In Victoria, and indeed in most of Canada, there is no middle ground of Maternity Care. A woman can choose a hospital or a woman can choose home. In a hospital (at least in BC) you can be attended by a GP, a midwife or an Obstetrician. At home you can be attended by a midwife. At a hospital, the environment may be less than appealing - uncomfortable beds, lack of privacy, potential exposure to some germs. At home, the lack of immediate access to medical intervention may not be appealing - there is no way an epidural happens at home. At the hospital (at least in Victoria) there is no birthing tubs.
This in and of itself is not really a problem, except that it is. There are women who would probably choose a home birth but for the lack of access to medical care (they like the safety net and who knows maybe their a fan of the epidural option), on the flip side there are women who choose home births who would benefit from choosing a hospital birth instead (like the 16 percent who transfer to a hospital during a home birth).
The obstetric community needs to ask itself what it can do to make the services it offers more attractive to women who would benefit from it. At the same time the midwifery/homebirth community need to ask what they can do to make birth safer.
If it were up to me, I'd establish stand-alone Maternal Health and Education Centres. These would be full-service maternity care centres that would take the best of all care approaches. They would have more family friendly birthing rooms, birthing pools, dedicated obstetric anaesthesiology, dedicated obstetric OR. They would also provide prenatal and postnatal education services - in an unbiased way. They would be focused on meeting the needs (both physical and psychological) of mothers and their babies (up to age 1). They would be a resource and a one-stop place to get connected to the resources available.
Care would truly be integrated - and mothers and families would feel truly valued....
But its a bit of a pipe dream...after all if such a hybrid was so great - why doesn't it exist yet?