The Illusion of Control in Birth: A Doula’s Perspective on Physiological Birth
Nothing brings me more deeply into contact with what I consider the essence of life than witnessing, supporting as a doula, and documenting a birth through photography or film.
Even after ten years of supporting birth, I am still moved every single time a newborn is placed in their mother’s arms — an encounter that dissolves every illusion in the face of the simplest and most profound truth: life does not belong to us.
No One Creates Life: Birth as a Physiological Process
It begins by letting go of illusion, because no human being creates life.
A woman offers an egg that receives a sperm — two cells that already contain the full potential of a human being. And that is all.
Neither the woman who becomes pregnant, nor the father, nor the obstetrician, nor any other human authority decides how the organs, systems, and structures of a human being develop. Pregnancy and birth unfold as physiological processes — silently, with a precision and intelligence that far exceed human understanding.
Why Labor Is Pressured Around 39–40 Weeks
I am genuinely surprised that we continue to fall for the narrative that birth — the culmination of a pregnancy we all know to be a natural and spontaneous process — must be controlled by people in white (or light green) coats, who often show little willingness to engage in real dialogue.
With rare exceptions, obstetric practice disregards evidence-based information and persists in ignoring World Health Organization guidelines, while simultaneously assuming the authority to decide when something that nature has created should be brought to an end.
They do not create life.
They do not carry it in their bodies.
Yet they decide when and how it should be born.
As a doula, I have closely accompanied hospital births and observed that within the Portuguese hospital system — and this is echoed in many Western medical systems — the idea still prevails that babies are “supposed” to be born at 39 or 40 weeks.
From around 38–39 weeks onward, women begin to hear talk of labor induction, as if something were wrong with babies who have not yet been born — despite the fact that pregnancy is a naturally variable process that can last anywhere between 37 and 42 weeks.
Evidence, Risk, and Fear in Modern Obstetrics
Scientific evidence does point to a slightly increased risk of certain complications after 41 weeks of gestation. However, in healthy pregnancies, this risk remains low and can be safely monitored through appropriate fetal and maternal surveillance.
Despite this, obstetric practice often chooses to ignore nuance, generalize fear, and pressure women into induction. The word risk is frequently used in vague, unspecific ways — even when, up to that point, both mother and baby are doing well.
The result is the creation of unnecessary stress — deeply counterproductive for a pregnant woman and for the physiological unfolding of labor itself.
It Takes Two to Tango: Shared Responsibility in Birth Choices
History is full of examples of individuals, institutions, and systems driven by power and control over others. What continues to surprise me is that, in an era of easy and free access to information — and with so many doulas supporting women and families through evidence-based care — we continue, collectively, to comply with interests that do not place the rights of women and babies at the center.
The persistence of this system is not sustained by the medical profession alone, but also by how easily we delegate decisions and relinquish responsibility. It takes two to dance.
As long as we accept without questioning, as long as we normalize the surrender of rights in exchange for a false sense of safety, we place ourselves in the background.
Seeing ourselves solely as victims of the system may be comforting, but it is also a subtle form of disengagement. Meaningful change requires awareness, informed choice, and shared responsibility.
Birth Is — and Always Has Been — Physiological
The way birth is approached has changed throughout human history, but birth itself has always been — and will always be — a physiological process.
When, as citizens, we are willing to look at this evidence with seriousness and responsibility, we may begin to understand the broader impact of our choices — not only on the health of those who give birth and those who are born, but also on the economy, public health, and politics of a society.
Until then, we will continue to live under the illusion of control and safety.
Preparing for Birth Is Not About Accumulating Information
Birth preparation is not about memorizing concepts or collecting information. It requires an investment in practices that reconnect us with the body and with the rhythms and cycles of nature, so that such an intense experience can be lived from the inside out — from a place of real trust and embodied awareness.
As long as we continue to place our trust, for something that belongs to the natural cycle of life, in technology and in forms of care that are not evidence-based, we will continue to multiply disconnection, trauma, and control over women’s bodies.
For this reason, I integrate conscious, body-based practices throughout pregnancy — such as yoga, regulated and conscious breathing, movement, and massage.
These practices may sound commonplace, but they are essential. They regulate the nervous system and prepare both body and mind for the challenges of labor and birth.
When integrated into daily life, they allow the nervous system to find rest. Day by day, they help a woman build a relationship of trust with her body. From that embodied trust emerges the ability to move through labor from the inside out — with surrender, awareness, and empowerment.
The Role of the Nervous System in Labor and Birth
The nervous system is the great mediator between body and mind. It perceives the environment, interprets what is safe or threatening, and adjusts the body accordingly.
Birth is, by nature, an intense physiological process that can easily place the nervous system into alert mode — inhibiting key labor hormones such as oxytocin and endorphins, which only flow freely in environments of privacy, safety, and calm.
Having access to clear, evidence-based information during pregnancy — information that confirms the body knows more than the rational mind can grasp — is not enough to withstand the pressures of an outdated, intervention-focused maternity care system, nor the challenges the body and mind will face during labor.
This is why it is essential, during pregnancy, to invest in practices of relaxation, surrender, and embodied presence — cultivating trust in oneself and in the body’s innate intelligence to respond appropriately to the experience of giving birth.
The body needs repeated opportunities to activate the parasympathetic nervous system, allowing regulatory mechanisms to be integrated well before labor begins.
An Invitation to Reclaim Responsibility
This is an invitation to let go of the illusion of control and reclaim responsibility.
Responsibility for the choices we make, the information we seek — or avoid — the systems we legitimize, and the bodies we inhabit.
As a doula, I have witnessed again and again how trust in the body is built day by day.
Trusting the body is not naïve or romantic. It is a political act — conscious, informed, and deeply intentional.
It is the recognition that life carries its own intelligence, and that our role is not to dominate it, but to create the conditions in which it can unfold with the least interference and the greatest respect.
About the Author
Susana Pereira is a doula, birth photographer, and yoga teacher supporting women and families through pregnancy, birth, and postpartum. Her work is grounded in evidence-based birth care, nervous system regulation, and deep respect for the physiology of birth.
