Birth In Australia Research Articles

Management of eating disorders during pregnancy: A survey of Australian dietitians in clinical practice.

Eating disorders (EDs) are estimated to affect 5.2%-7.5% of pregnant women, equating to 15,800-23,000 births in Australia annually. In pregnancy, an ED increases the risk of complications for both mother and child. Heightened motivation and increased utilisation of healthcare services during pregnancy present an opportunity to identify and commence ED treatment. Dietetic management of EDs differs from nutrition guidelines for pregnancy. This study aimed to assess current practice, confidence and training needs of dietitians to manage EDs in pregnancy. A cross-sectional survey of Australian dietitians with past year exposure to ED and/or antenatal fields was completed using Microsoft Forms between November 2022 and January 2023. One hundred and seventeen responses were analysed. Confidence was less for assessment of a woman with an active ED in pregnancy than a pregnant woman with a history of an ED, pregnancy or an ED alone (p < 0.001). Greater than 5 years of experience as a dietitian, but without recent exposure to the patient population, was associated with increased confidence (p < 0.01). Almost half provided descriptions of treatments and interventions used to treat a pregnant woman with an ED, some of which conflict with ED or antenatal guidelines. Dietitians were more likely to weigh a person with an ED in pregnancy. Most respondents indicated further training (93%) and guidelines (98%) would be helpful. This is the first investigation into the dietetic management of EDs in pregnancy, and it highlights a need for guidelines and training for dietitians.

Self-Care and General Well-Being in Postpartum Mothers

INTRODUCTION:Mothers are crucial to society, yet they may experience depression or other mental illnesses during pregnancy and after birth. Preventative programs to reduce postpartum mental illness lack a clear evidence base, and a strength-based approach focusing on well-being is generally not provided. This study aims to explore postpartum mothers’ self-care practices and well-being from the perspective of a strength-based approach. Rather than rely on a deficit approach and further problematize the experiences of postpartum women, this study aimed to identify the relationship and predictability of self-care with general well-being for postpartum mothers.METHODS:This study was a quantitative, cross-sectional survey design using an online survey with women aged 18 years and older who had given birth in Australia to a child between 6 weeks and 12 months (N =140) regarding their self-care practices and general well-being.RESULTS:A hierarchical multiple linear regression found a strong relationship between self-care behaviors and well-being during the first year of motherhood. Findings also revealed that significant confounding factors impacted the relationship between self-care and well-being with the number of complications experienced during pregnancy to postpartum and prior experiences of “baby blues.”DISCUSSION:Findings from the current study provide evidence of the importance of self-care, and a strength-based approach for enhancing self-care skills may assist in improving the well-being of postpartum mothers. Further research is needed to identify other interactions affecting the relationship and to investigate causality.

Baby Bump or Baby Slump? COVID-19, Lockdowns, and their Effects on Births in Australia

This study examines changes in birth rates in Australia during the COVID-19 pandemic and the extent to which such changes were influenced by lockdowns. We use natality data at State and small regional area levels spanning the period from 2011 to 2022. In our empirical approach, we first take advantage of a unique quasi-experimental setting that arose in Victoria, Australia's second most populous State, during the first year of the pandemic. Victoria imposed a 111-day stay-at-home lockdown while other States and Territories enforced milder restrictions on social and economic activities. We then exploit lockdowns that lasted more than three months in Victoria and New South Wales in the second year of the pandemic. Within these quasi-experimental settings, our empirical approach was to first use monthly data at the State-level and estimate birth rate deviations from secular trends for the months affected by COVID-19 policies. We also estimate separate models to examine variations in births across regional areas with different compositions of Indigenous population, unemployment, low-income, and non-English speaking residents. Our findings reveal a nationwide fertility increase in 2021, but Victoria exhibited slower growth, especially in areas with higher unemployment, lower income, and more non-English speaking residents. In 2022, we find evidence of a gradual return of birth rates to pre-pandemic trends, though this is mainly concentrated in the major cities. While the second-year lockdowns had limited impacts, language-diverse areas still mostly experienced lower rates of growth in birth rates.

Identifying Longer-Term Health Events and Outcomes and Health Service Use of Low Birthweight CALD Infants in Australia

IntroductionApproximately one-third of all births in Australia each year are by culturally and linguistically diverse (CALD) women. CALD women are at an increased risk of adverse pregnancy and birth outcomes including prematurity and low birthweight. Infants born weighing less than 2500 g are susceptible to increased risk of ill health and morbidities such as cognitive defects including cerebral palsy, and neuro-motor functioning.MethodsAn existing linked administrative dataset, Maternity 1000 was utilized for this study which has identified all children born in Queensland (QLD), Australia, between 1st July 2012 to 30th June 2018 from the QLD Perinatal Data Collection. This has then been linked to the QLD Hospital Admitted Patient Data Collection, QLD Hospital Non-Admitted Patient Data Collection, QLD Emergency Department Data Collection, and Medicare Benefits Schedule and Pharmaceutical Benefits Scheme Claims Records between 1 and 2012 to 30th June 2019.ResultsCulturally and linguistically diverse infants born with low birthweight had higher mean and standard deviation of all health events and outcomes; potentially preventable hospitalisations, hospital re-admissions, ED presentations without admissions, and development of chronic diseases compared to non-CALD infants born with low birthweight.DiscussionResults from this study highlight the disparities in health service use and health events and outcomes associated with low birthweight infants, between both CALD and Australian born women. This study has responded to the knowledge gap of low birthweight on the Australian economy by identifying that there are significant inequalities in access to health services for CALD women in Australia, as well as increased health events and poor birth outcomes for these infants when compared to those of mothers born in Australia.

Effect of the COVID-19 pandemic on life expectancy in Australia, 2020-22.

Australia provides a valuable international case study of life expectancy during the pandemic. In contrast to many other countries, it experienced relatively stringent restrictions and low COVID-19 mortality during 2020-21, followed by relaxation of these restrictions when high vaccination rates were achieved. This study measures Australia's life expectancy trends and the contributions of age group and causes of death, during the pandemic. Trends in life expectancy at birth in Australia and its states and territories were measured from 2020 to 2022. The contributions of age group and cause of death to these trends were measured using decomposition methods. Life expectancy was compared with other high-income countries. Australia's life expectancy fell by more than half a year in 2022, following a sharp increase in 2020 and moderate decline in 2021. For the 3 years 2020 to 2022, life expectancy was 0.13 years (95% confidence interval 0.07-0.19) higher for males and 0.09 years (0.03-0.14) higher for females versus 2017-19. Australia's life expectancy increase in 2020 was larger than that in the vast majority of other high-income countries, but its decline in 2022 was greater than in other countries whose life expectancy rose in the first year of the pandemic. The small negative contribution of COVID-19 deaths to life expectancy in Australia was more than offset by lower non-communicable disease mortality. There were only small differences in life expectancy change between the states with the most stringent restrictions (Victoria and New South Wales) and the rest of Australia. Australia's life expectancy trends during 2020-22 were relatively favourable compared with other high-income countries, with the exception of its sharp decline in 2022 once restrictions were loosened.

Intrapartum use of sildenafil citrate to prevent fetal compromise and emergency operative birth in term pregnancies in the United Kingdom and Australia: Apreliminary cost-effectiveness analysis.

To compare cost-effectiveness of oral sildenafil citrate, administered after onset of labor, with standard care to health system funders in the UK and Australia. We conducted a modeled cost-effectiveness analysis, measuring costs and quality adjusted life years (QALYs), using a decision-analytic model covering onset of labor to 1 month post-birth. The relative risk of emergency cesarean section and operative vaginal birth was taken from a Phase 2 placebo controlled double blinded randomized control trial. Both options of care resulted in the same QALYs gained over the model time period (0.08). Sildenafil citrate was cost-saving compared with standard care, saving £92 per birth in the UK (AU$303 per birth in Australia). Sensitivity analyses did not identify any areas of uncertainty that stopped sildenafil citrate being cost saving compared with standard care. Threshold analysis revealed that sildenafil citrate would be cost saving up to a per birth drug or administration cost of £152.32 in the UK (AU$333.61 in Australia). Oral sildenafil citrate may be cost saving compared with standard care; however, the effects on neonatal outcomes still need to be demonstrated in large randomized trials.

Perinatal outcomes among Indian-born mothers in Australia

ObjectiveTo examine the incidence of adverse perinatal outcomes and the risk of adverse perinatal outcomes for Indian-born mothers compared to other mothers living and giving birth in Australia.Design, setting and participantsThis retrospective cohort study was designed to investigate all births in Australia in 2012 and those in the Monash Health Birthing Outcomes System (BOS) 2014 to Indian-born mothers in Australia. Data sets were analysed involving descriptive statistics using Statistical Package for Social Sciences (SPSS vs. 23).ResultsIndian-born mothers in Australia are at increased risk of induced labour, emergency caesarean section, very preterm birth (20–27 weeks), babies with low to very low birth weight, and low Apgar score (0–2) at 5 min, gestational diabetes, hypothyroidism, iron deficiency anaemia and vitamin B12 deficiencies compared to other mothers giving birth in Australia. This is despite a range of protective factors (25–34 years, married, nonsmokers, and a BMI < 30) that would normally be expected to reduce the risk of adverse perinatal outcomes for mothers giving birth in a developed country.ConclusionIn the absence of many of the recognized maternal risk factors, Indian-born mothers continue to face increased risk of adverse perinatal outcomes, despite access to high quality maternity care in Australia. Recommendations arising from this study include the need for an intervention study to identify maternal risk factors for Indian-born mothers in mid to late pregnancy that contribute to the risk for very preterm birth and low birth weight.

The burden and trend of diseases and their risk factors in Australia, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

A comprehensive understanding of temporal trends in the disease burden in Australia is lacking, and these trends are required to inform health service planning and improve population health. We explored the burden and trends of diseases and their risk factors in Australia from 1990 to 2019 through a comprehensive analysis of the Global Burden of Disease Study (GBD) 2019. In this systematic analysis for GBD 2019, we estimated all-cause mortality using the standardised GBD methodology. Data sources included primarily vital registration systems with additional data from sample registrations, censuses, surveys, surveillance, registries, and verbal autopsies. A composite measure of health loss caused by fatal and non-fatal disease burden (disability-adjusted life-years [DALYs]) was calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). Comparisons between Australia and 14 other high-income countries were made. Life expectancy at birth in Australia improved from 77·0 years (95% uncertainty interval [UI] 76·9-77·1) in 1990 to 82·9 years (82·7-83·1) in 2019. Between 1990 and 2019, the age-standardised death rate decreased from 637·7 deaths (95% UI 634·1-641·3) to 389·2 deaths (381·4-397·6) per 100 000 population. In 2019, non-communicable diseases remained the major cause of mortality in Australia, accounting for 90·9% (95% UI 90·4-91·9) of total deaths, followed by injuries (5·7%, 5·3-6·1) and communicable, maternal, neonatal, and nutritional diseases (3·3%, 2·9-3·7). Ischaemic heart disease, self-harm, tracheal, bronchus, and lung cancer, stroke, and colorectal cancer were the leading causes of YLLs. The leading causes of YLDs were low back pain, depressive disorders, other musculoskeletal diseases, falls, and anxiety disorders. The leading risk factors for DALYs were high BMI, smoking, high blood pressure, high fasting plasma glucose, and drug use. Between 1990 and 2019, all-cause DALYs decreased by 24·6% (95% UI 21·5-28·1). Relative to similar countries, Australia's ranking improved for age-standardised death rates and life expectancy at birth but not for YLDs and YLLs between 1990 and 2019. An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing. Bill & Melinda Gates Foundation.

Causes of Perinatal Deaths in Australia: Slow Progress in the Preterm Period

(Aust N Z J Obstet Gynaecol. 2022;62:511–517) The rate of stillbirth in Australia decreased from 25% to 15% over the last 20 years. Ninety percent of Australian stillbirths are born before 28 gestational weeks (EGA), and the number of deaths following preterm birth in Australia has remained stable. Despite perinatal and neonatal death being relatively similar, many studies attempt to ignore their similarities and focus on one of them. This study researched the impact of EGA on preterm stillbirth and neonatal death to identify where future research should focus.

Long-term cost-effectiveness of implementing a lifestyle intervention during pregnancy to reduce the incidence of gestational diabetes and type 2 diabetes

Aims/hypothesisThe aim of this study was to determine the long-term cost-effectiveness and return on investment of implementing a structured lifestyle intervention to reduce excessive gestational weight gain and associated incidence of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus.MethodsA decision-analytic Markov model was used to compare the health and cost-effectiveness outcomes for (1) a structured lifestyle intervention during pregnancy to prevent GDM and subsequent type 2 diabetes; and (2) current usual antenatal care. Life table modelling was used to capture type 2 diabetes morbidity, mortality and quality-adjusted life years over a lifetime horizon for all women giving birth in Australia. Costs incorporated both healthcare and societal perspectives. The intervention effect was derived from published meta-analyses. Deterministic and probabilistic sensitivity analyses were used to capture the impact of uncertainty in the model.ResultsThe model projected a 10% reduction in the number of women subsequently diagnosed with type 2 diabetes through implementation of the lifestyle intervention compared with current usual care. The total net incremental cost of intervention was approximately AU$70 million, and the cost savings from the reduction in costs of antenatal care for GDM, birth complications and type 2 diabetes management were approximately AU$85 million. The intervention was dominant (cost-saving) compared with usual care from a healthcare perspective, and returned AU$1.22 (95% CI 0.53, 2.13) per dollar invested. The results were robust to sensitivity analysis, and remained cost-saving or highly cost-effective in each of the scenarios explored.Conclusions/interpretationThis study demonstrates significant cost savings from implementation of a structured lifestyle intervention during pregnancy, due to a reduction in adverse health outcomes for women during both the perinatal period and over their lifetime.Graphical abstract

Unexpected neonatal death due to medium-chain acyl-CoA deficiency

Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is the most common fatty acid oxidation disorder, with an incidence of 1:19,000 live births in Australia.1 The typical presentation of MCADD is between 3 and 24 months of age and include hypoglycaemia, hepatomegaly and sudden death.2 Our case is a full term well grown male baby who was born in good condition. He became lethargic and had long periods without feeds on day 2 of life. On day 3 of life, he developed tachypnoea and grunting and was admitted to the Neonatal Intensive Care Unit at The Royal Children’s Hospital.

Shelter and shade for grazing sheep: implications for animal welfare and production and for landscape health

Shade and shelter may provide protection from cold and heat stress, a source of feed during prolonged or seasonal drought, specific essential nutrients, increased pasture and crop production and improved landscape health. Cold stress contributes to the average of 8% (single) and 24% (twin) of lambs that die within 3 days of birth in Australia and the estimated 0.7% of the Australian flock that die post-shearing during extreme or unseasonal weather. Shelter has resulted in an average reduction in mortality of 17.5% for twin-born lambs and 7% for single-born lambs according to Australian studies and decreases the susceptibility of ewes to metabolic disease and possibly dystocia. Because many of the published studies are from research areas where cold stress is expected, they are not indicative of industry-wide responses, a research priority is to determine the probability of lamb and ewe deaths from cold stress across different sheep production areas. Although shelter may improve lamb survival, ewes do not always choose to lamb in a sheltered location. For this reason, there is a requirement for research into the voluntary use of shelter in commercial-sized paddocks and the role that nutritive value of shelter plays in attracting and holding ewes to shelter, and to their lambs. Heat stress may also result in lamb deaths and influences feed conversion efficiency, appetite, reproduction, wool growth and disease susceptibility. The consequences of heat stress may go unnoticed over a yearly production cycle, although there is some evidence that shade may increase weaning rates and feed intake of grazing sheep. There are ancillary benefits from shade and shelter. Trees may improve crop production through reducing wind damage and evapotranspiration and provide timber. Shrubs provide feed during the summer–autumn feed gap or drought, are useful for the management of land degradation and provide habitat for native fauna. It is clear that shade and shelter in the correct locations provide a range of benefits to livestock and the landscape; nevertheless, adoption appears low. Research that focuses on defining the benefits on a farm or landscape scale is required to support extension programs.

Out-of-hospital health care costs of childhood food allergy in Australia: A population-based longitudinal study.

Australia has one of the highest prevalence of childhood food allergy in the world, but there are no data on its economic burden in Australia. We used data from the HealthNuts study, a population-based longitudinal study undertaken in Melbourne, Australia. Infants were recruited at age 12 months between Sept 2007 and Aug 2011 with food allergy diagnosed using oral food challenges. Health care costs of out-of-hospital services were collected through data linkage to Australia's universal health insurance scheme Medicare. Two-part model was used to compare costs after controlling for potential confounders. 2919 children were included, and 390 (13.4%) had challenge-confirmed food allergy at age 1year. Compared with children without food allergy, children with food allergy had significantly higher costs for GP visits, specialist visits, tests, and prescriptions in the first four years of life. The total Medicare cost associated with food allergy from age 1 to 4 years was estimated to be AUD$889.7 (95% CI $566.1-$1188.3) or €411.0 (95% CI €261.5-€549.0) per child. This was projected into an annual Medicare cost of AUD$26.1 million (95% CI $20.1-$32.3 million) or €12.1 (95% CI €9.3-€14.9 million) based on population size in 2020. Childhood food allergy causes considerable Medicare costs for out-of-hospital services in the first four years after birth in Australia. These findings can help anticipate the financial impact on the health care system associated with childhood food allergy, act as a useful costing resource for future evaluations, and inform management of childhood food allergy internationally.

Factors that Promote a Positive Childbearing Experience: A Qualitative Study.

Experiences of pregnancy and birth are important and have long-term impacts on the well-being of women and their families. Perinatal services should aim for care that promotes a positive childbearing experience, as well as optimizing health outcomes for the woman and newborn. This study aimed to understand the health system factors that promote a positive childbearing experience. Women who had a positive experience and had given birth in Australia in the previous 12 months were recruited for individual semistructured interviews. The interview guide focused on health system factors that participants credited with contributing to their positive experience of perinatal care. Interviews were conducted until data saturation was reached. Qualitative data were transcribed verbatim and analyzed using inductive thematic analysis. Data from 36 interviews were thematically analyzed, and 4 major themes were generated: health care provider attributes, health system attributes, communication and decision-making, and experience of care. The salient factors that promoted positive experiences included care that was respectful and individualized with effective communication, access to midwifery continuity of care models, and good integration between services. Competent and professional health care providers who facilitated shared decision-making were also essential. Although women often sought out care that promoted physiologic birth, they emphasized that the way they were cared for was more important than fulfilling specific birth aspirations. Quality maternity care has the capacity to support a woman's confidence in her own abilities and promote a positive, and sometimes transformative, childbearing experience.

O82 - Mandarin Caseload Midwifery Program-Using Non-English Language Concordance and continuity of midwifery care

This presentation will focus on the experiences of bilingual midwives providing care to Chinese born women. It will also discuss the results of a retrospective cohort study that evaluates birth outcomes of the Mandarin Caseload Midwifery Program (MCMP). Cultural variances become more pronounced during the perinatal period, and language difficulties can be more impactful for women from non-English speaking backgrounds affected by the heterogeneity of health determinants, needs, and vulnerabilities. Discordant language communication, when a woman and care provider don't share proficiency in the same language, creates an added disadvantage. Chinese-born women are the third-largest group of women giving birth in Australia, and more than 20% of them require an interpreter when receiving maternity care. However, migrants are not just recipients of care but are also increasingly represented amongst clinicians providing care. At Westmead Hospital, we used an opportunity to utilise bilingual midwives to provide caseload midwifery services for women who share their ethnic background and first language. MCMP was established within an existing low-risk entry, no exit model of caseload midwifery care. It started in August 2019 with two full-time Mandarin-speaking midwives, each caring for 36 women a year. By September 2021 MCMP looked after 142 Chinese born women and their babies. The Midwives providing the care develop strong relationships with women. They feel more confident delivering education in their first language and understand and support the cultural differences encountered when accessing the Australian healthcare system . Routine audits evaluated the outcomes of care, and the data in this retrospective cohort review demonstrates high levels of vaginal birth (87%), lower reliance on epidural analgesia (30%), and shorter hospital stays. Westmead hospital MCMP demonstrates the benefits of language concordant care for midwives using bilingual skills and maternity care outcomes.

Biopsychosocial factors influencing the occurrence and recurrence of preterm singleton births among Australian women: A prospective cohort study

IntroductionIn Australia, 8.6% of all births are premature, and this figure has relativelyincreased by 10% in the past decade. A range of biological, psychological, and socialfactors have previously been identified as predictors of preterm birth using cross sectionaldata; however, this lacks ascertainment of a cause-and-effect relationship.This study harnessed the power of longitudinal cohort data by investigating pretermbirth among women prospectively followed for 19 years using a comprehensiveframework that examines biological, psychological, and social factors concurrently. MethodsData from 5,292 women (11,256 newborns) who reported singleton birthsbetween 1996 and 2015 in the Australian Longitudinal Study on Women’s Health wereincluded. ResultsThe prevalence of preterm birth was 8.5% for first-births and 5.9% for allbirths.The recurrent preterm birth rate was 9.5% . Risk factors for first preterm birthswere chronic hypertension (OR 2.34; 95% CI: 1.67-3.27), gestational hypertension (OR2.87; 95% CI: 2.22-3.72), gestational diabetes (OR 1.66; 95% CI: 1.14-2.41),menarche before 12 years (OR 1.36; 95% CI: 1.02-1.82) and history of miscarriage(OR 1.35; 95% CI: 1.01-1.79). Risk factors for all preterm births were a history ofpreterm birth (OR 2.33; 95% CI: 1.46-3.70), menarche before 12 years (OR 1.33; 95%CI: 1.00-1.77), not being partnered (OR 1.31; 95% CI: 1.02-1.69), chronic hypertension(OR 2.02; 95% CI: 1.45-2.82), gestational hypertension (OR 3.22; 95% CI: 2.43-4.25),gestational diabetes (OR 1.67; 95% CI: 1.16-2.41), and asthma (OR 1.40; 95% CI:1.14-1.72). Premature birth was less likely for second or later births (OR 0.44; 95% CI:0.36-0.55) compared to first births. Premature birth was also less likely for women whocompleted a university degree compared to women with a high school certificate (OR0.73; 95% CI: 0.57-0.94). ConclusionFurther development of multi-sectoral policies for chronic diseaseprevention and reducing social inequalities is required to prevent preterm birth inAustralia.

Population-wide contribution of medically assisted reproductive technologies to overall births in Australia: temporal trends and parental characteristics.

Population-wide contribution of medically assisted reproductive technologies to overall births in Australia: temporal trends and parental characteristics.

Private provider incentives in health care: The case of caesarean births

Private doctors and hospitals face incentives to intervene in the process of childbirth because they are employed and paid differently from their public counterparts. While private obstetric care has been associated with higher rates of caesarean birth, it is unclear to what extent this is attributable to unobserved selection effects related to clinical need or patient preferences. Using administrative birth data on over 280,000 births in Australia between 2007 and 2012, we implement an instrumental variables framework to account for the endogeneity of choice of care. We also exploit Australia's institutional framework to examine the differences in doctor-level and hospital-level incentives. We find that giving birth in a private hospital leads to a 4 percentage point increase in the probability of having an unplanned caesarean birth. Over our study period, this equates to an additional 3241 caesarean births.

Fertility, pregnancy and post partum management after bariatric surgery: a narrative review.

Summary •Of the women who gave birth in Australia in 2018, 47% had overweight or obesity, with obesity being associated with both maternal and fetal complications.•Bariatric surgery improves fertility and some pregnancy‐related outcomes.•Following bariatric surgery, pregnancy should be delayed by at least 12–18 months due to adverse pregnancy outcomes associated with rapid weight loss.•Contraception should be prescribed after bariatric surgery, although the effectiveness of the oral contraceptive pill may be reduced due to malabsorption and contraceptive devices such as intrauterine devices should be considered as first line therapy.•After bariatric surgery, women should undergo close monitoring for nutritional insufficiencies before, during and after pregnancy. Expert opinion recommends these women undergo dietary assessment and supplementation to prevent micronutrient deficiencies.•Bariatric surgeons, bariatric medical practitioners, bariatric dieticians, the patient’s usual general practitioner, obstetricians, and maternity specialists should be involved to assist in the multidisciplinary management of these complex patients.

An exploration of potential output measures to assess efficiency and productivity for labour and birth in Australia

BackgroundIn maternity services, as in other areas of healthcare, increasing emphasis is placed on improving “efficiency” or “productivity”. The first step in any efficiency and productivity analysis is the selection of relevant input and output measures. Within healthcare quantifying what is produced (outputs) can be difficult.The aim of this paper is to identify a potential output measure, that can be used in an assessment of the efficiency and productivity of labour and birth in-hospital care in Australia and to assess the extent to which it reflects the principles of woman-centred care.MethodsThis paper will survey available perinatal and maternal datasets in Australia to identify potential output measures; map identified output variables against the principles of woman-centred care outlined in Australia’s national maternity strategy; and based on this, create a preliminary composite outcome measure for use in assessing the efficiency and productivity of Australian maternity services.ResultsThere are significant gaps in Australia’s maternity data collections with regard to measuring how well a maternity service is performing against the values of respect, choice and access; however safety is well measured. Our proposed composite measure identified that of the 63,215 births in Queensland in 2014, 67% met the criteria of quality outlined in our composite measure.ConclusionsAdoption in Australia of the collection of woman-reported maternity outcomes would substantially strengthen Australia’s national maternity data collections and provide a more holistic view of pregnancy and childbirth in Australia beyond traditional measure of maternal and neonate morbidity and mortality. Such measures to capture respect, choice and access could complement existing safety measures to inform the assessment of productivity and efficiency in maternity care.