Fear of litigation has brought about increasing medicalisation of maternity services, demoralising staff and reducing women's choice, midwives have claimed.

At its annual conference this week, the Royal College of Midwives will launch a report claiming that services in some parts of the country have 'demonstrated creative and committed responses' to the official drive for woman-centred care. But Vision 2000 says 'others have witnessed reversals in progress'.

RCM practice development manager Stephanie Meakin said: 'There has been medicalisation beyond belief.

'This is supposed to be about risk management and reducing legal costs. But every time Caesarean sections go up by 1 per cent, it costs the NHS£5m.

'An acceptable level of Caesarean sections is about 10 per cent - the average in this country at the moment is 20 per cent.'

Obstetric claims account for about 50 per cent of the£312m future liabilities of the clinical negligence scheme for trusts, administered by the NHS Litigation Authority.

Ms Meakin linked increased medicalisation with staff shortages.

'Midwives are leaving because of the medicalisation of childbirth - not because they are not paid a lot.

'If you gave 'normality' back to midwives you would save millions.'

Trusts and GPs have also been accused of denying women the option of a homebirth.

Beverly Beech, chair of the Association for Improvement in Maternity Services, said: 'There's still a huge number of GPs in this country who do not approve of home births, have not read the evidence and continue to tell women horror stories.'

Independent midwives' freedom to practice in hospitals is also being restricted, the RCM claims, because some trusts refuse honorary contracts to those without insurance. Moira Wheeler, head of midwifery at Epsom and St Helier trust, which refuses non insured midwives, said insurance costing an average of£15,000 a year was 'prohibitively expensive' and trusts had been 'grappling with' the problem.

Hamish Meldrum, joint deputy chair of the British Medical Association's GP committee, said some GPs might have 'a degree of prejudice' against midwives.

'We certainly would not support that. But there is a lack of information for GPs on what's available - it's important to have evidence that the person they refer a patient to is fit for purpose.'

Vision 2000 . RCM Welsh Board, 02920228111.£5. Executive summaries from RCM policy department, 020-7291 9220. Free.