Wow, again, it seems hard to believe that I have reached this milestone! I have compiled a rough group of stats from these births, but I do have some disclaimers. First, these births are only the ones that I was able to “catch”. So, these do not include Mama’s that I labor sat with and then passed to my midwife sisters. Second, these do not include Mama’s that I had to transfer to the hospital before the birth…which would include both vaginal births and cesarean sections. In putting these numbers together, this is an area that I realize I have unfortunately missed. In the future, I plan to also keep track of those births as well. Also, the first 40 births were done as a student and 21 of those ocurred in a hospital. Well, here goes:
There were 52 boys and 48 girls and 4 (two girls and two boys) of these babes were born en caul.
There were 11 cases of PPH (EBL > 500ml).
I had 4 Shoulder Dystocia’s…however, I feel that 3 of them were more like “tight shoulders” as they were easily relieved by McRobert’s position.
I performed AROM in 19 labors.
There were 4 retained placenta’s.
I had 1 cord evulsion and found 1 true knot in an umbilical cord after the birth.
I cut 2 episiotomies, one of which extended to a fourth degree laceration and the other was a second degree, both were done for significant fetal heart decelerations during crowning.
38 perineums were intact, 33 had first degree lacerations (about half required suturing), 24 second degree lacerations, 3 third degree lacerations and 2 fourth degree lacerations (1 was from the epis and one ocurred spontaneously).
4 newborns were transferred to the hospital after birth; 2 for TTN, 1 with more severe resp distress and 1 with anomolies.
9 women were transferred postpartum; 4 for retained placenta’s and 5 for repairs of the 3rd and 4th degree lacerations.
26 births were H2O births (for 21 of my catches, water birth was not an option at the site) Birth positions: semi-reclining = 26, hands and knees = 25, birth stool = 14, McRoberts = 14, squatting = 10, side lying = 8 and standing = 3.
Whew. Those are the big things that I can think about to tally up. I have mixed feelings on the results. I feel that the two epis’s that I did were valid, though they are never “fun” to do. I am curious about the amount of PPH and want to investigate that further. I have had a tendency to practice a more active management of third stage. However, a new study was just published from Australia which puts this practice into question. It is something I will continue to monitor.
The big surprises for me were the rate of water birth and the birth position. I had thought there were more water births. The percentage works out to be 32% (when corrected for the births where not an option), which is still a good amount. I feel that almost of my Mama’s have labored in the water. I think that perhaps, as a new midwife, I was more likely to have a woman get out of the pool for perceived concerns and I am becoming more comfortable with having her stay in the water now. Part of this is because the water births have increased as my numbers have gone up. The break down of birth positions was also surprising, particularly the amount of births in the McRoberts position. Again, I think this may have to do with comfort level as well and has ocurred less frequently as numbers went up.
The exercise of putting these numbers together has been very informative, it is something that I would recommend to all midwives. We can easily remember things differently…like, I would have estimated my water birth rate to be much higher and my PPH rate to be lower. Some information may not be what is expected, for good or bad, but we must always strive for the facts in order to improve our practice.