The Sanctum, Natural Birth Center – Natural Birth Rates 2016
What does gentle MotherBaby Centric Collaborative Model of Care look like at Healthy Mother? While birth stories, advocacy, knowledge sharing and testimonials are all important in helping mothers-to-be and fathers-to-be understand the immense beauty and safety of physiologic, natural birth, it is equally important to put out birth statistics.
This year, we also had an immense internal physical shift. From being a Midwife Run Natural Birth Center inside of an existing maternity care hospital, we moved into our own premises on November 23rd, 2016. We now are a free-standing Birth Center – The Sanctum, Natural Birth Center. It is not attached to any hospital, but has all the emergency infrastructure like a fully equipped operating theater, a small level 1 NICU, a Lab and a pharmacy built into it. And, after 8 years of having provided collaborative back-up partnership, our main Obstetrician, Dr. Jayanthi Reddy, has also come on board as a full time partner at our Birth Center.
What makes the Sanctum different from the average free-standing birth centers one might see in other developed countries is that though midwives run birth centers, they are restricted to taking on low-risk clients because they do not have the skills, facilities or backup required to manage clients with complex needs or complications. Obstetricians in hospitals do. At our Birth Center we can take on and assist clients with more complex needs. This includes women with twins, Gestational Diabetes, Gestational Hypertension, breech babies, etc. because we have full support of backup Obstetricians, Physicians, and Pediatricians if the help is required, all available on site.
This collaborative model of care has led to some pretty amazing, safely assisted, and satisfying natural births. However, if there are any red flags during pregnancy or labor, we have a number of backup OBs nearby whom we can consult with or have come and perform a c-section if necessary, in The Sanctum itself.
Our collaborative model of care works. We have an amazing team of Nurses (who we have cross-trained to provide excellent labor support), Midwives who have education, training and experience in providing excellent maternity care with the Midwifery Model of care, Ayammas who provide MotherBaby Care from the heart, as much as with their hands, Physiotherapist, Prenatal Yoga Instructor, and Lamaze Certified Childbirth Educators who teach with unparalleled passion and energy, to help women have a safe and healthy childbirth experience. Of course, our team of back-up OB/Gyns , On Call Anesthetists, Physician, and Pediatrician excel in their respective roles, to provide well-rounded comprehensive care for both the Mother and her Baby, as per their individual needs.
Our statistics speaks for themselves. Of the 613 births so far (15 January 2017), we have an 8% C-section rate, 4 vacuum births, and only one forceps birth. These statistics span over 8 years. We currently have a 95% VBAC (vaginal birth after a previous C-Section) success rate, and have successfully helped 6 women have a successful VBA2C (a vaginal birth after 2 previous C-sections) – this in a country where VBACs are almost non-existent.
All of this of course happens because mothers and their families want access to good evidence-based, respectful, informed, transparent maternity care. We are really thankful for excellent back-up obstetrical care, even though we very rarely need it. Just knowing that excellent Collaborative Care is available, also allows for the Mother to birth her baby without fear.
So here is “Birth By The Numbers” for 2016 at Healthy Mother – These are derived from all the births that took place between January 1 2016 to Jan 31 2017.
~ 150 babies were born
~ 93.24% were normal deliveries (overall C-section rate of 6.6%)
~ Of this, we had a Primary C-section rate (first time mother) – 4.72%
This is important! The more we reduce the incidence of C-sections in first time Mothers, the better their overall reproductive health for the rest of their lifetime!
~ And, a Repeat C-section rate (second time mother, with a previous C-section, needing another C-section) – 5.88%
Data about the 7 primary C-sections:-
- One mother with postdates @ 41 weeks and 6 days, with meconium and fetal distress
- Two first time mothers, with breech babies. 1 of them tried for a breech vaginal birth, but with non-progressing labor, decided to go in for a C-section. The other Mamma made a conscious decision to birth her breech baby via a planned C-section, after carefully considering the risks and benefits of a breech vaginal birth
- Two mothers with severe PIH (Pregnancy Induced Hypertension), and cholestasis of pregnancy; One of them also had severe oligohydramnios
- One mother with severe Gestational Diabetes, PIH with and an IVF pregnancy, and very slow labor progression
- One mother with unexplained severe accidental hemorrhage (placental abruption)
On the other hand, having excellent collaborative care meant that we could also help women with complex needs birth their babies naturally, sometimes with medicines in pregnancy, and rarely with medical augmentation during labor and birth.
- 5 mothers with PIH could birth naturally
- 2 mothers with severe Gestational Diabetes could give birth naturally
- 1 mother with an extremely low lying placenta (Placenta 2 cms from Internal Os) could also birth her baby completely naturally, with excellent monitoring and support.
- 2 babies were born naturally despite having congenital deformities (one of them was known through prenatal scan testing, the other had been missed despite having a scan)
- The heaviest Mom to birth her baby naturally weighed in at 128 kgs when her labor started at 42 weeks complete (Yes, there are risks of being obese, but with good monitoring and care, they can also have a natural birth. Being fat should never be a]the only factor determining whether Mom can have a natural birth!
- At the other end, we also had a 42 kg Mom give birth naturally. When she switched care to us mid-pregnancy, she weighed 35 kgs (Yes, there are risks to being extremely underweight. But this alone should never be the only indication for a C-section)
- Postdates – Routine in our practice. At least 80% of our first time mothers will go past their due date. Most will go into labor at some point prior to 42 weeks complete.
- 2 sets of twins were born naturally
- 1 Frank Breech baby was also born naturally
- 1 baby with mild IUGR was also helped to be born naturally
VBAC (Vaginal Birth After Previous C-section) Data:
~ 51 women tried for a VBAC
- 48 of them had a successful VBAC!
- 2 women had successful VBA2C (Vaginal birth after 2 Cesarean Sections)
- VBAC success rate for this year: 94.11%
- VBA2C success rate for this year: 100%
Data about the 3 repeat C-sections:-
- One mother had scar dehiscence (both mother and baby were well, it was a prolonged labor, with body indicating something was off when we spotted a small bleed which was disproportionate to the dilation)
- One mother with severe PIH
- One mother with unexplained severe fetal distress after complete dilation.
~ 100% Breastfeeding Rates (both at 6 weeks and at 6 months postpartum)
What do these numbers tell us?
Birth is inherently safe. Interventions are sometimes needed, especially if there are higher risk cases. In these cases, good Collaborative Model of Care such as the one used at Healthy Mother, with Primary Midwifery Care and the 24X7 availability of OB-Gyns, along with Physicians, and other professionals allows for most Moms to labor safely and birth normally in many instances. In the rare instance that a Cesarean is required, 24X7 in house facilities for surgery, and a excellent team of Ob-Gyns, Anesthetists and Pediatricians allow for excellent chances of optimal outcomes for MotherBaby.
Some key points to note –
- Fetal distress is rare in normal progressing natural births
- Cord around the neck is seldom a cause for a C-section (1 out of every 3 babies is born with a cord around the neck!)
- Baby being heavy is seldom a cause for a C-section – planned or unplanned. We had at least 10 babies born this year who weighed in at more than 4 kgs. All of them were born naturally.
- We never check pelvis shape or engagement of baby into the pelvis or cervical dilation, prior to labor (these things are routine at many hospitals)! And yet, almost all babies were born naturally, despite some of the Mammas having a very compact pelvis. The body that made the baby knows how to bring it out, in the vast majority of cases.
- Short, tall, heavy/obese, or low weight/petite – mostly of the times, these mammas can give birth naturally!
- Just going past the Expected Due Date is never a reason for a C-section! Patience is the key!
- Meconium may cause fetal distress once in a while. However, out of 150 births this year, there was only one baby who needed to come out by C-section due to postdates, meconium and fetal distress! The rest of them, did just fine.
- Just having a broken bag of waters for a few hours is not a reason for immediate inductions, which then lead to “failure of labor to progress”. Such non-evidence based approach can only be called by its true name -“Failure of doctor to wait!” With good monitoring, and good shared decision making, it should be possible to wait for at least 24 hours, and evidence says that it is okay to wait for upto 72 hours, prior to actively considering induction/augmentation. The longest we waited this year was for 8 days with broken bag of waters, and this particular Mamma had her much dreamt of VBAC successfully!
- Midwives are experts at normal birth! The Midwifery Model of Care is holistic, personalized, evidence-based, MotherBaby friendly, and improves maternal fetal outcomes.
- Collaborative Care is worth its weight in gold, in taking care of women with complex needs.
- Mothers are the true rock stars and heroes! It is deeply satisfying and empowering to the Mother to know that she has powerfully birthed her baby naturally!