What in the Word?
It’s 2022. When will the medical industry retire outdated terminology like "geriatric pregnancy" and "hostile uterus"?
“Barren”. “Geriatric pregnancy”. “Missed miscarriage”. “Habitual aborter”. These are just a few of the phrases medical professionals have used over the last few years to describe my reproductive standing during my journey into motherhood.
The lexicon surrounding fertility and motherhood is riddled with failure. After 50 hours of induced labour with my daughter, during which I physically worked harder than I have in my life– I was informed by the doctor that I was “failing to progress” and would require intervention.
The goal of medical terminology should be to educate and empower women and people with vulvas. Not create shame, place blame, or stoke feelings of inadequacy. Outdated and undermining terms can deeply affect the mental health of those navigating the trajectory of motherhood. For someone struggling to conceive, being told by a medical professional that you have an “incompetent cervix”, or a “lazy uterus” is unnecessary– and grossly inaccurate. Such lack of consideration for the anguish many women experience when trying to have a baby, and the impact that this kind of terminology can have on person’s mental health is not just insensitive. It’s cruel.
All too often, this kind of outdated terminology is used during some of the most sensitive and vulnerable times in women’s lives. After I had my first of two miscarriages this year, the female sonographer wielded the ultrasound wand in the air and declared: “You have retained products of conception in your uterus.” It turned out she meant the placenta of the fetus I had grown for three months. I do understand why ‘products of conception’– a medical term used to identify any tissues that develop from a pregnancy– is used between doctors and nurses. But surely there’s a kinder option for those who are dealing both with pregnancy loss and the understanding that the miscarriage isn’t complete (a very particular kind of emotionally exhausting and physically draining hell)?
When it comes to the word ‘abortion’, a considerable amount of work needs to be done to unpack our biases. I admit that I still cringe when I remember a nurse who referred to me as a “habitual aborter” following my back-to-back pregnancy losses. Despite wholeheartedly believing in a women’s right to chose, and knowing I would absolutely have an abortion if I were to become pregnant and not wish to carry to term, I found it an uncomfortable label to accept for my own circumstance without really questioning why that was. But OB-GYN and Nyssa advisor, Dr. Laura Laursen, made a great point in a discussion we had recently: “By using the correct medical terms of spontaneous vs. induced abortion you help destigmatize both. They are both part of the normal reproductive lifecycle and should be talked about as such.”
Reproductive heath journalist, Rachel Wells, agrees: “The word abortion has been slandered so much its medical meaning has taken a backseat, if not left the building entirely. Abortion has such baggage. Abortion must mean you didn't want the baby, right? Abortion must mean you didn't have faith that the baby would be okay, right? You didn't have faith that your body could handle it, huh? Blah, blah, blah, no. That's blasphemous. Some abortions, like ‘spontaneous abortions’ (otherwise known as miscarriages) just occur. They happen to people who desperately want babies and they happen to people that don't. The term elective abortion makes it sound like people are running wild to go and get one. And some may be and that's great! Others though may choose an abortion because they've been told their baby or they themselves would die. We can never know, can we? Let's give words and each other more empathy.”
My desire for the medical lexicon to shift isn’t about ‘policing’ language. I believe that linguistic tussles regarding politically correct language can sometimes be in danger of veering so far into asserting ‘rightness’ that effectiveness is negated. This research article, Humanising Birth: Does the Language We Use Matter?, puts it well:
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. It is pointless to change the term “crash section” to “a caesarean section that we will recommend to the woman is done as rapidly as possible” if this alteration prevents rapid understanding of the gravity of the situation among medical practitioners. Language must still be adjusted according to whom we communicate with and why.
I think that’s key: using the filter of compassion and tweaking our language depending on who we’re talking to. But there are also many terms that are so woefully misguided and easy to replace that we should just do away with them altogether (looking at you, “inhospitable uterus”). We asked our Nyssa community over at Instagram to weigh-in on the words they most wished to never here again– and suggest some alternatives. Take a look at our co-created glossary below, as well as research articles and thought pieces related to how we use language and why it matters so much to our health and wellbeing.
Please feel free to share and comment. What did we miss? How are you thinking about language used when it comes to women’s health and fertility? Let us know down below. This month, we’re giving away a copy of Unwell Women to a commenter, picked at random. In Unwell Women, author Elinor Cleghorn traces the almost unbelievable history of how medicine has failed women by treating their bodies as alien and other, often to perilous effect. The result is an authoritative and groundbreaking exploration of the relationship between women and medical practice, from the “wandering womb” of Ancient Greece to the rise of witch trials across Europe, and from the dawn of hysteria as a catchall for difficult-to-diagnose disorders to the first forays into autoimmunity and the shifting understanding of hormones, menstruation, menopause, and conditions like endometriosis.
Join us for the next issue of Body of Knowledge, where we’ll dig into what to expect when you have Pelvic Floor Therapy for the first time– and why it’s so critical for women’s health, regardless of whether or not you’ve been pregnant and/or have given birth.
Warmly,
Mia (Body of Knowledge Editor-in-Chief)
Body of Knowledge’s Revised Glossary of Terms:
Co-created with suggestions from our Nyssa community over at Instagram. If you have thoughts or suggestions, please let us know– we’re going to keep building this out.
Shout-out to Peanut, who launched its Renaming Revolution campaign last year. Their team has been working hard to redefine the negatively-charged terms that are too often used during the most sensitive and vulnerable times in women’s lives. Check out their glossary, which serves as an important resource for anyone who speaks to women about their maternal experiences moving forward, and be a part of creating a stigma-free future.
Humanising Birth: Does the Language We Use Matter?
I referenced above an interesting op-ed in the British Medical Journal from doctors and advocates working in the UK, in response to recent changes in emphasis in the NICE Intrapartum Care Guidelines. Alongside advice on drug doses for oxytocics and optimal fetal monitoring techniques, a direction is now made to senior staff to “demonstrate, through their own words and behaviour, appropriate ways of relating to and talking about women and their birth companion(s), and of talking about birth and the choices to be made when giving birth.
Suggested good practices in birth communication (from NICE Intrapartum Care Guidelines):
Research Articles:
The Language of Women's Pain: Ideology and Critical Cultural Competencies in Pain Literacy (Frontiers in Communication, 2020) looks specifically at language gaps in care for Black women.
Women’s Reproductive Health and “Failure Speak” (Canadian Medical Association Journal, 2023). Definitely worth pulling out the conclusion here:
Language, simply put, is not innocuous. This is not to say that the language of failure has no place in medicine. However, the difference between nonfunctional lungs or kidneys and nonfunctional ovaries is arguably substantial. This language is particularly meaningful in reproductive health care insofar that reproduction is interlaced with social expectations for women’s bodies and lives.5 It carries with it the implication that women not only fail to reproduce, but also fail as women. Addressing the continued use of failure speak and its problematic associations ultimately means that providers must come to recognize women as authorities and autonomous actors in their experiences of reproductive health.
The Importance of Language in Maternity Services (British Journal of Midwifery, 2019). This article examines three key themes in the use of language– medical jargon, emotive language and those for whom English is not a first language– and its impact on women’s mindsets and experiences during and after birth.
Relevant Links From Around the Web:
Negative medical language is having a direct impact on women's health services. When the quality of women's lives are at stake, misuse of words develops into a lack of action, adequate care, and a widening of the gender health gap.
The words adding insult to injury in women’s health care. Occasionally in pregnancy the cervix can’t hold the weight of the growing baby, who can be born too early to survive. It’s already appalling, right? Now let’s call the problem “cervical incompetence”, to rub salt into your heartache.
We can finally leave "incompetent uterus" and 62 other honestly rude motherhood words in the past.
The language of maternity is alive and well – so why not expand it to include trans parents? We could all do with a little more solidarity between those entering into parenthood, regardless of their gender.
I have not given birth, but I think I can safely say that if anyone said 'good girl' to me while I was in labor, a homicide would ensue (not that I endorse violence in any way--but I do think I would be pretty immediately blinded with rage).