WOW! I have been blessed by 400 (actually 401) babies and their families.
Since the beginning of my work as a midwife, I have been committed to keeping and maintaining my outcome statistics. Partially this is because I am a bit of a nerd, partially because I love to record each birth story and partially because I firmly believe in the power of objectively assessing my practice. I want to be very clear, these outcomes are mine personally and are not outcomes for my birth center as a whole. The birth center has welcomed at least 2,500 babies Earthside, while I have caught my 401.
There is a big difference with these outcomes and that is that I have started using an electronic database called BirthTracks ( https://birthtracks.com/ ) to help me with the math. What this means is that I have spent the last two weeks entering all of my outcomes since birth 1 into this database. It was a labor of love for sure! This process, while a little tedious, was also a lovely opportunity to relive all of these births. To remember the magic of this work along with the heartbreak and hours of physical, emotional and psychological energy required. In the past two weeks, I have laughed out load, cried and been filled with warm fuzzies while going through this process.
A couple of points and observations about releasing this data. First, in the past, each time I have done this, it has lead to much discussion and some debate. I welcome this, even though it is not all happy or positive, because I hold lives in my hands and that means I should be accountable. I simply request that all discussion and debate remain respectful. Second, if you go back and notice discrepancies in my math between each set of 100 births, I will venture to say that it would have to do with the first 300 being done by me, by hand. I will stand by these most recent outcomes, as I meticulously entered (checked and double checked) all the data and the program did the math for me. Lastly, you will notice a couple of new data points; this is because the BirthTracks program has the ability to record data that I never calculated on my own. Going forward, I will be collecting many more data points using this tool!
So, here are my outcomes, warts and all….
- Births 401, transfers in labor 55 for an Intrapartum transfer rate of 12.1%. What this means is that of the 456 clients that I have attended in labor, 55 of them required transfer to the hospital. This rate makes me happy as according to the World Heath Oganization ( http://www.who.int/en/ ) the given percentage of low risk pregnancies that will require an additional level of support in labor and birth is between 10-15%.
- Cesarean Birth Rate 4.8%. Of course, I do not preform cesarean sections and we do not do them at the birth center. So, of the 456 laboring clients I have attended, 4.8% of them required a cesarean. I am very fortunate to have wonderful collaborating physicians, midwives and supportive hospitals when I transfer someone and this is a great example of that!
- Waterbirth rate 31.3%. If I had to guess, I would say that well over 90% of my clients have spent a significant amount of time in the birth pool. It is an amazingly effective tool for working through labor and birth.
- The youngest pregnant person I have attended was 15 years old and the oldest was 45.
- Baby Boys 50.4% and Baby Girls 49.6%. The biggest baby I have caught weighed 10lbs. 10oz. and the smallest baby I have caught weighed 5lbs 3oz. (Fun fact, at the birth center, the biggest baby born was 12# 6oz.!)
- Group Beta Strep Positive 17.5%
- Artificial Rupture of Membranes (AROM) rate 9%. In my opinion, AROM is a significant intervention and should not be taken lightly! Each time I have done this, it has been after thorough informed consent and has been primarily done to augment a long labor.
- Meconium stained fluid in 11.2% of births.
- Position for Birth: Hands and Knees 39.4%, Birth Stool 14%, Side Lying 12%, Semi-Reclining 11.3%, McRoberts 11%, Squatting 7.7% and Standing 4.6%.
- Perineal Outcomes: Intact 27.6%, 1st degree 26.8%, 2nd degree 31.9%, 3rd degree 3.1%, 4th degree 0.7%, labial and peri-urethral lacerations 7.7% and an episiotomy rate of 2.2%. In the births where I have preformed episiotomy it was either for significant fetal heart rate decelerations or for shoulder dystocia. In the case of shoulder dystocia, I only preform episiotomy if necessary to help with internal maneuvers and this is not always required.
- Postpartum Hemorrhage (PPH) total 16.7%, of that percentage, blood loss greater than 1,000cc 4.6%. This is a tough one for me and it always has been. For births 1-300 I did “estimated blood loss” and starting with birth 301 I have weighed blood loss at each and every birth. I have many thoughts on this topic and look forward to discussing it….hopefully this will trigger some comments and questions….
- Shoulder Dystocia 5.5%. This is another one that is higher than I would think. Expected rates commonly quoted range from 1-6% depending on the source. I have thought long and hard about this one and feel each of the births I have counted as a shoulder dystocia truly warrants the label. If a birth involves what many midwives refer to as “sticky shoulders” and only requires a quick position change, I do not count that as a shoulder dystocia. If a birth involves multiple position changes and/or internal maneuvers then I have counted it as a shoulder dystocia. Of my counted shoulder dystocias, only two took more than two-three minutes to resolve from the birth of the head to the birth of the shoulders. In one the time required was 5 minutes and in one the time required was 7 minutes. All baby outcomes have been positive. Again, I am looking forward to possible discussion on this one.
- Postpartum Maternal Transfers 7%. The most common reason for this was repair of third and fourth degree perineal lacerations. I do not (and neither do any of the midwives at my birth center) preform these repairs. The next reason for transport postpartum is postpartum hemorrhage (clearly, not all clients who experience a PPH require transport), followed by retained placenta. Our current state regulations that govern birth centers require automatic transport for retained placenta at 30 minutes post birth. This is a requirement that I do not agree with, but am bound to by law.
- Neonatal Transfers to the NICU 3.1%. The vast majority of these transfers has not been emergent and have been for Transient Tachypnea of the Newborn or TTN. These are babies who are breathing fast and require oxygen support but are otherwise well. I have had 1 newborn transfer for spontaneous pneumothorax and one for congenital anomalies that were undiagnosed prenatally and required intervention.
- Retained Placenta: I have had 7 of these. As mentioned above our state regulations require transport for retained placenta at 30 minutes post birth. Of these 7 instances, 4 of them were birthed without incident at the hospital upon arrival.
- Manual Removal of Placenta: I have done this 3 times, all three incidents were in response to significant bleeding after partial seperation of the placenta without spontaneous release of the full placenta.
- Umbilical Cord Avulsion: or “cord snapping” has happened in 4 births. Two of which were waterbirths and only one caused any concerns for baby. Also, speaking of cords, I have had one true knot and it did not cause any issues during labor or birth for the baby.
- Babies Born en Caul: I have caught 14 babies who were born in their amnitoic membranes!
OK, folks there it is! Again, I am used to lively discussion after releasing all of my outcomes and look forward to it. I also want to expand my sincere gratitude to all the families who have trusted me with their care. And especially to my own family who have endlessly supported me on this journey, I couldn’t have done any of this without them. Here’s to 400 more!!!
Image credit http://www.monetnicole.com/