No guarantee

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Dear care providers,

Could you please do us all a favour and stop giving women the impression that you can guarantee outcomes? Pregnancy and birth can be a scary journey for some women – a lot of “what ifs” come up. What if my baby is sick or dies? What if I die? What if I need an emergency caesarean under a general anaesthetic?

And care providers are not really helping us out with these what ifs. We’re often told “You must do the GTT or I can’t guarantee your baby won’t be too big” or “We have to induce otherwise I can’t guarantee your baby will be healthy” or I hear women say that they are having an elective caesarean so they can “guarantee I’ll be awake for the birth”.

But here’s the catch - in birth, as in ALL life, there are no guarantees. I can imagine that this must be tough for care providers to deal with. The complete unpredictability. But here it is.


You simply cannot guarantee:

• A positive caesarean: There are many things that can go wrong in the preparation stage, the surgery and the recovery. And you simply can’t guarantee that these things won’t happen. You can’t guarantee that the mum won’t have a reaction to the epidural or even that the epidural will work. You can’t guarantee that mum won’t start to bleed out on the table. You can’t guarantee that bub won’t have breathing difficulties that require NICU admission. You just can’t – sorry.

• A positive vaginal birth: I’ve never heard of a care provider making this guarantee but thought it best to put it out there. No matter how well prepared and supported the mother is and no matter how skilful you are sometimes things just go wrong.



• A healthy baby: At no point during the pregnancy can you advise a mum that her baby’s health is guaranteed. No test or procedure that you can offer will guarantee a healthy baby. This sucks, but it is a fact that us mums simply have to live with. You do too.

• That my baby and I will be alive at the end: Regardless of where, how or with whom I birth my baby, sometimes things go wrong. Sometimes mums and babies die. Sometimes it’s no-one’s fault. Another very sucky fact of life.


But before you get all gloomy and wonder what on earth you’re doing in obstetrics if you can’t guarantee health, safety and positive births, here’s a few things that you CAN guarantee (if you wish):

• Respectful care: You can guarantee that all your clients will be offered all the information and time they need in order to make fully informed decisions. You can ensure that they feel confident in their choices by respecting their wishes and supporting them.

• That the mother is heard: You can guarantee that the mother’s voice will be the most powerful in the birthing room. You can guarantee that her voice will be listened to. You can guarantee that you will respond to her voice.

• Ethical behaviour: You can guarantee that you will behave in an ethical manner. You can guarantee that you will not bully, coerce or manipulate a mother. You can guarantee that you will not try to frighten her.



So there you have it. You cannot guarantee health, safety or any other outcome. You can’t guarantee that a mother will have a positive experience. You can only guarantee your own behaviour. And that there are no guarantees.

#Birth


%matterhatter