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There is a contrast between the context often seen in midwifery practice with the will to favor physiological birth. In many places midwives’ practice is institutionally and medically oriented with routinized, standardized care and risk intolerance. In contrast, physiology is recognized as being unique, varied and by endogenous competencies of the mother and the baby. Working in such a context and wanting to augment physiological birth is a big challenge because physiology is asking to tolerate uncertainty, give time for the processess and trust the mother and the baby’s processes. This is why physiology needs wisdom i.e. the utilization of deliberation, judgement, reflective reasoning, taking in account the context as well of each situation at a particular moment. Wisdom is needed to practice in a medically oriented context and meeting the challenges of a genuine trust and will to promote physiological childbirth.