The choices arent vast or fantastic but there ARE choices. Women have choices, and they do assess the risk of each and assume the risks of their choice.
Therefore a woman may seem to have no choice but to give birth in a hospital because she didnt get in at a birthing centre. However she has the choice to have an illegal midwive, a UC, or a hospital birth, or to relocate to an area with better access to care for their birth(my mom stayed with relatives 3 hrs away from her home during her pregnancy with me to avoid a caesarean).
Now if a woman is not willing to assume the risks of a UC or an illegally assisted birth she is willing to assume the risks of a hospital birth.
This understanding is an important part of prenatal preparation for problems. If she is 100% unwilling to consent to unneccesary intervention at any time she needs to reconsider having a birth at a hospital. Is it fair? No. Is it ideal? No way! Is it reality? yes. We are functioning in a broken system and we need to empower ourselves to make decisions that we can live with. Clients also need to know that they absolutely have the right to refuse anything, but what they will have to go through to have that happen in a hospital and that if they go in with their fists up they are going to wind up with a battle.