ...................................................... 22

Figure 4: Reasons for induction of labour, SA, 2009 (n=5,770) ................................................................ 32

Figure 5a: Method of birth, women who gave birth, South Australia, 2009 (n = 19,604) ....................... 33

Figure 5b: Reason for caesarean section, 2009 (n=6,357) ........................................................................... 35

Figure 5c:  Reason for elective caesarean section, 2009 (n=3,084) ............................................................. 35

Figure 5d: Reason for emergency caesarean section, 2009 (n=3,273) ........................................................ 35

Figure 6: Perinatal mortality rate by birthweight, all births, South Australia, 2009 ............................... 45

Figure 7:  Abortion rate in South Australia, 1970-2009 ............................................................................. 51

Figure 8a: Abortions and live births by age, South Australia, 2009 ........................................................... 52

Figure 8b: Teenage pregnancy, abortion and birth rates, South Australia, 1970-2009 ............................ 53

Figure 9: Percentage of Aboriginal women by hospital category ........................................................... 60

Figure 10: Percentage of women with &lt;7 antenatal visits by hospital category ...................................... 60

Figure 11: Percentage of teenage women by hospital category ............................................................... 60

Figure 12: Percentage of women 35 years or more by hospital category ................................................. 61

Figure 13: Percentage of single women by hospital category ................................................................... 61

Figure 14: Percentage of women with 4 or more prior livebirths by hospital category ........................... 61

Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category ............... 62

Figure 16: Percentage of women with obstetric complications by hospital category .............................. 62

Figure 17: Percentage of women with complications during labour or birth by hospital category ........ 62

Figure 18: Percentage of women with induction of labour by hospital category .................................... 63

Figure 19: Percentage of women having epidural analgesia by hospital category .................................. 63

Figure 20: Percentage of breech births by hospital category ..................................................................... 63

Figure 21: Percentage of emergency caesarean sections by hospital category ......................................... 64

Figure 22: Percentage of elective caesarean sections by hospital category .............................................. 64

Figure 23: Percentage of total caesarean sections by hospital category ................................................... 64

Figure 24: Percentage of births with birthweight below 2,500g by hospital category ............................ 65

Figure 25: Percentage of births with gestation less than 37 weeks by hospital category ........................ 65

Figure 26: Percentage of births with prolonged hospitalisation by hospital category ............................ 65

Figure 27: Percentage of live births requiring neonatal intensive care by hospital category .................. 66

Pregnancy Outcome in South Australia 2009page 8

Figures



Figure 28: Percentage of births with birth defects by hospital category .................................................. 66

Figure 29a: Induction of labour proportion for selected primiparae, SA hospitals with &gt;=500 births  
 per year, 2009 ............................................................................................................................... 71

Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with &gt;=500 births  
 per year, 2009 ............................................................................................................................... 71

Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary  
 (first) caesarean section &amp; no intervening births, SA hospitals with &gt;=500 births per  
 year, 2009 ..................................................................................................................................... 72

Figure 29d: PRIMIP no repair: proportion of primiparous women not requiring surgical repair  
 following vaginal birth, SA hospitals with &gt;=500 births per year, 2009 .................................. 72

Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than  
 congenital abnormality, SA hospitals with &gt;=500 births per year, 2009 .................................. 72

Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals  
 with &gt;=500 births per year, 2009 ................................................................................................ 73

Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals  
 with &gt;=500 births per year, 2005-2009 ....................................................................................... 73

Figure 30a: Percentage of teenage women among women giving birth in SA .......................................... 77

Figure 30b: Percentage of women aged 35 years and over among women giving birth in SA ................. 77

Figure 30c: Percentage of primiparous women aged 35 years and over in SA ........................................... 77

Figure 30d: Percentage of Aboriginal women and Asian women among women giving birth in SA ....... 78

Figure 30e: Percentage of women never married and with no de facto partner among  
 women giving birth in SA ........................................................................................................... 78

Figure 30f: Percentage of multiple births among births in SA .................................................................... 78

Figure 30g: Percentage of low birthweight babies among births in SA ...................................................... 79

Figure 30h: SA standardised perinatal mortality ratio (SPMR) ..................................................................... 79

Pregnancy Outcome in South Australia 2009 page  9

Figures



Executive Summary

This Report on pregnancy outcome in South Australia for 2009 provides statistics derived mainly from the South 
Australian perinatal statistics collection of births. These are notified by hospital and homebirth midwives and neonatal 
nurses. For a more complete picture of pregnancy outcome, some statistics from the abortion statistics collection 
are also included. More statistics on abortions in the state in 2009 are available in the Seventh Annual Report of the 
Abortion Reporting Committee. Comparisons of selected pregnancy characteristics and outcomes are provided for 
five different hospital categories in the state. Individual hospital reports (Pregnancy and Neonatal Care Bulletins) with 
these comparisons made in greater detail are provided to hospitals in the state with at least 100 births per year. Group 
reports are provided for hospitals with smaller numbers of births. Comparisons of maternity performance indicators 
are also provided for hospitals with at least 500 births per year.

1. Numbers and fertility rates
The number of births notified in South Australia in 2009 was 19,901, which was 69 fewer than the previous year. 
The number of women who gave birth was 19,604. The total fertility rate was 1.87 live births per woman, a decrease 
from 1.91 in 2007 and 2008. The fertility rate decreased slightly in all age groupings other than the 25-29 years age 
grouping which remained stable and there was a slight increase in the group of women aged 40-45 years. 

2. Place of birth
The numbers of births increased at Flinders Medical Centre and the Lyell McEwin Hospital and decreased at the 
Women s and Children s Hospital. Births decreased at metropolitan private hospitals. Six percent of women (1,166 
women) gave birth in birthing units in teaching hospitals and 125 women (0.6%) had planned home births.

3. Teenage women
811 teenage women gave birth, accounting for 4.1% of women who gave birth, and 912 teenage women had 
terminations of pregnancy, accounting for 18.0% of terminations. In 2009, the proportion of  known  pregnancies 
terminated was 52.9% for teenagers compared with 20% for women of all ages. The teenage pregnancy rate 
declined in the 1970s and 1980s, but increased in the early 1990s. It declined again after 1996. The teenage 
pregnancy rate of 32.7 per 1,000 women in 2009 was the lowest rate recorded since 1970.

4. Older women and first time mothers
The mean age of women giving birth increased from 26.55 years in 1981 to 30.14 years in 2009, and, among first 
time mothers, from 24.42 years to 28.27 years. The proportion of women aged 35 years or more increased from 
4.6% in 1981 to 21.1% in 2009. Among first time mothers, this proportion increased from 1.2% to 12.8%.  As in 
the previous seven years, more women gave birth in the 30-34 years than in the 25-29 years age group. 

5. Country of birth and race
Eighty-one percent of women who gave birth in 2009 were Australian-born.  Of women born overseas who gave birth, 
the largest proportions came from the United Kingdom and Ireland (2.9% of women), India (1.9%), Vietnam (1.3%), 
New Zealand  and China (1.1% each), the Philippines (1.0%) and Sudan (0.7%). Eight percent of women (1,585 women) 
who gave birth in the state in 2009 were Asian, compared with 2% in 1981. They gave birth mainly in teaching hospitals.

6. Smoking during pregnancy and Body Mass Index
The proportion of women smoking at the first antenatal visit has declined steadily from 25% in 1998 to 16% in 2009. 
About 4% each year quit smoking before the first antenatal visit.

While statistics on Body Mass Index were available only for 68% of women who gave birth in 2009 (an improvement 
from 42% in 2007), and must be interpreted with caution, these show that 27% of women were overweight and 
23% were obese, including 10% who were severely or morbidly obese.

Pregnancy Outcome in South Australia 2009page 10

Executive Summary



7. Antenatal care and length of stay
Statistics on gestation at first antenatal visit were available only for 89% of women who gave birth. These show that 
78% of women attended for antenatal care within the first 14 weeks of pregnancy. Nearly 92% attended at least 
seven antenatal visits. Although many women had more than one type of antenatal care, the most common types 
used were hospital clinics (45%), obstetricians in private practice (32%) and general practitioners (17%). Thirty-two 
percent of women were private patients. The median length of stay of women after a birth was three days; it was 
three days for those who had a vaginal birth and five days for those who had a caesarean section.  Amongst private 
patients, hospital stay was two days longer for vaginal births and one day longer for caesarean births.

8. Aboriginal women
607 Aboriginal women gave birth in South Australia in 2009, accounting for 3.1% of all women who gave birth in 
the state. Twenty percent of Aboriginal women were teenagers (compared with 3.6% of non-Aboriginal women). 
Fifty-one percent of Aboriginal women attended for antenatal care within the first 14 weeks of pregnancy (compared 
with 79% of non-Aboriginal women) and 68% attended at least seven antenatal visits during pregnancy (compared 
with 92% of non-Aboriginal women).  While the proportion of non-Aboriginal women smoking during pregnancy 
declined steadily from 24% in 1998 to 15% in 2009, no similar decline was observed in Aboriginal women. However, 
in 2009 Aboriginal women recorded their lowest level of smoking during pregnancy of 52%, although this was higher 
than for non-Aboriginal women (15%). In 2009 their proportions of preterm births (&lt;37 weeks gestation), and low 
birthweight births (&lt;2,500g), remained nearly twice as high as those of non-Aboriginal births. The perinatal mortality 
rate of babies of Aboriginal women was the second lowest recorded, but remained higher than that of babies of non-
Aboriginal women (14.6 compared with 9.3 per 1,000 births).

9. Procedures
Ninety-eight percent of women who gave birth had an ultrasound examination; 29% had labour induced while 
another 22% had spontaneous labour augmented; epidurals were used for pain relief during labour for 31% of 
women, and 11% had an episiotomy (17% of women who gave birth vaginally). The main reasons for induction 
of labour were prolonged pregnancy (20%), hypertension (14%), diabetes or gestational diabetes (8%), poor 
fetal growth (6%) and premature rupture of membranes (3.7%). Fifty-three percent of inductions of labour were 
performed for other than defined indications.  

10. Method of birth
Fifty-five percent of women had normal spontaneous vaginal births. Seven percent gave birth by ventouse and 4.6% 
by forceps (compared with 1% and 15% respectively in 1981). In 2009 the proportion of women giving birth by 
caesarean section was 32%, a proportion which has been relatively stable for four years. Of those who had previously 
given birth, 30% had previously had a caesarean section. Only 17% of women had a vaginal birth following a 
previous first caesarean without intervening births, compared with 30% in 1998. The main reasons given for 
caesarean section were previous caesarean section (39%), failure to progress in labour or cephalopelvic disproportion 
(27%), fetal distress (16%) and malpresentation (12%). 

11. Multiple births
Multiple births accounted for 3.0% of births; women with twins or triplets accounted for 1.5% of women who gave 
birth in 2009. These proportions increased in the 1980s and 1990s as a result of the use of assisted conception and 
the increasing proportion of older women, who have higher rates of multiple pregnancies than younger women. 
However, the peak proportion of multiple births was recorded in 2002 and 2003 (3.6%). The subsequent decline 
in the proportion of multiple births was probably related to the increasing use of single embryo transfer in assisted 
conception practice.

Pregnancy Outcome in South Australia 2009 page  11

Executive Summary



12. Abortions
5,054 terminations of pregnancy were notified, 47 less than in 2008. The abortion rate was 15.6 per 1,000 women 
aged 15-44 years, a slight decrease from 2008 (16.0 per 1,000 women aged 15-44 years). The rate has declined 
significantly since 2001, when it was 17.7 per 1,000 women. Approximately 93% of terminations were performed 
in metropolitan public hospitals, including the Pregnancy Advisory Centre, and 78% were performed by doctors 
in family advisory clinics in these hospitals. Ninety-two percent of terminations were performed within the first 14 
weeks of pregnancy and 1.8% (90) were performed at or after 20 weeks gestation. Fifty-four percent of terminations 
performed at or after 20 weeks gestation were for fetal abnormalities. Approximately 21% of reported pregnancies 
ended as terminations in 2009.

13. Perinatal mortality
The perinatal mortality rate for all births in 2009 was 9.5 per 1,000 births, the stillbirth rate was 7.0 per 1,000 
births and the neonatal mortality rate was 2.5 per 1,000 live births. For international comparison, the World 
Health Organisation recommends including only stillbirths of at least 1,000g birthweight (or 28 weeks gestation if 
birthweight unavailable ) and early neonatal deaths within the first 7 days of life (instead of 28 days) in calculating the 
perinatal mortality rate. This rate for international comparison for South Australia for 2009 was 3.5 per 1,000 births, 
with an early neonatal mortality rate of 0.9 per 1,000 live births. 

14. Congenital Anomalies
In 2009 there were 539 births (2.7%) notified at birth with congenital anomalies, compared with an average of 2.5% 
over the past decade. In 2009 the number of spina bifida cases reported at birth increased from 4 cases in 2008 to 18 
in 2009. No reason for this recent sudden increase can be determined. Following a statewide campaign to promote 
periconceptional folate in 1994 and 1995, the use of folate supplementation in pregnancy increased, and rates of 
neural tube defects decreased. It is  important that all women are advised to use supplementary folate when planning 
to conceive and in early pregnancy.

Pregnancy Outcome in South Australia 2009page 12

Executive Summary



I. Introduction

This Report summarizes the statistics for 2009 from the South Australian perinatal statistics collection and the South 
Australian abortion statistics collection, both of which are held in the Pregnancy Outcome Unit. Some definitions used 
by the Unit are provided in Appendix 1. Guidelines1 with some of these definitions are issued to all South Australian 
obstetric units to promote the uniform completion of forms.

1. The Perinatal Statistics Collection
This collection utilises notifications of births in South Australia made by hospital and homebirth midwives and hospital 
neonatal nurses on the Supplementary Birth Record (SBR - Appendix 2). The SBRs are checked manually for completeness 
and data discrepancies and then go through a series of automated validation procedures during data entry.

Information on congenital abnormalities detected at birth or in the neonatal period (within 28 days of birth) is 
provided by doctors using the Congenital Abnormality Form (Appendix 3). Few statistics on birth defects are included 
in this report as these are reported annually by the South Australian Birth Defects Register at the Women s and 
Children s Hospital.2 The Register complements statistics on birth defects from the perinatal and abortion statistics 
collections with statistics on birth defects detected and notified after discharge from the birth hospital up to the 
child s fifth birthday. 

Perinatal data are provided under legislation, the South Australian Health Care Regulations 2008, Part 5 Pregnancy 
outcome data and statistics. The South Australian perinatal statistics collection includes all births occurring in South 
Australia, including those to women who normally reside interstate, mainly in New South Wales near the South 
Australian border and in the Northern Territory. Births of South Australian residents which occur in other states are not 
included. The perinatal data have been collected since 1981, but there have been changes in the data items collected 
over the years. 

Perinatal death certificates are obtained from the Births, Deaths and Marriages Registration Division, chromosome 
analysis reports from the Cytogenetics and Molecular Genetics Unit at Women s and Children s Hospital, autopsy 
reports from pathology departments and Coroner s autopsy reports and findings from the Coroner s Office. All these 
are linked with the SBRs to provide more complete information on births and deaths. All maternal, perinatal and 
infant deaths in the state are reviewed by the Maternal, Perinatal and Infant Mortality Committee and details of 
these are reported in the annual report of the Committee entitled  Maternal, Perinatal and Infant Mortality in South 
Australia 2009.3 

2. The Abortion Statistics Collection
Notifications made by doctors of medical terminations of pregnancy under the Criminal Law Consolidation (Medical 
Termination of Pregnancy) Regulations 1996, are included in this collection. It commenced in 1970, when specific 
abortion legislation was introduced under the Criminal Law Consolidation Act. Termination of pregnancy became 
legal in the state if performed in a prescribed hospital by a medical practitioner for a woman who has been resident 
at least two months in the state. The practitioner and another medical practitioner must have examined the woman 
and formed the opinion that the continuation of the pregnancy would involve greater risk to her life or greater risk of 
injury to her physical or mental health than if the pregnancy were terminated; or that there is a substantial risk that 
if the pregnancy were not terminated and the child were born, the child would suffer from such physical or mental 
abnormalities as to be seriously handicapped. A termination may not be performed on a woman who is pregnant 
with a child  capable of being born alive  unless it is performed to save the woman s life. The legislation states that 
evidence that a woman has been pregnant for a period of 28 weeks or more is prima facie proof that she was 
pregnant with a child that was capable of being born alive.

Pregnancy Outcome in South Australia 2009 page  13

Introduction



II. Mothers and Babies: Characteristics &amp; Outcomes

The births in 2009 in South Australia described in this Report include live births of any gestation, and stillbirths and 
terminations of pregnancy of at least 400g birthweight or 20 weeks gestation. There was one birth of unknown 
birthweight. Sixty four births of less than 400g birthweight have been included, consisting of 52 stillbirths and twelve 
live births. The twelve live births were born at 18-25 weeks gestation and all but premature twins died in the neonatal 
period. SBRs were received for all 19,901 births reported by hospital and home birth midwives in their monthly 
notification lists. These comprised 19,761 live births and 140 stillbirths. The number of women who gave birth was 
19,604, 68 less women than in 2008. Findings relating to Aboriginal women and babies in the text of this Report 
have been italicised for easy identification, in accordance with the request of the Aboriginal Health Council.

1. Place of residence of mother
South Australia is divided into nine CURB (Committee for Uniform Regional Boundaries) Regions, comprising five 
country Regions and four Central Regions. Each of the Central Regions (Northern, Eastern, Western, Southern) has a 
Metropolitan (Adelaide) and a non-Metropolitan component (Figures 1A and 1B). The distribution of births according 
to the mother s place of residence by CURB Regions is provided in Table 1 together with the estimated resident 
population and crude birth rate. The crude birth rate in 2009 for South Australia was 12.3 per 1,000 population. It 
was lowest in the Murraylands and the Central Eastern Regions. It was highest in the Central Northern Region and 
was also high in the Northern and Eyre.

Table 1: Births and crude birth rate by CURB regions, South Australia, 2009

CURB Region
(Mother s residence) Total births Live births

Estimated resident 
population,  

June 30, 2009+
Crude birth 

rate per 1,000 
population

Number Percent Number Number

Central Northern 6,041 30.4 5,997 428,080 14.1

Central Western 2,476 12.4 2,453 223,538 11.1

Central Eastern 3,068 15.4 3,051 285,582 10.7

Central Southern 4,500 22.6 4,471 386,889 11.6

Yorke &amp; Lower North 499 2.5 499 47,052 10.6

Murraylands 811 4.1 800 70,426 11.5

South East 839 4.2 835 65,978 12.7

Northern 1,053 5.3 1,046 80,489 13.1

Eyre 495 2.5 493 35,556 13.9

Interstate 119 0.6 116 na na

Total 19,901 100.0 19,761 1,623,590 12.3

+ Australian Bureau of Statistics. Population estimates by age and sex, South Australia, 2009. Canberra: ABS, 2010  (Catalogue No 3235.0). 

na: not applicable

Pregnancy Outcome in South Australia 2009page 14

Mothers and Babies



2. Place of birth of baby
Of the 19,901 births in 2009, 134 (0.7%) were home births and of those 125 were planned homebirths. The place 
of birth of one baby, who died in the perinatal period, was not known. The remaining 19,766 births occurred in 
hospitals or (in 76 cases) before arrival at hospitals into which the women had been booked. These 76  Born Before 
Arrival  (BBA) births have been included in the statistics for those hospitals. The distribution of births by place of birth 
(home or hospital) and plurality is provided in Table 2. Locations of South Australian hospitals with obstetric beds in 
2009 are provided in Figures 1A and 1B.

Table 2: Total births notified in 2009, by place of birth and plurality, South Australia

Condition at birth
Home births Hospital births

     Total
Singleton Twin Singleton Twin Triplet

Live birth 133 0 19,047 569 12 19,761

Stillbirth 1 0 129 9 0 139

Total births 134 0 19,176 578 12 19,901*

*includes one stillbirth for whom the place of birth was not known

Figure 1a: Map showing SA hospitals with obstetric beds in 2009

W
A

N
SW

NORTHERN

EYRE

Ceduna

Q
LD

NT

V
ic

Kangaroo Island

Pt Lincoln

Pt Augusta
Pt Pirie YORKE &amp;

LOWER
NORTH

MURRAY
LANDS

Wallaroo

Whyalla

Clare

Riverland
Regional

(Berri)

Murray Bridge

Naracoorte

Mt Gambier

SOUTH EAST

SEE INSET
Figure 1b

CENTRAL REGIONS

0 40 80 120 160 Km

Metropolitan Adelaide

CURB Regions - Boundaries

&gt; 2000 births per annum

1000-1999 births per annum

500-999 births per annum

100-399 births per annum

&lt; 100 births per annum

* The six centres near the
north-western border 
are Aboriginal clinics

Pregnancy Outcome in South Australia 2009 page  15

Mothers and Babies



Of the 19,766 hospital births, 79.9% occurred in metropolitan hospitals (teaching and private) and 20.1% in country 
hospitals. This distribution is summarized in Table 3a and Figure 2. Table 3b provides the numbers of births and 
women by race in individual hospitals. Metropolitan hospitals are listed in order of number of births and country 
hospitals in alphabetic order within their category of number of births. Fifty-four percent of births in South Australia 
in 2009 occurred in metropolitan teaching hospitals. Level III teaching hospitals - the Women s and Children s Hospital 
and Flinders Medical Centre - provide a high risk pregnancy service and neonatal intensive care. The Lyell McEwin 
Hospital has a special care (Level II) neonatal unit. These levels are defined in the Report  Operational Policy, Guidelines 
and Standards for Maternal and Neonatal Services in South Australia. 4

Compared with 2008, births increased at the Lyell McEwin Hospital and Flinders Medical Centre, while births at the 
Women s and Children s Hospital decreased.  The total number of births in metropolitan private hospitals decreased 
slightly, with only the North Eastern Community Hospital showing a small increase.  Births at Calvary remained constant.

The total number of births in country hospitals decreased overall by 66. In the two major country centres, births 
decreased slightly at Mount Gambier, while there was a slight increase in births at Whyalla. Increases occurred at 
some hospitals with 100-399 births per year, eg Gawler Health Service, Murray Bridge, Port Lincoln and the Riverland 
Regional Hospital at Berri, while decreases were seen at Barossa Health (Tanunda), Naracoorte, Port Augusta and 
South Coast (Victor Harbor). Births increased at the smaller country centres of Southern Flinders Health Service 
(Crystal Brook) and Peterborough, while numbers of births fell at Ceduna, Mid North Health (Jamestown campus), 
Kapunda, Kangaroo Island, Millicent and Quorn.

Figure 1B: Map showing Central Regions of SA

CENTRAL EASTERN
Mt Barker

SCDH
(Victor Harbor)

CENTRAL WESTERN
(includes Kangaroo Island)

0 10 20 30 40

Metropolitan Adelaide
Hospital abbreviations
as in Table 3B

&gt; 2000 births per annum

1000-1999 births per annum

500-999 births per annum

100-399 births per annum

&lt; 100 births per annum

kilometres

CENTRAL NORTHERN

CENTRAL SOUTHERN

Tanunda

Kapunda

Gawler Health Service

Lyell
McEwin

FMC

Calvary

Ashford
Flinders
Private

W&amp;CH
BWMH

NECH

Pregnancy Outcome in South Australia 2009page 16

Mothers and Babies



Table 3a: Hospital births by category of hospital, South Australia, 2009

Hospital category Number of births Percent hospital births

Metropolitan teaching 10,680 54.0

    Level III (7,630) (38.6)

    Other teaching (3,050) (15.4)

Metropolitan private 5,119 25.9

Country 3,967 20.1

   Major country (861) (4.4)

   100-399 births per annum (2,651) (13.4)

   50-99 births per annum (265) (1.3)

   &lt;50 births per annum (190) (1.0)

Total 19,766 100.0

Figure 2: Distribution of hospital births by hospital category, South Australia, 2009 (n=19,766)

14.0%

b

0 10 20 30 40 50 60

Country hospitals

Metropolitan private
hospitals

Teaching hospitals

Percentage of hospital births

20.1%

25.9%

54.0%

a Ashford 7.6%
b Burnside 6.6%
c Calvary 4.5%
d Flinders Private 3.3%
e North Eastern Community 3.9%

r Mt Gambier 2.8%
s Gawler 2.0%
t Mount Barker 1.9%
u Port Lincoln 1.6%
v Whyalla 1.6%
w Port Augusta 1.4%
x Other hospitals with 100-399 births per year 6.5%
y Hospitals with 50-99 births per year 1.3%
z Hospitals with &lt;50 births per year 1.0%

W&amp;CH FMC LMHS

e

u

24.6% 15.4%

a c

r s x y zt v w

d

Pregnancy Outcome in South Australia 2009 page  17

Mothers and Babies



Table 3b: Hospital births in South Australia in 2009 by race and hospital 

Hospital Caucasian Aboriginal Asian Other Total births
Total number of women 

who gave birth

Metropolitan teaching

Women s &amp; Children s Hospital 
(W&amp;CH)

3,330 192 914 432 4,868 4,729

Flinders Medical Centre (FMC) 2,449 68 157 88 2,762 2,716

Lyell McEwin Hospital (LMH)** 2,562 109 244 135 3,050 3,017

Total 8,341 369 1,315 655 10,680 10,462

Metropolitan private

Ashford** 1,424 6 56 15 1,501 1,475

Burnside War Memorial (BWMH)** 1,214 1 71 10 1,296 1,276

Calvary** 838 8 42 6 894 890

Flinders Private** 631 1 23 6 661 653

North Eastern Community (NECH)** 745 1 14 7 767 761

Total 4,852 17 206 44 5,119 5,055

Country

Major country

Mt. Gambier** 528 5 8 4 545 537

Whyalla 279 30 3 4 316 315

Subtotal 807 35 11 8 861 852

100-399 births per annum

Barossa Health (Tanunda Centre) 119 0 3 0 122 122

Gawler Health Service*** 385 7 5 3 400 398

Lower North Health Centre (Clare) 106 1 0 0 107 107

Mt. Barker 363 2 9 2 376 376

Murray Bridge Soldiers  Memorial 231 17 7 12 267 267

Naracoorte 138 2 6 9 155 155

Pt. Augusta 171 88 5 6 270 269

Pt. Lincoln 287 21 8 2 318 318

Pt. Pirie 170 12 1 4 187 187

Riverland Regional (Berri) 186 17 9 12 224 221

South Coast District (Victor Harbor) 116 2 2 2 122 122

Northern Yorke Peninsula Regional 
Health Service (Wallaroo)

97 5 1 0 103 103

Subtotal 2,369 174 56 52 2,651 2,645

** These hospitals have neonatal special care nurseries.

*** This is a metropolitan hospital situated at the metropolitan/country boundary; it has the characteristics of a country hospital and has  
been included as such.

Table 3b continued

Pregnancy Outcome in South Australia 2009page 18

Mothers and Babies



Hospital Caucasian Aboriginal Asian Other Total births
Total women who  

gave birth 

50-99 births per annum

Loxton 66 1 1 0 68 68

Millicent 82 1 0 1 84 84

Southern Flinders Health Service 
(Crystal Brook)

59 2 1 1 63 63

Waikerie 45 1 1 3 50 50

Subtotal 252 5 3 5 265 265

1-49 births per annum

Ceduna 31 11 2 1 45 45

Central Yorke Peninsula (Maitland) 1 1 0 0 2 2

Cowell 2 0 0 0 2 2

Cummins 7 0 0 0 7 7

Ernabella 0 1 0 0 1 1

Kangaroo Island 34 0 0 1 35 35

Kapunda 46 0 1 0 47 47

Meningie 1 0 0 0 1 1

Mid North Health (Jamestown 
Campus)

28 0 0 0 28 28

Mid West Health (Streaky Bay) 1 0 0 0 1 1

Mimili 0 1 0 0 1 1

Oodnadatta 0 1 0 0 1 1

Peterborough 10 0 0 0 10 10

Quorn 6 0 0 0 6 6

Southern Yorke Peninsula 
(Yorketown)

1 0 0 0 1 1

Strathalbyn 1 0 0 0 1 1

Yalata 0 1 0 0 1 1

Subtotal 169 16 3 2 190 190

Total (country) 3,597 230 73 67 3,967 3,592

Grand total 16,790 616 1,594 766 19,766 19,469

Table 3b continued

Pregnancy Outcome in South Australia 2009 page  19

Mothers and Babies



3. Maternal race
The distribution of women who gave birth, by race is provided in Table 4a and also by category of birthplace in Table 
4b. In these tables and all others where distribution by race is shown,  Aboriginal  includes Aboriginal (589 women), 
Torres Strait Islander (6 women) and those who are Aboriginal and Torres Strait Islander (12 women). Aboriginal 
women accounted for 3.1% of women and gave birth mainly in metropolitan teaching hospitals and country 
hospitals. Asian women accounted for 8.1% of women, and gave birth mainly in metropolitan teaching hospitals, but 
13.0% gave birth in private hospitals.

Table 4a: Race of women who gave birth, South Australia, 2009

Race Number of women % Women

Caucasian 16,655 85.0

Aboriginal 607 3.1

Asian 1,585 8.1

Other 757 3.8

Total 19,604 100.0

Table 4b: Race and birthplace category of women who gave birth, South Australia, 2009

Birthplace

Race of women

Total       Caucasian        Aboriginal            Asian            Other

Number % Number % Number % Number % Number %

Metropolitan
teaching 
hospital

8,151 48.9 360 59.3 1,305 82.3 646 85.3 10,462 53.4

Metropolitan  
private hospital

4,789 28.8 16 2.6 206 13.0 44 5.8 5,055 25.8

Country 
hospital

3,584 21.5 229 37.7 73 4.6 66 8.7 3,952 20.2

Home 130 0.8 2 0.3 1 0.1 1 0.1 134 0.7

Unknown  
place of birth

1 0 0 0 0 0 0 0 1 0

Total 16,655 (85.0) 607 (3.1) 1,585 (8.1) 757 (3.8) 19,604 100.0

Pregnancy Outcome in South Australia 2009page 20

Mothers and Babies



4. Maternal age
Among the five-year age groups the largest number of women who gave birth was in the 30-34 years age group 
(Table 4c). The proportion of women in this age group (30.4%) has exceeded that of the 25-29 years age group 
(29.0%) since 2001.  Teenage women accounted for 4.1% of women who gave birth and older women aged 35 
years or more accounted for 21.1% (Table 4c and Figure 3). Aboriginal women were generally younger than non-
Aboriginal women: 19.6% were teenagers and only 8.1% were 35 years or older. Among Asian women, on the other 
hand, only 0.9% were teenagers but 19.7% were 35 years or older. 

The age-specific fertility rates have increased in the 25-29 and 40-44 age groups and decreased in the teenage, 
20-24, 30-34, 35-39 and 40-44 age groups, when compared with 2008 (Table 4d). The rate was highest in the age 
group 30-34 years (120.7 per 1,000 women), followed by the 25-29 years age group (108.5 per 1,000 women). The 
general fertility rate (see Appendix 1) was 61.1 per 1,000 women aged 15-44 years, down from 62.0 in 2008. The 
total fertility rate (see Appendix 1) was 1.87 live births per woman, down from 1.91 in 2007 and 2008, which was the 
highest for more than a decade, but still below replacement level (2.1).

Table 4c: Age and race of women who gave birth, South Australia, 2009

Age 
(years)

Caucasian Aboriginal Asian Other Total

Number % Number % Number % Number % Number %

&lt;15 4 0.0 1 0.2 0 0 0 0 5 0

15-19 638 3.8 118 19.4 14 0.9 36 4.8 806 4.1

20-24 2,467 14.8 212 34.9 164 10.3 165 21.8 3,008 15.3

25-29 4,774 28.7 156 25.7 540 34.1 214 28.3 5,684 29.0

30-34 5,136 30.8 71 11.7 555 35.0 194 25.6 5,956 30.4

35-39 2,986 17.9 42 6.9 255 16.1 122 16.1 3,405 17.4

40-44 605 3.6 7 1.2 54 3.4 24 3.2 690 3.5

45+ 45 0.3 0 0 3 0.2 2 0.3 50 0.3

Total 16,655 (85.0) 607 (3.1) 1,585 (8.1) 757 (3.8) 19,604 100.0

Pregnancy Outcome in South Australia 2009 page  21

Mothers and Babies



Figure 3: Age and race of women who gave birth, 2009 (n=19,604)

0%

20%

40%

60%

80%

100%

Caucasian
n=16,655

Aboriginal
n=607

Asian 
n=1,585

Other 
n=757

Total n
=19,604

Pe
rc

en
ta

g
e 

o
f 

w
o

m
en

14-19 20-24 25-29 30-34 35+ Age (years)

Table 4d: Age-specific fertility rates, South Australia, 2009

Age (years) Number of live births
Estimated resident female 

population*
Age-specific fertility rate per  

1,000  women (ASFR)***

15-19 809** 52,685 15.4**

20-24 3,020 55,493 54.4

25-29 5,731 52,797 108.5

30-34 6,009 49,777 120.7

35-39 3,448 55,935 61.6

40-44 739** 56,455 13.1**

Total 19,756** 323,142 61.1**

* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2009. Canberra: ABS, 2010 (Catalogue No 3235.0).

** the number of live births and fertility rate for women aged 15-19 years include live births for younger ages, and the number and rate for women 
aged 40-44 years include live births for older ages, while the total number and  rate (general fertility rate) include all live births. Live births in this 
table exclude terminations of pregnancy.

*** Sum of 5-year ASFRs = 373.7 per 1,000 women. Total fertility rate = 373.7 x 5 = 1,868.5 live births per 1,000 women  
= 1.87 live births per woman.

Pregnancy Outcome in South Australia 2009page 22

Mothers and Babies



5. Country of birth
The distribution of women by country of birth is provided in Table 5a by major group, and in Table 5b by specified 
countries of birth that had 40 or more women who gave birth. Of the 18.6% of women born outside Australia, the 
largest proportion was born in the United Kingdom and Ireland (2.9%). Other countries contributing relatively large 
proportions of migrant women were India (1.9% of women ), Vietnam 1.3, China and New Zealand (1.1%), the 
Philippines (1.0%),  Sudan (0.7%), Afghanistan, Cambodia, Malaysia and South Africa (0.4% each), Poland, South Korea, 
Thailand and the United States of America (0.3%), and  Canada, Germany, Indonesia, Iraq and Japan, (0.2% each).

Table 5a: Country of birth, major groups,* women who gave birth, South Australia, 2009

Country of birth Number %

1 Oceania and Antarctica 16,205 82.7

2 Europe and the USSR 968 4.9

3 The Middle East and North Africa 311 1.6

4 Southeast Asia 777 4.0

5 Northeast Asia 364 1.9

6 Southern Asia 553 2.8

7 Northern America 94 0.5

8 South America, Central America and the Caribbean 68 0.3

9 Africa (excluding North Africa) 263 1.3

10 Unknown 1 0

Total 19,604 100.0

* Australian Bureau of Statistics. Australian Standard Classification of Countries for Social Statistics (ASCCSS).  Canberra: ABS, 1990  
  (Catalogue No 1269.0).

Table 5b: Specified country of birth,* women who gave birth, South Australia, 2009

Specified country of birth Number % of women
% of migrant women who gave 

birth (n=3,649)

1100 Australia 15,954 81.4 na

2101-2107 The United Kingdom and Ireland 573 2.9 15.7

6104 India 371 1.9 10.2

4110 Vietnam 263 1.3 7.2

5101 China 218 1.1 6

1301 New Zealand 206 1.1 5.6

4107 Philippines 188 1.0 5.1

3207 Sudan 130 0.7 3.6

4105 Malaysia 85 0.4 2.3

9220 South Africa 83 0.4 2.3

6101 Afghanistan 76 0.4 2.1

4102 Cambodia 75 0.4 2.1

4109 Thailand 65 0.3 1.8

2504 Poland 54 0.3 1.5

7104 United States of America 53 0.3 1.4

5105 South Korea 50 0.3 1.4

5103 Japan 49 0.2 1.3

4103 Indonesia 46 0.2 1.3

3104 Iraq 43 0.2 1.2

2305 Germany 41 0.2 1.1

7102 Canada 40 0.2 1.1

All other countries 940 4.8 25.8

Total  19,604 100 100

* ASCCSS, Australian Bureau of Statistics

Pregnancy Outcome in South Australia 2009 page  23

Mothers and Babies



6. Marital status and type of patient
While 88.8% women who gave birth in 2009 were married or in a de facto relationship, 11.2% were single (10.0% 
were never married and 1.2% were widowed, separated or divorced, Table 6a). Of never married women, over a fifth 
were teenagers and nearly a third were in the early twenties age group. Relatively more single women were hospital/
public patients than married women and women in de facto relationships (92.2% v 65.2%, Table 6b). Nearly a third 
of all women were private patients (31.8%).

Table 6a: Marital status and age, women who gave birth, South Australia, 2009

Age (years)

Marital status of women

TotalNever married Married/de facto
Widowed/ 

separated/divorced

Number % Number % Number   % Number %

&lt;20 420 21.4 384 2.2 7 2.9 811 4.1

20-24 628 32.0 2346 13.5 34 13.9 3,008 15.3

25-29 435 22.2 5190 29.8 59 24.2 5,684 29.0

30-34 300 15.3 5588 32.1 68 27.9 5,956 30.4

35-39 145 7.4 3201 18.4 59 24.2 3,405 17.4

40-44 30 1.5 646 3.7 14 5.7 690 3.5

45+ 3 0.2 44 0.3 3 1.2 50 0.3

Total 1,961 (10.0) 17,399 (88.8) 244 (1.2) 19,604 100.0

Table 6b: Type of patient and marital status, women who gave birth, South Australia, 2009

Type of  
patient

Marital status of women

TotalNever married Married/de facto
Widowed/ 

separated/divorced

Number % Number % Number % Number %

Hospital/public 1,807 92.1 11,342 65.2 225 92.2 13,374 68.2

Private 154 6.3 6,057 34.8 19 7.8 6,230 31.8

Total 1,961 (10.0) 17,399 (88.8) 244 (1.2) 19,604 100.0

Pregnancy Outcome in South Australia 2009page 24

Mothers and Babies



7. Occupation of father and mother
This categorisation is based on the Australian Statistical Classification of Occupations (ASCO) of the Australian Bureau 
of Statistics and is provided in Table 7. Unclassified occupations have been assigned a separate category (Category 9). 

A much larger proportion of mothers than fathers (24.4 v 0.4%) was included in the occupation  home duties . Larger 
proportions were also found for the groups of clerks and salespeople and personal service workers. More fathers were 
managers and administrators, tradespeople, plant and machine operators and labourers. Occupation was unknown 
for 9.7% of fathers and 4.1% of mothers.

Table 7: Occupation* of father and mother, women who gave birth, South Australia, 2009

Occupation

Father Mother

Number % Number %

1 Managers and administrators 3,265 16.7 1,533 7.8

2 Professionals 2,880 14.7 2,909 14.8

3 Para professionals 968 4.9 1,203 6.1

4 Tradespersons 3,552 18.1 683 3.5

5 Clerks 554 2.8 2,427 12.4

6 Salespersons and personal service workers 1,108 5.7 2,955 15.1

7 Plant and machine operators and drivers 1,236 6.3 85 0.4

8 Labourers and related workers 2,459 12.5 573 2.9

9 Students 443 2.3 758 3.9

Pensioners 107 0.5 34 0.2

Home duties 83 0.4 4,785 24.4

Unemployed 774 3.9 691 3.5

Other 264 1.3 162 0.8

Unknown 1,911 9.7 806 4.1

Total 19,604 100.0 19,604 100.0

*  Australian Bureau of Statistics. ASCO. First Edition. Occupation Definitions. Canberra: ABS,1990. (Catalogue No. 1223.0).

Pregnancy Outcome in South Australia 2009 page  25

Mothers and Babies



8. Previous pregnancy outcomes
Forty-two percent of women had no previous birth and 30.1% were pregnant for the first time. Among Aboriginal 
women and those of  other  races, these proportions were lower, with 35.1% and 34.5% respectively giving birth for 
the first time. The proportion of women giving birth for the first time was the highest among Asian women (52.2%). 

The proportion of women of parity 4 or greater was much higher among Aboriginal women (12.9%) and women of 
 other  races (13.5%), than among Caucasian women (2.9%) and Asian women (1.6%) (Table 8a).

Table 8a: Parity by race, women who gave birth, South Australia, 2009

Parity

Race of women

TotalCaucasian Aboriginal Asian Other

Number % Number % Number % Number % Number %

0-primigravida 4,937 29.6 145 23.9 619 39.1 191 25.2 5,892 30.1

0-multigravida 1,902 11.4 68 11.2 208 13.1 70 9.2 2,248 11.5

1 5,959 35.8 156 25.7 524 33.1 213 28.1 6,852 35.0

2 2,587 15.5 109 18.0 156 9.8 111 14.7 2,963 15.1

3 781 4.7 51 8.4 52 3.3 70 9.2 954 4.9

4 281 1.7 42 6.9 18 1.1 49 6.5 390 2.0

?5 208 1.2 36 5.9 8 0.5 53 7.0 305 1.6

Total 16,655 (85.0) 607 (3.1) 1,585 (8.1) 757 (3.8) 19,604 100.0

Among women with previous pregnancies (multigravid women), the proportions who had had previous specified 
adverse pregnancy outcomes are shown in Table 8b. Just over a third of the women had had a miscarriage and a fifth 
had had a termination of pregnancy.

Table 8b: Previous pregnancy outcomes, women who gave birth, South Australia, 2009  
(multigravidae only, n= 13,712)

Previous pregnancy outcome Number %

Miscarriage 4,680 34.1

Termination of pregnancy 2,802 20.4

Stillbirth 224 1.6

Neonatal death 93 0.7

Ectopic pregnancy 313 2.3

Of the 11,464 women who had previously given birth, 3,471 (30.3%) had had a previous caesarean section.

Pregnancy Outcome in South Australia 2009page 26

Mothers and Babies



9a. Gestation at first antenatal visit
In 2009 gestation at the first antenatal visit was reported as  unknown  for 10.8% of women (Table 9a). If the 
 unknowns  are excluded, among the remaining women, 78.1% attended within the first 14 weeks. This proportion 
was much lower for Aboriginal women (51.0%) than for non-Aboriginal women (78.9%).

Table 9a: Gestation at first antenatal visit, women who gave birth, by race, South Australia, 2009 (n=19,604)

Gestation 
at first 
antenatal 
visit

Race of women

TotalNon-Aboriginal Aboriginal

Number %

Adjusted % 
(excluding 

 unknown )
(n=16,951) Number %

Adjusted %
(excluding

 unknown )
(n=545) Number %

Adjusted %
(excluding

 unknown )
(n=17,496)

&lt;14 weeks 
gestation

13,381 70.4 78.9 278 45.8 51.0 13,659 69.7 78.1

14 weeks or 
greater*

3,570 18.8 21.1 267 44.0 49.0 3,837 19.6 21.9

Unknown 2,046 10.8 - 62 10.2 - 2,108 10.8 -

Total 18,997 (96.9) 100.0 607 (3.1) 100.0 19,604 (100.0) 100.0

* includes 34 women with no antenatal care

9b. Body Mass Index (BMI)
Reported height and weight at the first antenatal visit were used to calculate the Body Mass Index (BMI, see Appendix 
1) for women who gave birth. This was considered valid only for women who attended the first antenatal visit before 
20 weeks gestation. Among these 16,305 women (83.2% of women who gave birth), height and weight were not 
reported for 2,995 women (18.4%), so that BMI could only be calculated for 13,310 women who gave birth in 2009 
(67.9%). Table 9b shows that of these women, 6,724 (50.5%) were overweight (BMI &gt;=25.0), with 3,080 (23.1%) 
obese (BMI &gt;=30.0) and 1,347 (10.1%) were severely or morbidly obese (BMI &gt;=35.0).

It is hoped that with interest in this area and wider use of the South Australian Pregnancy Record, reporting of 
gestation at first antenatal visit and height and weight will improve.

Table 9b: BMI of women who gave birth, South Australia, 2009

BMI 
(based on height and weight at first antenatal visit where gestation 
at first  antenatal visit was &lt;20 weeks) Number %

Adjusted %
(excluding  unknown )

(n=13,310)

&lt;18.5 (underweight) 420 2.6 3.2

18.5   24.9 (normal) 6,166 37.8 46.3

25.0   29.9 (overweight) 3,644 22.3 27.4

30.0   34.9 (obese) 1,733 10.6 13.0

35.0   39.9 (severely obese) 811 5.0 6.1

40 or more (morbidly obese) 536 3.3 4.0

Unknown 2,995 18.4 -

Total 16,305 100.0 100.0

Pregnancy Outcome in South Australia 2009 page  27

Mothers and Babies



9c. Antenatal visits
Women who gave birth are grouped in Table 9c according to the number of reported antenatal visits: no visits, 1 - 6 
visits, 7 or more visits. However, for 6.3% of women (9.6% of Aboriginal women), the number of antenatal visits 
attended was not known. If women for whom the number of antenatal visits was unknown are excluded, 32.6% of 
Aboriginal women compared with 6.9% of Caucasian women were reported to have made less than 7 visits. Among 
Asian women this proportion was 11.1%. A low frequency of antenatal visits may be taken, particularly in term births, 
as an indication of inadequate antenatal care. It is hoped that the proportion of  unknown  number of antenatal visits 
will be reduced by wider use of the Pregnancy Record,5 which will also facilitate continuity of care.

Table 9c: Antenatal visits by race, women who gave birth, South Australia, 2009

Antenatal visits

Race of women

TotalCaucasian Aboriginal Asian Other

Number % Number % Number % Number % Number %

None 20 0.1 12 2.0 1 0.1 1 0.1 34 0.2

1-6 1,065 6.4 167 27.5 162 10.2 105 13.9 1,499 7.6

?7 14,573 87.5 370 61.0 1,304 82.3 596 78.7 16,843 85.9

Unknown 997 6.0 58 9.6 118 7.4 55 7.3 1,228 6.3

Total 16,655 (85.0) 607 (3.1) 1,585 (8.1) 757 (3.9) 19,604 100.0

9d. Type of antenatal care
Table 9d shows that the main types of antenatal care used were hospital clinics (44.6%), obstetricians in private 
practice (32.2%), general practitioners (17.1%) and birth centres (7.7%). There were 34 women (0.2%) who had no 
antenatal care at all. Individual women may have used more than one type of antenatal care.

Table 9d: Type of antenatal care, women who gave birth, South Australia, 2009 (n = 19,604)

Type of care Number %

No antenatal care 34 0.2

Hospital clinic 8,745 44.6

Obstetrician in private practice 6,311 32.2

General practitioner (GP) 3,361 17.1

Birth centre 1,506 7.7

GP/midwife (shared care) 1,287 6.6

Midwifery Group Practice (W&amp;CH) 923 4.7

Obstetrician/midwife (shared care) in private practice 392 2.0

Home birth midwife 131 0.7

Northern Women s Community Health Centre (NWCHC) 111 0.6

Other 52 0.3

Not stated 32 0.2

Pregnancy Outcome in South Australia 2009page 28

Mothers and Babies



10. Smoking
Table 10a shows that 15.9% of all women were reported to be smokers at their first antenatal visit, and 3.7% had 
quit smoking before their first visit.  Smoking status was unknown for 1.7% of women. The proportion of all women 
smoking during pregnancy has been declining in the state, from 25% in 1998 to 15.9% in 2008 and 2009. 

The proportion of Aboriginal women who reported that they smoked at the first antenatal visit (52.2%) was 
the lowest recorded over the past decade, with the highest rate (61.2%) reported in 2005. However, this was 
considerably higher than  non-Aboriginal women (14.7%). Additionally, 4.4% of Aboriginal women reported that 
they quit smoking in pregnancy prior to their first antenatal visit, compared with 3.7% of non-Aboriginal women. 

Among age groups, the highest rates of smoking were among teenagers (32.9%) and women aged 20-24 years 
(29.1%). Smoking rates were high among all age groups of Aboriginal women varying from 47.9% among teenage 
women to 56.1% among those aged 20-24 years. 

In the second half of pregnancy (Table 10b), 13.8% of women (2,715 women) were reported to be smokers and 
0.5% (106 women) smoked more than 20 cigarettes per day, but the number of cigarettes smoked was not known 
for 2.5% of women. In the second half of pregnancy, 46.8% of Aboriginal women smoked, compared with 12.8% 
of non-Aboriginal women. A higher proportion of Aboriginal women (3.0% compared with 0.5%) also smoked more 
than 20 cigarettes per day, but the number of cigarettes smoked was not known for 5.4% of Aboriginal women and 
2.4% of non-Aboriginal women.

Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women who gave 
birth, South Australia, 2009

Smoking status

Non-Aboriginal Aboriginal Total

Number % Number % Number %

Smoker 2,797 14.7 317 52.2 3,114 15.9

Quit before 1st visit 695 3.7 27 4.4 722 3.7

Non-smoker 15,192 80.0 251 41.4 15,443 78.8

Unknown smoking status 313 1.6 12 2.0 325 1.7

Total 18,997 (96.9) 607 (3.1) 19,604 100.0

Table 10b: Average number of tobacco cigarettes smoked per day in the second half of pregnancy, non-
Aboriginal and Aboriginal women who gave birth, South Australia, 2009

Average number of tobacco  
cigarettes smoked per day

Non-Aboriginal Aboriginal Total

Number % Number % Number %

None 16,115 84.8 290 47.8 16,405 83.7

Occasional (&lt;1) 42 0.2 5 0.8 47 0.2

1-10 1,686 8.9 186 30.6 1,872 9.5

11-20 615 3.2 75 12.4 690 3.5

21-30 80 0.4 14 2.3 94 0.5

31-40 6 0.0 2 0.3 8 0.0

41+ 2 0.0 2 0.3 4 0.0

Unknown 451 2.4 33 5.4 484 2.5

Total 18,997 (96.9) 607 (3.1) 19,604 100.0

Pregnancy Outcome in South Australia 2009 page  29

Mothers and Babies



11. Medical conditions
Medical conditions were recorded in the current pregnancy for 6,683 women (34.1%). The frequencies of specified 
medical conditions are provided in Table 11.

Table 11: Medical conditions in current pregnancy, women who gave birth, South Australia, 2009

Medical condition Number % of women (n = 19,604)

1 None 12,921 65.9

2 Anaemia 1,334 6.8

3 Urinary tract infection 520 2.7

4 Hypertension (pre-existing) 216 1.1

5 Diabetes (pre-existing) 126 0.6

6 Epilepsy 109 0.6

7 Asthma 1,210 6.2

8 Other 4,430 22.6

12. Obstetric complications
Obstetric complications were recorded for 6,665 women who gave birth (34.0%). The reported frequencies of the 
more common complications are presented in Table 12. 

There was one direct, one indirect, and one incidental maternal death as well as two late direct deaths and two late 
incidental deaths (see definition in Appendix 1) notified to the Maternal, Perinatal and Infant Mortality Committee in 2009.3

Table 12: Frequency of some obstetric complications, women who gave birth, South Australia, 2009

Obstetric complication Number % of women (n= 19,604)

No complication 12,939 66.0

Threatened miscarriage 379 1.9

Antepartum haemorrhage (APH) - Abruption 108 0.6

APH - Placenta praevia 118 0.6

APH   Other &amp; unknown causes 466 2.4

Pregnancy hypertension 1,395 7.1

Intrauterine growth restriction (suspected) 757 3.9

Gestational diabetes 1,083 5.5

Other complications (including 4 women with impaired glucose tolerance) 3,823 19.5

Pregnancy Outcome in South Australia 2009page 30

Mothers and Babies



13. Procedures performed in current pregnancy
Procedures performed are listed as reported in Table 13.  At least one ultrasound examination was performed for 
98.1% of women, amniocentesis for 3.4% and chorion villus sampling for 0.7%.

For a proportion of women, it was not known whether a specific procedure had been performed, eg 1.9% for 
maternal serum alpha feto-protein (MSAFP) screening.  It is hoped that the increasing use of the Pregnancy Record 
will reduce the number of  unknown  entries. The listing of procedures on the Supplementary Birth Record will also be 
improved, eg to distinguish first from second trimester Down syndrome screening.

Table 13: Procedures performed in current pregnancy, women who gave birth, South Australia, 2009

Procedure

Yes No Unknown

Number % Number % Number %

MSAFP (Neural tube defect screen etc) 5,558 28.4 13,671 69.7 375 1.9

Triple/Quadruple screen (Down syndrome etc) 11,951 61.0 7,332 37.4 321 1.6

Ultrasound 19,226 98.1 272 1.4 106 0.5

Chorion villus sampling 145 0.7 19,221 98.0 238 1.2

Amniocentesis 665 3.4 18,699 95.4 240 1.2

Cordocentesis 9 0.0 19,351 98.7 244 1.2

Other surgical procedure 86 0.4 19,518 99.6 0 0

14a. Onset of labour
Labour occurred spontaneously in 52.7% of women who gave birth (Table 14a).  It was induced in 29.4%, and the 
methods of induction used were artificial rupture of membranes (ARM) in 66.9% of inductions, prostaglandins in 
60.7% and oxytocics in 49.8% (Table 14b).  More than one method was used in many cases.

Table 14a: Onset of labour, women who gave birth, South Australia, 2009

Onset of labour Number %

Spontaneous 10,327 52.7

No labour   caesarean section 3,507 17.9

Induction 5,770 29.4

Total 19,604 100.0

Table 14b: Method of induction of labour, women who gave birth, South Australia, 2009

Method of induction Number
% of women  
(n =19,604)

% of inductions  
(n =5,770)

No induction 13,834 70.6 -

ARM 3,861 19.7 66.9

Oxytocics 2,873 14.7 49.8

Prostaglandins 3,503 17.9 60.7

Pregnancy Outcome in South Australia 2009 page  31

Mothers and Babies



14b. Reasons for induction of labour
Up to two reasons could be provided for induction. These reasons for induction of labour are defined (see page 55) in 
 The Australian Council on Healthcare Standards Obstetrics Indicators - Clinical Indicator Users  Manual Version 5 for 
use in 2007 .

Figure 4 demonstrates that 20.3% of women were induced for prolonged pregnancy (41 or more completed weeks), 
13.7% for hypertension, 7.7% for diabetes (including gestational diabetes and glucose intolerance), 6.2% for 
intrauterine growth restriction (IUGR) and 3.7% for premature rupture of membranes (PROM). Other defined reasons 
accounted for smaller proportions. Other than defined reasons accounted for 53.2%.

Figure 4: Reasons for induction of labour, SA, 2009 (n=5,770)

0 10 20 30 40 50 60

Other

Prolonged pregnancy

Chorioamnionitis

Fetal death

Fetal distress

Isoimmunisation

IUGR

Hypertensive disorders

PROM

Diabetes*

Percentage

*includes diabetes mellitus, gestational diabetes and glucose intolerance

The proportion of women giving birth who had labour augmented was 21.9%. Of the 10,327 women who went into 
spontaneous labour, augmentation was used for 4,286 (41.5%). Methods used in augmentation were artificial rupture 
of membranes (ARM) (74.6%), oxytocics (40.1%) and prostaglandins (0.7%). More than one method may be used. It 
should be noted that prostaglandins are not recommended by the manufacturers as a method of augmenting labour. 

Table 14c: Augmentation of labour after spontaneous onset, women who gave birth, South Australia, 2009

Method of augmentation Number % of women (n=19,604) % of augmentations (n=4,286)

Any augmentation 4,286 21.9 100.0

1 ARM 3,198 16.3 74.6

2 Oxytocics 1,720 8.8 40.1

3 Prostaglandins 31 0.2 0.7

Pregnancy Outcome in South Australia 2009page 32

Mothers and Babies



15a. Presentation and method of birth
Of the women who gave birth, 55.4% had normal spontaneous vaginal births (Table 15a and Figure 5A). Caesarean 
section was performed for 32.4% of women, with 15.7% of women having elective sections; forceps were utilised 
for 4.6%, ventouse for 7.2% and breech birth for the remaining 0.4%. The method of birth given for women who 
had multiple births is that for the first birth. The method of birth by presentation for all births is provided in Table 15b. 
Breech presentation occurred in 4.7% of births and caesarean section was the method of birth for 89.6% of breech 
presentations. Caesarean section was utilised for 90.5% of breech presentations in singletons (Table 15c). 

Table 15a: Method of birth, women who gave birth, South Australia, 2009

Method of birth Number %

Normal spontaneous vaginal 10,854 55.4

Forceps 902 4.6

Assisted breech (no forceps) 18 0.1

Caesarean section (elective) 3,084 15.7

Caesarean section (emergency) 3,273 16.7

Ventouse 1,416 7.2

Breech extraction 1 0.0

Breech spontaneous 53 0.3

Assisted breech (with forceps for head) 3 0.0

Total 19,604 100.0

Figure 5a:Method of birth, women who gave birth, South Australia, 2009 (n = 19,604)

Ventouse (7.2%)

Caesarean section
(32.4%)

Forceps (4.6%)
Breech delivery (0.4%)

Normal
spontaneous

vaginal (55.4%)

Pregnancy Outcome in South Australia 2009 page  33

Mothers and Babies



Table 15b: Method of birth by presentation, all births, South Australian 2009 (n=19,901)

Method of birth

Presentation

TotalVertex Breech Other Unknown

Number % Number % Number % Number % Number %

1 Normal 
   spontaneous

10,855 58.0 0 0 38 19.1 10 29.4 10,903 54.8

2 Forceps 895 4.8 0 0 13 6.5 0 0 908 4.6

3 Assisted 
   breech (no 
   forceps)

0 0 30 3.2 1 0.5 0 0 31 0.2

4 Elective 
   caesarean

2,630 14.0 483 51.3 47 23.6 9 26.5 3,169 15.9

5 Emergency 
   caesarean

2,930 15.6 360 38.3 90 45.2 13 38.2 3,393 17.0

6 Ventouse 1,417 7.6 0 0 9 4.5 0 0 1,426 7.2

7 Breech  
   extraction

0 0 10 1.1 1 0.5 0 0 11 0.1

8 Breech 
   spontaneous

0 0 55 5.8 0 0 2 5.9 57 0.3

9 Assisted 
   breech  
   (forceps)

0 0 3 0.3 0 0 0 0 3 0.0

Total 18,727 (94.1) 941 (4.7) 199 (1.0) 34 (0.2) 19,901 100.0

Table 15c: Method of birth in breech presentation, by plurality, all births, South Australia, 2009 (n = 941)

Plurality
Assisted* 
breech

Elective  
caesarean

Emergency  
caesarean

Breech  
extraction

Breech 
spontaneous

Total

Singleton 21* 413 284 1 51 770

Twins 12_ 67 74 9 4 166

Triplets 0_ 3 2 0 0 5

Total 33 (3.5%) 483 (51.3%) 360 (38.3%) 10 (1.1%) 55 (5.8%) 941 (100.0%)

* in three of the assisted breech births forceps were applied to the head.

15b. Reason for caesarean section
Up to two reasons may be provided on the Supplementary Birth Record for caesarean section, and these have been 
collated in Figure 5b (all caesarean sections), Figure 5c (elective caesarean sections only) and Figure 5d (emergency 
caesarean sections only). The main reasons given for all caesarean sections were previous caesarean section (38.7%), 
failure to progress/cephalopelvic disproportion (CPD) (26.8%), fetal distress (15.5%) and malpresentation (11.5%). 
The main reasons for elective sections were previous caesarean section (67.6%), malpresentation (13.3%) and 
multiple pregnancy (2.5%), and the main reasons given for emergency sections were failure to progress or CPD 
(49.9%), fetal distress (30.1%), previous caesarean section (11.5%) and malpresentation (9.7%). 

Pregnancy Outcome in South Australia 2009page 34

Mothers and Babies



Figure 5b: Reason for caesarean section, 2009 (n=6,357) 

0 10 20 30 40 50 60

Other

IUGR

Multiple pregnancy

APH

Pregnancy hypertension/hypertension

Malpresentation

Fetal distress

Previous caesarean

CPD/Failure to progress

Percentage

Figure 5c: Reason for elective caesarean section, 2009 (n=3,084)

0 10 20 30 40 50 60 70

Other

IUGR

Multiple pregnancy

APH

Pregnancy hypertension/hypertension

Malpresentation

Fetal distress

Previous caesarean

CPD

Percentage

Figure 5d: Reason for emergency caesarean section, 2009 (n=3,273)

0 10 20 30 40 50 60

Other

IUGR

Multiple pregnancy

APH

Pregnancy hypertension/hypertension

Malpresentation

Fetal distress

Previous caesarean

CPD/Failure to progress

Percentage

Pregnancy Outcome in South Australia 2009 page  35

Mothers and Babies



16. Complications of labour and birth and perineal status after birth
Complications of labour or birth were recorded for 7,196 women who gave birth (36.7%).  The reported frequency 
of some complications is presented in Table 16. Among all 19,604 women who gave birth, episiotomy was performed 
for 2,245 (11.5%). Among the 13,247 women who gave birth vaginally, 3,726 (28.1%) had an intact perineum after 
birth, 5,704 (43.1%) had a repair of a perineal tear, of whom 422 (3.2%) had a third or a fourth degree tear; 16.9% 
had an episiotomy. 

Table 16: Frequency of some complications of labour and birth, women who gave birth, South Australia, 2009

Complication of labour Number of women % of women (n=19,604)

None 12,408 63.3

Post-partum haemorrhage (PPH)   primary (amount not specified) 65 0.3

PPH - 600-999ml 1,299 6.6

PPH   1,000 ml or more 707 3.6

Fetal distress 2,334 11.9

Retained placenta 286 1.5

Prolonged labour 178 0.9

Cord prolapse 22 0.1

Wound infection 23 0.1

Third degree tear (391) or fourth degree tear (31) 422 2.2

Failure to progress 2,532 12.9

Other 4,609 23.5

17. Fetal monitoring during labour
Cardiotocography (CTG) was performed during labour for 62.3% of women who gave birth. The majority of these 
(50.5% of women) were external CTGs (Table 17a) while a scalp clip was used for 11.8%. 

A fetal scalp pH was taken during labour in 181 women who gave birth (0.9%, Table 17b).

Table 17a: CTG performed during labour, women who gave birth, South Australia, 2009

CTG during labour Number of women % of women  (n=19,604)

1 None 7,403 37.8

2 External 9,893 50.5

3 Scalp clip 2,308 11.8

Table 17b: Fetal scalp pH taken during labour, women who gave birth, South Australia, 2009

Fetal scalp pH taken Number of women % of women  (n=19,604)

1 No 19,423 99.1

2 Yes 181 0.9

Pregnancy Outcome in South Australia 2009page 36

Mothers and Babies



18. Analgesia for labour and anaesthesia for birth
These distributions are provided in Tables 18a and 18b. Epidurals were used for analgesia in labour for 31.4% and 
for anaesthesia for birth for 26.6% of women. The proportion of women who had an epidural for either was 32.5% 
(6,362 women). The proportion of women who had a spinal anaesthetic increased between 1991 and 2009 from 
0.2% to 0.9% for analgesia and from 0.5% to 23.6% for anaesthesia.  General anaesthesia was used for 2.1% of 
births. It was used in 6.2% of caesarean sections. Approximately 36% of women who gave birth received none of the 
specified methods for analgesia during labour.

Table 18a: Analgesia for labour,* women who gave birth, South Australia, 2009

Analgesia Number % of women

1 None 7,106 36.2

2 Nitrous oxide and oxygen 7,573 38.6

3 Narcotic (parenteral) 3,742 19.1

4 Epidural (lumbar/caudal) 6,148 31.4

5 Spinal 174 0.9

6 Other 281 1.4

7 Combined spinal-epidural 9 0.0

 * more than one method may be used for each woman

Table 18b: Anaesthesia for birth,* women who gave birth, South Australia, 2009

Anaesthesia Number % of women

1 None 6,984 35.6

2 Local anaesthesia 2,527 12.9

3 Pudendal 181 0.9

4 Epidural (lumbar/caudal) 5,209 26.6

5 Spinal 4,635 23.6

6 General anaesthesia 402 2.1

7 Other 166 0.8

8 Combined spinal-epidural 62 0.3

* more than one method may be used for each woman

Pregnancy Outcome in South Australia 2009 page  37

Mothers and Babies



19. Postnatal length of stay of women
The distribution of length of stay of women who gave birth in hospitals is presented in Table 19a for public and 
private patients. The median duration for all women was three days. It was three days for vaginal births and five days 
for caesarean section births (Table 19b). The median duration of stay was two days longer for private patients for 
vaginal and one day longer for caesarean births (four and five days respectively for private patients compared with 
two and four days respectively for public patients).

Table 19a: Postnatal length of stay by type of patient, women who gave birth in South Australian hospitals, 2009

Postnatal length of stay (days)

Public Private Total

Number % Number % Number %

&lt;1 640 4.8 24 0.4 664 3.4

  1 2,282 17.1 84 1.4 2,366 12.2

  2 3,299 24.7 240 3.9 3,539 18.2

  3 3,042 22.8 743 12.1 3,785 19.4

  4 2,282 17.1 2,431 39.6 4,713 24.2

  5 1,120 8.4 1,850 30.1 2,970 15.3

  6 359 2.7 554 9.0 913 4.7

  7 or more 309 2.3 210 3.4 519 2.7

Total 13,333 100.0 6,136 100.0 19,469 100.0

Table 19b: Average postnatal length of stay by type of patient &amp; type of birth, women who gave birth in  
                 South Australian hospitals, 2009

Average length of stay

Public Private Total

Vaginal  
(n=9,435)

Caesarean 
(n=3,898)

Total  
(n=13,333)

Vaginal  
(n=3,677)

Caesarean 
(n=2,459)

Total  
(n=6,136)

Vaginal  
(n=13,112)

Caesarean 
(n=6,357)

Total  
(n=19,469)

Mean number of days 2.29 4.13 2.83 3.88 5.13 4.38 2.74 4.52 3.32

 ( SD) ( 1.80) ( 1.71) ( 1.96) ( 1.85) ( 1.17) ( 1.72) ( 1.95) ( 1.60) ( 2.02)

Median number of days 2 4 3 4 5 4 3 5 3

Pregnancy Outcome in South Australia 2009page 38

Mothers and Babies



20. Sex of baby
The sex distribution of babies is provided in Table 20; the male:female sex ratio was 1.08:1.

Table 20: Sex of baby, all births, South Australia, 2009

Sex of baby Number %

Male 10,338 51.9

Female 9,563 48.1

Total 19,901 100.0

21. Birthweight and gestation
The birthweight distribution of all births is presented in Table 21. The percentage of low birthweight babies (&lt;2,500g) 
was 7.3%, and that of very low birthweight babies (&lt;1,500g) was 1.6%. The mean birthweight was 3,328g (SD 
622.6g), with birthweights ranging from 55g to 5,930g.  The proportion of low birthweight babies was 13.6% 
among babies of Aboriginal women compared with 7.1% among babies of non-Aboriginal women. Among live born 
babies, these proportions were 12.8% and 6.6% respectively.

Table 21: Birthweight distribution of all births, South Australia, 2009

Birthweight (g) Number of births Percentage of births

&lt;400 64 0.3

400-499 22 0.1

500-749 37 0.2

750-999 54 0.3

1,000-1,499 144 0.7

1,500-1,999 299 1.5

2,000-2,499 838 4.2

2,500-2,999 3,157 15.9

3,000-3,499 7,192 36.1

3,500-3,999 5,987 30.1

4,000-4,499 1,814 9.1

4,500+ 292 1.5

Unknown 1 0.0

Total 19,901 100.0

In 2009, 1,458 babies (7.3%) were of low birthweight and 1,785 (9.0%) were preterm (&lt;37 weeks gestation). The 
proportion of preterm births was 15.5% among babies of Aboriginal women compared with 8.8% among babies of 
non-Aboriginal women. 

Pregnancy Outcome in South Australia 2009 page  39

Mothers and Babies



22. Birth injuries
Birth injuries were reported in 128 live births (0.6%). The most common injury reported was cephalhaematoma. 
Fracture and nerve injury occurred less frequently (Table 22).

Table 22: Birth injuries* in 19,761 live births, South Australia, 2009

Birth injury Number of live births % of live births

None 19,633 99.4

Fracture 13 0.1

Dislocation 1 0.0

Nerve Injury 20 0.1

Cephalhaematoma 67 0.3

Other 32 0.2

*more than one injury may occur in each birth

23. Treatment given in neonatal period
The proportions of live births who received specified treatments in the neonatal period are provided in Table 23, which 
shows that   84.8% of neonates did not receive any of these treatments.

Table 23: Neonatal treatment given, all live births, South Australia, 2009

Neonatal treatment Number % of live births

None of the treatments listed below 16,764 84.8

Oxygen therapy for more than 4 hours 968 4.9

Phototherapy for jaundice 1,364 6.9

Gavage feeding more than once 1,626 8.2

Any intravenous therapy 1,853 9.4

Pregnancy Outcome in South Australia 2009page 40

Mothers and Babies



24. Level of care utilised
Table 24 shows that 84.5% of neonates utilised Level I care only. Level II care was used by 15.3% of neonates, Level 
III care at the Women s and Children s Hospital or Flinders Medical Centre by 2.9% and paediatric intensive care at 
the Women s and Children s Hospital by 0.3% of neonates. As would be expected, with decreasing birthweight, an 
increasing percentage of babies required Level II and Level III care.

Table 24: Level of nursery care utilised by birthweight, all live births, South Australia, 2009

Level of care utilised

Birthweight (g)

&lt;1,500
(n=223)

1,500-2,499 
(n=1,117)

2,500+ 
(n=18,421)

Total 
(n=19,761)

Number % Number % Number % Number %

Level I only 18 8.1 198 17.7 16,474 89.4 16,690 84.5

Level II 192 86.1 909 81.4 1,928 10.5 3,029 15.3

Level III (W&amp;CH &amp; FMC) 187 83.9 219 19.6 167 0.9 573 2.9

Level III (W&amp;CH Paediatric intensive care) 4 1.8 14 1.3 32 0.2 50 0.3

25. Length of stay of babies
Table 25 shows the distribution of length of stay of liveborn babies in hospital for preterm (&lt;37 weeks gestation) 
and term births (?37 weeks gestation). The mean duration of stay for all liveborn babies was 5.1 days (SD 9.64) and 
the median duration 4 days. The mean duration was 3.5 days (SD 3.14) for term births and 22.3 days (SD 25.80) for 
preterm births, while the median durations were 3 and 14 days respectively.

Table 25: Length of stay of liveborn babies in hospital, South Australia, 2009

Length of stay (days)

Preterm births Term births Total

Number % Number % Number %

&lt;1 24 1.4 590 3.3 614 3.1

  1 17 1.0 2,189 12.2 2,206 11.2

  2 39 2.3 3,274 18.2 3,313 16.9

  3 63 3.8 3,501 19.5 3,564 18.2

  4 105 6.3 4,318 24.0 4,423 22.5

  5 119 7.1 2,676 14.9 2,795 4.2

  6 86 5.2 783 4.4 869 4.4

  7-13 337 20.2 493 2.7 830 4.2

  14-20 279 16.7 76 0.4 355 1.8

  21-27 197 11.8 27 0.2 224 1.1

  28 or more 400 24.0 35 0.2 435 2.2

Total 1,666 100.0 17,962 100.0 19,628 100.0

Pregnancy Outcome in South Australia 2009 page  41

Mothers and Babies



26. Congenital anomalies
Among the 19,901 births in 2009 there were 539 births (2.7%) notified with congenital anomalies, compared with 
an average of 2.5% over the past decade.; 510 (2.6%) of these births had anomalies notified in the congenital 
anomalies range 74000-75999 of the British Paediatric Association (BPA) Classification of Diseases. This is a 5-digit 
extension of the 4-digit classification of the ICD-9 (International Classification of Diseases. Manual of the International 
Statistical Classification of Diseases, Injuries and Causes of Death, 1975 Revision. Geneva: World Health Organisation, 
1977). Table 26 includes births with the more readily identifiable defects used for international monitoring (sentinel 
defects) notified to the perinatal statistics collection in 1999-2009.

Terminations of pregnancy are not included in this table unless they meet a criterion for inclusion in the perinatal data 
collection, ie at least 400g birthweight or 20 weeks gestation. Notifications of births with birth defects identified after 
discharge from the hospital of birth but within the first five years of life are made to the South Australian Birth Defects 
Register at the Women s and Children s Hospital, and more complete statistics on birth defects in South Australia are 
available from the Register s Annual Report.2 

In 2009 the number of spina bifida cases reported at birth increased considerably from 4 cases in 2008 to 18 in 2009. 
No reason for this recent sudden increase can be determined, but these cases will remain under review. Following 
a statewide campaign to promote periconceptional folate in 1994 and 1995 the use of folate supplementation in 
pregnancy increased, and rates of neural tube defects decreased.2  It is  important to ensure that all women continue 
to use supplementary folate periconceptually.

Table 26: Selected congenital abnormalities notified to the perinatal statistics collection, 1999-2009, South Australia

Congenital abnormality Year

BPA* CODE 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Number of births = 18,519 17,871 17,704 17,745 17,844 17,522 18,196 18,803 19,757 19,970 19,901

74000-74029 Anencephalus 2 3 1 4 0 1 0 1 1 1 3

74100-74199 Spina bifida 4 5 9 4 7 5 5 8 5 4 18

74200-74209 Encephalocele 1 0 0 1 0 0 1 1 2 1 0

74230-74239 Hydrocephalus 7 4 4 3 7 6 9 10 12 11 14

74900-74909 Cleft palate 8 10 14 17 9 10 15 11 12 9 11

74910-74929 Cleft lip and palate (Total cleft lip) 17 16 15 16 14 17 9 16 30 28 25

75030-75038 Tracheo-oesophageal fistula, 
oesophageal atresia and stenosis

6 2 10 3 2 2 5 4 12 5 6

75120-75124 Atresia and stenosis of large 
intestine, rectum and anal canal

5 9 3 9 6 6 12 4 7 9 7

75260-75261 Hypospadias and epispadias 43 40 40 42 34 41 38 29 41 40 39

75300-75301 Renal agenesis and dysgenesis 4 5 7 5 10 4 12 8 8 3 11

75520-75549 Limb reduction defects 9 11 6 7 5 8 8 13 18 9 8

75660-75669 Anomalies of diaphragm 4 7 6 7 4 4 7 12 7 9 9

75670-75679 Anomalies of abdominal wall 8 8 13 10 13 12 9 10 7 9 17

75800-75809 Down syndrome 25 19 21 19 13 14 19 17 17 21 22

* British Paediatric Association Classification of Diseases. London: The British Paediatric Association, 1979.

Pregnancy Outcome in South Australia 2009page 42

Mothers and Babies



27. Multiple births
Among women who gave birth there were 289 twin and 4 triplet pregnancies compared with 19,311 singleton ones. 
Thus there was one twin pregnancy in every 68 pregnancies and one triplet pregnancy in every 4,901 pregnancies 
among women who gave birth. Women who gave birth with twins or triplets comprised 1.5% of all women who 
gave birth. The total number of multiple births was 590 (3.0% of total births).

A comparison of multiple births with singleton ones shows that multiple births were of lower birthweight (with 
59.8% being of low birthweight compared with 5.7% for singletons, Table 27a), and gestation (with 67.5% being 
preterm births compared with 7.2% for singletons, Table 27b). The proportion of live births in hospital at 28 days was 
20.3% for multiple births compared with 1.7% for singletons, and the perinatal death rate for multiple births was 
also elevated (28.8 compared with 8.9 deaths per 1,000 births for singletons, Table 27c).

Table 27a: Birthweight by plurality, all births, South Australia, 2009

Birthweight (g)

Singleton births Multiple births

Number % Number %

&lt;400 56 0.3 8 1.4

400-499 20 0.1 2 0.3

500-749 29 0.2 8 1.4

750-999 41 0.2 13 2.2

1,000-1,499 114 0.6 30 5.1

1,500-1,999 198 1.0 101 17.1

2,000-2,499 647 3.4 191 32.4

2,500-2,999 2,988 15.5 169 28.6

3,000-3,499 7,138 37.0 54 9.2

3,500-3,999 5,973 30.9 14 2.4

4,000-4,499 1,814 9.4 0 0

4,500+ 292 1.5 0 0

Unknown 1 0.0 0 0.0

Total 19,311 100.0 590 100.0

Table 27b: Gestation at birth by plurality all births, South Australia, 2009

Gestation (weeks)

Singleton births Multiple births Total

Number % Number % Number %

&lt;24 87 0.5 10 1.7 97 0.5

24-27 63 0.3 14 2.4 77 0.4

28-31 140 0.7 47 8.0 187 0.9

32-36 1,097 5.7 327 55.4 1,424 7.2

37-41 17,845 92.4 192 32.5 18,037 90.6

42+ 79 0.4 0 0 79 0.4

Total 19,311 100.0 590 100.0 19,901 100.0

Pregnancy Outcome in South Australia 2009 page  43

Mothers and Babies



Table 27c: Perinatal outcome by plurality, all births, South Australia, 2009

Perinatal outcome
Singleton births Multiple births Total

Number % Number % Number %

Stillbirth 131 0.7 9 1.5 140 0.7

Discharged within 28 days 18,812 97.4 453 76.8 19,265 96.8

In hospital at 28 days 327 1.7 120 20.3 447 2.2

Neonatal death 41 0.2 8 1.4 49 0.2

Total 19,311 100.0 590 100.0 19,901 100.0

28. Perinatal mortality
High crude perinatal mortality rates were associated with low birthweight births (Table 28a), low gestation births 
(Table 28b) and multiple births (Table 27c). The perinatal mortality rate for all births (livebirths of any gestation and 
stillbirths of at least 400g birthweight/20 weeks gestation) in 2009 was 9.5 per 1,000 births. The stillbirth rate was 
7.0 per 1,000 births and the neonatal mortality rate was 2.5 per 1,000 live births. 

The relationship between perinatal mortality and birthweight is demonstrated in Table 28a and Figure 6. The highest 
perinatal mortality rate was observed for the lowest birthweight group weighing &lt;500g (953.5 per 1,000). The 
lowest perinatal mortality rate of 1.1 per 1,000 births was observed for births weighing 3,000-3,499g, with heavier 
birthweights showing increasing perinatal mortality rates: the perinatal mortality rate for the birthweight group 
3,500 3,999g was 1.5 per 1,000 births, and for 4,000-4,499g birthweight group 2.2 per 1,000 births. The perinatal 
mortality rate for babies of normal birthweight (2,500g or more) was 1.7 per 1,000 births. The decline in perinatal 
mortality with increasing gestational age is demonstrated in Table 28b.

Table 28a: Perinatal mortality by birthweight, all births, South Australia, 2009

Birthweight  
(g)

Total 
births

Live 
births

Stillbirths Neonatal deaths Perinatal deaths

Number

Deaths  
per 1,000 

births Number

Deaths
per 1,000  
live births Number

Deaths
per 1,000

births

&lt;400 64 12 52 812.5 10 833.3 62 968.8

400-499 22 5 17 772.7 3 600.0 20 909.1

500-749 37 24 13 351.4 7 291.7 20 540.5

750-999 54 48 6 111.1 2 41.7 8 148.1

1,000-1,499 144 134 10 69.4 6 44.8 16 111.1

1,500-1,999 299 290 9 30.1 6 20.7 15 50.2

2,000-2,499 838 827 11 13.1 4 4.8 15 17.9

2,500-2,999 3,157 3,151 6 1.9 5 1.6 11 3.5

3,000-3,499 7,192 7,185 7 1.0 1 0.1 8 1.1

3,500-3,999 5,987 5,983 4 0.7 5 0.8 9 1.5

4,000-4,499 1,814 1,810 4 2.2 0 0 4 2.2

4,500+ 292 292 0 0 0 0 0 0

Unknown 1 0 1* na 0 0 1* na

Total 19,901 19,761 140 7.0 49 2.5 189 9.5

* this stillbirth at 20 weeks gestation was not weighed at parents request. 
na: not applicable

Pregnancy Outcome in South Australia 2009page 44

Mothers and Babies



Figure 6: Perinatal mortality rate by birthweight, all births, South Australia, 2009

0.1

1

10

100

1000

&lt;5
00

50
0-

75
0-

10
00

-

15
00

-

20
00

-

25
00

-

30
00

-

35
00

-

40
00

+

45
00

+

Birthweight (g)

Pe
ri

n
at

al
 d

ea
th

s 
p

er
 1

,0
00

 b
ir

th
s

 (
lo

g
ar

it
h

m
ic

sc
al

e)
 

Table 28b: Perinatal mortality by gestational age at birth, South Australia, 2009

Gestational  
age at birth 
(weeks)

Total 
births

Live 
births

Stillbirths Neonatal deaths Perinatal deaths

Number

Deaths  
per 1,000 

births Number

Deaths 
per 1,000 
live births Number

Deaths  
per 1,000  

births

&lt;24 97 22 75 773.2 16 727.3 91 938.1

24-27 77 65 12 155.8 8 123.1 20 259.7

28-31 187 174 13 69.5 5 28.7 18 96.3

32-36 1,424 1,410 14 9.8 13 9.2 27 19.0

37-41 18,037 18,012 25 1.4 7 0.4 32 1.8

42+ 79 78 1 12.7 0 0 1 12.7

TOTAL 19,901 19,761 140 7.0 49 2.5 189 9.5

The perinatal mortality rates for other specified minimum birthweights or gestational ages (where birthweight was 
unavailable) are provided in Table 28c. The perinatal mortality rate recommended by the World Health Organisation 
(WHO) for use in international comparison refers only to stillbirths of at least 1,000g birthweight (or, if birthweight 
is unavailable, 28 weeks gestation) and to (early) neonatal deaths within the first 7 days of life. This rate was 3.5 
per 1,000 births in 2009, with a stillbirth rate of 2.6 per 1,000 births and an early neonatal mortality rate of 0.9 per 
1,000 live births. The perinatal mortality rate for births to Aboriginal women was the second lowest on record in 
the State at 14.6 per 1,000 births in 2009 compared with 9.3 per 1,000 births for births to non-Aboriginal women 
(Table 28d). This was considerably lower than the previous year s rate of 23.5 per 1000 births for Aboriginal women 
in 2008, however, due to the small numbers involved, the perinatal mortality rate for Aboriginal births may fluctuate 
considerably from year to year.

Pregnancy Outcome in South Australia 2009 page  45

Mothers and Babies



Table 28c: Perinatal mortality, South Australia, 2009 (all births of specified birthweight/gestation)

Specified 
birthweight/
gestation

Total births Live births Stillbirths Neonatal deaths Perinatal deaths

Number Number Number

Deaths  
per 1,000 

births Number

Deaths  
per 1,000 
live births Number

Deaths  
per 1,000 

births

?400g/20 weeks* 19,901 19,761 140 7.0 49 2.5 189 9.5

?500g/22 weeks 19,814 19,744 70 3.5 36 1.8 106 5.3

(WHO National 
Statistics)

27** 1.4 97** 4.9

?1,000g/28 weeks 19,723 19,672 51 2.6 27 1.4 78 4.0

(WHO International 
Statistics)

18** 0.9 69** 3.5

* includes live births of any gestation. There were 64 births of birthweight &lt;400g 
** only neonatal deaths within the first 7 days of life are included

Table 28d: Perinatal mortality by race, all births, South Australia, 2009

Race

Total births Stillbirths Neonatal deaths Alive at 28 days Perinatal deaths

Number Number Number Number Number

Deaths 
per 1,000 

births

Caucasian 16,921 105 41 16,775 146 8.6

Aboriginal 618 8 1 609 9 14.6

Asian 1,595 18 5 1,572 23 14.4

Other 767 9 2 756 11 14.3

Total 19,901 140 49 19,712 189 9.5

29. Home births
Supplementary Birth Records were received from home birth midwives for 125 planned home births which occurred 
at home in 2009. There were nine unplanned home births in South Australia in 2009 which have been excluded from 
the planned home birth statistics. Six of these were to women who received antenatal care with the Midwifery Group 
Practice at the Women s and Children s Hospital or the Northern Women s Community Health Centre. The other three 
unplanned home births were to women who had no antenatal care. Ascertainment of planned home births occurring 
at home in South Australia for the year 2009 is estimated to be 94.5% (121 out of 128 home births). This estimate 
has been derived from a comparison with data from the Births, Deaths and Marriages Registration Division on births 
registered, which did not occur in hospital (and were not BBAs - babies born before arrival at the hospital into which 
the woman had been booked). In addition, 35 women who planned to birth at home were transferred to hospital 
care before birth.  Statistics for all 160 planned home births in 2009 are provided in Tables 29-32, by place of birth.

Pregnancy Outcome in South Australia 2009page 46

Mothers and Babies



Table 29: Planned home births by age of women, South Australia, 2009

Age (years)

Birthed at home Birthed in hospital Total

Number % Number % Number %

&lt;20 2 1.6 1 2.9 3 1.9

20-24 5 4.0 5 14.3 10 6.3

25-29 33 26.4 7 20.0 40 25.0

30-34 40 32.0 14 40.0 54 33.8

35-39 38 30.4 7 20.0 45 28.1

40-44 7 5.6 1 2.9 8 5.0

45+years 0 0 0 0 0 0

Total 125 100.0 35 100.0 160 100.0

Table 30: Method of birth in planned home births, South Australia, 2009

Method of birth

Birthed at home Birthed in hospital Total

Number % Number % Number %

Normal spontaneous vaginal 122 97.6 20 57.1 142 88.8

Forceps 0 0 3 8.6 3 1.9

Emergency caesarean section 0 0 10 28.6 10 6.3

Breech spontaneous 3 2.4 2 5.7 5 3.1

Total 125 100.0 35 100.0 160 100.0

Table 31: Birthweight distribution of planned home births, South Australia, 2009

Birthweight (g)

Birthed at home Birthed in hospital Total

Number % Number % Number %

1,500-1,999 0 0 1 2.9 1 0.6

2,000-2,499 2 1.6 0 0 2 1.3

2,500-2,999 2 1.6 3 8.6 5 3.1

3,000-3,499 41 32.8 8 22.9 49 30.6

3,500-3,999 49 39.2 11 31.4 60 37.5

4,000-4,499 25 20.0 9 25.7 34 21.3

4,500+ 6 4.8 2 5.7 8 5.0

Unknown 0 0 1 2.9 1 0.6

Total 125 100.0 35 100.0 160 100.0

Table 32: Perinatal outcome in planned home births, South Australia, 2009

Perinatal outcome

Birthed at home Birthed in hospital Total

Number % Number % Number %

Stillbirth 1 0.8 2 5.7 3 1.9

Discharged within 28 days 122 97.6 33 94.3 155 96.9

Neonatal death 2 1.6 0 0 2 1.3

Total 125 100.0 35 100.0 160 100.0

Pregnancy Outcome in South Australia 2009 page  47

Mothers and Babies



30. Birthing unit births
Statistics presented for births in birthing units in South Australia (Tables 33-36) relate to the birthing units at the 
Women s and Children s Hospital, the Lyell McEwin Health Service and Flinders Medical Centre. The units at the 
Women s and Children s Hospital and the Lyell McEwin Health Service were established in 1992 and 1993 respectively 
under the Alternative Birthing Services Programme.  In October 1996 the birthing unit at Flinders Medical Centre 
commenced a birthing service. These statistics relate to all 2,305 women for whom it was reported that  birthing 
unit  was their intended place of birth. Of these women, 1,166 gave birth in the birthing units while 1,139 women 
(49.4%) gave birth in labour wards. Some of these women were transferred to labour wards because of medical or 
obstetric complications. With the commencement of the Midwifery Group Practice model of care at Women s and 
Children s Hospital in 2004, more of these women who gave birth in labour wards than previously did so because the 
birthing unit was not available at the time. Among the women who gave birth in labour wards, 24.7% had caesarean 
sections and 17.8% had instrumental births. These statistics have also been included in the statistics for the respective 
hospitals. Sixty-nine babies (3.0%) were of low birthweight and there were twelve perinatal deaths (perinatal 
mortality rate 5.2 per 1,000 births).

Table 33: Planned birthing unit births by age of women, South Australia, 2009

Age (years)

Birthed in birthing unit Birthed in labour ward Total

Number % Number % Number %

&lt;20 74 6.3 49 4.3 123 5.3

20-24 269 23.1 199 17.5 468 20.3

25-29 376 32.2 354 31.1 730 31.7

30-34 291 25.0 350 30.7 641 27.8

35-39 139 11.9 157 13.8 296 12.8

40-44 15 1.3 29 2.5 44 1.9

45+ 2 0.2 1 0.1 3 0.1

Total 1166 100.0 1,139 100.0 2,305 100.0

Table 34: Method of birth in planned birthing unit births, South Australia, 2009

Method of birth

Birthed in birthing unit Birthed in labour ward Total

Number % Number % Number %

Normal spontaneous vaginal 1,136 97.4 651 57.2 1,787 77.5

Forceps 6 0.5 100 8.8 106 4.6

Assisted breech (no forceps) 0 0 2 0.2 2 0.1

Caesarean section (elective) 0 0 34 3.0 34 1.5

Caesarean section (emergency) 0 0 247 21.7 247 10.7

Ventouse 24 2.1 102 9.0 126 5.5

Breech spontaneous 0 0.0 2 0.2 2 0.1

Assisted breech (with forceps for head) 0 0.0 1 0.1 1 0.0

Total 1,166 100.0 1,139 100.0 2,305 100.0

Pregnancy Outcome in South Australia 2009page 48

Mothers and Babies



Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2009

Birthweight (g)

Birthed in birthing unit Birthed in labour ward Total

Number % Number % Number %

&lt;1,500 0 0 12 1.0 12 0.5

1,500-1,999 1 0.1 9 0.8 10 0.4

2,000-2,499 9 0.8 38 3.3 47 2.0

2,500-2,999 130 11.1 134 11.7 264 11.4

3,000-3,499 429 36.8 383 33.5 812 35.2

3,500-3,999 437 37.5 428 37.4 865 37.4

4,000-4,499 139 11.9 123 10.8 262 11.3

4,500+ 21 1.8 17 1.5 38 1.6

Total 1,166 100.0 1,144 100.0 2,310 100.0

Table 36: Perinatal outcome in planned birthing unit births, South Australia, 2009

Perinatal outcome

Birthed in birthing unit Birthed in labour ward Total

Number % Number % Number %

Stillbirth 1 0.1 9 0.8 10 0.4

Discharged within 28 days 1,164 99.8 1,123 98.2 2,287 99.0

Prolonged hospitalisation  (in hospital 
at 28 days)

1 0.1 10 0.9 11 0.5

Neonatal death 0 0 2 0.2 2 0.1

Total 1,166 100.0 1,144 100.0 2,310 100.0

Pregnancy Outcome in South Australia 2009 page  49

Mothers and Babies



III. Terminations of Pregnancy

1. Numbers and rates
There were 5,054 terminations of pregnancy notified in South Australia in 2009. This was 47 less than in 2008. The 
abortion rate was 15.6 abortions per 1,000 women aged 15-44 years. Specific abortion legislation was introduced 
in 1970, following which the abortion rate rose to a peak of 13.9 in 1980, followed by a period of relative stability 
in the 1980s. Another increase in the abortion rate commenced in 1991 (Table 37 and Fig 7) and reached a peak of 
17.9 in 1999.  The rate declined significantly from 17.7 in 2001 to 15.3 in 2005 and was stable for three years before 
increasing to 16.0 in 2008.

Table 37: Abortion rate per 1,000 women aged 15-44 years, South Australia, 1970-2009

Year Number of abortions Abortions per 1,000 women aged 15-44 years

1970 1,440 6.0

1971 2,409 9.6

1972 2,692 10.6

1973 2,847 11.1

1974 2,867 10.9

1975 3,000 11.1

1976 3,289 11.9

1977 3,494 12.4

1978 3,895 13.6

1979 3,880 13.3

1980 4,081 13.9

1981 4,096 13.7

1982 4,061 13.4

1983 4,036 13.1

1984 4,091 13.1

1985 4,079 12.9

1986 4,327 13.5

1987 4,229 13.1

1988 4,263 13.0

1989 4,342 13.2

1990 4,463 13.4

1991 4,696 14.1

1992 4,717 14.2

1993 4,959 15.0

1994 5,140 15.7

1995 5,475 16.9

1996 5,545 17.2

1997 5,609 17.5

1998 5,488 17.2

1999 5,679 17.9

2000 5,580 17.6

2001 5,579 17.7

2002 5,467 17.5

2003 5,216 16.7

2004 4,931 15.9

2005 4,715 15.3

2006 4,889 15.5

2007 4,884 15.4

2008 5,101 16.0

2009 5,054 15.6

Pregnancy Outcome in South Australia 2009page 50

Termination of Pregnancy



Figure 7: Abortion rate in South Australia, 1970-2009

0

4

8

12

16

20

19
70

19
72

19
74

19
76

19
78

19
80

19
82

19
84

19
86

19
88

19
90

19
92

19
94

19
96

19
98

20
00

20
02

20
04

20
06

20
08

Abortions per 1,000 women aged 15-44 years

Year

2. Age of women
The age distribution of women who had terminations is shown in Table 38. Among the five- year age groups (Table 
39), the highest abortion rate was among women aged 20-24 years (27.0 per 1,000 women) followed by women 
aged 25-29 years (20.9) and teenage women 15-19 years (17.0 per 1,000 women). Compared with 2008, abortion 
rates have fallen for teenage women (18.5 per 1,000 women in 2008) and women aged 20-24 years. The abortion 
proportion (abortions as a proportion of abortions and live births) was 0.20; it was highest among teenagers (0.53), 
and was also high among women aged 20-24 years (0.33) and older women aged 40 years or more (0.24). This 
indicates that about 53% of known teenage pregnancies were terminated. This proportion was highest for younger 
teenagers (0.76 for those aged &lt;15 years). 

Table 38: Terminations of pregnancy by age, South Australia, 2009

Age (years) Number %

12 1 0.0

13 2 0.0

14 13 0.3

15 51 1.0

16 142 2.8

17 161 3.2

18 240 4.8

19 302 6.0

20-24 1,498 29.6

25-29 1,105 21.9

30-34 726 14.4

35-39 588 11.6

40-44 213 4.2

45+ 12 0.2

Total 5,054 100.0

Pregnancy Outcome in South Australia 2009 page  51

Termination of Pregnancy



The distribution of abortions and live births by age in South Australia in 2008 (Table 39 and Figure 8A) demonstrates 
that the largest proportion of abortions occurred in the age group 20-24 years while the largest proportion of live 
births occurred among those 30-34 years, who had the highest fertility (live birth) rate of 120.7 per 1,000 women. 
Teenagers accounted for 18.1% of the abortions and 4.1% of the live births in South Australia in 2009. The teenage 
pregnancy rate (per 1,000 women aged 15-19 years) declined in the 1970s and 1980s with the decline in the teenage 
birth rate but increased in the 1990s till 1996. After that it declined again, and, from 2003, this was associated with 
a decline in the teenage abortion rate (Figure 8B). The teenage pregnancy rate in 2009 was 32.7 per 1,000 women, 
and is the lowest rate recorded since 1970.

Table 39: Abortion and live birth rates and abortion proportions by age, South Australia, 2009

Age 
(years)

Number of 
abortions

Estimated resident 
female population

June 30 2008*

Abortion 
rate per 

1,000 
women

Number 
of live 

births**

Fertility rate
per 1,000 
women

Abortions 
+ live 
births

Abortion 
proportion

&lt;15 16 na na 5 na 21 0.76

15-19 896 52,685 17.3** 804 15.4** 1,700 0.53

20-24 1,498 55,493 27.0 3,020 54.4 4,518 0.33

25-29 1,105 52,797 20.9 5,731 108.5 6,836 0.16

30-34 726 49,777 14.6 6,009 120.7 6,735 0.11

35-39 588 55,935 10.5 3,448 61.6 4,036 0.15

40-44 213 56,455 4.0** 689 13.1** 902 0.24

45+ 12 na na 50 na 62 0.19

Total 5,054 323,142 15.6** 19,756 61.1** 24,810 0.20

*Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2009. Canberra: ABS, 2010 (Catalogue No 3235.0).

**Terminations of pregnancy are excluded from the numbers of live births. The abortion and live birth rates for women aged 15-19 years include 
terminations and live births at younger ages, and the rates for women aged 40-44 years include terminations and live births at older ages, while the 
total rates include all terminations and live births.

Figure 8a: Abortions and live births by age, South Australia, 2009

0%

20%

40%

60%

80%

100%

Abortions Live births Abortions &amp; Live births

Age (years)

Pe
rc

en
ta

g
e 

o
f 

w
o

m
en

&lt;20 20-24 25-29 30-34 35-39 40+

n=5,054 n=19,756 n=24,810

Pregnancy Outcome in South Australia 2009page 52

Termination of Pregnancy



Figure 8b: Teenage pregnancy, abortion and birth rates, South Australia, 1970-2009

0

10

20

30

40

50

60

70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99
20

00
20

01
20

02
20

03
20

04
20

05
20

06
20

07
20

08
20

09

Year

Pregnancy rate* Birth rate* Abortion rate*

Rate per 1,000 women aged 15-19 years

*Abortions and births to w omen aged less than 15 years are included in the numerator

3. Place of residence and place where termination performed
While 81.8% of terminations were performed for metropolitan residents (Table 40), a larger proportion (95.0%) 
was performed in metropolitan hospitals (Table 41), which include the Pregnancy Advisory Centre at which 2,854 
terminations (56.0% in the state) were performed.

Table 40: Terminations by place of residence, South Australia, 2009

Residence of women Number %

Metropolitan 4,135 81.8

Country 919 18.2

Total 5,054 100.0

Table 41: Terminations by hospital category, South Australia, 2009

Hospital where termination performed Number %

Metropolitan public 4,709 93.2

Metropolitan private 94 1.9

Country 251 5.0

Total 5,054 100.0

The proportion of terminations performed by obstetricians was 19.1%, and the proportion performed by medical 
practitioners in family advisory clinics was 77.8% in 2009 (Table 42). 

Table 42: Terminations by category of doctor, South Australia, 2009

Category of doctor performing termination Number %

Obstetrician/gynaecologist 966 19.1

Trainee obstetrician/gynaecologist 78 1.5

Medical practitioner in family advisory clinic 3,932 77.8

General practitioner 78 1.5

Total 5,054 100.0

Pregnancy Outcome in South Australia 2009 page  53

Termination of Pregnancy



4. The reason for termination
The number of terminations performed for fetal reasons was 172 (3.4% of terminations), of which 165 (95.9%) were 
for specified fetal or chromosomal abnormalities (Table 43).

Table 43: Reason for termination for fetal reasons, South Australia, 2009

Reason for termination Number %

Identified chromosomal abnormality 83 48.3

Other identified fetal abnormality 82 47.7

Possibility of damage from drugs 7 4.1

Possibility of hereditary disease 0 0.0

Total 172 100.0

5. Gestation, method and complications
The majority of terminations (92.0%) were performed within the first 14 weeks of pregnancy and most frequently (in 
82.3% of cases) by vacuum aspiration. There were 90 terminations performed at 20 weeks gestation or later: 54.4% 
of these were performed for fetal reasons. 

Twenty-five women were reported to have had complications (0.5%). The types of complications are listed in Table 44. 
Complications are known to be under-notified as the notification forms are usually completed about the time the woman 
is discharged from hospital after the procedure. The South Australian Abortion Reporting Committee reported that 42 
other women who had terminations in 2009 had complications after discharge, which had not been notified. This was 
ascertained through linkage of the abortion data with the South Australian hospital morbidity collection (ISAAC).

Table 44: Complications of terminations, South Australia, 2009

Complications Number % of complications

Haemorrhage  - intra-operative 1 4.0

                        - post-operative 5 20.0

Perforation of or trauma to body of uterus 1 4.0

Cervical tear 3 12.0

Retained products of conception 13 52.0

Other 2 8.0

Total 25 100.0

Pregnancy Outcome in South Australia 2009page 54

Termination of Pregnancy



6. Previous terminations. Total abortion rate and Total first abortion rate
Of the 5,054 women who had terminations, 1,689 (33.4%) had had a previous termination (Table 45a). Among the 
teenagers 14.4% had had a previous termination; 29.6% of women aged 20-24 years and 45.4% of women aged 
35-39 years had undergone a previous termination. The total abortion rate (TAR) for 2009 was 471.5 per 1,000 
women aged 15-44 years (Table 45b). This represents the number of abortions 1,000 women would have during their 
lifetime if they experienced the abortion rates of the different age groups for 2009. As a woman may have more than 
one abortion in her lifetime, to estimate how prevalent abortion is at these age-specific abortion rates for 2009, a 
total first abortion rate (TFAR, Table 45c) may be calculated after exclusion of women with repeat terminations. This 
TFAR for 2009 was 313.5 per 1,000 women aged 15-44 years. This suggests that 31.3% of women would have an 
abortion in their lifetime if they experienced the abortion rates of the different age groups for 2009.

Table 45a: Women with previous terminations by age, South Australia, 2009

Age (years) Number % % of age group

&lt; 15 0 0.0 0.0

15 - 19 131 2.6 14.6

20 - 24 443 8.8 29.6

25 - 29 459 9.1 41.5

30 - 34 303 6.0 41.7

35 - 39 267 5.3 45.4

40+ 86 1.7 38.2

Total 1,689 100.0 33.4

Further details of abortions in South Australia in 2009 may be obtained from the Seventh Annual Report of the South 
Australian Abortion Reporting Committee   for the year 2009.6

Pregnancy Outcome in South Australia 2009 page  55

Termination of Pregnancy



Table 45b: Calculation of total abortion rate (TAR) for 2009 for South Australia*

Age 
(years)

Number of women
who had terminations

Estimated female resident  
population 30th June 2008

Abortion rate
per 1,000 women

15-19* 912* 52,685 17.3*

20-24 1,498 55,493 27.0

25-29 1,105 52,797 20.9

30-34 726 49,777 14.6

35-39 588 55,935 10.5

40-44* 225* 56,455 4.0*

Total 5,054 323,142 15.6

*In these calculations, abortions for women under 15 years are included in the age group 15-19 yrs and abortions for women aged 45 years or more 
   are included in the age group 40-44 years, as is traditional.

Total abortion rate = sum of abortion rates for 5-year age groups x 5 = 94.3 x 5 = 471.5 per 1,000 women aged 15-44 years.

Table 45c: Calculation of total first abortion rate (TFAR) for 2009 for South Australia*

Age 
(years)

Number of women 
who had  

terminations (A)

Number of women  
who had previous  
terminations (B)

Number of women  
who had first  

termination (A) 
  (B)

Estimated 
female resident 

population
June 30th 2008

First abortion  
rate per 1,000 

women

15-19 912* 131* 781* 52,685 14.8*

20-24 1,498 443 1055 55,493 19.0

25-29 1,105 459 646 52,797 12.2

30-34 726 303 423 49,777 8.5

35-39 588 267 321 55,935 5.7

40-44 225* 86* 139* 56,455 2.5*

Total 5,054 1,689 3,365 323,142 10.4

 * In these calculations, abortions for women under 15 years are included in the age group 15-19 yrs and abortions for women aged 45 years or more 
    are included in the age group 40-44 years, as is traditional.

Total first abortion rate (TFAR) = sum of first abortion rates for 5-year age groups x 5 = 62.7 x 5 = 313.5  per 1,000 women aged 15-44 yrs. 

Pregnancy Outcome in South Australia 2009page 56

Termination of Pregnancy



IV. OBSTETRIC PROFILES BY HOSPITAL CATEGORY

Obstetric profiles for five hospital categories for 2009 are provided in Table 46 and Figures 9-28.

These hospital categories are:

1. Metropolitan teaching Level III hospitals with neonatal intensive care facilities, ie the Women s &amp; Children s  
Hospital and Flinders Medical Centre,

2. Other metropolitan teaching hospitals, ie the Lyell McEwin Health Service and Modbury Hospital,

3. Metropolitan private hospitals,

4. The two major country hospitals (Mount Gambier and Whyalla) and

5. Other country hospitals (mainly smaller).

A list of maternal and baby factors identified either as risk factors for poor perinatal outcome in earlier analyses,7 or 
of general interest, is provided with  means  for all state hospital births as well as proportions for the five hospital 
categories.

The  mean  is the proportion for women who gave birth in all state hospitals (for maternal factors) or births in all 
state hospitals (for baby factors),

e.g. % Aboriginal women 

x100
Total number of women who gave birth in state hospitals

Number of Aboriginal women who gave birth in state hospitals

Where indicated (+) in Table 46, it is the mean (number of women who gave birth, or births) for the 24 hospitals 
or groups of hospitals for which obstetric profiles have been provided, and which have also been included in the 
provision of the 10th and 90th percentile values. These are as follows:

1. Women s &amp; Children s Hospital

2. Flinders Medical Centre

3. Lyell McEwin Hospital

4. Ashford Hospital 

5. Burnside War Memorial Hospital Inc

6. Calvary Healthcare Adelaide

7. Flinders Private Hospital

8. North Eastern Community Hospital

9. Mount Gambier &amp; District Health Service Inc

10. The Whyalla Hospital &amp; Health Services Inc

11. Barossa Health (Tanunda Centre)

12. Gawler Health Service

13. Lower North Health Centre (Clare)

14. Mount Barker District Soldiers  Memorial Hospital Inc

15. Murray Bridge Soldiers  Memorial Hospital Inc

16. Naracoorte Health Service Inc

Pregnancy Outcome in South Australia 2009 page  57

Obstetric Profiles by Hospital Category



17. Northern Yorke Peninsula Regional Health Service (Wallaroo)

18. Port Augusta Hospital &amp; Regional Health Service Inc

19. Port Lincoln Health Service Inc

20. Port Pirie Regional Health Service Inc

21. Riverland Regional Health Service (Berri)

22. South Coast District Hospital Inc (Victor Harbor)

23. Country hospitals with 50-99 births per year

24. Country hospitals with &lt;50 births per year

The 10th percentile is the proportion below which 10% of the 24 hospital proportions, ie the two lowest hospital 
proportions, would be found if the 24 proportions were ranked from highest to lowest. The 90th percentile is the 
proportion above which 10% of the 24 hospital proportions, ie the two highest proportions, would be found if the 
24 proportions were ranked from highest to lowest. As the two Level III hospitals which account for 39.0% of hospital 
births have proportions of some factors (such as prolonged hospitalisation and use of neonatal intensive care) which 
are much greater than for the other 22 hospitals, occasionally the mean for all hospitals will be seen to be higher than 
the 90th percentile.

The table and figures provide obstetric profiles for the five different categories of hospitals. These have been provided 
since 1986 to hospitals with 100 or more births per year, together with their individual hospital profiles, including 
crude and standardized perinatal mortality ratios,8 the latter with exclusion of perinatal deaths from congenital 
abnormalities3 and terminations of pregnancy. For country hospitals with less than 100 births per year, group reports 
have been provided.

Each hospital s statistics for each factor may be compared with those for state hospitals and for categories of 
hospitals, eg whether a hospital s proportion for any factor falls within the range of the more common proportions 
prevailing in hospitals in the state (ie between the 10th and the 90th percentiles).

Pregnancy Outcome in South Australia 2009page 58

Obstetric Profiles by Hospital Category



Table 46: Obstetric profiles by hospital category, South Australia, 2009: live births of any gestation and 
stillbirths of &gt;=400g or &gt;=20 weeks gestation

Factors

All state hospitals Metropolitan hospitals Country hospitals

Mean
10th 

percentile
90th  

percentile
Level III 
teaching

Other 
teaching

Private Major Other

Maternal factors

Women (n=19,469) 811+ 122 2,716 7,445 3,017 5,055 852 3,100

% Aboriginal women 3.1 0.1 8.4 3.4 3.6 0.3 4.1 6.3

% Antenatal visits &lt;7* 8.3 0.3 13.8 13.8 10.6 0.6 7.8 6.2

% Teenage women 4.2 0.1 8.2 4.4 8.2 0.2 6.1 5.5

% Women ?35 years 21.0 12.3 32.9 19.9 13.3 31.9 12.7 15.7

% Single women 11.3 2.1 18.5 16.6 13.1 2.1 11.6 11.6

% 4+ prior live births 3.3 0.5 8.6 3.6 5.7 0.6 3.6 4.4

% 1+ prior perinatal deaths 1.6 0.3 2.2 2.0 1.7 1.0 2.3 1.2

% Obstetric complications 34.2 18.0 38.8 42.9 36.9 26.2 29.5 24.8

% Labour complications 36.9 23.4 45.8 46.8 39.7 27.9 27.0 27.7

% Induction 29.6 23.1 34.6 29.9 27.4 32.1 28.9 27.3

% Emergency caesarean 16.8 10.8 20.1 17.7 17.4 16.9 13.7 14.7

% Elective caesarean 15.8 10.9 23.5 12.6 13.0 23.5 16.7 13.7

% Total caesarean 32.7 22.4 41.3 30.3 30.4 40.4 30.4 28.5

% Ultrasound examination* 98.8 97.0 99.4 99.0 98.6 99.0 98.2 98.1

% Amniocentesis* 3.4 0.8 5.1 4.3 2.3 4.1 2.2 1.8

% Episiotomy 11.5 4.5 16.2 10.8 12.2 15.3 9.2 7.1

% Repair of perineal tear 29.3 19.0 38.3 30.6 21.5 34.3 23.6 27.2

% Epidural analgesia 31.6 8.2 41.3 32.9 23.7 44.2 27.5 16.7

% Spinal analgesia 0.9 0.2 2.6 0.3 1.3 1.1 0.6 1.6

% Private patients 31.5 2.5 100.0 7.1 2.4 100.0 15.5 11.2

% Primiparous women 41.6 34.7 45.1 43.2 39.0 44.8 36.5 36.5

% Previous caesarean 17.7 13.1 22.7 16.1 16.4 22.4 16.3 15.7

% PPH 10.6 3.2 11.9 15.8 12.5 5.0 7.3 6.5

Baby factors 

Births (n=19,766) 824+ 122 2,762 7,630 3,050 5,119 861 3,106

% Birthweight &lt;2,500g 7.4 1.1 7.8 12.3 6.7 3.7 4.5 2.8

% Gestational age &lt;37 weeks 
at birth

9.0 0.4 9.3 14.5 9.2 5.4 5.0 2.2

% Prolonged hospitalisation 
(&gt;27 days)

2.3 0 1.6 5.1 0.8 0.4 0.9 0.4

% Neonatal intensive  care 
(Level  III or W&amp;CH  paediatric 
intensive care)

3.0 0.3 1.9 6.4 1.5 0.6 1.4 0.8

% Birth defect 2.7 0.5 2.8 4.2 3.1 1.2 2.3 1.2

* adjusted for missing values

+ mean number of women who gave birth, or mean number of births for the 24 hospitals or groups of hospitals

Pregnancy Outcome in South Australia 2009 page  59

Obstetric Profiles by Hospital Category



Figure 9: Percentage of Aboriginal women by hospital category

0

2

4

6

8

10

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure 10: Percentage of women with &lt;7 antenatal visits by hospital category

0

2

4

6

8

10

12

14

16

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure 11: Percentage of teenage women by hospital category

0

1

2

3

4

5

6

7

8

9

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Pregnancy Outcome in South Australia 2009page 60

Obstetric Profiles by Hospital Category



Figure 12: Percentage of women 35 years or more by hospital category

0

5

10

15

20

25

30

35

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure 13: Percentage of single women by hospital category

0

2

4

6

8

10

12

14

16

18

20

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure 14: Percentage of women with 4 or more prior livebirths by hospital category

0

2

4

6

8

10

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Pregnancy Outcome in South Australia 2009 page  61

Obstetric Profiles by Hospital Category



Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category

0

0.5

1

1.5

2

2.5

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure 16: Percentage of women with obstetric complications by hospital category

0

10

20

30

40

50

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

10th percentile

90th percentile

Mean

Figure 17:  Percentage of women with complications during labour or birth by hospital category

0

10

20

30

40

50

60

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Pregnancy Outcome in South Australia 2009page 62

Obstetric Profiles by Hospital Category



Figure 18: Percentage of women with induction of labour by hospital category

0

5

10

15

20

25

30

35

40

45

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure 19: Percentage of women having epidural analgesia by hospital category

0

10

20

30

40

50

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure 20: Percentage of breech births by hospital category

0

0.2

0.4

0.6

0.8

1

1.2

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Pregnancy Outcome in South Australia 2009 page  63

Obstetric Profiles by Hospital Category



Figure 21: Percentage of emergency caesarean sections by hospital category

0

5

10

15

20

25

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure  22: Percentage of elective caesarean sections by hospital category

0

5

10

15

20

25

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Figure 23: Percentage of total caesarean sections by hospital category

0

5

10

15

20

25

30

35

40

45

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

Mean

10th percentile

Pregnancy Outcome in South Australia 2009page 64

Obstetric Profiles by Hospital Category



Figure 24: Percentage of births with birthweight below 2,500g by hospital category

0

2

4

6

8

10

12

14

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e 90th percentile

Mean

10th percentile

Figure 25: Percentage of births with gestation less than 37 weeks by hospital category

0

2

4

6

8

10

12

14

16

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile
Mean

10th percentile

Figure 26: Percentage of births with prolonged hospitalisation by hospital category

0

1

2

3

4

5

6

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

10th percentile

90th percentile

Mean

Pregnancy Outcome in South Australia 2009 page  65

Obstetric Profiles by Hospital Category



Figure 27: Percentage of live births requiring neonatal intensive care by hospital category

0

1

2

3

4

5

6

7

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

90th percentile

10th percentile

Mean

Figure 28: Percentage of births with birth defects by hospital category

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1 2 3 4 5

Hospital category

Pe
rc

en
ta

g
e

10th percentile

90th percentile
Mean

Pregnancy Outcome in South Australia 2009page 66

Obstetric Profiles by Hospital Category



V. Clinical and Maternity Performance Indicators

1. Clinical indicators
These clinical indicators of The Australian Council on Healthcare Standards ( ACHS Obstetrics Indicators - Clinical 
Indicator Users  Manual Version 5 for use in 2007  ) are reported for the state in pages 55-58. They are also reported 
for hospital categories and individual hospitals in the Pregnancy and Neonatal Care Bulletin 2009.

Indicator 1: Induction of labour other than for defined indications 

Rationale:  These indicators have been included because induction of labour is a common obstetric 
intervention and one which is often stated by community critics to be unnecessarily high.

Clinical indicator 1.1: Induction of labour other than for defined indications among all inductions

Numerator:  The number of women undergoing induction of labour for indications other than those 
defined (n=2,919). These defined indications are diabetes, premature rupture of membranes, 
hypertensive disorders (including chronic renal disease), intrauterine growth restriction, 
isoimmunisation, fetal distress (as documented by the clinician), fetal demise, chorioamnionitis, 
prolonged pregnancy (41 completed weeks or more), twins and antepartum haemorrhage.

  Patients having augmentation of labour are excluded in both numerator and denominator data.

Denominator:  The total number of women undergoing induction of labour for any reason (excluding 
augmentation of labour) (n = 5,770).

Clinical indicator 1.1 = 
5,770

2,919 x 100
= 50.6%  (95%CI 49.3%-51.9%).

Clinical indicator 1.2: Induction of labour other than for defined indications among all women who  
gave birth

Numerator:  The number of women undergoing induction of labour for indications other than those listed 
above (excluding augmentation of labour) (n=2,919).

Denominator:  The total number of women who gave birth (including augmentation of labour) (n=19,604).

Clinical indicator 1.2 = 
19,604

2,919 x 100
= 14.9%  (95%CI 14.4%-15.4%).

Indicator 2: Rate of vaginal birth following primary caesarean section

Rationale:  This indicator has been included to monitor the conduct of labour and trial of scar in those 
women who have had a previous primary (first) caesarean section

Clinical indicator 2.1: Rate of vaginal birth following primary caesarean section

Numerator:  The number of women who gave birth vaginally following a previous primary (first) caesarean 
section and having no intervening pregnancies greater than 20 weeks gestation (n=427).

Denominator:  The total number of women who gave birth who have had a previous primary (first) caesarean 
section and no intervening pregnancies greater than twenty weeks gestation (n=2,450).

Clinical indicator 2.1 = 
2,450

427 x 100
= 17.4%  (95%CI 15.9%-19.0%).

Pregnancy Outcome in South Australia 2009 page  67

Clinical and Maternity Performance Indicators



Indicator 3: Primary caesarean section for failure to progress

Rationale: This indicator is to monitor the adequacy of trial of labour. There are two indicators, one for 
failure to progress after a period of labour with cervical dilatation of 3cm or less and the other 
with cervical dilatation of more than 3cm. As information on cervical dilatation is not collected, 
the two indicators have been combined.

Clinical indicator 3.0: Primary caesarean section for failure to progress among primary non-elective 
caesarean sections

Numerator: The number of women undergoing primary (first) caesarean section for failure to progress 
(clinician s documented statement), which may include CPD, uterine inertia, persistent occipito-
posterior position (n=1,443).

Denominator:  The total number of women undergoing primary non-elective caesarean section (n=2,589).

Clinical indicator 3.0 = 
2,589

1,443 x 100
= 55.7% (95%CI 53.8%-57.7%).

Indicator 4: Primary caesarean section for fetal distress

Rationale: To determine the comparative frequency of caesarean section for fetal distress.

Clinical indicator 4.1: Primary caesarean section for fetal distress among all women who gave birth

Numerator: The number of women undergoing primary caesarean section for fetal distress in labour as 
evidenced by the clinician s documented diagnosis of fetal distress (n=890).

Denominator:  The total number of women who gave birth including those with a vaginal birth (n=19,604).

Clinical indicator 4.1 = 
19,604

890 x 100 = 4.5% (95% CI 4.3%-4.8%).

Clinical indicator 4.2: Primary caesarean section for fetal distress among primary caesarean sections

Numerator: The number of women undergoing primary caesarean section for fetal distress as defined above 
(n=890).

Denominator: The total number of women who gave birth by primary caesarean section only (n = 3,507).

Clinical indicator 4.2 = 
3,507

890 x 100 = 25.4% (95%CI 23.9%-26.9%).

Indicator 5:  Incidence of an intact lower genital tract in primiparous patients birthing vaginally

Rationale: This indicator has been included because a high incidence of an intact perineum is considered a 
desirable outcome.

Clinical indicator 5.1:  Incidence of an intact lower genital tract in primiparous women who gave  
birth vaginally

Numerator: The number of primiparous patients not requiring surgical repair or suture of the lower genital 
tract (those structures below and not including the cervix) following birth (n=1,379).

Denominator: The total number of primiparous women who gave birth vaginally (n=5,483).

Clinical indicator 5.1 = 
5,483

1,379 x 100
= 25.1% (95%CI 24.0%-26.3%).

Pregnancy Outcome in South Australia 2009page 68

Clinical and Maternity Performance Indicators



Indicator 6:  Apgar score

Rationale: This indicator has been included as a measure of the outcome of labour, with particular emphasis 
on the assessment of baby well-being.

Clinical indicator 6.1: Apgar score of 4 or below at five minutes after birth among all babies except 
antepartum fetal deaths

Numerator: The number of babies born with an Apgar score of 4 or below at five minutes post birth (n=80).

Denominator: The total number of babies born (excluding fetal deaths in utero diagnosed prior to 
commencement of labour) (n=19,833).

Clinical indicator 6.1 = = 0.4%
80 x 100
19,833

 (95%CI 0.3%-0.5%).

Indicator 7:   Term babies transferred or admitted to a neonatal  intensive care unit for reasons other 
than congenital abnormality

Rationale: This indicator has been included as an index of the overall management of labour in terms of 
outcome.

Clinical indicator 7.1: Term babies transferred or admitted to a neonatal intensive care unit for reasons 
other than congenital abnormality

Numerator: The number of term babies (37 weeks gestation or later) transferred/admitted to a neonatal 
intensive care unit for reasons other than congenital abnormality (n=95).

Denominator:  The total number of term live babies born (n=18,090).

Clinical indicator 7.1 = 
18,090
95 x 100 = 0.5% (95%CI 0.4%-0.6%).

Pregnancy Outcome in South Australia 2009 page  69

Clinical and Maternity Performance Indicators



2. Maternity performance indicators, hospitals with at least 500 births per year
The first two of these indicators are from the original Victorian set of maternity performance indicators, while three 
others are ACHS clinical indicators.  These six indicators are as follows:

1. Induction of labour proportion for selected primiparae

  =  Number of selected primiparae undergoing induction of labour 
                         Number of selected primiparae who gave birth

2. Caesarean section rate for selected primiparae

 =  Number of selected primiparae undergoing caesarean section 
             Number of selected primiparae who gave birth

The selected primipara is aged &gt;=20 and &lt;=34 years, with a singleton pregnancy, delivered at gestation &gt;=37 and 
&lt;=41 weeks, with an infant not small for gestational age (classified using birthweight percentiles rather than clinical 
suspicion of light for dates). The birthweight percentiles used are the national birthweight-gestation percentiles.9

These specifications are slightly different from those of the  selected primipara  of the Core Maternity Indicators 
Project10 and will be modified to those specifications in later reports.

3. VBAC: proportion of women who gave birth vaginally following a previous primary (first) caesarean 
section and no intervening births.

This is as defined for Clinical indicator 2 (page 56) and was 17.4% for the state in 2009 (and 17.1% for state 
hospitals) in 2009.

4. PRIMIP no repair:  proportion of women not requiring surgical repair following vaginal birth.

This is as defined for Clinical indicator 5 (page 57) and was 25.1% for the state in 2009 (24.7% for state hospitals).

5. TERM NICU: proportion of term babies admitted to neonatal intensive care (NICU) for reasons other than 
congenital abnormality.

This is as defined for Clinical indicator 7 (page 58) and was 0.5% for the state (as well as for state hospitals) for 2009.

6. SPMR: Standardized perinatal mortality ratio for all births.

This is as defined8 in the Pregnancy and Neonatal Care Bulletin 2009. It adjusts for the difference between the 
distribution of births by birthweight between the hospital and state hospital births. As perinatal mortality is much 
higher in babies of low birthweight, this adjustment ensures that a hospital is directly comparable with other hospitals 
and state hospitals as a whole if it has a higher proportion of low birthweight babies than state hospital births.

Expected number of deaths

Observed number of deaths
SPMR = x 100

To obtain the expected number of deaths for a hospital, the state hospital perinatal mortality rate for 2009 for each 
of the birthweight groups in Table 28a is applied to the number of births in each corresponding birthweight group for 
the hospital.  This gives an expected number of deaths in each birthweight group.  These expected deaths are then 
totalled to give a total number of expected deaths for the hospital.

SPMRs provided in this report exclude deaths attributed to congenital abnormalities (as determined by the Maternal, 
Perinatal and Infant Mortality Committee3), which are the least preventable, as well as terminations of pregnancy. 
An SPMR above 100 means that after adjustment for birthweight differences and deaths attributed to congenital 
abnormalities and terminations of pregnancy, perinatal mortality for that hospital is higher than that for state hospital 
births eg an adjusted SPMR of 120 means that it is 20% higher.

A 95% confidence interval (CI) which includes the value 100 in its range means that the hospital s perinatal mortality 
is not (statistically) significantly different from that for state hospital births for 2008. The SPMRs and 95%CIs for 
individual hospitals and categories of hospitals have been programmed using indirect standardization methods.11

Pregnancy Outcome in South Australia 2009page 70

Clinical and Maternity Performance Indicators



Statistics for the six maternity performance indicators for 2009 are provided in Figures 29a   29g for the nine 
hospitals, A   I, with at least 500 births in 2009.  SPMRs for the preceding five years combined, 2005-2009, are 
provided in Figure 29G. Metropolitan teaching hospitals and Mount Gambier Hospital have been named with their 
permission and are as follows:

A.  Women s and Children s

B.  Flinders Medical Centre

C.  Lyell McEwin Hospital

D.  Mt Gambier Hospital

For the last 5 years the Women s and Children s Hospital SPMR (ranging from 67   93) has been significantly lower 
when compared with state-wide hospital data.

Otherwise, none of the elevations in the SPMR for the individual hospitals for 2009 or for the last five-year period 
2005-2009 (Fig 29G) was statistically significant. 

Figure 29a: Induction of labour proportion for selected primiparae, SA hospitals with &gt;=500 births per year, 2009

0

10

20

30

40

50

A B C D E F G H I

Hospital

%

Induction of labour %

*SA hospitals = 36.5%

Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with &gt;=500 births per year, 2009

0

10

20

30

40

50

60

A B C D E F G H I

Hospital

%

Caesarean section %

*SA hospitals = 30.8%

Pregnancy Outcome in South Australia 2009 page  71

Clinical and Maternity Performance Indicators



Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first) 
caesarean section &amp; no intervening births, SA hospitals with &gt;=500 births per year, 2009

0

10

20

30

40

A B C D E F G H I

Hospital

%

VBAC %

*SA hospitals = 17.1%

Figure 29d: PRIMIP no repair: proportion of primiparous women not requiring surgical repair following 
vaginal birth, SA hospitals with &gt;=500 births per year, 2009

0

10

20

30

40

A B C D E F G H I

Hospital

%

Primip no repair % 

*SA Hospitals = 24.7%

Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital 
abnormality, SA hospitals with &gt;=500 births per year, 2009

0

0.2

0.4

0.6

0.8

1

1.2

A B C D E F G H I

Hospital

%

Term NICU % 
*SA hospitals = 0.5%

Pregnancy Outcome in South Australia 2009page 72

Clinical and Maternity Performance Indicators



Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with &gt;=500 births per 
year, 2009

0

50

100

150

200

250

300

A B C D E F G H I

Hospital

   SPMR

*SA hospitals 

Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with &gt;=500 births per 
year, 2005-2009

0

50

100

150

200

A B C D E F G H I

Hospital

SPMR
*SA hospitals 

Pregnancy Outcome in South Australia 2009 page  73

Clinical and Maternity Performance Indicators



VI. Trends In Perinatal Statistics In South Australia,1981-2009

Perinatal statistics are presented in Tables 47 and 48 for both socio-demographic and obstetric aspects for each 
year from 2000-2009, as well as for 1981, when the perinatal data collection was commenced. Some features are 
illustrated in Fig 30.1   30.8 for the years 1985-2008. The trends noted between 1981 and 2009 are as follows:

1. The total fertility rate stabilising at 1.87 live births per woman, in 2009 following a steady increase from 1.71 in 
2000 to 1.91 live births per woman in 2008.

2. The increase in the proportion of Asian women from 1.8% in 1981 to 8.1% in 2009 and of Aboriginal women 
from 1.5% in 1981 to 3.1% in 2009.

3. The decrease in the proportion of teenage women giving birth from 7.8% in 1981 to 4.1% in 2009. Over the 
past decade, there has been a general decline in both the teenage birth and abortion rate. The teenage pregnancy 
rate in 2009 of 32.7 per 1,000 women was the lowest recorded since 1970, when abortion statistics were first 
collected, enabling calculation of a pregnancy rate.

4. The increase in the age of women giving birth. The proportion of women who gave birth who were 35 years or 
older increased from 4.6% in 1981 to 21.1% in 2009, and among primiparous women from 1.2% to 12.8%. The 
mean age among women giving birth increased from 26.55 years to 30.14 years and among primiparous women 
from 24.42 years to 28.27 years. 

5. The proportion of single women giving birth peaked in 1996 at 14.9%, since within time there has been a gradual 
decrease to 11.2% in 2009, which is the lowest in the past two decades.

6. In the last decade, the proportion of births in country hospitals, especially in small country hospitals, has gradually 
declined from 24.9% in 1997 to 19.9% in 2009.  The proportion of births in teaching hospitals was highest 
in 2000 at 54.6%, and following a low of 49.6% in 2002, has gradually increased to 53.7 in 2009.  In 2009 
metropolitan private hospitals accounted for 25.7% of births.  The number of births in birthing units in teaching 
hospitals increased from 125 (0.6%) in 1992 to 1,166 (5.9%) in 2009. Home births increased from 44 (0.2%) in 
1997 to 134 (0.7%) in 2009.

7. The increase in the proportion of multiple births, related to assisted conception pregnancies, and the older age 
of women, from 2.0% in 1981 to a peak of 3.6% in 2002 and 2003. After that the proportion declined to 3.0% 
in 2008 and 2009. The decline is likely to be related to the increasing use of single embryo transfer in assisted 
conception practice.

8. The induction rate increased from 22.1% in 1981 to 29.3% in 2002, after which it declined slightly. It was 29.4% 
in 2009. Fifty-three percent of inductions in 2009 were performed for other than defined indications.

9. The fall in the proportion of normal spontaneous vaginal births (from 66.1% in 1981 to 55.4% in 2009, but 
stable for the last five years), breech births (from 1.1% to 0.4%) and forceps births (from 15.2% to 4.6%). The 
proportion delivered by ventouse increased from 0.7% to 7.2%, and by caesarean section, from 16.9% in 1981 
to 32.4% in 2009. The caesarean section rate has been relatively stable for the last five years.

10. The gradual increase in the proportion of low birthweight births from 5.8% in 1981 to a peak of 7.6% in 2005. 
This proportion has been around 7.0% in the last four years (7.3% in 2009). The proportion of preterm births also 
increased from 5.5% in 1981 to a peak of 9.0% in 2005 and 2009. 

11. The proportion of births with congenital abnormalities identified before discharge from hospital after birth has 
been relatively stable at 2.3%-2.7% during the last decade (2.7% in 2008 and 2009).

12. The increase in the proportion of babies utilising Level II care from 6.7% in 1982 to 16.6% in 2002 and 2003, 
followed by a decline to 15.3% in 2009.

13. The proportion of babies utilising neonatal intensive care has decreased from 3.0% in 2000 to 2.9% in 2009, 
while the proportion using paediatric intensive care remained at 0.2%-0.3%. The proportion in hospital at 28 days 
has been between 2.0% and 2.5% (2.2% in 2009). 

14. The considerable fall in the perinatal mortality rate, despite the increasing proportion of preterm births. The 
perinatal mortality rate for national statistics (for babies of at least 500g birthweight or 22 weeks gestation 
if birthweight unavailable) has fallen from 11.6 in 1981 to 4.9 per 1,000 births in 2009, while the rate for 
international statistics (for births of 1,000g or 28 weeks if birthweight unavailable) has fallen from 7.2 to 4.0 per 

Pregnancy Outcome in South Australia 2009page 74

Clinical and Maternity Performance Indicators



1,000 births during the same period. The fall in this neonatal mortality rate (for early neonatal deaths) has been 
particularly outstanding, reaching 0.6 per 1000 live births in 2007 and 2008, the lowest recorded in the state. This 
figure was 0.9 per 1,000 livebirths in 2009. The fall in perinatal mortality is reflected in the standardized perinatal 
mortality ratio which has been calculated in Table 48 for each year utilising perinatal mortality rates for 500g 
birthweight groups for the years 1981-1989 combined as the standard. It was 65.1 in 2009 compared with 117.6 
in 1981, with fluctuations in the last decade. 

Table 47: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 2000   2009

Characteristic

Year

1981 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

1 Total births 19,052 17,872 17,704 17,745 17,844 17,522 18,196 18,803 19,757 19,970 19,901

2 Live births 18,905 17,765 17,584 17,623 17,710 17,409 18,067 18,663 19,624 19,819 19,761

3 Women who gave birth 18,857 17,578 17,427 17,421 17,517 17,229 17,897 18,519 19,471 19,672 19,604

4 Total fertility rate  
per woman 1.75 1.71 1.71 1.73 1.75 1.74 1.82 1.82 1.91 1.91 1.87

5 Place of birth (%)

 Teaching hospital 52.2% 54.6% 51.6% 49.6% 50.6% 49.9% 51.6% 52.1% 52.6% 53.2% 53.7%

 Private hospital 19.7% 21.9% 25.2% 27.9% 28.1% 27.2% 26.5% 26.7% 26.6% 26.5% 25.7%

 Country hospital 27.8% 23.5% 22.9% 22.2% 21.3% 22.5% 21.6% 20.8% 20.2% 20.3% 19.9%

 Domiciliary* 0.3% 0.2% 0.2% 0.3% 0.3% 0.4% 0.3% 0.5% 0.5% 0.5% 0.7%

(65) (35) (37) (48) (60) (67) (63) (87) (107) (101) (134)

6 Race (%)

 Aboriginal 1.5% 2.5% 2.3% 2.5% 2.7% 2.8% 2.7% 3.0% 3.0% 3.2% 3.1%

(Women who gave birth) (277) (446) (399) (445) (468) (484) (487) (548) (578) (624) (607)

(Births) (280) (450) (401) (452) (473) (491) (492) (559) (590) (637) (618)

 Asian 1.8% 4.5% 4.4% 4.8% 4.7% 4.8% 5.3% 5.1% 6.2% 7.0% 8.1%

7 Age 
Mean age (years) 26.55 29.50 29.52 29.62 29.77 29.81 29.86 30.01 30.05 30.11 30.14

 Teenage  (%) 7.8% 5.3% 5.4% 5.6% 5.4% 5.3% 5.2% 4.8% 4.6% 4.5% 4.1%

  ?35 years  (%) 4.6% 16.2% 16.3% 17.0% 17.6% 17.9% 18.7% 20.4% 20.2% 21.1% 21.1%

8 Marital status (%)

  Never married 7.6% 12.0% 12.3% 12.3% 11.9% 11.8% 12.5% 11.7% 11.0% 10.7% 10.0%

  Widowed/ divorced/  
  separated (%)

2.0% 1.7% 1.6% 1.6% 1.5% 1.3% 1.3% 1.3% 1.4% 1.2% 1.2%

  (Single) (9.6%) (13.7%) (13.9%) (13.9%) (13.3%) (13.0%) (13.8%) (13.0%) (12.5%) (11.9%) (11.2%)

9 Primiparae

 Mean age (years) 24.42 27.61 27.66 27.77 27.91 28.13 28.02 28.20 28.30 28.24 28.27

 Teenage 15.4% 10.6% 10.9% 11.3% 10.9% 10.0% 10.1% 9.5% 8.9% 8.8% 8.4%

  ?35 years 1.2% 9.3% 9.5% 9.9% 10.6% 11.0% 11.4% 12.6% 12.5% 12.7% 12.8%

*includes unplanned home births

Pregnancy Outcome in South Australia 2009 page  75

Trends in Perinatal Statistics in South Australia



Table 48: Obstetric aspects of perinatal statistics, South Australia, 1981 and 2000   2009

Characteristic

Year

1981 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

1 Plurality

Multiple births (%) 2.0% 3.3% 3.1% 3.6% 3.6% 3.3% 3.3% 3.0% 2.9% 3.0% 3.0%

   Twins (363) (560) (550) (632) (626) (578) (570) (552) (544) (592) (578)

   Triplets (21) (21) (3) (12) (21) (6) (21) (12) (21) (3) (12)

   Quadruplets (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0)

2 Induction of labour (%) 22.1% 27.3% 28.3% 29.3% 29.0% 27.9% 28.3% 28.9% 29.8% 28.6% 29.4%

3 Method of birth

Normal
spontaneous

66.1% 61.7% 59.5% 58.7% 57.8% 55.9% 55.8% 56.0% 56.0% 56.0% 55.4%

Elective caesarean 8.2% 10.4% 11.9% 12.6% 13.3% 14.0% 14.6% 15.5% 15.3% 15.4% 15.7%

Emerg caesarean 8.7% 14.8% 15.8% 16.6% 16.7% 17.6% 17.6% 17.4% 17.1% 16.8% 16.7%

Forceps 15.2% 6.4% 6.1% 5.9% 4.8% 5.0% 4.2% 3.7% 4.1% 4.2% 4.6%

Breech 1.1% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.5% 0.4%

Ventouse 0.7% 6.3% 6.3% 5.9% 6.9% 7.1% 7.3% 7.0% 7.1% 7.1% 7.2%

Total caesarean (16.9%) (25.2%) (27.8%) (29.2%) (30.0%) (31.5%) (32.3%) (32.9%) (32.3%) (32.2%) (32.4%)

4 Birthweight &lt;2,500g 5.8% 7.2% 6.8% 7.1% 7.0% 7.0% 7.6% 7.0% 6.9% 7.0% 7.3%

Singletons 4.9% 5.6% 5.5% 5.4% 5.3% 5.3% 5.9% 5.5% 5.5% 5.5% 5.7%

Multiples 52.1% 55.9% 46.3% 50.5% 53.0% 55.8% 57.7% 53.4% 53.6% 53.4% 59.8%

5 Gestational age &lt;37 
weeks 5.5% 8.6% 8.1% 8.3% 8.4% 8.7% 9.0% 8.2% 8.5% 8.6% 9.0%

Singletons 4.8% 6.9% 6.7% 6.6% 6.7% 7.0% 7.3% 6.8% 7.1% 7.0% 7.2%

Multiples 41.1% 57.3% 50.8% 52.2% 54.6% 58.4% 58.4% 54.4% 57.2% 59.3% 67.5%

6 Congenital abnormalities 3.4% 2.3% 2.5% 2.4% 2.3% 2.5% 2.5% 2.3% 2.6% 2.7% 2.7%

7 Level II care Na 15.8% 15.2% 15.8% 16.6% 16.6% 16.2% 15.3% 16.1% 15.4% 15.3%

8 Level III care 3.3% 3.0% 2.6% 2.8% 2.7% 2.9% 2.9% 2.5% 2.3% 2.5% 2.9%

9 W&amp;CH ICU care Na 0.2% 0.3% 0.2% 0.2% 0.2% 0.3% 0.2% 0.3% 0.3% 0.3%

10 Hospitalisation for 28 
days or more 4.2% 2.5% 2.1% 2.2% 2.2% 2.3% 2.4% 2.0% 2.1% 2.2% 2.2%

11 Neonatal deaths 96 57 64 54 42 52 63 38 55 51 49

12 Stillbirths 147 106 120 122 134 113 129 140 132 151 140

13 Perinatal deaths 243 163 184 176 176 165 192 178 188+ 202 189

14 Perinatal mortality rate 
per 1,000 births

?400g/20 weeks 12.8 9.1 10.4 9.9 9.9 9.4 10.6 9.5 9.5 10.1 9.5

?500g/22 weeks* 11.6 6.1 6.9 6.8 6.5 5.7 6.2 4.9 5.2 5.3 4.9

?1,000g/28 weeks* 7.2 3.6 3.9 4.0 3.9 3.5 3.7 3.1 2.6 3.4 3.5

15 Standardized perinatal 
mortality ratio 117.6 62.0 70.6 70.3 68.1 66.9 66.5 63.0 65.1 67.3 65.1

* only neonatal deaths within the first 7 days of life are included, as recommended by the World Health Organisation for national and  
international statistics.

Pregnancy Outcome in South Australia 2009page 76

Trends in Perinatal Statistics in South Australia



Trends in Perinatal Statistics in South Australia (SA), 1985   2009

Figure 30a: Percentage of teenage women among women giving birth in SA

0

2

4

6

8

19
85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

19
94

19
95

19
96

19
97

19
98

19
99

20
00

20
01

20
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20
03

20
04

20
05

20
06

20
07

20
08

20
09

Year

Pe
rc

en
ta

g
e

Figure 30b: Percentage of women aged 35 years and over among women giving birth in SA

0

4

8

12

16

20

24

19
85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

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94

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20
04

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06

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07

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08

20
09

Year

Pe
rc

en
ta

g
e

Figure 30c: Percentage of primiparous women aged 35 years and over in SA

0

5

10

15

19
85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

19
94

19
95

19
96

19
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20
00

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20
08

20
09

Year

Pe
rc

en
ta

g
e

Pregnancy Outcome in South Australia 2009 page  77

Trends in Perinatal Statistics in South Australia



Figure 30d: Percentage of Aboriginal women and Asian women among women giving birth in SA

0

2

4

6

8

10
19

85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

19
94

19
95

19
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00

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20
04

20
05

20
06

20
07

20
08

20
09

Year

Pe
rc

en
ta

g
e

Asian Aboriginal

Figure 30e: Percentage of women never married and with no de facto partner among women giving birth 
in SA

0

3

6

9

12

15

19
85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

19
94

19
95

19
96

19
97

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99

20
00

20
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02

20
03

20
04

20
05

20
06

20
07

20
08

20
09

Pe
rc

en
ta

g
e

Figure 30f: Percentage of multiple births among births in SA

0

1

2

3

4

19
85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

19
94

19
95

19
96

19
97

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99

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20
08

20
09

Year

Pe
rc

en
ta

g
e

Pregnancy Outcome in South Australia 2009page 78

Trends in Perinatal Statistics in South Australia



Figure 30g: Percentage of low birthweight babies among births in SA

0

2

4

6

8
19

85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

19
94

19
95

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96

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97

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99

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05

20
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Year

Pe
rc

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g
e

Figure 30h: SA standardised perinatal mortality ratio (SPMR)

0

50

100

150

19
85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
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Year

SP
M

R

Pregnancy Outcome in South Australia 2009 page  79

Trends in Perinatal Statistics in South Australia



VII. Summary Statistics For 2009

These statistics refer to all live births of any gestation as well as stillbirths of at least 400g birthweight or 20 weeks 
gestation. Sixty-four babies of less than 400g birthweight have been included.

1. Number of births
Reported number of births (from monthly notifications): 19,901

Notified births with Supplementary Birth Records: 19,901

Notified women who gave birth with SBRs: 19,604

Crude birth rate: 12.3 live births per 1,000 population.

Total fertility rate: 1.87 live births per woman

2. Place of birth
Home births: 134 home births in all (0.7%), of which 125 were planned home births (0.6% of births in the state). 

Metropolitan teaching hospitals: 10,680 (53.7%)

Metropolitan private hospitals: 5,119 (25.7%)

Country hospitals: 3,967 (19.9%)

3. Sex
Males 10,338, Females 9,563. Male: Female sex ratio = 1.08:1

4. Plurality and condition at birth

Condition at birth
Plurality

Total
Singleton Twins Triplets

Live birth 19,180 569 12 19,761

Stillbirth 131 9 0 140

Total 19,311 578 12 19,901

5. Race of women

Race Number of women %

Caucasian 19,655 85.0

Aboriginal 607 3.1

Asian 1,585 8.1

Other 757 3.8

Total 19,604 100.0

Pregnancy Outcome in South Australia 2009page 80

Trends in Perinatal Statistics in South Australia



6. Obstetric interventions in 19,604 women who gave birth
Induction of labour was performed for 5,770 women (29.4%) and labour was augmented for another 4,286 women 
(21.9%) who gave birth.

Forceps were utilised for 902 women (4.6%), ventouse in 1,416 (7.2%) and episiotomy was performed for 2,245 
women who gave birth (11.5%, or 16.9% of women who gave birth vaginally).

Caesarean section was performed in 6,357 women who gave birth (32.4%), of which 3,084 (15.7%) were elective, 
and 3,273 (16.7%) emergency operations.

7. Low birthweight (&lt;2,500g)
Number of singleton births of low birthweight =1,105 (5.7% of singleton births).

Number of multiple births of low birthweight =353 (59.8% of multiple births).

Number of all births of low birthweight =1,458 (7.3% of all births).

8. Congenital abnormalities
Births notified with congenital abnormalities: 539 (2.7%).

9. Perinatal morality rates (numbers of deaths in parentheses)

Birthweight/Gestation
Stillbirth rate per 

1,000 births
Neonatal death rate per 

1,000 live births
Perinatal mortality rate 

per 1,000 births

1 ?400g/20 weeks (including live births 
of any gestation)

(140)    7.0 (49)    2.5 (189)    9.5

2 ?500g/22 weeks if birthweight 
unavailable
(WHO National Statistics*)

(70)    3.5 (27)    1.4* (97)     4.9*

3 ?1,000g/28 weeks if birthweight 
unavailable (WHO International/ 
Standard Statistics*)

(51)    2.6 (18)    0.9* (69)     3.5*

* Only neonatal deaths within the first 7 days of life are included.

10. Terminations of pregnancy
Total number of terminations notified: 5,054

Abortion rate per 1,000 women (15-44 years): 15.6

Total abortion rate per 1,000 women (15-44 years): 471.5

Total first abortion rate per 1,000 women (15-44 years): 313.5

Abortion proportion: 0.20

Pregnancy Outcome in South Australia 2009 page  81

Summary Statistics for 2009



References

1. Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record. 
Adelaide: Pregnancy Outcome Statistics Unit , South Australian Department of Health, 2006.

2. The South Australian Birth Defects Register. 2006 Annual Report. Adelaide: Women s and Children s Hospital, 
Children, Youth and Women s Health Service, 2009.

3. Maternal, Perinatal and Infant Mortality Committee. Maternal, Perinatal and Infant Mortality in South Australia 
2008. Adelaide: SA Health, Government of South Australia, 2009.

4. Strategy and Operations Service, Statewide Services Division. Operational Policy, Guidelines and Standards for 
Maternal and Neonatal Services in South Australia. Adelaide: Department of Human Services, 2000.

5. South Australian Health Commission. Report of the South Australian Birthing Services Working Group. Adelaide: 
Social Health and Policy Development Branch, South Australian Health Commission, 1994.

6. South Australian Abortion Reporting Committee. Seventh Annual Report - For the Year 2009. Adelaide:  SA 
Health, Government of South Australia, 2011.

7. South Australian Health Commission Epidemiology Branch. Risk factors for adverse perinatal outcome: 
determination from a perinatal statistics collection. Adelaide: South Australian Health Commission, December 
1986.

8. Mallett R, Knox EG. Standardized perinatal mortality ratios: technique, utility and interpretation. Community Med 
1979; 1: 6-13.

9. Roberts CL, Lancaster PAL. Australian national birthweight percentiles by gestational age. MJA 1999;170:114-8.

10. Women s Hospitals Australasia. Supporting Excellence in Maternity Care. The Core Maternity Indicators Project. 
Turner, Australian Capital Territory: Women s Hospitals Australasia, 2007.

11. Breslow NE, Day NE. Statistical methods in cancer research Vol II. The design and analysis of cohort studies. Lyon: 
International Agency for Research on Cancer, 1987.

Publications

The following is a list of publications from 1985 from the Pregnancy Outcome Unit or which utilised data from  
the Unit.

Annual Reports
1. Pregnancy Outcome in South Australia (from 1985), website:  

www.health.sa.gov.au/pehs/pregnancyoutcome.htm.

2. Maternal, Perinatal and Infant Mortality in South Australia. Annual Report of the Maternal, Perinatal &amp; Infant 
Mortality Committee (from 1985), website: www.health.sa.gov.au/pehs/pregnancyoutcome.htm.

3. Committee appointed to examine and report on abortions notified in South Australia Annual Report  (from 
1985 to 2002). South Australian Abortion Reporting Committee Annual Report (from 2003).

4. Pregnancy and Neonatal Care Bulletin (from 1985): for individual hospitals.

The Unit provides birth defects data to the South Australian Birth Defects Register at the Women s and Children s 
Hospital and perinatal and birth defects data to the Australian Institute of Health and Welfare National Perinatal 
Statistics Unit in Sydney for their reports.

Pregnancy Outcome in South Australia 2009page 82

Trends in Perinatal Statistics in South Australia




These reports are as follows:

The South Australian Birth Defects Register Annual Report (from 1986).1. 

South Australian Birth Defects Register,  Public Health Research Unit, Women s and Children s Hospital, Children, 
Youth and Women s Health  Service, 72 King William Road, North Adelaide, South Australia 5006. 

Telephone (08) 81616518

 Website: www.wch.sa.gov.au/services/az/other/phru/birthdefect.html

Australia s Mothers and Babies (from 1991) and 2. 

Congenital anomalies in Australia  (from 1981) 3. 

AIHW National Perinatal Statistics Unit, Sydney Children s Hospital, Level 2, McNevin Dickson Building, Randwick 
Hospital Campus, Randwick NSW 2031. 

Telephone (02) 9382 1014 

Website: www.npsu.unsw.edu.au 

Other reports/papers

1  Birth defects

1. Jonas O, Stern LM, Macharper T. A South Australian Study of Pregnancy and Birth Risk Factors associated with 
Cerebral Palsy. Int J Rehab Research 1989; 12 (2): 159-166.

2. Chan A, Robertson EF, Haan EA, Keane RJ, Ranieri E, Carney A. Prevalence of neural tube defects in South 
Australia, 1966   91: effectiveness and impact of prenatal diagnosis. BMJ 1993; 307: 703-6.

3. Bower C, Norwood F, Knowles S, Chambers H, Haan E, Chan A. Amniotic band syndrome: a population-based 
study in two Australian States. Paediatr Perinat Epidemiol 1993; 7: 395-403.

4. Chan A, Robertson E, Haan E, Ranieri E, Keane R. The sensitivity of ultrasound and serum alpha-fetoprotein 
in population-based antenatal screening for neural tube defects in South Australia 1986-1991. Br J Obstet 
Gynaecol 1995; 102 :370-376.

5. Chan A, Keane RJ, Hanna M, Abbott M. Terminations of pregnancy for exposure to oral retinoids in South 
Australia, 1985-1993. Aust NZ J Obstet Gynaecol. 1995; 35 : 422-426.

6. Byron-Scott R, Chan A, Haan EA, Bower C, Scott H, Clark K. A population-based study of abdominal wall 
defects in South Australia and Western Australia. Proceedings, 14th Annual  Congress Australian Perinatal 
Society, Adelaide, March 1996, P82.

7. Chan A, Hanna M, Abbott M, Keane RJ. Oral retinoids and pregnancy. MJA 1996;165: 164-167.

8. Chan A, McCaul KA, Cundy P, Haan EA, Byron-Scott R. Perinatal risk factors for developmental dysplasia of the 
hip. Arch Dis Child 1997; 76 : F94   F100.

9. Yiv BC, Saidin R, Cundy PJ, Tgetgel JD, Aguilar J, McCaul KA, Keane RJ, Chan A, Scott H. Developmental 
dysplasia of the hip in South Australia in 1991: Prevalence and risk factors. J. Paediatr Child Health 1997; 33: 
151-6.

10. Cheffins T, Chan A, Keane RJ. The effects of rubella immunisation in South Australia. Proceedings, Rights to 
Health 29th Annual Conference, Public Health Association of Australia Inc., Melbourne, 5-8 October 1997.

11. Byron-Scott R, Haan E, Chan A, Bower C, Scott H, Clark K. A population-based study of abdominal wall 
defects in South Australia and Western Australia. Paediatr Perinat Epidemiol. 1998; 12: 136-151.

12. Cheffins T,  Chan A, Keane RJ, Hann EA, Hall R. The impact of rubella immunisation on the incidence of 
rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia. Br J 
Obstet Gynaecol 1998; 105: 998-1004.

13. Chan A, McCaul K, Keane RJ, Haan EA. Effect of parity, gravidity, previous miscarriage, and age on the risk of 
Down s syndrome : population-based study. BMJ 1998; 317: 923-4.

Pregnancy Outcome in South Australia 2009 page  83

References




14. Byron-Scott R. et al. A validation study of congenital heart defects in South Australia. Proceedings, Australian 
Birth Defects Society. Annual Scientific Meeting. Sydney 1998.

15. Byron-Scott R. et al. A comparison of selected birth defects in Aboriginal and non-Aboriginal babies in South 
Australia. Proceedings, Australian Birth Defects Society. Annual Scientific Meeting, Sydney 1998.

16. Byron-Scott R. Richardson M, Hiller J, Chan A, Haan E, Knight B, Adams P. The prevalence and validation of 
congenital heart defects in South Australia, 1986-94. Proceedings of the 3rd Annual Congress of the Perinatal 
Society of Australia and New Zealand, Melbourne, 1999. P153.

17. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Late diagnosis of congenital dislocation of the hip and 
presence of a screening programme. South Australian population-based study. Lancet 1999;354:1514-17.

18. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Screening for congenital dislocation of the hip (letter). 
Lancet 2000;355:232-33.

19. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ.  Folate before pregnancy : the 
impact of a South Australian health promotion campaign on women and health professionals. Western 
Australian Birth Defects Registry Twentieth Anniversary Scientific Symposium April 27-28, 2000. Perth, 
Western Australia. Teratology 2000;62: 365.

20. Cheffins T, Chan A, Haan EA, Ranieri E, Ryall RG, Keane RJ, Byron-Scott R, Scott H, Gjerde EM, Nguyen A-M, 
Ford JH, Sykes S. The impact of maternal serum screening on the birth  revalence of Down s syndrome and the 
use of amniocentesis and chorionic villus sampling in South Australia. Br J Obstet Gynaecol 2000;107:1453-9.

21. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ.  Folate before pregnancy :the 
impact on women and health professionals of a population-based health promotion campaign in South 
Australia. MJA 2001; 174:631-636.

22. Chan A, Foster BK, Cundy PJ. Invited commentary. Problems in the diagnosis of neonatal hip instablity. Acta 
Paediatr 2001;90:836-9.

23. Metz MP, Ranieri E, Gerace RL, Priest KR, Luke CG, Chan A. Newborn screening in South Australia: is it 
universal? MJA 2003;179:412-415.

24. Chan A. Invited commentary: Parity and the risk of Down syndrome   caution in interpretation. Am J 
Epidemiol 2003;158:509-511.

25. Gibson CS, MacLennan AH, Hague WM, Rudzki Z, Sharpe P, Chan A, Dekker GA. Fetal thrombophilic 
polymorphisms are not a risk factor for cerebral palsy. Perinatal Society of Australia and New Zealand 8th 
Annual Congress, Convention Centre, Darling Harbour, Sydney, Australia, 15th-18th March 2004, A41.

26. Gibson CS, MacLennan AH, Rudzki Z, Hague WM, Haan EA, Sharpe P, Priest K, Chan A, Dekker GA for the 
South Australian Cerebral Palsy Research Group. The prevalence of inherited thrombophilias in a Caucasian 
Australian population. Pathology  2005;37:160-163.

27. Byron-Scott R, Sharpe P, Hasler C, Cundy P, Hirte C, Chan A, Scott H, Baghurst PB, Haan E. A South Australian 
population-based study of congenital talipes equivarus. Paediatr Perinat Epidemiol  2005;19:227-237.

28. Gibson CS, MacLennan AH, Hague WM, Haan E, Priest K, Chan A, Dekker GA  for the South Australian 
Cerebral Palsy Research Group. Associations between inherited thrombophilias, gestational age and cerebral 
palsy. Am J Obstet Gynecol 2005;193:1437.e1-1437.e12.

29. Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in South Australia 1986-
2000: a population-based cohort study. Birth Defects Research Part A  Clin Mol Teratol 2005:73;605-611.

30. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral 
Palsy Research Group. Neurotropic viruses and cerebral palsy: a population bases case-control study. BMJ 
,doi:10.1136/bmj.38668.616806.3A (published 6 January 2006).

31. Sharpe PB, Mulpuri K, Chan A, Cundy P. Differences in risk factors between early and late diagnosed DDH. 
Arch Dis Child 2006;91:F158-162.

32. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral 
Palsy Research Group. The association between inherited cytokine polymorphisms and cerebral palsy. Am J 

Pregnancy Outcome in South Australia 2009page 84

References



Obstet Gynecol 2006;194: 674.e1-674.e11.

33. Gibson CS, MacLennan AH, Janssen NG, Kist WJ, Hague WM, Haan EA, Goldwater PN, Priest K, Dekker GA 
for the South Australian Cerebral Palsy Research Group. Associations between fetal inherited thrombophilia 
and adverse pregnancy outcomes. Am J Obstet Gynecol  2006; 194: 947.e1-947.e10.

34. Gibson CS, MacLennan AH, Dekker GA, Goldwater PN, Dambrosia JM, Munroe DJ, Tsang S,  Stewart C, 
Nelson KB. Genetic polymorphisms and spontaneous preterm birth. Obstet Gynecol 2007;109:384-391.

35. Muller PR, Cocciolone R, Haan EA, Wilkinson C, Scott H, Sage L, Bird R, Hutchinson R, Chan A. Trends in 
state/population-based Down syndrome screening and invasive prenatal testing with the introduction of 
first-trimester combined Down syndrome screening, South Australia, 1995-2005. Am J Obstet Gynecol 
2007;196:315.e1-315.e7.

36. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral 
Palsy Research Group. Mannose-binding lectin haplotypes may be associated with cerebral palsy only after 
perinatal viral exposure. Am J Obstet Gynecol 2008;198:509.e1-509.e8.

37. Khoo NS, van Essen P, Richardson M, Robertson T. Effectiveness of prenatal diagnosis of congenital heart 
defects in South Australia: a population analysis 1999-2003. Aust NZ J Obstet Gynaecol 2008;48:559-563.

38. Chan AC, van Essen P, Scott H, Haan EA, Sage L, Scott J, Gill TK, Nguyen A-M T. Folate awareness and the 
prevalence of neural tube defects in South Australia, 1966-2007. MJA 2008;189: 566-569.

39. Djukic M, Gibson CS, MacLennan AH, Goldwater PN, Haan EA, McMichael G et al. Genetic susceptibility to 
viral exposure may increase the risk of cerebral palsy. Aust NZ J Obstet Gynaecol 2009: 49:247-253.

40. De Souza, Halliday J, Chan A, Bower C, Morris JK. Recurrence risks for trisomies 13,18, and 21. Am J Med 
Genet Part A (In press).

2  Termination of pregnancy

1. Hart G, Macharper T. Medical termination of pregnancy in South Australia 1970-1984. Adelaide: South 
Australian Health Commission, 1986.

2. Chan A, Taylor A. Medical Termination of Pregnancy in South Australia - The First 20 Years 1970-1989. 
Adelaide: Pregnancy Outcome Unit, South Australian Health Commission, December 1991.

3. Chan A, McColl M, Versteeg J, Gameau B, Scanlan C, Pridmore B. A South Australian Study on Contraception 
and Abortion. Public and Environmental Health Service, South Australian Health Commission and Department 
of Obstetrics and Gynaecology, The Queen Elizabeth Hospital, Adelaide, March 1994.

4. Hart G, Macharper T. Clinical aspects of induced abortion in South Australia from 1970-1984. Aust.  
NZ J Obstet Gynaecol 1986; 26: 219-224.

5. Hart G, Macharper T. Induced abortion trends in South Australia. Am J Public Health 1987; 77: 200-202.

6. Chan A, Keane RJ. Prevalence of induced abortion in a reproductive lifetime. Am J Epidemiol  
2004;159:475-480.

7. Chan A, Sage LC. Estimating Australia s abortion rates 1985-2003. MJA  2005;182:447-452.

3  Perinatal epidemiology

1. Connon AF, Macharper T. Teenage pregnancies in South Australia. Adelaide: South Australian Health 
Commission, September 1986.

2. South Australian Health Commission, Epidemiology Branch:  Characteristics of pregnancies and births among 
migrant women in South Australia. Adelaide : South Australian Health Commission, October 1986.

3. South Australian Health Commission, Epidemiology Branch. Risk factors for adverse 

 perinatal outcome: determination from a perinatal statistics collection. Adelaide: South Australian Health 
Commission, December 1986.

Pregnancy Outcome in South Australia 2009 page  85

References



4. South Australian Health Commission, Epidemiology Branch. Variation in perinatal risk by place of residence of 
mother in South Australia. Adelaide: South Australian Health Commission, December 1986.

5. South Australian Health Commission, Epidemiology Branch. Variations in Perinatal Risk by Hospital of Birth in 
South Australia. Adelaide: South Australian Health Commission, January 1987.

6. South Australian Health Commission, Epidemiology Branch. Aboriginal Births in South Australia, 1981-1986: 
An Analysis of Perinatal Outcomes, Adelaide: South Australian Health Commission, May 1988.

7. South Australian Health Commission, Epidemiology Branch: Pregnancy Outcome Attributes by Postcode: South 
Australia 1981-1986. South Australian Health Commission, Adelaide: August 1988.

8. Jonas O, Scott J, Chan A, Macharper T, Lister J. A validation study of the 1986 perinatal data collection form. 
Adelaide: Pregnancy Outcome Unit, South Australian Health Commission, 1991.

9. South Australian Cancer Registry. Associations between perinatal characteristics and risk of childhood cancer: 
South Australian cancer cases born in 1981-1993. In: Epidemiology of Cancer in South Australia. Incidence, 
Mortality and Survival 1977 to 1994. Adelaide South Australian Health Commission, 1995.

10. Taylor A, Twisk A-M, Chan A. Perinatal risk factors by postcode in South Australia 1989-1992. Epidemiology 
Branch, South Australian Health Commission, Adelaide: June 1995.

11. Pregnancy Outcome Unit. Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record. 
Adelaide: South Australian Health Commission, December 1997.

12. McLean A, Scott J, Keane RJ, Sage L, Chan A. Validation of the 1994 South Australian perinatal data collection 
form. Adelaide: Pregnancy Outcome Unit, Department of Human Services, 2001.

13. Hart G, MacHarper T, Moore D, Roder D. Aboriginal pregnancies and births in South Australia. MJA 1985;  
143: S54-56.

14. Chan A, Roder D, Macharper, T. Obstetric Profiles of Immigrant Women from Non-English Speaking Countries 
in South Australia, 1981-83. Aust NZ J Obstet Gynaecol 1988; 28: 90-95.

15. Jonas O, Roder D, Esterman A, Macharper T, Chan A. Pregnancy and Birth Risk Factors for Intellectual Disability 
in South Australia. Eur J Epidemiol 1989; 5: 322-327.

16. Jonas O, Chan A, Macharper T, Roder D. Pregnancy and Perinatal Factors associated with persistently low 
Apgar scores: an analysis of the birth records of infants born in South Australia. Eur J Epidemiol 1990; 6:  
136-141.

17. Crotty M, Ramsay AT, Smart R, Chan A. Planned Homebirths in South Australia 1976-1987 MJA 1990; 153: 
664-671.

18. Jonas O, Chan A, Roder D, Macharper T. Pregnancy Outcomes in primigravid women aged 35 years and over 
in South Australia, 1986-1988.  MJA 1991; 154: 246-249.

19. Zhang B, Chan A. Teenage Pregnancy in South Australia, 1986-1988. Aust. NZ J Obstet Gynaecol 1991;  
31: 291-298.

20. Jonas O, Roder D, Chan A. The Association of Maternal and Socioeconomic Characteristics in Metropolitan 
Adelaide with Medical, Obstetric and Labour Complications and Pregnancy Outcomes. Aust NZ J Obstet 
Gynaecol 1992; 32: 1-5.

21. Chan A, Roder D, Priest K, Esterman A. A perinatal perspective on South Australia in the 1980s. MJA 1992; 
157: 515-518.

22. Jonas O, Roder D, Chan A. The association of low socio-economic status in Metropolitan Adelaide with 
maternal demographic and obstetric characteristics and pregnancy outcome. Eur J Epidemiol 1992; 8:708.

23. Jonas O, Roder D. Breech Presentation in South Australia, 1987-1989. Aust NZ J Obstet Gynaecol 1993;  
33: 17-21.

24. Scott J, Chan A. Planned birthing unit deliveries in South Australia. Proceedings, 14th Annual Congress 
Australian Perinatal Society, Adelaide, March 1996, P21.

25. Dal Grande E, Chan A, Keane R. Asian, but different: Obstetric characteristics of women born in Vietnam 
and Philippines who delivered in South Australia in 1991-1994. Proceedings, 14th Annual Congress Australian 
Perinatal Society, Adelaide, March 1996, P22.

Pregnancy Outcome in South Australia 2009page 86

References



26. Keane R, Dal Grande E, Chan A, McCaul K. Episiotomy   a decline in the cutting edge. Proceedings, 14th 
Annual Congress Australian Perinatal Society, Adelaide, March 1996, P75.

27. Chan A, McPhee AJ. A safer leap into this dangerous world. Lancet 1996; 348 (suppl II) :12.

28. Carter JR, Hiller JE, Ryan P, Chan A. The Association between maternal age and preterm births to primiparous 
women in South Australia, 1991-1993, Proceedings, First Annual Congress, Perinatal Society of Australia and 
New Zealand, Fremantle, Western Australia, 16-24 March 1997.

29. Zhang B, Hiller JE, Chan A. Asthma in pregnancy in South Australia. Proceedings, First Annual Congress, 
Perinatal Society of Australia and New Zealand, Fremantle, Western Australia, 16-24 March 1997.

30. Roder D, Nguyen A-M, Chan A. Trends in perinatal characteristics in South Australia, 1981 to 1994, by place 
of residence of mother. Aust NZ J Public Health 1997; 21: 483-8.

31. Zhang B, Hiller JE, Chan A. Asthma in pregnancy: Association with Spontaneous Preterm Birth. Proceedings of 
the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand, Melbourne, 1999, A113.

32. McLean AP, Hiller JE, Chan A. Maternal epilepsy and fetal outcomes in South Australia. Perinatal Society 
of Australia and New Zealand 4th Annual Congress. Brisbane Convention and Exhibition Centre, Brisbane, 
Australia, 12-15 March 2000, P192.

33. Chan A, Keane RJ, Robinson JS. The contribution of maternal smoking to preterm birth, small for gestational 
age and low birthweight among Aboriginal and non-Aboriginal births in South Australia. MJA 2001;174:  
389-93.

34. van der Klis KAM, Westenberg L, Chan A, Dekker G, Keane RJ. Teenage pregnancy: trends,characteristics and 
outcomes in South Australia and Australia. Aust N Z J Public Health 2002; 26: 125-31.

35. Westenberg L, van der Klis KAM, Chan A, Dekker G, Keane RJ. Aboriginal teenage pregnancies compared with 
non-Aboriginal in South Australia 1995-1999. Aust N Z J Obstet Gynaecol 2002;42: 187-191.

36. Wang JX, Knottnerus A-M, Schuit G, Norman RJ, Chan A, Dekker GA. Surgically obtained sperm and risk of 
gestational hypertension and pre-eclampsia. Lancet 2002;359: 673-4.

37. Jacobs DJ, Vreeburg SA, Dekker GA, Heard AR, Priest KR, Chan A. Risk factors for hypertension during 
pregnancy in South Australia. Aust NZ J Obstet Gynaecol 2003; 3: 421-428.

38. Heard AR, Dekker GA, Chan A, Jacobs DJ, Vreeburg SA, Priest KR. Hypertension during pregnancy in South 
Australia, Part 1: Pregnancy outcomes. Aust NZ J Obstet Gynaecol 2004; 44: 404-409.

39. Vreeburg SA, Jacobs DJ, Dekker GA, Heard AR, Priest KR, Chan A. Hypertension during pregnancy in South 
Australia, Part 2: Risk factors for adverse maternal and/or perinatal outcome   results of multivariable analysis. 
Aust NZ J Obstet Gynaecol 2004;44: 410-418.

40. Leahy K, Elliot E, Kennare R, Chan A. Characteristics and pregnancy outcomes of first time mothers aged 
35 years and over compared to younger first time mothers in South Australia 1991-2002. Before and 
Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual Congress. Adelaide 
Convention Centre, Adelaide, South Australia, 13-16 March 2005, A144.

41. Kennare R, Heard A, Chan A. Substance use during pregnancy: risk factors and obstetric and perinatal 
outcomes in South Australia. Aust NZ J Obstet Gynaecol  2005;45:220-225.

42. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of spontaneous preterm birth. Perinatal 
Society of Australia and New Zealand 10th Annual Congress. Perth Convention Exhibition Centre, Perth, 
Western Australia, 3-6 April 2006, FC17.1, p 165.

43. Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record. 
Adelaide: Pregnancy Outcome Statistics Unit, South Australian Department of Health, 2006.

44. Budde MP, De Lange TE, Dekker GA, Chan  A, Nguyen AM. Risk factors for placental abruption in a socio-
economically disadvantaged region. J Matern Fetal Neonat Med 2007 Sep; 20(9):687-93. 

45. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of pre-term birth: a population study. J 
Matern-Fetal Neonat Med 2009;22(1):1-7.

46. Kennare RM, Keirse MJNC, Tucker GR, Chan AC. Planned home births in South Australia 1991-2006. MJA (In press).

Pregnancy Outcome in South Australia 2009 page  87

References



4  Perinatal mortality

1. Roder D, Chan A, Esterman A. Birthweight   specific trends in perinatal mortality by hospital category in South 
Australia, 1985   1990. MJA 1993; 158: 664-667.

2. Connon AF, Chan A on behalf of the Postneonatal Subcommittee, maternal, perinatal and Inmfant 
Mortality Committee. Accidental deaths of babies in the postneonatal period in South Australia (letter). MJA 
1994;161:397. 

3. Roder D, Chan A, Priest K. Perinatal mortality trends among South Australian Aboriginal births 1981-92. J 
Paediatr Child Health 1995; 31: 446-450.

4. Haslam R, McPhee A, Chan A, Keane R. Neonatal mortality   a system of classification and trends in South 
Australia. Proceedings of the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand, 
Melbourne, 1999. P86.

5. Robson S, Chan A, Keane RJ, Luke CG. Subsequent birth outcomes after an unexplained stillbirth: preliminary 
population-based retrospective cohort study. Aust NZ J Obstet Gynaecol 2001;41: 29-35.

6. Flenady V, Chan A, Haslam R, King J, Tudehope D, McCowan L. Cause specific perinatal mortality in Australia 
and New Zealand using a new clinical classification system (ANZACPM and ANZNDC). Perinatal Society of 
Australia and New Zealand 7th Annual Congress, Hotel Grand Chancellor, Hobart, Tasmania, March 9th-12th 
2003, A87.

7. Dodd JM, Robinson JS, Crowther CA, Chan A. Stillbirth and neonatal outcomes in South Australia, 1991-
2000. Am J Obstet Gynecol 2003;189: 1731-1736.

8. Chan A, King JF, Flenady V, Haslam RH, Tudehope DI. Classification of perinatal deaths: Development of the 
Australian and New Zealand classifications. J Paediatr Child Health 2004;40: 340-347.

9. Flenady V, King J, Chan A, McCowan L, Tudehope D, Haslam R, Charles A, Roberts C for the Perinatal Mortality 
Audit Guidelines Working Party of the PSANZ Perinatal Mortality Special Interest Group. Development of Clinical 
Practice Guideline for Perinatal Mortality Audit incorporating psychological and social aspects of perinatal 
bereavement. Before and Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th 
Annual Congress, Adelaide Convention Centre, Adelaide, South Australia, 13-16 March 2005, P58.

10. De Lange TE, Budde MP, Heard AR, Tucker G, Kennare R, Dekker GA. Avoidable risk factors in perinatal deaths: 
a perinatal audit in South Australia. Aust NZ J Obs Gynaecol 2008;48:50-57.

5  Caesarean section

1. Jonas O, Chan A, Macharper T. Caesarean Section in South Australia, 1986. Aust NZ J Obstet Gynaecol 1989; 
29: 99-106.

2. Chan A. Epidemiology of the rising Caesarean section rate. Proceedings, 14th Annual Congress Australian 
Perinatal Society, Adelaide, March 1996, A70.

3. Chan A, Keane RJ, Scott J. Elective Caesarean section and child deprivation (letter). Lancet 1996; 347: 1196.

4. Kennare, R. Why is the caesarean section rate rising? MIDIRS Midwifery Digest 2003; 13 (4): 503-508.

5. Kennare R, Heard A, Chan A. Is caesarean section in the first birth a problem for women in the next birth? 
Before and Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual Congress. 
Ade;laide Convention Centre, Adelaide, South Australia, March 13-16 2005, A 127. 

6. Kennare R, Tucker G, Heard A, Chan A. Risks of adverse outcomes in the next birth after caesarean delivery. 
Obstet Gynecol 2007;109:270-276.

7. Dekker G, Chan A, Luke C, Priest K, Riley M, Halliday J, King J, Gee V, O Neill M, Snell M, Cull V, Cornes S. 
Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a 
retrospective population-based cohort study. BJOG 2010;117:1358 1365.

Pregnancy Outcome in South Australia 2009page 88

References



Appendix 1: Definitions

Women who gave birth (previously called confinements).: women who gave birth to a live birth of any gestation or 
a stillbirth of at least 400g birthweight or 20 weeks gestation 

Primigravida: A woman pregnant for the first time.

Multigravida: A woman who has been pregnant more than once.

Parity:  the total number of previous pregnancies resulting in live births or stillbirths.

Primipara: pregnant woman who has had no previous pregnancy resulting in a live birth or stillbirth.

Race

1. Caucasian:  individuals of European descent.

2. Aboriginal:  this includes part-Aboriginals as well as full blood Aboriginals.  An Aboriginal is a person of 
Aboriginal descent who identifies as an Aboriginal and is accepted as such by the community in which he or she 
lives.

3. Asian:  (exclude Asia Minor) - In this category, include women originating from all Asian countries, including the 
Indian subcontinent (India, Bangladesh, Pakistan, Nepal, Sri Lanka), who were formerly listed as  Other  race.

4. Torres Strait Islander (TSI): A Torres Strait Islander is a person of Torres Strait Islander descent who identifies as a 
Torres Strait Islander and is accepted as such by the community in which he or she lives.

5. Aboriginal &amp; TSI: persons of both Aboriginal and Torres Strait Islander descent. 

6.  Other:  Races other than (1) - (5).  Include women from the Middle East and Africa.

Guidelines for use regarding Indigenous Status - categories (2), (4) and (5).

There are three components to the definition:

descent &gt;

self identification &gt;

community acceptance &gt;

It is not possible to collect the three components of the definition in a single question. The Australian Bureau of 
Statistics (ABS) proposes that the focus of a single question should be the descent, the first component of the 
definition. The ABS therefore proposes the use of the following alternative questions, depending on whether the 
person is present or not.

Where the person is present :  Are you of Aboriginal or Torres Strait Islander origin? ;

OR

where the person is not present and someone who knows the person well responds for him/her:  Is the person of 
Aboriginal or Torres Strait Islander origin? 

If the response is  Yes , then clarify whether the person is of Aboriginal origin (2), Torres Strait Islander origin (4) or 
both Aboriginal and Torres Strait Islander origin (5).

Self reporting of descent is not equivalent to self reporting of identity but because of the absence of a second 
 identity  question some respondents will interpret the  origin  question to mean both descent and identification. 
What identification in the context of the variable Indigenous Status should measure is an individual s self assessed 
historical and cultural affiliation.

Body Mass Index (BMI):  weight ( in kg)  height2 (in metres).

This is used as a standard for recording obesity statistics and also as a measure of underweight. However the 
categories do not take into account factors such as frame size, muscularity, varying proportions of components such 
as fat, bone, cartilage and water, and may be misleading in athletes, children and some ethnic groups. The categories 
for describing weight using BMI are:

Pregnancy Outcome in South Australia 2009 page  89

References



BMI category Name

&lt;18.5 Underweight

18.5-24.9 Normal

25-29.9 Overweight

30-34.9 Obese

35-39.9 Severely obese

40 or greater Morbidly obese.

Induction of labour:  An intervention undertaken to stimulate the onset of labour by pharmacological or  
other means.

Caesarean section: Birth of a child by an abdominal operation.

Elective caesarean section:  One which takes place as a planned procedure before the spontaneous onset of labour.

Emergency caesarean section:  One which is undertaken for a complication:

(a) before the onset of labour or

(b) during labour, whether that labour is of spontaneous onset or following induction of labour.

Gestational age:  The duration of pregnancy in completed weeks from the first day of the last normal  
menstrual period.

Preterm: less than 37 completed weeks gestation.

Birthweight: The first weight of a fetus or newborn obtained after birth.  This is preferably measured within the first 
hour of life before significant post-natal weight loss has occurred.

Low birthweight:  Birthweight of less than 2,500g.

Very low birthweight:  Birthweight of less than 1,500g.

Congenital abnormality:  Any defect probably of prenatal origin; thus structural, chromosomal and biochemical 
defects are included. An exclusion list of isolated minor abnormalities is provided by the Unit. Abnormalities are 
classified as major if they are either lethal or significantly affect the individual s function or appearance.

Apgar score: A numerical scoring system applied after birth (usually at 1 minute and again at 5 minutes) to evaluate 
the condition of the baby, as specified below:

Sign

Score

0 1 2

Heart rate Absent Slow (below 100) Over 100

Respiratory effort Absent Slow, irregular Good, crying

Muscle tone Flaccid Some flexion of extremities Active motion

Reflex irritability No response Grimace Vigorous cry

Colour Blue, pale Body pink, extremities blue Completely pink

Live birth: The complete expulsion or extraction from its mother of a product of conception, irrespective of the 
duration of pregnancy, which after such separation breathes or shows any other evidence of life, such as beating of 
the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical 
cord has been cut or the placenta is attached.

Pregnancy Outcome in South Australia 2009page 90

Appendix



Crude birth rate:

Average population in that year

Number of live births in any year
x 1,000=  

Age-specific fertility rate:

Estimated resident population of women of that age group in the same year

Number of live births to women in an age group in a year
x 1,000

General fertility rate:

Total number of live births in a year

Estimated resident population of women aged 15-44 years in the same year
x 1,000

Total fertility rate (TFR): the sum of age-specific fertility rates (live births at each age of women per female 
population of that age). It represents the number of children a woman would bear during her lifetime if she 
experienced current age-specific fertility rates at each age of her reproductive life. 

Fetal death: Death prior to the complete expulsion or extraction from a woman of a product of conception, 
irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the fetus does 
not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or 
definite movement of voluntary muscles.

Early fetal death:  Death in a fetus of less than 400g birthweight, and of less than 20 weeks gestation. A 
miscarriage is a spontaneous early fetal death.

Late fetal death or stillbirth:  Death in a fetus of at least 400g birthweight, or of at least 20 weeks gestation.

Late fetal death rate or stillbirth rate:

Number of live births and stillbirths in that year

Number of late fetal deaths or stillbirths in any year
x 1,000=

Neonatal death: Death of a liveborn infant within 28 days of birth.

Neonatal death rate: 

Number of live births in that year

Number of neonatal deaths in any year
x 1,000=

Perinatal death:  Includes late fetal death (stillbirth) and neonatal death.

Perinatal mortality rate (PMR):

Number of stillbirths and live births

Number of stillbirths and neonatal deaths
x 1,000=

For South Australian statistics, the rate refers to live births of any gestation and stillbirths of at least 400g birthweight 
or 20 weeks gestation.

For national statistics, the rate refers to all births of at least 500g birthweight, or when birthweight is unavailable, 
of at least 22 weeks gestation (as recommended by the World Health Organisation (WHO)) and neonatal deaths 
occurring within seven days of birth.

For international comparison, the rate refers to all births of at least 1,000 g birthweight or, when birthweight 
is unavailable, of at least 28 weeks gestation and neonatal deaths occurring within seven days of birth (as 
recommended by WHO).

Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, 
irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy 
or its management  but not from accidental or incidental causes.1

1  World Health Organisation. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Volume 2. 
Geneva: WHO, 1993, p 134.

Pregnancy Outcome in South Australia 2009 page  91

Appendix



Maternal deaths are divided into two groups:

1. Direct obstetric deaths: those resulting from obstetric complications of the pregnant state (pregnancy, labour  
and puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any 
of the above.

2. Indirect obstetric deaths: those resulting from previous existing disease or disease that developed during 
pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects  
of pregnancy.

As an extension of the WHO definition, accidental and incidental deaths occurring in pregnant women are also 
reviewed by the Maternal, Perinatal and Infant Mortality Committee so as to avoid missing indirect deaths which may 
be difficult to distinguish from incidental deaths. Examples of incidental deaths are deaths from drowning and road 
accidents, where the pregnancy is unlikely to have contributed significantly to the death, although it may be possible 
to postulate a remote association.

Termination of pregnancy:  Termination performed by a medical practitioner in a prescribed hospital in South 
Australia, on specified grounds under the Criminal Law Consolidation Act and notified under the Criminal Law 
Consolidation (Medical Termination of Pregnancy) Regulations 1996. Terminations of pregnancy at gestations of  
20 weeks or later or where the fetus weighs at least 400g, performed by induction of labour resulting in a birth   
are included in the South Australian perinatal data collection. These are usually for congenital abnormalities or 
medical reasons.

Abortion rate:

Estimated resident population of same group in the same year

Number of induced abortions in a group of women in a year
x 1,000=

The abortion rate per 1,000 women in the reproductive age group 15-44 years has been calculated in this report 
using as the numerator all abortions; the denominator used has been the estimated resident population for women 
aged 15-44 years in that year.

Abortion proportion:

 
Abortions + live births

Abortions
=

This is often called the abortion ratio, which is strictly:  
Live births

Abortion

Total abortion rate = the sum of the five-year age-specific abortion rates multiplied by 5.  

This represents the number of abortions 1,000 women would have during their lifetime if they experienced the rates 
of the year shown.

Pregnancy Outcome in South Australia 2009page 92

Appendix



Appendix 2: 2009 Supplementary Birth Record Form

17 Type of antenatal care
 1.  ? No antenatal care
 2.  ? Hospital clinic
 3.  ? Obstetrician in private practice
 4.  ? General practitioner
 5.  ? Birth centre
 6.  ? Home birth midwife
 7.  ? Obstetrician/midwife  
   (shared care) in private practice
 8.  ? GP/midwife (shared care)
 9.  ? Other (specify) ............................................
 10. ? Not stated
18 Tobacco smoking status at first visit
 1.  Smoker
 2.  Quit in pregnancy before first visit
 3.  Non smoker
 4.  Unknown smoking status
19 Average number of tobacco cigarettes  
 smoked per day in 2nd half of pregnancy
 ? None
 ? Number per day = ............................................
 ? &lt;1 (occasional)
 ? Unknown number 
20 Medical conditions present in this  
 pregnancy
 1. ? None
 2.  ? Anaemia
 3.  ? Urinary tract  
   infection
 4. ? Hypertension  
   (pre-existing)
 5.  ? Diabetes  
   (pre-existing)
 6.  ? Epilepsy
 7.  ? Asthma
 8.  ? Other (specify) ............................................
21 Obstetric complications
 1. ? None
 2. ? Threatened 
   miscarriage
 3. ? APH - Abruption
 4. ? APH - Placenta  
   praevia
 5. ? APH - Other &amp;  
   unknown cause
 6. ? Pregnancy hypertension (all types)
 7. ? Suspected IUGR
 8. ? Gestational diabetes
 9. ? Other (specify, including impaired  
   glucose tolerance)
    ...................................................................
22 Date of admission prior to delivery

 day month year
23  Procedures performed in this pregnancy
Tick if Yes        Tick if Unknown
 1. ? MSAFP (NTD etc) ?
 2. ? Triple/Quadruple screen ?  
   (Down s etc) 
 3. ? Ultrasound examination ?
 4. ? Chorion villus sampling ?
 5. ? Amniocentesis ?
 6. ? Cordocentesis ?
 7. ? Other surgical procedures (specify)
    ...................................................................

LABOUR  AND  DELIVERY
24 Onset of labour
 1. Spontaneous
 2. No labour (LSCS)
 3. Induction (excluding augmentation) 
 Give reason/s for induction 
 (If postdates, state T+ ..............  days)

  ....................................................................

  ....................................................................
25 If induction, or augmentation after  
 spontaneous onset, specify method/s
 1. ? ARM
 2. ? Oxytocics
 3. ? Prostaglandins
 4. ? Other (specify) ............................................
26 Presentation prior to delivery
 1.  Vertex 
 2.  Breech
 3.  Face 
 4.  Brow
 5.  Other 
 6.  Unknown

4 Hour of birth 
 (24 hour clock)
5 Sex
 1.  Male  
 2.  Female  
 3.  Indeterminate
6 Birthweight (grams)
7 Gestation at birth 
 (best clinical estimate in weeks)

CONDITION  AT  BIRTH

8 Apgar Score      1 minute

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

 1. ? None    
 2. ? Fracture
 3. ? Dislocation    
 4. ? Nerve injury
 5. ? Other (specify)

    ...................................................................
12 Congenital abnormalities
 1.  ? Nil apparent     
 2.  ? Yes (specify)

  ....................................................................

  ....................................................................

  ....................................................................

  ....................................................................

  ....................................................................

  ....................................................................
13 Treatment given
 1.  ? None of the treatments below
 2.  ? Oxygen therapy &gt; 4 hours
 3.  ? Phototherapy for jaundice
 4.  ? Gavage feeding more than once
 5.  ? Any intravenous therapy

14 Nursery care required
 1.  ? Level 1 only
 2.  ? Special nursery (Level 2)

 Number of days .......................
 3.  ? Neonatal Intensive Care Unit (NICU) 
   - FMC/WCH (Level 3)

 Number of days .......................
 4.  ? Paediatric Intensive Care Unit (PICU)  
   - WCH

 Number of days .......................
15 Was transfer to NICU/PICU for a  
 congenital abnormality?
 ? Yes 
 ? No

OUTCOME OF BABY
16 Outcome of baby
 1.  Fetal death
 2.  Discharged
 3.  In hospital at 28 days
 4.  Neonatal death
17 Baby transferred to

  ....................................................................
 on

   day  month   year

18 Date of final discharge (or death)

   day month  year

2009 SUPPLEMENTARY BIRTH RECORD

Mother s name .............................................................................................................................
 Surname Given Names

Child s surname (if different) ........................................................................................................

Mother s address .........................................................................................................................

..................................................................................................... Postcode

Personal information above this line is con?dential                      SLA

MOTHER S  INFORMATION

1 Mother s date of birth

 day month year
2 Race
 1.  Caucasian    
 2.  Aboriginal    
 3.  Asian
 4.  Torres Strait Islander (TSI)
 5.  Aboriginal &amp; TSI    
 6.  Other
3 Country of birth

  ....................................................................
4 Type of patient
 1. Hospital/Public    
 2.  Private
5 Marital status
 1.  Never married    
 2.  Married/De facto 
  3.  Widowed            
 4.  Divorced 
 5.  Separated

OCCUPATION

6 Baby s father

  ....................................................................

 Baby s mother

  ....................................................................
PREVIOUS  PREGNANCY  OUTCOMES

7 Number of previous pregnancies 

8 Number of previous pregnancies resulting 
 in births &gt;20 weeks (parity)

9 Number of previous outcomes
                                                     Singleton      Multiple

 Livebirths, not neonatal deaths

 Livebirths, neonatal deaths

 Stillbirths

 Miscarriages

 Ectopic pregnancies

 Terminations of pregnancy

10 Outcome of last pregnancy

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

                                 month          year
12 Method of delivery in last birth
 0. No previous birth     
 1. Vaginal
 2. Caesarean  
 9. Not known
13 Number of previous caesareans

THIS  PREGNANCY

14 Date of last menstrual period 

               day            month          year
15 Intended place of birth
 1. Hospital          
 2. Birth centre
 3. Home        
 4. Other (specify)  ..................................................
 5. Not booked
16a Number of antenatal visits
16b First antenatal visit

 Gestation (weeks)

 Height (cm)

 Weight (kg)

 BMI

Please return top copy to: 
Pregnancy Outcome Unit, PO Box 6, 

Rundle Mall, Adelaide SA  5000

27 Method of delivery
 1.  Normal spontaneous
 2.  Forceps
 3.  Assisted breech (no forceps)
 4.  LSCS (elective)
 5.  LSCS (emergency) 
  If LSCS state reason/s: 
    ...................................................................
 6.  Ventouse 
 7.  Breech extraction            
 8.  Breech spontaneous
 9.  Unknown
 10.   Assisted breech (with forceps for head)
28 Complications of labour, delivery and 
 puerperium
 1. ? None
 2. ? PPH (Primary)
   ?600 - 999ml
   ?1000ml or more
 3. ? Fetal distress
 4. ? Retained placenta
 5. ? Prolonged labour  
   (&gt;18 hrs)
 6. ? Cord prolapse
 7. ? Wound infection
 8. ? Failure to progress (specify)
    ...................................................................
 9. ? Other (specify)
    ...................................................................
29 Perineal status after delivery
 Tick tear, repair &amp; episiotomy if all
 1. ? Intact
 2.  ? 1st degree tear/vaginal graze    
 3.  ? 2nd degree tear
 4.  ? 3rd degree tear
 5.  ? 4th degree tear
 6.  ? Repair of tear 
 7.  ? Episiotomy
 8.  ? Other (specify) ...........................................
 9.  ? Not stated
30 CTG performed during labour
 1.  None               
 2.  External    
 3.  Scalp clip
31 Fetal scalp pH taken during labour
 1.  No                   
 2.  Yes
32 Analgesia for labour
 1.  ? None
 2.  ? Nitrous oxide and oxygen
 3.  ? Narcotic (parenteral)
 4.  ? Epidural (lumbar/caudal)
 5.  ? Spinal 
 6.  ? Other (specify) ............................................
 7.  ? Combined spinal-epidural
33 Anaesthesia for delivery
 1.  ? None
 2.  ? Local anaesthesia to perineum
 3.  ? Pudendal
 4.  ? Epidural (lumbar/caudal)
 5.  ? Spinal 
 6.  ? General anaesthesia
 7.  ? Other (specify) ............................................
 8.  ? Combined spinal-epidural
34 Mother s outcome for birth hospital/  
 home birth
 1.  ? Discharged    
 2.  ? Transferred   
 3.  ? Died
 Transferred to ........................................................
 on

 day month year
35 MOTHER S  FINAL  DISCHARGE/DEATH

 Date

 day month year

BABY  DETAILS

1 Case record  number

2 Place of birth
 1.  Hospital     
 2.  BBA
 3.  Domicilary   
 4.  Birthing unit/centre
3 Date of delivery

 day month year

4    0    9

FOR COMPLETION BY MIDWIVES AND NEONATAL NURSES

Hospital/Place of birth.........................................................

Mother s Case Record Number ..........................................

Plurality  (1=single, 2=twin, 3=triplet, 4=quad)

For multiple births,  please complete a separate baby form for each baby.

.

Pregnancy Outcome in South Australia 2009 page  93

Appendix



Appendix 3: Congenital Abnormality Form

Pregnancy Outcome in South Australia 2009page 94

Appendix



For more information 

SA Health 
Pregnancy Outcome (Statistics) Unit  
Epidemiology Branch 
162 Grenfell Street  
Adelaide 5000 South Australia

Postal Address 
SA Health 
Pregnancy Outcome (Statistics) Unit 
PO Box 6, Rundle Mall,  
Adelaide 5000 South Australia 
Telephone: (08) 8226-6382 
Fax: (08) 8226-6291 
Web:  www.health.sa.gov.au/pehs/pregnancyoutcome.htm 

www.dh.sa.gov.au/pehs/pregnancyoutcome.htm

E-mail:  Pregnancy.Stats@health.sa.gov.au

If you require this information in an alternative language or format please contact  
SA Health on the details provided above and they will make every effort to assist you.

  Department of Health, Government of South Australia.  
All rights reserved. ISSN: 0819-3835    
FIS: 11105.1. Printed July 2011.


	Acknowledgements 
	Executive Summary
	I. Introduction
	II. Mothers and Babies: Characteristics and Outcomes
	III. Terminations of Pregnancy
	IV. Obstetric Profiles by Hospital Category
	V. Clinical and Maternity Performance Indicators
	VI. Trends in Perinatal Statistics in South Australia, 1981 2008
	VII. Summary statistics for 2008
	References
	Publications
		Annual Reports
	Other reports/papers




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