Australian Institute of Health and Welfare (2022) National Core Maternity Indicators, AIHW, Australian Government, accessed 08 December 2022.
Australian Institute of Health and Welfare. (2022). National Core Maternity Indicators. Retrieved from https://pp.aihw.gov.au/reports/mothers-babies/national-core-maternity-indicators
National Core Maternity Indicators. Australian Institute of Health and Welfare, 28 September 2022, https://pp.aihw.gov.au/reports/mothers-babies/national-core-maternity-indicators
Australian Institute of Health and Welfare. National Core Maternity Indicators [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2022 Dec. 8]. Available from: https://pp.aihw.gov.au/reports/mothers-babies/national-core-maternity-indicators
Australian Institute of Health and Welfare (AIHW) 2022, National Core Maternity Indicators, viewed 8 December 2022, https://pp.aihw.gov.au/reports/mothers-babies/national-core-maternity-indicators
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The Douglas Inquiry into obstetric and gynaecological services carried out between 1990 and 2000 at the King Edward Memorial Hospital (KEMH) for Women in Perth, Western Australia, recommended that Australia establish an enquiry process with annual benchmarking and/or reporting of performance indicators for obstetric and gynaecological practice and outcomes (Fahy et al. 2001). In 2002, Australian Health Ministers agreed to support a collaborative project coordinated by the Department of Health, Western Australia (Department of Health Western Australia (DoHWA) 2007) to enable the analysis of comparative clinical performance data from tertiary obstetric and gynaecological hospitals in Australian jurisdictions (Women's Healthcare Australasia (WHA) 2007). In 2003, DoHWA conducted a 3-month pilot project of maternity data benchmarking. This ‘proof of concept’ project demonstrated the potential to improve the quality of maternity care through benchmarking.
In 2005, the National Maternity Services Collaboration on Health Policy (then Maternity Services Inter-Jurisdictional Committee (MSIJC)) noted to the Australian Health Ministers’ Advisory Council (AHMAC) that it would be necessary to identify and develop a set of national performance indicators with a view to aligning service and clinical indicators (WHA 2007).
Under a grant from the Australian Council on Safety and Quality in Health Care (now the Commission), the DoHWA consulted with a number of agencies, establishing the Core Maternity Indicators Project (CMIP) to develop a national set of risk-adjusted maternity performance indicators. WHA managed the Project Plan developed by this group. This extensive body of work aimed to ‘measure and evaluate safe and effective maternity care in a timely fashion’ (WHA 2007).
In late 2008, the AHMAC transferred responsibility for the management and continuation of CMIP from the Australian Commission on Safety and Quality in Health Care to the MSIJC. The MSIJC’s role was to provide consistency on national reporting of core maternity indicators. This project was also needed to identify an appropriate national repository for this information for ongoing coordinating, reporting and analysis.
The development of core maternity indicators aligns with the first recommendation of the National Review of Maternity Services undertaken by the Chief Nursing and Midwifery Officer on behalf of the Australian Government in 2008 which states:
That the Australian Government, in consultation with states and territories and key stakeholders, agree and implement arrangements for consistent, comprehensive national data collection, monitoring and review, for maternal and perinatal mortality and morbidity (Commonwealth of Australia 2009).
The MSIJC established an Expert Working Group in 2009 to reaffirm the core maternity indicators. A list of 20 National Core Maternity Indicators (NCMIs) was proposed by the Expert Working Group in early 2010 and funded by AHMAC in 2015–16; this formed the basis for the work undertaken by the Australian Institute of Health and Welfare (AIHW) (see Table 1).
In the first phase of the project a report on 10 of the 20 proposed NCMIs was produced using the AIHW National Perinatal Data Collection (NPDC) with clinical commentary from an Expert Commentary Group (ECG) (AIHW NPESU & AIHW 2013).
For more details see Table 1 and the report: Foundations for enhanced maternity data collection and reporting in Australia: National maternity data development project - Stage 1.
In 2012–13, the project explored the validity and feasibility of a possible 8 additional NCMIs to be added to the current set of 10 NCMIs. Clinical advice and input were provided by an ECG.
In consultation with key stakeholders and experts, definitions and technical specifications were developed for the 8 additional NCMIs, and existing and potential data sources for reporting were investigated. Further, an additional indicator (Indicator 21) was proposed during the consideration and development of the 8 additional indicators. Recommendations for next steps were made for each proposed NCMI.
The 9 potential additional indicators developed and investigated were:
For more details see Table 1 and the report: National core maternity indicators—stage 2 report: 2007–2011.
In 2015, the AIHW undertook further work on the NCMIs which included finalising 2 indicator specifications for reporting, data development, finalising the scope for 1 indicator based on the recommendations of the validity and feasibility work undertaken previously, and facilitating the revised data resupply from Victoria for 2009–2011.
The 2 additional indicators reported:
Specifications were developed for NCMI 18: Caesarean section <39 weeks of gestation (273 days) without obstetric/ medical indication and NCMI 21: Skin-to-skin contact between mother and baby after birth. These specifications received support from the ECG. The specifications are still under review and have yet to be referred to the National Perinatal Data Development Committee (NPDDC) or tabled for endorsement by National Health Data and Information Standards Committee (NHDISC), formerly National Health Information and Performance Principal Committee (NHIPPC).
Specifications were developed for NCMI 12: Babies born at or after 37 completed weeks of gestation admitted to a neonatal intensive care nursery or special care nursery for reasons other than congenital anomaly. Following consultation, development work still needs to be conducted and this specification is under review. This specification has not yet been supported by the ECG.
For more details see Table 1 and the report: National Core Maternity Indicators stage 3 and 4 results from 2010–2013.
The AIHW will endeavour to undertake further development of the current, proposed and any additional NCMIs in the future, particularly in response to changes in evidence, policy, service provision or clinical practice.
Indicator specifications approved by NHIPPC*
1. Smoking in pregnancy for all women giving birth
Published 2011 to 2020
2. Antenatal care in the first trimester for all women giving birth
20. Models of care
Referred for further work elsewhere(a)
Labour and Birth Indicators
5. Induction of labour for selected women giving birth for the first time
Published 2004 to 2020
6. Caesarean section for selected women giving birth for the first time
7. Unassisted (non-instrumental) vaginal birth for selected women giving birth for the first time
8. Assisted vaginal birth for selected women giving birth for the first time
3. Episiotomy for women having their first baby and giving birth vaginally
9. General anaesthetic for women giving birth by caesarean section
Published 2007 to 2020
11. High-risk women undergoing caesarean section who receive appropriate pharmacological thromboprophylaxis
Not to be reported(b)
15. Women having their second birth vaginally whose first birth was by caesarean section
17. One-to-one care in labour
Not to be reported(c)
18. Caesarean sections at less than 39 completed weeks of gestation (273 days) without obstetric/medical indication
Further development required(d)
Birth outcome Indicators
4. Apgar score of less than 7 at 5 minutes for births at term
10. Small babies among births at or after 40 weeks of gestation
12. Babies born at or after 37 completed weeks of gestation admitted to a neonatal intensive care nursery or special care nursery for reasons other than congenital anomaly
Development work done in 2015-16. Further development required
13. Third and fourth degree tears for (a) all first births and (b) all births
Published 2013 to 2020
14. Blood loss of (1) >1,000 mL and < 1,500 mL and (ii) ≥1,500 mL during first 24 hours after the birth of the baby (i.e. primary PPH) for (a) vaginal births and (b) caesarean sections
16. Separation of baby from the mother after birth for additional care
19. Supporting breastfeeding
Referred for further work elsewhere(e)
21. Skin-to-skin contact after birth
Development work done in 2015–16. Further development required
* National Health Information and Performance Principal Committee (NHIPPC) is now retired and has been replaced by the National Health Data and Information Standards Committee (NHDISC).
AIHW NPESU (Australian Institute of Health and Welfare National Perinatal Epidemiology and Statistics Unit) & AIHW 2013. National core maternity indicators. Cat. no. PER 58. Canberra: AIHW.
Commonwealth of Australia 2009. Improving maternity services in Australia: report of the maternity services review. Canberra: Commonwealth of Australia.
DoHWA (Department of Health, Western Australia) 2007. Improving maternity services: working together across Western Australia: a policy framework. Perth: Government of Western Australia, Department of Health.
Fahy K, Robinson J, Douglas NF & KEMH (King Edward Memorial Hospital) 2001. Inquiry into obstetric and gynaecological services at King Edward Memorial Hospital 1990–2000: final report 2001. Perth: Government of Western Australia, Department of Health.
WHA (Women’s Healthcare Australasia) 2007. Supporting excellence in maternity care: the core maternity indicators project: findings from the core maternity indicators project. Canberra: WHA.
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