Fourteen hours into her acutely painful first labour, Kari Elise's obstetrician held a pair of forceps around her baby's head, his foot against the hospital bed, trying in vain to pull her 4.5-kilogram son through her narrow pelvis. Keenly aware of her determination to have a natural birth, her doctor delivered the words that he knew would hurt her more than the contractions themselves: "It's not budging. You're going to have to have a caesarean".

Kari's eyes filled with tears, as a single thought overwhelmed her: "I've failed".

"I was crying because I had to have a caesar, which is so demented," she says now. "I shouldn't have been crying because I hadn't been successful at having a natural birth - I should've been worried about my baby. But that's the emotional attachment I had to this idea."

A few weeks later, with the knowledge that it would have been impossible to have delivered her son Samson vaginally, Kari attended one of the local yoga classes that is popular among her friends in inner Melbourne. A former music industry booker, Kari, now 36, had almost completed her yoga teacher's training when she became pregnant with Samson - and she was eager to restart her regular practice.

"I said I'd just had a baby and the yoga teacher asked, 'Oh, a home birth?' and I replied, 'No, it wasn't a home birth.' She said 'Oh, natural birth, though?' and I said, 'No, I ended up having a caesar, actually.' And before I could launch into my whole, 'But...' she went 'A-ha,' looked me up and down, literally turned around and walked away. I felt so judged."

Much has been made of the pressures placed on pregnant women by medical professionals, but Kari's experience highlights a malaise less often acknowledged: the way in which women can be unfairly judged - often by other women - according to how they give birth. A cultural context has developed where birth has become increasingly ideological, to the extent that the goal of delivering a healthy baby can become clouded by sentiment, societal pressures and even fashion.

Celebrities including Britney Spears, Elizabeth Hurley and Victoria Beckham all had babies via elective caesarean - a phenomenon that has helped to normalise a medical advancement intended for problematic labours. On the other hand, the media has contributed to an environment where almost any woman who has a caesarean is at risk of being derided with the term "too posh to push".

At the other end of the spectrum, home birth - a minority practice in most developed countries - has gained kudos among natural-birth advocates, with some adherents spreading the word in evangelical style. Former US talkshow host Ricki Lake has produced a highly politicised documentary called The Business Of Being Born, which presents midwife-assisted home birth as warm and healthy, while hospital birth is demonised as invasive and clinical.

Last March, home birth made headlines again, when leading Australian advocate Janet Fraser gave interviews in the early stages of labour as she "free-birthed" - or gave birth without medical assistance. Tragically, her baby did not survive.