Professor James Dornan is incorrect when he claims that the "natural" maternal mortality rate is equivalent to the African rate. The World Heath Organisation notes that because of the prevalence of female genital mutilation in Africa many women are unable to birth without assistance, and will die without medical care - which they often don't have. Add malnutricion to this, and you have a picture of an extremely different population of women to British women. To compare them is nonsensical in the extreme. A doctor should know better.

Rebekka, Melbourne, Australia

Women don't necessarily need doctors - they need midwives though. To say the UK doesn't have enough doctors working in maternity services is irrelelevant, that's not the issue. All pregnant women should have a choice where and with whom they give birth. It's time to stop assuming that healthcare professionals 'know best', because they don't. They may know more, but not necessarily best. All too often their experience of the pathological affect their view of what is a predominantly normal life event.
Countries like Holland and New Zealand, which have a midwife-based system of care have lower perinatal and mortality rates than the UK. It' is also worth noting that these countries have a far lower teenage pregnancy rate, due to the enlightened attitudes towards sex education than in the UK.
This is not a governmental problem, as such, it's an issue which is societal.

Lesley, Paphos,

Two points
1. Before you can begin to make a claim that natural childbirth increases risk you should at least publish comparisons with a country similar to ours. You publish the death rates for Sweden and Germany. What proportion of births occur outside obstetric units in Sweden and Germany?

2. The UK does not have enough doctors working in maternity services to provide care for every woman in labour. The reasons are complicated. I can elaborate as much as you like but the fact remains that our UK obstetric units could not at present cope with all UK births.

This article does not present a balanced, evidence based view and will unnecessarily cause anxiety for those women who have chosen to have their babies outside of obstetric units.

Dr Morag Martindale
Blairgowrie

Morag Martindale, Blairgowrie, Perthshire

What study demonstrates what these fear-mongerers are saying?
Where did Prof. James Dornan get his "facts" that the natural mortality rate is 1%, and it is only obstetrics that "saves" women from death? The African mortality rate is in large part due to poor nutrition and unclean living conditions which lead to all sorts of health problems--pregnant or not.
What *facts* underlie the *fear* of some medical staff that natural birth increase maternal mortality rates? The fact is, that every large well-designed study demonstrates that home-birth with a midwife is as safe as or safer than hospital birth, for both mother and child. Not only are the statistics similar (or better for home-birth), but the use of medications and procedures (which can all have unintended effects--some deadly) is much lower in planned home-births.

Kathy, Ripley, MS, USA

With the reconfiguration of maternity services and closure of consultant led units in many district general hospitals, this will get worse. It is only a matter of time before there is either a perinatal or maternal death in an ambulance during transfer from a midwife only unit to a consultant unit in another hospital. When this happens I would expect those politicians and hospital chief executives who orchestrated this to take the blame and not try to point the finger at the poor midwife in the maternity unit or ambulance.

John Priestman, Huddersfield, England

Oh well the Government has given the impression that it doesn't matter how old or fat or 'green' you are, you MUST have children. This is what you get when you believe Labour.

Judy , Liverpool, england