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Yvonne Roberts warns that the risks associated with intervention make natural childbirth worth a second look.

Natural birth is often portrayed as a middle-class fad associated with earth mothers, incense and the indigestible contents of health food shops. "Modern" women opt for Caesareans and medical intervention - not necessarily because they must, but to avoid the pain of labour and maintain control of their schedule. Meanwhile, for consultants, natural birth means uncivilised hours.

But unnatural births carry a penalty. A recent study showed that a high proportion of women who had elected, or had been required, to have a Caesarean were so traumatised they had no further children.

Nevertheless, figures released last week by the Department of Health revealed that most mothers undergo intervention - a Caesarean (one in five births), induced labour or delivery by instruments. All of these methods carry considerable risks. Also, only a third of mothers receive one-to-one attention from a midwife during labour.

Against this backdrop, the achievement of the Albany midwifery practice is all the more impressive. Based in a deprived area of south east London, it employs the equivalent of six full-time midwives. In 1999, a two-year evaluation of the practice was begun in which women were referred by local GPs. It emerged that a high proportion of women using the practice - 45% - were from African, Asian and other ethnic minority groups, and many of these were asylum seekers.

The practice's philosophy is that the mother-to-be should exercise informed choice over where and how she has her child - at home or in hospital. She receives continuous care from the same midwives who address anxieties and monitor mother and child.

The difference in outcome is staggering. Only 18% of the women had Caesareans compared with 25% of those using King's College London; 93% breastfed from birth (75% in other practices); 43% opted for home births (11% in other practices); and 69% wanted no pain relief compared with 18% in other practices. Women in the Albany practice had far fewer episiotomies and instances of depression.

Becky Reed, one of the midwives there, says that many of the Albany mothers, in spite of acute poverty, recovered well physically and mentally, making far fewer demands on health and social services' resources. And they were happy with the choices they had made.

The key to Albany's success isn't difficult to detect and emulate: power lies with the mother and the midwife - and doctors do less.

Evaluation of the Albany Midwifery Practise Final Report March 2001, contact 020 7848 3605.