The Illusion of Control in 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: no one creates life!
Why everyone says that birth is a physiological process?
When we look at pregnancy, there are thousands of processes taking place within the human body. For the sake of simplicity, let’s focus in the general process: a woman offers an egg that receives a sperm—two cells that together contain the genetic blueprint of a new human being.
From that moment, the fertilized egg begins to divide. Cells differentiate into different tissues, organs, and systems, that gradually gives form to a unique human being. The complexity of this process is extraordinary, and yet it unfolds without conscious direction from any human being.
Neither the woman who becomes pregnant, nor the father, nor any obstetrician, nor other human authority decides how billions of cells organize themselves into a functioning human body.
Can we agree that pregnancy and birth are guided by intricate biological mechanisms that operate largely beyond conscious control? We surely can influence the conditions surrounding them, support them, monitor them, and, when necessary, intervene. But we do not create or direct the fundamental processes themselves.
Perhaps this invites us to let go of the illusion that we are in control of life and instead recognise that our role is to receive, support, and care for a process whose complexity and intelligence continue to exceed our full understanding.
What happens 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 ( light green or blue) coats, who often show little willingness to engage in real dialogue based in scientific evidence with the person that carries the miracle of life unfolding in her own body.
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.
This means that if your pregnancy is being followed by a Portuguese Obstetrician expect to start hearing about labour induction around 38-39 weeks despite the fact that you are having a regular pregnancy and you and your baby are healthy.
Typically, Portuguese OBs, and yes, of course, there are exceptions, act with low-risk pregnancies as if something were wrong with the mothers and their babies who have not yet been born until 40 weeks of gestation ( on the limit 41 weeks)—even though pregnancy is a naturally variable process that can last anywhere between 37 and 42 weeks.
Evidence, Risk, and Fear in Modern Obstetrics
At this point, it is important to clarify that we are speaking exclusively about low-risk pregnancies, which represent the majority of pregnancies, not pregnancies complicated by medical conditions such as hypertension, diabetes, fetal growth restriction, pre-eclampsia, or other factors that may justify different recommendations and interventions.
The question is whether recommendations designed for higher-risk situations should not automatically be applied to women experiencing healthy, low-risk pregnancies.
One of the challenges women face when they are introduced to the topic of induction after 40 or 41 weeks is how the concept of risk is communicated.
Healthcare professionals often refer to an increase in risk without always distinguishing between relative risk and absolute risk.
Relative risk tells us how much a risk has increased compared with another point in time. For example, if a risk increases from 0.4 per 1000 pregnancies to 0.8 per 1000 pregnancies, the risk has doubled. This represents a 100% increase in relative risk.
Hearing that a risk has doubled can sound alarming. However, absolute risk tells us how many additional pregnancies are actually affected. In that example, the risk increased from 0.4 to 0.8 per 1000 pregnancies. In absolute terms, this means an increase of 0.4 additional deaths per 1000 pregnancies. Can we see that even if it doubled is still not even 1 death per 1000 pregnancies!?
So, both statements are true and It is essential that women understand both:
- The risk doubled (relative risk).
- The increase was less than 1 additional death per 1000 pregnancies (absolute risk).
When researchers looked specifically at low-risk pregnancies, the rates of stillbirth remained very low. As Rachel Reed highlights:
“When the review looked at data for low-risk pregnancies, the rates of stillbirth were even lower – 0.80 per 1000 at 41 weeks and 0.88 per 1000 at 42 weeks.”
You can read full article HERE:
https://www.rachelreed.website/blog/induction-of-labour-for-prolonged-pregnancy
This does not mean that risk should be ignored. It means that risk should be presented accurately, transparently, and in context.
The question should therefore not simply be whether risk exists. Risk exists in every pregnancy, every birth, and indeed in every aspect of life.
There is no such thing as a risk-free pregnancy, a risk-free birth, or a risk-free intervention.
The question is not how to eliminate risk—an impossible task—but rather how to understand the different risks and benefits associated with each option.
When discussing induction after 41 weeks, women deserve to know not only the risks associated with continuing the pregnancy, but also the potential risks, consequences, and benefits associated with induction itself.
The relevant question is therefore:
What are the risks and benefits of induction compared with the risks and benefits of continuing the pregnancy under appropriate maternal and fetal surveillance?
Too often, discussions focus almost exclusively on the risks of continuing the pregnancy, while the potential risks and consequences of induction itself receive less attention.
Induction is not a neutral intervention. Depending on the method used, it may be associated with stronger and more frequent contractions, uterine hyperstimulation, changes in fetal heart rate patterns that may raise concerns about fetal wellbeing, epidural analgesia, instrumental birth, and further medical interventions.
Only when both sides of the balance are considered can a truly informed decision be made.
It Takes Two to Tango: Shared Responsibility in Birth Choices
As long as we accept without questioning because we get frightened, and 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 the effects on the economy, public health, and politics of a society.
Until then, we will continue to live under the illusion of control and safety.
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.
In a future article, I will explore what this trust looks like in practice, and why preparing for birth requires much more than simply gathering information.
