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This summary is about birthing options in southeast Wi. from my view as a birthworker, researcher, forever student, and person.  This summary is not medically based in any way. There are three general categories:  Free birth (aka unassisted), community based with a midwife, and in-hospital.  


1-FREE BIRTH.  In this model, you are the sole power and authority for your birth.  You are the only person managing your birth and you have consciously decided to do this.  During the birth process you and your baby remain a single unit.  You birth in your home, another's home, outdoors or “other” such as a motel.  Your labor and birth are physiologic and undisturbed.  You may choose to do this alone, or with a support team.  When a doula attends free birth, the scope is the same as midwife or doctor managed births in that the doula role is non-medical, for example:  NOT performing cervical exams, blood pressure checks, blood loss estimates, baby's physical health, etc.  Some people receive medical management during their pregnancy  and then free birth, while others skip medical treatments entirely.  Some people research and make personal choices such as what to eat, water-birth etc. based on this research.  Some people birth this way because they have full faith and trust in the birth process and value the sacred nature of pregnancy and birth.  Some people birth unassisted due to fear and/or have been brutalized or traumatized by  people in the medical establishment. Some people birth unassisted when they have hidden their pregnancy. And, of course, this is a continuum with people free birthing for many reasons.
2- COMMUNITY BIRTH aka PLANNED HOME BIRTH OR BIRTH CENTER BIRTH WITH A MIDWIFE. In this model, you and your midwife together manage your pregnancy and birth.  Attention is on your over-all health and you and baby are viewed as a single unit.  You are cared for with attention, respect, and holistically.  Midwives  spend plenty of time with you at prenatals, work with you to reduce stress, and suggest you maintain your health and baby's health usually somewhat from a holistic perspective.  You birth physiologically  or close to physiologically and often primarily undisturbed. Your midwife comes to you during labor, catches your baby, and medically assesses you and your baby during labor, birth, and post-birth. A second midwife joins the primary midwife at some point during your labor so that when baby is born there is a midwife for you and one for baby.  Midwives carry emergency equipment such as oxygen, newborn CPR equipment, and medicine to stop hemorrhage.  You may have a nurse-midwife or a certified professional midwife and both are highly trained.  These midwives operate within the scope of Wisconsin law and  are accountable to the medical model; for example, you are sent for medical tests sometimes,  you must be in progressing labor at least 24 hours from membrane release, you must maintain a certain blood pressure, etc. If the midwife, at any point during your pregnancy or labor, feels you are not low-risk enough, you get “risked out” and sent to birth in-hospital. When a doula attends a midwife birth, as with unassisted birth, the role is  non-medical.  Midwives can and do help with labor support, but their basic role is “instead of a doctor” as opposed to “doula work.”  Most people choosing midwife attended birth do so because they trust the birth process, value the sacred nature of pregnancy and birth, and feel safest in a home or birth center environment

3-IN HOSPITAL BIRTH WITH A HOSPITAL BASED MEDICAL MANAGER DURING YOUR PREGNANCY. This is when you see a nurse midwife or a obgyn doctor or a family doctor regularly during your pregnancy.  There is a wide variety in the attitudes, protocols, and outcomes of these managers.  For example, induction rates, csection rates, "allowing" a birthing person to move freely during labor, degree of fear-based  advise during pregnancy, amount of prenatal testing advised and interpretation of those tests results, and more vary widely among these medical managers.  The majority of the time your care is medical-manager centered as opposed to mom-baby unit, or birthing person, or baby centered.  This often (and definitely not always) means you are viewed as machine that needs fixing and testing and external interventions because the birthing person is inherently a faulty machine.  You choose to what degree you allow the medical manger to be your authority figure.  Many people are comfortable allowing their medical manger to make all decisions and then they comply.  Some people discuss things with their medical manger.  Nurse midwives are more likely to be in this discussion model.  Some people do their own research and employ informed refusal to some or all of the medical protocol. Most of my clients birth in-hospital and as your doula I  support you as one in the circle of your medical mangers and nurses.  There are many ways to be in this circle of support, but the authority is the medical manger and hospital protocol. It is my role translate, suggest, mention options, and help, but I must never counter or interfere with a medical manger.  People choose hospital based management for many reasons of which the most common are:  planned epidural, desire to be seconds from an O.R. and/or nicu, custom,  insurance rules, pleasing a partner or other family member,  feel comfortable in hospital as a patient and with allowing medical mangers to determine outcome for their body and baby.
UNPLANNED COMMUNITY BIRTH. This happens when you planned to allow managed birth by a doctor or midwife either at home, hospital, or birth center, and your baby is born prior to the arrival of the medical provider and/or prior to your arrival at the hospital.  Most of the time this happens when you have a fast labor or fetal-ejection-reflex meaning your body goes totally primal and your baby suddenly appears earthside.  This could also happen due to logistics, such as extreme weather, traffic jams, being tied to duties such as providing childcare, family member care, or paid employment. 

Sincerely, Martha at Doula Woman in Milwaukee, Wi. 262-902-8714. And feel free to ask me how to obtain more info. on any or all of this.