Maternity care professionals should avoid saying "good girl", during labour, and steer clear of language suggesting women are simply "baby producing containers", according to new advice published in the British Medical Journal.
"Positive communication and interactions throughout the birthing process significantly affect the woman's experience, which in turn can affect both her mental and physical health, as well as her relationship with her baby post-natally," write authors Natalie Mobbs, Catherine Williams and Andrew Weeks.
In their paper, Ms Williams and Mr Weeks argue that as some women may not be aware of their human rights during childbirth, "rights for respectful care, privacy, and freedom of choice concerning their birth", it is the duty of caregivers to use language that will help empower all women.
"This requires careful use of language, reflection on our own practice as caregivers, listening to women, and communicating appropriately, plainly, and respectfully to guide her through the complexities of maternity care," they write.
Over a three-month period, using the Maternity Experience (#MatEx) Facebook page, the authors collated and examined examples of language currently being used in maternity care settings. From there, the authors identified six key categories requiring change:
- Paternalistic or patronising language
- Language which objectifies women
- Anxiety-provoking language
- Dictatorial language
- Discouraging language
- Exclusive or codified language
'Those providing #maternity care need to consider their use of language seriously. Not only as a way of respecting women’s views &ensuring; that they're empowered to make decisions but also to respect their #humanrights' https://t.co/6TvGAxEWQH @BMJ_latest #MatExp #healthliteracy pic.twitter.com/GJYzeBKvuz
— MHTF (@MHTF) February 15, 2018
The article further outlines several examples of "poor language" commonly used in birth communication.
Professionals, the authors say, should avoid language that is over-dramatic, anxiety-provoking or violent, which means no to "bloody show" and yes to "a show with blood in it."
Rather than seeing women as simply a "container or mechanism for producing a baby", women should be respected as individuals. As such, "gave birth" is more appropriate than "delivered", the advice states.
And it's time to bin codes and acronyms, too. That means it's "your waters have broken" not "SROM" and "vaginal birth after caesarean birth" rather than VBAC.
The authors also want to rid discouraging or insensitive language from birthing suites. "Poor maternal effort" should be substituted for "not finding it easy", while "high risk" should be "medically complex." And, in cases where there is a terminal diagnosis, "compassionate induction" should be used, instead of "terminate pregnancy".
While the authors concede that eyes may roll at the thought of "political correctness gone mad," they believe the change is necessary - and well-founded.
"Good communication during the birthing process is critical to good maternity care; but achieving a shift in deeply ingrained language, and the thinking it reflects, is difficult," the authors write. There are some caveats, however. "There is a fine line between changing terminology to integrate language which is more respectful, inclusive, and less intimidating for the mother, and substituting vague, verbose language which hinders the original message," the authors explain.
For example, it's unlikely "crash section" will ever be changed to "a caesarean section that we will recommend to the woman is done as rapidly as possible", they note, if such a change prevents rapid understanding of the gravity of the situation among medical professionals.
The authors argue that using insensitive language can be indicative of an "underlying malaise which reveals underlying attitudes and prejudices. "It is essential that we achieve respectful practice, ensuring that women have complete understanding and control of their own care," they write. "If we can achieve that, then the use of appropriate language will follow on naturally."
Sarah Stewart, Midwifery Adviser, Policy & Professional Practice Unit at Australian College of Midwives (ACM) told Fairfax Media that the ACM is supportive of clear communication that is woman-focused, relevant and appropriate. "Use of language, what is said, and how it is said is a fluid thing, from woman to woman, and even from context to context," Stewart explains, adding that she would expect a midwife to constantly be evaluating how they communicate so they provide effective, empathetic, and appropriate language at all times.
But Stewart wouldn't be rushing to ban particular phrases from birthing suites entirely, noting that there may be times when their use is appropriate. "I certainly welcome the opportunity for midwives to reflect on their use of language and consider how they can be better communicators," she says. "My view is this becomes much less problematic in continuity of care models of care, especially midwifery, where a midwife gets to know the woman and her family really well over a period of months and knows exactly how to level communication."
But while she may not be advocating a complete ban of certain phrases, Stewart has her own pet hates.
"I hate 'she's 5 cm dilated'" she says. "No one is 5 cm dilated ... a cervix is 5 cm dilated!" And "failure to progress", is another bug bear. "This has terrible communication about a woman's ability to be a mother," she says. "Imagine you are a woman and have been told that you haven't birthed your baby because you have 'failed'. That can compound a woman's feeling of failure and guilt that she is already feeling.
"There are more accurate ways of describing the reason for medical intervention that tell the story without being judgmental (depending on the clinical scenario)."
And last, but most definitely not least, "people talking about 'vaginas' when they really mean labia," Stewart says.