I was a doula and childbirth educator before I was a L&D RN and let me tell you- there is a huge difference. Have you ever attended an out-of-hospital birth? Without that experience, you really can't compare. Nearly everything that we do to women in the hospital disrupts "normal birth". Heck, just being in the hospital can slow down labor, affect her fear level, and cause complications. Starving women, denying them liquids, denying them freedom of movement, starting IVs, continuous EFM, et are all considered to be "normal" in the hospital (ie- not an intervention) but all of these things ARE interventions and do affect the course of the labor. Let alone the actual interventions that we do! AROM, internal monitoring, hanging pit, pain meds, epidurals, et (some have their place) but all immediately increase the risk of the labor. Lets talk about pushing... In the 50 or so out-of-hospital births that I have attended I have NEVER seen a woman choose to deliver on her back. Yet, that is the only way that I have ever seen an OB deliver a pt in the hospital. I did see a CNM deliver in side-lying once though. How many dystocias happen because of maternal positioning during the 2nd stage? A LOT IMO. Now, lets talk about expectant vs active management of the 3rd stage. There is some new research that makes this inconclusive, but what I will say is that at my hospital they routinely cut the cord right away which leads to a lot of pale babies. I never saw a baby born so white until I started working as a LAD RN. I HATE having to call NICU to do an IV bolus on a baby- if that OB had just waited for the cord to stop pulsating, it wouldn't of been needed.
Sorry to rant there. I'm a little frustrated with my job right now, but I am very happy to be starting grad school this Spring!
Normal birth is out there, but it is rarely seen in the hospital setting.