Among a “lethal mix” of failings, the key finding of the investigation into baby deaths at Furness general hospital was a group of “over-zealous” midwives known as “the musketeers” who imposed the natural childbirth approach “at any cost”; refused to call doctors when needed; and colluded to conceal their negligence.

This finding runs counter to an orthodoxy that has governed childbirth for the past half-century. To learn that the rationale behind midwife-led units will now be scrutinised in a review of NHS England’s maternity services is to hear the screeching of brakes on the juggernaut that is childbirth ideology.

Morecambe Bay report exposes 'lethal mix' of failures that led to baby deaths Read more

To put it this way may seem surprising. It is doctors, we are so often told, that dominate the business of giving birth. Pregnant women are warned – by the National Childbirth Trust (NCT) and the media – that childbirth is highly medicalised in the UK; that epidurals will be foisted upon them; and that they may well be coerced into having unnecessary interventions.

The reality is the exact opposite. The Morecambe Bay trust investigation, which looked into the Furness deaths, rang many bells for me, and I gave birth in one of the best hospitals in the country. When I pitched up late on a Sunday night, panicking with contractions that already felt too much for me to handle, the duty midwife told me to go home and only come back when labour was properly established.

I showed her I was bleeding but she was dismissive, implying that there was nothing for me to complain about. When I returned two hours later, I was rushed into theatre and had an emergency caesarean under general anaesthetic. The placenta had become detached from my womb lining – one of the most common causes of maternal and infant mortality.

Time and again I have heard from women who felt their concerns were dismissed or downplayed by midwives, had to lobby ridiculously hard to be “allowed” an epidural, and were fobbed off with a gentle “see how you get along”. Countless friends have told me that they felt guilty, selfish or a failure if they asked for an epidural or ended up having a caesarean.

Of course every birth is different, and women hold passionately to their positions on what is right for them. I have encountered midwives who are compassionate, inspiring and sensible. But women refrain from making complaints in public for fear of disrespecting other women’s decisions and midwives’ professionalism.

Facebook Twitter Pinterest Families at the Morecambe Bay inquiry into baby deaths at Furness hospital. Photograph: Peter Byrne/PA

There is a widespread assumption that natural childbirth is the plucky underdog in cultural attitudes. Yet a glance at the Daily Mail reveals that this is not the case. “11 hours’ labour and all natural!” ran a headline following the arrival of Prince George: “How serene Kate sailed through a textbook delivery as she goes through the perfect birth she was hoping for.” The idea that women have free choice about how to give birth is an illusion when one course of action becomes validated as morally correct.

A choice is not free when the two paths – “medicalised” and “natural” – are so starkly divided: it’s irrational that the full range of alternatives, from birthing pools to anaesthesia, are not available in the same room.

The Morecambe Bay investigation exposed a them-and-us culture with midwives and doctors. When things go wrong, it is women in late stages of labour who are made to traverse the ideological gulf, negotiating lifts and corridors while fighting the urge to push.

In the majority of cases, birth should be regarded as a normal life event rather than a medical procedure. But emergencies reveal hierarchies, and if we want to save lives then it’s appropriate that doctors are ultimately in charge. None of this, however, is openly talked about. Midwife-led units therefore represent a kind of lip service, and too often midwives’ resulting resentment towards what they perceive to be silently domineering doctors on one side and loudly demanding women on the other is played out in their ideological management of labour.

In the 1950s a woman undergoing a typical hospital birth would have been shaved, given an enema and strapped into stirrups. The medical establishment was indeed paternalistic, and episiotomies were routine. The natural birth movement, spearheaded by the French obstetrician Fernand Lamaze and the British doctor Grantly Dick-Read – the first president of the National Childbirth Trust – represented an understandable reaction. A need to redress imbalances of power between doctors, midwives and mothers is what led to natural childbirth becoming enshrined in the medical establishment, even if individual obstetricians have remained privately unconvinced.

A choice is not free when the two paths – “medicalised” and “natural” – are so starkly divided

Natural childbirth has mistakenly come to be regarded as automatically woman-centred, with midwives portrayed as helping women – in the teeth of the white-coated male establishment – to achieve the authentic experience they supposedly really want. But being bullied or cajoled into having a natural birth because of trumped-up risks to “baby” is not what I call feminism. I was alarmed when hardly any flags were raised when guidelines were recently released suggesting women with low-risk pregnancies should give birth at home or in a midwife-led unit: for these women, anaesthesia is out of the question.

The earth-mother, chest-beating version of natural childbirth pioneered by Ina May Gaskin has cemented the associations between natural childbirth and empowerment. It is right that a woman should have control over her own body. But in the cult of natural childbirth, the body is everything. Telling women to “just let go” can be liberating, but it’s also a command to switch your brain off. As the phrase “too posh to push” reveals, the emphasis on getting in touch with your inner animal is targeted perniciously at the status and assertiveness of what the Daily Mail calls career women.

I know that for many women, giving birth at home or in a birth centre is exhilarating and profound. But our culture regards natural childbirth as a hazing ritual, a fitting prelude to maternal martyrdom. Dick-Read described childbirth as “Nature’s first hard lesson in the two greatest assets of good motherhood. Children will always mean hard work and self-control. Tell her the truth: motherhood is not fun, it is not a hobby.” In 2008 Belinda Phipps, then chief executive of the NCT, said: “If we just dropped babies like eggs without noticing, what would that say about the responsibilities we’re taking on for the next 20 years? Birth marks you out as a mother and a carer for a very long time.”

If there is pressure for babies to be born promptly and inside normal working hours, if there are untimely inductions and caesareans of dubious necessity, the impetus is not from knife-happy obstetricians. It’s a burgeoning insurance industry and public spending cuts, leading to a shortage of staff and beds. In this sense, women are not so much choosing a birthing style as being caught between atavistic misogyny and the consequences of neoliberalism.