NSW Perinatal Data Collection (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
3.1 Intact perineum: Total number of selected primipara with an intact perineum or unsutured perineal tear as a percentage of the total number of selected primipara delivering vaginally.
3.2 Intact perineum with episiotomy: Total number of selected primipara undergoing episiotomy with an intact perineum and no perineal tear while giving birth vaginally as a percentage of the total number of selected primipara delivering vaginally.
3.3 Perineal tear and no episiotomy: Total number of selected primipara sustaining a perineal tear and no episiotomy as a percentage of the total number of selected primipara delivering vaginally.
3.4 Perineal tear with episiotomy: Total number of selected primipara undergoing episiotomy and sustaining a perineal tear while giving birth vaginally as a percentage of the total number of selected primipara delivering vaginally.
3.5 Surgical repair of 3rd degree tear: Total number of of selected primipara undergoing surgical repair of the perineum for third degree tear as a percentage of the total number of selected primipara delivering vaginally.
3.6 Surgical repair of 4th degree tear: Total number of of selected primipara undergoing surgical repair of the perineum for fourth degree tear as a percentage of the total number of selected primipara delivering vaginally.
Selected first time mother (primipara) is a woman 20-34 years of age at the time of giving birth, giving birth for the first time at greater than 20 weeks gestation; singleton pregnancy; cephalic presentation; and at 37 to 40 completed weeks gestation. A 3rd degree perineal tear is a laceration that extends from the birth canal up to and including the anal sphincter. A 4th degree perineal tear also includes the anal or rectal mucous membrane. Episiotomy is an surgical incision that enlarges the birth canal. See Methods Tab for further information.
Hospitals with at least 200 births in the latest year are identified individually. Totals include Other and not stated category.
Data include all mothers who gave birth (stillbirth or live birth) in a NSW facility (or a home) regardless of place of permanent residence.
The number of ‘not stated’ cases varied by geographic area and year. This may reduce the reliability of the estimates in the instances where ‘not stated’ cases are a large proportion.
This is a clinical indicator definied in: Australian Council of Healthcare Standards. Obstetrics Indicators Users' Manual 2017. Obstetrics version 8. Sydney: ACHS, 2017.Clinical indicators 3.1-3.6: Major perineal tears and surgical repair of the perineum.
The NSW Perinatal Data Collection (PDC), formerly the NSW Midwives Data Collection (MDC), is a population-based surveillance system covering all births in NSW public and private hospitals, as well as homebirths. The PDC is a statutory data collection under the NSW Public Health Act 2010.
The PDC encompasses all live births, and stillbirths of at least 20 weeks gestation or at least 400 grams birth weight. Prior to 2006 the PDC encompassed all births of at least 20 weeks gestation or at least 400 grams birth weight. The data collection has operated since 1987 but with population coverage since 1990.
For every birth in NSW the attending midwife or medical practitioner completes a notification form (latest version for 2011: http://internal.health.nsw.gov.au/data/collections/mdc/NSWH%20Perinatal%20Data.pdf), or its electronic equivalent, giving demographic, medical and obstetric information on the mother and the condition of the infant. The PDC form was revised in 1998, 2006, 2011, and 2016.
There are several source systems that generate the PDC data. In 2018, 100% of PDC notifications were received electronically from public and private hospitals obstetric information systems. Electronically submitted records were received by secure upload to the state database. Historically, a proportion of records were received via completed paper forms that were submitted to the System Information and Analytics Branch of the NSW Ministry of Health, where they were compiled into the PDC database.
There are several electronic systems that generate the PDC data including ObstetriX, eMaternity, and Cerner in public hospitals and a variety of systems in private hospitals. ObstetriX is the most commonly used maternity information system in public hospitals in NSW.
Table 1. Perinatal Data Collection Notification Sources, NSW 2018
|Notification source||Local Health District or Hospital||
Per cent of PDC records 2018
All public hospitals in South Eastern Sydney, Illawarra Shoalhaven, Hunter New England, Nepean Blue Mountains and Western Sydney Local Health Districts, as well as some hospitals in Murrumbidgee, Southern NSW, Western NSW and Far West Local Health Districts for part of 2017.
|Cerner||Sydney and South Western Sydney Local Health Districts.||19.2|
|Meditech||Ramsay Private Hospitals - North Shore Private Hospital, Westmead Private Hospital, St George Private Hospital, Kareena Private Hospital and Wollongong Private Hospital.||7.6|
|Sydney Adventist Obstetric Information System||Sydney Adventist Hospital||1.8|
|Healthscope||Healthscope hospitals - Prince of Wales Private Hospital, Norwest Private Hospital, Sydney South West Private Hospital, Nepean Private Hospital and Newcastle Private Hospital||8.0|
|The Mater Hospital database||The Mater Hospital, North Sydney||2.2|
|eMaternity||All public hospitals in South Eastern Sydney, Illawarra Shoalhaven, Hunter New England, Nepean Blue Mountains and Western Sydney Local Health Districts, as well as some hospitals in Murrumbidgee, Southern NSW, Western NSW and Far West Local Health Districts for part of 2017.||59.0|
Note: The total from these sources is slightly below 100% as independent midwives and hospitals with small numbers of births report using PeriForm. These figures are not included.
The information sent to the NSW Ministry of Health is checked and compiled into one statewide dataset. One record is reported for each baby, even in the case of a multiple birth. The PDC includes notifications of births which occur in NSW which includes women whose usual place of residence is outside NSW and who give birth in NSW; it does not receive notifications of interstate births where the mother is resident in NSW. The collection is based on the date of birth of the baby. In 2018 there were a number of records with missing information that has resulted in a fluctuation in trends for analyses of subgroups.
Data are reported by calendar year. For this report, the PDC was accessed via SAPHaRI.
Local Health Districts (LHDs) are health administrative areas constituted under Section 17 of the NSW Health Services Act, 1997 which became effective from January 2011 and were initially called Local Health Networks.
There are 15 geographically-based LHDs (8 covering the Sydney metropolitan region and 7 rural and regional NSW) and two specialist networks focussing on Children's and Paediatric Services and Forensic Mental Health. A third network operates across the public health services provided by three Sydney facilities operated by St Vincent's Health: these include St Vincent's Hospital and the Sacred Heart Hospice at Darlinghurst and St Joseph’s at Auburn.
LHDs replaced the former Area Health Services and have their own budgets, management and accountabilities. Geographically-based LHDs are overseen by Governing Boards. Please refer to the NSW Health website for a list of Local Health Districts and the membership of Boards.
Local Health Districts are:
Metropolitan NSW: Central Coast, Illawarra Shoalhaven, Nepean Blue Mountains, Northern Sydney, South Eastern Sydney, South Western Sydney, Sydney, Western Sydney.
Rural & regional NSW: Far West, Hunter New England, Mid North Coast, Murrumbidgee, Northern NSW, Southern NSW, Western NSW
The term ‘small area’ refers to a small geographical area or a small population. Data analysed for small areas may result in estimates that display considerable variability from year to year, particularly for rare conditions or events. Smoothing is a general term for statistical methods used to reduce the random variability of data. Examples include rounding, moving averages, extending the period of time in which cases are counted or increasing the size of the areas. In addition, Bayesian statistical smoothing can be used to adjust raw estimates in small areas by taking into account information from adjacent areas (local or spatial variability) and from the whole state (global or non-spatial variability).
In HealthStats NSW, the most frequently used smoothing technique for data presented by Local Health District is the aggregation of several years of data together followed by the calculation of a rolling average across the aggregated years. For some indicators, data for particular Local Health Districts may be suppressed due to very low numbers and privacy concerns. Please refer to Notes under the graphs or Methods tabs for confirmation of suppression and the smoothing technique used.
NSW Health. Local health districts and specialty networks. Available at https://www.health.nsw.gov.au/lhd/Pages/default.aspx
Hospitals are assigned to a Local Health District based on a standard listing produced by the NSW Ministry of Health. Details can be found at www.health.nsw.gov.au
The data concerns perineal status in mothers after vaginal birth. The clinical indicator (3.1-3.6) additionally includes surgical repair of perineal tears and concerns only selected first time mothers.
These data come from the NSW Perinatal Data Collection (PDC) where they are coded according to a completed NSW Perinatal Data Collection Form (also called NSW Midwives Data Collection Form), which can be accessed via the intranet by NSW Health staff at http://internal.health.nsw.gov.au/data/collections/mdc/NSWH%20Perinatal%20Data.pdf.
Selected first time mother (primipara) is a woman 20-34 years of age at the time of giving birth, giving birth for the first time at greater than 20 weeks gestation; singleton pregnancy; cephalic presentation; and at 37 to 40 completed weeks gestation.
Perineum is the name for pelvic floor and associated structures occupying the pelvic outlet. It is bounded anteriorly by the pubic symphysis, laterally by ischial tuberosities and posteriorly by the coccyx.
Episiotomy is a surgical incision of the perineum and vagina to enlarge the vulvar orifice before or during birth. It is undertaken in cases of instrumental vaginal birth or when there is suspected fetal compromise. Episiotomy is not performed routinely in spontaneous vaginal birth. It is strongly associated with a higher frequency of third and fourth degree tears.
Perineal status after childbirth
Perineum can be intact or sustain one of the following:
1st degree tear: a perineal graze-laceration-tear involving: the fourchette, hymen, labia, skin, vaginal or vulva.
2nd degree tear: a perineal laceration or tear involving the pelvic floor or perineal muscles or vaginal muscles.
3rd degree tear: a perineal laceration-tear involving the anal sphincter or retrovaginal septum.
4th degree tear: a third degree perineal laceration or tear that also involves the anal mucosa or rectal mucosa.
Management of perineal tears
Third and fourth degree tears are not necessarily obvious and all women having an operative vaginal delivery or who have experienced any perineal injury are examined by an experienced practitioner trained in the recognition and management of perineal tears.
Repair of third and fourth degree tears is usually conducted in an operating theatre, under regional or general anaesthesia.
The current data collection form for the NSW Perinatal Data Collection (PDC) commenced in 2016. Codes are described in the NSW Perinatal Data Collection Manual - 2016 Edition, which is available on the internet at http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2015_025.pdf
In 2018 there were 95,552 births to 94,170 mothers in NSW, a decrease of 1.8% from 97,325 births in 2014. The percentage of multiple (twin and triplet) pregnancies has remained fairly stable over recent years at about 1.4%.
Between 2014 and 2018:
• The proportion of mothers who were teenagers continued to fall, from 2.7% to 1.9%.
• The proportion of births to mothers over 35 years of age has remained stable.
• The rate of low birth weight (less than 2,500 grams) has remained stable, ranging from 6.3% to 6.8%.
• The perinatal mortality rate was 8.1 per 1,000 births in 2018, increased from 7.8 per 1,000 births in 2014.
Aboriginal and Torres Strait Islander mothers and babies
Between 2014 and 2018:
• The number of reported births to Aboriginal or Torres Strait Islander mothers increased from 3,808 to 4,270, representing 3.9% and 4.5% respectively of all babies born in NSW.
• The percentage of Aboriginal or Torres Strait Islander mothers who were teenagers fell substantially from 15.8% to 11.5%.
• The percentage of Aboriginal or Torres Strait Islander mothers who commenced antenatal care before 14 weeks increased from 54.4% to 73.6%.
• The perinatal mortality rate of 11.7 per 1,000 births in Aboriginal or Torres Strait Islander mothers in 2018 is higher than the rate of 7.9 per 1,000 births experienced among babies born to non-Aboriginal or Torres Strait Islander mothers.
The health of Australian mothers and babies is generally good by world standards. Maternal deaths are rare, and perinatal mortality rates are low.
The average woman in NSW can currently expect to give birth to 1.9 babies in her lifetime.
NSW mothers are getting older with the mean maternal age at first birth around 29 years and at subsequent birth just over 30. The proportion of teenage mothers is declining.
Aboriginal mothers and babies, those from socioeconomically disadvantaged areas, and some overseas-born mothers and their babies continue to experience worse outcomes than other NSW mothers and babies.
The NSW Ministry of Health maintains two population-based surveillance systems that collect information concerning pregnancy and birth: the NSW Perinatal Data Collection and the NSW Register of Congenital Conditions. They assist in monitoring the health of mothers and babies and, maternity service planning in NSW.
The implementation of the NSW Aboriginal Maternal and Infant Health Strategy has improved access to culturally appropriate maternity services for Aboriginal mothers.
The NSW Maternal and Perinatal Mortality Review Committee reviews each death of a mother or newborn baby to assess the cause and identify any possible avoidable factors. This information is used to improve services for mothers and babies.
NSW Ministry of Health at http://health.nsw.gov.au, in particular see the annual New South Wales Mothers and Babies report, published by the Centre for Epidemiology and Evidence. The latest edition is available at http://www.health.nsw.gov.au/hsnsw/Publications/mothers-and-babies-2017.pdf
Australian Bureau of Statistics at http://www.abs.gov.au, in particular see Births (ABS Cat no 3301.0)
Australian Institute of Health and Welfare at http://www.aihw.gov.au in general and in particular the AIHW's National Perinatal Statistics Unit and the annual publication: Australia’s mothers and babies.
healthdirect at http://www.healthdirect.gov.au
Population and Public Health Division. Improved reporting of Aboriginal and Torres Strait Islander peoples on population datasets in New South Wales using record linkage–a feasibility study. Sydney: NSW Ministry of Health, 2012. Available at: http://www.health.nsw.gov.au/hsnsw/Publications/atsi-data-linkage-report.pdf
Australian Council on Healthcare Standards. Obstetrics Indicator User Manual. Sydney: ACHS. Available at: https://www.achs.org.au/