News

City–remote health divide starts from birth


Matt Woodley


19/09/2019 4:00:33 PM

Statistics designed to track clinical activity and outcomes related to pregnancy have revealed marked differences in a number of key areas.

Rural road
More than one-third of women living in very remote parts of Australia smoked during the first 20 weeks of pregnancy, in comparison to 7.2% of women in major cities and 9.6% nationwide.

The recently released National Core Maternity Indicators (NCMI) show mothers in very remote parts of Australia are much more likely to smoke during pregnancy and give birth to underweight babies than women in major cities, but less likely to access antenatal care in their first trimester.
 
More than one-third of women living in very remote parts of Australia smoked during the first 20 weeks of pregnancy, in comparison to 7.2% of women in major cities and 9.6% nationwide.
 
Socioeconomic disadvantage also seemed to be a factor, with women in the most disadvantaged parts of Australia six times as likely to smoke during the first 20 weeks of pregnancy in comparison to women in the least disadvantaged areas.
 
The highest rates of smoking during the first 20 weeks of pregnancy were recorded in the northern regions of Australia. Nearly half (49.8%) of all pregnant women living in the Daly – Tiwi – West Arnhem Local Statistical Area Level 3 (SA3) smoked during the first 20 weeks, in comparison to only 0.5% of mothers-to-be in Manly and North Sydney – Mosman.
 
These statistics were reflected in several birth-outcome indicators, including birthweight and the Apgar score – a clinical indicator of a baby’s condition shortly after birth on skin colour, pulse, breathing, muscle tone and reflex irritability. An Apgar score of seven or more at five minutes after birth indicates a baby adapting well to the environment, while a score of less than seven indicates complications.
 
The Northern Territory, which had the highest overall smoking rates in pregnant women (20.5%), also recorded the highest percentage of newborns with an Apgar score lower than seven (2.1%), as well as small babies at or after 40 weeks gestation (2.3%). Babies born in very remote areas are at least twice as likely to be considered small than remote babies, and three times as likely as babies born in inner-regional areas.
 
The divide between women from potentially vulnerable patient populations and the rest of Australia has previously led to calls for GPs to have a greater role in maternity care.
 
However, one field where women living in very remote areas appear to have an advantage over their city counterparts is in the percentage of vaginal births without intervention for first-time mothers. This is seen by many as the preferred method of birth, as women tend to have fewer postnatal complications and are more physically able in the short term to care for their new babies.
 
More than half of all births in very remote parts of Australia occurred in this way, compared with only 43.2% of cases in major cities, the lowest rate in the country.
 
Nationwide, non-instrumental vaginal birth among first-time mothers declined from 51.9% in 2004, to 44.6% in 2017.
 
Other statistics of note:

  • Women aged 20–34 who gave birth to a singleton baby in the vertex presentation between 37–41 weeks were more likely to have a caesarean in 2017 (29.3%) than 2004 (25.3%)
  • This same group was also much more likely to have had an induction of labour in 2016 (40.5%) than 2004 (31%)
  • Aboriginal and Torres Strait Islander women were nearly four times as likely to smoke during the first 20 weeks of pregnancy than the rest of Australian women (43.4% versus 11.5%)
  • Nationwide, Apgar scores of less than seven increased from 0.9% in 2004 to 1.3% in 2017
  • Mildura (Victoria) and Barkly (NT) were the SA3s with the highest percentage of Apgar scores of less than seven in Australia, at 3.4%
  • Babies born in public hospitals were nearly twice as likely to have an Apgar score of less than seven for births at or after term (1.5% versus 0.8%)
  • Vaginal births in a public hospital setting were twice as likely to have involved a third- or fourth-degree tear than births in private hospitals (3.2% versus 1.6%)



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