Choosing the best birth location for your birth is an individual choice.  Having a friend or family member that liked a birth location won't tell you what that birth location can do for you.  The best way to choose the best birth location for your birth is to take a tour of the location and know the routines and policies that birth location utilizes for birth.  Considering home birth, birth center birth, and hospital birth can all help to provide you with the most well rounded approach to making an informed decision for your birth.  In most cases, your care provider determines the birth location, so choosing the birth location and care provider are choices that go hand in hand.

Trusting your birth location for the options available to you that allow you to feel comfortable laboring in this space for the pregnancy that you are experiencing now will allow your oxytocin levels to be at their highest for labor progression rather than labor suppressing adrenaline.

Why are You Selecting This Birth Location?

Are you selecting a location other than your home?  Do you know why you are selecting home or not your home? Your birth location not only comes with your care provider, but also the team of people working with your care provider.  In most hospital births, your care provider won't even be present until shortly before the actual birth, so you need to be well aware of the staff that you will be interacting with as if they were the chosen care provider.  Routines and policies can influence not only what you may have to request differently than the routines, but the respect you receive during labor, birth, and the days following.

Use the table below as a guide to help you find the best birth location and birth environment for your #happyhealthybirth.

Thoughts and questions to ask yourself and to research about your chosen birth environment Biological Birth Supportive May want to seek other location
I am excited to walk into my chosen birth location and it feels like a place I can kick up my feet and relax if I want to without feeling like I'm burdening anyone YES NO
I enjoy the presence of the staff or assistants available in this birth locations YES NO
I do not have time limits for birth expected of me in this birth location YES NO
Medications are not a first recommendation for labor progression YES NO
Cytotec is NOT a method used for induction at this birth location YES NO
Pitocin is NOT a routine approach to the birth of the placenta or following the birth of the placenta YES NO
Eating and drinking is encouraged, as the mother desires, during labor YES NO
Movement is encouraged through labor YES NO
Quiet, calm, and dark environments are encouraged through labor and birth [the pushing stage], as well as the first few hours after birth YES NO
Using the placenta for postpartum hemorrhage is an option YES NO
The cord is routinely kept intact until the placenta is birthed and the cord becomes white and stops pulsing YES NO
Lotus birth is an option YES NO
Staff do not become aggressive or sarcastic when handling home birth transfers YES NO
Women choose their own labor and birth position YES NO
Doulas are encouraged to be present and respected YES NO
Siblings can be present during labor and birth YES NO
Water (tub or shower) is encouraged and available as a method of relaxation through labor and birth YES NO
Physical and emotional support is a first approach to helping a mom be confident and comfortable through labor, not medications YES NO
Staff encourage me to talk with my birth team about the benefits, risks, alternatives, intuition, and choosing not to use a recommendation or option YES NO
Babies are encouraged to be skin to skin with mom, or dad if mom is unavailable YES NO
Mandatory nor encouraged nursery time is NOT a part of routine care YES NO
Experienced lactation providers are available at all hours and days and a part of routine care for new mothers YES NO
Birth partners are encouraged to participate and are supported through labor, birth, and postpartum YES NO
I don't feel like I need a birth guide [birth plan] to get the birth that I desire at this location because the routines and policies align with my views of birth and care throughout labor, birth, and postpartum for me and my baby YES NO

Of course, the ideal is a YES to all of these, right?  At least much more than the majority. Are these the only priorities?  No, of course not... and there are many other factors that will play into the quality and care of a birth location.  Each mother may have different needs that help her determine the specific options she may want to utilize during birth, but facilities and the staff that support in those facilities create an environment of belief of the body's ability, or belief that birth is always a risk waiting to happen.  From unassisted birth to any level of risk, providers can be supportive of birthing families through respectful care.

You ALWAYS have a choice in birth, in pregnancy, as a parent.  Always.  Even when it appears that there are no choices available for your birth, you still get to make the choice to make a choice, or not.  You get to decide if you want to learn something new, try something untried, travel, be at home, just say No Thanks, or learn a new perspective on your situation.

Birth choices can sometimes be hard.  Birth Choices can challenge our views.  Birth Choices can challenge our beliefs.  Birth Choices can sometimes not feel like choices at all.  But the fact remains, you will be making choices that support your birth everyday.  Let's look at what these choices might be:

Birth Choices for Optimal Nutrition

Adequate nutrients allows your hormones to function adequately (including oxytocin), your body to digest what it eats (avoiding toxin overload and even hemorrhoids), and nourish your growing baby.  You get to choose what you eat, drink, don't eat, and don't drink.  Some of these choices you make may include:

  • Reducing or eliminating added sugar
  • Reducing or eliminating unnecessary caffeine drinks - switching to herbal coffee - switching to nourishing tea
  • Drinking enough
  • Eating hydrating foods
  • Eating donuts and cookies
  • Eating enough greens
  • Eating all the colors of the rainbow
  • Reducing processed foods
  • Making your own processed foods
  • Reading labels
  • Learning about balanced nutrition
  • Getting healthy fats, proteins, and carbohydrates
  • Eating whole foods
  • Eating fast food
  • Trying a new dinner
  • Learning to cook
  • Leading the family with healthy habits
  • Explaining to your family the necessity for healthy eating
  • Reducing or eliminating dairy and other allergens
  • Eating enough
  • Eating small meals throughout the day
  • Getting support for healthy eating habits
  • Taking it one food at a time - one meal at a time - one step at a time

What can you add here?  What questions do you have about nutrition that you feel like you're stuck in a choice?

Birth Choices for Optimal Alignment

Aligned movement throughout the day provides you with optimal comfort, supports your growing baby (avoiding pregnancy "symptoms"), and improves the birth process due to fetal positioning.  Aligned movement also improves healing postpartum and helps avoid common breastfeeding concerns like painful nursing and "tongue tie."  Birth choices for alignment that you can make may include:

  • Seeing a physical therapist & receiving body work
  • Moving more
  • Moving better
  • Checking your body and pelvis alignment
  • Stretching often
  • Walking more
  • Getting rid of the positive rise shoes (yes, including sneakers and many "flats" and men's shoes)
  • Developing butt muscles
  • Using your whole body for movement
  • Joining a movement group like Esali Birth's MOV for Birth walks or hosting one yourself
  • Creating a dynamic work station where you sit, stand, stretch your legs, squat, lie down...etc.
  • Balance your movement to keep all movement and sedentary positions at equal amounts
  • Squat to eliminate, like with a Squatty Potty.

What is your favorite way to move?  Have you checked your alignment?  Are you feeling "symptoms" of pregnancy that are actually "symptoms" of ill-health and poor alignment?  Make the connections and feel better!

Birth Choices for Optimal Oxytocin

Oxytocin, among many other hormones, is vital for a happy healthy birth.  Oxytocin allows spontaneous labor, allows labor progression (with proper alignment), prevents postpartum hemorrhage, helps us to bond with our baby, creates the breastfeeding experience, and brings us closer as a family.  There are many moments throughout your day to improve oxytocin which may include:

  • Relationship building activities
  • Relationship therapy
  • General or trauma therapy
  • Birth counseling & perinatal mentoring
  • Eye gazing
  • Touching
  • Tea with a friend
  • Petting your dog
  • Back rubs and massages
  • Saying "Three Nice Things"
  • Learning about the birth industry and birth physiology to reduce fear

Do you feel at ease with birth?  Are you fearful of something in the birth process?

Birth Choices for Care Provider & Birth Team

The people you have with you during birth from friends and family to the doula, the nurses, the midwives and the obstetricians, all influence your options for birth and how you feel.  Care provider and birth team options available (though sometimes you have to be savvy about finding them) include:

  • Choosing unassisted birth
  • Selecting a doula
  • Midwifery Care
  • Family Practitioner Care
  • Obstetric Care
  • A combination of midwives and doctors
  • Licensed providers & unlicensed providers
  • Adding people to your birth space
  • Removing people from your birth space
  • Telling one of the staff to leave your birth space or "firing" your provider
  • Knowing your birth rights

Does the relationship with your birth team feel connected?  Do you feel trust between those you've

Birth Choices for Birth Location

Where you birth goes hand in hand with who you allow in your birth space.  Where you birth not only dictates the routines that are common, but also the amount of control and comfort you have for making decisions.  Birth location choices may include:

  • Home birth
  • Birthing in the woods
  • Birthing at a friend's house
  • Birthing at a hotel
  • Birth Center Birth
  • Hospital Birth
  • Birthing at your midwife's house
  • Changing your mind about your birth location, for any reason, during pregnancy
  • Changing your mind about your birth location, for any reason, during birth or postpartum

Your birth location isn't set in stone.  You can decide to change anything about your birth location and care provider at any point in time.

Birth Choices for Healing & Support

Knowing what you have available for support helps you reach out in times of need.  Healing and support options for birth may include:

  • Researching care providers, therapists, breastfeeding supporters, postpartum care, mom groups, family groups, loss groups, play groups
  • Writing down contact information for people and keeping it handy
  • Actually calling the people available for support
  • Paying for support
  • Asking your insurance if they will cover support
  • Resting
  • Journaling
  • Reducing the activities on the schedule
  • Taking off extra time from work
  • Quitting your job
  • Changing jobs
  • Changing work schedules
  • Telling your family how to help
  • Expecting your family to help
  • Prepping meals and snacks and routines when extra hands are available
  • Asking for meals (at any time)
  • Finding a mother helper
  • Not asking for support
  • Doing it all or not doing it all

You don't have to do it all.  Period.

Birth Choices to Speak Up

You get to decide if you speak up about what you need.  It can be hard to do that, but you get that choice.  Finding the group that supports your desires is easier - it means less arguing and adrenaline in your birth space (or during pregnancy or postpartum). Some options for speaking up include:

  • Saying, "No Thanks."
  • Saying, "Not Right Now."
  • Asking for privacy
  • Getting a new nurse, provider, asking someone to please leave your home
  • Being respectful and being forward
  • Refusing an induction
  • Refusing vaginal exams
  • Refusing a cesarean
  • Finding a lawyer
  • Standing up and signing yourself out
  • Keeping your baby with you
  • Telling people thank you for their care
  • Changing your mind

It may take time to have the confidence to speak up, but THIS is the most important choice because YOU get to decide if you remain silent.  Sometimes there are so many routines in our world others don't think automatically about what each individual person wants.  It is OK to ask for what you want.  You do not have to do what someone else says simply because they recommend it (or are disrespectful).

There are a lot of people that care about you and your birth and respect that mothers and families are capable of making informed decisions.  Know this about yourself, and you now know that the choice is yours.



photo from

Birth guides, or birth plans, are lists that lay out your priorities for labor and the immediate postpartum. Whether at home or in the hospital, these can become great communication tools for your birth team (which includes your birth partner, doula(s), assistants/nurses, and your provider). What is important to keep in mind, however, is that a birth guide should only be used as a reminder and only *after* you’ve carefully selected your birthing environment and birth team.

A birth guide cannot fix choices that don’t support your idea of a healthy and happy birth.

What does a birth guide include?

  • Introduction – Brief information about you and often accompanied with a box of cookies for the nursing staff. Baking homemade cookies are a great early labor activity.
  • Labor Wishes – Include priorities such as your wishes for natural or medicated birth, ability to move and eat as you wish, and suggestion preferences from the birth team (including staff/provider) on how to birth your baby.
  • Birth & Newborn Care Wishes – Will you allow the cord to stop pulsing on its own? Will you avoid vaccines or eye treatments? Have someone remind the staff that they are required to ask your permission before performing any procedures on you or the baby. Sometimes, this is overlooked. Will you allow the placenta birth to come naturally?
  • Emergency & Cesarean Birth – Do you want to watch your baby being born? Which hospital would you prefer to be transferred to in case of an emergency? Which hospital would you prefer your newborn transfer to in case of an emergency?

There is a lot to think about, so start taking notes now. Find a provider (if you wish) and birth location that matches your belief of safety, health, and happiness for your baby and your family. Then, narrow down your priorities and consider alternative options for when birth takes a different course. This is why Esali Birth likes to refer to this as a birth “guide” and not a “plan.” You can’t plan biological birth – but you can prepare for it!

Keep your birth guide to no longer than a page, and only list simple bullet points that are easy to read and understand.  Remember that if you're birthing in a hospital, the team probably has multiple other mothers they're working for and a lot of paperwork to complete.  Take a hospital tour to get to know some of the staff before hand and know more of what to expect from the facility so you can better judge your choices.  If you're at home, your birth team likely has taken a lot of time already to understand your vision for birth. If you exceed a page, you might want to consider changing your location and/or care provider to better match your wishes.

To learn more about all the options you have for birth, and in depth details on how your choices influence your baby and your birth, take an Esali Birth perinatal education class locally or online!


A lot of people have a very skewed perspective of what a professional doula is and how this differs from other birth support.  This is because doulas, like all birth professionals... and humans, are different.  Their perspective on birth is different, their practice is different, the locations that they work within are different.  This doesn't make one way right or wrong... just different.  A lot of hype has come up recently about a doula's ability to "really help" a birthing mother.
I wanted to shed some light on one perspective of this...If someone is a part of certain doula certification organizations - those organizations limit what their certified doulas can or cannot say/do. It is different for each one. It is a liability for the company if a doula starts telling moms "no, you don't need that medicine. No, there isn't anything wrong...etc...etc." It is also an issue for the women when the doula should not be providing medical care... that isn't her experience or area of expertise (as a doula).  A doula is support NOT a care provider or nurse.  An independent doula *can* say whatever she wants without risking her certification... but if she starts giving medical advice, she risks issues from the hospital or care provider regarding that... and possibly lawsuits depending on what her suggestions affect.  It will be her personal business if she offers that service or not.  (Esali Birth mentors are completely independent and accept their own personal risks for how they carry out their services.  They should, however, practice logic and understanding).
A doula can't tell a provider or hospital staff what to do... but neither can her husband. In the end, it is the MOTHER's choice to do or not do anything until she is in a position of not being able to make a decision for herself - in which case she has already signed her rights over to the care provider to make decisions on her behalf in the moment.  If a situation is not "in the moment" then a living will provides someone else rights to make decisions for her - that is, if she has a living will.  Esali Birth mentors encourage birth students/clients to make their wills when they're pregnant if they haven't already.
However, in the US, we do have laws protecting people from abuse... any abuse... and anyone can speak up about that.  We also have programs like Improving Birth that shed light on various maternity related issues which also include birth abuse.  A lot of people (doula or not) won't, however, because it can be an awful feeling to have a bully come down on you for speaking up against any form of abuse.  Right or wrong to not speak up, it is one of the reasons it doesn't happen when it could.  Additionally, not many will say when... or if... medical staff are abusive; they just go along with it believing a birthing women has to "listen to her doctor." What can a doula do in this situation?  A doula can *remind YOU* of your rights and unbiased options.  They can speak up against #birthabuse.  If they will is individual.  What your responsibility is, as with all birth responsibilities, is to interview your potential doula and ask what THEY will or will not do for you.  Every doula is different, just like every care provider is different.   An OB is not the same everywhere.  A midwife is not the same everywhere.  Hospital birth is not the same everywhere.  Home birth is not the same everywhere.
All this being said - the reason women hire a doula is FOR the emotional and physical support because even with a hospital that supports birth plans, there is usually not enough staff to provide continuous support to the mother - and because birth is *mostly* an emotional event (OXYTOCIN gets the baby out AND provides mom with a satisfying experience... when its natural oxytocin) - moms NEED to feel safe. For most moms, feeling EMOTIONALLY safe is often only attainable through a doula.... like a mother that *really* understands birth.... not understands birth in the past 50 years... but real, raw, birth.  Some of us have this, others don't.  This doesn't mean a doula replaces a mom or a husband...  it is just a different, often incredibly beneficial, style of care.
Doulas rates on increased positive outcomes (both emotionally AND physical health of the mom and baby) are because of their *continuous* emotional and physical support.... NOT because of medical or perceived medical assistance.
That being said. If you NEED someone telling you your provider is lying to you.... then you NEED to hire a new provider. If you NEED someone whispering that the nurses at the hospital are lying to you... then you NEED to birth somewhere else.
[heading type="h3" margintop="28px" marginbottom="28px" bordered="no" align="center"][color]Whether a doula can or cannot say things doesn't fix a choice that should have been changed because you know you're not birthing in a supportive environment. [/color][/heading]
Most doulas I know don't provide on the spot childbirth education... they either recommend/require childbirth education before taking on a client, offer classes themselves and/or won't take clients unless they've proven they're educated or taken a class from that specific doula.  This isn't just for the doula, it is also so the mom... family... can have the best birth (health and happy) possible.  It is so that the client isn't expecting the doula to be a superhero during the birth. They can certainly seem like superheros, but they want to enjoy their job, too... and they want to be able to do their job to the best of their ability. 
We wouldn't have so many issues in births as it is if providers *required* ....  offered... excellent perinatal education.  Unfortunately, again, most classes that are scantily recommended are "how to be a good patient."  Or, "you can have a great birth if you don't have an educated birth philosophy or wish to do things 'out of the norm' - just do what we say, and here is #whattoexpect."  At Esali Birth we share how to make choices and why they're important.
Knowing your options and making choices that support your birth beliefs comes *before* hiring a doula. The doula then supports you AFTER you've chosen a supportive environment. No matter what a doula can or can't say - if the mom hasn't chosen an environment (provider/location) that supports her wishes - the doula can't magically create a positive experience.  It might happen (because doula support can make that big of a difference) - but it isn't the best situation for anyone. If anyone has to fight for the mom's rights - even though that's a legal option - it makes the birth space an intense place to be for someone... often the mother or the father... and neither of them need to be doing anything other than bonding with each other and their baby!  We're trying to build oxytocin, right?  Not just because its safer for mom and baby... not just because it progresses the birth process... but also because oxytocin builds in everyone in that birth space.  This is an event from a higher power that knew that mom and baby will need a lot of love and support during the postpartum period. 
[heading type="h3" margintop="28px" marginbottom="28px" bordered="no" align="center"][color]Make birth as simple as it can be by understanding that birth is a profoundly intricate transformation.[/color][/heading]
Believe this, make the choices that support it, and birth is (in most cases) incredibly simple.
In an environment (location/birth team) that SUPPORTS biological birth AND a mom that has a birth partner (her husband is wonderful when they're relationship is connected and respectful, or mom, or friend...etc....... a midwife)... that truly understands biological birth and the need to be quiet and let mom instinctively do her thing... a doula might not be necessary. Or, a doula might be that birth partner that is quiet and lets mom do her thing - and giving her the confidence to do so.
You have to understand that [color]BIRTH IS EMOTIONAL[/color]. Almost all complications with birth these days stem from an incredible misunderstanding that humans can or should meddle with birth. If you don't believe that you can #freebirth (birth unassisted... birth alone... birth without a care provider) - then I would encourage positive continuous support... which is exactly what a doula provides.  Someone else on your birth team may already provide that, I don't know... but it isn't a black/white "a doula does this" kind of situation.  It depends on what you need, what you want, and where you're preparing to birth.
A montrice on the other hand is often a midwife who is providing doula services. They can do limited provider care for the mom because of their midwifery background.... but they don't intend to catch the baby as a provider nor take responsibility in that manner. Once they get into a birthing facility or hospital, their ability to act as a sort of care provider stops because of liability with the hospitals and providers in that location.  Their role moves towards that of a doula.
I hope this clears up some of the issues regarding if you should really save/spend the money on a doula.  What have your experiences been?  Can you add to this?


Tell me your story. I'd love to help you have a happy healthy birth!

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