Luke and Matthew are at pains to assure us that Jesus' conception was carefully planned by God. Planned pregnancies have a better outcome than haphazard ones, and that was important when this conception was to become not only the greatest man that ever lived, but also ‘God with us’, Emmanuel.

With that in mind, Mary Joseph and Jesus deserved all the advantages of royalty. But in fact, the Holy Family received no advantages at all, and, in my view, the arrangements for the planned incarnation were contrary to good obstetric practice and exposed both Jesus and his mother to un-necessary risk.

To begin with Mary was only betrothed to Joseph, which means she was probably no more than 12 years old.

Pregnancies in the very young have a higher mortality and complication rate than for girls in their late teens.

And to be only betrothed would leave Mary’s reputation in tatters, her family shamed, disgraced and furious.

All of Nazareth would know and disapprove. I well remember a 14 year-old unmarried girl in Nigeria who died unnecessarily because her family did not take her for help, as they were so shamed and angered by her pregnancy.

Could not the Holy Spirit, who engineered the conception, have waited a few more months until Mary was married? Betrothal rarely lasted more than a year, and pregnancy outcomes are better when the parents are married.

Next, the couple that God chose for parents had very little money, and the breadwinner was only a carpenter. If both parents had been from a professional background it would at least have helped to balance the major risks associated with poverty.

Added to those adverse factors God chose a first pregnancy for his son. Granted there were cultural and theological reasons for this, but should these not have been overruled in the quest for safety, when the baby was so unique?

Eclampsia, a long labour and various other problems are much more common in those having their first babies, with second and third pregnancies recorded as the safest and easiest for both mother and baby.

Girls, of course, have a better chance of surviving the first five years of life.

Then there was that trip to Bethlehem. I guess Joseph had to take Mary, but she was not needed for the census, and his journey would have been quicker and easier without his heavily pregnant wife.

Maybe he kept Mary with him as he feared that she would be neglected by family and villagers when she went into labour, as had happened to that Nigerian girl of my experience. But such a long journey at the end of pregnancy was courting disaster.

It was not the most salubrious of delivery rooms for the house was so crammed with visitors that Mary had to deliver in the stable below where the animals were kept. I hope there was clean straw and someone had cleared out the dung, because Jesus would have been born onto the floor before he was placed in the manger. It was in the manger that he was wrapped in swaddling cloths – both a sign that he was loved and wanted, and a way of preventing hypothermia.

The chance of developing neonatal tetanus and puerperal fever couldn't have been higher with oxen, goats and donkeys in near attendance. So, the circumstances of the birth were shocking.

Mary should have been in her home surrounded by a loving family of encouraging women, which included the village midwife. It is possible that she had only Joseph in that male excluded territory. I hope some kindly Bethlehem women left their lucrative cooking pots and came to help the young strangers in their midst. The mention of swaddling cloths makes this likely.  

As a finale to this risky pregnancy and labour there were: cut-throat soldiers, a night-time escape, and a long journey to Egypt. These must all have had an effect on Mary’s milk.

With a conception so carefully crafted by our Creator one would have expected a plan that would avoid unnecessary risks and guarantee a healthy and comfortable outcome. But the circumstances God chose placed Mary and her baby in a situation of constant stress, difficulty and the risk of obstetric complications.

What this does is set the pattern for Jesus’ later life, by revealing that humility and vulnerability were present in God’s incarnation from the very beginning.

God's ‘foolishness’ in planning this birth harmonises with Jesus’ second name ‘Emmanuel’ – God with us.

A privileged royal birth would resonate only with the few in our world who can afford that luxury, but not with most of humanity whose births still occur in circumstances closer to a stable than a palace.

Jesus as Emmanuel identifies with the least fortunate in our world who can find comfort and inspiration in seeing greatness arise even out of similar experience to their own.

As an obstetrician I would not have planned a royal pregnancy in that way. But that only goes to prove what Isaiah has told us about God, 

‘My thoughts are not your thoughts, neither are your ways my ways, says the Lord. For as the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts.’ Isaiah 55.8,9.