Learn about the choices from moms who have been there.

Suzanne Schmidt Bloise has a friend in Seattle who delivered her baby at a birthing center four years ago. "That was the first time I had ever heard of not using a hospital," says the Monroe mom who gave birth to her daughter, Charlotte May, 18 months ago.

"My husband and I went on a tour and I knew instantly that's what I wanted," says Bloise. "It had offices downstairs and basically an apartment upstairs: kitchen, living room, bedrooms and bathrooms set up for birthing."

Her pregnancy was normal until the last eight weeks when they sent her for a sonogram and noticed that her daughter's belly wasn't growing at the same rate as the rest of her body. Bloise was admitted to the hospital and induced while a midwife worked with the doctors. "It was the best possible care I could have had without delivering in the birthing center," she says.

Bloise realized that she had birthing options and made the decisions that were right for her.

The options have evolved
"Obstetric care has evolved greatly over the last 10 years and for the better," says Marcel Hinds, an obstetrician and gynecologist with Health Quest Medical Practice. "The paternalistic approach to childbirth, which has led to a lot of patient mistrust, has become extinct. The care of a woman and her baby is less medically oriented, more flexible and focuses more on patient experience."

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Essentially, expectant mothers still have the same birthing options they had a decade or two ago -- a cesarean section, natural birth, home birth and water birth, but according to Kate Desa, director of maternity services at the Neugarten Birth Center at Northern Dutchess Hospital in Rhinebeck, the handling of these options is what has changed.

Know your choices
"We make every attempt to make the cesarean birth as much like a vaginal delivery as possible," says Desa.

The Neugarten Birth Center has a family-centered cesarean center. "We use a drape that allows parents to see the baby being born," says Desa. "The baby also goes skin to skin with mom after delivery, in order to allow that bonding time and make breastfeeding easier and to try to take away some of that very clinical feel of a cesarean section."  

The lights are dimmed and the room is warmed. "We really don't separate mom and baby during cesarean any longer," she says. "The baby stays in there with a dedicated nurse to help her and mom during the procedure, and then they both go back to the room together."

For a vaginal delivery, Desa says now the entire family is encouraged to have that time together too. "We highly encourage skin to skin contact right after delivery, breast feeding as soon as possible after delivery and delaying any medications for as long as we are allowed to, or as long as we can, to allow that time for mom and baby to be together," says Desa. "We keep that sacred first hour to encourage the family to bond and to really adjust to having this new baby in their life."

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Jennyfer Cruz-Bernave wanted a water birth, but it wasn't available at the time she was in labor, so she chose a natural birth at the hospital instead. "I wanted to be an active participant throughout labor and have minimal routine intervention," she says. "For my first daughter, I felt a strong feeling of empowerment during labor, and after labor I felt so accomplished. I felt like super mom because I had a natural birth with no pain meds."

Kahla Johnson Skonber always wanted an at home water birth too.  "My labor and delivery was very calm and quiet and they let me do what my body told me, instead of them telling me what to do," says Skonber.

Decide on a plan with your doctor
Deciding on what birthing option is best for the mom starts with a conversation between the mom and the obstetrician. "We keep an open conversation with our mothers as to how they want their birth to go," says Desa. "I highly encourage mothers to take a childbirth class or do some reading or talk with their OB providers as to what options they would like to have. It's good if moms come with an idea of how they'd like their birth to go, but also with an open mind."

Keep in mind that some medical reasons may dictate what choices you have. "If you decided that you had wanted an epidural for pain management, you can't use the birthing tub," says Desa. "If you have thick meconium, which means that the baby has passed a bowel movement while it was inside, you wouldn't deliver in the tub either. If there are any signs that the baby is in distress, you wouldn't be in the tub, because we couldn't closely monitor and make sure that the baby stays safe during that time."

Christine Vinson was hospitalized for hyperemesis, or severe morning sickness. "I was in labor for nearly 30 hours, and with a migraine. My doctor was great, she encouraged me to keep going, my baby was doing good, but eventually I begged for a C-section and it was done. Because I was so sick and my son was small, I didn't hold him for a few hours and spent the entire day out of it. But overall recovery was easy."

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Do your research, make a perfect environment
In addition to the type of birth, a mom can also design her perfect environment. Desa says, "Some people will bring music, clothes that they're comfortable in and massage or scented oils that they use during labor. Whatever it is that breaks that stress, anxiety and pain cycle."
Hinds explains that each woman has her own personal vision for her delivery experience, shaped by many factors. "After accounting for those factors, she should choose a venue that best suits her personal and medical needs. Women should also diligently research."

Desa cautions moms about researching on the internet. "There are some good resources out there for childbirth and childbirth options, but there's also some misinformation," she says. "If you come across anything that you are concerned about, speak to your provider. I think that people do risk sometimes being misinformed."

Know that plans can change
Kimberlee Ann Donahue had her first son in a traditional hospital setting with an epidural. "I was about 10 seconds away from a C-section and a very skilled physician used forceps and got him out, but he ended up in the NICU for four days and that was heartbreaking."

When she found out she was pregnant again, she did more research on natural childbirth. "I desired a home birth because I felt my body was designed to have a baby, and I didn't want to be pressured with the epidural.

Sometimes, even a well thought out birth plan can go awry. Jessica Carola had a birth plan in place, but ended up with a C-section. "I dilated two centimeters, my water broke at home a week later, and dilated to 10 centimeters within a couple hours," she says. "Then I pushed for 2 1/2 hours and nothing. They rushed to do a C-section and when I asked for other options they said there was none."

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When Helen Hoffman gave birth to her oldest child, she had a plan too, but said that the hospital she was in didn't listen to it. "I had signs on my door, and told every nurse there that I did not want narcotic drugs and not to offer them," says the Phoenicia resident. "After being in mild labor for six hours the hospital decided I was taking too long and they wanted to give me Pitocin to speed things up. I declined. There was no medical indication that Pitocin was needed."

Hoffman felt bullied into using Pitocin. "My progress halted, because I couldn't stop crying from feeling my autonomy and control over my birth being stripped away from me," says Hoffman. "I called for a new nurse who let me get up and move, shower, and labor in water which was amazing."

"Like so many other things in life, choice matters," says Hinds. "Women today have more choices for where, when and how they will deliver their babies."  

Lisa Iannucci is a freelance writer based in Poughkeepsie, New York. Her latest book, On Location: A Film & TV Lover's Travel Guide, will be published February, 2018 by Globe Pequot Press.