Natural Birth

Here in Montreal, a woman has a few choices when it comes to giving birth:

We have several large hospitals, most of which have maternity centers. If you are birthing in a hospital, you will be followed either by a family physician or by an obstetrician. Because doctors here in Montreal get paid less, are more overworked, and have to work under worse conditions than in the rest of the country, there is a real problem of access and availability. This means that a woman may not find a doctor who necessarily agrees with  her approach to childbirth. The larger hospitals are also teaching units, so women in labor are under the care of several people other than the doctor she is officially being followed by.

There are three midwife-run birthing centers in Montreal. Two of these offer women a choice to birth either at the center or at home. The third provides home-birth midwives to eligible women. Demand for these provincially registered midwives is high, and the eligibility requirements are strict.

There are women in Montreal who do not want to follow the provincial rules, and these women have two choices. Some hire "lay midwives", who have been trained elsewhere and are not registered with the Quebec college. Still others give birth on their own or with their partner or a friend.

For years I was getting swamped with requests from women who were desperate about their chance of having a natural birth. The conversation would go something like this:
 "I was on the waiting list for the Birthing Center but I know I have a very slim chance. So I've decided to go with Doctor x at y hospital, because I have heard they have a more natural approach. I would like to give birth at home with a midwife but I do not feel comfortable with an unassisted childbirth, and my husband is not happy about hiring a lay midwife. So we feel our best choice is to hire a doula."

Yes, the presence of a doula can reduce interventions. Yes, my c-section statistics (6%) compare well with most of the Montreal hospitals' statistics (25-30%). Yes, birth can take unexpected turns and you are well advised to have a trained attendant. But to be able to stay in your own bed after giving birth, and bring your child into an environment that is your own means a great deal not only to the mother, but also to the newborn.

And my concern is, I am not getting those phone calls any more. The calls are still about hiring a doula, but they are usually not from women who are serious about natural birth. The women who are on the midwives' waiting lists are actually getting in to the birthing centers. They are not hiring lay midwives, and they are not giving birth unassisted. I know that the birthing centers are not working at over capacity; they have rules about how many they can take on. So my conclusion can only be that the desire for a midwife-assisted birth is becoming more rare, and this makes me wonder. Is the doula-accompanied birth in the hospital the way of the future?