The birth of baby M!

Oh this was such a sweet and dreamy birth. It was swift and hard, intense and healing. And I adore getting to watch big siblings meet their little siblings, such a treat! A huge huge thanks to this amazing family for sharing these photos. And tons of gratitude to Erica Morrow for capturing these images and being willing to share them here. Enjoy!

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Erica Morrow, owner of Slow Road Photography, is passionate about capturing all of the stages of new life, from beautiful bellies to birth stories to babies. Learn more at http://slowroadphoto.com/birth-story or find her on Instagram (@slowroadphoto).

Highlights of Twin Cities Midwifery’s Stats through 2016

by Kate Saumweber Hogan, CPM, LM

Here you’ll find a quick snapshot of TCM’s statistics, but I’d recommend heading over to the full stats posts to get the details!

This first image shows what the journey looks like from establishing care to birth. You’ll see that most of our client’s births happen at home, as planned. However, some pregnancies end in miscarriage, and sometimes there are medical or non-medical reasons to transfer care during pregnancy.

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The second image looks at labor itself. For all of our clients who started labor intending to birth at home, 90.2% welcomed their babies at home, as expected. We transferred to the hospital 9.8% of the time, which resulted in only a 2.3% cesarean rate.

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This third image represents all of the pregnancies which care was established for, and looks to the end of their journey, their postpartum and newborn care. It shows that regardless of where a TCM family ends up giving birth, they are still a TCM family, they still have TCM support during labor (non-medical support if the birth occurs in the hosptial), and are welcomed back into the practice for postpartum and newborn follow up care. Choosing a homebirth midwifery practice committed to continuity of care is one of the only ways that you can have your care provider walk with you through the full journey of pregnancy, birth, and parenthood.

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I so enjoy getting to be there every step of the way with each one of these families. Be sure to head over to the full 2016 stats blog post to get to learn more about TCM journeys.

A huge shout out and thank you to Brandi Olson of Brandi Olson Consulting for dreaming up and creating these gorgeous infographics! Brandi builds the capacity of mission-driven business to deepen their impact through agile strategic planning, evaluation, and data storytelling.

Twin Cities Midwifery’s Cesarean Rate and other Statistics through December 2016

Twin Cities Midwifery’s Cesarean Rate and other Statistics through December 2016

by Kate Saumweber Hogan, CPM, LM

When I meet with families who are looking to choose a midwife, I am often asked about the statistics available for my home birth practice. While I do gather data, the small size of my practice brings the usefulness of these particular rates into question. With such a small pool of data, how statistically significant would these numbers be? Thus, I often direct families to studies that look at a much larger pool of data than mine.

Home birth studies shed light on safety and other key indicators

A number of studies demonstrate the safety of planned home birth for healthy, low-risk pregnancies with a trained attendant, such as this one from Canada, this one from the Netherlands, this one from England, and this one from New Zealand. An article by Johnson and Daviss, Outcomes of planned home births with certified professional midwives: large prospective study in North America,” is especially important in that it uses data from planned home births in the U.S., and it not only addresses safety but also looks at hospital transport rates, cesarean rates, and other statistics that families commonly ask about. In 2014, Cheyney released a study looking at outcomes of almost 17,000 planned home births in the United states. This study is a great reference for similar outcomes that I track in my practice, such as transfer rates, vaginal birth, assisted delivery, and cesarean birth rates for families planning a home birth.

Birth statistics are becoming more freely available

Over the past few years, I have noticed that hospitals and clinics are becoming more transparent in the care they provide. There is still a long road ahead of them, but due to the demand from informed consumers (pregnant people and families!), data on interventions like cesarean sections is becoming easier and easier to find. Annually, a report comes to my email discussing the cesarean rates by Minnesota hospital and Wisconsin hospital, and this report details rates by clinic (starting on page 175).  I think it is fantastic that families have this information accessible to them as they choose a provider and consider who will walk with them on their journey of pregnancy, birth, and postpartum care.

I’m also inspired by our very own, local Childbirth Collective, which requires members to participate in a data-gathering project to learn more about the births its doula members attend. I always look forward to seeing what is included in their data report!

Statistics are a mirror that help us see and improve practice

I have been amazed by how Twin Cities Midwifery has grown and flourished over the past six years. I still limit my practice to about 3-5 due dates a month, and there are certain months when I plan ahead, not taking any due dates, allowing for a planned vacation, or a birth in my own family. This means that the pool of data is still small, but I need to start somewhere. I intend to update my statistics annually to provide a level of transparency to families wanting to learn more about my practice.

I know that the numbers will ebb and flow. I think that the Johnson and Daviss article gives good estimates of where my statistics will eventually hover around. For example, when they looked at all home births attended by certified professional midwives in the U.S. and Canada in 2000, they found:

  • 12.1% of clients who intended to deliver at home when labor began were transferred to hospital during labor or postpartum. People giving birth for the first time had a 25.1% transfer rate and those having a second or subsequent baby had a 6.3% transfer rate.

Medical intervention rates included:

  • Epidural: 4.7%
  • Forceps: 1.0%
  • Vacuum extraction: 0.6%
  • Caesarean section: 3.7%

Another great place to look for statistics is Cheyney’s article, Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Her study found that of the 16,924 pregnant people who planned homebirths at the onset of labor:

  • 89.1% gave birth at home, meaning 10.9% were transferred to hospital during labor. Of people giving birth for the first time, 22.9% transfered during labor, while only 7.5% of non-first time parents transfered.
  • There was a postpartum transfer rate of 1.5%
  • There was a newborn transfer rate of 0.9%
  • 93.6% gave birth vaginally

Medical intervention rates included:

  • Epidural and/or oxytocin augmentation: 4.5%
  • Assisted vaginal birth (forceps or vacuum extraction): 1.2%
  • Caesarean birth: 5.2%

All obstetrical interventions have a place, and I’m glad that I practice in an area where we have access to wonderful hospital care when it is needed. Being able to transport when we need to and receiving appropriate care in the hospital is what makes planning a home birth so safe; when we need extra help, we get it.

The problem we have in our country is not that people have cesareans or other interventions, but that so many have unnecessary cesareans or unnecessary interventions (which in turn carry risks and cause additional health problems for birthing people and babies). Just like all obstetrical interventions, when overused, they can cause more harm than good. The Childbirth Connection has a useful article about why our national cesarean rate of 32.2% is so high. According to the article, the optimal cesarean rate is 4-6% for a low-risk population. Since home birth midwives work with an exceptionally healthy and low-risk population, it would make sense for the rate in this population to close to that range. The Johnson and Daviss study found a 3.7% cesarean rate. The Cheyney study found a 5.7% cesarean rate.

So what are Twin Cities Midwifery’s stats over the past five years? 

These statistics below encompass all 175 pregnancies which care was established for, starting from when I opened Twin Cities Midwifery in December of 2010 with due dates or pregnancy end dates through December of 2016. In this six year period, 38.9% (68) were first-time pregnancies, and 61.1% (107) were a subsequent pregnancy. Unfortunately, 9.1% (16) of the pregnancies ended in miscarriage. Another 14.9% (26) transferred out of my care during their pregnancy; 7.4% (13) were for non medical reasons (such as moving out of my service area, or changing their mind on place of birth or provider), and 7.4% (13) were transferred during pregnancy for medical reasons (such as preterm labor, preterm rupture of membranes, high blood pressure, or cholestasis). I joined all 13 of the clients who transfered prenatally for medical indications at their hospital births, providing non-medical support (such as doula support), and accepted them all back into my care for postpartum and newborn care after hospital discharge. Out of all 175 pregnancies under the care of TCM, 7.4% (13) transferred to the hospital during labor.

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Stats for full term pregnancies, starting labor as a planned home birth

Of the 133 pregnant people who were under my care when their labor started, 36.1% (48) were first time parents, and 63.9% (85) were experiencing their second, third, fourth, or sixth babies.first-time

The majority of those families, 87.2% (116), chose to have a water birth tub available to them in labor. Of those who had water immersion available, 91.4% (106) labored in water, and 58.6% (68) gave birth in water, which is 51.1% (68) of the total births. Not all of the clients who had water available planned or wanted to birth in the water. There were 10 clients who planned to labor in the water but did not. They were not able to utilize the tub in labor either because their labor was so fast that there was no time to set up the tub, once the tub was set up they were already pushing and did not want to move to get in the water, or because they transferred to the hospital prior to active labor.water

Of the babies I helped to welcome in the world, 49.6% (66) were girls, and 50.4% (67) were boys. The smallest baby was 5 pounds 14 ounces, the heaviest was 11 pounds 5 ounces, and the average was 7 pounds 15.5 ounces.doula

A doula was present at 57.9% (77) of these labors; 62.5% (30) of first-time parents had a doula, while 55.3% (47) of parents of two or more had a doula with them.homeOf these 133 clients who intended to deliver at home when labor began, 90.2% (120) gave birth at home, meaning that we transferred 9.8% (13) of these labors to the hospital. All of the hospital transfers during labor were non-urgent, 10 were first time labors, and 2 were VBAC labors; one transfer was due to signs of infection during labor, one due to thick meconium stained amniotic fluid, one due to abnormal heart tones with history of previous cesarean, and the others were due to very long labors with a labor progression that slowed or had stopped.vaginalDue to transfers to the hospital during labor, Twin Cities Midwifery has an epidural rate of 6.8% (9) and a pitocin augmentation rate of 7.5% (10). All but three clients who transferred gave birth vaginally (2 primary cesareans, 1 repeat cesarean); 0.8% (1) were assisted by vacuum, and 0.8% (1) were assisted by forceps. Twin Cities Midwifery’s cesarean rate is 2.3% (3).

tcm-graph-2-002

We have had a 3% (4) postpartum transfer rate (one retained placenta, three for significant laceration repair) and a 3% (4) newborn transfer rate (all for signs of respiratory distress). Of the total 47 transfers (prenatally, during labor, postpartum, and newborn), only 6.4% (3) were considered urgent. Most transfers, 93.6% (44) were not urgent.

I’ve also tracked rates of intact perineums and perineal tears. I have recently heard people say things such as “all first time moms tear,” “most people need stitches after giving birth,” or “it just doesn’t matter what we do, you will tear.” I’ve been shocked when I hear these statements, because they don’t resonate as true in my experience.

Over the past six years, 72.2% (96) of clients who started labor under my care had no or minimal tearing (37.6% (50) had an intact perineum, 7.5% (10) had minor skids, 27.1% (36) had a 1st degree tear). There were 25.6% (34) clients who experienced a 2nd degree tear, 2.3% (3) who had a 3rd degree tear, no 4th degree tears, and 0.8% (1) who required an episiotomy. Not all tears require suturing, therefore only 24.8% (33) of those who started labor in my care needed sutures to repair their tear.

I also separated this data by clients giving birth for the first time and non-first time parents. I found that in my practice, it is true that when giving birth for the first time, a tear is more likely, however I would not agree that most first time moms tear. Of the 48 clients giving birth for the first time who started labor under my care, less than half, 41.7% (20) required a repair. There were 20.8% (10) of first time clients who had a perfectly intact perineum, 31.3% (15) who had a skid or 1st degree tear, and 47.9% (23) who had a 2nd or 3rd degree tear. Looking at perineal outcomes for the 85 multiparous clients (people who have previously given birth), only 15.3% (13) required a repair. There were 47.1% (40) who had an intact perineum, 36.5% (31) who had a skid or 1st degree tear, and only 16.5% (14) who experienced a 2nd or 3rd degree tear.

In 2015, we also started tracking insurance reimbursement rates. State funded Medical Assistance (MA) or MN Care plans do not cover services provided by Twin Cities Midwifery, however, private insurance plans often do cover our midwifery care. Out of all of our clients who have birthed since 2015 with private insurance, 85% had 100% coverage after meeting their deductible. Since deductible levels varied, we also looked at specific dollar amounts families were reimbursed. Of those who have birthed since 2015 with private insurance, 71% were reimbursed at least $1,000, 42% were reimbursed over $2,000, and almost one-third (31%) received more than $3000 back from their insurance plan to pay for their care. Almost a tenth (8%) of those families received more than $4,000! For more information on insurance coverage of home birth services, check out our Insurance Benefits blog post.

Toward healthier, safer births for pregnant people and babies in Minnesota

I am honored to have attended each and every one of these births and am so grateful for the opportunity to be with families during this incredibly special time. I look forward to our regular TCM events so that I get to watch these babies grow! With this midwifery model of care, Twin Cities Midwifery is helping to improve our state’s maternal and newborn outcomes in a healthy and safe way, one birth at a time.

A huge shout out and thank you to Brandi Olson of Brandi Olson Consulting for dreaming up and creating these gorgeous infographics! Brandi builds the capacity of mission-driven business to deepen their impact through agile strategic planning, evaluation, and data storytelling.

Peter’s Birth Story

Thank you to this incredibly strong and sweet mama for sharing her birth story. It was the best surprise when she emailed it to me on her son’s first birthday! Her writing talent is magical. I’ll let her story speak for itself. Enjoy this treasure!
Hugs,
Kate

When I found out I was pregnant with our second child, joy filled my body like helium. Our son, James, had turned two just five days before. He should have been in bed that afternoon, soft and heavy with sleep; instead he was full of laughter. I gathered him into my arms and together we walked the quarter mile to our mailbox. It was late September, warm and dry, and the entire gold-threaded landscape reverberated with new energy. James fell asleep on our way back to the house, head heavy on my shoulder, legs dangling on either side of my belly where already our baby’s cells wimageere multiplying furiously.

On June 6th, the day before our due date, I noticed a streak of pink on the toilet paper. I called our midwife, Kate, knowing that labor could start soon or not for several more days. There was no change in the rhythmic tightening of my belly, so despite my excitement and slight nervousness I tried to go about my day as normal. That night I took a photo of my round, low belly in front of the bathroom mirror, knowing that it could be one of my last chances to document my pregnancy.

After a restless night, I woke unusually early with very mild and erratic contractions. I left James and my husband, Aaron, sleeping in bed and took a hot shower before making myself breakfast. Halfway through my yogurt and muesli, I lost my appetite. My mom had woken early too, and we spent some time talking together before I retreated upstairs and gently shook Aaron awake, eager to tell him that I was in early labor.

I paged Kate at 9:30, wanting to keep in touch since my first labor had happened quickly and she lived an hour’s drive away, and was also planning on attending Bellyrama in St. Paul. “Hi sweetie, what’s up?” she asked when she called back, and her warmth brought a smile to my face. I told her that I was experiencing mild contractions that hadn’t settled into a pattern – most were coming 7-15 minutes apart and didn’t disrupt my normal activity. I had lost my appetite and felt slightly ill, and she recommended that I try to eat a few bites frequently, and reminded me to stay well hydrated. She told me that we could inflate our birth pool but should wait to fill it until she was on the road, and to call her back as soon as I felt my labor turn a corner.

Along with Kate, her student-midwife Rachel, and assistant Annika, I planned to have Aaron, my mother, and my two younger sisters with me for this birth, as well as my mother-in-law, Patrice, who had agreed to help care for James during my labor. My youngest sister, Laura, drove down from St. Paul that morning while Annie, who would be photographing our birth, headed to work in town with her back-ups on call. I called Patrice to let her know that I was in early labor, but that Laura had made it home and could look after James until things intensified.

I cocooned myself in our bedroom, knowing that rest would benefit my body. In bed, I opened Ina May’s Spiritual Midwifery to one of my favorite birth stories, but distraction was no longer a comfort and I found it difficult to focus on the words. I dozed for about half an hour before my contractions became too uncomfortable to sleep through.

Aaron was eager for Kate to join us, but I worried that it was too soon to call her and that the growing intensity had only brought me within sight of the corner of my labor, not around it. I hadn’t experienced early labor with James and felt unsure about what was to come. What if this labor didn’t move quickly like my first? What if Kate came down to us and I stalled, stranding her in our home for hours?

image (1)My contractions continued to gain strength and I could no longer cope with them alone. I needed Aaron’s presence and support, so we called Patrice to look after James. I began to travel between the toilet and birth ball, rocking my body as it simultaneously tightened and opened. The toilet and close security of the bathroom had been my favorite place to labor with James, but this time I felt a lot of pressure on my perineum when I sat, and I preferred the gentle support of the birth ball. Aaron sat quietly in front of me as I circled my hips, reminding myself to keep my eyes, mouth, and throat soft. He was such solid support, and serious. I asked him to smile for me, as his smiles lightened the sensations I was experiencing and brought me some gentle relief.

Just before 1:30, my labor demanded my entire focus and I began truly vocalizing during contractions. Each wave felt like an incredible weight against my belly, as if my body was trapped in a vise. As it ebbed and the pressure lifted, I felt for a moment like I was floating.

We called Annie home and got back in touch with Kate. I still felt shy about asking her to come to us – I craved a clear sign that our baby would be born soon. When she asked if I was ready for them to head our way, I said hesitantly, “I don’t know. I think so.” I’m grateful she didn’t wait for a show of greater confidence, because just before she arrived almost an hour later, I badly wanted her with me. Labor was intensifying quickly and I needed her there to feel like everything was okay, to feel safe.

I heard Kate’s voice from the bathroom and felt instantly relieved. She was here and I was having our baby. I joined her in our living room, sitting next to her on my birth ball while she removed a few things from her bag. When she pulled out the blood pressure cuff, I started to cry. Kate gently asked me what I was feeling but in that moment I had no words to describe it. I felt open, sensitive, and vulnerable. I was overwhelmed by the vastness of what was about to happen to myself and to our family: the birth of a baby. “Let it all out,” she said. “Don’t hold anything back.” In the few moments before the next contraction, while I watched the numbers climb on the monitor around my wrist, I cried, and felt a quiet relief.

Kate asked if I’d like to get into the birth pool, but I felt I could cope a little longer on my birth ball, and in the support and comfort of Aaron’s arms. During the next contraction I braced my hands on Aaron’s knees while he gently held my shoulders. I pressed my forehead against his forearm, rubbing it back and forth while I rocked my pelvis. As the contraction lifted I looked into Aaron’s smile and out the window behind him, watching Rachel’s car pull up the hill and her quick steps toward the house, a bag slung over her shoulder.

After two more contractions I suddenly decided that I needed the warmth and security of the birth pool. I stripped down to my bra, which I left on not for modesty’s sake but because I felt the next contraction approaching like a thunderhead and I wanted to submerge my body before it overtook me.

image (3)There was so little to anchor myself with in the water and I struggled at first to find a comfortable position. Between contractions I draped my arms over the edge while Aaron moved his hands firmly down my spine and put pressure on my lower back. I loved the effort he put into comforting me. Eventually I settled with my arms around Aaron while he sat on a low stool by the edge of the pool. During contractions I rocked back and forth on my knees while he held me. Sometimes his embrace was too tight and I had to shake it off to move my body freely. I closed my eyes and in the spaces between came to rest deep inside of myself.

Someone began pouring pots of boiling water into the pool to maintain its temperature. It slid over the surface like oil, encircling my belly. It burned and comforted. My contractions were becoming very intense and I was having a difficult time coping. I tried to keep my tones low but my voice started to climb at the peak of each contraction. I felt like I might vomit, and Aaron got a bowl under my chin just in time to catch it. I thought I must be getting close to the end. Now and then I would hear Kate tell me that I was strong, and to trust my body and move how it wanted to. When I felt discouraged, I thought to myself, “You’re doing this today and you won’t have to do it tomorrow.” Remembering my first labor, I reminded myself that I just needed to make it through transition, and once I felt the urge to push I would find relief.

I began opening my mouth wide during contractions and moving it back and forth over the edge of the pool. I felt a pop in my belly, then another deep in transition, a warm gush between my legs. Flecks of white floated in the water.

image (2)I was deep in the intensity of transition when my body suddenly bore down and a pain I never experienced in my first labor tore through my pelvis. I felt like I would split in two and I panicked. I began to fight my body. I struggled to gather myself back together, to tell myself that everything was okay, that I wasn’t being ripped open and that I needed to try to relax, let my body do its work, and let my baby come.

The pressure was unbelievable and constant, and I barely had time to catch my breath between contractions. I bellowed, pressing my face against the inflated pool, my body curling in on itself. I felt like I was still trapped in transition and I started to despair. I couldn’t do it anymore. I didn’t want to labor anymore. I didn’t want to have our baby. It wasn’t supposed to feel like this.

I felt for my baby’s head between contractions, soft and firm and about 2 1/2 knuckles in. Kate asked where I was feeling our baby but I couldn’t answer her. Another contraction surged through me and I felt for our baby again. He or she was still 2 1/2 knuckles in. I felt another rush of panic. I was losing my hold and I needed our baby out now.

Kate and Rachel passed the doppler up between my legs and swept their hands across my lower belly. Another contraction seized my body and still their hands were there, searching. I was near breaking; I wanted to knock them away. In that moment I didn’t care whether our baby’s heart was strong or struggling – my thoughts were consumed by pain. Kindly they asked me if I could move to my back and I clumsely shifted onto my heels and rolled into a semi-reclined position. I could feel our baby moving down the birth canal and I roared even louder. I screamed from the deep cave of my belly. I wonder now what my baby thought as he felt those primal vibrations and the constant pressure of my contracting muscles. Did he feel my strength? Did he feel fear? I was too overwhelmed by my own body to offer any comfort.

image (4)Every push was painful but it was all I could do. I looked up at the women gathered around me, ready to welcome our baby, and I met my mother’s eyes. I silently begged her to help me. I wanted to cry. She looked back at me with so much empathy that I knew she could see I was having a hard time. I closed my eyes again. The only way out was through, and I roared through another contraction.

Kate supported my perinium as our baby crowned. Finally there was a pause, a release of pressure as our baby was held between. “That feels good,” I sighed. What a relief to have a moment of rest before those last contractions, before every muscle bore down again and our baby’s slick body tumbled out of mine and into Kate’s waiting hands.

image (5)Kate helped lift him onto my chest, his arms spread wide, and as I gathered him to me I began to sob. I felt such complete relief. I had made it through. It was over, the pain was gone, and my baby was in my arms.

And he was beautiful. Smaller than James was at birth, and duskier, but after a few moments he let out a vigorous cry and his skin turned pink and rosy. “I know, baby, I know,” I said as I stroked his body and we cried together. The pain had been isolating, but as I held my newborn against my chest I felt suddenly how intimate our experience had been. I looked up at the faces around me. “That was so intense,” I said. It was so intense.

image (6)I stroked my son’s cheeks and circled my fingers around the small patch of vernix on his head. Here were my first memories of James as a newborn – the soft hair coming down over his temples, curling along the rim of his ears, velvety over his arms and back. There was something of James in this baby’s face, but something wholly new as well. He was simply himself, the same baby who, at 25 weeks, we had watched play with his toes on the ultrasound screen, his lips touching the umbilical cord to feel its reassuring pulse. And now in my arms on the day I least expected to meet him: his due date.

image (7)I cupped our baby’s small feet as Aaron leaned forward to cut cord. My placenta was loosening from my body, blood coloring the water, but it took some effort to push out. The water cooled. After lifting our new son into Aaron’s arms, I stood carefully, surprised again by the strength of my legs. But I also felt tender and a little raw, and I feared that I had torn deeply again. Kate could see my discomfort and asked if I would like her to examine me. Her touch was gentle but still painful, and so I was amazed and relieved when she announced that I hadn’t torn at all, hadn’t bruised, wasn’t even swollen. Ibuprofen and an ice pack gave me immediate relief.

Out of the water, I felt suddenly ravenous. My mom brought me a small, sweet strawberry that my dad had plucked from our garden where he had spent the afternoon, now and then hearing the sounds of my labor. My youngest sister disappeared into the kitchen and returned a few minutes later with a plate of scrambled eggs and sourdough toast. She tore the bread into bite-sized pieces and fed me with a tenderness I hope I’ll never forget. Nothing could have tasted better.

image (8) When James came in from his play several hours later, I was sitting up in bed, Peter cradled in my arms. I hadn’t seen him since that morning, and in that time my little boy had grown into a long-limbed child. He carried a book in his hands and shyly asked us to put the baby in the crib. A few moments later he brought his face close to Peter’s and gently stroked his hair and cheeks. Later, when I nursed James to sleep, I marveled at how much space he took up next to me in his bed, how heavy his head was, the sun just beginning to lighten his blonde hair.

For two days after Peter’s birth, I felt shaken by the differences in my two labors. Both progressed quickly and intensely. But while the three hours that I pushed with James were full of effort, they were also painless and almost serene. Afterward I felt strong, ready to tackle anything. The 28 minutes that it took for me to push Peter into the world were nearly excruciating, a raging storm, and I discovered how deeply rooted that strength was. I saw it in our birth photos, the deep intensity of my quiet and then straining body. Several days later, I played our birth video with a feeling of trepidation, afraid of revisiting the pain. Instead I heard the strength in my breaking voice. I watched my husband bury his face into my neck as I birthed our son. I saw love in every touch. I walked away empowered.

There are other things I think as I look back on my birth photos, things I was too busy to consider in the throes of labor. I look at the purple birth pool and I think of the other women it has cocooned during their labors and births. I think of how it has traveled through city, suburbs, country, how its been filled in family rooms and bedrooms. I think of women laboring against a backdrop of snow reflecting light, the first lush growth of spring, the bloom of summer, the leaves dry and curling. The hum of furnaces, air-conditioners, insects outside an open window. Intimate dark and bright sunshine. Partners, doulas, mothers, sisters, friends, children. I think of women who have brought their babies into the world with a quiet intensity or with a ferocity we sing from our bones. But always the women, the water, and Kate sitting quietly by our sides.

image (9)

Nursing Peter on the spot of floor where he was born one year ago. ❤

Twin Cities Midwifery’s Cesarean Rate and other Statistics through December 2015

When I meet with families who are looking to choose a midwife, I am often asked about the statistics available for my home birth practice. While I do gather data, the small size of my practice brings the usefulness of these particular rates into question. With such a small pool of data, how statistically significant would these numbers be? Thus, I often direct families to studies that look at a much larger pool of data than mine.

Home birth studies shed light on safety and other key indicators

A number of studies demonstrate the safety of planned home birth for healthy, low-risk women with a trained attendant, such as this one from Canada, this one from the Netherlands, this one from England, and this one from New Zealand. An article by Johnson and Daviss, Outcomes of planned home births with certified professional midwives: large prospective study in North America,” is especially important in that it uses data from planned home births in the U.S., and it not only addresses safety but also looks at hospital transport rates, cesarean rates, and other statistics that families commonly ask about. In 2014, Cheyney released a study looking at outcomes of almost 17,000 planned home births in the United states. This study is a great reference for similar outcomes that I track in my practice, such as transfer rates, vaginal birth, assisted delivery, and cesarean birth rates for families planning a home birth.

Birth statistics are becoming more freely available

Over the past few years, I have noticed that hospitals and clinics are becoming more transparent in the care they provide. There is still a long road ahead of them, but due to the demand from informed consumers (pregnant people and families!), data on interventions like cesarean sections is becoming easier and easier to find. Annually, a report comes to my email discussing the cesarean rates by Minnesota hospital and Wisconsin hospital, and this report details rates by clinic (starting on page 175).  Here is a blog post from a local doula stacking up the cesarean rates for local hospitals. I think it is fantastic that families have this information accessible to them as they choose a provider and consider who will walk with them on their journey of pregnancy, birth, and postpartum care.

I’m also inspired by our very own, local Childbirth Collective, which requires members to participate in a data-gathering project to learn more about the births its doula members attend. I always look forward to seeing what is included in their data report!

Statistics are a mirror that help us see and improve practice

I have been amazed by how Twin Cities Midwifery has grown and flourished over the past five years. I still limit my practice to about 2-5 due dates a month, and there are certain months when I plan ahead, not taking any due dates, allowing for a planned vacation, or a birth in my own family. This means that the pool of data is still small, but I need to start somewhere. I intend to update my statistics annually to provide a level of transparency to families wanting to learn more about my practice.

I know that the numbers will ebb and flow. I think that the Johnson and Daviss article gives good estimates of where my statistics will eventually hover around. For example, when they looked at all home births attended by certified professional midwives in the U.S. and Canada in 2000, they found:

  • 12.1% of women who intended to deliver at home when labor began were transferred to hospital during labor or postpartum. First time moms had a 25.1% transfer rate and those having a second or subsequent baby had a 6.3% transfer rate.

Medical intervention rates included:

  • Epidural: 4.7%
  • Forceps: 1.0%
  • Vacuum extraction: 0.6%
  • Caesarean section: 3.7%

Another great place to look for statistics is Cheyney’s article, Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Her study found that of the 16,924 pregnant people who planned homebirths at the onset of labor:

  • 89.1% gave birth at home, meaning 10.9% were transferred to hospital during labor. Of first time mothers, 22.9% transferred during labor, while only 7.5% of non-first time mothers transfered.
  • There was a postpartum transfer rate of 1.5%
  • There was a newborn transfer rate of 0.9%
  • 93.6% gave birth vaginally

Medical intervention rates included:

  • Epidural and/or oxytocin augmentation: 4.5%
  • Assisted vaginal birth (forceps or vacuum extraction): 1.2%
  • Caesarean birth: 5.2%

All obstetrical interventions have a place, and I’m glad that I practice in an area where we have access to wonderful hospital care when it is needed. Being able to transport when we need to and receiving appropriate care in the hospital is what makes planning a home birth so safe; when we need extra help, we get it.

The problem we have in our country is not that women have cesareans or other interventions, but that so many have unnecessary cesareans or unnecessary interventions (which in turn carry risks and cause additional health problems for moms and babies). Just like all obstetrical interventions, when overused, they can cause more harm than good. The Childbirth Connection has a useful article about why our national cesarean rate of 32.8% is so high. According to the article, the optimal cesarean rate is 4-6% for a low-risk population. Since home birth midwives work with an exceptionally healthy and low-risk population, it would make sense for the rate in this population to close to that range. The Johnson and Daviss study found a 3.7% cesarean rate. The Cheyney study found a 5.7% cesarean rate.

So what are Twin Cities Midwifery’s stats over the past five years? 

These statistics below encompass all 138 pregnancies of clients who established care from when I started Twin Cities Midwifery in December of 2010 with due dates through December, 2015. In this five year period, 41.3% (57) of my clients were first-time moms, and 58.7% (81) were experiencing a subsequent pregnancy. Unfortunately, 8.7% (12) of the pregnancies ended in miscarriage. Another 12.3% (17) transferred out of my care during their pregnancy, 6.5% (9) were for non medical reasons (such as moving out of my service area, or changing their mind on place of birth), and 5.8% (8) were transferred during pregnancy for medical reasons (preterm labor, preterm rupture of membranes, or high blood pressure). I joined all 8 of the clients who transferred prenatally for medical indications at their hospital births, providing non-medical support (such as doula support), and accepted them back into my care for postpartum and newborn care after hospital discharge. Out of all 138 pregnancies of clients who established care with TCM , 5.8% (8) transferred to the hospital during labor.

Place of birth for all Twin Cities Midwifery pregnancies with due dates between December 2010 and December 2015

Place of birth for all Twin Cities Midwifery pregnancies with due dates between Dec 2010 and Dec 2015

Stats for full term pregnancies, starting labor as a planned home birth

Of the 109 pregnant people who were under my care with full term pregnancies (37 weeks or later) when their labor started, 38.5% (42) were first time parents, and 61.5% (67) were experiencing their second, third, fourth, or sixth labors.

The majority of those families, 87.2% (95), chose to have a water birth tub available to them in labor. Of those women who had water immersion available, 90.5% (86) labored in water, and 57.9% (55) gave birth in water. Not all of the clients who had water available planned or wanted to birth in the water. There were 9 women who planned to labor in the water but did not. They were not able to utilize the tub in labor either because their labor was so fast that there was no time to set up the tub, once the tub was set up they were already pushing and did not want to move to get in the water, or because they transferred to the hospital prior to active labor.

Of the babies I helped to welcome in the world, 48.6% (53) were girls, and 51.4% (56) were boys. The smallest baby was 5 pounds 14 ounces, the heaviest was 11 pounds 5 ounces, and the average was 7 pounds 15 ounces.

A doula was present at 57.8% (63) of these labors; 64.3% (27) of first-time moms had a doula, while 53.7% (36) of mothers of two or more had a doula with them.

Of these 109 clients who intended to deliver at home when labor began, 92.7% (101) gave birth at home, meaning that we transferred 7.3% (8) of these labors to the hospital. All of the hospital transfers were non-urgent, and all except one were for first-time moms; one transfer was due to signs of infection during labor, one due to elevated heart tones with history of previous cesarean, and the others were due to very long labors with a labor progression that slowed or had stopped.

Due to transfers to the hospital during labor, Twin Cities Midwifery has an epidural rate of 5.5% (6) and a pitocin augmentation rate of 5.5% (6). All but one of the women who transferred gave birth vaginally; 0.9% (1) were assisted by vacuum, and 0.9% (1) were assisted by forceps. Twin Cities Midwifery’s cesarean rate is 0.9% (1).

We have had a 2.8% (3) postpartum transfer rate (going to the hospital for extra care for mom after baby arrives) and a 2.8% (3) newborn transfer rate. Of the total 31 transfers (prenatally, during labor, postpartum, and newborn), only 6.45% (2) were considered urgent. Most transfers, 93.5% (24) were not urgent.

I’ve also tracked rates of intact perineums and perineal tears. I have recently heard people say things such as “all first time moms tear,” “most women need stitches,” or “it just doesn’t matter what we do, you will tear.” I’ve been shocked when I hear these statements, because they don’t resonate as true in my experience.

Over the past five years, 72.5% (79) of women who started labor under my care had no or minimal tearing (36.7% (40) had an intact perineum, 7.3% (8) had minor skids, 28.4% (31) had a 1st degree tear). There were 25.7% (28) women who experienced a 2nd degree tear, 1.8% (2) who had a 3rd degree tear, no 4th degree tears, and 0.9% (1) who required an episiotomy. Not all tears require suturing, therefore 24.8% (27) of the women who started labor in my care needed sutures to repair their tear.

I also separated this data by first time mom and non-first time mom. I found that in my practice, it is true that first time moms are more likely to tear, however I would not agree that most first time moms tear. Of the 42 first time moms who started labor under my care, less than half, 42.9% (18) required a repair. There were 19% (8) of first time moms who had a perfectly intact perineum, 33.3 (14) who had a skid or 1st degree tear, and 47.6% (20) who had a 2nd or 3rd degree tear. Looking at perineal outcomes for the 67 multiparous women (women who have previously given birth), only 13.4% (9) required a repair. There were 47.8% (32) who had an intact perineum, 37.3% (25) who had a skid or 1st degree tear, and only 14.9% (10) who experienced a 2nd degree tear.

This year I also started tracking insurance reimbursement rates. State funded Medical Assistance (MA) or MN Care plans do not cover services provided by Twin Cities Midwifery, however, private insurance plans often do cover our midwifery care. Eighty-one percent of our clients who birthed in 2015 with private insurance had 100% coverage after meeting their deductible. Since deductible levels varied, we also looked at specific dollar amounts families were reimbursed. Of those who birthed in 2015 with private insurance, over 90% were reimbursed at least $1,000, 62% were reimbursed over $2,000, and almost half (47.6%) received more than $3000 back from their insurance plan to pay for their care. Almost a tenth (9.5%) of those families received more than $4,000! For more information on insurance coverage of home birth services, check out our Insurance Benefits blog post.

Toward healthier, safer births for moms and babies in Minnesota

I am honored to have attended each and every one of these births and am so grateful for the opportunity to be with families during this incredibly special time. I look forward to our regular TCM events so that I get to watch these babies grow! With this midwifery model of care, Twin Cities Midwifery is helping to improve our state’s maternal and newborn outcomes in a healthy and safe way, one birth at a time.

Happy Holidays 2015 & Happy New Year 2016!

What a wonderful year we had this 2015! We welcomed 26 new babies to families within Twin Cities Midwifery, and I got to welcome my own little bundle of joy on September 29th, 2015! No one had time to send in drawings or paintings for the coloring contest this year, so we came up with our own artwork to wish our TCM community a happy holiday season.

If you are a past or present TCM family, you should have already received your card in your mail box! If not, it means I don’t have your current address. Feel free to email any address changes to info@TwinCitiesMidwifery.com so that we can update our list!

Much love and light to each of you!

Welcoming baby August!

Kate, Ryan, & Emalyn Saumweber Hogan of Twin Cities Midwifery are thrilled to welcome a sweet baby boy into their hearts and into their lives. August “Augie” Gregory Saumweber Hogan was born at 6:49pm, September 29th 2015, weighing in at 8 lbs 13 ounces.

Mom, baby, big sister, and dad are all doing wonderfully. Emalyn helped announce that it was a boy and cut the cord with help from dad! She snuggled right in with mom and baby to check him out and say hi once he arrived. 

Augie at birth

Thanks for all of your love and support and we enjoy our babymoon! We are getting tons of rest, snuggles, and nourishment.

Thank you Meghan Pate Photography for the amazing birth photos!

New Family of Four Brother Sister Love

Megan of Megan Crown Photography stopped over for a newborn session when August was 6 days old. Here are some of our favorites!

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