by Kate Saumweber Hogan, CPM, LM

When we meet with families choosing a midwife, we are often asked about the statistics available for Twin Cities Midwifery’s home birth practice. While we do gather data, the small size of our practice limits the statistical significance of our rates. Because of this, we frequently refer families to larger studies that offer more comprehensive data.

Home birth studies shed light on safety and other key indicators

Numerous studies demonstrate the safety of planned home birth for healthy, low-risk birthing people attended by trained professionals. Some notable studies include research from Washington state, Canada, the Netherlands, England, and New Zealand. Additionally, the article by Johnson and Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America,” is especially important in that it uses data from planned home births in the U.S., and it not only addresses safety but also looks at hospital transport rates, cesarean rates, and other statistics that families commonly ask about. In 2014, Cheyney released a study looking at outcomes of almost 17,000 planned home births in the United states. This study is a great reference for similar outcomes that we track in our practice, such as transfer rates, vaginal birth, assisted delivery, and cesarean birth rates for families planning a home birth.A more recent study released in 2024 compared the safety of planned home birth and planned birth center births in the US, concluding that “planned home births are as safe as planned birth center births for low-risk pregnancies.” 

Birth statistics are becoming more freely available

Over recent years, hospitals and clinics have become more transparent in statistics around the care they provide. While there is still progress to be made, demand from informed consumers (pregnant people and families!) has led to greater accessibility of data on interventions like cesarean sections rates. Annually, this website is updated reflecting cesarean rates by state, and this one has VBAC rates by state. It is also possible to find rates by hospital in MN. The Annual summary of Minnesota health statistics also lists data for births by place of delivery, comparing rates of hospital, birth center, and home birth. Fees for hospital charges can be found here. This national report looks at the data on Changes in Home Births by Race and Hispanic Origin and State. It is fantastic that families have this information accessible to them as they choose a provider and consider who will walk with them on their journey of pregnancy, birth, and postpartum care.

Our state professional organization, MCCPM, also periodically reviews data trends for out-of-hosptial births in Minnesota.

Statistics are a mirror that help us see and improve practice

It has been amazing how Twin Cities Midwifery has grown and flourished over the past fourteen years. Each midwife in our practice limits their client load to 2-5 due dates per month, and there are certain months when we plan ahead, not taking any due dates, allowing for a planned vacation, or a birth in our own families. This means that the pool of data is still small, but we need to start somewhere. We update the statistics annually to provide a level of transparency to families wanting to learn more about the practice.

Trends naturally fluctuate. However, the Johnson and Daviss article offers a benchmark where our statistics will eventually hover around. For example, when they looked at all home births attended by certified professional midwives in the U.S. and Canada in 2000, they found:

• 12.1% of clients who intended to deliver at home when labor began were transferred to hospital during labor or postpartum. First time parents had a 25.1% transfer rate and those having a second or subsequent baby had a 6.3% transfer rate.

Medical intervention rates included:

• Epidural: 4.7%
• Forceps: 1.0%
• Vacuum extraction: 0.6%
• Caesarean section: 3.7%

Another great place to look for statistics is Cheyney’s article, Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Her study found that of the 16,924 pregnant people who planned homebirths at the onset of labor:

• 89.1% gave birth at home, meaning 10.9% were transferred to hospital during labor. Of first time people giving birth, 22.9% transferred during labor, while only 7.5% of non-first time birthing people transferred.
• There was a postpartum transfer rate of 1.5%
• There was a newborn transfer rate of 0.9%
• 93.6% gave birth vaginally

Medical intervention rates included:

• Epidural and/or oxytocin augmentation: 4.5%
• Assisted vaginal birth (forceps or vacuum extraction): 1.2%
• Caesarean birth: 5.2%

All obstetrical interventions have a place, and we are grateful to practice in an area where we have access to wonderful hospital care when it is needed. Being able to transport when we need to and receive appropriate care in the hospital is what makes planning a home birth so safe; when we need extra help, we get it.

A key issue in the U.S. is not that interventions exist but that many cesareans and other procedures are performed unnecessarily, increasing risks for both parents and babies. The Childbirth Connection has a useful article about why our national cesarean rate of 32.2% is so high. According to the article, the optimal cesarean rate is 4-6% for a low-risk population. Since home birth midwives work with an exceptionally healthy and low-risk population, our cesarean rates align more closely with the optimal range. The Johnson and Daviss study found a 3.7% cesarean rate. The Cheyney study found a 5.7% cesarean rate.

So what are Twin Cities Midwifery’s stats over the past fourteen years? 

These statistics below encompass all 541 pregnancies which care was established for, starting from when Twin Cities Midwifery opened in December of 2010 with due dates through December of 2024. In this fourteen year period, 35.6% (192) were first-time pregnancies, and 64.8% (349) were subsequent pregnancies. Unfortunately, 5% (27) of the pregnancies ended in miscarriage. Another 13.9% (75) transferred out of our care during their pregnancy, 5% (27) were for non medical reasons (such as moving out of our service area, or changing their mind on place of birth or provider), and 8.9% (48) were transferred during pregnancy for medical reasons (such as preterm labor, preterm rupture of membranes, high blood pressure, non-reassuring fetal surveillance, cholestasis, breech at term, polyhydramnios, or a fetal congenital anomaly that indicated a need for a hospital birth). All 48 of the clients who transferred prenatally for medical indications had the option to have their TCM midwife join them at their hospital birth, providing non-medical support (such as doula support), and accepting them back into care for postpartum and newborn follow up after hospital discharge. Out of all 541 pregnancies under the care of TCM, 7.9% (43) transferred to the hospital during labor.

This image shows what the journey looks like from establishing care to birth. You’ll see that most of our client’s births happen at home, as planned. However, some pregnancies end in miscarriage, and sometimes there are medical or non-medical reasons to transfer care during pregnancy.

We also track demographics of all previous and current TCM families. We’d love to see the diversity of our practice grow, and our whole homebirth community would like to see more kinds of families having more access to home birth. But to be able to see that grow, we need to be tracking to see where we are starting from. Of the 541 pregnancies we’ve cared for with due dates through 2024, 91.9% of our clients identified as white, 0.9% as American Indian, 1.5% as Asian, 0.9% as Black or African American, 2% as other and 2.8% as two ore more races. 87.8% of partners identified as white, 0.7% as American Indian, 2.2% as Asian, 2.4% as Black or African American, 0.2% as Pacific Islander, 3.3% as other, and 3% as two or more races. Clients identified as Hispanic 1.8% of the time, and partners 5% of the time. Clients identified as heterosexual 93.2% of the time, 3.9% as bisexual, 0.6% homosexual, and 2.4% as other.

To support equity in perinatal health, TCM donates a portion of every midwifery fee to local organizations supporting racial justice and decreasing perinatal health disparities, such as the MN Healing Justice Fund, MN Black Home Birth Initiative, Roots Community Birth Center Community Seed Fund, The Snuggle House Foundation, Sweet Water Alliance, and Queer Birth Project. From 2021-2024, TCM donated over $7,600, divided between these organizations.

Stats for full term pregnancies, starting labor as a planned home birth

Of the 441 pregnant people who were under our care when their labor started,  29.3% (129) were first time parents, and 70.7% (312) were experiencing their second, third, fourth, fifth, sixth, or seventh births.The majority of those families, 90% (397), chose to have a water birth tub available to them in labor. Of those who had water immersion available, 87.2% (346) labored in water, and 57.9% (230) gave birth in water. The water birth rate for all of the 441 births was 52%.

Not all of the clients who had water available for labor planned or wanted to birth in the water. Of those clients who had the option available to labor in water, 10% (44) did not. They were not able to utilize the tub in labor either because their labor was so fast that there was no time to set up the tub, once the tub was set up they were already pushing and did not want to move to get in the water, because they transferred to the hospital prior to active labor, or one time it was due to a medical situation which risked them out of using the tub.Of the babies TCM helped to welcome into the world, 48.3% (213) were girls, and 51.5% (227) were boys. The smallest baby was 5 pounds 13 ounces, the heaviest was 11 pounds 10 ounces, and the average was 8 pounds 1.15 ounces. A doula was present at 50.1% (221) of these labors; 55% (71) of first-time parents had a doula, while 48% (149) of parents of two or more had a doula with them.Of these 441 clients who intended to deliver at home when labor began, 90.2% (398) gave birth at home, meaning that we transferred 9.8% (43) of these labors to the hospital. All but one of the hospital transfers during labor were non-urgent, 32 were first time labors, and 5 were VBAC labors. For non-first time labors, our intrapartum transfer rate was only 3.5%. Three transfers were due to thick meconium stained amniotic fluid, three were due to abnormal heart tones, three were due to client request for pain medication, one was due to signs of infection during labor, one was due to decreased fetal movement, one was due to elevated blood pressure (hypertension), one was due to signs of placental abruption, one was due to non-cephalic presentation, and the other twenty nine were due to very long labors with a labor progression that slowed or had stopped. Of our 43 intrapartum transfers, we were able to transfer to Certified Nurse Midwives 58.1% (25) of the time, Family Practice Medical Doctors 7% (3) of the time, and Obstetricians 34.9% (15) of the time.

Due to transfers to the hospital during labor, Twin Cities Midwifery has an epidural rate of 6.8% (30) and a pitocin augmentation rate of 6.1% (27). All but twenty clients who transferred gave birth vaginally (16 primary cesareans, 4 repeat cesarean; 11 due to limited progression of labor, 8 due to non-reassuring fetal heart tones, 1 due to breech presentation); 0.9% (4) were assisted by vacuum, and 0.2% (1) were assisted by forceps. Twin Cities Midwifery’s cesarean rate is 4.5% (20), with a primary cesarean rate of 3.8% and successful VBAC rate of 83.3%.

We have had a 5.2% (23) postpartum transfer rate (four for retained placenta, one for signs of infection, two for hemorrhage, sixteen for significant laceration repair) and a 2.9% (13) newborn transfer rate (ten for signs of respiratory distress, one for jaundice, one for intestinal blockage, one for a congenital anomaly). Of the total 154 transfers (prenatally, during labor, postpartum, and newborn), only 6.4% (10) were considered urgent (or 2.3% out of all of our births). Most transfers, 93.5% (144) were not urgent.

We also track rates of intact perineums and perineal tears. We have heard people say things such as “all first time moms tear,” “most people need stitches after giving birth,” or “it just doesn’t matter what we do, you will tear.” It can feel shocking to hear these statements, because they don’t resonate as true in our experience.

Over the past fourteen years, 68.3% (301) of clients who started labor under our care had no or minimal tearing (30.6% (135) had an intact perineum, 9.5% (42) had minor skids, 28.1% (124) had a 1st degree tear). There were 29.7% (131) clients who experienced a 2nd degree tear, 1.6% (7) who had a 3rd degree tear, 0.2% (1) 4th degree tears, and 0.2% (1) who had an episiotomy. Not all tears require suturing, only 30.6% (135) of the people who started labor in our care needed sutures to repair their tear.

We also separated this data by clients giving birth for the first time and non-first time parents. I have found that in my practice, it is true that first time parents are more likely to tear, however I would not agree that most first time birthers tear. Of the 129 first time parents who started labor under TCM care, less than half, 45.7% (59) required a repair. There were 26.4% (34) of first time parents who had an intact perineum, 34.9% (45) who had a skid or 1st degree tear, 37.2% (48) who had a 2nd degree tear, 3.1% (4) who had a 3rd degree tear, and 0.8% (1) who had an episiotomy. Looking at perineal outcomes for the 312 multiparous clients (those who have previously given birth), only 24.4% (76) required a repair. There were 36% (96) who had an intact perineum, 38.8% (121) who had a skid or 1st degree tear, 26.6% (83) who experienced a 2nd degree tear, 1% (3) who had a 3rd degree tear and 0.3% (1) with a 4th degree tear.

In 2015, we began tracking insurance reimbursement rates. State funded Medical Assistance (MA) or MN Care plans do not cover services provided by Twin Cities Midwifery, however, private insurance plans often do cover our midwifery care. Out of all of our clients who birthed in 2015-2021 with private insurance, 23.5% had 100% coverage after meeting their deductible. Since deductible levels varied, we also looked at specific dollar amounts families were reimbursed. Of those who birthed in 2015-2021 with private insurance, 54.3% were reimbursed at least $1,000, 34% were reimbursed over $2,000, and 25.5% received more than $3,000 back from their insurance plan to pay for their care. Families received at least $4000 in reimbursement 13% of the time. We will update these numbers once additional claims have processed. For more information on insurance coverage of home birth services, check out our Insurance Benefits blog post.

Toward healthier, safer births for birthing parents and babies in Minnesota

TCM midwives are honored to have attended each and every one of these births and are deeply grateful for the opportunity to support families during this incredibly special time. We stay connected through our regular TCM events and watching these babies grow! Families from any practice are welcome to join our Free Postpartum Group on Friday mornings, and it is extra sweet to continue our relationship with TCM families there! Additionally, our 12 week parenting series, Gather & Grow, welcomes families of any age, stage, or geographical location.

With this midwifery model of care, Twin Cities Midwifery is helping to improve our state’s maternal and newborn outcomes in a healthy and safe way, one birth at a time.

A huge shout out and thank you to Brandi Olson of Brandi Olson Consulting for dreaming up and creating these gorgeous infographics! Brandi builds the capacity of mission-driven business to deepen their impact through agile strategic planning, evaluation, and data storytelling.