What Presence Asks of Us
Notes from a Doula on Birth, Loss, and Becoming.
A few weeks ago, I sat across from a woman preparing to welcome her first child. She was thoughtful, articulate, and visibly uneasy. She was looking for a doula to support her and shared with me that her relationship with her current doctor felt impersonal, even transactional, yet she was reluctant to switch. She’d already paid a concierge fee of $5,000 and changing doctors felt like more risk than she was willing to take.
I gently asked how she was feeling both physically and emotionally. Her voice trembled as she spoke. She told me she was considering an amniocentesis, a procedure where a long needle is used to draw amniotic fluid from the uterus in order to test for genetic abnormalities in the baby.
I asked with curiosity what had prompted this choice. Had something come up in her pregnancy, any red flags or medical concerns? She shook her head. Everything appeared healthy. No anomalies; no conditions to speak of. The baby was growing as expected and her body was adapting as it should.
So I asked her why she wanted this test.
She admitted, almost apologetically, that what she was really seeking was certainty. She wanted the kind of assurance that she believed a medical test, something supposedly definitive and measurable, could offer. Not because something was wrong, but because she needed the certainty that the baby was healthy because she did not want to have a child with special needs. "That’s just not the kind of life I want to live," she said.
Her words hit me like a ton of bricks because of the proximity to something deeply personal in my own life. She didn’t know that my brother had been born with a rare genetic condition. She had no idea that he passed away just before my sixteenth birthday, or how profoundly his life and his loss have shaped my own. The ways his presence continues to echo through my life are too intimate to fully articulate here.
Her words burned the back of my throat. I don’t usually share personal stories with potential clients because it’s rarely relevant, and their choices should be guided by what feels right for them, not by my own history. But in that moment, I could feel how tightly she was holding on. She was torturing herself with the need to control, the need to know; a knowing that, in truth, can only come through living.
I could hear the ache beneath her words, the desperation to find clarity in something that felt too vast and too uncertain to contain. She wasn’t being unreasonable or cold; she was afraid. And fear, when left to its own devices, takes the shape of control. It offers the illusion of safety, when what we truly need is comfort, connection, and the courage to sit with not knowing.
So I told her something I knew she probably wouldn’t want to hear, something that wouldn’t offer the reassurance she was searching for, and something I suspected might mean we wouldn’t end up working together.
I said, “I don’t think you’re going to get the certainty you’re hoping for. Even if the test comes back ‘normal,’ there are no guarantees. I imagine you’ll find something else to fixate on, because that’s what fear does. It searches for something to hold. And control, while comforting, offers only the illusion of safety in what is, by its very nature, an unpredictable experience: being pregnant, bringing life into the world.”
She looked away. I knew I didn’t say what she wanted to hear.
This conversation has stayed with me.
I have no desire to build connections with those who believe they can outpace grief or curate a life untouched by hardship. That’s not the truth of being human and it’s certainly not the truth of birth. I didn’t become a doula to be agreeable or to tell people what’s easy to hear. My role isn’t to keep things neat or palatable. It is to hold space for what’s real. Even when it’s uncomfortable. Especially when it’s uncomfortable.
Sometimes people turn away from the truth because they are afraid of what it asks of them, it is inconvenient and it’s easier to stay distracted than to confront what life ultimately reveals about ourselves, our culture, and the stories we’ve inherited.
Photograph by Matt Bockal
What if the very things we are taught to fear, the unpredictable, imperfect, unplanned things, are what tether us together?
When I think of my brother, I realize he is the reason I am able to show up the way I do. Loving him taught me how to hold space for pain that can’t be fixed. If he hadn’t been born, I’d be a different person. And so would my mother.
I often imagine her, a young and expectant mother and I wonder, if amniocentesis had been available back then, would she have chosen differently? But before the question even settles, I feel the answer. No. Even if she could have known what was coming, I know with every fiber of my being that she would not have chosen a life without her son.
Because life is not precious only when it is easy. It becomes sacred when it asks something of us. When health falters. When time runs short. When love stretches beyond what we thought we could hold. That is the real test of love, not just how we stay in joy, but how we stay soft in the face of sorrow, of losing someone.
My brother did not live a long life. But his life was incredibly meaningful. It shaped me in every direction. And my capacity to hold grief, sit with fear and name what’s unfixable, that was all born from loving him.
So when people ask me what it takes to prepare for birth, I think of my mother and brother. I think of the sacredness being a witness. Not in avoiding suffering, but in not turning away from it.
There’s a quiet myth so many of us carry: that we can somehow outrun grief.
That if we heal ourselves, we’ll become clear enough to manifest a pain-free life. But birth (like life) is not a problem to solve. You can prepare. You can do your research, take your vitamins, hire the right support, go to therapy, eat all organic food, meditate every day, read every book, make all the money. Still no outcome is guaranteed. No experience is ever entirely within our control.
And to cling to that illusion is to miss the truth of what it means to be alive.
I think our culture make it seem like life is a problem to solve when really it is a mystery to live inside of. And human life holds value in every form. Not just the healthy. But the sick, the aging, the disabled, the neurodivergent, the infertile, the differently formed. Every single body belongs.
I think that when we glorify only peak health, we flatten the human experience. We reduce life to a narrow spectrum of worthiness, one that leaves little room for what is real, raw and unexpected. But there is a depth and a beauty in choosing to stay with what aches. There is truth in learning to love a life that doesn’t match the picture we once held.
That isn’t failure. And it isn’t tragedy. It’s an invitation.
And for anyone reading this who doesn’t know me personally, I’ve come to believe that the sacred is not reserved for temples, churches or spiritual doctrine. It lives in the everyday. In breath. In bodies. In moments that ask us to pay attention.
The sacredness of life is everywhere… if only we slow down enough to witness and care for it.
Such a beautiful essay. As a midwife I work with moms who tend to have a very different world view than the mom you're describing. They are mostly immigrants from Latin America. They often decline genetic testing. They have an attitude of accepting what comes. While I try to meet all moms where they're at, I really enjoy working with those who, as you say, don't view pregnancy and birth as something to be controlled but something to be experienced.
My son has a rare genetic condition and I also just had my life upended by the loss of my father - this resonated with me for many reasons ❤️