By Caroline Flint midwifery sister, St George's Hospital, Tooting

The houseman looked down the list on the case notes: no artificial rupturing of the membranes; no epidural; no episiotomy; no routine fetal monitoring.

`If this woman wants natural childbirth she shouldn't have come here' he said scathingly, ` she should go and have her baby behind a bush on Hampstead Heath. Doesn't she realize that in this unit we have a technological approach because of all the high risk women we have here, we can't cater for the nut and sandal brigade as well'.

Something inside my head burst (a blood vessel perhaps?). `Here is the only hospital which is available to her.This is the district general hospital, there is nowhere else for any woman in this area to go - we have closed all the small intimate units in the area. We have told her repeatedly, and with no basis in fact for the last 16 years, that it is unsafe for her to have her baby at home. We give her no alternative, and when she comes in with a perfectly reasonable set of requests we think she is being deviant-she is in a no win situation and the situation we have put her in is extremely cruel'.

The houseman was surprised at my vehemence. `But', he countered,` we are doing it for the safety of the babies, we don't want to take any risks, we only want to monitor her to make sure that there is no fetal distress'.

`I wonder if we really are doing it for that reason' l said.`The Dublin Trial showed that for women labouring for a reasonable length

`Rupturing membranes too, why should she have her membranes ruptured if she doesn't want them ruptured?'

'Well,' said the houseman, `it's our policy to rupture them at four centimeters, so that we can see the colour of the liquor, so that we can fit a scalp electrode and so that we can make sure that she progresses well in labour and keeps to the Friedman's curve'.

I went to quote to the houseman Dunn's list of hazards and disadvantages of rupture of membranes, and Kay Mordecai Robson who found that women had a 74 per cent chance of experiencing indifference towards their baby if her membranes had been artificially ruptured. And as for the Friedman curve - did anyone ever expect any other human being activities to conform to a time limit?'

I asked him if anyone ever grabbed his fork and began force feeding him because he had taken too long with his lunch; or if anyone banged on his door when he was on the lavatory and insisted that he be `helped' because he had taken too long; or if ever when he was making love, someone had taken over because he was being too long. We argued together in the small hours, amicably because

we are fond of each other. But never really did we find a common ground because where each of us stands is light years apart.

The woman got what she wanted and her labour and delivery went well and happily, but that conversation got me thinking really hard.

What has happened to our maternity services? We try and humanize them but when a woman asks to be treated as the normal healthy woman she is `different', even `irresponsible'. Every hospital I ever visit tells me its clients are `high risk'. What happened to the normal women who, until about 20 years ago, had their babies at home? What about the normal women who until last year went to the little units which have been closed down so rapidly during the recent past?

Have all the normal women stopped having babies? Professor MacVicar in 1981 said that women who were having babies were less at risk than in the past because of less very elderly mothers, smaller families, therefore less grand multiparae, and less unwanted babies because of better contraception and more use of abortion. The type of women who are using the maternity services now means that we should have more 'normal' women. They should be given more choice and less intervention.

When people tried to put fluoride in the drinking water there was an uproar- not because it wasn't acknowledged that it might be good for many people to ingest fluoride but because the choice was being taken away. Imagine someone handing out lollies to every passer-by. You might like lollies and take one eagerly, I might like lollies and take one but, as sure as humans are humans , there will be some people who don't like lollies and who won't take one. Thank goodness we have the choice.

Isn't it time we stopped trying to foist all our follies on all women and gave them a choice? And isn't it time we looked at where all the `normal' women have gone. Maybe they are the women we have sitting in the hospitals, renamed high risk because we want to use all our gadgets? Or am I just an old cynic?