Hmm, where to begin. I work at a hospital in a large metro area in the Midwest.  Continually, I am amazed to find women presenting to labor and delivery (at this very popular level three-- high risk hospital) with birth plans, doulas, etc. in hand, expecting to experience successful natural, unmedicated birth!!!!!
It is sad and frequently very difficult to see: time after time (but not always), to witness very well intentioned laboring moms "run over" by the hospital/medical system.  After seeing thousands of births (and hearing of tens of thousands of other births) I sadly shake my head and wonder WHY???
Why would a healthy, well educated, well intentioned mother EVER choose to birth her baby in a hospital setting with a physician????? The only answer I can come up with is FEAR. Sadly, I think that our birth culture is infused with fear: fear of pain, fear of the unknown and fear of the unexpected.

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Can I ask what you suggest as an alternative? I am also in a metro area in the midwest and don't seem to have any other options that are accessible to me. As this is my first time being pregnant I don't have a birth center in the area and it is illegal to have a home birth with a midwife in my state. I feel very stuck.

There may not be free standing birthing centers in your area (especially if you are in Illinois) but there may be one within a hospital setting. In your situation, I think you have to look for the lessor of two evils. First, I would find a midwife (CNM)-- one with hospital privileges in your area. Be sure to ask her what percentage of her clients birth with epidurals, how many unmedicated, how many water births, etc. Ask her for client references-- this way you will know if she is a midwife who will truly advocate for the birth you want or some version of the birth she wants you to have.  Where I live not all midwives are not created equal. Some would rather practice as OB MDs: AROM, Pitocin and epidural, etc, There are a few, however, who have great heart and soul and practice with integrity-- they honor their clients and birth in general. First find a good midwife, it will make all the difference in the world!!

Also, investigate the hospitals in your area-- ask friends and/or get on the net and see what the buzz is about the hospitals you may choose. Find out which ones are mother/birth friendly (or friendlier). Level three hospitals (treat complicated, sicker population) will usually be more aggressive, interventional than a level one hospital .

I would strongly recommend that you educate yourself about birth in general, learn about the birth process-- reading, a good doula and/or midwife can teach you. I find a lot of couples have birth plans but very little education about how normal labor happens, hospital protocols and their options. The more you learn, the better prepared you will be to navigate the system, if necessary. 

You may also consider waiting until you are in active labor, before entering the hospital for your delivery. Make sure to surround yourself with knowledgable, supportive, people for this situation.

What state are you in? I'm in the Chicagoland area and even though the perception is that non nurse midwives are "illegal" (no actual law on the books)  there are still Certified Professional midwives as well as direct entry (have to be careful as there is no minimum standard here ) and Certified Nurse Midwives offering out of hospital birth. If you are only interested in hospital birth there are some great nurse midwives that practice at the Alternative Birth Center at West Suburban Medical Center. One of the practices has a 90% unmedicated rate! It is true that there are many midwives that do not encourage their clients to even consider experiencing labor. They also have their hands tied if the they have tight protocols. 

Can I correct myself and say, probably fear and lack of education motivate many women in MY community (where other options are available) to birth their babies in a hospital, with a physician. Women living elsewhere may not have birthing alternatives or may have limited options (very sad!!). Hopefully, as we become aware, and advocate for ourselves (as educated consumers), the systems will change to accommodate our needs/desires.

Thank you. I appreciate your thoughtful response. I know it's been very easy for me to learn about the birth process, my ideal process thanks to a lot of great resources but feel angry that I don't have access. Most of the CNM practices have closed due to the OB/GYN practices and hospitals putting pressure on them and not having a supportive OB back-up. Therefore it's been difficult to even find practicing midwives in my area (Cincinnati). My next step is to interview Doulas.  I def. feel like the system HAS to change- this is unacceptable. One last question, is there such a thing as supportive OBs in a hospital birth center?

Occasionally, however, keep in mind that they are also governed by hospital protocols, etc. I just got off the web and read about an MD in your area who is "more like a CNM than an MD." his name is Daniel Bowen. He is also frequently a backup MD (dotted line connection) for "underground" midwives in Cincinnati. There is also a website you may be interested in:  www.safebirthohio.org if you want to see the system change.

take care.

I also live in a state where my options are VERY limited. Midwives cannot legally practice in Alabama, and I don't think there are any birth centers in the state PERIOD (although I could be wrong). Unfortunately my state is not very progressive when it comes to alternative medicine and natural childbirth. However, I was very blessed to give birth in a WONDERFUL hospital that is natural labor friendly. I was even given the option to have a water labor (which I didn't end up using). I posted my experience in the Hospital Birth section of the forum. Hopefully one day things will change :(

I think Illinois is the only state in the U.S. that has no birthing center.  Glad to hear that you had a positive experience  with a hospital attended birth!

I have been a birth advocate in Illinois since 1996! My challenge is how to reach parents before they have their first baby so that I can educate them about their birth options. We do have some great choices here. It is just that most parents don't know about them. I offer birth options consultations to parents who want to make informed decisions. I have an organization that promotes the midwifery model, undisturbed birth, bonding and breastfeeding. Parents want to make the best choices for their babies. They often have no idea they have choices outside the medical model for birth. 

I love working with parents. My web site is BirthLink. I hope to hear from anyone wanting to have a fun and easy lesson in birth options. 

I am puzzled by a recent development regarding birth education and birth choices. There seems to be an increasing number of birthing moms presenting to labor and delivery with birth plans, asking and expecting the medical staff to help with their execution. A couple of points here: first, most nurses and doctors (and some midwives) working in hospitals have little skill to or interest  in helping these mothers have natural/unmedicated/noninterventional births. Second, if they do have skill and the desire to help, they may sadly be restricted by protocols, time and staffing issues: this leaves 

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