600 Births in as a Midwife. This number seems both huge and small at the same time. I have also been a midwife for a decade, which also feels like a drop in the bucket and monumental. Over the years, I have collected cards and photos from families and keep them in a small chest next to my desk. Every so often, especially if I have had a rough patch, I will open it up and remember back on all these moments. Each card and photo will trigger a memory for me and I always feel honored to be included on the lives of my clients. So many beautiful little souls!
I have always been into the numbers and have kept data on every birth I have attended. Data on the heart, little stories or phrases that stand out to make each birth memorable. Data from the head, statistical information on outcomes. They are both equally important to me. I believe that in order to take honest, objective looks at our practice as midwives, we need to keep these data. (In fact, I feel strongly that all health care providers should keep outcome data.) Sharing this data publicly is also a practice that I have committed to since the beginning of my practice. You can read my last post on this here https://amidwifeonthepath.com/blessed-400-babies/ . This is not an easy choice, every time I publish my outcomes, I open myself up for scrutiny. It is an act that forces me to sit in some uncomfortable vulnerability. It has led to some great conversations and it has led to some ugly commentary. Yet, I remain committed to the philosophy behind it; that we has providers must be transparent in our work. That we must hold each other and ourselves accountable.
I started my midwifery career as a community based provider, working in a free standing birth center. Then in 2017, I left my original home and moved to a new practice. This move was not easy and was a huge leap of faith. I was hired by a private physician group to design, build and run a new free standing birth center for them. This move also meant that I would also be attending births in the hospital setting. Talk about change! And growth and boundary pushing and heart expanding and gratefulness. Expanding the care I can offer and to whom I can offer it has been challenging and wonderful. It is not always easy but it is worth it for the families. This has of course, affected my numbers and I can see the changes. OK, let’s get to it!
Some important disclaimers: these are my personal numbers and not those of the groups I work, or have worked in. If some percentages do not add up exactly, that is due to the fact that my early births may not have included all the data points I am sharing here.
600 Births In, by the Numbers
- Cesarean Birth Rate = 4.3%. Clearly, as a midwife, I do not preform the cesarean. However, since moving to my new practice, I have become certified to First Assist so am able to follow my families through to the operating room.
- Waterbirth rate = 25.6%. Prior to my new position this number was higher. The hospital where I also work does not offer this service.
- Postpartum Hemorrhage = 5%
- Epidural Rate = 21%. This is a completely new category for me. While working on getting the birth center open, my practice was exclusively hospital based, the group I was with had a very high volume and many of these clients had planned on epidurals from the beginning of their pregnancy.
- Induction of Labor = 6.2%. These were primarily for medical need such as hypertension disorders, prolonged rupture of membranes or cholestasis of pregnancy. I have done a very small number of “social” inductions, these were typically for military families when the non-birthing parent was preparing to be deployed. I have done two due to the non-birthing parent having a severe medical condition that affected their life expectancy and ability to meet their baby.
- NICU Admission = 2.6%. All of these babies went on to make full recoveries. Most of these were for minor respiratory issues. There have been a few that were for undiagnosed congenital anomalies.
- Fetal Monitoring: Intermittent Auscultation 72%, Continuous Electronic Fetal Monitoring 16%, Internal Electronic Fetal Monitoring 1.3%
- Artifical Rupture of Membranes = 15.7%
- Birth Position: Hands and Knees 25.8%, Semi-reclining 22%, Birth Stool 11.9%, McRoberts 9.6%, Side Lying 8.1%, Squatting 6.3%, Standing 3.5%. (there is also a percentage of unknown as it is not recorded.)
- Perineal Integrity: Intact 27.3%, Laceration not requiring repair 19%, First Degree 18.5%, Second Degree 27.6%, Third Degree 3.1%, Fourth Degree 0.8%, Peri-urethral 1.2%, Episiotomy 2%.
- GBS Positive Rate = 18.8%
- Retained Placenta = 1.7%. The first birth center I practiced in had a very strict, regulatory enforced, time limit for retained placenta. In 2017, the state regulations were updated regarding this issue.
- En Caul Births = 2.8%
- Cord Avulsion = 1.2%
- True Knots in the Cord = 4 total
- The youngest birthing parent I have attended was 15 and the oldest was 45.
- The biggest full term baby I have caught weighed 10lbs 12oz and the smallest full term baby was 5lbs 3oz.
And there you have it, my first 600 Births, laid out in numbers. I am open to respectful, constructive discussion. Hostile comments will not be entertained and will be deleted. This is my space and I will not be attacked in it. I also challenge my peers to keep and share their outcome statistics.
Image credit for the Top and Bottom Images https://amidwifeonthepath.com/about-the-midwife/
Image credit for Middle Image https://www.monetnicole.com/