Today I received a note from a former patient I helped at Bumi Sehat. Her baby recently celebrated her third birthday. Each year she has written to me on Facebook to thank me for helping to bring her little girl into the world.

The thing about this special mama and her special baby is that her birth did not go according to plan. We were unable to help her at the clinic, and ultimately I spent a couple days with her navigating the Balinese hospital system, so that she could deliver her baby via cesarean section. I tried to help her attempt an induction, at least, but I failed. Both my communication skills and their medical facilities were lacking. So, I feel like I really didn’t do anything for her other than to be there with her.

Sometimes our clients get their dream birth, and sometimes they don’t. Usually, they are happy with their care (regardless of outcome), but sometimes they are not–and these two may not even be linked. Sometimes women have what we think to be great labors, but still find themselves dissatisfied with their birth experience in some way. The reality is, though, that sometimes the outcome is largely out of our hands. Indeed, if all is well and labor is fully functional, there is nothing we can do to¬†stop the process from happening. But the flip side of that is that if it is a dysfunctional labor, or a problem emerges, there may be nothing we can do short of seeking medical intervention to help. Remember, midwifery care is only appropriate in low-risk, uncomplicated situations. Once we leave the parameters of normal, there may not be anything that can be done to keep us on plan A.

I have been around the block enough times now to know that it is important to distinguish good care from outcome. I tell women there are no guarantees. It is my job to monitor you and your baby, to support you, and even to advise you–but I can’t promise you anything. We forget in our culture of high expectations that sometimes things just don’t go according to plan. Planning is important because it sets the intention and unfolds a road map of where you want to go, but it still does not guarantee anything. And anyone who does promise you something (whether it’s a vaginal birth, a homebirth, or even a healthy baby) should be questioned. It is those wise women and their partners who can accept that plans needed to change, who can recognize the fact that they were cared for–those are the ones who are at peace at the end of the day.

So, today, I wish for wisdom for the women we work with to know that sometimes we need to change plans, but also for them to feel peace that any such decisions were made after careful monitoring and evaluation and thoughtful, collaborative decision making.