January 7, 2018

Birth at Home Midwifery Services Statistics

These are my statistics as of 4 August 2020. Most of the births described below occurred in Michigan, while a handful occurred in Colorado and in Haiti. No vaginal breech or vaginal twin births occurred in Colorado.

I’ve conducted 4,878 prenatal appointments and 2,046 postpartum appointments, caring for the mothers of more than 1,000 babies.

I’ve attended 600 of those babies’ births. 

I’ve now spent well over 15,000 hours serving childbearing families through the last 27 years!

I’ve been in service to some of the families those babies represent for all of those years. Many of the mothers I served through my training are the grandmothers of the babies who came later. One of those mothers became a grandmother as she and I knelt together between the feet of her birthing daughter—the very daughter she pressed into my hands eighteen years earlier—to receive the newest child in her line to life. Two of the babies included in this review of my work are my nephews and three are my nieces. Still five others are my own beloved grandchildren.

I did not attend the births of the 400-some other babies mentioned above for a great variety of reasons. Many of their mothers suffered miscarriages. Many of their mothers were the clients of other midwives. A few of their mothers changed their minds about having homebirths. I felt three of their mothers would be better served by other providers. Some of the babies were born while I was away or ill or having one of my twelve throat surgeries, some were born after I moved from Michigan to Colorado, and seven babies were born at exactly the same time as seven other babies.

The mothers of seventeen of those babies were referred out of care prior to birth for serious medical conditions, but I was unable to accompany them to the hospital for their births. I give an accounting of those babies and their mothers at the end of this section with a desire both to acknowledge them, as well as to highlight how infrequently serious medical conditions arise in pregnancy.

I’ve attended the births of 600 living babies.

2, or less than half of a percent of babies in my care died.

All mothers in my care have lived.

I’ve attended the births of two stillborn babies. One baby died prior to labor and one baby died during her birth. I give an accounting of both babies at the end of this section. I also attended the birth of one baby who died in her mother’s womb just prior to 20 weeks, and was part of the birthings of three others so very tragically tiny.

549, or 92% of the births occurred at home. I missed 35, or 6% of those homebirths by heart-pounding seconds.

49, or 8% of the births occurred at the hospital. I missed 12 of those hospital births.

40, or 6.5% of the births occurring in the hospital were in-labor transports.

11, or just under 2% of the births occurring at the hospital were planned hospital births.

21, or 3.5% of the babies were born by cesarean section.

8, or just over 1% of the babies born in my care were born prematurely. Five were born in in the hospital, four vaginally and one by cesarean section. Three were born at home. One was born at home because the birth was so fast-occurring we were unable to manage a transport, two were born at home because the parents refused to transport. We transported one of those latter babies post-birth.

7, or just over 1% of mothers birthing in my care were transported to the hospital after their births.

I’ve called for an ambulance 5 times, or just under 1% of the time I’ve been in attendance at homebirths. One of those times, or just over a tenth of a percent resulted in a tragedy I describe toward the end of this section.

3, or just over half a percent of babies born in my care were transported to the hospital very soon after their births. I give a more in-depth accounting of those babies a few paragraphs below.

31 of the women birthing in my care had birthed previously by cesarean section. 28, or 90% of these women birthed vaginally. Two of these women birthed by twice by cesarean section prior to giving birth vaginally. Both of those initial vaginal births occurred in the hospital. One woman who’d birthed her first baby by cesarean section birthed her fifth baby by elective cesarean. Because she requested the cesarean despite having birthed vaginally three times between the surgical births, I decided to keep her out of these statistical measurements.

134, or 22% of the mothers I’ve served were first-time birthers and 46, or 8% of mothers were giving birth for the seventh, eighth, ninth, tenth, or eleventh times. One woman in my care has been pregnant eighteen times, and another sixteen. Neither of those mothers gave birth to nearly so many full-term, living babies.

A handful of babies in my care have been posteriorly positioned through labor or at the time of birth, and twelve babies in my care have manifested brow or military presentations. Nine of the brow or military presentations finally flexed, but three were actually born brow first. I transported one first-time mother laboring to birth such baby to the hospital. She labored a total of 71 hours, and was completely dilated and pushing for eight hours before her baby flexed its head at last and was born.

Thirteen babies in my care have presented breech. Four were born by cesarean in the hospital, one was born vaginally in the hospital, and the rest were born at home. One of the vaginally born babies was a footling breech, the second of a set of twins, born at home. The baby born vaginally in the hospital was an incomplete breech, presenting by a foot and a knee. Two of the vaginally born babies were complete breeches. One of the babies presenting frank breech died before she drew breath. I give a more detailed accounting of her death in a section below.

Three babies in my care have presented face first. One was born at home to a first-time mother, one was born vaginally in the hospital, and one was born by cesarean.

Fourteen babies born in my care were twins. Thirteen of those twins were born at home, but one was born by cesarean after the birth of the first twin destabilized the second twin’s lie. One of those sets of twins were born on separate days, though they’re the twins born closest together with only thirty-nine minutes between them.

I’ve been part of resolving 22 shoulder dystocias. All of the dystocias were satisfactorily resolved, though two of the babies suffered broken clavicles and one suffered a broken humerus.

I’ve been part of the resuscitative efforts for 32 babies. One of my efforts to resuscitate a baby was unsuccessful, and that was my effort to resuscitate the baby who was born breech. Again, I tell that baby’s story more fully a few paragraphs down.

I’ve been part of resolving 50 postpartum hemorrhages. Only one of those times did I arrange for the transport to occur by ambulance.

I’ve personally repaired 50 lacerations. Though I haven’t counted, certainly more than fifty women birthing in my care have suffered lacerations. Some of the lacerations were repaired by other practitioners while some were so slight they didn’t require repair. All second or third-degree lacerations occurring to women in my exclusive care were repaired.

I’ve transported four mothers to the hospital for laceration repair. I’ve served two other mothers who required repairs beyond my skill set but happily, I was able to get a more skilled practitioner to come to those mothers. Four of the lacerations were second-degrees and two were third-degrees. One of the third-degree lacerations was for a missed birth. I listened to the birth as I careened wildly toward her house along a congested highway while begging her not to push the way I could hear she was pushing, but alas! A woman has to do what a woman has to do! I’ve never had a fourth-degree laceration.

The babies have ranged in size from 5lbs, 4oz to 12lb, 3oz, with 30 babies weighing more than ten pounds. Three of those babies weighed more than eleven pounds. Then, of course, there was the twelve-pounder. He slipped from his forty-year old mother in less than two and a half hours, slick as a stick of butter. All but one of those hefty babies were born vaginally.

The youngest mother I served was seventeen and the oldest was forty-six.

The longest labor among my clients was the 71-hour labor I mentioned previously, though one of the women I referred out for preeclampsia (and wasn’t able to attend) had a 108-hour labor! Both moms were first-timers and both managed to birth vaginally.

The longest I’ve stayed with a birthing mother so far is 66 hours and my shortest stays have been between three and four hours. Most of the time I spend from eight to ten hours with a birthing family.

The shortest labor among my clients was forty-seven minutes. Of course, I missed that birth. The next shortest labor was one hour and one minute. I also missed that birth. The next shortest labor was one hour and nine minutes, and to that birth I managed to arrive with 29 minutes to spare.

The longest a woman who’s birthed at home in my care has gone with ruptured amniotic fluid is 91 hours. Both the mother and the baby remained healthy for the duration of their labor, birth, and postpartum period.

I’ve attended the births of two babies with both little hands on their heads, and one baby with both fists jammed beneath its chin. I’ve attended the births of two babies with single artery cords, five babies with knots in their cords, two babies whose cords were damaged during their births, and ten babies who were born fully enclosed within their amniotic sacs.

I’ve served three women whom, post-birth, I suspected had gestational diabetes. Only one of those women gave birth to a baby weighing more than ten pounds. I’ve served one woman with a bicornate uterus. I served another woman multiple times who appeared to have two cervixes and whom I suspect has two uteri. I served a woman with six fingers on each hand who gave birth to a baby with six fingers on each hand. I served a woman who gave birth to a baby with two teeth in its mouth.

I transferred one mother to the hospital for maternal cardiac concerns. I transferred four mothers to the hospital when their babies displayed non-reassuring heart tones. I arranged to transfer one laboring mother to the hospital for a prolapsed cord by ambulance, and transported two laboring mothers with prolapsed cords to the hospital by car. Three mothers I transferred to the hospital in labor were able to return home! Two of them then birthed their babies at home, but one I returned to the hospital. She still managed to have a very lovely vaginal birth, though. Most of the other in-labor transfers were for malpresentations and/or positions of babies carried by first-time mothers or for elevated blood pressures, though two transfers were for mildly flattened pubic arches and one was for a baby dramatically tangled up in its cord.

I arranged for the transfer of one mother to the hospital post-birth by ambulance for a severe postpartum hemorrhage and I transferred three mothers to the hospital post-birth for retained placentas by car. I transferred one mother to the hospital after birth for elevated blood pressure.

I referred one mother out of care for postpartum infection at a week after her birth. I referred two mothers out of care in the weeks after birth for retained placental fragments. I referred one mother out of care for deep vein thrombosis around two weeks after her birth.

Three mothers in my care have required medical treatment for severe postpartum depression, though I suspect a handful more would have benefited from medical treatment.

Three births I’ve attended concluded with babies admitted to the NICU. Of those births, I served as primary midwife at only one, and that baby was born eleven hours after our arrival at the hospital.

I transferred three babies to the hospital soon after birth, all with breathing difficulties. One baby was born at home at 35 weeks and one baby was born at home at 37 weeks while one baby was born with a nasal malformation called choanal atresia. The nasal malformation was surgically corrected.

I referred two babies out of homebirth care for circulatory malformations that manifested in the days after birth. One baby required open-heart surgery to correct a set of transposed cardiac vessels and the other required laparoscopic surgery to correct pulmonary stenosis. I discovered one case of ventral-septal defect by fetoscope at around 30 weeks gestation. The diagnosis was provided by a maternal-fetal medicine doctor who indicated we could proceed with our plans to welcome the baby at home. He was born in excellent condition and is now under the surveillance of a pediatric cardiologist.

I referred ten babies out of care in the days following their births for a number of less severe abnormalities. Two babies manifested heart murmurs, one had a sizeable inguinal hernia, one had a cleft lip, one had an oral hemangioma, three babies had severe jaundice, and one had a set of undescended testes. I referred two babies out of care for broken clavicles and one baby out of care for a broken humerus, all broken during the resolution of the babies’ shoulder dystocias. Three babies in my care have been diagnosed with disorders via Newborn Screen. All babies but one enjoyed a favorable outcome. One of the jaundiced babies was permanently damaged. I provide a fuller accounting of that baby’s experience below.

The births of nineteen sets of mothers and babies initially in my care occurred in the hospital and for a variety of reasons, I was not able to attend them. Seven of those births were for pregnancy-induced hypertension or preeclampsia, three were for truly postdates pregnancy, one was for severe polyhydramnios with lethal fetal anomalies, two were for unstable lie, one was for placenta previa, one was for breech presentation, one was for an abrupted placenta, and three were for preterm labor. Of these babies, thirteen were born by cesarean section. One of these babies has Down Syndrome. Two of the births I was barred from attending per COVID-19.

Three tragedies have occurred within my practice.

One full-term baby in my care suffered brain damage prior to being diagnosed with a condition called Criglar Nijjar, a rare inherited disorder affecting the metabolism of bilirubin, a chemical formed from the breakdown of the heme in red blood cells. The disorder results in a form of nonhemolytic jaundice, which results in high levels of unconjugated bilirubin, and often leads to brain damage in infants. The baby became moderately jaundiced in the week following his birth and remained mildly jaundiced through six weeks post-birth. His parents declined medical evaluation as their three older sons and several nieces, nephews, and cousins had also experienced prolonged periods of mild to moderate jaundice minus harm. The baby became severely jaundiced shortly after his six-week visit and was taken to the hospital, but the damage was fast-occurring. He was diagnosed with the condition about two weeks later. One of his two younger sisters also has the condition, but she was diagnosed very soon after birth (a homebirth in my care) and in-home light therapy was secured immediately. The child is fine today, though she required nighttime light therapy treatments until she was finally able to receive a liver transplant in 2019. The child who suffered the brain damage is his mother’s fourth child.

A second full-term baby in my care was born after passing away in the womb a week prior to his birth due to an umbilical cord accident. The mother reported absence of movement on a Tuesday. I went to her immediately and when we were unable to auscultate heart tones, I took her to the hospital to confirm the baby had died. The couple still wanted to have their son at home, and he was born the next Sunday. At birth his cord appeared wrapped in amnion constriction bands an inch or so from the baby’s navel. He was his mother’s first baby.

A third full-term baby in my care was born in a state of severe depression after a cessation of her mother’s contractions during the expulsion phase of her breech birth. She was born just to the line of her nipples, and then her mother’s uterus refused to provide us another contraction until after the baby was born. I performed the Louwen maneuver to release the baby’s arms and the Mauriceau-Smellie-Viet maneuver to complete the birth. It took fully sixteen minutes to free the child and I immediately initiated resuscitation, but I was unable to inflate the baby’s lungs. Emergency Services was summoned. EMS facilitated a monitoring system between the family’s home and the hospital while I continued to attempt resuscitation. After fifty-nine minutes of effort, the doctor at the hospital ordered my resuscitative efforts be discontinued, and I wrapped the baby in a soft blanket and laid her away in her mother’s arms. She was her mother’s first baby.

At two of the three peer reviews I submitted this case to, the idea the baby may have suffered a respiratory tract anomaly was raised. A doctor I consulted with later suggested the same. Naturally, I’d like to think an anomaly was behind my inability to inflate the baby’s lungs. An autopsy wasn’t performed, however, so we simply cannot know. It does remain the only time I’ve experienced such an issue.

Through the years since, all three families have enjoyed the beautifully uneventful births of happy, healthy babies with me—four before I moved to Colorado and two after—six all together.

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