As a certified doula since age 16, I felt beyond passionate about pregnancy and birth. I joked with friends that I would be the first to have a baby just to create a positive birth narrative in their minds. I told my now-husband on our first date during my freshman year of college that he would one day talk about how inspiring it was to witness me, his wife, give birth. I spent most conversations and college papers debunking labor and delivery myths and laying out how broken our maternity care system is. Let's just say I was a little off from the average teenager.

I ended up being the first of my friends to get pregnant. I asked all our loved ones to send natural birth encouragement videos to watch during labor. I asked my closest friend Julie to be at my birth. I want you to see what a beautiful, natural birth looks like, I said. She was excited, but also nervous that she didn’t know enough. Don’t worry, I kept telling her. I have complete confidence that my body will know what to do.

Then one early May morning, I rolled over in bed to wake up my husband. It’s time! We started our list of comfort rituals: massage, shower, watching movies. Hours passed and the contractions did not increase in intensity or frequency. What’s happening? my husband kept asking, expecting me to have all the answers. I usually did. My body is just getting ready for labor, I guessed. I will have my perfect birth, although maybe not today, but maybe tomorrow.

These contractions went on for weeks. I fell asleep with pain and then woke up every hour with more pain, but never enough. My husband got tired of hearing It’s time! And I got tired of saying it. I found it impossible to sleep and yet stayed too frustrated to be awake. Would this actually be "it" tonight? I kept breathing, swaying, and changing positions. My birth experience was supposed to be medication free but I turned to OTC pain killers for some hope of relief. When was this going to end?

You are 2 centimeters dilated, said the midwife we finally saw. After weeks of unbearable pain and sleepless nights, that’s all my body did? That was not possible. I wanted to be holding my baby close by now. I had already lost a baby before all this, after many months of pregnancy. I needed this, a normal, fast, natural birth. I deserved this. But instead, I was hearing Let's have you try morphine for sleep and I think you would benefit from Pitocin and an epidural. My husband and Julie held each of my hands, squeezing them tighter with each word. They knew this wasn’t what I wanted to hear.

I agreed. I felt so exhausted and weak. I started to worry about my baby and my own health. Perhaps I would not have a completely natural birth, but I knew surgery would not be necessary. I had no medical conditions. I was in my mid-20s. All the while, Julie continued to stroke my hair and tell me I was strong. She and my husband had been awake with me for 50 hours by now. They became the ones who knew exactly what to do as I started to feel completely lost.

The next few hours were somewhat peaceful. Sleeping never felt better. I got to hear that I was 10 centimeters dilated and would soon hold my baby. Finally, I had the chance to redeem myself, to show the world that my body was worthy. I pushed, I pushed, and I pushed. I pushed on my hands and knees, I pushed holding onto a bar, I pushed on my side, on my back, and on my other side. I watched, through a mirror, as my baby’s head came down towards the world for a millisecond and then retreated back into the womb. I’m so sorry, said the midwife after four hours. Your baby is not moving down the birth canal.

This must all be some sort of mistake, a terrible joke. Why was I so cursed? I feel so terrible I’ve traumatized your vision of birth, I said to Julie as they placed the surgical cap over my hair. These were the last words I said before they took me to the OR. I had never felt more like a failure.

The second I was able to hold my baby boy after surgery, I put all my energy into loving and nursing him. I never watched the encouragement videos from my friends. I did not want visitors or to talk on the phone. I was too afraid people would ask about the birth. I refused to look down at the scar. I moved around as if I was not recovering from surgery. This was not the birth I wanted, and so it did not exist ... except for those moments, in the middle of the night, when I felt like the only person awake in the world. Only then would I remember the bright lights, the blue gowns, and the sterile air. How did that possibly happen to me?

It’s been three years now. For a long time, whenever the subject of childbirth came up with Julie, I instinctively looked away and said, Like that time I traumatized your vision of birth. Although she usually thinks I’m funny, she never laughed at this. She would look at me straight in the eyes and firmly tell me that birth is beautiful, that my birth was beautiful too, one of the most special memories of her life. She reminded me of the strength and grace I had demonstrated. She is such an honest friend that I had to learn how to believe her, and to believe in myself. I had to learn I did nothing wrong and there was nothing wrong with me.

When my friends now ask me for the advice I have about pregnancy and birth, I’m finally OK sharing the messiness and beauty of my own birth. It’s not what I wanted, but it is part of who I am. My advice is simple: to accept, even embrace, the uncertainty and lack of control we face when bringing babies into this world. It's what makes pregnancy and birth so magical. I started to truly believe my own advice by the time I welcomed my daughter into this world two years later. In doing so, I began to see birth as beautiful again.

Now, as a physician for hospitalized adults, I care daily for people that also have incredibly strong expectations about their health and illness. I try to be proactive in telling patients to be optimistic and motivated, but also prepared for all possibilities. There is so much we cannot predict. Will the antibiotics stop the infection in time? Will the cancer be cured, or at least go into remission? We can hope, but we also worry. What we can control is being flexible and forgiving; being OK with the unknown. I know it's hard. I try to be patient and understanding when patients show their frustration and disbelief. I remind myself just how disappointed I was when my birth did not meet the perfect vision I had. I try to sit with this sadness. I don't see the point of trying to ignore it or push it away. Time may help make it more OK. I also remind myself that the best thing I did was surround myself with the two people I love most in the world and choose providers I trusted. Now with my own patients, I advocate that they lean on their support networks and I encourage shared decision-making. Even if a desired outcome is not obtained, I hope that the experience of feeling loved and heard can make it a little more manageable.

Charlotte Grinberg is an oncology hospitalist at Beth Israel Hospital in Boston, MA. She has a particular interest in palliative care and narrative writing. Her writing has appeared in JAMA, Health Affairs, and the Annals of Internal Medicine. She is a 2020–2021 Doximity Op-Med Fellow.