Recently, I was interested to read a review of communication used in maternity care, published in the British Medical Journal (Mobbs et al, 2018). Some of the terms criticised by those women asked (such as ‘good girl’), I was surprised to see were still in use. Other phrases, such as ‘my woman’, ‘the primigravida’ and ‘the patient refused’, I know are still commonly used.
As midwives, we are aware of the privileged relationships we have with women and their families, and that ‘power’ should not be a part of that. Using patronising terms could make women feel undermined in their ability to birth, and adversely affect decision-making. We know that time can be of the essence in practice, but using a woman's name does not mean communication is any more protracted than the phrases women identified in use as above. Using people's names is surely the first step in the personalised care we are seeking to provide and part of the Better Births values.
Conversely, I do think that midwives use the term ‘my woman’, not as a mark of disrespect, ownership or disempowerment, but from the perspective of a nurturing partnership. Is it political correctness gone mad, as suggested by some, or part of some ill-informed and outdated medical model of care?
It was suggested that ‘refusal’ should be replaced by the softer term ‘declined’—but are either of those necessary? Choices are discussed and options outlined in care provision, and if a woman chooses one over another, is she guilty of non-compliance? A summary of discussions and the decisions made does not require a health professional's opinion, over and above that they might wish to record that they had recommended a different path.
Health records are scrutinised more closely now than ever before—not just by colleagues, but also by the women themselves, who have a right to know what has been written. I have always been an advocate for plain English and see no need to use either overly elaborate terms or what could be viewed as insensitive remarks. I remember, as a student, challenging an obstetrician who, after seeing a woman who was requesting a termination of pregnancy, wrote to her GP, describing her as a ‘promiscuous 21-year old’. He had absolutely no grounds for this comment other than the medical request. He did not amend his records and I assume it is still on her file.
The review appears to have received comments both on social media and in the press. It has also been reported that midwives are being ‘banned’ from using certain terms and should ‘abide’ by these findings. I believe that the language being used by the press might be as objectionable to midwives as the reported phrases were to women. At a time when the profession is seeing high levels of staff shortages and low morale do we need yet more rules to impact on our day to day work?
I think we often simply forget, when busy, the effect that language can have. Some 10 years on, I vividly remember the consultant treating my father stating that our family looked ‘dressed for a wedding’ before telling us that he had ‘about 12 weeks to live’. I'm sure he does not even recall that, but it will stay with me forever as a totally insensitive and redundant comment. Other family members have recalled comments that have stayed with them and still cause distress. One was a doctor stating that a friend's body had been ‘shattered’ following birth; something that affected her relationship and self esteem for many years.
I am very aware of the language I use and try to ensure it is both appropriate and respectful; however, it is not always easy or straightforward. Gender-specific terms are now being seen as irrelevant and I try to avoid them, although I do sometimes say ‘ladies and gentlemen’. I do not mean to offend, but it's been part of my vocabulary for a long time. A common sense attitude needs to prevail, where people are encouraged to highlight comments that are offensive or upsetting, allowing midwives to learn. I feel that it is easy to differentiate between someone who is inherently disrespectful, and someone who makes a genuine mistake.
One of the other discussions around this topic is the difference between language used in public and private, such as the office. In my opinion, it is better to use appropriate terms at all times so that it becomes part of accepted practice. All health professionals need to be able to discuss any thoughts and feelings, but they should do so within their professional boundaries. Part of being a leader and team player is having a sense of humour and camaraderie, as long as it is not at anyone else's expense.
It is important to be conscious of the language we are using with those we meet, but let common sense prevail. The profession does not need to become more defensive; just evolve with the times.