People who think that "normal" birth is in a hospital and nominally overseen by an obstetrician seem to view anything non-medical as more-or-less the same thing. That's the hundred-miles-away thing. The reasoning seems to go: "A doula's not a doctor. A midwife's not a doctor. They must be similar." They're not. If you're going to have a birth, I strongly recommend a midwife as your primary caregiver. Having a doula around might be nice, too. They have a special role to play, but they're not the same.

I pointed out that Reston Hospital has a policy against doulas. Doulas, while many are trained and certified to significant standards, are not recognized by medical boards the way doctors and registered nurses are. Thus, for a hospital to have a policy against (in their view) unqualified attendants is (again in their view) justified. On the other hand, no hospital is likely to have a policy against certified nurse midwives, because that's like having a policy against registered nurses. It doesn't make sense. So what I said about Reston Hospital is that they ban doulas. Coincidentally, but unrelated, they have no currently practicing midwives there. There aren't many midwives in the area as it is, and the ones that are around don't work at Reston. So "ray" who agreed "with the hospital's decision not to allow doula's and mid wives," doesn't get that difference. The hospital doesn't ban midwives. The midwives choose to work elsewhere.

Folks who lump midwives in with other caregivers simply because neither is an obstetrician have no earthly idea what they're talking about. Consider the dentist's office. You don't lump dentists in with dental hygienists. Sure, you see both at the dentist's office, but one has been to medical school and is the equivalent of an MD. The other has been to significant training, but not at the same level, rigor, and depth. Certified Nurse Midwives are RNs and then some. (In Virginia, "direct entry midwives" are also now legal, but there are very few of them. In this article, I'm only talking about CNMs) They serve as primary care providers in some situations and they even have limited abilities to write prescriptions. Doulas on the the other hand, are trained in helping women cope with labor, understand their body's signals, and get through labor well. They do a lot more, but I have less experience with them so I don't want to get too far afield. Anyways, one is a registered nurse who went on and got further medical training in childbirth. The other is a lay person trained in helping with emotional and physical aspects of labor, but not medical issues.

So the notion that midwives "sometimes ... are more of a distraction than help (many a times they argue with the doctors/nurses, right or wrong..., and create a chaotic environment" is absurd. Midwives are the nurses. A well-trained doula does anything but create chaos, since chaos and stress work against labor—something doulas understand well.

Consider the other comment on my blog, from a woman who had significant problems with her birth and would not want to deliver at home. No argument here. Midwives are not the same thing as home birth. Again, people tend to lump all the non-obstetrician stuff together. Midwives, home births, it's all the same. It's not. Could a midwife have led that high-risk birth? I think most midwives would say "that's high risk. I'm going to refer you to our obstetrician." Rightly so, and well done. In fact, in Virginia, all CNMs are required to be affiliated with an obstetrician, who presumably collaborates on their work and handles the high-risk pregnancies. The midwife can attend and assist like any nurse can, and arguably better than an RN because of her/his additional medical training. Midwives only lead the low-risk, normal births, which, by the way, is the vast majority of women. They're trained to recognize signs of high-risk circumstances and call in obstetricians at the right time. This is real, medical nursing.

Then there's the issue of having a doula when you're eclamptic and hemorrhaging and all that. Given that a doula is not a medical practitioner and isn't expected to address the eclampsia or hemorrhaging, you have to decide whether she can be of service to you in one of the ways she is trained to help. Can she help you relax and get through it with greater confidence and comfort? If so, get yourself a doula. If having that person around will not actually help you, then a doula is not for you. Does a doula have a place in a high-risk, high-intervention birth? Absolutely, if everyone is on-board with that decision. If the mother will benefit and the medical staff are amenable, a doula can be a real asset.

I never argued against hospitals. I argue against the artificial norm that hospitals are establishing. Having a baby at a hospital is safe and its a great place to be. The interventions, however, (pitocin, epidurals, caesarians) should not be seen as normal. They have their uses, but obstetricians and hospitals are reaching for them much too often, to the point that women don't realize that childbirth can happen perfectly well without them.

1. The Caesarian rate is off the charts

My friends who asked the hospital staff recently were told that the Caesarian section rate is an astounding 47% for 2006. When my wife enquired about the 2005 numbers, it was 42%. There is no excuse for a caesarian rate to be so high. In our area, Fairfax Hospital handles the bulk of the really high risk mothers, neonatal intensive care, and other unusual circumstances that would push statistics higher. Reston has no such formalized role. If you're having a birth at Reston, you have a seriously good chance of having a Caesarian section. There are a lot of reasons you don't want that, but those reasons are not the subject of this rant.

2. My Way or the Highway

This boils down to a few specific issues:

2.a. No Doulas

It is my understanding that Reston has banned doulas of all sorts from the labor and delivery process. Want a doula to be part of your birth? Go somewhere else. They're not welcome here. [update: This seems to have created some confusion. If you don't know the difference between a midwife and a doula, check out my post "Midwives and Doulas: Not the Same Thing"].

2.b. No Dads in the Nursery

This is a bit more hearsay than some of the other statements here. My friend's wife recently gave birth at Reston and he was not allowed into the nursery to bathe his newborn daughter, nor was he allowed in the nursery when the PKU test was administered.

Loudoun Hospital, where my second son was born, was more reasonable on this point. I bathed my son in the nursery, and I was present for the PKU test. There are times when non-staff are not allowed in the nursery at Loudoun—namely when the doctors and/or hospital staff are discussing the particulars of a patient. That makes sense. Categorically denying dads in the nursery does not make sense. My friend says he was explicitly told, during their hospital tour, that he would be allowed into the nursery.

2.c. No Midwives

The hospital, as far as I know, has no policy against midwives. In fact, in 2003, my first son was delivered there by a midwife. (Our experience at that time wasn't so bad) When we looked in 2006 to have another child, we could not find any midwives practicing at Reston. Probably due to the hostile attitude, but that's just conjecture and opinion on my part.

3. A Bright Spot

Sounds to me like the anaesthesiologists at Reston have a somewhat unusual and good practice with respect to epidurals. Nevermind that epidurals are administered way too often It sounds like my friend's wife was administered the lowest effective dose, enabling her to feel something, but still eliminating most of the pain. As far as i know, the vast majority of anaesthesiologists fully numb the mother from the waist on down, and don't consider the option of leaving her some sensation.

My Point

My point in all this is that doctors and hospital officials are pushing childbirth towards unnecessary interventions and are really not giving women the benefit of options. Through "policies" that unnecessarily restrict the woman's options, they artificially create a "norm" of pitocin, epidural, caesarian births.