Harms, risks and opportunities of uncertainty: It is not as toxic as we think

Uncertainty is ubiquitous in neonatal medicine often reflecting incomplete knowledge of diagnoses, prognosis and optimal treatments. It profoundly influences decision-making and the relationships between parents and clinicians. Despite its pervasiveness, uncertainty is often perceived as toxic, conflictive and something to be eliminated or minimized. However, when acknowledged and accepted, it can become a source of hope and a foundation for trust between parents and clinicians. This article explores the existing literature on uncertainty in antenatal decision-making organized around three themes: harms, opportunities and recommendations. We highlight the challenges uncertainty poses for both parents and clinicians, including its potential to create conflict, feelings of loss, regret, and bias. At the same time, we emphasize the importance for clinicians to understand and embrace uncertainty to support parents, facilitate honest and balanced communication, and build trusting relationships. We acknowledge the need for more research on effective strategies to help productively navigate uncertainty and propose an approach to supporting parents by positively leveraging the inherent uncertainty in antenatal medical decision-making.