My first was born at the local hospital. My provider was a CNM/OB group, and after I indicated I wanted to see the midwives, that's all I saw.
The hospital is the largest in about an hour radius (or more) but is still quite small. At the time, they did not have a staff anesthesiologist, so they only offered intrathecals, not true epidurals. Because intrathecals aren't left in place to deliver continuous meds, they only last about 90 minutes and wear off fast when they're gone. Because of that, all local practioners at the time strongly encouraged women to wait until they were very very far along in labor to get one if they wanted it. This also meant the medicated labor rate at the time was pretty low (I think it was less than half?) and the nursing staff were very used to natural birth.
The hospital requested a birth plan -- they handed out binders of information to expecting moms at about 35 weeks with info on breastfeeding etc, and there was a fill-in-the-blank birth plan that covered desire for medication, whether you'd prefer to tear over an episiotomy, whether you planned to nurse, circumcise, etc. A copy stayed with your provider and a copy went on file at the hospital and was actually pulled and reviewed when you showed up. Hospital also has a large jetted tub for laboring moms. AT the time, there wasn't a real nursery at all -- which meant anyone in labor at less than 36 weeks got life-flighted to a hospital with a better nursery. There was a room that they called the nursery, but no one was ever in it that I saw -- everyone roomed in.
I went into labor at 40 weeks exactly, got checked by the CNM who found me at 5cms, went to the hospital, spent awhile in the tub, then got fidgety and wanted to pace around (hello transition!) so got out, paced and rocked for awhile while DH and midwife hung out. Water broke while I was trying to use the bathroom, contractions immediately switched to strong urges to push. Pushed squatting or half-squatting for about 45 minutes, pushing entirely with the uncontrollable urges to push. Pushing felt really good -- like I was weightlifting with each heave downwards. Never felt the ring of fire (Midwife was saying I probably was, I was all, "Um, no, it doesn't burn it actually feels kinda good.") Midwife thought baby would be out faster based on how fast he started to descend, but I'm pretty sure in retrospect he had to rotate - he was posterior the whole pregnancy. DH and I were cracking jokes between pushes about how baby must have my big Dutch nose and that's what was hanging things up.
But finally he squooged out in a satifying "ploop." Despite meconium staining, there was no panic, and baby went straight to my belly where he was gently towelled off a bit and immediately put to the breast for his first nursing before they took him back to clean him up, weigh him etc. No one yanked on my cord and they waited to cut it until it stopped pulsing. I was higher than a kite on birth hormones and hungry as heck!! They got me a big plate of whatever was for dinner and I wolfed that down while DH rocked the baby. I remember feeling like I was ready to get up and dance around, and it being wierd that I was a little wobbly when I hopped out of bed to pee after I got cleaned up and changed and ate. I felt so awesome. -- I described the whole thing in an email when I got home as "awe-full, as in I was filled with awe by the entire experience."
I saw lactation consultants and got what I now know was really good advice. Most of the nurses had also gone through the process to become LCs, so they all were great with answering questions, etc. They made sure nursing was getting off to a solid start before we left, as well as checking out the fact that DS turned yellow right away (midwife had predicted it - "That's a really ruddy baby," she said. "He's gonna be really yellow by tomorrow.")
So yeah, my first birth was pretty damned awesome. Even in a hospital. I'd done my reading, I'd talked frankly with the midwives about all their policies. I also lucked out in that my local hospital still knew (knows, I hope) what birth looks like and didn't need to turn it into a conveyor belt. But I went in figuring I'd do my best and came out feeling like a million bucks...