I have always kept data and numbers for births. Since starting my midwifery practice, I have kept and publicly shared my personal stats. You can check out my latest post here. Outcome data is crucial for two primary reasons. First, to demonstrate our safety and secondly to objectively “check” ourselves and make sure we are providing safe care. Seasons Midwifery & Birth Center was open from late April of 2019 to early November of 2022. In those years we welcomed 697 babies through our center. We have kept and maintained our outcome statistics since opening our doors. In late September of 2022, we were informed by the company that owned our center that we would be shut down within 30 days. Of course, this was devastating for all of us. I have shared some feelings and information about our closure here. I am publishing this post to share our data and outcomes, to push back against the narrative that birth centers aren’t valuable and to uplift the amazing work our team provided to our community.
First, it is important to describe our practice: the provider types, services offered and philosophy. Seasons was started with the intention to provide care to our full community, from the beginning we accepted Medicaid without restriction, private health insurance and self pay. The birth center and clinic were staffed with Certified Nurse Midwives (CNMs). When we first opened we had 4 but quickly staffed up to 5 full time midwives. These midwives had clinical privileges at our community hospital, this allowed us to admit and manage clients that required hospital care. Additionally, the midwives were certified to act as surgical First Assist in the operating room for our clients that required cesarean birth. Through hospital privileges and first assist capability, we were able to offer comprehensive continuity of care.
At the birth center, our assistants were a mix of Registered Nurses (RN) or Certified Birth Assistants (CBA). In the clinic, we had Medical Assistants who assisted with the day-to-day running of the clinic: drawing labs, preparing specimens, assisting with office procedures, taking vital signs, administering medications, etc. Seasons was also highly committed to preparing new midwives and as such, we precepted midwifery students throughout our history. There were 2 other components of the clinic that were crucial to our running: the Admin team who ran the day-to-day business aspects and client communication as well as the superb people who made up our educational teams teaching everything from childbirth prep to lactation.
This post will be reviewing and sharing our outcomes for pregnancy care. It is important to remember that Seasons also provided full scope, well person care as well. We offered annual exams, full spectrum contraception and reproductive care, visits for GYN problems or complaints and Family Building through IUI/ICI care. All of these are services that were also lost to the community when we were closed.
Philosophically, Seasons was dedicated to Informed Consent with the right to decline through the Shared Decision Making process. With their innate and excellent knowledge of their bodies, family and culture we viewed our clients as equal members of our care team.
Let’s talk demographics of clients served. When looking at race, our numbers closely mirrored those of the state as a whole.
- White: CO and Seasons = 70%
- Hispanic: CO = 22% and Seasons = 16.3%
- Black: CO = 4% and Seasons = 3.1%
- Asian: CO = 3.5% and Seasons = 2.3%
- Native/Indigenous: CO =1.3% and Seasons = 1.8%
- Of Seasons clients 6.5% self identified as non-white and not belonging to any one of the other groups listed.
Our payer mix was comprised of 35% Medicaid, the CO state rate is 36.1% and the national rate is 41%. We had 4.1% of families self pay and the remaining 60.9% was a mix of private health insurance. As far as age, 80.6% of pregnant people were between the ages of 15-34 and 19.4% were between 35-44.
Cesarean Birth Rate
As a free standing birth center, we did not preform cesarean sections at the center. However, we kept all the statistics of the cesarean births that our clients received. All clients who started care with us and remained with us through the birth are included. Additionally, as discussed above, our midwives acted as First Assist for the majority of these surgeries. Per the World Health Organization (WHO) in low risk populations, the cesarean birth rate should not exceed 10-15%.
- The National rate, per the National Vital Statistics Report (NSVR) 2021, is 32.1%
- The Colorado state rate is 27.2%
- The Seasons Midwifery & Birth Center rate was 8.2%
Preterm Birth Rate
Preterm Birth (PTB) is a critical indicator of health both for the individual baby and for populations as a whole. Preterm birth is defined as birth that happens before the 37th week of pregnancy. Seasons PTB rate is based on all clients who initiated care with our practice and remained with us till the birth of their baby. The risk factors for PTB are multifaceted and many times they are not identifiable. Of the risks that are known, many do not automatically risk a client out of birth center birth and so they can and do receive care at centers. In the United States, our PTB rate has been steadily increasing, specifically it rose by 4% in 2021 alone.
- The National rate, per the NSVR 2021, is 10.5%
- The Colorado rate is 9.7%
- The Seasons Midwifery & Birth Center rate was 2.8%
Low Birth Weight Rate
Low birth weight (LBW) babies are at risk for many short and long term health complications and like PTB rates, these numbers are used as part of an overall indicator of health in populations. Low birth weight is defined as a baby weighing less than 5 pounds 8 ounces at birth. Not all babies who weigh less than this will have health concerns but some will.
- The National rate, per the NSVR 2021, is 8.24%
- The Colorado rate is 9.3%
- The Seasons Midwifery & Birth Center rate was 2.4%
Here are some other great numbers:
- Gestational Age, full term, at birth: 37-40 weeks = 50.3% and 40-42 weeks = 45.8% with a handful of babies born past 42 weeks, managed by our midwives at the hospital.
- Waterbirth rate: 32.7%
- Folks who either did not have a laceration or did not require stitches: 45.2%
- Episiotomy rate: 0.3%
- Use of Nitrous in labor: 16.6%
- Use of Nitrous postpartum: 2.2%
- Most common birth position: Hands & Knees
- 15 babies were born en caul, or with the amniotic membranes intact
The numbers speak for themselves, the care provided by our midwives, birth assistants and staff speaks for itself. Birth center care, through the midwifery model of care is valuable and needs to be valued. This is why a dedicated group of community members and Seasons staff in partnership with a local grassroots, birth justice organization Elephant Circle and joined by COLOR Latina, Soul2Soul Sisters and Birth Center Equity are building a new non-profit center. This new center will be located in the same physical space and have some original staff, we will have to start small and regrow, but regrow we will. I am overjoyed to share that our efforts are coming together and we will be reopening our doors this month! We will have a new Mission and Vision and will represent just the beginning of a bigger movement for our state, stay tuned for all the details and updates to come.