The Language of Birth.
This is from the talk by Jennifer Watkins and Cheryl Glenie presented to the ACMI National Education Forum, ÔFrom Here to MaternityÓ held in Adelaide on Friday 27th September 2002.
We began by introducing each other in obstetric language and then in (wise) women language.
This is Jen: As a primip experiencing a normal pregnancy Jen was allowed to deliver in a public birth centre with the permission of the obstetrician at the booking in visit. The delivery was managed by an independent midwife who had visiting rights at the hospital. As mentioned Jen is a doula, helping women through delivery and supporting their husbands. Over the past 4 years sheÕs had births in public and private hospitals and even at home.
Jen's introduction of herself as a woman and mother: I gave birth to my son 5 years ago, on all fours, with my partner and a community based midwife by my side, and it was a powerful life-changing experience. I gave birth and now I know I can do anything. I have the enormous privilege of being with women as they give birth in the place of their choice.
This is Cheryl: After three normal vaginal deliveries, as an elderly grand multi 10 years ago, Cheryl was not considered a low-risk candidate for a trial of labour in the birth centre. She found an independent midwife willing to take the risk of delivering her at home, and has since had three deliveries at home, without needing to transfer to hospital.
Cheryl's introduction of herself as woman and mother: I am a mother of 6 beautiful children. I have enjoyed 6 sets of arms and legs growing and moving inside of my now ample belly. I have breastfed for more than 12 years and am still breast-feeding although now my baby sits lower on my lap to reach the nipple than her older siblings. My first three children, now all adults were born in hospitals. When I was pregnant with my 4th child I already knew how to birth, and being told I was too old (at 34) to birth in a birth centre (my heart was not strong enough so the young obstetric registrar told me), I needed to find a better alternative than a labour ward. We found a wonderful midwife and birthed our 4th 5th and 6th children at home together, with all their older sibblings around them. I know how life changing birthing is. I know how important midwifery is.
This quote is from 'What to expect when youÕre expecting.' Eisenberg, Arlene, 1996.
"...when there is some suspicion of cephalopelvic disproportion (sometimes called fetopelvic disproportion), the practitioner will allow the mother to go into labor naturally. This trial of labour is carefully monitored, and if the fetal head descends and the cervix dilates at a normal rate, then the labor will be permitted to continue."
Eisenberg, 1996, p.216.
What a quote, this is a beauty! It is not from a medical textbook, but from a book written for pregnant women, to answer their questions about pregnancy and birth, and according to the preface, to dispel women's worries.
What does it tell them ? That doctors are suspicious? That you need to be allowed to go into labour? That this is just a trial that is inherently dangerous, needing careful monitoring?
The following excerpt from the same book:
Consumer advocates... are often tremendously helpful, but almost as often they are medically inaccurate, unnecessarily alarming, and/or disproportionately focused on the inadequacies of the health care profession, driving a wedge of suspicion and doubt between parents and their obstetrical caregivers. Eisenberg, 1996, introduction. We are sharing this because it is so funny !!! The language in this quote and in fact the book is dreadful.
It is also annoying to read that consumer advocates such as Jen and I want to drive a wedge between women and midwives (which seem to be included as obstetric caregivers). We may be pushing our own wheelbarrows and have personal agendas, but we are working with midwives to improve maternity care for all women because we know what good maternity care is. We midwives and consumers are working together to promote midwifery care. We know that the way women feel about their birth experiences matters very much.
Why is the language used with women important?
Women rely on communication with their midwives to understand what is going on, to make decisions, and then to understand what happened during birth.
Language gives clear messages about power relationships.
Language gives messages about attitudes and ideologies.
Language affects how women feel about themselves and their birth experience
Much of the language around childbirth is very disempowering.
Changing language around childbirth is an evolving process. It cannot change immediately. Habits are difficult to change, as are deep feelings about wanting credibility with colleagues who use different language. It is not useful to jump on people who slip up and slip in the big D word. It is the attitude, the intention behind the words that is far more important. We want the language of birthing to be reconsidered.
What language is appropriate?
These are questions you could ask yourself about how you communicate with and about, the women who birth with you.
- Does the language put the woman, as a whole person, at the active centre of her experience?
- Are the words ones that she would use? Are they technical words she does not understand, or do they patronize her?
- Is she being manipulated? Are assumptions being made about her social situation?
- Is the language suggesting that she needs help? Does it suggest that she has failed, or that she is a failure?
We have 6 categories of words that we think need reconsidering:
- Doing or Being Done
- The Power of Name
- Using WomenÕs Words
- Pulling the Rug Out q Guilt or Manipulation
- Baby Talk
Doing or Being Done
Think about who is giving birth, who owns the birth experience.
"I had a women...."
" the midwife who delivers you...."
" She had 200 births last year..."
" I did 100 deliveries..."
" I had 100 women..."
" my lady, my woman, my baby..."
" we like to have the placenta delivered within 20 minutes"
manage, conduct, allow, permit
empowering women (giving power to someone else is a problematic idea)
helping, supporting, assisting, looking after (midwives work WITH women)
The Power of Name
How do we talk about women? What do we call them?
Lady (Historically this term was for the landed gentry, ladies and gentlemen, and depicted a woman of class and substance.
We are not suggesting that we women are not classy, substantial and some of us even land owners, but we do want to distance ourselves from the inherent power and social injustice in the word: lady).
Girls, dear, love, lovey, darling, sweetie
'you guys' (Did you hear about the antenatal class where the educator referred to everyone as 'you guys' for the whole class?) Ô
' the induction in room 16...'
patient, consumer / client
Using WomenÕs Words
jargon / abbreviations / acronyms
foetus (NO woman has a foetus, even when the baby is tiny in early pregnancy.)
spontaneous abortion (a woman has a miscarriage)
" we want to see progress of the presenting part" (what is a presenting part?)
primagravida, multiparity (even as a mother of 6 I donÕt know what these mean)
VE (I do know what a VE is because with my last three pregnancies I did not have one.)
CPD (This stands for cephalopelvic disproportion but I have no idea what it means, it sounds like a venereal disease.)
rupture of membranes,
EFM , PND
- DonÕt presume that women and their partners understand - e.g. epidurals and sleeping, forcepsÉalways take the time to explain so they understand.
Pulling The Rug Out
This is language that undermines the woman.
still.... only..... still only.... (This could negative language makes women feel inadequate and could be laying the foundation for intervention. Women need to be encouraged and to feel they are doing well, not undermined.)
Normal (What is normal?)
low risk / high risk
favorable outcome / poor outcome
false labour "not considered in labour until changes happen to the cervix"
estimated date of confinement / due date
incompetent cervix, failure to progress
placental inadequacy / insufficiency
faulty placement of the placenta
untried pelvis / trial of labour sizeable pelvis
There are many others:
intrauterine growth retardation, blighted ovum, abnormal hemoglobin, hormonal insufficiency, management of breastfeeding, inadequate milk supply / insufficient milk, average, normal etc
Guilt and Manipulation
Guilt is often used in our society.
' you're happy with this arenÕt you?' (This does not give the women a chance to really answer the question in an informed manner.)
'well, itÕs your choice, but IÕve seen babies die from this..'
When a woman is pregnant she is having a baby not becoming one.
bub, bubby, bubs, tummy, tum, pains
' dad, you can cuddle bubs while mum hops up and has a wee' (No personal pronoun used.)
Hubbie, 'down thereÉ private partsÉ birth canalÉ up insideÉ bottom' (euphemisms - don't be afraid of the big V word!! )
hop up, pop into, (This is trivializing of the woman and the birth experience.)
it wonÕt take long...
just a little prick...
we're just going to...
We are not persecuting. This should be fun. We all make mistakes and that is how we learn. We would like to break some language habits. We all make mistakes as we learn, mistakes helps us to learn. We would like there to be ongoing discussion about the language used to describe pregnancy and birthing. We would like the discussion to include women, midwives, GPs and obstetricians.
These closing excerpts are from a woman's description of birth.
What is birth? Birth is smell- birth is the smell of the lovely liquids surrounding the baby. É Émind the waters that the baby gently swims in, one might let those waters lie deepÉuntil they release on their own, and drench mother with warm wetness and rich, sweet smells. What does this lovely birthjuice smell like? Éevery good sex smell, the smell of baby pee- add a bit of sweet and you have the smell that gets stuck in newborn hair and makes mothers swoon in luscious, loving abandon. This is birth smell- a big part of what birth is. What is birth? Ðsound and sensation. Lots of rolling, rocking, thundering, climactic rumbling, and hip-grinding, wild sensations that leave their imprint on a womanÕs soul and psyche forever. When a women is in full sublime control of her undrugged senses she enters into a birthdance- (then a birth trance)- she moans and swings her hips with each low guttural sensation. What is birth? Éthe blueprint for a lifetime of love between mother and child. The moments of birth are huge ones in a lifetime- the mother remembers in her mind and skin every nuance of sound, touch an emotion of birth. The child remembers in spiritÉ birth is the time when mind, body and spirit all collide in one holistic blast- and gentle, gentle, gentle is what our senses crave and love best. Symbols, smells, sounds, rhythmic movement- dancing to the pace of oneÕs own birth sensations (not "contractions")- swinging oneÕs hips in tune to the bat. This is what birth is- freedom to become wholly female- powerfully Woman-richly, ferociously, passionately animal in seizing life by the horns, and riding it as hard as you can. This is birth, this is life- this is passion- this is love. This is what birth is- a panting, sobbing, wet, fierce release- then landing sweet and heavy into the purest love. Round, smooth- female. Complete.
(www.birthlove.com - June 2002)
- McCraken, Leilah; www.birthlove.com ; June 2002.
- Kitzinger, Sheila; Sheila KitzingerÕs Letter from Europe - Obstetric Metaphors and Marketing: www.sheilakitzinger.com ; April 2000.
- Leap, Nicky: The Power of Words: MidwivesÕ Journal: Nursing Times; May 20th; Volume 88; Number 21; May 1992.
- Conversations with many women and midwives. Eisenberg, Arlene; What to expect when youÕre expecting; 1996.