BACKGROUND : The definition of natural birth remains nebulous for birthing people. There is a lack of consensus regarding the factors that render a birth experience no longer natural or normal. In the United States, Indigenous birthing people experience some of the highest rates of maternal mortality, morbidity, and mistreatment during childbirth, yet there remains a paucity of research on the root causes of these findings. Some Indigenous birthing people have continued to use midwives throughout the past century, indicating that even before the organized 1970s Indigenous movement to remove any connotation that pathologized birth, individual birthing people were demonstrating their resistance to the medicalization of Indigenous birth practices. Theres a gap in understanding, however, of indigenous birthing people's use of medication pain relief. We argue that understanding the intricacies of Indigenous birthing people's notions of and preferences for "natural" birth can guide the development of interventions that increase access to desired options and thereby support autonomy. Moreover, existing literature on birthing people's preferences and birth outcomes in the United States tends to examine the experiences of American birthing people generally, but to the authors' knowledge, there remains no research specifically exploring Indigenous preferences regarding the mode of delivery, hospital versus home birth, pain management, and use of midwives. AIM : This study's aim was to fill this gap, contribute to an understanding of the full scope of North American Indigenous birthing people's preferences, and catalyze further discussion regarding interventions to increase Indigenous birthing people's access to the birthing options they need and desire. METHODS : A qualitative descriptive research design was used to investigate and convey the insights of Indigenous birthing people surrounding their birth experiences and desires. A qualitative description is an approach to naturalistic investigation often used in the examination of health topics because of its strength in relaying complex experiences in everyday language. SAMPLE : All adult, women-identifying, self-identified members of a specific state-recognized Indigenous tribe in the Gulf Coast region of the United States were eligible for inclusion in this study. Thirty-one interviews were conducted. DATA ANALYSIS : The interview transcripts were analyzed using qualitative content analysis, which entails categorizing and grouping pieces of a broader data set based on common themes. RESULTS : Three major themes emerged from the analysis of participants' interviews: (a) beliefs about and desire for a vaginal birth, (b) pain management methods and preferences, and (c) beliefs about and use of midwives. This study found that Indigenous birthing people in the Gulf South have varying definitions of "natural" birth, ranging from home birth to vaginal birth to unmedicated birth to midwife-attended birth. [ABSTRACT FROM AUTHOR]