Summary
This report builds on previous work undertaken by the AIHW for the Maternity Services Inter-Jurisdictional Committee (MSIJC) of the Australian Health Ministers' Advisory Council (AHMAC) on the development of a set of National Core Maternity Indicators (NCMIs) to monitor the quality of maternity care in Australia.
This report represents the second stage of the project, which was undertaken by the AIHW during 2012-13. It involved exploring the validity and feasibility of a possible 8 additional NCMIs to be added to the current set of 10 NCMIs. Clinical advice and input was provided by an Expert Commentary Group (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. Recommendations for next steps were then made for each proposed NCMI.
The 8 potential additional indicators developed and investigated were:
- High risk women undergoing caesarean section who receive appropriate pharmacological thromboprophylaxis (Indicator 11)
- Babies born at or after 37 completed weeks gestation admitted to a neonatal intensive care nursery or special care nursery for reasons other than congenital anomaly (Indicator 12)
- Third and fourth degree tears for (a) all first births and (b) all births (Indicator 13)
- Blood loss of (i) greater than 1,000 mL and less than 1,500 mL, and (ii) 1,500 mL or more during first 24 hours after the birth of the baby (that is, major primary postpartum haemorrhage) for (a) vaginal births and (b) caesarean sections (Indicator 14)
- Women having their second birth vaginally whose first birth was by caesarean section (Indicator 15)
- Separation of baby from the mother after birth for additional care (Indicator 16)
- One-to-one care in labour (Indicator 17)
- Caesarean sections at less than 39 completed weeks gestation (273 days) without obstetric/medical indication (Indicator 18).
During consideration of Indicator 16, the ECG proposed an additional new indicator for further investigation, 'Skin-to-skin contact between mother and baby after birth'.
Recommendations
- Indicators 13, 15 and 18 should be added to the current set of 10 NCMIs for reporting using the National Perinatal Data Collection.
- Indicator 14 to be: aligned with items on postpartum haemorrhage in the 2014-15 Perinatal Data Set Specification (lower limit now to include 1,000 mL blood loss and be reflected in the Indicator title); and added to the current set of 10 NCMIs for reporting.
- Indicator 12 and the ECG-suggested indicator 'Skin-to-skin contact between mother and baby after birth' require further data development, and this development should be undertaken to enable future reporting against these 2 indicators.
- Indicators 11, 16 and 17 should not be further developed or added to the current set of NCMIs at this stage.