Choices, choices: pregnancy is all about them. Or so we are told, as we're handed our antenatal notes and given the run-down on what's available from our increasingly user-friendly maternity services.

The trouble is the reality doesn't always live up to its billing, as thousands of women discover. Four years ago I was one of them. Thirty-five years old, pregnant with my third child, I was in love with the idea of a home delivery. My previous baby had been a textbook normal birth in hospital, and I was confident as I arrived for my antenatal appointment that the midwife would smile broadly at my request for a home delivery this time around.

She did smile - at first. Then she started to take my history, and the smile disappeared. Six years before, my first baby had been born by caesarean section. The reason - pre-eclampsia - was unlikely to recur: she accepted that. But a previous section meant that I just wasn't considered "a good risk" for a home delivery. Yes, she agreed, the subsequent vaginal delivery did suggest everything would go swimmingly this time around. But guidelines are guidelines, dear - we can't break them. Hospital it will have to be. Next!

The fact that seven months later I had my dream birth, at home, is entirely due to my good fortune in being able to hire the services of an independent midwife. Alice Coyle of Birth Rites, an independent practice, wasn't at all surprised to hear I'd been turned down for a home birth on the NHS. Many of her clients, like me, are women who have been told that their uteruses don't fit the narrowly-defined criteria of what makes you a good bet. The fact is that only a tiny minority of women who have had a section experience a tear in their scar during a subsequent delivery. Since home birth has been shown to be a safer option if everything else is straightforward, it really isn't - as Coyle explained - a good enough reason to deny a woman a home delivery.

Now, though, the future of independent midwifery in the UK is under threat. For the past few years many of the 50 or so independent midwives have practised without indemnity insurance after the Royal College of Midwives, which used to underwrite them, stopped doing so. "It was simply too expensive for many of us to arrange insurance privately," says Annie Francis, one of Coyle's colleagues at Birth Rites. "The rates were always high, but over the past few years they've gone up further - from around £5,000 every year for each midwife to something in the region of £18,000. But since March this year even the companies that used to insure us have left the market."

Until now that hasn't really mattered: when Coyle came to see me for my first antenatal appointment she explained she had no insurance, so if I felt I had a case against her for negligence after the birth of my child there would be no insurance company behind her if I wanted to sue. I agreed that was fine, signed a form to say she had told me about it, and we moved on. Now, though, the Nursing and Midwifery Council (NMC) has decided that all those registered with it, including midwives, should be insured. It has put out a consultation document in an attempt to change the current situation. If a decision is taken to insist on insurance for all midwives, those who are independent will be unable to continue to work or will have to go back to jobs within the NHS.

Losing a small number of private midwives working outside the mainstream maternity services might not sound much of a tragedy. But that's what it would be - a huge loss, not only for individual women like me who couldn't get the birth they wanted within the NHS, but also for maternity care as a whole.

"What we're about is keeping alive midwifery skills in normal birth," says Francis. "There's a growing concern in the NHS about the low number of births taking place without intervention - it's around 16% for first-time mothers - and what we're doing is important because we are showing that birth can be low-tech and non-interventionist and safe.

"Midwives who work within the NHS often point to us and what we're doing to back up their arguments about improving midwifery care within mainstream services. Some people argue that we're part of the private health system and only available to the privileged few, but most of us would go back to the NHS like a shot if we felt we could practise in the way we want to. We don't want to have to charge women, but the protocols of NHS trusts make it impossible for us to practise in the way we feel we should within those narrow guidelines. Many women who use our services, in fact, aren't rich - I've had clients who make huge sacrifices to pay the £2,500 fee."

For its part, the NMC agrees that independent midwives have a vital part to play in maternity services - but protecting the public, it says, comes first. "The council took the view that tens of thousands of women could be at risk if midwives aren't insured," says Stuart Skyte of the NMC. "We accept that independent midwives are a pioneering group and we are not trying to put them out of business. We'll look at all the proposals we get from our consultation and try to come up with a solution."

Independent midwives, meanwhile, feel their cause could be to point up much broader issues. "Many NHS trusts are trying to reduce the costs of medical litigation, which are an increasing problem, with more and more rigorous protocols about what is and isn't allowed," says Francis. "The net result is that medical intervention in childbirth is likely to be more and more common, and we think that this will ironically mean more, not fewer, claims.

'Added to this is the wider issue of whether as a society we should be requiring someone who's had medical damage to prove blame before they're compensated: wouldn't it be better to have the kind of system they have in New Zealand, where there's a "no fault" fund for people who need to claim against the health service?"

Mary Cronk, who's been an independent midwife for 12 years, believes that a way forward will be found and she will be able to continue her work. "I think the Department of Health would be extremely wary of the rebound they would get from women if we couldn't practice," she says. "But not all my colleagues share my optimism. And I have to say that if all else failed, I'd still go on. I'd practice illegally - that's how strongly I feel."

· For more information call 01483 821104 or go to www.independentmidwives.org.uk