700 Babies, born in the water, welcomed in the hospital, born on the land, welcomed in the community setting.
Rooted in the soil
Reaching through the milky stars
A midwife stands guard
The soul cracks and grows
The water swirls and supports
The eyes glow with grace
Strong hands open wide
A brow furrowed in love
A midwife stands guard
700 Babies and counting, I have been on this journey for well over a decade. I started as a nurse in 2005 and was a witness and supporter to countless births in that role and they are near and dear to my heart. Then, as a midwife in 2010 with these 700 births. From my first birth through to now, I have always kept a record of each one. Records of the ‘soft’ data: the words spoken, the feelings shared, the time spent. And the ‘hard’ data: the calculations and the outcomes. Both encompass the art and science of Midwifery. The labor we expend, the love we share, the spaces we guard. Both are necessary and valid. I have made a tradition of sharing these data and will continue to do so as long as I am attending births. For me, knowing these numbers helps to ensure that I am providing safe, appropriate care. In looking back, I can learn and grow as a practitioner, I can keep myself honest so to speak. Sharing these numbers also takes some bravery as every time I do so, I open myself up to opinions and scrutiny. I am always open to respectful thoughts, questions and discussion but will not engage in negative attacks.
When I started my career in 2010, I worked exclusively in the community setting at a free standing birth center. Then in 2017, I transitioned to a new role as I built and developed a new birth center. This one with the support of a physician group and so I have hospital privileges now and attend births in both a birth center and a hospital. This shift is of course reflected in my statistics.
Disclaimers: these are my personal numbers and not those of the groups I work within. 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.
- Cesarean Birth Rate = 4.3%, of course as a midwife I am not a surgeon. However, since 2017, I have been certified as a First Assist in the operating room so I have been able to follow my families through this process. Curious about what a First Assist is? Read more here.
- Waterbirth = 25.1%, sadly, the hospital in which I also attend births does not offer waterbirth so this number has gone down.
- Postpartum Hemorrhage (PPH) Rate = 4.5%. PPH rates have been and are notoriously under-reported as most providers and facilities use “estimated” blood loss (EBL). For years, I have utilized “quantified” blood loss (QBL), meaning that I weigh all the materials that have been used to catch the blood. When doing QBL’s you will have a seemingly higher PPH rate but this is misleading as you are truly calculating the loos and not simply eye-balling it. And we as humans are not that great at eye-balling blood loss and will subconsciously under guess. You can read more about this concept here.
- Epidural Rate = 19.9%, in 2017, when I started at my new practice, I started attending hospital births. From 2017-2019 most of these were planned hospital births where the birthing person had been planning an epidural before the onset of labor. Currently, I only attend hospital births with families who had been planning a community birth without an epidural but may change these plans when a transfer is necessary.
- Induction of Labor (IOL) = 6.6% Primarily, these were all for medical reasons such as prolonged rupture of membranes, hypertensive disorders or cholestasis or pregnancy. However, I have done a small handful of these for “social” reasons such as partner who is the military and is being deployed or a partner who had a serious medical condition affect their life expectancy and wanting them to be able to meet the baby.
- Neonatal Intensive Care Unit (NICU) Admission: 2.4% Each of these babies has made a full recovery, most were admitted for minor respiratory issues and some have been related to congenital anomalies.
- Fetal Monitoring: Intermittent Auscultation (IA) = 72%, Continuous Electronic Fetal Monitoring (CEFM) = 16% and Fetal Scalp Electrode (FSE) = 1.3%
- Artificial Rupture of Membranes (AROM) = 16.9%
- Birth Position: Hands and Knees = 24.7%, Semi-reclined = 21.5, Birth Stool = 12.2%, McRoberts = 11.2%, Side Lying = 7.7%, Squatting = 7.2%, Standing = 3.9% and Semi-fowlers = 0.6%
- Perineal Integrity: Intact = 28.3%, First degree laceration = 16.3%, Second degree laceration = 28.5%, Third degree laceration = 3.1%, Fourth degree laceration= 0.9%, Episiotomy = 1.7% and Peri-urethral lacerations = 1.1%
- Group Beta Strep (GBS) Positive Rate = 18.7%
- Retained Placenta = 1.6%, in 12 years of practice, I have had 2 clients with unknown placenta accreta for which there were no risk factors or cause apparent.
- En Caul Births = 3.1%
- Cord Avulsion = 1.4%
- True Knots in the Umbilical Cord = 5 total
- Youngest Birthing Person = 15
- Oldest Birthing Person = 45
- Biggest Full Term Baby = 10lbs 12oz
- Smallest Full Term Baby = 5lbs 3oz
Walking this path has been rewarding, exhausting and inspiring. I am constantly in awe of the birthing people and families that choose to invite into their most private space. As I continue to walk this path, hopefully, for years to come I often feel the flow of the waters carrying me, calming me, giving me strength and soothing me. I believe that birth is a deeply elemental process and for me, the element that I feel most often is that of water. It is powerful and soft, loud and gentle, it fills and takes the shape of each individual space.