National Women's Annual Clinical Report 2010

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6.11 Labour and birth at Birthcare Auckland Birthcare Auckland is a Level 1 obstetric facility located close to Auckland City Hospital. It is able to provide labour and birth care and postnatal care in normal pregnancies and labours. It does not have anaesthetists or obstetricians available and so does not provide for epidurals or operative births. In April 2009 Birthcare started an initiative to give more women the opportunity of birthing in a primary maternity unit within the central Auckland area, and to give midwives the opportunity of providing LMC services within a supported environment. This has resulted in an increase in the number of births which occur at Birthcare. Methods The data for mothers birthing at Birthcare (n=417) during <strong>2010</strong> were provided by Birthcare. The data on mothers transferred to NW in labour and birthing at NW and for mothers transferred to NW after birthing at Birthcare have been obtained from the NW clinical database Healthware. Findings Five hundred and seventy seven women started labour at Birthcare Auckland and 129 (22%) transferred to NW in labour (36% of nullipara and 10% if multipara ). Table 57: Demographic characteristics of women labouring at Birthcare by place of birth Birth at Birthcare n= 448 Intrapartum transfer to NW n= 129 Total N= 577 n % n % n % Parity Nullipara 176 39.3 99 76.7 275 47.7 Multipara Age 272 60.7 30 23.3 302 52.3 40 Ethnicity 3 0.7 2 1.6 5 0.9 NZ European 209 46.7 57 44.2 266 46.1 Māori 44 9.8 9 7 53 9.2 Pacific 57 12.7 10 7.8 67 11.6 Other Asian 42 9.4 12 9.3 54 9.4 Indian 13 2.9 5 3.9 18 3.1 Other European 76 17 32 24.8 108 18.7 Other DHB of Domicile 7 1.6 4 3.1 11 1.9 Auckland DHB 295 65.8 79 61.2 374 64.8 Counties Manukau DHB 55 12.3 19 14.7 74 12.8 Waitemata DHB 96 21.4 31 24.0 127 22 Other DHB 2 0.4 0 2 0.3 100
Table 58: Interventions and outcomes by parity among women who commenced labour and birthed at Birthcare and women who commenced labour at Birthcare and birthed at NW. ( 129 intra partum transfers to NW)* Nullipara Multipara n= 275 n= 302 n % n % Intrapartum transfer to NW Analgesia 99 36 30 9.9 Epidural 82 29.8 17 5.6 Pethidine 40 14.5 17 5.6 Entonox 119 43.3 72 23.8 TENS 4 1.5 3 1.0 Water 62 22.5 47 15.6 Syntocinon Mode of birth 68 24.7 6 2 Normal vaginal 216 78.5 293 97 Operative vaginal 28 10.2 6 2 Emergency caesarean Perineal trauma 31 11.3 3 1 Episiotomy 38 13.8 12 4 Third/fourth degree tear 4 1.5 0 Vaginal wall tear Blood Loss 5 1.8 4 1.3 >500 mls Perinatal outcomes 53 19.3 16 5.3 Still birth * Many of these interventions occurred at <strong>National</strong> Women’s 0 0 101
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National Women’s Annual Clinical
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It is my pleasure to present the 20
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7 LABOUR AND BIRTH OUTCOMES .......
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Table 50: Neonatal outcomes followi
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Table 153: Preterm birth and matern
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Table 258: Perinatal mortality rate
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Figure 53: Mode of birth (1991-2010
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Chapter 1 INTRODUCTION 1
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Chapter 8: Postnatal care This chap
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1.5.3 Gynaecologic data quality As
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2 SERVICE PROVISION 2.1 Maternity s
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2.2.4 Antenatal and Postnatal Wards
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The service has access to the ACH L
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2.5.3 University Links There are cl
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Reportable events All incidents (mi
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Chaptern 3 SUMMARY STATISTICS 19
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3.2 Summary of maternal outcomes 20
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Rate Table 7: Perinatal related mor
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Maternal indicator Caesarean sectio
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50 45 40 35 30 25 20 15 10 5 0 % Ep
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4 MATERNAL DEMOGRAPHY This chapter
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4.2.2 Maternal ethnicity When more
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% 60 50 40 30 20 10 0 NZ European M
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4.5 Body mass index Thirty five per
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% 100 80 60 40 20 0 European Maori
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Women booked with a private obstetr
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5 ANTENATAL COMPLICATIONS This chap
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Ethnic differences in rates of pret
Page 63 and 64: of women under 20 with SGA babies s
Page 65 and 66: Perinatal deaths in term SGA infant
Page 67 and 68: The rate of multiple pregnancy rema
Page 69 and 70: Summary / Implications Multiple pre
Page 71 and 72: 5.4.1 Demographic characteristics o
Page 73 and 74: 5.4.5 Perinatal losses Diabetes Per
Page 75 and 76: A confirmed placental abruption is
Page 77 and 78: 70 60 50 40 30 20 10 0 % Gestationa
Page 79 and 80: 5.7 Body Mass Index Methods BMI is
Page 81 and 82: % European Maori Pacific Other Asia
Page 83 and 84: 50 45 40 35 30 25 20 15 10 5 0 % Eu
Page 85 and 86: 16 % 40 14 12 10 8 6 4 2 0 Iatrogen
Page 87: Table 38: Mothers with babies diagn
Page 91 and 92: 6 LABOUR AND BIRTH This chapter inc
Page 93 and 94: Table 39: Maternal demographic char
Page 95 and 96: Table 40: Gestation at birth among
Page 97 and 98: Women given syntocinon prior to 3 c
Page 99 and 100: 70 60 50 40 30 20 10 0 % NZ Europea
Page 101 and 102: 6.5 Caesarean section WHA Maternity
Page 103 and 104: Caesarean section rate 60 50 40 30
Page 105 and 106: Sixty percent of para 1 women with
Page 107 and 108: 6.6 Instrumental vaginal birth WHA
Page 109 and 110: Table 52: Neonatal outcomes followi
Page 111 and 112: 6.10 Obstetric analgesia WHA Matern
Page 113: Table 56: GA use and mode of birth
Page 117 and 118: Chaptern 7 LABOUR and BIRTH OUTCOME
Page 119 and 120: 7 LABOUR and BIRTH OUTCOMES This ch
Page 121 and 122: 7.2 Third stage management Methods:
Page 123 and 124: Table 61: Postpartum haemorrhage ra
Page 125 and 126: 7.4 Emergency peripartum hysterecto
Page 127 and 128: Chaptern 8 POSTNATAL CARE 113
Page 129 and 130: 8 POSTNATAL CARE This chapter provi
Page 131 and 132: % 90 85 80 75 70 65 60 55 50 45 40
Page 133 and 134: 8.2 Postnatal admissions Methods Pr
Page 135 and 136: Table 70: Reason for admission to N
Page 137 and 138: Chaptern 9 NEWBORN SERVICES 123
Page 139 and 140: 9 NEWBORN SERVICES This chapter pro
Page 141 and 142: 9.2 NICU occupancy For 2010 the ver
Page 143 and 144: Number 700 600 500 400 300 200 100
Page 145 and 146: 9.3.4 Reasons for admission to NICU
Page 147 and 148: 9.4.3 Intraventricular haemorrhage
Page 149 and 150: 246 for 2010. This number is higher
Page 151 and 152: 9.4.8 Trends in the use of assisted
Page 153 and 154: 9.4.10 Positive pressure ventilatio
Page 155 and 156: 9.4.12 Term/post-term infants on as
Page 157 and 158: 9.5.2 Survival of inborn babies (23
Page 159 and 160: 20% 18% 16% 14% 12% 10% 8% 6% 4% AN
Page 161 and 162: 9.5.10 Postnatal corticosteroids (A
Page 163 and 164: express milk for many weeks before
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9.9 Child Development Unit 9.9.1 Fo
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9.9.2 Development at 4 years of chi
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Chapter 10 PERINATAL MORTALITY 155
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10 PERINATAL MORTALITY This chapter
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Table 87: Perinatal related loss an
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10.5 Causes of perinatal-related de
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Chapter 11 SEVERE MATERNAL MORBIDIT
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11 SEVERE MATERNAL MORBIDITY This c
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Chapter 12 GYNAECOLOGY 167
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12 GYNAECOLOGY This chapter provide
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12.2 Termination of pregnancy Epsom
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12.3 Second trimester Termination o
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12.4 Gynaecology inpatient surgery
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Table 101: Demographic details of w
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ACHS Gynaecology Indicators: Injury
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12.5 Gynaecologic laparoscopic proc
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12.6 Hysterectomy Methods See Gynae
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% 80 70 60 50 40 30 20 10 0 Abdomin
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12.7 Urogynaecology Methods As in p
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Table 113: Complications of surgery
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12.8 Colposcopy Methods: The data p
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Referral smear cytology Table 117:
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The number of treatments and percen
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Number of patients 4.5 4 3.5 3 2.5
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12.9 Gynaecologic oncology surgical
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11.9.2 Gynaecologic oncology surger
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203
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Antenatal Summary screen; Reason fo
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Postnatal Mothers Destination to Wa
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APPENDIX 2. SUMMARY STATISTICS Tabl
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Table 135: Time trends in nullipari
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Table 141: Rates of smoking at book
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Table 149: LMC at birth and materna
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APPENDIX 4. ANTENATAL COMPLICATIONS
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Table 157: Demographic characterist
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4.4 Hypertensive disease Table 160:
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Table 164: LMC at birth and BMI (20
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APPENDIX 5. LABOUR AND BIRTH 5.1 In
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5.2 Outcomes following induction Ta
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Table 180: Mode of birth by LMC at
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5.5 Operative births Table 189: Pri
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Table 196: Referral for ECV (women
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APPENDIX 6. LABOUR and BIRTH OUTCOM
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APPENDIX 7. POSTNATAL CARE 7.1 Infa
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Table 213: Maternal destination fol
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Table 220: Admissions of inborn bab
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Table 224: Admissions of outborn ba
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8.2.5 Antenatal corticosteroids Tab
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8.3.2 Intraventricular haemorrhage
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8.4.1 Survival Table 240: Numbers o
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8.5.4 Patent Ductus Arteriosus Tabl
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Table 252: Inborn babies receiving
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APPENDIX 9. PERINATAL MORTALITY Tab
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Table 260: Cause of perinatal-relat
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10.2 Gynaecology Inpatient Surgery
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APPENDIX 11. GLOSSARY OF ABBREVIATI
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APPENDIX 12. DEFINITIONS Antepartum
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Lead Maternity Carer (LMC) The Lead
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Standard primipara A woman with no
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National Women's Annual Clinical Report 2010

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