The Mistakes That Keep Me Awake Every Day

What forty years in obstetrics taught me about error, accountability, and the kind of teamwork that actually saves lives

The first thing to understand here is simple. In obstetrics, mistakes are inevitable because humans are fallible and childbirth is unforgiving. That truth unsettles many clinicians, especially early in their careers. It still unsettles me. I stopped delivering babies many years ago. I led large obstetric units, built safety programs, and reported outcomes.

Yet the mistakes I made decades ago, and the ones my teams made under my watch, continue to surface in the quiet hours of the night. They remind me why safety is a discipline rather than an achievement.

I remember the lab result I did not see in time. The abnormal ultrasound I minimized because the day was long and the list was full. The patient whose complaint I brushed aside because it did not fit the pattern I expected. The fetal tracing that slipped into abnormal territory while I convinced myself that things would improve if we waited. The IV that should never have been started. Most were “near-missess” and did not hurt patients.

These events did not define my career, many were unknown to others, but they shaped my conscience. Forever. They taught me that obstetrics punishes complacency and rewards vigilance, humility, and shared responsibility.

In every one of those cases the error was preventable. That fact is painful to admit. It is even harder to say publicly. But silence helps no one. Errors grow when they are hidden. Cultures fracture when people pretend they are infallible. The modern safety movement in obstetrics began when we understood that transparency is not weakness. It is the operating system for safe care.

One thing I learned as a department leader is that individual excellence is never enough.

A good obstetrician does not rely on memory or personal heroics. Instead, they build safety nets that compensate for human limits.

Checklists, alerts, huddles, second reads of ultrasounds, independent review of fetal tracings, structured communication, and mandatory follow up of abnormal results are not bureaucratic burdens. They are the architecture that keeps patients alive.

Teaching others how to confront their mistakes constructively became one of the most meaningful parts of my career. I told my residents that their first instinct after an error would be fear. Their second instinct would be self-protection. Neither improves care.

The real work begins with owning the truth, sharing it with the team, and creating a safer system than the one you inherited. When they did this, they became better doctors. When they did not, their patients paid the price.

Patients also play a role in safety, not as substitutes for clinical judgment but as partners in a system that depends on communication.

Pregnant women who keep copies of their test results, ultrasound reports, and visit summaries create another layer of protection. Women who ask questions when something feels off, who speak up when symptoms change, and who insist on clarity when explanations are vague contribute meaningfully to safe care. They should never feel that advocacy is bothersome. It is essential.

Obstetric care works best when doctors and patients meet with aligned goals and mutual respect. The obstetrician brings knowledge of physiology, risk, and intervention. The pregnant woman brings lived experience, intuition, and awareness of her own body. When both sides communicate clearly, small deviations are detected earlier, decisions are made faster, and errors are less likely to accumulate unnoticed.

Today, long after my last delivery, I still review those moments that went wrong. Not to punish myself but to stay honest. To remind myself that safety depends on systems that assume the possibility of failure. To teach the next generation that humility is not a personality trait. It is a clinical tool.

Reflection: Perhaps the most important question for all of us is this. What would obstetrics look like if every doctor and every pregnant woman treated each encounter as a shared safety mission rather than a series of tasks?