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ABSTRACT: The alternatives or choices available in childbirth may not address parents' or caregivers' concerns about maternity care adequately because the choices offered are limited, and because parents are not really free to choose. Obstetric care is organized in ways that limit choices, being a hierarchical system dominated by an engineering model of birth, in which caregivers contact parents very briefly and are themselves interchangeable, where efficiency is paramount, and where the technology that has been adopted is confining rather than freeing. Safety is a spurious issue in limiting most choices. Several ways to increase choices in childbirth are discussed.