I think most women choose pain relief because labour pain's worse than they ever anticipated. Studies tend to bear that out. Not being willing to endure terrible pain, when it can be alleviated, isn't a bad decision IMO - I think it's great that pain is to an extent optional, so the woman can choose for herself how much she's prepared to take. I'm hoping I'll be lucky, as my mother was (relatively easy labours, not too painful, fairly rapid) but I'm willing to roll with it if I really can't cope, because I know that I'm fortunate enough to have an alternative option. And I don't think that the total positive thinking approach is any more helpful than the over-medicalised one, because some women just can't birth naturally. Friend of mine got to 9cm dilated with both her dd before she had to have a section - she's small, had exceptionally big babies, they were just not going anywhere. But her midwives and she wanted to try, and both times she did, before the section was resorted to. She cheerfully says she is just not cut out for natural labour, and all she feels is pleased that other options are available so it's no biggie. What distresses me is how many women feel failures for not being able to cope with the pain/have vaginal deliveries, because that's almost fetishised, when to a certain extent it's down to blind luck. Surely the only thing that actually matters is that both mother and baby are healthy, and the labour isn't too traumatic for them? Yet a lot of women are devastated that their confidence was misplaced and they "failed" at giving birth vaginally - famously, Kate Winslet even lied about her first birth for years, because she felt so ashamed of needing a section, after 2 days of fruitless labour, after confidently asserting in pregnancy that her body would be capable of birth without much pain relief, that that was what it was designed to do. Her confidence was misplaced, and it set her up for a terrible fall - and there are many, many women who feel that way after psyching themselves up with great confidence before actually arriving at labour. That's an appalling burden to lay on anyone - that they've failed in some fundamental way, when their maternity has barely begun. And I have a couple of friends whose babies were so badly positioned that their births were agonising - one had been infertile for 5 years and still refused to consider another child for months after because of the pain - and they both felt that they'd far rather have had a section if they'd had any idea of what they were facing. At the end of the day, does it matter if you give birth vaginally or by section? If both mother and baby are safe and well? The ONLY reason it matters is that risk is higher in a section, according to some research (though I note others here say different research disagrees) and really the risks of anything going badly wrong are low, thank God, whichever route. So surely the women's experience is important, too?
Can't speak for your hospital, or what you mean by "choose" to have an epidural - all I know is the study I saw said that the majority of women in labour have epidurals, and of those who do, only 20% went into labour intending to, the rest all planned to avoid one at all costs. Epidurals carry risks, but extreme pain over a long time-frame is potentially very damaging psychologically as well as very unpleasant, and that's a serious risk too. I just think we are so lucky to have that option, if we need it. We're blessed to have alternatives that so many women in the world do not.
Of course our maternity care at present is shocking in a first world country. Basic cleanliness is ignored in a lot of hospitals, women aren't supported enough, their environment can be completely unconducive to the relaxation that is so important when labouring, over-medicalisation for the convenience of the staff and not mother is reportedly resorted to much too frequently, and a bit of tlc has become unavailable to many due to understaffing. That's appalling, as I doubt anyone would disagree. But I don't think the answer is to say women shouldn't have the choice of a section if that's really what they want, as opposed to need - a natural birth can bee a traumatic and scarring experience in physical and emotional terms, and someone opting for a controlled alternative should be supported in that choice, too. Surely the optima is for all forms of birth to be as safe, pleasant and equally available as possible. In the final analysis, a woman should be able to choose her birthing method and venue, no? Because an element of control does more for confidence than anything else, and it is the body of the labouring woman.
Finally, I'm confused - if your only interest is in best outcomes for mothers in general, why did you ever bring financing into it? Why not argue for better financing for all maternity care, full stop, rather than a reallocation of resources towards your preferred birthing options, away from sections? In my experience, people only interested in something from a welfare perspective don't feel the need to bring unrelated arguments reinforcing your position to the fore - that always seems to speak of a dogma, rather than a concern. People always argue that their concern is only the welfare of women/children when they take a position on their reproductive choices - there was a lot of that in evidence in Parliament, last night. It seems a bit odd that the women in question aren't trusted to make good choices for themselves, especially when there are very different opinions on what the best choices might be.