This is not to question the good intentions of many caregivers nor to suggest a disregard for medical expertise and technology. It is, rather, a call to support women in trusting their abilities to make informed decisions, and their body�s ability to give birth-naturally. It advocates medical technology being reserved for cases in which it is required (high risk pregnancies that can be detected through prenatal care), and unforeseen complications (the latter occur in 5-10 percent of prepared homebirths.) It requires skilled birth attendants who regard birth as a normal physiological process and encourage couples to share in decision-making rather than being patients.

Most physicians remain resistant to alternative birthing practices. They still don�t know how to prevent a woman from tearing or needing an episiotomy. Few learn how to give a gentle perineal massage, or how squatting can prevent tears. Since so few doctors are trained in normal birth, or willing to enter into this new relationship with women, many couples are turning to midwives and asking doctors to fulfill their role only in the small percentage of births requiring medical intervention.

Despite the proven long-term benefits of midwives and more recently of doulas, the US continues to train more specialist physicians, build larger hospital and intensive care nurseries, and buy more equipment: from expensive electronic monitoring equipment to expensive "birthing beds" - beds that can be moved into various positions and permit the birthing woman to sit or half-squat for delivery.

A low padded platform big enough for the woman and her partner, an inexpensive U-shaped birthing stool, and a dimmer to darken the room are all that are needed. A shower or tub that can be filled with warm water is a wonderful addition. Environments that are conducive to privacy, informality, making noise, and freedom of movement result in more normal births.

While most hospitals today are making more inviting cosmetic changes to the physical environment of maternity wards, substantial changes, such as assigning one nurse or midwife for each laboring woman rather than subjecting her to changing shifts of staff and using high-tech equipment only when necessary, is not a priority. The big dollars still go to high tech rather than high touch scenarios.

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