Pregnant with her first child, Julie Speier prepared to deliver with the help of a midwife at a New York City birthing center. But in June -- three weeks before the due date and 600 miles from home -- her water broke.
Speier gave birth at a Cincinnati hospital, where she and her fiancé tried desperately to keep the birth natural -- a vaginal delivery without pain medication.
"I believe in the power of nature and that creation is next to perfect," said Speier, a 34-year-old yoga teacher. "I knew what I wanted and I had the confidence."
But as labor pains increased and Speier asked about breathing techniques, the doctor replied, "How do I know? I've only ever done two [natural childbirths]."
Today, natural childbirth is a medical anomaly in the United States, so much so that doctors are often thrown off guard by a determined woman like Speier.
A small but growing number of women who seek to avoid aggressive medical techniques like induced labor, epidural blocks and Caesarean sections find they are a lone voice among their friends and doctors.
"All of my friends think I am a little nuts," Speier said. "They say why would you do it natural?"
Speier said her own mother told her traumatic stories of her brother's breech birth. "Everyone I know has an 'I can top you' gory birthing story."
Pre-planned Caesareans are also in vogue. Women want to avoid future complications of multiple vaginal births, like uterine or bladder collapse. And today's body-conscious women worry needlessly about loss of muscle-tone.
With the latest feminine plastic surgery rage -- so-called "pimping the vadge" -- some women prefer what the British call the "Posh push," referring to the planned Caesarean births of soccer celebrity David and Victoria Beckham's three boys.
Like the generation that pioneered the first wave of feminism in the 1970s, women like Speier want to take an active role in their health care. They view childbirth a normal, healthy process that requires time, patience, strength and endurance.
But in the decades since, new technologies, the rising cost of malpractice insurance and even the changing attitudes of women have all contributed to the near-demise of natural childbirth.
"It's a little tsunami," said Dr. Ben Sachs, chief of obstetrics at Tulane University in Louisiana. "All these forces are coming together at the same time."
Both doctors and midwives have been hit hard with the high cost of liability insurance. All agree they must take on more patients to keep their practices lucrative, giving them less time to wait out a long labor.
Doctors more frequently induce labor, using synthetic hormones like pitocin to strengthen and quicken labor, an intervention that was once used only as a "last resort."
But induction also heightens the pain of labor and can precipitate the use an epidural -- an injection in the lower back that blocks the pain of contractions while the woman is awake. And some say that, in turn, can delay the pushing mechanism and even trigger the need for a Caesarean.
Induction rates rose 5 percent in 2005 to 22.3 percent of all births -- double the rate since 1990, according to the National Center for Health Statistics. Caesarean deliveries have also jumped -- to more than 30 percent of all births, a 46 percent rise in the last decade and a 4 percent increase over the 2004 record.