Certain words raise my hackles almost automatically. One example is people referring to ‘nurses’ providing maternity care. As I have shouted at the television and radio many times, no they don't! After all, you wouldn't say that a doctor replaced your filling, so why do the public get confused?
Words have power and we should never forget the influence our language has (Furber and Thomson, 2010). When I began as a midwife many years ago, we cared for ‘patients’, despite all the connotations of passivity and compliance that that word encompasses. Now, almost universally, midwives speak of ‘women’ and ‘mothers’. Our medical colleagues have not always followed suit and some use the term ‘ladies’ which, for some reason, feels patronising. Similarly, let us consign to the history books the word ‘confinement’ with all its connotations of restriction: women giving birth at home are the opposite of confined.
Then we come to the term ‘deliver’, a passive verb. Women ‘give birth’, an active expression that acknowledges the efforts they put in. People argue that assisted births, using forceps or vacuum are ‘deliveries’, but these can and are, births. With assisted vaginal births, the obstetrician adds to the woman's own efforts and assists with the birth. Providing ‘a little help’ means that the woman remains central to the birth process.
So, is it time to return to the name ‘labour ward’ or to have ‘midwifery and obstetric birth units’, rather than the daunting ‘central delivery suite’? Does the name given to the place in which a midwife works influence practice, albeit subconsciously?
I also wonder if we sow the seeds of failure before birth by not challenging women who say not that they ‘will breastfeed’, but that they ‘plan to try to breastfeed’, suggesting they may not succeed. The ubiquity of such language worries me and I wonder what we can do.
So what other uses of language exercise me? The word ‘allow’ makes my nerves tingle as in, ‘I was allowed to get off the bed’ or ‘I was allowed a home birth’. This puts women in a subservient position, needing permission for things to happen. Women should be offered choice (and real choice with the full range of options), and then, after exploring the pros and cons, should make their own decisions. They can also change their mind at almost any point. Women should also be encouraged during pregnancy, labour, birth and the postpartum period to actively chose what it is they want.
The environment can also assist communication: having seating for antenatal appointments that enables face-to-face conversation, or avoiding birth rooms where the bed is the central attraction are two examples. We also need to review information and warnings in areas to which women and their families have access. Reminders for maternity staff, however well meaning, can give rise to significant anxiety (Royal College of Midwives, 2015), and so safety notices should ideally be out of the sight of women and their partners.
Before (and after) birth, many women and their partners refer to ‘things getting back to normal’ once they return home with their baby. I believe it is important to gently remind the couple that the old normal has gone and that it will be replaced with a new one. Their time as a child-free couple has gone, as has the way they operated as parents of one, two or more children. Each baby exerts their own influence on the home environment and there is no going back.
Another value-laden word is ‘risk’. What does it mean? Data on risk refer to populations but are unable to say anything meaningful for the particular woman in your care. In the Lancet Midwifery Series they did not use the term, but instead spoke about women's needs (The Lancet, 2014). This seems a more sensible approach and is certainly more individualised. There is also the false dichotomy of high and low risk: there is no such thing as a ‘high-risk woman’ but there may be a woman who is at a higher risk of complications. Rather than speaking of ‘transferring women for high-risk care’, perhaps we should instead say that this woman has ‘complex care needs’? I believe that many women feel uncomfortable being labelled in a way that depersonalises them. If midwives are to provide care that is truly woman-centred, we need to avoid labelling women in a way that suppresses their individuality.
The #MatExp ‘Whose Shoes?’ project (Phillips, 2017) is also looking at language from women's point of view. What does your language mean to women? Are you empowering those you care for? Time to hold up the mirror.