Statistical Outcomes 1999 – 2007


This section is taken from ‘Birth Models That Work’ edited by Robbie E Davis-Floyd et al (2009). It describes the Albany statistics up to December 2007. We are in the process of analysing the data for the whole twelve and a half years and the final outcomes will be available soon.

One of the criticisms of new ways of working or new models of midwifery is that they are expensive and do not make much difference to outcomes for mothers and babies. Between 1999 and 2007 we provided midwifery care to 2064 women. Our data for this period shows a home birth rate of 44%, a spontaneous vaginal birth rate of 80%, a caesarean section rate of 16% and a forceps/ventouse rate of 3%. The caesarean section rate for England in 2007 was 23.5% and the instrumental delivery rate (forceps and ventouse) was 11.1% (Birthchoiceuk 2008).

Ethnic Origin

The Practice caseload has a higher proportion of Black African women than King’s College Hospital as a whole, but otherwise is representative of the general population served by the hospital. The data reflect the demographic mix of the geographical area of the practice, demonstrating that the Practice provides care to a non-selective group of local women. Women who describe themselves as Black (African, British, Caribbean or other) make up more than 50% of our caseload, with a further 14% of women from ethnic groups other than white.

Table 1: Ethnic Origin

Place of Birth

Table 2 shows trends in the place of birth since 1999. The home birth rate has steadily increased since 2001 and overtook the number of hospital births in 2004. This increase reflects how the Practice over time has had an influence on local birthing culture. Visiting women at home in labour and keeping their options regarding place of birth open until labour is established undoubtedly contributes to this high home birth rate, which was 57.5% in 2004.

Table 2: Place of Birth

Normal Birth

In the UK there has been much discussion over the amount of intervention now occurring even in vaginal births. Birthchoiceuk publishes a normal birth rate for England of 46.6% for 2004. This definition includes women who had a spontaneous onset of labour, no anaesthesia (sic) during labour and a spontaneous vaginal birth. Our definition of normal physiological birth includes the same criteria but also requires that women had no episiotomy and had a physiological third stage. Using this stricter definition, 75% of all AMP women giving birth spontaneously had a normal physiological birth.

Our induction rate has remained consistently low, ranging between 4% and 9%. The rate of induction for England in 2007 was 20.2% (Birthchoiceuk 2008)

Caesarean Section

The AMP cesarean section rate for the years 1999-2007 was 16.4%. This includes 12.3% emergency caesarean sections (9.6% in labour) and 4% elective caesarean sections. Figure 3 shows that, contrary to national trends, caesarean section rates are declining in our practice.

Table 3: Caesarean Section Rate

Pain Relief in Labor

14.5% of women used Entonox in labour and 11% had an epidural. 70% of women did not use any type of pharmacological analgesia in labour. This includes 22% who laboured in water. This unusually large percentage is at odds with the prevailing philosophy of the “menu” approach to pain relief promoted by many centres in the UK, where women are routinely offered a range of pharmacological techniques (Leap and Anderson 2004). The high rates of satisfaction with our care suggest that women are not feeling deprived of pain relief.

Breastfeeding

The midwives actively promote an expectation of breastfeeding and work hard to maintain high rates of exclusive breastfeeding. 92% of women breastfed their babies at birth; 74.5% were exclusively breastfeeding at 28 days and a further 17% were mixed feeding. The breastfeeding initiation rate for the UK was 76% in 2005. (Information Centre 2006)

Perinatal mortality

The perinatal mortality rate (PNMR) for the Practice was 4.9/1000 for this period. This compares with a PNMR for England and Wales in 2006 of 7.9/1000 (CEMACH 2008) and 11.4/1000 for Southwark (the Borough of London where the Practice is based).

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