Thursday, June 07, 2007

Statistics for the Utterly Confused

I usually wait for a full year to pass before doing my client stats, but a lot of doctors, nurses, doulas, childbirth educators, and clients have recently been expressing concern about the high epidural rate (reports are as high as 80%) at local hospitals. A recent article in The Vancouver Sun also reported that the cesarean rate in B.C. had climbed to almost a third of all births, far in excess of what the World Health Organization deems acceptable.

So, here's a glimpse into my own client outcomes from January 1/07 to June 7/07. Now, remember, these are not a special group (i.e. highly motivated multips under age 30 with a history of fast births). These are 30 women with an average age of 36, most (73%) having their first baby, who hired me to help them and their partners. The majority entered the process without hard and fast expectations about the birth experience. They all hoped to "do their best on the day", some wanting an epidural at the door (and not needing it), and some wanting to avoid a cesarean (and needing it). They are all capable and amazing women.

30 clients
Ages 27-42 (average age is 36, with only one woman under age 30)
22 (73%) primips (including 1 twin SVB)
8 (27%) multips (all SVB, including 3 successful VBACs, no epidurals for any multip)
4 (13%) cesarean births (2 after many hours (one 5 hrs.) of pushing, both posterior babies - 9lb6oz and 10lb, 1 placental abruption, and 1 with malpresentation and incoordinate contractions from large fibroids)
9 (30%) overall epidural rate - all primips, this includes 4 later resulting in cesareans, plus 1 prophylactically for SVB twins, and 4 for pain management with subsequent SVB)
13/22 (60%) of primips had no epidural

Other facts:
18 (60%) arrived at hospital at, or close to, full dilation (Please note: This is not an aim, but a side-effect of the fast labours that often occur with a doula. Clients are encouraged to attend hospital when they feel it is "time," or if they feel anxious, unsafe, or worried about the baby.)
7 (23%) are medical personnel (including 3 family practice doctors, all primips)
1 (3%) client (primip) had her baby at home before I could reach her!
19 (63%) had family doctors (of these, 89% were SVB, with a 21% epidural rate for FP group)
8 (26%) had obstetricians (all primips with OBs had epidurals, only one cesarean in OB group)
3 (1%) had midwives (1 cesarean, 1 vacuum, 1 SVB)

No editorial comments here...analyze at will... - Jacquie Munro, Vancouver Doula

Note: SVB means "spontaneous vaginal birth"


doulicia said...

Very interesting to look over. I need to update my stats. Do you keep a spreadsheet or just tally up from your files?

Jacquie Munro said...

I'm on a Mac, and tweaked my own database/spreadsheet on Excel for Mac - not as good as the old days when I used an Apple app...but okay. Some stats I have to tease out of my notes.

I take comprehensive notes (including client quotes, and their first words to the baby) during each birth, and give them (unedited) to the clients at a later date.

I encourage the staff to write comments to the couple in my client notes (very personalized and lovely).