The MaCCS will enable individual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia.

Background Stillbirth remains a public health concern in high‐income countries. Over the past 20 years, stillbirth rates globally have shown little improvement and large disparities. The overall stillbirth rate, which measures risk among births at all gestations, masks diverging trends at different gestations. This study investigates trends over time in gestation‐specific risk of stillbirth in Australia. Methods Analytical epidemiological study using nationally reported gestational age data for births in Australia, 1994‐2015. Average annual change in gestation‐specific prospective risk of stillbirth (per 1000 fetuses at risk [FAR]) was calculated among births in 1994‐2009 and 2010‐2015 at term (37‐41 weeks) and for preterm gestational age subgroups: 28‐36, 24‐27, and 20‐23 weeks. Results The decline in risk of stillbirth at term from 2010 to 2015 from 1.43 to 1.16 per 1000 FAR was more rapid than from 1994 to 2009; for preterm gestations from 24 to 27 weeks, there were no discernible trends; from 28 to 36 weeks, the decline between 1994 and 2009 was not sustained; among births from 20 to 23 weeks, the risk of stillbirth plateaued in 2010‐2015, fluctuating around 3.3 per 1000 FAR. Conclusions Improvement in the stillbirth rate from 28 weeks’ gestation aligns with changes in other high‐income countries, but more work is needed in Australia to achieve the levels of reduction seen elsewhere. Gestation‐specific risk of stillbirth is more informative than the overall stillbirth rate. The message that the overall risk of stillbirth is not changing disregards gains at different stages of pregnancy.

Background: The caesarean section (CS) rate is over 25% in many high-income countries, with a substantial minority of CSs occurring in women with low-risk pregnancies. CS decision-making is influenced by clinician and patient beliefs and preferences, and clinical guidelines increasingly stipulate the importance of shared decision-making (SDM). To what extent SDM occurs in practice is unclear.Aims: To identify women's birth preferences and SDM experience regarding planned CS. Material and Methods: Survey of women at eight Sydney hospitals booked for planned CS. Demographic data, initial mode of birth preferences, reason for CS, and experiences of SDM were elicited using questions with multiple choice lists, Likert scales, and open-ended responses.Quantitative data was analysed using descriptive statistics and qualitative data using content analysis. Responses of women who perceived their CS as "requested" versus "recommended" were compared.Results: Of 151 respondents, repeat CS (48%) and breech presentation (14%) were the most common indications. Only 32% stated that at the beginning of pregnancy they had had a definite preference for spontaneous labour and birth. Key reasons for wanting planned CS were to avoid another emergency CS, prior positive CS experience, and logistical planning. Although 15% of women felt pressured (or were unsure) about their CS decision, the majority reported positive experiences, with over 90% indicating they were informed about CS benefits and risks, had adequate information, and understood information provided. Conclusions:The majority (85%) of women appeared satisfied with the decision-making process, regardless of whether they perceived their CS as requested or recommended.

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