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INTRODUCTION

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I felt the first signs of my labor in the early evening and by midnight my contractions were strong enough that I had to breath through them and I was beginning to feel myself tense up in anticipation of each one. They were still too far apart to go to the hospital, so I woke my husband up for some support. He could see I was really stressed, so he turned down the lights, lit some candles, and played some music. I began to feel better though the contractions kept coming. By three it was time to go to the hospital. The ride was hard and when we arrived everything was so loud and bright. They asked me a lot of questions and I realized my body was really tense and cold. My contractions had spaced out too. Luckily we had hired a doula and the first thing she did when she arrived was to turn down all the lights, put on some battery candles and music, and I felt like I was at home again. My labor picked back up but it was more manageable in a calm space. I definitely feel like mood of the room changed the mood of my labor.

—E. P., new mother

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I would like to birth in the comfort of my home or a freestanding birth center

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The debate surrounding out-of-hospital birth either at home or in a freestanding birth center could very well fill a book on its own; however, it is impossible to discuss birth plans without acknowledging the small percentage of women who, no matter how much hospital birth changes, will never be comfortable with hospital-based care. Several studies have examined the reasons women decide to birth out-of-hospital, even if it means a skilled attendant is not available to deliver their child. Some common motivations expressed by many women who have had out-of-hospital births were a strong desire to maintain control over their birth, as well as avoid a traumatizing hospital experience and remain in a loving, supportive family friendly environment. Many women expressed more fear of hospital interventions than complications during childbirth, with a common theme being that they wanted to trust their body and the process of birth.13

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The question is whether or not it is safe. Until recently, there was little research available on the safety of home birth in the United States, as it was only in 1991 that nonmedical midwives formed a credentialing organization and registry of nonmedical midwives and their outcomes began to be tracked.4 Home birth was also such a rare event prior to the last two decades that it generated little attention for study, as it had no significant contribution to public health outcomes and was regarded as simply a fringe practice. Furthermore, the research that did exist out of countries where home birth was more common was ...

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