In a controversial book, Val Clarke claims that mothers' instincts are being eroded by the childbirth 'system' and encourages them to heed their inner voice. She tells Sarah Foster about her experiences as a midwide including delivering Paula Yates' child.

VAL Clarke remembers clearly her first months as a midwife. It was Epsom in the early 80s, and she was based in a hospital delivery suite. "Suddenly you would hear the labour ward sister call out, 'Would you go and deliver the woman in room such and such?' You had never met her before. You were a stranger impacting on the most important time in a woman's life, and it was wrong," says Val, 62.

It certainly didn't fulfil her dream. At 18, Val had started as a nurse, working, over time, in several different roles. Yet she felt midwifery was her true vocation. "That desire to be a midwife never went. I've always had a passion for babies and I promised myself that one day, I would be a midwife, but I started my nurse's training then met and married my husband then had four children, so my midwifery training was put on the back burner until my youngest son started school."

Working in a typically overstretched NHS hospital, Val was frustrated by the conveyor belt approach to childbirth - so she decided to opt out. "After a year, I began applying for community midwives' posts because that's where my heart was - out in the community with mothers," she says. "That's where I ended up."

Dealing with women she got to know, without the same constraints as in hospital, Val truly found her niche. She remembers her years in the community, from 1983 to 1994, as a truly special time. "Every woman in my care had my home phone number so that I was on hand for her. It wasn't the norm - that was what I chose - but it worked. I have to say that most of my GPs asked me to deliver their wives' babies and I felt so proud and privileged," she says.

What Val developed with her mums was a holistic care package in which she tried to meet all their needs, whether physical, emotional or psychological. "My philosophy is that if you care for a woman emotionally, the woman's body will do the best that it can. These days, no-one has time to ask, 'How are you feeling?'," she says.

Contrasting this with hospital care, Val sees a marked difference. She claims not least of the harmful effects is that on midwives. "The sad thing is we have these midwives coming in for training and the training is not how to develop midwife skills. It's about technology. Although midwife means 'with women', it's not about that, which is why we have a shortage of midwives. They go into it with their hearts and minds and they find out it isn't anything like they thought it would be."

While most mums choose to have their babies in hospital, Val says that due to the lack of personal contact and over-prescriptive protocols, the experience can be negative. Certainly, she felt dissatisfied with the births of her own sons. "I think possibly that my own birth experiences made me realise that you don't fill a woman full of drugs so that she doesn't recall the birth of her babies, which is what happened to me. It's a lottery of care - you will hear women saying they had the most wonderful midwife and that's great if that happens, but it's a lottery," she says.

To ensure the best outcome, Val believes that throughout their pregnancy, women should have a one-to-one relationship with their midwife. Stemming from her work in the community, this is something she has continued throughout her career. After a stint with well-known midwife Caroline Flint, she became self-employed, and is now one of around 100 independent midwives.

As she can't practise in hospitals, most of her clients opt for home births - although she stresses that there's no pressure to do this - and will otherwise act as a birth partner. She feels that at home, women can take control and most importantly, follow their instincts. "Historically, mothers have always been instinctive about pregnancy and childbirth - they know when something's wrong and, equally, they know when something's right. Why should it be that when they go into hospital, someone else takes control?," says Val.

She says her own deliveries are as interference-free as possible, with the mum calling the shots. "I don't do anything that's invasive, and the mother feels confident and in control. If anything deviates from the norm, I refer her to hospital. That's why the process is so safe - I know the mother and we've built up a partnership of trusting care."

Val says that this approach has widespread benefits, which extend far beyond the birth. "It means fewer caesareans, fewer interventions, fewer drugs and happier mums, and as a result, they have more success with breastfeeding. Ninety eight per cent breastfeed successfully," she says.

"I give postnatal care for up to six weeks because I know that most mothers are going to struggle with the commitment of caring for a newborn."

Such is her reputation that when Paula Yates had her fourth child, Tiger Lily, to popstar Michael Hutchence, Val was asked to be her midwife. "She'd had three hospital births prior to that and it was Michael Hutchence who wanted her to have the baby at home. It was lovely going to see them and we had the most beautiful birth - Paula said it was the most beautiful she'd had. For me, she was just another mother and he was just another father," she says.

Another home delivery involved a pair of New Age travellers. "They had piercings where you wouldn't like to talk about. The father delivered his own baby in the birthing pool," says Val.

In the NHS, mums may or may not know their midwife, often depending on sheer chance. Yet while Val feels this shouldn't be the case, she says it needn't mean a bad birth. "In the NHS, there are some birthing centres which are springing up that are absolute centres of excellence and if you can get into a birthing centre, fantastic. My feeling is that if mothers are empowered by being given information, they can stay in control of their birth. If I can change the balance of power from the hospital midwife to the woman, that's what I want to do," she says.

In the meantime, she's looking forward to being present at many more births - including that of her own grandchild. "Now I choose how many mothers I look after and it's just heaven. I can see myself going on for as long as I can," she says.

* Instinctive Birthing by Val Clarke is available to readers at the special price of £13.50, including p&p (RRP £14.99). To order, call Carroll and Brown on 020 7372 0900 and quote 'Northern Echo'.

* For more information, contact the Independent Midwives Association on (01483) 538615 or at www.independentmidwives.org.uk; the Active Birth Centre on 020 7281 6760 or at www.activebirthcentre.com, or the Association for Improvement in Maternity Services (Aims) on 0870 7651433 or at www.aims.org.uk