Statistical categories for LMAR ~ 2014

by faithgibson on August 9, 2016

Categorical Data from LMAR ~ 2014

Total number of Ca licensed midwives, number of Ca LMs practicing in 2104,
average number of client families service by each Ca LM

T.CaLMs Prac_LMs Clients_2014  averg_per_LM
 363 220    4,104        18.6  families


Number of PHB clients @ onset of labor, # who gave birth OOH &
the apparent number (total number is in dispute) transferred after labor started but
before the baby was born

@_onset_labor  Birth_OOH   total_diff_btw 
    3,397     2,833          564

Comparison between Ca LMs & MANA Statistical Project 2004-2009

 Hosp transfer rate   Ca LM ~ 17% MANA ~  11%
 Vaginal birth rate   Ca LM ~ 84%  MANA ~  89%
 Cesarean delivery   Ca LM ~ 16%  MANA ~  11%
 Perinatal Mortality*   Ca LM ~ 3.2 /1,000*  MANA ~  2.6 /1,000*

** Term intrapartum fetal-demise/stillbirth & neonatal death, excluding lethal anomalies

Section O of the LMAR – reports of vaginal births after hospital transfer,
number clients delivered by Cesarean and the numerically impossible
disparity between the apparent number of intrapartum transfers –> 564.
This is the difference btw # clients began labor @ OOH and # gave birth
and the combined numbers of vaginal births plus Cesareans in the hospital transfer 
cohort. Obviously, the combined number of 859 impossible to reconcile.   

Rpt#_HospVagBrth   Rpt#_CS   Rptr# IP trans LMAR  Unexplained Diff
            592       267                *859*  ??             ** 295 **

If 859 women delivered in the hospital, then 1 of every 4 laboring
women would have had an intrapartum transfer, which does not
square other facts.

Perinatal Mortality = fetal deaths after 20 wks,
intrapartum stillbirths & neonatal deaths up to
28 days after the birth after birth *see note

There were 13 perinatal deaths  in this cohort of 4,104 pregnancies.
Data for PMis reported in sections “E” & “P” of the LMAR.

The frequency of fetal loss from extreme prematurity, intrapartum
stillbirth and neonatal death has been expressed as ratio. In this example,
there was 1 perinatal death for every 316 pregnancies in the cohort of
pregnant women receiving care from a Ca LM in 2014.

There were no maternal deaths reported in 2014.

F demise_20wks   PM -> 4,104 clients   IP fetal & NN deaths   term PM -> 3,397 
       t. 13              1: 316*     2 ip / 4 nn (t. 6)               1:566*

*Note: In the Letters to the Editor” section of the American Journal of Obstetrics, identifies the perinatal mortality rate in the US during the period of 2007 and 2010 as 7 per 1,000 or 1:142. The author cites MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep 2009;57:1-19.

Seen in this light, the PMN of 3.1 per 1,000 or a ratio of 1:316 is a 2-fold reduction over the US average. However, perinatal outcomes for Ca LMs only apply to a self-selected cohort of healthy that for the most part are not ethnic minorities (i.e. caucasian) childbearing women.

Neonatal Mortality = numbers of live-born
neonate who died w/ in 28 days of birth

This section also include data on lethal birth defects dx @ term,
the ratio of births to deaths, and NNM rate per 1,000 live births
(excluding birth defects)

  neonatal deaths    birth defects  raw total ratio  excluding b. defects  NNM rate (ex. b.Defects)
               4               2     1: 849   1: 1,698  0.7 per 1,000


Raw numbers for all AP, IP, PP & NN transfers
as reported on LMAR

Total clients AP-Elective  AP-Urgent  total AP transfers
      4,104        401         112

  513 // 1:8

Single most frequent reason for elective transfer was miscarriage (69 out of 4,104 healthy pregnant women or ratio of 1:59)

Most frequent reason for urgent transfer was PTL &/or PPROM (47 for a ratio in a healthy population of 1:87)

Intrapartum Transfers, elective and urgent for 3,397 women
w/ SOOL @ term who intended (i.e. planned) to deliver OOH

Total L. Clients  IP-elec  IP-Urgent  Total IP Transfers
         3,397       476      69

   545 // 1:6 [18%]

Most frequent reason for elective IP transfer was lack of progress (260) or ratio of 1:13
Most frequent urgent IP transfer was for abnormal FHT/signs fetal distress (45) or a ratio of 1:75 

Postpartum transfers, elective and urgent for 2014

Total D. clients     PP-Elec    PP-Urgent  totals Postpartum transfers
       2,833       57          37

     94  // 1: 30

Most frequent reported cause for PP elec transfer was repair of laceration (20) or 1:141
Most frequent urgent PP transfer was for retained placenta (17) or 1:166

Neonatal transfers, Elective & Urgent

Approx # babies    NN-elec  NN-Urgent  Total NN hospitalizations
           2,833         31          28

      59 // 1:48

Most frequent elective NN transfer was for “poor transition to extra-uterine life (13) or 1:217
Most frequent Urgent NN transfer was for abnormal vital signs, lethargy, poor tone/color (11) 1:257

Satistically, the likelihood of a baby born in an OOH setting under the care of a Ca LM requiring hospital care for this general category (poor transition as evidenced by abnormal VS, lethargy, poor tone and or color, etc) is the aggregate of both types of transfer.    That ratio is 1:104