Maternal deaths in Australia 2021–2023

Understanding the clinical characteristics of maternal death cases, such as antenatal care, labour and birth details, baby outcomes, and the timing and location of death can assist in identifying clinical factors that could influence the risk of maternal death in Australia. Such data can help health care providers better understand what can be done to help ensure mothers stay healthy through pregnancy and beyond.

While these clinical characteristics are important parts of pregnancy, birth and beyond, it is not implied that clinical care necessarily directly contributed to the maternal deaths. See Contributing factors in maternal deaths for further information on how contributing factors are assessed.

Antenatal care

There is wide variability in the length of pregnancies that end in a maternal death. As such, a lower number of antenatal visits does not necessarily suggest that an improper level of antenatal care was received.

In 2021–2023, 29 (55%) of the maternal deaths were among women whose pregnancy extended beyond 20 weeks’ gestation. Of these, 8 (28%) attended 0–4 antenatal visits during their pregnancy, and 21 women (72%) attended 5 or more (Figure 4.1).

Data on the 13 women whose pregnancy ended before 20 weeks’ gestation were either not available or not applicable as the pregnancy ended prior to the first antenatal visit or before routine antenatal care was indicated or had commenced. This group includes women who died in early pregnancy and women who had miscarried or had an ectopic pregnancy at time of death.

Onset of labour

Onset of labour data were provided for 39 women who died and for whom birth occurred in 2021–2023. Among these 39 women, 26 (67%) had a caesarean section without labour, 9 (23%) had spontaneous labour and 4 (10%) had induced labour (Figure 4.2).

The proportion of women who died that had a caesarean section without labour (67%), was higher than for all women giving birth in Australia during the same period (26%) (AIHW 2025). The higher proportion of caesarean section without labour among the women who died could reflect, in some cases, emergency caesarean sections performed because the life of the mother and/or baby was at risk. Of the 26 maternal deaths where a caesarean section without labour was performed, information on the urgency with which these caesareans were performed was reported for 21 deaths. For 9 of these 21 deaths, the urgency category of the caesarean section was reported as ‘immediate threat to the life of mother or baby’. However, these statistics need to be interpreted with caution due to the small number of maternal deaths.

Birth method

Of the 59 maternal deaths in 2021–2023, 39 (66%) women had given birth. Of these women, 8 delivered vaginally and 31 delivered by caesarean section (Figure 4.3). Eleven caesarean sections were performed in the perimortem period; perimortem caesarean sections are performed when a woman is close to death to try to resuscitate the mother and/or save the life of the baby.

Twenty women (34%) had not given birth when they died, which includes where the pregnancy ended before 20 weeks gestation due to termination or miscarriage or where the baby remained in utero at the time of maternal death.

Timing of maternal death

Understanding the timing of maternal deaths is important for identifying periods of critical risk. Of the 159 maternal deaths between 2014 and 2023 with timing of death recorded:

• Almost 2 in 5 (37%) occurred in women who were pregnant at the time of their death. Of these women, almost 2 in 5 (35%) died during the first trimester of pregnancy (less than 14 weeks of pregnancy).
• Almost 1 in 5 (18%) occurred during the birth process or within 24 hours of giving birth.
• More than 2 in 5 (45%) occurred after the woman gave birth, with more than half (58%) of these deaths occurring within 1 to 13 days of giving birth.

These proportions do not include maternal deaths following or due to miscarriage or termination of pregnancy as the timing of death is not routinely reported for these cases.

Data on the timing of maternal deaths between 2014 and 2023 can be explored in the interactive visualisation below, with data also presented in Table 3 of the annual update supplementary data tables (Data tables: National Maternal Mortality Data Collection annual update 2023).

Location of death

Of the 59 maternal deaths in 2021–2023, 40 mothers died within a hospital setting (68%), 14 died at home (24%) and 4 died elsewhere (6.8%) (Table 4.1).

Where the site of the hospital death is known (33 deaths):

• 18 (55%) of the women died in an intensive care unit
• 8 (24%) died in an emergency department
• 4 (12%) died in an operating theatre
• 2 (6.1%) died in a maternity setting.

(a) Includes deaths in intensive care, dependency, and coronary care units.

(b) Includes deaths in birth suites and maternity wards.

(c) Includes deaths in psychiatric or palliative care units.

Notes 

1. Total maternal deaths includes maternal deaths classified as direct, indirect, and those not further classified. In 2021–2023 there were no maternal deaths not further classified. Does not include coincidental deaths, deaths awaiting classification, and late maternal deaths (deaths occurring from 43–365 days postpartum).
2. Location of death indicates where a death occurred. It does not imply that birth occurred in that setting (for example, a birth might occur in hospital, and death might subsequently occur at home).

Source: AIHW analysis of the National Maternal Mortality Data Collection.

Baby outcomes in maternal deaths

Of the 59 women who died in 2021–2023, 39 (66%) gave birth. Of these, 34 gave birth to a live born baby and 5 gave birth to a stillborn baby (Table 4.7). For multiple births, the birth outcome of the first-born baby is reported. For 20 women who died, the baby remained in-utero at the time of maternal death, or the pregnancy ended before 20 weeks gestation due to termination or miscarriage.