Location is everything. Especially when it comes to giving birth.
If you've taken the time to envision what your best birth experience looks like, then you must also do the research to determine where you have the most likely chance to achieve your vision. In my state, women have three viable options for giving birth.
In a Hospital
Contrary to popular strategy, I highly recommend choosing a hospital before choosing a doctor or midwife. The reason for this is simple: if you deliver your baby in a hospital, then the majority of your care during labor will be determined by the hospital's standard procedures and administered by the nurses on duty, NOT by your primary physician. Most of the time, the doctor shows up when the mother is ready to push the baby out, i.e., at the very end of labor. It is the hospital's policies and the hospital's nurses who can dramatically affect the course your labor will take.
Take time to research and tour the various hospitals in your area. Ask questions related to anything that can influence labor and delivery, including the rate of interventions and cesarean sections, if the hospital has a "time limit" on how long a woman is allowed to labor, if a birth tub is available (for waterbirth), policies regarding eating and drinking during labor, the hospital's feelings about doulas, and any after-care concerns. Personal recommendations from friends who have had positive hospital births can also inform your choice.
Hospital policies vary greatly so I cannot stress the importance of doing thorough research enough. For example, in my city, one hospital has a 37% rate of c-sections (the national average is 32.8%) and an 80% rate of any intervention. This means that, in this hospital, only 2 out of 10 women give birth naturally and more than 1 in 3 births end in c-section. But less than 10 miles away is another hospital with a 13% cesarean rate and only a 30% rate of intervention. In that hospital, 7 out of 10 women achieve a natural birth and just slightly more than 1 in 10 end in c-section. Two hospitals, within 10 miles of each other, yet with radically different birth statistics.
Know the type of labor experience you want. Know the hospital that is most likely to provide it.
In a Birth Center
Birth centers are more recently appearing in my area and provide a home-like experience with some of the privileges of a hospital birth. Birth centers provide a private bedroom where mothers can wear their own clothing and labor in any way that is comfortable for them, including in a tub (where they can also choose to give birth). Centers can be staffed by midwives and nurses who often have privileges at a nearby hospital in case of a need to transfer.
Birth centers are an excellent option for moms who want to labor naturally within a more comfortable home setting, as no interventions are available in the center. The midwife who is on-call when a mom begins her labor will stay with the mom through the entire birth, providing a consistent presence and care for the delivery. Some centers are overseen by or work in partnership with obstetricians, pediatricians, lactation consultants and other specialists as needed so that parents have access to services similar to hospital births.
If you know that you want a natural birth experience and holistic midwifery care but are hesitant to be out of a hospital, find out if there are birth centers in your area. Again, just like hospitals, the policies and staff vary from center to center, so it is important to research, tour, and talk to the various centers available. Also, since birth centers are relatively new, some insurance companies do not cover the costs of labor and delivery, so be sure to check with your insurance provider if money is a concern.
Or, Give Birth at Home!
Homebirth deserves a post all of its own, especially since it is near and dear to my heart and yet incredibly misunderstood by the majority public. In some states, homebirth is not a legal option, but for those where it is possible, I highly encourage any woman who wants a natural and empowering birth experience to consider this a valid option.
Let me state clearly, however, that homebirth is not for everyone. By this I mean that, unlike hospital births, homebirth mothers and midwives actually self-select in order to achieve the best possible outcome. Homebirth midwives, just like hospitals and birth centers, vary in their experience and comfort level with risk factors involved with births. A mother's personal health history, previous births or miscarriages, and current health during pregnancy may preclude her from being able to have a homebirth. Additionally, at any time during prenatal care, if a midwife feels that the mother or child is at risk, she will (or should) refer the mom to an obstetrician for more involved care.
With all that said, however, if you are a healthy mom with a low-risk pregnancy who wants the comfort and control of delivering her baby naturally, then you are an excellent candidate for homebirth. Some benefits of homebirth include being assured that the same pair of midwives who care for you during pregnancy will be present for your baby's birth; an increased involvement of the baby's father (just ask my husband - homebirth is alot of work for the dad!); and the security of your own familiar environment during labor. Not to mention the fact that you are guaranteed a natural delivery, unless you transport to a hospital.
The point is, where you choose to have your baby will impact how you have your baby - and how you may feel about yourself and your experience afterwards. Take the time to understand the options available to you and to imagine the possible outcomes at the locations you investigate. This is your body, your baby, and your birth experience; you deserve to make a choice that is most comfortable to you and which allows you to be in charge of the route your experience will take. Even though we cannot predict the type of labor we will have, we can plan the place where it will happen. And that decision lays the foundation for all of the choices we will (or will not) have once labor actually begins. Choose wisely!