I'm pregnant with my first and I'm also a birth and postpartum doula.
First I want to address your fear issues. I think it's only natural to feel some fear, because it's something you've never experienced before, which makes everything scarier, it's quite lonely feeling, and by that I mean, birth is something only you can do. Yes, that has the potential to be incredibly empowering, but it's scary. There aren't that many things in life that truly no one else can help with. And of course we live in a culture where most of our exposure to birth is very sensationalized in a scary way.
I've been very fortunate that I was able to see my half siblings (different mom) born at home and I got to see what a healthy, respected, unmedicated birth process was like. I too was born at home, but my mom had an 82 hour labor and placenta accreta (uterus was too deeply attached into the uterus), and didn't go to the hospital because home birth was illegal. So I grew up hearing about birth really negatively from my own mom (she's very supportive of my home birth plan). I was terrified of giving birth, but at the same time I had tremendous respect for birth and knew I wanted to birth at home. When I began studying to be a doula 5 years ago I was still quite scared of going through it myself. Ina May's Guide to Childbirth, really changed that. I highly recommend her books. They are extremely informative, and the one I mentioned is also full of first hand accounts of birth stories from women who, for the most part, had really positive labors. Reading lots of stories about how women enjoyed the process, even with the intense sensations, or what some described as intense pain, really affected that fearful internal voice, kinda shut it up, if you will.
Next let's address birthing location because that will lead to the topic of interventions and pain relief techniques.
In a hospital you are more likely to have to spend energy defending your right to informed denial of routine interventions. It's possible you may get nurses that take offense to your preferences and if they have a negative attitude that can really affect your birth. Some hospitals have great staff, and very supportive nurses though. If you would like to birth at a hospital, it's important to shop around.
Birth Centers allow some women to feel more comfortable and that improves birth outcomes and in that regard they can be very beneficial. However, I don't see any benefits they have over homebirth, personally, and the midwives I've talked to have agreed. They are mostly great if you'd like a homebirth but can't do it, like you share a house, or you are homeless........For me the BIG downside to birth centers is that you still have to travel when you are pretty deeply into labor, which I'm not is quite terrible, and you also have to leave the birth center within a couple of hours. They are not staffed with nurses for round the clock care like a hospital, so you have to pack up and leave right after birth. And potentially if others are birthing there too you don't have the wonderful support of individual attention that you'd have from a midwife at home. And like a hospital, there is a subtle power imbalance. It may be that no one will pressure you to do anything, but our comfort zones, our homes, are places of power for us, they allow us to more comfortably claim or needs and desires. This is one of the reasons that for many women birth goes more smoothly and with less pain at home. Many women find their labor slows when they enter a hospital or birth center. In fact, though virtually unreported, women's cervix can and do close back down when they are stressed. How frustrating to have your labor regress upon entering a hospital! That said, for some women being in the hospital makes them feel safe and relaxes them and they have no problems entering the hospital, and may in fact open faster once there.
Chemical pain relief:
Epidurals and narcotics can be of tremendous benefit. And...everything that I've learned about them has indicated to me that using them prophylactically carries more risk than benefit. We know that those drugs cross the placenta and have both a short and long term effect on infant behavior. By this I mean they seem to have more trouble acclimating to their enviroments, nursing, and engaging. (I am not suggesting that mothers and babies can't bond or that these babies aren't healthy and developmentally sound.) It seems strange to me to avoid all drugs and medications in pregnancy, only to take high doses in labor without them being really needed. And I think it's important for every pregnant women to read thoroughly all of the risks and possible side effects associated with any pain drugs. The more mild ones are severe itching, or incomplete numbing, which is difficult to cope with because none of the natural pain techniques will work once the women is totally imobilized, and slowing of labor. The more severe ones can be permanent or fatal, like back pain, spinal headaches and allergic reactions.
Epidurals very frequently slow labors down, which means they will likely want to add a pitocin drip, which makes contractions really intense, so they need to up the epidural. Not a good cycle. Once you have an epidural you are more likely to have a cesarean, in part because they tend to lower babies heart rates, and more likely to have pitocin, which is also known to significantly up the chances of cesarean.
But.........Epidurals have their place, and can be a tremendous gift. They can, when a women is far too tired, or in far too much pain, prevent cesareans, as someone on here said about her labor. And I do believe women experience things differently. Sometimes it's mental, sometimes emotional, and sometimes physical. (An example is that studies show red heads are more sensitive to pain and need high doses of pain relief). I believe dealing with ones anxieties and fears surrounding birth and learning pain management techniques make a big difference, but sometimes other things are necessary. Many women have told me that they embraced the birth goddess wholistic perspective, ended up having a different experience than they envisioned and ended up feeling isolated and angry at the community they had wanted to be a part of. They felt lied to that nobody said "even if you try, natural birth/nursing/co-sleeping/etc may not work for you". I have seen the most (as in the number of people) positive outcomes from homebirth with strong support people present. But that doesn't mean that those ingredients will make for a great birth, and it doesn't mean it's not possible for a woman to have a really wonderful cesarean with no loved ones present.
And I think it's REALLY important to find a care provider that you trust and that respects you and your decisions completely. My midwife is really clear that ANY tests or intervention is completely my choice. And she very thoroughly explains all the benefits and risks. For example, she was clear that Rhogam is a choice. She was the first to inform me that Rhogam can actually cause sensitization to the babies blood, and also the only one to mention to me that Rhogam is made from prisoners blood. What I like so much about her always phrasing everything as an option is that it puts all the responsibility square on my shoulders. It requires me to be pro-active in my care and I think that is an important aspect of birthing a child.
My recommendations as a doula are to get really well informed, surround yourself with positive birthing imagines/words/people, work through unresolved fears, don't shove surfacing emotions deep inside and be pro-active in your care. If you don't have the birth you worked for, don't blame yourself, surround yourself with supportive people, and people who can relate from experience, and enjoy your baby either way!
Didn't mean for that to be so lengthy, but it's hard to be brief when discussing birth.
Congratulations on your pregnancy!