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Childbirth and the language we use: does it really matter?

Born

Yesterday several student midwives tweeted about their dislike of some of the language used in maternity services.

I hate the phrase “failure to progress” it’s so disempowering’ was one comment. And “trial of scar”’ was another phrase tweeters disapproved of. Indeed.

It’s an old issue. I remember in the early 1990’s the Head of Midwifery (Pauline Quinn) where I worked saying how she didn’t like the use of the word ‘patient’ as she felt it disempowered women. She also disliked women who used maternity services being called ‘ladies’, as she thought it patronising and it reminded her of ladies at the golf club! And in addition to that, could saying  ‘she’s one of my ladies’ be an even bigger crime, even though unintentional? The woman doesn’t really belong to anyone, does she?

Mrs Quinn interestingly also changed our midwifery titles, and dropped the use of ‘sister’ and ‘staff midwife’, as she believed it potentially influenced the midwife-mother relationship by establishing a defined hierarchy.

These ideas really made me think. I was always careful from then on to consider the words I used. I listened to others, and read interesting articles on the topic. I became more and more aware, and talked to others about it.

The words ‘Not allowed’ became intolerable. Hearing women saying ‘They wouldn’t let me go over my dates’ started to sadden me.

Other examples:

She told me I was only 3cms’ instead of ‘Wow! You are 3cms! Your body is working brilliantly!’

Using the name Labour Ward, or Central Delivery Suite instead of Birth Suite.

The list goes on.

Research carried out into the power of language in relation to infant feeding suggested that midwives used language that influenced decision making to what the midwife wanted rather than words that enabled the woman to make her own choices. Interestingly, the study’s (Furber and Thompson 2000) implications for practice confirmed my managers beliefs from all those years ago:

‘It is important that the language used when interacting with women is considered carefully in order to facilitate an unbiased perspective and to promote partnership. The word ‘women’, rather than ‘girls’ or ‘ladies’, should be used when referring to users of the maternity services.

Working in the same organisation, decades later, things were different. From time to time my colleagues would ask me, ‘does using different words really matter Sheena? We don’t mean harm and what we do is more important than what we say. We have enough to worry about!’ But my answer was (and is) it does matter. Because what we say and how we say it, influences what we do. If we are mindful of the language we use ( i.e. facilitate not teach, share instead of educate) we are thinking about the relationship we have with women and families and our actions will reflect that. Being with, not doing to. It doesn’t take much effort, and needs no extra resources.

See the photograph at the beginning of this post? The use of the word ‘BORN’ instead of ‘DELIVERED’ on the Birth Suite board to let staff know the woman has given birth? This is the result of a couple of committed (and strong!) midwives thinking about the language they used and the consequential impact on care. They started the ball rolling and although there was much opposition, years later it’s regular practice. It makes my heart sing.

So maternity care workers. Words do matter. To you and to all in earshot of you.

Lead the shift in your workplace even though it may take years for others to follow. Remember Pauline Quinn OBE, and golf. Make a difference, and

Be the change you want to see!’ (Ghandi)

Image

Reference

Furber CM, Thomson AM (2010) The power of language: a secondary analysis of a qualitative study exploring English midwives’ support of mother’s baby-feeding practice Midwifery Volume 26, Issue 2, April 2010, Pages 232–240

Photograph

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57 comments on “Childbirth and the language we use: does it really matter?

  1. Language is crucial but not only verbal language. Non-verbal language is very important too. How many times have you been on the receiving end of negative body language and in opposition positive body language? If you walk into a room to be greeted with a beaming smile are you are more likely to smile back? If you walk into a room to a gloomy look or even if the person avoids eye contact with you, what feelings does this sort of behaviour elicit? Thanks for sharing this post. Let’s all think about how we come across both verbally and non-verbally and make interactions as positive as possible.

    • Thank you so much Vivien. This is spot on. Smiling came out as the top desire for what women wanted when I did a small survey years ago. Positive body language and smiling takes less energy, and is uplifting as it all comes back. Let’s keep spreading the word. :)

  2. Words are so powerful, carry the potential of making and breaking trust at such a critical time, we need to be careful. Thanks for another great post! (Incompetent cervix is another personal bugbear of mine!)

  3. Particularly in the hours, days and weeks immediately post birth, sentences the HCP never intended to be taken to heart get remembered, written down, talked about, and misconstrued. It is so important to remember that as a HCP you may see many clients in a day, and forget the words you say to them all, but the client/patient/mum has only seen you, may memorise the entire conversation as it’s the only ‘advice’ she has got that day, and will dwell on it.
    So the HV who said ‘you’re not looking your best today’ (which was probably true, what with having waited in a waiting room for 2 hours covered with baby sick) will have long since forgotten the comment that I still remember as a hall mark of ‘offensive HCPs who don’t get the point’. The midwife who came with formula who told me ‘you’ll never get any milk out of those’ four hours after birth never intended that to be the reason that I’m still breastfeeding 11 months later. But as a new mum those phrases – and there are others – are seared deep inside me, along with all the other doubts that are a natural point of that phase.
    And someone is never ‘only’ dilated a bit. You’re either dilated, or not. Whether you’re dilated ‘enough’ is a different thing.

    • Jennifer this is such a great response. Thank you! A member of my family recently went to visit a Paediatrician about her baby and is comment was SO damaging it upset the whole family. That’s all we talked about. Not one positive element of the consultation was discussed.

      We need to keep trying to influence! Onwards and upwards… Sheena :)

  4. In the feminist movement in Canada many would see the word “sister” as a great word to use..equal in the relationship. I think it’s different in the UK.
    I hate the term “patient denies” instead of “no history of”.

    I used to not like using “ladies” but now I kind of like it although not from a man.

    Nice article.

    • Hi Ann I think sister in the context of my post is a different matter. It relates to a position of seniority in the workplace, not a mutual partnership or group. And ‘patient denies?’ Never heard of that one! I always try to encourage the use of the word ‘decline’ instead of ‘refuse’ as it suggests there has been a choice rather than a compulsory treatment!

      Thanks for taking time to respond..and I’m pleased you liked the post. Sheena :)

  5. Great article Sheena, I’m always banging on at my students about language and how we speak about the women we come into contact with. I dislike it intensely when students refer to women as, she’s only X dilated or she’s contracting, or the c-section in bed x. It so dehumanises women and students are adopting the language of the institution by osmosis from their midwifery mentors.

    • I think more and more midwives and health care professionals are considering their communication approaches; hopefully we can nudge enough to create a change. How do we influence the mentors? Social media (especially Facebook) seems to reach more people (including midwives) than published articles……let’s keep going! Thanks for your comment and time Luisa, Sheena :)

  6. Having been involved in this conversation on twitter, it is heartwarming to see someone I personally aspire to take on an important subject and blog about it.

    I’ve had many a conversation with my fellow cohort members regarding language we have heard in practice. From women being ‘allowed’ to do things (like push their baby out) to us students being referred to as ‘my’ student. A personal bugbear.

    Language is powerful!

    • Hi Becky what a thoughtful response. I agree with all you say and it’s important to keep the fire burning! We will debate it further via @wemidwives and hopefully influence further. Thank you so much Sheena :)

    • This is a light-hearted reply..”Fellow cohort” ..ohoh.. Can’t use fellow unless you’re referring to men in your cohort!

      It’s fun to pick up all the places where we inadvertedly(sp?) use wrong gendered language too.

    • @ Becky: I actually like someone saying ‘my student’ rather than ‘THE student’ which I get a lot. Makes me feel a relationship has formed, rather than just another obligatory student.

      @Sheena: Reread this again and it’s brilliant, will try my hardest to be aware of my choice of words. They are so powerful.

  7. Well said! Over the years as a CNM I have noticed a certain amount of ownership present in the way we talk as well… I find midwives more likely to say to colleagues, “I got a 3e tear last night” rather than “the patient had a 3e tear”. I think it demonstrates an awareness of the joined experience we have with our birthing mothers.
    Sara Holt, CNM, Portland OR

  8. Having been involved in this conversation on twitter, it is heartwarming to see someone I personally aspire to take on an important subject and blog about it.

    I’ve had many a conversation with my fellow cohort members regarding language we have heard in practice. From women being ‘allowed’ to do things (like push their baby out) to us students being referred to as ‘my’ student. A personal bugbear!

    Language is so powerful!

  9. I disagree that saying a woman is ‘one of my ladies’ has a negative connotation. As a student I have used that phrase to describe my follow through women and I have found it has a positive reaction – the women feels that someone genuinely cares for her, and is taking some responsibility for her care, rather than just being another woman coming through the antenatal clinic or birthing unit. I say it in a similar manner to the language Sara Holt mentioned.

    • Hi Denise thanks for commenting. I think our perception of what women like and want varies, and what women actually want and like varies too! We are all individuals and I am sure you’ll agree…

      For example I used to work with a midwife who was so lovely and very motherly in her approach. She used the phrases ‘my ladies’ and ‘my mummies’ with such good intent. However whilst some women liked this approach, and I am sure some never even noticed, there were others that told me they disliked it and found it patronising and condescending. I am sure this could be the case for everything we do or say, and my post isn’t to dictate. Just to consider what we say, as often we don’t! Lovely to be in touch…Sheena :)

  10. Of course, if we kept our fingers out of women’s vaginas, we’d have no reason to label the cervix at all, would we!

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  12. I really love this post. I think it absolutely does matter – in so many things. I had so many nurses and doctors use positive language toward me in labor and it made such a difference. But then again at one point in my (very long drawn out labor) a doctor told me that I could be back tonight or in 2 weeks (they were discharging me after I had been admitted and labored all night) and that was so discouraging I went home and cried the whole way home.

    • Melissa I am so sorry to hear that. Sometimes words that are meant to encourage actually do the opposite. And remain as a memory more than all the positive words put together. It’s so important that we keep raising awareness as improving how we communicate isn’t resource bound and doesn’t take more time. But the impact can be life changing! Thank you so much for taking time to comment. Sheena :)

  13. I agree with all that has been said in this article. As a student midwife I feel really sad when women ask their midwife for permission to do certain things. The thing that upsets me the most is when women say ‘can I pick him/her up?’ when referring to their newborn baby. Of course they can pick their own child up! – how have we come to make women feel that they must seek permission from the midwife to hold their own child?? – clearly the midwife is viewed in a powerful position by some women and this is not necessarily a good thing…

    • Hi May, many thanks for taking time to comment and to add your thoughts on this important issue. I had forgotten about this, women asking to hold their baby. Health care professionals have taken control in so many ways. Let’s keep on highlighting the need to change with our colleagues…it works! Thanks again, Sheena :)

  14. Thank you for writing this Sheila. It’s such a critical issue.

    My personal bugbear is the phrase ‘but you should be grateful you have a healthy baby’ and how it’s used to justify poor birth experiences.

    I hate for two reasons:

    Most importantly, because it locks women into a place where they are unable to speak of how they truly feel about their birth experience, particularly if it’s difficult or traumatic. Forcing women into silence on the grounds that they must be grateful is a cruel thing to do and it has terrible repercussions.

    Secondly, that anyone who says this to women is unable to see the cruelty of what they are doing. A healthy child just not justify the quality of a birth experience. They are two separate entities and must be treated as such. It goes without saying that every woman who gives birth is grateful when her child is born safe and well. But that does not mean that she is equally happy or grateful for the experience of how that child arrived. One does not validate the other.

    I feel that health professionals, in particular, need to really not say this to women. It provokes dis-engagement at so many levels.

    • Hi Kath, you are right…because wellbeing as you say means so much more than a live and healthy baby, although the latter is always primarily paramount for parents and family. I do think as health professionals we try to ‘fix’ a problem, so by offering a potentially positive slant on a situation we believe we are smoothing over things. And really, I am sure none of these comments are made with bad intent. Thanks for contributing to the debate, it’s good to keep up momentum. Sheena :)

  15. My biggest bugbear is when women are referred to by bed/cubicle number rather than name. They are people at the end if the day and as a Student Midwife I try to refer to them by name first such as ‘x in 7.2′. I don’t mind the term ‘ladies’ so much when talking anout them generally but I hate it when some Midwives refer to them as ‘girls’.

    Body language is also of huge importance. I naturally stand/sit quite often with my arms crossed when I am talking to people – not because I am defensive or anything, I just find it comfortable. I have noticed that now and when I speak to the women or are listening to my mentors speak to the women, I try to be more aware of my body language and in cross my arms to try to be more open. I figure if I try and remember to do it now as a Student, it will become natural not to cross my arms by the time I’m qualified.

    There is obviously a lot more scope for body language as well as the verbal communication but these are just a couple of things I felt we’re important to me. It’s got me thinking that maybe I could look at communication for my dissertation though its 18 months before I have to start thinking about that.

    • Hi Ree, it’s great that you are thinking about this now, and considering taking it further with your dissertation. I agree with your comments, and just want to thank you for joining in the debate. Good luck! Sheena :)

  16. “Catching babies” There’s one. We have been taught that we birth babies, we don’t deliver them, or ‘catch’ them.

    • Take your point Emily! But there’s a story behind that one! But I really don’t think as midwives we birth babies, but as mothers we do! My title was to demonstrate midwives’ facilitative role, rather than one of control.
      Thanks for taking time to comment! Sheena :)

  17. Oh I love your article! I love it when care providers commit to making changes within themselves to benefit the women. And it takes effort to start with, but then you just can’t imagine going back. We love to share this information with our dads in our online classes. I think the language we use when we are talking with dads is extremely important too, it helps to normalise birth for them too and take out some of the fear that can be present in men – and having a relaxed birth partner is important :)

    Cath @ http://DadSkills.com – online childbirth classes for men

  18. A really interesting topic and one which I am thinking about more and more as I reach September when I’ll become a student MW. As a breastfeeding peer supporter, I’ve witnessed many mothers who have been upset by the way HCPs have worded their ‘advice’/support. In supporting mums, I always try to imagine how I would feel and how I would like someone to speak to me as or before formulating my reply. Even seemingly insignificant words and sentences can make a huge difference to how a mum perceives her maternity care facilitator.

  19. I qualified as a midwife in the UK a couple of years ago and can’t remember any part of the 3-year course that dealt with communication in midwifery. So we just had to pick it up on the fly during our work placements, meaning that bad habits get passed down from one generation of midwives to the next with no real guidance.

    • Hi Declan, that’s interesting…I wonder if midwifery courses differ?
      That’s why we need to make use of social media channels such as this, to try to raise awareness and to break those bad habits. Thanks for helping by responding to my post. Much appreciated. Sheena :)

  20. Hi, Ive read this article and the comments with much interest. I was recently turned down for a place at University and I think my body language in interview was mis construed and from things spoken about here have made me realise where I may have gone wrong. Ive learnt alot from what has been mentioned here and I will take on board and probably re-read everything here a dozen times over and be mindful of how I describe the role of the midwife in my next interview as I am determined that I will succeed in joining you all in this utterly privelaged career. Thanks so much for sharing x

    • Hi Sally, it’s great that you got in touch, and that you feel that my post may help you in a future interview. We often don’t think of our body language, especially when we’re nervous. Good luck next time…and stay positive! Sheena :)

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  22. Hello sheena and other girlfriends:)

    I’m a third yr midwife towards the end of my course and I’m about to do my final exam! I have memorized this article and I love it, I always use different terms on placements such as surges instead of “are u feeling PAINS?” It gets some laughs from midwives but I don’t care it comes natural to me. I’m going to ref this article not just bcos of extra marks but because I really believe in positive speech and positive thinking.
    Thanks for sharing this sheena:))))
    Abby.

    • Ah you are welcome Abby! It’s definitely been one of my most read and commented on posts….thanks for letting me know you found it useful, and good luck with your work!
      Sheena :)

  23. Yes, language reflects our thoughts and it matters. Changing our thoughts changes the words we use, but changing the words we use also changes our thoughts. If we want to empower women, we have to be careful about how we speak. Who would cheer on a marathon runner by saying, “You look tired, honey? Do you need some help?” rather than, “Wow! You’re doing great! You can do it!”

  24. You are so right about remembering the negative part of the experience. My Mother is in her 80’s and to this day she recalls when she asked the Midwife what she was going to inject her with as she was miscaring her baby ,” not to worry love it is just to make your hair curl”. I realise this was a long time ago but my point is that the women we care for and work with don’t forget ……
    It is such an important topic, I remember one Mother I worked with we discovered she has been sexually abused and when she was having her first baby she was very upset as the words used by midwives and Dr’s alike were simular words used by her abuser. Needless to say her care was adapted by use. I was the Midwife who visited her most in her home postnatally.We discussed her experience for her labor and brithing of her second child. In a word impowerment was what she used. I was very moved by this and asked her why she felt this ….”you listened ,and you traveled with me “. I was very humbled and thanked her for allowing me to learn from her .
    maybe our choice of words can adapt when we are always mindful that we travel with Mothers and their families.
    Thank you Sheena ,
    Diana

    • Diana, thank you for your important and sensitive comments. I am not surprised (but saddened) that your mother remembers such careless and hurtful words. Many women never forget the words spoken to them during childbirth, and I have letters from some after they read my book, Catching Babies. I am pleased you drew attention to those women who have been abused. There is a double vulnerability here, and we must always be mindful.
      Thanks again and best wishes, Sheena :)

  25. I couldn’t agree more. Twice I have been told that I have failed. “Failed induction” and “Failure to progress” and “failure to push” and, more recently I have been told that I am “highly unlikely to succeed” in my goal of a VBAC. At my last consultant appointment I was told baby was “too small” and that they want to get me to 34 weeks and then discuss delivery. When I told them that usually my babies arrive around 42 weeks and that 34 weeks is VERY early for me, I was told that I “had” to have a c-section “of course.” None of my feelings or intentions have been considered so far and actually it seems more and more likely that the idea of a VBAC is nonsense to my doctors, and some of the midwives I’ve seen too. What you say to a woman really is important because although my eldest is now almost 10 years old, I remember everything as clear as day, and I’ve carried those words through a traumatic birth and two subsequent stressful pregnancies. And you’re right. We’re not patients, we’re not sick and there is no need to label us as such.
    x x

  26. Pingback: Childbirth and the Language we use: does it really matter? By Sheena Byrom - Birth Balance

  27. I wholeheartedly agree – although I would add a couple of things and disagree with one – simply that I don’t care whether I am referred to as a lady or a woman… Very low on the (considerable) list of damaging things said to women during labour, in my opinion. I would add though that I think consultants are generally more prone to unhelpful – sometimes downright damaging – language than midwives. I had “failure to dilate” ,”failure to progress” amongst other frankly pejorative language thrown about during my first labour. And also being referred to as “she” as if there were not a sentient, conscious human at the other end of the vagina. “She’s not pushing effectively” – from the consultant to the midwife was probably the worst conflation of these two. And actually not being communicated to directly at all in several instances, som of them critical and frightening. Actually it made what was already a physically very difficult labour (51 hours, cascading interventions, forceps and lots of resulting damage) into a very emotionally and mentally damaging experience too. I had severe PND for months afterwards, largely centred around feeling like a total failure as a mother, and as a woman. I can’t help but think both the language used during delivery and the way it was used, contributed to a large degree to this. I’m a firm believer in the idea that the means by which a woman gives birth doesn’t actually matter all that much, but that how a woman FEELS about her birth experience is hugely, hugely important for her wellbeing (and that of her baby) afterwards.

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