Letter: Childbirth: heaven at home and hell at the hospital, or vice versa?

Sir: There is nobody so convinced as someone with views about childbirth, and consequently the responses to the report Changing Childbirth have been predictable ('Women to be given control over childbirth' and 'Home truths from hospital', 6 August). Despite good evidence to the contrary, doctors - with a few notable exceptions - have successfully convinced each other, and two generations of women, that birth can only be considered normal in retrospect, that hospital is safer, that electronic foetal monitoring will ensure their baby's safety and that anyone wanting a home birth is foolhardy and selfish.

The so-called childbirth lobby, on the other hand, can sometimes appear to be insisting that everyone should have a home birth and that childbirth is always a wonderful experience. This view invariably provokes a spate of publicity about women (often journalists) who have had difficult births and who have reasons to be grateful to the medical profession and technology. Such articles are often followed by stories of women who had wonderful home births for their second babies, having had horrifying and humiliating experiences in hospital with their first babies. And so the argument continues.

For most women, reality lies between these extremes, but how are they to judge what is right for them rather than what they can expect from the existing system? It is not a simple issue of hospital versus home, and women need detailed, balanced information about all their options.

Enabling women to make informed choices is a complex business. Most doctors will need to re-examine their beliefs and their motivations and assess these against hard evidence. Many midwives will have to reclaim their status as experts in normal childbirth and practitioners in their own right. Health service managers will have to offer an organisational framework in which midwives can respond flexibly to each woman's needs.

Yours faithfully,

JUDITH SCHOTT

London, NW11

7 August