It strikes me as odd sometimes that the language our medical professionals use when talking to pregnant women and women in labour and new parents can be so easily misinterpreted. I suppose to them, the medical fraternity, they are doing their job and communicating using a language which does what they need it to do, but sometimes I wish they would think twice before using some of their words with us.
I had a conversation with a client last week where she described how reading through the notes from her baby’s birth she came across the phrase “unproductive labour”. “How,” she asked me, “can my labour have been unproductive when I ended up with a baby?” How indeed. I know that this phrase refers to the fact that her contractions weren’t of “sufficient” strength (according to whom, exactly?) to produce her baby in the time limit specified by the hospital, but how rude! This sort of judgemental language does no one any favours.
What about being told you have an “incontinent cervix” or a “retrograde uterus”? How about an “incompetent cervix”, then? That you are an “aging primate”? That your baby has an “immature oesophageal valve”? That during labour you are “failing to progress”? Or even that you are “big for dates”? That your waters have “gone”? (“gone where and why am I still leaking, if they are no longer present?” you may well ask yourself.)
How about being told you are not “in labour yet” when you are quite clearly experiencing contractions and a great deal of pain because you are (officially) "not considered in labour until changes happen to the cervix"? Language gives clear messages about power relationships. Language gives messages about attitudes and ideologies. Language affects how women feel about themselves and their birth experience and, in my experience, much of the language around childbirth is very disempowering.
What about the very term “delivery”? Does that actually do justice to the mother’s experience of giving birth or does it take away the woman's own work in the process? The phrase: “the doctor delivered the baby” does not even recognize the mother as being present. Instead, some midwives prefer to say they caught a baby; a more descriptive and, it seems to me, more accurate term, because that is what a midwife literally does. How about “the mother birthed the baby”? That phrase reclaims the woman's agency in the process, recognizing her crucial role as more than just a vessel through which a baby is born. Think how powerful a message such changes in language would send to our sisters and to our daughters as they grow up. Think how differently they might come to view birth, how much more confidence they might have in their ability to do exactly what their bodies were designed to do?
As a woman going through pregnancy, labour and birth, you want to be the active centre of your own experience, not incidental or a selection of body parts which may or may not be performing as expected or as “normal”. Language that suggests that you need help or that you have somehow failed is not helpful. Midwives and doctors frequently use the phrases: manage, conduct, allow, permit – which have very distinct meanings in our own vocabulary, and none of them are particularly conducive to having a positive, respected birth experience. Negative language can make a woman feel inadequate and could be laying the foundation for intervention. Women need to be encouraged and to feel they are doing well, not undermined by being negatively compared to NICE guidelines or hospital protocols… All these phrases, like Normal (What is normal?) ; low risk/high risk; favorable outcome/poor outcome; false labour; estimated date of confinement/due date; incompetent cervix; failure to progress; placental inadequacy/insufficiency; dysfunctional labour; faulty placement of the placenta; untried pelvis/trial of labour or trial of scar; sizeable pelvis… do nothing to inspire confidence in yourself or your own body, do they?
What about being referred to as “Mummy” instead of someone using your name? and even your baby being referred to as a foetus? Surely you are pregnant with a baby, even if you suffer a miscarriage, it was still a baby, surely!
There are many others: intrauterine growth retardation, blighted ovum, abnormal hemoglobin, hormonal insufficiency, management of breastfeeding, inadequate milk supply/insufficient milk, average, normal etc and what about those little red books with the growth chart? (I was once told the growth chart was based on American bottle fed babies anyway… and who is to say that your baby will develop the way a chart dictates? And what does that say about you or your baby if it “fails” to meet those expectations?)
Midwives in a hurry may pose a question to you in a way that anticipates compliance: “I need to give you a vaginal exam…” they might say, when they are actually asking your permission to examine you and you may say no if you prefer not to have one. You need to be aware of all these things and arm yourself against them before you embark on your labour and birth.
I have heard midwives and obstetricians saying to mothers: 'well, it’s your choice, but I’ve seen babies die from this...' and other versions of the same shroud waving when trying to pressurize a woman into taking a decision they believe will suit their ends. Of course you don’t want to take a chance with your health or the health of your baby, but given all the information, you could probably make a pretty good decision for your self and your baby if you are given a chance and not patronized or bullied by ill chosen words.
Be aware of the power of language. Guard against anyone trying to undermine you or your abilities during pregnancy and birth. The birth of your baby is your experience and you can be in charge if you choose. Wrangle the power back from those “in charge” and remember as you embark on motherhood how important it is to speak to your little one with care…