What Happens at Birth Has Already Happened at Conception
photograph, essay
August 2026
When people used to ask how many babies I had delivered, I would correct them.
“I don’t deliver babies,” I’d say, borrowing the words of a mentor. “Pizza is delivered. Babies are caught.”
I believed it. It was a good line. A little irreverent, a little midwife-ish, and, as far as I knew, true.
Then I started doing assisted inseminations. I've done hundreds now, and somewhere along the way, the joke stopped working.
At an IUI (assisted intrauterine insemination), I fill a tiny catheter with sperm cells my client has chosen with the kind of care most people reserve for naming a child. I guide the catheter through a cervix that has already begun to open.
First dilation.
The catheter is almost ceremonial in its simplicity—a wand more than an instrument. I press, and the sperm move from a glass vessel into an expectant body, toward a home, small like a cocoon.
I deliver the baby in. Months later, I catch the baby out.
The more times I do this, the more I notice that the body doesn't seem particularly interested in the neat boundaries we have created between conception and birth. We call them two different events. The body seems to understand them as part of the same story.
For years, I met babies near the end of that story.
I watched bellies grow. I measured fundal heights. I listened to heartbeats. I waited through the long middle of pregnancy until, eventually, there was a birth-wet head and a pair of impossibly soft feet in my hands. Now I meet them at the beginning, too. And once you've seen both ends, the similarities are hard to miss.
Take the cervix.
It opens during ovulation, sometimes by as much as a centimeter, creating a passage for sperm. Months later, it will open again to make room for a baby’s body. Same cervix. Same event: dilation. The first time, almost no one is paying attention. The second time, there is usually a room full of people.
Then there is the fluid.
Under a microscope, cervical fluid can dry into a delicate, fern-like pattern called ferning. It is the same kind of pattern clinicians recognize later in pregnancy when looking at amniotic fluid to rule out or confirm membranes ruptured (water breaking). The body makes the same little signature twice. The first time, it is saying: I am ready to receive. The second time: I am ready to let go. Almost nobody sees the first one.
We document so much of pregnancy and birth—the first ultrasound, the first heartbeat, the first photograph of a face, the first cry. But conception happens quietly. There is no room full of people waiting for it. No camera. No applause.
The cervix is changing. The uterus is contracting, helping move sperm where they need to go and helping draw the egg along. Hormones and electrical signals are beginning their work. At fertilization, there is even a visible burst of activity across the surface of the egg—a flash of light, a tiny biological announcement that something has begun.
We don't call that labor. But sometimes I wonder if we should recognize it as part of the same conversation. Because the body doesn't suddenly become a birthing body at thirty-nine weeks. It has been practicing.
And then there is the part I can't measure with a speculum or see through a microscope.
The human part. The hands. The person lying back on the table, trying to relax. The partner holding a hand. The long inhale. The slow exhale.
“Stay in your body,” I say. It is the same voice I use in labor. Low. Steady. Unhurried.The voice that says, You're okay. Keep breathing. One thing at a time. The voice that will eventually count someone through a contraction they are certain they cannot survive.
I've spent years thinking of birth as the moment a baby arrives.
Of course it is.
But the longer I work around conception, the less convinced I am that birth is where the story begins—or even that there is a clear threshold that defines the beginning. After all, isn’t the cyclical bleeding a small death too? Does birth come after death? Of course it does.
We photograph birth because it is visible. Because there is a baby at the end of it. Because everyone in the room knows something extraordinary has just happened.
Conception is quieter. A cervix opens. A few cells move. An egg flashes. A uterus contracts. A body makes room. No one calls it a birth.
But the body has already started doing the work.
And maybe that's what has changed for me. I used to think I caught babies at birth. Now I know that sometimes, months before I catch one, I have already been there for the beginning, delivering them in.