Evidence Library · The two kinds

Two kinds of expectation, and only one of them can be promised

One kind is about what happens to you. The other is about how you are treated. They are not the same thing, and they should never be traded against each other.

Almost everything you can expect about a pregnancy falls into one of two boxes. Sorting them is the single most useful thing this part of the guide does.

	Expectations of outcome	Expectations of treatment
Examples	A healthy baby. A pregnancy without complications. A vaginal birth. Feeling like yourself again in six weeks.	Being told the truth. Being asked before you are touched. Being believed when you report a symptom. Being offered the choice to say no.
Who controls it	Nobody. Biology, chance, and things nobody can see in advance.	The people looking after you. Entirely.
Can it be promised?	No. Anyone who promises you an outcome is either guessing or selling something.	Yes. And it is owed to you, not granted as a favour.

The World Health Organization built its whole intrapartum guideline on the second box. Its definition of a good birth is this: Women want a positive childbirth experience that fulfils or exceeds their prior personal and sociocultural beliefs and expectations. This includes giving birth to a healthy baby in a clinically and psychologically safe environment with continuity of practical and emotional support from birth companion(s) and kind, technically competent clinical staff. Most women want a physiological labour and birth, and to have a sense of personal achievement and control through involvement in decision-making, even when medical interventions are needed or wanted.

Read the last eight words again. Even when medical interventions are needed or wanted. WHO is saying that a good experience does not require a particular outcome. It requires particular treatment.

The failure this part is trying to preventA woman is told, correctly, to be realistic about the first box. She quietly lowers the second box as well. She stops asking. She decides her pain is probably normal, her worry is probably silly, and her question is probably a nuisance. Nothing about an uncertain outcome makes worse treatment acceptable. No result, however bad, works backwards to justify not having told you the truth.

Say this out loud"I understand you cannot promise me an outcome. What can you promise me about how this will be handled?"

"If something goes wrong, I still expect to be told what is happening and asked before anything is done."

Where this comes from:

450. World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. ISBN 978-92-4-155021-5.

419. Informed consent and shared decision making in obstetrics and gynecology. ACOG Committee Opinion No. 819. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2021;137(2):e34-e41.

453. Refusal of medically recommended treatment during pregnancy. ACOG Committee Opinion No. 664. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;127(6):e175-e182. Reaffirmed 2019.

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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.