As a collective, the birth community spouts off numbers and statistics quite regularly. We cite studies, projects, and reviews at the drop of a hat. Rarely though do we explore those numbers in depth, really dig deep and tear apart studies, or ask providers to provide their own statistics. That last point is a HUGE issue in the birth world- there is no required transparency for providers.
As a Florida Licensed Midwife, we are encouraged to report our statistics to the Department of Health however, we are not required to do so. As a Certified Professional Midwife, we are encouraged to report our statistics to the Midwives Alliance of North America's Mana Stats Project, but we are not required.
Can you imagine the body of evidence we would have supporting midwifery care if EVERYONE reported their stats? The transparency it would provide for consumers would be paramount. I have to admit- reporting stats is TIME CONSUMING, especially for a busy homebirth practice or birth center, and I fall off of the stats wagon more than I am on it. BUT! I am committed to providing families with transparency about their care, what to expect when planning a homebirth, and how different decisions can change outcomes.
We need to continue providing the solid evidence of data that (as the Mana Stats Project has proven) home birth for normal, low risk women, is just as safe as a hospital delivery with added benefit of less intervention. There are also great studies like the BMJ Birthplace Study from England as well as the Stapleton Study which looked at birth center births.
Mana Statistics Project, published in January of 2014 concluded "Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively."
So without further ado- here are the 2013-2014 statistics for our very own home birth practice
66 total births
16% transferred in labor, none transferred emergently, and those who did included such reasons for transfer as failure to progress, desire for pain management, and fetal malposition. All were either first time mothers or attempted VBACs.
7% of mother's transferred in the immediate postpartum period (for the sake of clarity, we are including up to 5 days postpartum) for bleeding that was too heavy or retained placental membranes.
No newborns were transferred in the immediate postpartum period.
91% vaginal birth success rate, with a 9% cesarean rate. Only two of these were primary cesareans, and the rest were after attempted VBACs.
80% successful VBAC rate!
91% of women delivered over an intact perineum, which is only a 9% laceration repair rate.
96% of women we're exclusively breastfeeding at 6 weeks postpartum.
No fetal, maternal, or newborn deaths.
So how do these stack up? As far as locally across out of hospital providers- we do not know as those stats must be self reported ( though we are hopeful more practices will follow suit and/or we will have Vital Statistics data from the State of Florida to report soon!) We can say though, that compared to our local cesarean rates we are able to facilitate vaginal deliveries at a rate that is nearly 4 times that of some local hospitals! According to the birth center study, birth centers have an average 32% transfer rate, double that of our practice and more than double the national home birth average. As for other outcomes such as transfers, morbidity, and mortality we rank pretty spot on with the national data comprised from Mana Stats.
What do you think? Did any of these numbers surprise you?