Laura Shanley not only had her four children at home, but she birthed them without a doctor or midwife. Hunkered over a plastic tub, she even tugged out a breech baby by herself while her husband was away. This was decades ago, before home births, much less unassisted births, gained popularity.

Shanley, author of Unassisted Childbirth, is not alone, although she is still in a distinct minority, probably because of the significant risks perceived to be associated with this decision.

"Doctors think I am crazy," laughs Shanley. "But I believe childbirth is not inherently painful or dangerous unless there is interference from within or from outside."

"She sounds like one of those women who have an easy time," deadpans Marion McCartney, a certified nurse-midwife and director of professional services of the American College of Nurse-Midwives in Washington. "Most of us are somewhere in the middle, between easy and hard."

Shanley says she had not even planned on having children until she met her husband-to-be, who was exploring various issues of consciousness and turned her on to a book called Childbirth Without Fear by Grantley Dick-Read. That must have been quite a first date! "That book told me about the fight-flight response [changing muscle behavior in response to fear] and approached it all so logically," she recalls. "It made sense to me."

High-Risk Pregnancies?

"People often contact me and say they are high risk," Shanley comments. "I don't tell them what to do: All I say is what I did." Shanley does argue, however, that a lot of problems that define high risk are the result of the overmedicalization of pregnancy and delivery. She mentions the confining belt monitors and sensors that are attached to the scalp of the emerging child. "Those can pick up variations that probably aren't dangerous at all," she claims. "If you become afraid, blood stops flowing to your uterus and labor is impeded. If I had had my breech baby in the hospital, they probably would have cut me open."

Most doctors and midwives would disagree.

Predictably, Shanley also had no prenatal care during her four pregnancies. "We call it 'prenatal scare,'" Shanley says.

The prenatal visits, McCartney points out, are when you learn how to stay healthy and have a healthy baby. The doctor or midwife will decide whether you are facing unusual risks. "It's hard to assess ahead of time what sorts of risks you face. The idea is to take away as many of the risks as you can take away."

Medical research and clinical experience demonstrate the profound benefits of prenatal care, and careful guidance during delivery, to both mother and baby. Medical practitioners, including physicians and midwives, have been emphasizing the importance of letting the pregnant woman guide her delivery -- including underwater births and the use of birthing rooms that are like a bedroom in a home. These advances have reduced the frequency of medical complications, while helping women have the childbirth they envision.