Local Care Midwifery MANA Stats 2018

Total Number of Births (clients in LCM care for labor/birth) 26
Vaginal Births 24 92%
Home Birth as planned (22 started labor planning home birth) 21 95%
Transports in labor (none urgent) 1 4%
Nulliparous, Term, Singleton, Vertex (NTSV) C/S Rate 1 17%
Average age at booking 33
First Time Mothers 6 23%
Total Inductions (Pharmaceutical Inductions) 1 4%
Total Augmentation 0 0%
Water births 3 11%
Vaginal Birth after Cesarean/Successful VBAC Rate 0 0%
Breech birth 0 0%
Twins 0 0%
Perineum Intact or Only Abrasions 17 71%
3rd or 4th degree vaginal laceration 0 0%
Episiotomy 0 0%
Cesarean Births/ C Section Rate 2 8%
Blood loss over 500 mls for vaginal delivery 1 4%
Blood loss over 500 mls for C/S 1 4%
Blood loss over 1000 mls for any delivery 0 0%
Male/Female infant ratio 19/7
Average Baby Weight  8 lbs
Breastfeeding at last visit** 29 100%
Infant deaths during labor or 6 weeks postpartum 0 0%
Infant with 5 minute Apgar under 7 0 0%
Maternal Death 0
*The specification ‘entered labor planning to birth at home’, is common to well designed place-of-birth studies and it is the specification that Midwife’s Alliance of North America (MANA) uses for their planned home birth data. Want to support MANA Stats? If you are a midwife, join the project! Want to donate to this project? Monies can be donated to the MANA Division of research and earmarked for MANA Stats.
** The 3 clients that transferred for MD management for planned surgical delivery, transferred back, to the total number is 29, not 26…

Michelle’s musings on 2018 LCM Stats

Posts on LCM Stats (and this is the 10th!) always leave me with a mix of emotions. Overall, the numbers are always great and show that we are doing a fine job. More than that, the numbers show that evidence based care works, that midwifery care works, that women’s bodies work, that babies’ bodies work, that families work! Yet, I am always left with the feeling that things could have been done better. And the deep knowledge, even while LCM’s 10 year C/S rate is only 4% (compare to the US rate of 32%) for each LCM mom that has a surgical delivery,  her personal C/S rate is 100%. Looking at annual LCM Stats, also brings firmly to my mind, that the US as a whole NEEDS to do better.

In 2018, Local Care Midwifery had a total of 29 births, and 26 clients in our care at the time of labor/birth. The Total Vaginal Delivery Rate for LCM clients in our care for labor/birth in 2018 was 92%, and the C/S Rate was 8%. We had three clients transfer to medical care due to need for planned Cesarean delivery prior to labor. Including these clients, there were 24 LCM babies born vaginally and 5 born by Cesarean Section. The Total Vaginal Delivery Rate for all LCM clients in 2018 was 83%, and the C/S Rate was 17%. (That’s 8% and 17% compared to the US C/S rate of 32% and a NYS C/S rate of 34%.)

In 2018, we had 22 clients that entered labor planning to birth at home* and except for one, they all birthed at home, that’s a 95% home birth as planned rate. That  woman transferred to hospital care due to prolonged labor and she ultimately birthed via Cesarean Section. Seven people choose planned hospital birth: some choose this at the onset of prenatal care, some choose later in pregnancy due to medical complications. (In 2018, complications included severe PreEclampsia, oligohydramnios, and even one baby with bilateral pleural effusions, severe hydrops and chylethorax. Wow!)

Last year, four women who had previously had Cesarean deliveries, birthed with LCM. Of these, none had previously also birthed vaginally. All started care hoping to have a vaginal delivery after C/S (VBAC). Three of these women developed complications and had scheduled Cesarean Sections, giving birth surgically. The other, went into labor, labored heroically and then birthed surgically. (As I wrote last year, repeat C/S after ‘Failed Trial of Labor’ is not my favorite medical phrasing. It’s right up there with ‘Elderly Primigravida’.)

In 2018, several clients told me that my privileges at Bellevue were a blessing. Hospital based birth is not the main focus of LCM care, but we aim to do it well. It is wonderful to have Bellevue Women’s Center as a partner in providing quality care to families of the Capital District.

Michelle

May all babies be born into loving hands