Call it "two gals and a guy," joked Margie Brandquist, a certified nurse midwife. She and another nurse midwife, who both work in the practice of a Leesburg obstetrician, are trying to become the first certified midwives allowed to deliver babies at Loudoun Hospital Center.
Brandquist and Wendy Dotson joined the practice of Chauncey Stokes III, an obstetrician and a gynecologist, about six months ago, and the three have formed Women's Healthcare Associates of Loudoun. Until they receive hospital privileges, the two certified midwives offer a full range of prenatal services, as does Stokes, who also handles deliveries.
Stokes, who has been practicing in Loudoun since 1991, said many of his more than 2,000 patients are 30- to 40-year-olds who are "pretty midwifery-savvy." He and his two new colleagues have been speaking over the past several months to churches and support groups for mothers to promote the idea.
Midwives are chosen most often by women who want as "natural" a birth as possible. Although midwives can write prescriptions, they also spend proportionally more time than doctors providing counseling to pregnant women on everything from eating well to juggling job responsibilities and preparing a 2-year-old for a new sibling--even finding the most comfortable position for sleeping with an enormous belly and a sore back.
At hospitals that approve their credentials, midwives not only coach during labor--encouraging, massaging, helping with a shower--but also deliver the baby. Loudoun Hospital officials say they are reviewing Brandquist's and Dotson's credentials and expect to reach a decision next month.
In 1995, the most recent year for which statistics were available, there were more than 100 certified nurse midwives in Virginia, who handled about 3 percent of the 92,000 births that year in the state, according to Martha Jones, chairman of the Virginia chapter of the American College of Nurse Midwives in Harrisonburg.
Stokes said: "A midwife gives a woman someone she knows will be able to spend more time with her through her labor process. There is a bonding between women that men don't have." Giving them hospital privileges, he said, "allows women who wanted to have midwives to have a safer environment in the hospital for a delivery."
About a dozen hospitals and birthing centers in Northern Virginia allow certified nurse midwives to deliver babies of healthy women, according to the American College of Nurse-Midwives in Washington. If there are any complications during a birth, the midwife is required to call for a doctor.
Brandquist and Dotson are not among the midwives who deliver babies in women's homes, although Dotson had experience with home deliveries in Texas. Lay midwives--those who tend to help with home deliveries--are not certified and are barred from practicing in Virginia, except for a few who are exempt under a "grandmother" clause.
"We're hoping to bring the beauty and natural things of a birth into a hospital where we have a [doctor] right around the corner," said Dotson, who has 15 years' experience in childbirth and midwifery.
Dotson has a bachelor of science degree in nursing from George Mason University and a master's in nurse midwifery from State University of New York. Brandquist's nursing degree is from the University of Phoenix, and her master's in midwifery is from the University of California at Los Angeles.
As women are becoming more educated about less intrusive ways of delivering babies, industry experts say that midwives are increasingly popular and that their number is rising. Last month, Shenandoah University in Winchester graduated its first class of five certified nurse midwives, women with bachelor of science degrees who also earned a master's in nurse midwifery.
"Nurse midwives are the 'in' thing," said Juliana Fehr, coordinator of the graduate nurse midwifery program. "We spend more time with women. We're there. It's a good selling point for a doctor's practice."
Another selling point is their popularity with managed care providers, who typically are billed less for midwives' services because they use less medication and fewer high-tech procedures during delivery. A certified nurse midwife can cost less than half the $7,000 to $8,000 delivery expense of an obstetrician in the Northern Virginia area, according to industry groups.
In addition, adding a midwife to a practice instead of an obstetrician costs less in salary or percentage of the business; Dotson and Brandquist receive salaries.
Obstetrician Lisa Park said she may consider adding certified nurse midwives to her Sterling and Leesburg practices to attract more patients.
"It's nice to have midwives, as long as they're rigorously trained and tested to make sure they're equipped to handle births," Park said. "They're a good teaching resource."
Midwives are able to address not only a woman's physical health in routine checkups but also "her mental, emotional and social concerns," Dotson said. She and Brandquist said they spend 20 minutes to an hour with a patient during each visit.
"We're not here to just check her belly," said Dotson. "We try to take care of them--to see how they're eating and how they're really doing."
That's what attracts Jennifer Lee, 34, of Ashburn, to their practice.
"They spend a lot more time with you, and it doesn't feel as rushed," said Lee, whose little girl Stokes was delivered last month. "I feel like somebody's really caring. They are women, and they have a clue."
CAPTION: Midwife Wendy Dotson, who works with obstetrician Chauncey Stokes, checks on Jo Ann Morrison, who is due any day.
CAPTION: Margie Brandquist has a master's degree in midwifery.
CAPTION: Wendy Dotson in her office. She spends 20 minutes to an hour with each patient. "We're not here to just check her belly," she said.