A Healthy Baby Is Not All That Matters

There is a sentence we need to retire from conversations about birth: “The baby is healthy, that’s all that matters.”

It is often said with good intentions. Sometimes it comes from relief. Sometimes people simply do not know what else to say. But it carries a message that is far more damaging than we acknowledge: The baby is okay, therefore you should be okay.

Your body may have been injured. You may have haemorrhaged. You may have experienced a third- or fourth-degree tear. Your baby may have been rushed to NICU. You may have believed that you or your baby were going to die. Procedures may have happened to your body before you understood what was happening. You may have been frightened, ignored, restrained, dismissed, separated from your baby or spoken about as though you were not in the room. But the baby is healthy, so the rest doesn't matter?

A healthy baby is an outcome. It is not the entire measure of safe maternity care.

Of course we want babies to be healthy. That has never been the issue. The problem begins when the health of the baby becomes the only outcome that is allowed to matter.

The World Health Organisation (WHO) does not define quality maternity care this narrowly. Its recommendations for a positive childbirth experience include not only clinical safety, but respectful care, dignity, privacy, effective communication, informed choice and continuous support. WHO specifically describes a positive birth as one in which a woman gives birth in an environment that is clinically and psychologically safe (World Health Organisation).

A baby can be medically well while their mother is not. A baby can have excellent Apgar scores while their mother leaves birth with PTSD. A baby can be discharged home while their mother is living with significant pelvic-floor injury, chronic pain, incontinence, sexual dysfunction, depression, anxiety, intrusive memories or a nervous system that still believes she is in danger. A healthy baby should not override these issues.

“At least the baby is healthy” can protect harmful systems from scrutiny

This is where the phrase becomes more than insensitive. It can become dangerous. Because if the ultimate defence of maternity care is “the baby survived and is healthy,” then almost anything that happened to the woman on the way there becomes easier to justify.

Poor communication.

Lack of consent.

Coercion.

Unnecessary intervention.

Being ignored.

Having pain dismissed.

Being spoken to disrespectfully.

Feeling abandoned during an emergency.

Butchering her body.

These things become secondary because the end is used to justify the means.

Australia has already had to confront this at a systemic level. The 2024 NSW Parliamentary Inquiry into Birth Trauma received more than 4,000 submissions and concluded that a significant number of people had experienced preventable birth trauma. The committee identified inadequate informed-consent practices, lack of trauma-informed care, insufficient continuity, inadequate antenatal education and lack of respect for women's preferences and experiences among factors requiring urgent attention (Parliment of NSW). And informed consent is not simply a nice communication skill. The Australian Commission on Safety and Quality in Health Care describes it as a key safety and quality issue grounded in a person's right to make decisions about their own body and healthcare (Safety and Quality in Health Care).

So when women describe feeling harmed and our response is “but your baby is healthy,” we do more than invalidate one woman. We risk making the conditions that produced the harm harder to see.

It also teaches mothers that suffering is evidence of ingratitude

There is another layer to this. Motherhood carries an enormous cultural expectation of gratitude.

You wanted this baby.

You love this baby.

Therefore you should be happy.

And if the baby is healthy, what exactly do you have to complain about? This is how gratitude becomes weaponised.

A mother can be profoundly grateful that her child is alive and devastated by what happened to her.

She can love her baby and grieve her birth.

She can know an intervention saved her / her baby's life and be traumatised by it.

These experiences do not cancel each other out.

But when we insist that gratitude should replace distress, mothers learn very quickly which version of their story other people are comfortable hearing. So they stop talking and suffer in silence.

Research on perinatal mental health has identified this kind of societal silencing. Women have described feeling like failed mothers, experiencing shame and guilt around negative experiences of motherhood, and finding healing when those experiences can finally be shared honestly (Law et al., 2021). And this matters because shame is not psychologically benign. A systematic review found postpartum shame was significantly associated with stress, postnatal depression and suicide, while guilt was also related to postnatal depression (Caldwell et al., 2021).

We need to change the conversation around gratitude, and allow for flexibility and nuance in motherhood experiences and maybe, just maybe, mothers would speak their secrets, reduce stigma and orient towards recovery because this is really what families need.

“All that matters is a healthy baby” also helps dismantle the village

When we believe the healthy baby is the endpoint, we begin behaving as though the work is finished. Research shows that lower social support is associated with a greater likelihood of postpartum depression, while reductions in practical and emotional support have also been associated with depression, anxiety and difficulties with parent-infant bonding (Cho et al., 2022).

The village disappears when motherhood is conceptualised as, Baby healthy = job done.

The mother becomes the village for everybody else while having very little village surrounding her.

And this is why maternal wellbeing is a baby issue too

Sometimes centring mothers is misinterpreted as taking attention away from babies but it is the opposite. Mothers and babies do not exist in completely separate psychological systems, they are a dyad. And then they exist within another system: partners, siblings, extended family, community. When a mother is supported, treated, rested, listened to and physically cared for, the benefits do not stop with her. The research suggests that supporting maternal mental health is also an investment in infant and family wellbeing (Racine et al., 2024). This is the ripple effect.

Support the mother, and that support can flow into her capacity to recover, connect, rest, parent, seek help and participate in relationships. Support the family, and that support reaches the baby. But the reverse assumption does not hold.

A medically healthy baby does not automatically heal maternal PTSD.

A healthy baby does not repair a pelvic-floor injury.

A healthy baby does not resolve postnatal depression.

A healthy baby does not undo an experience of violation.

A healthy baby does not give somebody their village back.

Infant health is not a proxy measure for maternal wellbeing.

So what should we say instead?

Perhaps we stop looking for a replacement platitude altogether. We listen. But if we need a new standard for maternity care, I would suggest - A good outcome is not only a healthy baby. It is a mother and baby who have been cared for as human beings with physical safety, psychological safety, dignity, informed choice, respect and appropriate support before, during and after birth.

The baby matters. The mother matters. Their relationship matters. The family around them matters.

You matter, too.

By Amber-lee Buendicho

@thepowerofbirth

References

Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: A meta-analysis and theoretical framework. Psychological Medicine, 46(6), 1121–1134. doi:10.1017/S0033291715002706. (City Research Online)

Caldwell, J., Meredith, P., Whittingham, K., & Ziviani, J. (2021). Shame and guilt in the postnatal period: A systematic review. Journal of Reproductive and Infant Psychology, 39(1), 67–85. doi:10.1080/02646838.2020.1754372. (PubMed)

Cho, H., Lee, K., Choi, E., et al. (2022). Association between social support and postpartum depression. Scientific Reports, 12, 3128. doi:10.1038/s41598-022-07248-7. (Nature)

Reed, R., Sharman, R., & Inglis, C. (2017). Women's descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy and Childbirth, 17, 21. doi:10.1186/s12884-016-1197-0. (PubMed)

Slomian, J., Honvo, G., Emonts, P., Reginster, J.-Y., & Bruyère, O. (2019). Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women's Health, 15. doi:10.1177/1745506519844044. (PubMed)

Tsakmakis, P. L., Akter, S., & Bohren, M. A. (2023). A qualitative exploration of women's and their partners' experiences of birth trauma in Australia, utilising critical feminist theory. Women and Birth, 36(4), 367–376. doi:10.1016/j.wombi.2022.12.004. (PubMed)

World Health Organization. (2018). WHO recommendations: Intrapartum care for a positive childbirth experience. (World Health Organization)

World Health Organization. (2022). WHO recommendations on maternal and newborn care for a positive postnatal experience. (World Health Organization)

NSW Legislative Council Select Committee on Birth Trauma. (2024). Birth Trauma: Report No. 1. Parliament of New South Wales. (Parliament of NSW)