I have to say that I am appalled that this article came up when I google searched natural birth. The attitude of the journalists is to birth is obviously very mechanical maybe in time she may prefer to miss out the pregnancy as well. She could go to the supermarket and select her child then she would be able to control everything. Childbirth is a natural life event, caesarian sections are supposed to be performed only when mother or baby are at risk. As a previous comment has made a caesarian section is major surgery, there are big risks to the mother; of bleeding ,infection and scar tissue damage to the bladder, and the baby; of respiratory distress. A comprhensive risk assessment must therefore be made before it is carried out. I also think that the author is very disrepectful of midwives, a profession which is committed to providing safe and effective care. The article seems to have been written in journalistic humour which quite frankly I found offensive.

Louise, Mijas Costa, Spain

Would you be allowed to have a "chosen" appendectomy? What about a "chosen" tonsillectomy, or any form of essential surgery? A Cesarean Section is SURGERY! There are ALWAYS risks of any surgery - from the anesthetic, from the cutting into the body, from the procedure itself, from the suturing and from the healing process itself. The body is itself designed to give birth "naturally", as you call it so facetiously. It could also be called "vaginally". Would you have optional surgery to remove the mucous from your lungs when ill? No. You cough - the body's "natural" process. Your article indicates that you are not only uninformed about the human body, about the physiological process of labor and childbirth, but also about the risks and dangers to BOTH the mother and the baby by "unnatural" (or "choices" according to you) interventions. These "choices" also results in much higher health costs to the entire society, both at birth and for later treatment.

S. Cooper-Stephenson, Vancouver, Canada

I found out at 20 weeks that I had placenta previa. The doctors and midwives said that there was no hope for a natural birth so to start preparing for an elected caesarean. I was upset and it took time to come to terms with the situation; this I did and even saw the positives of a planned surgery. Having discussed the situation with doctors in the family and my husband it seemed the safest and calmest thing to do for both mother and child. Women I discussed my situattion with felt sorry for me (highly irritating) and tried to console me with stories of them going ahead with natural births despite having the same risky condition, jeopardising both themselves and their babies. How selfish! I am doing this to have a healthy baby witth a minimal danger risk - not for the glamour. It appears that many women value their experience of 'natural' child birth above the safety of their unborn child.

Kathryn, Auckland, New Zealand

What about what is best for the baby? I have had one natural birth and I am about to have another. With the right care a natural birth can be much less traumatic than caesar. A caesarian is far more traumatic for the baby as it is wrenched from one world into another, it does not allow for the natural process of fluid being removed from the lungs in the birth canal which means the baby has to be suctioned... also traumatic, the cord is cut immediately which means the baby does not benefit from the extra red blood cells that it gets from the mother if the cord is only cut when it stops pulsing, giving the mother an epidural stops her labour pain and increases that of the baby as the mother's natural pain killers in the form of endorphins are no longer produced. These are just a few of the things that adversely affect the BABY! Perhaps women should learn to be a little less selfish, we do not go into labour alone and we are much better equipped to deal with the trauma of it than a baby!

Jane, Waterfall, South Africa

Just wanting to know why some women continue to say that caesarian birth is the easier option to having a natural birth and not so normal........i have had two children and have had caesarian for first then natural for second...couldnt say that either were easy just get a little annoyed at some peoples mentality...when it comes down to it you have had a baby. what is your opinion on this has anyone experienced this?

Annette Lamont, gold coast, queensland australia

True feminism preserves women's right to make their own choice, which includes cesareans, planned and unplanned. True feminism doesn't tell women what to do, it presupposes that they are adults who can choose for themselves, bending neither to doctors or midwives.

As far as doing something just because it was the way to do it back then, well, we did a lot of stuff back then. Why not bring back leeches and outdoor toilets? Just because something is traditional doesn't mean it's the best way to do something. If it's the best for you, fine. But just as I've never told a home birthing, midwife using woman that she 'shouldn't' do it that way, I expect that my views should receive the same respect. After all, it's nobody else's damn business.

beqi, st. louis,

I am a mother of three. My first two I gave birth in the hospital, no epidurals, and they were natural births and yes I got episiotomies. My last baby, which is 1 year now, was a home birth. I LOVED IT!! Yes, it requires more work but if you really know your body and understand how to go with the flow, it can be a really beautiful experience. I gave birth in a jacuzzi with my husband. My midwife was the best. The reason why women usually hurt at a hospital is because they are nervous, their minds are set to "I need epidurals...this pain is horrible..blah blah.." Labor is just that..Labor.Those who choose the drugs, the "easy way", then judge those who birth at home by saying we are primitive, they are missing the whole part of womanhood. The hospital limited me in doing things and I was never at ease. At home, you are your own person and you do what makes you feel comfortable..your body, your terms. I encourage those who are thinking about home births to do it, ITS A BEAUTIFUL EXP.

Lisette Sandoval, Lakeland, FL

I love the passion for both these topics and think there are obviously risks and benefits of both methods. My thought is that midwives must be the only medical professional that are allowed their own agenda's & bias and will push their opinions onto fragile woman who are often going through a very new and frightening experience and who are often worried about upsetting them if they choose something different from what their midwife recommends - which is always a "natural" birth. I had a natural birth & it was extremely painful and throughout I couldnt understand why I had to suffer in such pain in this modern world. I take my hat off to woman who can do it 2,3 or more times - they must have a high tolerence to pain, or perhaps they, like the midwives can see the 'bigger picture' that I certainly couldnt. I was so exhausted I couldnt even hold my daughter at the end of the labour - is that how its supposed to be...really? Certainly didnt feel empowered. Elective C next time definately.

Theresa, Wellington, NZ

It is not merely some strange "virtue of pain." (That makes absolutely no since and has nothing to do with the reasons that natural birthers would give for doing what they choose to do. The negative aspects of drugged children that have a 300% more chance of having brain damage due to epidurals, a much small chance of breastfeeding due to slow reaction from induced labor, the average lengthening of the labor process by 25% due to epidural, the 25% more chance that an episiotomy will be needed, etc... The list goes on but you don't want to mention those cold hard facts in your rant do you? Hmmm??!! Can anyone say, "misinformation?"

Emily Washington, va beach,

When anesthesia was introduced to child-birthing in the Victorian era, many doctors and moralists were opposed to it because they thought it interfered with God's will that women suffer in childbirth (dating back to the Garden of Eden). However, when Queen Victoria began using anesthesia during child-birth, much of the opposition disappeared. There was a huge demand for this medical intervention. I think the emphasis on natural childbirth is rooted in earth muffin holistic philosophies (not necessarily science) that put a premium on revolt against modern practices. If a person chooses pain-killers, it doesn't mean they love their baby less or are somehow morally deficient. I'm astonished at how critical women are of other women who make different parenting choices. I never realized how judgmental and moralistic women are to other women until now, my first pregnancy. Fortunately, I married into a family of nurses, so I'm getting excellent advice!

Rebecca, Stillwater, Oklahoma, USA

FINALLY someone has written about this. Throughout my pregnancy I have been hounded by women and also by people who feel an irreststible urge to 'educate' me that any kind of medical intervention, pain relief or assistance is just wrong. Natural birthing is a marketing concept. It says reject technology, fear medical intervention because it is bad for you and your baby, and do ti the 'natural' way. My husband, my best friend and most of my family are doctors. It is complete nonsense that having your baby at home with a midwife and some lavender oil is better for the baby. It is better for midwifery, and it is better for the people who sell books on birthing yoga and natural pain relief techniques. Before we had obstetricians and modern medicine, many women died in childbirth. The proponents of 'natural', have-it-like-we-are-meant-to-in-the-cornfield advicates seem to forget this. Grrr. Midwives are not doctors. Remember that.

Belinda, Melbourne, Victoria

Why do women have to be so hard on each other? I was told not to have a caesarian and undertook every step to ensure a "natural childbirth". I wanted to discuss the possiblity of an elective caesarian having gone over my date for induction but the consultant intentionally avoided me and I was left to determine my own fate. I went into labour on Sunday at 6.15am and delivered my angel baby on Wednesday am "naturally". A half an hour before delivery, a young doctor with broken English told me she was going to perform a caesarian. I had no idea who she was or whether she had the skill to deal with the particular complications I had which had indicated natural delivery. I was terrified. In the end I was assisted by a fabulous midwife and a wonderful doctor in a forceps delivery. I can get over the four blood transfusions, the mutilation of episiotomy, the subsequent infection and the long term damage, but I will never forgive the absent consultant for risking my baby's life.

CD, London, UK

Many women think that we should do what women of history did. Im all for natural birth. Im also for choice of birth method,such as, pain medicine. If you ask me women in history would have opted for pain medicine. If you went back in time to the Victorian era and found a women in labor and there stood her midwife ready to help deliver, and you said to the soon to be mother "would you like some pain medicine? I have medicine that will help you cope better with the pain." Im thinking she would say yes right away. I think if you have a vaginal birth that is still very natural even if you had pain medication. Because natural is how we deliver our babies anyways. And for women of c-sections, why can't that be natural to. Maybe the birth was different then the supposed way but you grew a child in your belly for 9 months and brought it into the world. That is very natural to me. So I say all birth and all its forms are very natural.

Tonya, Elk, PA USA

I was under the impression that the Feminist perspective was that women should reclaim their right to a natural birth back from the male-influenced interventions of modern society.

Vanessa, nr Eastbourne,

That was a fantastic article and thank you very much! At last soem sense as I am sick and tired of not having the choice and pain is good. According to medical journals there are risks in both c sections and natural births. I would never feel less of a woman or selfish because I didn't want to go through a long labour. It was my choice. It took me several weeks to ASK FOR A C SECTION AS I AM FEELING ASHAMED that i emotionally was not strong enough to deal with the stress of labour and natural birth. It is all about choices.

Maria, exeter, uk

I had an uncomplicated natural homebirth with my first child and it was the most empowering experience of my life. Did it hurt, sure, but once it was over, it was over. Having a birth attended by a midwife has better outcomes when it comes to things like episiotomies, c-sections, etc. I would never consider a birth with medical intervention unless it was required. Women have been having babies since the beginning of time. I actually feel sorry for women who are so misinformed that they are willing to put it all in the hands of the medical professionals and undergo major surgery in an attempt to avoid pain. Like any surgery, it is wonderful to have if you need it but obviously not the best outcome for mom or babe.

Jessica, Toronto, Canada

Hey, it's the 21st Century, right enough. Why bother with all that messy childbirth palarva at all. Just grow them in a jar. Or better still, clone them, then they can be just like YOU!

Joe, Glasgow, Scotland

Alice, I know many women who chose the pain free???? predictable route of élective'caesarean - many whose babies spent terrifying days in NICU due to respiratory distress or a hospital induced staph infection, are now permanently incontinent with nerves severed to her bladder, without their uterus and lucky to be alive, or a chance of ever having another baby due to resulting infection, endometriotis and horrific scar tissue.
Does that sound scary - because the reality is that it should scare you.
Do us all a favour and get off the 'give us a caesarean now!' soap box.

carolyn, south australia,

See Alice Miles, here's where you are wrong.

Midwives are the preservers of "normal" birth. Yes. Normal. It is not normal to have your baby surgically removed from you. That is ab-normal and should only be medically indicated for the incredibly small percentage of woman who truly need it. Cesarean sections are an absolute abuse of women. There is an obsession with cutting women in this country and some of us refuse to be a part of that! So, we make choices. A midwife is a great place to start! 30% of babies being born surgically? Hardly "normal". Having a surgeon take care of a healthy normal pregnant woman? Also, not "normal". And, please don't misinform, or assume that all these pleasurable drugs and amazing techniques that we have in our modern day are without consequence! See, the reason that we insane women choose to use midwives and birth unmedicated has much to do with being connected to our children and the birth process. Sorry you missed the boat on that!

Christine, Marietta, Ohio

I would Much rather have the pain of going through a Vaginal Birth then having a C-section .
Why, Because for me, the thought of giving birth vaginally and having that pain end within a Day (as it did for all of my births Except my section) than to have a Section done and then have to deal with the Pain of that healing for weeks, makes much more sense.
Why anyone would WANT a c-section is Beyond me, as a Mother who has had many Vaginal births, and One Section,
The answer is in the pain. =-)
Yes, Labor hurts..
but the Section hurt Longer.

Emily, uniontown, PA

I see her point, but the author seems to miss the point that research demonstrates natural childbirth with midwives mean better outcomes for mothers and babies. Women should be able to choose, but they should be able to make informed choices.

Julie, South Orange, USA

Excellent article! It was about time somebody spoke loud for us. I had my son via an emergency cesarean after 40 hours of contractions, two vaginal sweeps and two horrible nights at the hospital. I had to beg for some kind of pain releif when I was in pre-natal ward, as the midwife disregarded my request for "at least" gas from the beginning on the basis that that was to be used only at the labour ward!
As I said, after an agonising 40 hours I was finally allowed an epidural and, less than an hour later, I had an emergency c-section (by the way: they'd missed my waters had been leaking for 5 days and I had an urinary infection). All I can say is we don't live in caves any more; medicine advances for a reason and that reason is to relief pain and cure illnesses. Therefore: why do they insist in putting us through all that pain and let our babies stress unnecesarily? Because "yes" babies do get much more stressed during vaginal birth.
Thumbs up for c-sections

Andrea, London,

I think nature intended childbirth to be a primordial struggle, a pitched battle for the prize - our precious babies. In pre-historic times maybe that was what made babies cherished. I personally am glad to have gone the drug-free route, I came through with such a feeling of pride and victory. However, I would NEVER say that this way was better or judge women who choose epidurals or need or choose Caesarians. The focus is on the birth of a healthy baby, after all, however he or she arrives. Just like in other areas of women's health and self-determination, we do well to respect points of view other than our own.

Michele, Kansas City, MO

I am so delighted to have just found this article as I am a complete advocate for the 'not so natural' birth procedure and for decent medical intervention to take place for women who are increasingly suffering traumatic births.
I gave birth in december and it has ruined my life. I had an awful pregnancy with no care from my 'many' midwives and when the big day arrived it emerged my most recent midwife had got the position of my baby wrong and hence I went through hell from the onset. To cut a long story short I had to demand drugs and demand help but Im not sure how much help I truely got. I was left exhausted, in intolerable distress, in agony, and all the midiwfes did was be rather aggressive, annoyed at my 'moaning' and irritated by my requests for help. I ended up having to have an instrumental delivery and three epidurals but again this was after much demanding and it appeared I annoyed to many people in the process of asking for some simple humaine help!

Ruth Hawkins, Bournemouth, UK

I thank you for such an awesome column! I can't believe the back lash you are receiving from other women. What happened to women supporting other women's choices and being a sister to all women not a cruel and harsh judger? Don't you think we have enough men to do that particular job? Your words were more than overdue, I have forwarded your column on to my dear friend who is about to give birth to her first child. The amount of guilt that other people, including women, our putting on her to have a "natural" no drug child birth is absolutely ridiculous and deeply disturbing!!! I could not argee with you more, it is the 21st century, THANK GOD!!! Anyone that disagrees with your opinion should never agian in their lives take another pain killer or cold medicine, just suffer through naturally so that you can experience the pure joy of when you are finally better!!! If it kills you, well at least you can say you were strong enough to try...

Kari, Rogers, AR

Maybe we could teach our children that they too don't ever have to experience any "pain" in life. Go into a drug induced coma for three weeks after your friends death so you skip the grieving, or take some vicoden while waiting in line at the dentist so you don't have to go through any impatience. Maybe life should be just bubbles and dreaming and skipping through life on substances that will fog your memory and keep your child asleep 9 months of their first year of life.

I however choose to experience my life to the fullest, how sad it would be to not have experienced the joy of pushing my baby out, after several hours of pain. The joy associated with the pain of labor is the most rewarding part of becoming a mother and I am soo sorry that you had to miss that experience that. I really am! You missed something, a connection to your baby, that no amount of pain killers can ever replace.

Colleen, Prescott Valley, AZ

The birth I did not need pain killers for was my home birth ... I am still taking painkillers for my caesarean scar four years later. Having had two hospital births, one caesarean delivery and a home birth I know which one I would do again tomorrow. I would never put myself and my baby willingly at the enormous risks of major surgery and early birth.

Few women but those who have done it and those brave enough to hear their stories understand the emense power and emotional strength which follows a birth in which the woman let her body do what it is designed to do. Every woman should have the support to make that possible...

As for following a celebrity lead, I found Davina Macall's story just about as powerful as it gets.

Vickikate, Midlands,

How about looking at the evidence before you start printing such a load of rubbish? Midwives are trained to look after women experiencing normal pregnancies and labour. Normal is not the same as natural. 'Normal' means women who do not have additional risk factors such as high blood pressure, diabetes, epilepsy etc. Midwives are also trained to detect deviations from normality and to refer women to the appropriate health care professional, as required.
If you had bothered to look at all the research evidence rather than using anecdotal evidence you would realise that for 'normal' pregnancies it is safer to have a vaginal delivery, not an elective CS. It has also been shown that for 'normal' pregnancies, it is just as safe to labour and deliver at home as it is in hospital.
At the end of the day though, midwives are trained to offer women informed choices about how and where they give birth i.e. based on good quality research not one newspaper columnists experiences.

Susan , EDINBURGH,

I could not agree more with the columnist, particularly with regard to the "conspiracy" against women who are expected to endure excruciating pain; and as for "April"; labour is "that terribly painful"!! I gave birth at 23 and suffered 3rd degree tears after the midwife behaved negligently.. i had wanted as little intervention as possible and chose an NHS birth centre..in the event i had to be rushed to hospital after delivering my baby and sutured under epidural. i will never put myself through that again and resent the pushy way midwives and antenatal instructors do their all to dissuade women from using pain relief. 3 friends gave birth in the last 2 years and not ONE had a positive experience with the NHS. Sarah Meir says obstetrics is not "one size fits all" but judging by shared experience the NHS would like to use such an approach to expend minimal resources and the consequence is most new mothers experience trauma and being made to feel like they are on a conveyor belt.

Zara, London,

Have you ever expereinced a natural birth? It really isn't all that terribley painful. And in the end doing it naturally allows the woman a greater sense of control, better success with breastfeeding immediately following the birth, the ability to move around more, etc. I for one am glad to have been able to deliver naturally. While it's not necessarily for everyone it's a beautiful thing. It isn't something to be looked upon as tortuous. As soon as you give birth you forget the pain and the "love hormone" rushes through both you and your baby's bodies. It's an awesome high... one that women who get epidurals miss out on. So, there are pros and cons to both I suppose.

April, Santa Rosa, Ca, USA

Reading some fo the comments here, I'm reminded as to how foolish 'public choice' can be. THe array of really poorly informed views that can only lead to death and distress is astounding.
The safest place to give birth is a hospital. FACT. Whether you have drugs or not, natural birth, birthing pools (some hospitals have them), and never see a doctor is irrelevant. The fact of the matter is that when things go wrong - which they may do even with the most 'normal' of pregnancy, they often go wrong fast.
In a hospital you can have a consultant obstetrician and paediatrician there in moments. At home/in a community midwife centre it can take over an hour just to get rushed to hospital.
How many lives - both mother and baby do you think this delay represents?

I have nothing but contempt for the hippy briage guilting women away from safe hospital births and painkillers.
But that is nothing to my hate of the likes of Hewitt for risking lives for a few pennys.

Jamie, London, UK

/Virtually all the comments refer to personal experience; I am a certified nurse midwife with 40 years experience (plus three children of my own, btw). What IS important, and where obstetrics becomes an art as well as a science, is MATCHING THE TREATMENT TO THE WOMAN'S NEEDS as well as desires. There are a few women who can deliver, unassisted, on the kitchen table and resume hoeing the garden an hour later. There are some women who require every bit of medical and surgical technology and expertise to survive the process of birth, and the baby does too. Most women fall somewhere in between. Each woman is individual, each labor and birth is individual. Obstetrics is not "one size fits all". What a woman deserves is that all options be available, and that would require a massive input into maternity services, not a reduction of them. But what NHS obstetrics is getting is lots of political input rather than resources, and that is not serving half the British population at all.

Sarah Meir, CNM, Jerusalem, Israel

I am a veterinarian - when I became pregnant I spent a great deal of time researching the way in which I would give birth. After studying the statistics for the various types of birth I discovered that the death rates for babies born at home and those born in hospital were the same.
The chances of a baby dying when born by caesarean for non-medical reasons is 3 times as high as for the same baby born vaginally. The process of being in labour prepares the baby to be able to breathe. It is better for the baby to go through a labour at term which ends in a caesarean than for the baby to be induced or to be born via a planned caesarean (unless 4 complications). My 4.12 kg baby was born at home drugfree in a birthing pool - no tears, no pelvic problems (lots of pelvic exercises during pregnancy). It was a fantastic experience (it did hurt). One of my first thoughts after stepping out of the birthing pool was how wonderful it was to be fully conscious and aware at such an amazing time.

Kylie, Adelaide, Australia

A major issue about his 'choice' thing is that ,especially with a first child, one has no idea how it will be and what choice to make - one can research and be influenced (NCT etc)beforehand and come up with a plan, but during the birth things change awfully quickly and it is very hard to know whose advice to trust.

I have had 3 sections, 2 emergency, 1 planned. I would not pick a section if I thought there were alternatives as it is no picnic. But I think it depends on the individal - some people seem to get their babies out 'normally' with ease and it would seem mad for them to risk a section, but for others facing otherwise complicated and prolonged births then intervention would seem to me to be best for both mother and baby. The risk of intervention needs to be balanced with the risk of complications.

I think the issue is we need good qualified people there to read how the labour is going and give the right advice at the time and that costs money, Ms Hewitt!!

carol, edinburgh,

My son Gus was born after six hours of labor, without my wife taking an drugs of any kind. When Gus appeared he was having trouble breathing due to fluid which had entered his lungs. Gus was suctioned and moved to an oxygen tent where he was given oxygen. I stayed with him for about an hour as he cleared his own lungs and began breathing normally. Had he been drugged with his mother's pain killers via the chord, I'm not convinced he would have been as strong and forceful in his efforts to clear his lungs.

We live in a world wide culture where medical intervention is being forced down our throats for every aspect of human life. Can't sleep? Have a pill. Can't have sex? Have a pill? Getting old? Go under the knife.

Natural birth is a choice being made by families who want to go from birth, to breast feeding, to attachement parenting, to home schooling and right on into a more human and more connected family experience. However, its not very profitable for the drug companies.

Mark, Kingson, New York USA

The UK should have a third world infant mortality rate shortly, thanks to this horrific "Maternity Matters" plan.

I guess the astonishingly low standards of NHS British dentistry and cancer care were not bad enough.

Edward Sodaro MD, Massapequa, USA/New York State

Thank you Alice Miles for telling it like it is. Yes, women have had babies naturally for centuries. But more women and children also died during childbirth for centuries and more babies suffered severe brain damage due to birth injuries than we now see. What would the midwife do if you had a complication while delivering your baby in your living room!! The whole concept of natural birth is an agenda driven by midwifes and not obstetricians. I am a Doctor and when I was pregnant, I did my homework and chose Elective C-section. I did have gestational diabetes which made the decision easier and the resistance from the establishment less, but I was told that I could have "normal" labour if I wanted. Did they think I was crazy to put myself and my baby through all the risks that entailed!! I say give women the choice of where and how they want to have their baby, but not at the cost of both their physical and mental wellbeing. And please dont believe a word of that Ms Hewitt says.

Seema Seetharam, London,

Let's see...I had one induced delivery with forceps, one induced delivery that turned into an emergency c-section when number 2 when into stress, and one VBAC. First delivery was national health in Australia, second was private in the US, third was in a US Navy hospital. All three offered medication as an option, which I took them up on once things got to be too much and the enjoyment in the impending deliveries was overshadowed by unnecessary pain. No horrendous scars and no problems "down there"....and I thank God that I was given the choice to do what was right for me and my babies and was not subjected to femi-nazis trying to dictate my actions. Each woman should have the right to make the choice appropriate to her particular situation and have her decisions respected.

Linda Lenox, Portsmouth, VA USA

For goodness sake I am fed up of some of the utter rubbish about birth I have read on this site over the past few days.

I believe that by 'natural' birth Ms Hewitt was referring to vaginal birth without forceps or ventouse.

I'm glad Alice Miles is happy with her elective caesarean experience. I'm assuming it was in a private hospital as I wasn't aware the NHS had resources to spare to schedule operations to fit in with patients' diaries. It does seem a shame that she chose a procedure that increases maternal mortality four-fold and has many severe possible implications for the baby. Presumably because the operation was scheduled so conveniently for diary planning it was carried out before the pregnancy reached 40 weeks and risked the baby being born before it was ready to be - pregnancy dating is not exact.

Many people find that caesareans are anything but pain-free. I was in a lot of pain after mine and still uncomfortable a long time afterwards.

Heather, Edinburgh, United Kingdom

Another point that has just occurred to me is this ridiculous obsession with caesareans to avoid problems 'down there' (as it is so ridiculously expressed).

If you mean urine leakage, that is usually caused by a weakened pelvic floor, which in turn in caused by pregnancy. There is a reason that women are encouraged to do pelvic floor exercises.

I accept that in some cases there will be some damage as a result of childbirth. Just as there will be some cases of damage during a caesarean (I have heard of bladders being cut) and as a result of a catheter being inserted.

Heather, Edinburgh, United Kingdom

Alice, if one can choose your C section because the date fits one's diary and one wants lots of drugs and what one thinks will be the easier recovery, then why can one not understand the desire of women who want do exactly the opposite. Surely one's desire for choice should be extended to everyone else and their choice?

That is what is wrong with the whole maternity system in this country. It sets up stupid argument like this to detract from the fact that, in most places, it is in a complete mess and very few people are getting what they want because its is grossly underfunded.

Fine if you want pain relief and convenience but please leave alone those of us who would like to try it a different way. But yes, I totally agree with you, save us from those who don't have the open eyes and flexibility to see each woman as different and an entity in her own right, to each be dealt with in an individual, unique situation.

Lesley, Maidenhead, UK

I'm from a third world country, and I definitely did not have to squat behind a bush. (In fact I had a very comfortable elective caesarean which took all of ten minutes with no discomfort!) You remind me of the time my family first moved to Los Angeles and my classmates would ask if we lived in trees back where I came from.

RM, Edinburgh,

I was in labour for 90 hours. I was told that becuase I was not dilated I could not have pain relief. It was only after manual dilation and screaming agony that it was "discovered" I was unable to dilate, that I had been in real labour for five days and that I had to have an emergency caesar. I had not slept for 5 days, the caesar left me weak and exhausted. The midwives made my husband leave the hospital at 5am after her birth, thrust her into my arms and left. I could not reach the call button and was left holding my child in terror that I would fall asleep and drop her. As a result it took me two weeks before I was well and recovered enough to appreciate the wonder that is my daughter. I will never recapture those moments and for that I am furious. I hope that these pain facists are seen for what they are and stopped. If I had been given my caesar 3 days earlier when I asked (I suspected a problem) I would have had more. My stomach muscles are ruined and may never recover.

Tamsin, Bath, Avon

Why can't Hospital and Independent Midwifes work together instead of fighting each other, to enable mums to- be the informed choice they want.

Women should be able to make the choice of place and birth they want and have the birth attended by the person they want, because it's right for them not because a "health pro" thinks it's better for them.

J. Biu, Islington, United Kingdom

Forget "natural"... a safe birth, a compassionate birth, and a supportive birth are what mothers have a right to. Regardless of how the process begins or ends, the safety and dignity of both mother and child should be paramount. When I hear the term "natural", with respect to babies, one may as well be speaking of unbleached diapers or organic baby food. It's a marketing tool designed to get in our pocket book. A proper midwife will provide support in whatever way possible to the woman giving birth.

sarah, Calgary, Canada

I think you raise some very good points. It is so easy to forget that childbirth can be a very risky business. One only has to look to the developing world to be reminded.
Follow this link for a recent article, April 2007, in the New England Journal of Medicine on just this issue!

http://content.nejm.org/cgi/content/full/356/14/1395?query=TOC

sarah, chicago, il, USA

I agree wholeheartedly with the columnist.
Who has ever heard of a man with a kidney stone being exhorted to 'pass it naturally'. Men would never be expected, if they had to experience something like childbirth, to do it 'naturally'. I am mystified by the pressure that is put on women to have a 'natural' birth, as noted in the column we are not in the 19th century.
As for C-section 'killing' babies and mothers-what absolute nonsense, I would like to know where you got your statistics??
I think that all women should be given a CHOICE if they want to go natural-great, if they choose to have a C-section that is great too. Just give women the facts and let them choose!

Madge, Sydney,

"I wanted it in the diary; anything wrong with that?"

You think the NHS should pay for you to have an operation which will increase the risk of both your death and the death of your child, just so you can organise your diary and you can't see anything wrong with it?

Jo, London,

I am a young mother of three (All born naturally 2 at home) 8 and a half stone no wide hips here. Lets be honest here. fear is what it's all about. An elective caesarean is planned and very controlled so do these women just want to feel ultimately comforted by this fact.
I have never felt more empowered than when my children were born. I did it my way and I bullied consultants and midwives to get it. I had no pain relief at all with my third child and the natural high that I experienced when I held her in my arms was unsurmountable. I am not a mother earth type and having that label was not my motivation in seeking the most natural birth that I was capable of achieving. I wanted what was best for me and my baby and that was not major surgery.
My confidence comes from a good understanding of the child birth process and a trust in the very capable midwives that cared for me at home. 2-1 by the way.

Mrs O'Grady, derbyshire,

C-sections kill mothers and babies, it is about as mad a choosing to feed your baby heroin, something which when you have a c-section you are very close to doing, there will be narcotic in the spinal anaethsetic and afterwards, either IV, or orally. C-section mothers are much more likely to have complications, such as bleeding, even a hysterectomy (about 1 in 500), c-sections increase the risk of problems in future pregnancy including tripling the risk of future still birth. It's also possible that the speedy cord cutting that almost invariably accompanies a c-section could be blamed for the massive rise in autism spectrum disorders.

Midwives need to be trained in normal birth, because every step you take away from that takes you closer to all the problems of c-section, but they are trained in non normal birth too, providing care, alongside doctors in complex situations.

Anne Rogers, formerly Cambridge, UK,

I also agree with the most recent posts - this journalist is quite unfair to say that we want less 'such' midwives - I gave birth twice , and on both occasions I had the most wonderful two women whose voices were soothing, their attitude lovely, their advice made sense and the approach used was very modern and natural... I can only imagine how awful it would have been for me without them!

In addition, when one of my babies was to be diagnosed with 'pyloric stenosis', a condition easy to operate, once recognised - it took 7 days for 'so called' experts to diagnose it (my baby nearly died), even so the midwife that sent us to the emergency knew what the problem was staright away!!! So, please do not tell false 'experienced doctors that know better' stories... Honestly, I trust these down to earth midwifes better then any of the 'GP/experts in something else doctors' [of course, I exclude the specialists Consultants].

Shined, London,

Birth is a normal physiological process, women are designed to labour and give birth . That's not to say we should be denied pain relief or that medical intervention hasn't saved countless lives. Without it my daughter and I would probably be dead. But study after study shows that unwarranted intervention tends to lead to worse outcomes for mother and baby. Caesarean sections are major abdominal surgery and recovery is far from pleasant, particularly at a time when you are uniquely emotionally vulnerable, sleep deprived and anxious.

A final thought - I do hope that if Ms Miles feels birth is something that can and should be scheduled around her other commitments that she has not been too shocked by the reality of motherhood. In my experience, children are rarely as accomodating of diary obligations as her obstetrician seems to have been

Cally, London, UK

I do agree that women should have choice although it sounds like a choice between the frying pan and the fire to me!

Have a home birth and go through agony
Have the baby in hospital with an epidural risking paralysis
Either of the above risk being split/cut down below - ow!
Pee yourself everytime you laugh (I've heard this happens)
Or
Be cut open
Is it worth it?? Well if I ever get any desire for a child I think I'll adopt!

Sophie, London, UK

I disagree with the majority of what Alice Fish has commented on in her article. All women who request a homebirth are not earth mothers but may have complete faith in their bodies ability to birth their babies. I have had two normal births in hospital which were horrific and an elective LSCS for a complication that arose during my third. I feel complelled to tell you that the elective casarean was the worst experience of my life. I am currently 22 weeks pregnant and will stay at home and birth my baby. Patricia Hewitt is not insisting that home births are right for all women but birth today is full of technocracy and I feel as a femminist an area full of male dominance. Childbirth is percieved as full of fear in the 1950's an obstetrian called Grantly Dick Read wrote childbirth without fear this book would certainly enlighten most people. Modern day obstetrics are good but really lets leave them for women who TRUELY require them. We should be empowering women in their choices

deb byrne, manchester, UK

Alice, When did normal childbirth mean the same as natural childbirth? Normal is without medical intervention - the induction and augmentation of labour that is often only prescibed because of staff shortages and hospital limitations on time. Even midwives attending a home birth have access to analgesia such as entenox and pethidine. Women do not have to give birth in the dark ages but it is only right that midwives endorse safe methods of care. Oh, and it isn't called 'labour' for nothing!

G, reston,

Choice is fine, as long as women are well informed. Did you know that the "easy option" (a Caesarean) could give you severe endometriosis if the surgeon is a bit heavy-handed? Pain so bad you faint every time you have your period? But it's your choice ...

Starling, Lancaster,

This argument is decades old. The point surely is to provide women with a genuine choice about where and how they give birth and not to enter into fruitless debates about which method is better, nor to demonise midwives, medical professionals or women who make choices that you would not have made. I have friends who would have died without access to hospital care and I had three very straightforward natural births at home (and I am neither religious nor masochistic). Neither is right for everyone. Genuinely providing women with safe choices is costly of resources and if the present government agenda is a closet cost cutting exercise that is of course lamentable, wrong and potentially dangerous. The midwives I know personally speak of services understaffed and stretched to breaking point, but creating a culture in which midwives are mistrusted and undervalued will not provide what most women want and need, which is to be cared for during birth by someone whom they know and trust.

Christina Morton, London,

People on both sides of the medical vs "natural" birth debate need to stop perpetuating the myth that women can choose what kind of birth they will experience. I chose a natural birth and after 36 hours of labour in the midwife-led birth centre - without even a paracetamol - I had to transfer to hospital to be pumped full of hormones and an epidural and eventually an emergency c-section to rescue my baby from being asphyxiated.

"Life is what happens while you're busy making plans." Cheesy but true.

Our generation is characterised by choices. We choose when and where to study, work and live, who to marry, when to have children: and if something doesn't go perfectly in life society blames us (or we blame ourselves) because after all, it's only what we've chosen.

Childbirth isn't the same. You can never predict precisely how it will unfold so arguing for the right to choose in advance either no intervention and a dream midwife, or drugs and a c-section - is pointlessly academic.

Helen, Oslo, Norway

WHAT SEEMS TO ESCAPE the modern media and their sponsors, is the TRUTH: Hospital birth is SCARY....FEAR feeds PAIN and amplifies it. The amygdala (primitive brain) stops birth when we are afraid. Hospital's call this: 'FAILURE TO PROCESS and then induce birth artificially. PAIN RESULTS. INTENSE PAIN! ....but we have an expensive quick fix....would you like demerol?, epidural, spinal, or general anesthetic and a C-section. Then when breast feeding is obfuscated we have 'infant formula'.90% of North Americans are born drugged to drugged mothers. 30% are c-sections. Oh! yes we have a 60% divorce rate too. It all correlates. Nations with the highest rates are the planet mongers. The nations with the lowest c-section rates are the most peaceable...IT ALL CORRELATES!

I say it again: Alice READ THE SCIENCE RESEARCH not the PHARMACEUTICAL paid spin and deception and for PRESS RELEASES....DO YOUR JOB....Investigate before speaking.
'SPIN DOCTORS' where could that name have come from eh?

Colin, Pickering, Ontario, Canada

It is not a conspiracy to keep women in pain as you purport! If you had done even the most rudimentary research for this pompous, ill-informed article you would know that the 'conspiracy' is to keep women away from interventions as much as possible because they are PROVEN to cause worse outcomes for mothers and babies over and over again!

Women should be encouraged to make INFORMED choices about their birth experience... something which is not even mentioned in this prejudiced piece of writing, masquerading as journalism!

Maria, Liverpool, UK

I am a mother of two both born naturally one with some pain relief the other with none. It was a time when C sections were performed in cases of emergency. There were no options for epidural. Both experiences were special in their own way. I was and am still not what Alice describes as earth mother material I am a woman born with the ability to give birth. Unfortunatelly birth in the last twenty years has become over medicalised; Alice mentions operations to cut out cancers and to heal other ailments; being pregnant and giving birth is not an illness. The risks following c section are numerous for mother and baby admitedly natrual birth is not without risk but Alice should examine the research surrounding both. I think she may find home birth is the least riskiest option both short and long term.

Alison Dobson, Bromsgrove,

I agree with the last post. Journalists can write about anything, yet they are not experts, especially medical! it would do for all readers to remember this. Get your information about important issues from a reliable source!

Elisabeth, Reading, Berks

When did childbirth become a disease to be treated by surgical intervention?

Do you control all your bodily functions with your diary ???

Mark, Manchester,

I always get a laugh out of the term "natural childbirth". Would someone please explain to me what "unnatural childbirth" is?

Kim Righetti, Upland, Calif.USA

my better half is expecting our third in couple of weeks, the last two she had by normal birth, with only gas and air for pain control - mainly because the babies were coming, ready or not!

So this time round my wife asked the midwife what the options were for pain control. The reply

"Why not go without it?"

Yeah, thanks alot - did I just ask you that?

Gavin, Sussex, UK

It's great that Monica can give us all the 'facts' about Caesarean surgery but I think she's missing the point. Whichever way you give birth there can be complications so surely it should be up to the woman to wiegh up these risks and make an informed decision. I don't think anyone should be dictated to and especially not about something as traumatic and painful as giving birth. Women need information not bias and they should never, never loose their right to 'choose' what happens to their bodies. It's all well and good for others to preach but they aren't the ones who are actually going to have to give birth. We should be advising and supporting women in whatever decision they make, not demonising them.

Suzanne, London, UK

There is sooo much more than "just getting the baby out!" how you are born can affect both the mother and baby emotionally as well as physically, these medications are there to help us through labour and not gloss over birth! Sections are rescue ops and should not be used for conivenence! I am not saying suffer cos thats the way it should be, but rather try so much else (as there is so much else) Thank goodness we have the choice for our babies to be born safely at all!

Ema, London, UK

Bless you! About time someone spoke up loud and clear. Feminism is about CHOICE for women. It is insidious this so-called "natural" movement for childbirth. A girlfriend of mine who is far from natural in the rest of her life (smoking, botox the lot) was horrified when in response to queries about my birthplan and I said "Oh, one word, epidural". I have no regrets and consider that I had a very successful and good experience. I am happy for those who have some kind of epiphany and bonding glory during the pain ... collect your medal on the way out. Each to their own and let's stop judging.

Heloise, Paris,

Fortunately for the sanity and sanctity of the species many can't afford a hospital birth. If you look for a moment at the science and empirical evidence, even superficially, you will see that the chances of death, maiming, suffering, infection, iatrogenesis, obfuscation of bonding and attachment, ability to breast feed, health both short and long term and recovery are hugely hampered by anything less than natural birth, away from fear inspiring environs. Pain killers are very rarely required for a home birth. Pain is directly related to fear. The merchants of fear have most western women scared to death of having a baby and yes THEY DO FEEL PAIN. Alice if we birthed naturally the pain would be real and diminished not exacerbated by the fears of a hospital. Most Importantly many of societies woes in the west, psychologically, physiologically and fiscally would be eliminated. I implore you to check out the science not the press releases; and write again so sanity can prevail. Thank you.

Colin K N A U F, Pickering, Ontario, Canada

As someone who has had a home birth (but is definetly not what you would call an 'Earth Mother') I would say that these are, in my experience, far more enjoyable experiences. I did my ironing until an hour before my baby was born and had the individual attention that Patricia Hewitt is advocating (lets face it where are the midwives going to go). I was lucky my birth was relatively quick and in less than an hour I was curled up on my own sofa, drinking a cup of tea, eating my tea and cuddling my baby - perfect.

I've also experience a hospital birth (child number 1) which was awful - I had 4 different midwives through my 6 hour labour! with no one-on-one time until they decided I needed an assisted birth.

I agree that everybodies expectations and wishes for their labour are different and drugs should be available where wished. However, I must argue strongly against elective C-sections for non-medical reasons. This is major abdominal surgery - madness!

vikki, Huntingdon, Cambs

Firstly may I please say how refreshing it is to see any article calling into question the cult of the homebirth Groupie (Alice miles April 4th 2007)
However I feel strongly that There is an area outside the general comfort of the expectant mother that needs adressing. Namely that of complications.

What can a midwife do - except call a doctor in amedical emergency? Call a doctor? This is of no reliefto the expectant mother who has a child who can not breath. They have been encouraged to birth at home so by the time a doctor arrives on the scene you have a tradgedy I am unaware of Foetuses that can hold their breath for the 15 - 20 mintes it takes for the Doctor to arrive. What about a severe unexpected bleed? Again you call adoctor as the midwife can not cope. Again you have tragedy on your hands this time to mother and bayby.

Even if a doctor arivves in time they will not have access to the Anestheic and Intensive care doctors Drugs and equipment needed to save the Life

Richard Fish, truro, Cornwall

caesarians cost a fortune and put unnessecary burdens on busy staff. many women opt for caesarians because they are too vain about their bodies. they believe natural childbirth will make their vaginas stretch. for goodness sake. have some common sense. a few drugs to ease the pain is acceptable, but every woman to have a caesarean is a disgrace. we shouldn't have to pay for women who are too posh to push!

jamei, london,

I was lucky enough to give birth in a private hospital in South Africa, and to deal with the same caring, highly qualified professionals throughout my pregnancy. I had major complications, and ended up having an emergency caesarean at 30 weeks. Had I been in a situation where less competent people were taking caring of me, it is likely that both my son and I would have died. I just thank goodness that I was not in the situation where a midwife, with a natural agenda, had been the one making the decisions! Instead, we have a wonderful 2 year old...

Anne, Joburg,

Thank you so much for this article. It really does strike a chord. The "holier-than-thou" judgements on mothers aren't limited to childbirth - it starts from conception and goes on all the way through child-rearing. Luckily ignoring prolonged whining and irrational tantrums are among the core competencies of mothering.

Stephanie Lawrence, London, UK

Naturally, modern liberated women should have a choice! Humans, unfortunately, have babies whose heads are almost too large for a natural birth. No other animal seem to have that problem. I don't have any children, but the mere thought of 28 hours of labour scares me. Why does it have to be like that if we can help it? The mother is expected to be ready to care for the newborn around the clock right after the birth (after a few days in hospital). Why not try to make the birth as pain free as possible so that the mother will have the energy to care for the child? Why not use our large heads to think of ways to make childbirth easier? I can't help thinking that if men could give birth, they'd never put up with the pain that women are expected to endure. Surgery is not a walk in the park, I know, but I would prefer a planned caesarien any day. And of course I would like to keep myself perfect 'down there' - for my sake! A man would.

Kirsten, Copenhagen, Denmark

I had an epidural for the birth of twins. This meant I had some control over what was happening to me and I was fortunate in that I had sensation and no pain. It also meant I was prepared for any emergencies that can occur in multiple births. I am no wimp and have all dental treatment including root canal work without any anaesthetic.
The day of the birth the newspaper headlines were about a woman who became paralysed from epidural and the lady in the next bed ,for whom english was not her first language, refused the epidural and lost one of the twins as they could not get him out quickly enough.
The power of the press was brought home to me that day it definitely killed a child. Wield your pen with caution and perhaps make it clear you are not medically trained. I hope no one is influenced by your article as you do have the power to kill.

Elizabeth, Oxford, England

Alice
If it is not too much of a fuss, there is another paper that says “Should woman go to war". This ails me hopelessly confused. I think Br. Brown, Mr Blair and Rice in Palestine have lots of explanation to do. Else of women, I have very little knowledge as I am not a woman and I have nothing against what they do. It is democracy that Bush wants. So why worry. Do me a favour. Give Patricia Hewitt, the book “The Rise and Fall of the Third Reich – William L. Shirer.”
I thank you. It saves me postage stamp sending this to her in NHS.

Firozali A.Mulla MBA PhD, Dar-Es-Salaam, Tanzania

The push for natural birth is not a consipracy against women, it is aimed to give mothers and babies the best possible start to life. Caesarean surgery is not risk free, recent research has shown that there are many increased risks associated with c-section for mother and baby, including thrombosis, sepsis, major infection, haemmorrage resulting in hysterectomy and death. For babies, there is twice the chance of needing care in Neonatal intensive care, usually due to respriratory problems as well as having a mother drugged up to the eyeballs and unable to establish breastfeeding properly. I wonder how many women would 'choose' c-section if they were told of these facts?
Intervention-free, normal birth attended by a midwife has been shown time and time again to be the safest way to bring a baby into the world. Countries where most women birth with a midwife or at home, have the best maternal and foetal outcomes.
I

Monica, Melbourne, Australia

The post natal ward experience – at Chelsea and Westminster Hospital - was absolutely appalling - the ward was filthy with dressings left on the floors, staff eating on duty, and a very unhelpful and unprofessional approach towards the mothers on the ward. This created a great sense of vulnerability to me and other mothers. With many of those who had had caesareans (both planned and emergency) discharging themselves within 24 hours of giving birth because they found the conditions on the PNW so unbearable.
It is only because of the state of the PNW that I can possibly understand anyone wishing to have a home birth – in order to avoid the hospital post natal experience – and I think that this is extremely concerning.

nicola kurtz, london, uk

I think that for all concerned a list of the midwife’s modus operandi should be given out to each expectant mother so that they know the angle that they are coming from with their advice. I found that the pro-natural, anti-intervention evangelical approach extremely intimidating – as you say, where else would the possible side effects pain relief for something be given such disproportionate emphasis. Also the utter condemnation towards bottle-feeding unjustified and very unhelpful –leading to many mums feeling an unbelievable sense of failure towards the care of their babies by bottle-feeding them – the fact at least the baby is well nourished and happy as a result seems to be completely overlooked by the midwives.

nicola kurtz, london, uk

Couldn't agree more! I had elective c-section for my 1st baby on advice from my doctors & midwives. It was a thoroughly positive experience, the doctors & midwives were wonderfully supportive throughout, and the recovery was truly no big deal. We had attended NCT classes, where c-section had been trashed as major, traumatic surgery, to be avoided at all costs, and I had also attended active-birth yoga. What really struck me was the fact that so many of my peers in the NCT & yoga classes, in attempting "natural" birth, had a traumatic birth and felt guilty and disappointed at the required intervention and their "failure" to stick to their birth plans. NCT was great in many respects but really needs to lighten up on c-sections. Now pregnant again & living in Australia, I will resist the pressure from the "VBAC gangsters" who villify caesareans & push for "normal" birth despite the alarming risks. I will be having another elective c-section - with the full support of my GP.

N Brandi, Townsville, Australia

Caesarians are pain-free? If only! I had an elective c-section (42 weeks and no sign of the baby) and suffered a haemorrhage as a result. The pain afterwards was awful, I gave up breast-feeding within 2 weeks because I couldn't cope and it took a blood transfusion and 3 months before I felt vaguely normal again. Caesarians are a major operation and presenting it as anything else is irresponsible and misleading. Of course women should be able to choose pain-relief if they want, but jumping straight for the most invasive and dangerous option straight away just seems mad.

Kate Clarke, London,

I thoroughly agree with Alice Miles column, and being pregnant with my first child found the nhs care appalling. I wanted a home birth purely because i don't like hospitals and would feel safer in my own environment. After receiving no care from the nhs after 16 weeks of pregnancy i opted, and am lucky enough to be able to utilise the services of an independent midwife. I have reeceived first-class treatment from her and built up a one-to-one relationship, and am able to give birth at home, with hospital being available should i require medical intervention.
UNFORTUNATELY despite what the NHS says, they and the Royal College of Midwives are doing their utmost to remove this choice of care from women by refusing to allow independent midwives access to professional insurance, thus removing over 200 highly experienced professionals from the under-resourced maternity services and the people who need them most - pregnant women.
SO MUCH FOR CHOICE!

c millins, st albans, uk

Well, for once it is not doctors being blamed for the failings in all aspects of healthcare! I cannot see why people (including SOME midwives, not all) get so upset about other people's choices regarding mode of delivery. Elective caesarian is right for some and is a safe procedure, but others should be allowed to choose whether or not they have pain relief during labour, bearing in mind that the plan might have to change according to the progress of labour. It is important to understand that people react to labour differently - it might be tolerable for some but others suffer enormously, and this cannot be predicted beforehand. Even though I am a GP and did obstetrics training I was not prepared for the awful labour and puerperium I had with my 1st child. What I do know is that when things go wrong in labour it happens really quickly and with devastating consequences so I was certain I did not want a home birth. I suspect Hewitt has a hidden agenda: destroying the nhs/saving money

sarah. utting, york, uk

For heaven's sake! The point of modern medicine is to reduce infant/maternal morbidity and mortality! Why do think so many women and children used to die in childbirth? II do think midwives are really going off the deep end and meddling where they have no business. That said, I was lucky to have good midwives myself that were very supportive of either option.
I had a c-section, planned - but necessary - as my baby was in a horizontal position. Before I knew this was necessary I had still planned on an epidural. Birth is a very brief experience in the scheme of things,and a healthy child and mother is the goal. Ask any OB and they'll tell you how even births going wonderfully well can take a turn for the worse. If one wants to have a "natural" birth - ok - but you better ask why and face the consequences if something goes wrong and immediate medical intervention wasn't possible.

Anna, Vienna, Austria

Ha! Great article! What's so wrong with making the most of modern medicine anyway? Herceptin = good, caesarian = evil. Why?

Lucy, London,

Couldn't ageee with you more, Alice. You might have strengthened your argument by quoting the research into attitudes among female obstetricians, a large majority of whom (as I recall from a survey about five years ago) said they would opt for elective caesareans. The registrar who performed my life-saving emergency caesarean echoed that view.
As for missing the experience of birth, all I can say is that, having been lucky enough to have an epidural before the caesarean, those first moments when I held my son were possibly the best moments of my life. The bonding was instant, absolute and forever.
i find it terrifying, given the poor quality and unsympathetic, slovenly attitudes of the midwives I encountered at a major London teaching hospital, that they should have any input whatsoever into medical decisions.

kate, oxford,

Childbirth can be dangerous. Mother & baby are vulnerable. No one way will suit every woman, so choice must be informed. Mumsnet website recently had a thread from an expecting mother asking how many women who had had an epidural had gone on to have an unassisted delivery (i.e. no ventouse, forceps, episiotomy). It would seem from the very informal responses that there were a high number of interventions post epidural. I've experienced both types of birth, highly assisted with my first with every drug going & no assistance with my second. The unassisted birth was considerably happier & I firmly believe my first could have been too, had I had proper care at the time. So I would advocate improved care, more midwives, more consistency & not the over-stretched system we have at the moment. Its not more choice we need but better care!

Bugsy, London, UK

British detainees in Iran, 4 april 2007.

If Iran wanted British hostages, all it had to do is go to Iraq and take the whole of the British army hostage.
That would be more my kind of fanatisism.

Taytelbaum, M.C., Rotterdam, Holland

Alice, you can rant all you like, but New Labour (driven by the Treasury and our happy-feely PM-in-waiting) have decided to reduce cost wherever possible. Learn to live with it, or use your position as a journalist to fight it.

clive, surrey,

I live in the Netherlands and most of the pregnant foreign women I know flee back to their own countries to give birth because of the insane Calvininst Dutch ethic of "pain is good!' I have frequently heard the most ridiculous and alarming belief expressed here that the more pain the mother suffers the better she will bond with her baby! I thought it was the other way round.
And on the rare occasions when a pregnant woman does qualify for some pain relief, better make sure you can get it before 5.p.m because that's when the anaesthetist goes home, folks!

Marianne, The Hague, Netherlands

Hewitt discovered that the NHS could not give women the hospital help they wanted. Hmm. What to do? She called her team and asked what to do. Some bright spark said 'lets call natural birth a 'right' and tell everyone that it is good, and everyone can have it.'. Hey presto! A shortage of help becomes a surplus in naturalness that the wonders of NULabour in it's munificence has granted the women of Britain.

R Mason, London, UK

from Abbott Labs epidural pack:
Local anesthetics rapidly cross the placenta, & when used for epidural, caudal or pudendal anesthesia, can cause varying degrees of maternal, fetal & neonatal toxicity...Adverse reactions in the parturient, fetus & neonate involve alternations of the central nervous system, peripheral vascular tone & cardiac function...
Neurologic effects following epidural or caudal anesthesia may include spinal block of varying magnitude (including high or total spinal block); hypotension secondary to spinal block; urinary retention; fecal & urinary incontinence; loss of perineal sensation & sexual function; persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities & loss of sphincter control all of which may have slow, incomplete or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; increased incidence of forceps delivery; cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid...
Nice!

Jane, London,

I think this new initiative may be nothing more than a cynical attempt to create more jobs in the health service and career progression for the (vociferous) nursing profession. The safety of the baby and mother should be paramount and both should be attended to in a quality environment (how many homes in the UK offer that?). This seems like another bonkers idea from a government that is bereft of any good sense whatsoever.

Charles, London, England

Sloppy, one sided journalism, anecdotal 'evidence' , oh dear, i would have expected better from he Times, really.
Why, oh why,do you think midwives, generally support normal chilbirth? Because we are 'pious' sadists who want to tell women to go bite on a stick in the outback? For God's sake. We support, and do our damned best to facilitate normal birth WHERE APPROPRIATE, because in in the majority of cases, it is far and away the optimum outcome for mothers and babies.
As for analgesia options, you simply cannot compare birth to going to the dentist, or undergoing other medical procedures. There ae too many physiological factors to take into account. No midwife would deny a distressed woman having a prolonged labour an epidural, but it is HER JOB to ensure she is making an informed decision. Yes, epidurals can be a godsend, but they come at a price, eg, further prolonging labour, increasing instrumental delivery rates, etc. You need to understand these implications.

Sharon Liming, Basingstoke,

I elected for a caesarean 12 years ago on medical advice and while I don’t regret it because the end result was a contented healthy child as an operation it was no picnic.
2 years later I needed a mastectomy for breast cancer – I was told “if you have had a caesarean then physically you will find this operation much less painful.” Emotionally and during subsequent chemo it was another matter but that’s not for this comment.
After the caesarean I had to do everything for my child myself, while barracked by midwives (and some evil auxillaries who took their cue from the madwives) for not doing it properly.
2 years later, on the ward upstairs, toughened by my experience on maternity I decided to wash my hair and didn’t expect help. The old time sister was very concerned, her auxillaries were there to do just that – help.
It is not greater access to caesareans that we need, unless they are necessary, but a change in the attitude of midwives, or madwives as proper nurses call them.

CAM, Essex,

A message to all those contemplating a home birth: The birth of my first child involved the surgeons and midwifes running down to the operating theatre with my wife on a trolly, yet there was no indication beforehand that the birth would be anything else but normal. After sewing my wife back up, I heard the surgeon mutter "to think people want home births".

Matthew, Ringwood, UK

I find this "maternity matters" issue curious, as a man and ex obstetrician. Surely the primary concern is for a safe delivery of mother and baby. This cannot be predicted in advance,as obstetrics is dynamic , so to prospectively book the type of delivery setting( and hence the availability of a backup plan) seems inappropriate. Obstetric practice has improved as a result of audit of perinatal and maternal mortalities. Improved safe practice is based upon this, and not the prospective decisions of the mother's delivery preferences. yes discuss the outcome afterwards when we all have the benefit of that most marvellous of scientific instuments, the "retrospectoscope"

phil, birmingham, uk

No doubt many commentators will claim that I, being a mere man, have no right to comment on a topic unique to women but, being a man, I'll stick my oar in anyway. It's quite right that the benefits of modern medicine should be available to those that choose them but, make no mistake, ALL drugs are potentially harmful and that risk must be weighed against the benefits. The chemicals ('drugs') produced naturally by the body in response to external stimuli are likely to be less harmful than synthetics, simply because they have evolved such that, were their outcome damaging, natural selection would work to eliminate them. It is unwise for people whose occupation gives them the ability to influence far outside their own circle, to advocate a personal belief as universally applicable. I will never know the pain of chidbirth (although my wife mangled my hand, holding it at such a time!) but, as with most other 'pains', It is not inherently 'bad', just temporarily unpleasant.

Bob Finbow, Haverhill, England

Poor Alice Miles. She obviously had a terrible experience during her pregnancy(ies). Her rants in this paper are testament to that. I am a man so cannot comment on the personal physical experience, however, my wife has been a midwife for some time, and I have been invoved in various midwifery studies, so I do have an opinion on the policy.

I tend to agree that perhaps there should be fewer PIOUS midwives, but the overwhelming requirement is for more midwives.

Alice is probably not aware of how many hospital midwifery units are at the point of being closed down on a daily basis because of the lack of staff - so where would the drugs she craves then be administered, or caesarians carried out. A personal consultant isn't available on the NHS, so one assumes that it is paid for, ergo not available to the average woman. The sad fact is that regardless, the child is born in a NHS facility with NHS midwives and supporting staff - more midwives is the only way.

Jimd, Norwich, UK

Perhaps Alice's view point on this whole debate is a bit myopic . I don't fully endorse or advocate her approach for scrapping of wid-wifery and recommending for optional caesarean child birth. Biologically speaking, with loads of medical evidences,when a woman runs through a Caesarean operation, unless it is warranted or needed to terminate or abort any complications during delivery, may lead to long term effects on her health . At times it halts or abondons the chances of future conception. As a point in case, in the rural and agrarian set up in Indian sub continent, the trend of natural child birth is in vogue. The role of mid-wife to assist the nature' s own process of delivery is preferred and prevalent too.One of the major reasons for painless child birth is women leads a rather pro-active life, doing daily chores of labour oriented works, like farming, cultivation cooking, washing etc.Life in cities and metros,being sedantary and luxury bound,can create delivery complications

Sandy, New Delhi, India

Alice, you will get some irate responses but i agree utterly with you. Also, in terms of research that is cited, does that include the 10% morbidity and 2% fatality figures from the WHO from births in cultures wirth no medical intervention. Also, is that slow recovery with people who, not fully supported, feel that they have failed?
There are arguments from both sides and, no doubt, you'll be mailed them but i don't understand why everyone thinks their way is the only way. Surely, those of us who have had a child (emergency caesar, which was absolutely fine) know how difficult parenting is and should just support whatever each individual mother's birthing choice is, whatever the way, without campaigning for our own.

Elizabeth Pearson, Sydney, Australia

As a midwife, with no children by the way, I am deeply concerned about Ms. Miles editorial. A woman with so much persuasion at her fingertips should think carefully about what she writes. To have her view taken on more seriously, remarks and name calling might be left out. Truly, all decisions in regards to her pregnancy and birth ultimately should be made by the mother in my opinion. That being said, consider what informed choice really is. It is not "if you have pain relief you are going to kill your baby...you still want some?" Or, "Cesarean section is a pain free childbirth." These are both completely false and alarmist statements. The reason midwives are primarily purveyors of natural birth is that unmedicated births, through troves of evidence based research, are found to be safer for mother and baby in all aspects of care: physically and psychologically. Should those who attend birthing mothers not have their patients health and well being at the center of their care?

Darjee Sahala RM LM CPM, Wellington, New Zealand

Why must you portray women who choose natural a "Earth Mothers" or people possibly too religious to accept the pain free methods? Did it ever occur to you that some women may prefer natural childbirth for other reasons? I have 4 children and went with the drugs with the 1st and 3rd and natural with the 2nd and 4th. If I were planning on any more I would definitely choose natural. Although the birth itself is more painful (but not as much people like to dramatize it) I recovered much faster from my natural births.

Valerie, Bath,

Perhaps Ms Miles should consult evidenced based research about the risks of an elective caesarean to mother and baby, before recommending it as the 21st century way to give birth. Ms Miles sweeping assumptions and value judgements about "Midwives” (pious, broad hipped and having "about” 8 children) are so superior and ignorant they speak volumes about the author, rather than her subject. Like any other profession, midwives are individuals with different beliefs, personalities and expertise. The midwives I have worked with in both the UK and Australia, are committed to working with the women in their care to meet their needs and choices, most especially with regards to analgesia. I’m not surprised that Ms Miles did not form positive relationships with the midwives she encountered, when she clearly considers the entire profession beneath her.

Cate Grindlay, Melbourne, Australia

Absolutely right in every particular except one: why shouldn't James Naughtie use the word "confinement"? It's very feminine and rather nice, redolent of times gone by when women didn't get turned out of hospital 4 hours after giving birth but actually did spend a bit of time cut off from society, "confined" in the strict sense of the word. Was that such a bad thing?

Helene, Strasbourg, France

April why would any mother make the conscious decision to thrust narcotics into the system of their unborn child? If a 16 year old comes home high on drugs most parents would be distraught, but yet women are more than happy to opt for this during birth without thinking of the consequences. I don’t disagree that pain comes with birth (yes I have given birth), but in most cases it is a manageable pain that can be effectively managed using other less toxic aids.
Narcotics such as pethidine used during childbirth are the main reason many babies find it difficult to breastfeed & the drug withdrawal is often why the sleepy baby becomes the nightmare baby. I too find it hard to function with a hangover so why should a baby be any different?
I don’t think midwives are playing the role of torturer by advising women to ideally opt for a natural birth; rather they have the health of the unborn child as a priority… which is no doubt how you would hope they are focused.

Melanie Walter, Leamington Spa,

Alice, shout your message from the rooftops. I had one awful experience and one excellent one, the former caused problems for years "down there" terrible pain and a small and hopefully not long-term problematic stroke for our daughter. Why does child birth have to be natural, but death and dentistry can now be achieved asleep with no guilt? I recommend the latter and strive for the former.

Sarah Barham, Toronto, Canada

I couldn't agree more! I had an epidural and it was the best thing I ever did - I had it after several agonising hours of non-progressing labour. Why anyone would choose to continue to suffer that amount of pain for hours and hours more is beyond me. The result is the same - the birth of a baby. But the difference is being able to look back on the experience as fairly enjoyable rather than (like my mother who gave birth at home) as deeply traumatising.
Moreover, I couldn't envisage another pregnancy unless I knew I could have another epidural.

Marie-Claire, London, UK