The Western Australia’s Mothers and Babies 2015 report providing statistics on pregnancy, labour and birth for WA has just been released. I have summarised the main points of interest to me here, but if you’d like to read the full review, you can find it here.
Place of Intended Birth
As you can see below, the overwhelming majority of births in WA were intended to be in hospital (97.5%). 1.8% of births were intended to be in birth centres and only 0.8% of births were intended to be at home. Yes this equals just over 100% – I’m guessing due to rounding.
Of intended home births, 76.2% were successful and of intended birth centre births, 61.2% were successful.
Complications of Pregnancy
69.7% of pregnancies had NO complications, 30.3% had one or more complications. Gestational diabetes was the most common aside from ‘other’.
Onset, Induction and Augmentation of Labour
Onset of labour can be spontaneous, induced or never occur. 48.6% of labours were spontaneous, 30.1% were induced and for 21.3% no labour occurred (c-section before labour).
Of the spontaneous labours, 36% had labour augmented. Augmentation is when the membranes are artificially ruptured or synthetic oxytocin is given (or both) in an attempt to ‘speed things up’.
So as a whole 31.1% of ALL labours occurred spontaneously and were not augmented. That’s a low percentage of all births to be untouched by augmentation or induction of some kind.
Of the births that were induced, 53.9% resulted in spontaneous vaginal birth, 23.1% resulted in assisted vaginal birth (vacuum or forceps) and 22.9% resulted in emergency c-section. These figures do not account for any augmented births and I couldn’t find these statistics in the report.
Caesarean Section by Maternity Service
Below is a breakdown of the major hospitals for WA and their vaginal vs caesarean rates for 2015. Most alarming is SJOG Murdoch with a higher caesarean rate than vaginal birth rate.
It is worth remembering that the World Health Organisation (WHO) recommends a caesarean rate of 10-15%. There is some work to be done here.
Complications of Labour and Birth
59.2% experienced a complication of labour and birth, although some ‘complications’ such as failure to progress (more correctly known as failure to wait!) and previous caesarean section are questionable complications.
Aside from the ‘other’ category, the most prevalent complication was postpartum haemorrhage (PPH) at 24.6%. PPH is considered 500ml or more and reporting on this data has changed since 2012. In 2004 the PPH rate was 9.8%. Although the reporting has changed since 2012 and may in part account for this increase, I still find that alarming. Something about the way third stage is occurring is not right and needs to be investigated.
PPH is significantly more prevalent in caesareans, at 39.8% compared to about 16% for vaginal births (exact amount could not be located in report).
Reason for Caesarean Section
Of those who had a c-section in 2015, 40.8% reported the reason as being a previous c-section. Please know that if you have had a previous c-section, a vaginal birth is possible! Many people are led to believe that their only option is another c-section however this is NOT the case. It is really important to find a provider who will support a VBAC (vaginal birth after caesarean section) so that you aren’t fighting an uphill battle.
18.3% of c-sections were reported as being due to ‘failure to progress’. This is more likely a case of failure to wait. Sometime labour progress takes time! Of course if it is a decision made by the person birthing that is a different scenario to a care provider saying that no progress has been made in x hours therefore a c-section is warranted. If you and baby are ok – you can absolutely give it more time.
Repair of Perineum and/or Vagina
The majority of vaginal births experienced a 1st or 2nd degree perineal tear (39.4%), followed by no notable tearing (32.9%).
Interestingly, the majority of 3rd and 4th degree tears were in relation to the use of forceps for assisted birth – likely as there was no episiotomy in these cases. 22.9% of vaginal births had an episiotomy – most significantly with the use of vacuum or forceps.
Perinatal deaths include stillborn infants (fetal deaths) where the infant died before the onset of labour or during labour, and neonatal deaths where the infant was born alive and died in the neonatal period, between birth and the 28th day of life.
Terminations of pregnancy after 20 weeks gestation are included in the statistics presented here. Data from the WA Abortion Notification System indicate that these cases numbered 76 for the calendar year 2015 and would comprise 27.6 per cent of the 275 perinatal deaths.
There were 275 perinatal deaths occurring for infants born in 2015 from pregnancies of 20 weeks or more gestation. There were 222 stillborn infants and 53 infants born alive who died in the neonatal period. There was a perinatal mortality rate of 7.9 per 1,000 infants born a decrease from 8.3 per 1,000 infants born in 2014. The stillbirth rate was 6.3 per 1,000 infants born and the neonatal mortality rate was 1.5 per 1,000 infants born alive.
Aboriginal Mothers and Infants
Mortality rates for infants of Aboriginal mothers were nearly double those for infants of non-Aboriginal mothers in all categories. The overall perinatal mortality rate for infants born to Aboriginal mothers was 12.6 per 1,000 compared to 7.6 per 1,000 infants born to non-Aboriginal mothers. I think it’s critical for us to acknowledge that our indigenous sisters are at significantly more risk. Continuing research, education, support and connection here is crucial to improve outcomes – and it needs to be done in a way that supports and respects indigenous culture.
There’s definitely been some interesting and eye opening statistics in this WA Mothers and Babies 2015 report. I find our induction, augmentation and caesarean rates alarming and it only confirms why I am in this field of work. I am hopeful that gradually the tide will change and we will see the increasing trend begin to decline.
I hope that as there is more education you – the consumer- make conscious choices about where and with whom you birth. By choosing carefully you are able to make a difference with your dollar. If there is more demand for respectful, evidence based maternity care then change will be created in order to meet the demand. If you are not sure about your care options in Perth, you can find out what they are here. In the words of anthropologist Margaret Mead,
“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”