After having a catch up with a lawyer friend last week I reflected on the desirability of certainty, and its antithesis, the messy reality of uncertainty. The law, my friend tells me, provides considerable certainty, especially so when considering principles known as the ‘black letter law’. This impressive term is defined as:
‘a principle of law so notorious and entrenched that it is commonly known and rarely disputed’ (Duhaime’s law dictionary)
This is when a belief, view or understanding becomes so resolutely agreed by those who hold the power, in this case judges, it becomes indisputable ‘fact’ and ‘is no longer subject to reasonable dispute’. Interesting stuff. It must be really helpful to have these entrenched beliefs to guide you as you confidently go through life; they are a given, an absolute, a certainty on which you can pin your colours and not worry again.
This brings me to some thoughts; how attractive certainty is, how you don’t need to worry if you are certain so it makes things a little bit easier. And how fragile certainty is, based on the collective views of others, often those in power, but passed to us as indisputable facts. And how birth can be such an uncertain time in a generally uncertain life.
In midwifery uncertainty is acknowledged and accepted as part of birth. As a midwife I learnt to be patient, to observe and prepare for any eventuality. The many nights waiting to be called for homebirths over the years was a warm reminder of how beautifully unplanned nature was. I learnt from women and their unique and individual birth journeys, spotting the common threads between them that help you to know the few occasions when women or babies needed help.
My experiences of discussing certainty and uncertainty with my obstetric colleagues has been fascinating. A good example is induction of labour when pregnancy is considered overdue (usually around 41 weeks gestation). I chatted with a doctor a few months ago who was convinced that no women would choose to continue the burden and uncertainty of pregnancy over ‘getting on with it’ induction, with the added benefits of being guaranteed a baby in arms by dinner time the next day-ish (very ish).
But despite the ongoing debate on what really is ‘overdue’ in pregnancy terms and ongoing concerns over the risks / benefits of induction this intervention has been widely adopted, leading to nearly a quarter of all pregnancies being induced (see Rebecca Dekker’s excellent summary here). But perhaps the attraction of induction is the attraction of certainty, for many it must be good to know they are on the final run and there is certainty in being told you will likely be back home with a baby in a day or two or three or four. It certainly helps with your Facebook status and stops those pesky enquiring phone calls from friends and family.
But what would happen if we turned this on its head and dealt with uncertainty in a different way. Uncertainty can bring stress and unhappiness but can also be the way that amazing things can happen, where we are more than we ever thought we could be. Women who I have talked with about their breech birth experiences described periods of intense uncertainty where they didn’t know what to do, they felt stressed and often fearful, exacerbated by the fears of others. Women described navigating this uncertainty finding their way and seeking alternatives and people who would listen and support them. But they also described the moments where they made their decision on how and where to birth, drawing deep within themselves and from others to reach a place of self-certainty about what to do next. These women described how they drew strength and confidence in themselves and their babies from their birth experiences, though many expressed how they wished they hadn’t needed to battle so much to have their decisions respected.
Perhaps this tells us that uncertainty allows a time for looking outside the box, ordering off the menu. It also suggests that certainty is very personal, rather than an entrenched notion or concept that is applied to (imposed on) all similar situations and populations. Developing self-certainty can be empowering as it develops from an individual’s own ideals, beliefs and situations, rather than those of others.
This doesn’t just apply to breech birth of course; women are faced with many situations within their pregnancy and beyond into motherhood where uncertainty and certainty go hand in hand. Certainty through care pathways doesn’t always provide definitive answers or guaranteed outcomes. Uncertainty is not always a negative, but perhaps also an opportunity for liberation and freedom of choice.
‘You must have chaos in your heart to give birth to stars.’ Nietzsche
Whilst we may not desire chaos, uncertainty may provide opportunities to explore, to consider the alternatives and perhaps, even, to give birth to stars