Health of mothers and babies is an Australia's health topic

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Health and wellbeing during the perinatal period can have lifelong implications for mothers and babies. Maternal demographics, such as maternal age and country of birth, can impact on maternal and perinatal health. Maintaining a healthy lifestyle during pregnancy and attending routine antenatal care contributes to better outcomes for both mother and baby. The health of a baby at birth is a key determinant of their health and wellbeing throughout life, for example the gestational age of a baby, and their birthweight, have important implications for their health, with poorer outcomes generally reported for those born early and with a birthweight below 2,500 grams.

This page uses data from the National Perinatal Data Collection (NPDC) (AIHW 2021) and other related perinatal collections to explore aspects of pregnancy and childbirth as well as key outcomes for babies at birth. For more information on data sources used in this page, and to see a full list of AIHW products that focus on mothers and babies, see Data sources and Reports.

Profile of mothers and babies

About 292,000 women gave birth to around 296,000 babies in 2020. The number of babies born and women giving birth has been decreasing since 2016, additionally the rate of women giving birth has fallen from 64 per 1,000 women of reproductive age (15–44) in 2010 to 56 per 1,000 women in 2020.

In 2020:

  • 73% of mothers lived in Major cities.
  • 36% of mothers were born overseas.
  • 20% of mothers were from the lowest socioeconomic areas.
  • 4.9% of mothers were Aboriginal and/or Torres Strait Islander people.
  • 6.2% of babies born were Indigenous babies.
  • 51% of babies born were male, with a ratio of 105 liveborn boys to 100 liveborn girls.

Detailed information on mothers and babies from population groups, such as Indigenous mothers and babies or those from remote areas, is available from Australia’s mothers and babies.

Mothers

Maternal age

Maternal age is an important risk factor for both obstetric and perinatal outcomes. Adverse outcomes are more common in younger and older mothers. Women in Australia are continuing to give birth later in life:

  • The average age of all women who gave birth was 30.9 in 2020 compared with 30.0 in 2010.
  • The proportion of women giving birth aged 35 has increased from 23% in 2010 to 26% in 2020, while the proportion aged under 25 decreased from 18% to 12%.

Smoking status

Smoking during pregnancy is the most common preventable risk factor for pregnancy complications and is associated with poorer perinatal outcomes, including low birthweight, being small for gestational age, pre-term birth and perinatal death. Women who stop smoking during pregnancy can reduce the risk of adverse outcomes for themselves and their babies. Support to stop smoking is widely available through antenatal clinics.

Almost 1 in 10 (9.2%) mothers who gave birth in 2020 smoked at some time during their pregnancy, a decrease from 14% in 2010 (Figure 1). Of mothers who were smoking at the start of their pregnancy, around 1 in 5 (22%) quit smoking during the pregnancy.

Antenatal care

Antenatal care is a planned visit between a pregnant woman and a midwife or doctor to assess and improve the wellbeing of the mother and baby throughout the pregnancy. Routine antenatal care, beginning in the first trimester (before 14 weeks gestational age), is known to contribute to better maternal health in pregnancy, fewer interventions in late pregnancy, and positive child health outcomes (AHMAC 2011; WHO RHR 2015).

Australian Pregnancy Care Guidelines

The Australian Pregnancy Care Guidelines recommend that the first antenatal visit occur within the first 10 weeks of pregnancy and that first-time mothers with an uncomplicated pregnancy have 10 antenatal visits during pregnancy (7 visits for subsequent uncomplicated pregnancies) (Department of Health and Aged Care 2021a).

Looking at the number of antenatal visits by mothers who gave birth at 32 weeks or more gestation in 2020:

  • Almost all mothers (99.8%) received antenatal care during pregnancy.
  • 79% of mothers received antenatal care within the first 10 weeks of pregnancy.

COVID-19 impacts

During 2020, shutdowns and service disruptions may have affected the ability of pregnant women to attend face-to-face antenatal care. Additionally, because of personal safety concerns, women may have opted not to attend face-to-face appointments, as health advice encouraged avoiding public spaces except for essential purposes (RANZCOG 2021; RCOG 2022). On 13 March 2020, the Australian Government added services to the Medicare Benefits Schedule to cover antenatal services delivered via telehealth (Department of Health and Aged Care 2021b).

During 2020, over 1.6 million services for antenatal care were processed nationally. Of these, there were around 136,000 fewer face-to-face antenatal services in 2020 compared with 2019. This decrease was mostly offset by telehealth services (added in March 2020) that contributed 126,000 antenatal services from March to December 2020. The overall reduction of antenatal services in 2020 compared with 2019 was less than 10,000 services (a 0.6% reduction).

For more information see Antenatal care during COVID–19, 2020.

Figure 1: Health factors of mothers, 2013 to 2020

The chart shows the proportion of mothers by maternal age categories between the years of 2010 and 2020. The rate of mothers aged less than 20 decreased from 3.8% in 2010 to 1.8% in 2020, the rate of mothers aged 20–24 decreased from 14.2% in 2010 to 10.3% in 2020, the rate of mothers aged 25–29 decreased slightly from 27.6% in 2010 to 25.7% 2020, the rate of mothers aged 30–34 increased from 31.4% in 2010 to 36.7% in 2020, the rate of mothers aged 35–39 increased from 18.9% in 2010 to 21.0% in 2020 and the rate of mothers aged 40 and over increased slightly from 4.1% in 2010 to 4.5% in 2020.  

Notes

  1. Trend data excludes Victoria.
  2. Percentage calculated after excluding records with Not stated values. Care must be taken when interpreting percentages.
  3. For multiple births, the method of birth of the first-born baby was used.
  4. Mother’s tobacco smoking status during pregnancy is self-reported.
  5. Percentages calculated after excluding records with Not stated values. Care must be taken when interpreting percentages.

Source: National Perinatal Data Collection

Method of birth

In 2020, 63% of mothers (190,853) had a vaginal birth and 37% (108,909) had a caesarean section (Figure 2).

Vaginal births may be either non-instrumental or instrumental. Half (50%) of all births were non-instrumental vaginal births. When instrumental births were required, vacuum extraction was more common than forceps (7% and 5% of all births, respectively) (Figure 2).

Since 2010, the rate of non-instrumental vaginal births has decreased (from 56% in 2010 to 50% in 2020) whereas the caesarean section rate has increased (from 32% in 2010 to 37% in 2020) (Figure 1). The rate of vaginal birth with instruments was relatively stable over this time, between 12% and 13%. These trends remain when changes in maternal age over time are considered.

Figure 2: Health factors of mothers, 2020

The chart shows the proportion of mothers in 2020 by maternal age categories.  The rate of mothers who were aged less than 20 was 2.0%, the rate of mothers aged 20–24 was 10%, the rate of mothers aged 25–29 was 26%, the rate of mothers aged
30–34 was 37.0%, the rate of mothers aged 35–39 was 21%, and the rate of mothers aged 40 and over was 5%.

Notes:

  1. Percentages calculated after excluding records with Not stated values. Care must be taken when interpreting percentages.
  2. Antenatal visit trend data excludes Victoria.
  3. For method of births of multiple births, the method of birth of the first-born baby was used.
  4. Mother's tobacco smoking status during pregnancy is self-reported.

Source: National Perinatal Data Collection

Babies

Gestational age

Gestational age is the duration of pregnancy in completed weeks. Gestational age is reported in 3 categories: pre‑term (less than 37 weeks gestation), term (37 to 41 weeks) and post-term (42 weeks and over). The gestational age of a baby has important implications for their health, with poorer outcomes generally reported for those born early. Pre‑term birth is associated with a higher risk of adverse neonatal outcomes.

In 2020:

  • The median gestational age for all babies was 39 weeks.
  • 91% of all babies born were born at term (Figure 2).

Birthweight

Birthweight is a key indicator of infant health and a principal determinant of a baby’s chance of survival and good health. A birthweight below 2,500 grams is considered low and is a known risk factor for neurological and physical disabilities. A baby may be small due to being born early (pre-term) or be small for gestational age, for example, due to fetal growth restriction within the uterus.

In 2020, 6.5% of babies born in Australia had low birthweight (Figure 2), and there has been little change since 2010. Birthweight and gestational age are closely related – low birthweight babies made up 57% of babies who were pre‑term compared with only 2.3% of babies born at term.

Apgar score at 5 minutes

Apgar scores are clinical indicators that determine a baby’s condition shortly after birth. These scores are measured on a 10-point scale for several characteristics. An Apgar score of 7 or more at 5 minutes after birth indicates the baby is adapting well post-birth.

The vast majority (98%) of liveborn babies in 2020 had an Apgar score of 7 or more at 5 minutes after birth (Figure 3). This rate has remained steady since 2010.

Resuscitation

Resuscitation is undertaken to establish independent breathing and heartbeat or to treat depressed respiratory effort and to correct metabolic disturbances. Resuscitation methods range from less intrusive methods like suction or oxygen therapy to more intrusive methods, such as external cardiac massage and ventilation. More than one type of resuscitation method can be recorded.

In 2020, 80% of liveborn babies did not require resuscitation. Where resuscitation was required, continuous positive airway pressure (CPAP) ventilation was reported as the most commonly used method and external cardiac compressions as the least common method.

Babies who required resuscitation were also more likely to have an Apgar score of less than 7, be of low birthweight, be born pre-term, and be born as part of a multiple birth.

Figure 3: Apgar score at 5 minutes of babies, 2020

The chart shows showing the proportion of live born babies in 2020 by Apgar score at 5 minutes after birth. The number of babies whose Apgar score was between 0 and 3 was 0.3%, the number of babies whose Apgar score was between 4 and 6 was 1.5% and the number of babies whose Apgar score was between 7–10 was 97.9%.

Notes

  1. Apgar score includes liveborn babies only.
  2. Pre-term birth may include a small number of births of less than 20 weeks gestation.
  3. Resuscitation status includes liveborn who received active resuscitation only.
  4. More than 1 type of active resuscitation method could be recorded; therefore, the sums of individual categories are greater than the total numbers of liveborn babies, and percentages add to more than 100%.

Source: National Perinatal Data Collection

Preliminary perinatal deaths

A stillbirth is the death of a baby before birth, at a gestational age of 20 weeks or more, or a birthweight of 400 grams or more. A neonatal death is the death of a liveborn baby within 28 days of birth. Perinatal deaths include both stillbirth and neonatal deaths.

In 2020, there were 9.9 perinatal deaths for every 1,000 births, a total of 2,944 perinatal deaths. This included:

  • 2,272 stillbirths, a rate of 7.7 deaths per 1,000 births.
  • 672 neonatal deaths, a rate of 2.3 deaths per 1,000 live births.

Between 2010 and 2020 the stillbirth and neonatal mortality rates remained largely unchanged at between 7 and 8 in 1,000 births and between 2 and 3 in 1,000 live births, respectively. In 2020, Congenital anomaly was the most common cause of perinatal death.

For more information see Stillbirths and neonatal deaths in Australia.

Maternal deaths

Maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy, irrespective of the duration and outcome of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Between 2011 and 2020, the maternal mortality ratio in Australia was relatively stable, ranging from between 5.0 to 8.4 per 100,000 women giving birth.

The most frequent causes of maternal death reported in Australia between 2011and 2020 were complications of pre-existing or new cardiovascular disease and thromboembolism.

For more information see Maternal deaths.

Congenital anomalies

Congenital anomalies encompass a wide range of atypical bodily structures or functions that are present at or before birth. They are a cause of child death and disability, and a major cause of perinatal death.

In 2016, over 8,900 (3%) babies were born with a congenital anomaly, almost 1 in 31 babies. Circulatory system anomalies (these are anomalies of the heart and major blood vessels) were the most common type of anomaly, 29% of babies with any anomaly having a circulatory system anomaly. Most (91%) babies with an anomaly survived their first year.

Congenital anomaly rates were higher in:

  • Babies born pre-term (before 37 weeks’ gestation), at a rate of 107 per 1,000 births.
  • Babies born with low birthweight (less than 2,500 grams), at a rate of 123 per 1,000 births.
  • Babies who were small for gestational age (that is with a birthweight below the 10th percentile for their gestational age and sex), at a rate of 45 per 1,000 births.

For more information see Congenital anomalies 2016.

Maternity models of care

A maternity model of care describes how a group of women are cared for during pregnancy, birth, and the postnatal period.

In 2022, nearly 900 maternity models of care were reported across Australian maternity services, and they can be grouped into 11 major model categories. Amongst them:

  • The most common major model category is public hospital maternity care with 40% of all models of care falling into this category.
  • Just under one-third of models (31%) have continuity of carer through the whole maternity period, meaning a single named designated carer provides or coordinates care for the antenatal, intrapartum and postnatal periods; around one-third (32%) of models have continuity of carer for some part of the maternity period (for example the antenatal period only or the antenatal and postnatal periods) and 37% of models have no continuity of carer in any stage of the maternity period, so there is no named carer assigned to each woman and care is given by different providers.
  • Around 540 (61%) models of care are targeted at specific groups of women who share a common characteristic or set of characteristics. Aboriginal or Torres Strait Islander identification is a target group in 11% of models.

For more information, read the full Maternal models of care report.

Where do I go for more information?

For more information on the health of mothers and babies, see:

References

AHMAC (Australian Health Ministers’ Advisory Council) (2011) National Maternity Services Plan, Department of Health and Ageing, Australian Government, accessed 16 March 2022.

AIHW (Australian Institute of Health and Welfare) (2020) Australia's mothers and babies, AIHW, Australian Government, accessed 13 February 2023.

Department of Health and Aged Care (2021a) Clinical practice guidelines: pregnancy care, Department of Health, Australian Government, accessed 16 March 2022.

Department of Health and Aged Care (2021b) COVID-19 temporary MBS telehealth services, Department of Health, Australian Government, accessed 6 March 2022.

RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) (2021) A message for pregnant women and their families, RANZCOG, accessed 24 February 2023.

RCOG (Royal College of Obstetricians and Gynaecologists) (2022) Coronavirus (COVID-19) infection in pregnancy. Information for healthcare professionals, RCOG website, accessed 7 March 2022.

WHO RHR (World Health Organization Department of Reproductive Health and Research) (2015) WHO statement on caesarean section rates, WHO website, accessed 3 March 2022.