In this column, the author answers the question, "Is choosing to give birth naturally a realistic option in today's birth environment?" Women's choices of health care provider and place of birth are limited by the general belief that birth is safe only in the hospital and when managed by obstetric medicine. In the typical hospital environment, women rarely have access to the wide variety of comfort measures and the continuous emotional and physical support required to give birth naturally. Routine care practices further limit women's birthing options. The Coalition for Improving Maternity Services' document, the "Mother-Friendly Childbirth Initiative," offers direction for creating birth environments that ensure options for women who choose to give birth naturally.