I am fascinated by the language of birth. Language is something that we learn unconsciously rather than in a deliberate fashion. And in our busy world we often say things without thinking too much about why we say them or where they come from. But words have a great deal of power.
For many years – in fact, ever since I first read Nicky Leap’s fabulous and germinal article, The power of words (Leap 1992) – I have paid ongoing attention to this issue. I frequently revisit this topic in these pages and elsewhere to share elements of my journey with language.
In this article, I want to discuss more of the linguistic examples that I have pondered in recent years, with the help of a few colleagues who share my passion.
Less sexist roots
So firstly, I’d like to draw your attention back to that last paragraph where I used the word germinal. Previously, I would have described Nicky’s paper and others like it as seminal (Wickham 2008). I had never been entirely comfortable with seminal, which is a bit male-focused, especially for a topic such as the use of language in a woman-centred arena, but I had never found an appropriate substitute which other people understood. Somehow, variations of ovular never sounded right. That was until a friend suggested germinal, which can relate to either the egg or the sperm, and now I am happily using this in everyday conversation and hoping that it will catch on. Please feel free to adopt it if you share my concerns!
Crossing the Ts
Another passion of mine is the very questionable language that we use around the end of pregnancy. I have been teaching frequently on the topic of post-term pregnancy in recent months – and not that I love that phrase either because often we don’t use it appropriately, but it’s not always easy to find a good substitute for that either – and a couple of the midwives who attended my workshops pointed out a fascinating linguistic change which I have since been sharing with anybody who will listen. In this case, the problem isn’t just the language but the bigger things that it implies. To paraphrase one of the midwives who first brought this to my attention:
I have noticed this trend in how we talk about the length of pregnancy. Firstly, people started to say T plus four (or seven or 10, referring to the number of days of pregnancy that had passed since the woman’s due date) rather than 40 plus four or seven or 10. They wrote it in women’s notes as T+4.
Then, we started to move from writing or saying T plus four or seven to saying or writing term plus four or seven. But term is a range and this makes it sound as if a woman is overdue from the first day after her guesstimated due date!
This midwife, and the other people who pointed this out to me at around the same time, are absolutely right. Even if we accept for a moment the traditional (and not very evidence-based, but that’s for another day) definition of term as being the time between 37 and 42 completed weeks of pregnancy, this is an entire span of time and not just one day. The use of language such as ‘T+7’ or ‘Term plus seven’ focuses on a fixed point rather than the normality of that span of time and serves to further narrow down the already-shrinking time frame in which we are telling women that they are allowed (another word that should be banned) to go into labour spontaneously before intervention will be proffered.
Being honest about what we’re saying
Using ‘T plus’ or ‘Term plus’ does make it sound, as my colleague said, as if a woman is overdue the second she crosses the threshold of her due date, which clearly isn’t very woman-centred or evidence based and, while I’m on the subject, I would like to mention another lovely alternative word that can be used here: ‘guess date’ instead of ‘due date’.
Although I had used the term ‘guesstimated date of birth’ for a good while, I think it was Rachel Reed (of www.midwifethinking.com fame) who I first heard use the phrase ‘guess date’ instead of ‘due date’, and it struck me as I was writing this article that, with their less formal language, blogs and social media platforms can be a useful medium for the transmission of more positive language. Of course, that also renders them a potentially powerful means of transmission of negative, disempowering language as well, but I prefer to focus on the positive possibilities.
I’ve read a number of social media discussions recently that have offered great summaries of some of the positive alternatives; common examples include ‘baby gel’ instead of ‘mucus plug’, ‘releasing waters’ instead of ‘rupturing membranes’ and ‘pre-labour’ instead of ‘false labour’. Hypnobirthing advocates are among those who remind us of the value of using words such as ‘wave’, ‘surge’ or ‘expansion’ instead of ‘contraction’. Friends have shared that they would like to ditch words and concepts such as ‘risk’ and anything beginning with or including the words ‘failure’, ‘trial’ or ‘prolonged’. One mum made me think when she suggested ‘chromosomal arrangement’ rather than ‘chromosomal abnormality’, which was a new idea for me and one which I really appreciate as, in our house, we reframe negative medical language by using ‘autistic spectrum diversity’ rather than ‘autistic spectrum disorder’.
In the labour room, we don’t want people to encourage harder pushing by telling women to ‘get angry with the baby’ and many midwives would like to ban the whole ‘keep it going, keep it going’ mantra. As with the ‘term plus’ example, this last one might be considered to be problematic more because of what it implies (that is, directed pushing) than because of the actual phrase itself.
Many advocates of woman-centred care also don’t like ‘shared decision-making’. It might be a trendy new buzz phrase, but actually it’s not a shared decision, it’s the woman’s decision. In their place, we could use words such as ‘woman/women’ (rather than patient), ‘your power’ and ‘physiological’. Women and midwives like phrases such as ‘Can I put my hands on you/feel your tummy/baby?’ and ‘With your consent, we could…’, which reminds women that they have a choice, as well as the power to decline.
A continuing passion
When I mentioned that I was writing this article on social media, and invited suggestions for inclusion, my page was swamped with ideas, and it took me ages to get back to everybody. What that illustrated to me is that this is an issue that many people – midwives, women, other birth workers – feel really passionate about. Which is great, because it means that we are open to adapting the way we communicate, which I hope, in turn, will mean that we will continue the move away from paternalistic, patriarchal, controlling language and towards more positive, woman-centred ways of speaking and writing about women, birth and midwifery.
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Leap N (1992). ‘The power of words’. Nursing Times, 88: 60-61.
Wickham S (2008). ‘Euphemisms: good, bad or ugly?’ TPM, 12(4): 35.