10. The Role of Control in Birth

I think about the concept of “control” a lot when it comes to birth. It’s something I go over with clients and am constantly reflecting on, and it’s incredibly complex and permeates many aspects of birth and birth culture. Today, I thought I’d do a deep dive into one of the ways the idea of control shows up in these spaces. This post is a bit heavy — so please skip it if you’re not in the right headspace.

So, why does control come up so often in birth and birth culture?

At the root of it, I believe we birthers want control over our births because we want to prevent bad things from happening. When I say bad things, I’m encompassing a lot, including:

• maternal morbidity and mortality

• neonatal morbidity and mortality

• obstetric violence

• coercive provider practices

• birth trauma

• any non-consented-to care

• violation of our human rights

• any treatment of ourselves and babies that isn’t rooted in compassion, dignity, and respect

• mental or physical suffering

In short, we want a positive experience. We want to be well, we want our babies to be well, and we want personalized, respectful, consented-to care. When I say well, know that I mean it in the physical, mental, and emotional sense. A physically healthy baby and a traumatized birther does not equal well. (Don’t even get me started on the phase, “healthy mom, healthy baby,” which I see handwritten as the “goal” on every hospital white board. But that is a post for another day.) We want our labors to go smoothly, or at least similarly to how we expect, and we want our care team to listen and be responsive to our needs. We want to be supported in our decision-making and in coping with and navigating challenges.

And here’s where things get interesting… So often when birthers express any preferences about their labor and birth, they’re warned that they “can’t control birth.” It’s usually in a condescending way too like, “Aw, that’s so cute you want to do X while you’re in labor. Just remember that we can’t control everything.” Sometimes there’s even this sinister unspoken undercurrent to it as if we should just close our mouths and be grateful when we have a “healthy baby” at the end of it. We’re told, explicitly or not, not to ask for too much.

And yet, I’ve never worked with a client who hasn’t acknowledged that much of birth is out of our control. We know that birth is a bodily process, and that nature is capable of chaos as well as order. In her class on physiologic childbirth, Dr. Rachel Reed, a former midwife and current birth scholar, states, “Nature is pathology too.” Birth can go smoothly. Birth can be challenging. Birth can have bad outcomes. These bad outcomes are very, very rare (here I’m talking about bad health outcomes for baby), but they can and do happen. Overall, no matter what we do or don’t do, birth is still in many ways an unpredictable, uncontrollable force.

The interesting flip side to this is that providers also struggle with what they can actually control in the uncontrollable process of birth. (When I was drafting this post, I went on a long tangent about this, but I decided to save it for a future post on the hospital maternity care system and how it functions. Would it surprise you to learn that I have 54 more posts planned out right now? Every time I sit down to write about birth, I wind up with another topic to add to the list! This is how I know I will never run out of ideas.) 

Let’s get back to us as birthers though. How do we view (and “deal with”) control when it comes to birth? Should we give up all control, making no plans or preparations, because birth will just unfold how it’s going to? Or do we try to control everything, in the hopes that if we make all the “right” choices and do all the “right” things, birth will go how we hope? Or have I just presented you with a false dichotomy?

Here’s what I think: there are actually many more things we can control when it comes to birth than most people think, and so many of those things happen way before you ever go into labor. If we spend our time in pregnancy laying a solid foundation for birth and practicing the skills we’ll need during it, then we can create a safe and supportive space where we can truly surrender to birth. 

Because that’s exactly what we need to be able to birth our babies: a safe space. That’s going to look different for different people, and once you figure out what it looks like for you, you can start building out your supportive layers. It takes a lot of work ahead of time, but I promise it’s worth it. When you create that safe space both externally and within yourself, you can fully release yourself into the unknown of birth when the time comes, knowing you have a supportive team and safe environment around you and the skills you need to handle whatever comes up.