I have recently joined the editorial board of the British Journal of Midwifery and have been asked to review papers for possible inclusion in the journal. The journal receives a high number of submissions for consideration but for some authors their submission is returned to be ‘revised and resubmitted’ or ‘rejected’. Having an article returned or rejected is not uncommon; however, it can be frustrating for the author and may decrease their confidence. Articles can be rejected for a number of reasons; it may well be suitable for another journal; it may not meet the current focus of the journal or it may be poorly written or lack scholarship.
An article returned for revisions can be problematical, as the author has to find additional time to attend to the suggested changes. For some authors, the reason for a paper being returned to be revised and resubmitted may be disconnect between in the writing the language that is used and the message intended to be conveyed. Language matters because being able to say what you mean necessitates the use of words that mean what they say! An example of this is when an article focuses on a midwifery-led approach to care, suggesting normal childbirth, but the author refers to and writes about ‘patients’, ‘bookings’ and ‘deliveries’, rather than ‘women’, ‘health assessment’ and ‘births’. Authors need to be mindful of the language used when writing the original paper to reduce the incidence of a request for revisions.
The language used in a written communication (article) may convey power dynamics in midwifery and maternity services, subliminal messages, or contentious beliefs, which may confuse and cause offence to the reader (Leap, 2012). Communication skills are a fundamental aspect of all health care practice. Written communication is as important as other forms (verbal, implied, behaviour). Meaning may be lost, misunderstandings created, inequalities reinforced and actions missed when communication skills are inadequate. The Nursing and Midwifery Council (NMC, 2009) identifies that student midwives should demonstrate good communication skills when providing midwifery care. Written communication may take many forms: reports, results, diary, statements, reflections or articles, which should all be written with consideration to the intended reader or audience. Obviously in a journal such as the British Journal of Midwifery using language that is offensive or politically incorrect is not acceptable and articles written in this way are easily discounted.
Words are powerful (Leap, 2012). The merest hint of criticism can often cause offence. Words can be both empowering and disempowering. A good example of the power of words is when we use affirmations such as ‘healthy eating’, ‘brilliant breathing’ or perhaps ‘creative writing’! These words promote positive thinking, encourage and increase confidence of the individual. Language also has the potential to disempower women, when writing about midwife–led care, the writer may refer to ‘my women’ or ‘allowing women to choose’ both of which imply power differentials. I am sure that the author is not intending to eliminate choice or act paternalistically.
Jarrett (2014) identifies that when student midwives ask questions about perinatal mental health, words such as ‘anxiety’ and ‘depression’ were not effective. Women were reluctant to disclose these feelings and using ‘depression’ or ‘anxiety’ limited the conversation. The students believed that using simple words such as ‘feeling down’, or ‘wanting to get out of bed’ enabled better exploration of women's mental health. Keeping words simple is a technique often used in verbal communication but when it comes to the written word authors often feel pressured to include complicated words. The medicalisation of birthing babies probably accounts for some of the complications and language barriers, which may be evident. For example ‘incompetent cervix’, ‘failure to progress’ and ‘intervention’ all imply inadequacy or deficit, which can be a criticism of physiology, the woman or the midwife. The vocabulary associated with a published article should also be balanced to ensure that the reader is able to explore and consider the key messages.
Mind your language
It is necessary to ‘mind your language’ to prevent misunderstandings or mixed messages. The current trend to adopt and use language and words from other disciplines and environments can detract from the readability of an article. Language associated with the army, navy and air force is an interesting approach, words such as: ‘comms’, ‘my watch’, ‘technical failure’, ‘ops’ and ‘risk’ are a reminder that maternity services may be considered a logistical nightmare and compared with a battle zone. Other words such as ‘cost-benefit analysis’ and ‘value for money’ are using language from industry, which may have a very different application for maternity services so clear definitions must be identified prior to usage. Language associated with management has also infiltrated midwives' language such as ‘product’, ‘output’ and ‘metrics’. Nursing terms such as ‘time to treatment’ and ‘bed occupancy’ have limited usage in midwifery care.
Language matters as some words are naturally contentious. The word ‘delivery’ has been an issue for students, midwives and mothers for years. Midwifery students are required to record the number of deliveries, not ‘births’ (EU Criteria). Therefore, midwives may find it difficult to refer to ‘birth attended’ and births (not deliveries) are notified (Births and Deaths Registration Act, 1953). Identification of an assisted delivery or caesarean section is important for care planning but should not be used to imply inability or negative beliefs about the mother.
The choice of language used is important as it can affect the number of readers and citations. ‘Research’ is a favourite word of mine and is frequently used in written articles. The use of the word research in a professional journal usually refers to a systematic enquiry, whereas research used in an informal setting may be concerned with a random or haphazard search for information. Being clear as to the meaning will ensure that the value and reliability of the ‘research’ will be evident.
Some words are ‘heavy’ with meaning or send subliminal messages; ‘labour’, for example, reinforces the notion of hard work, pain and medicalisation, whereas ‘childbirth’ suggests an opportunity, experience and a result. So the language used in written communications requires mindfulness (Warriner et al, 2013) from a reader's perspective. What do you mean when writing about a positive outcome or positive birth? A positive outcome may refer to the birth of a baby which has good Apgar scores, no physical abnormalities and is the desired sex. For others a positive birth is about informed choices, empowered women and compassionate care. Our choice of words can suggest powerful images and hidden meanings.
‘The choice of Language used is important as it can affect the number of readers and citations.’
Abbreviations are also associated with misunderstandings and loss of meaning. I recently attended a meeting where abbreviations were frequently used; this technique can exclude some participants, alienate and disenfranchise individuals. It is important to know the audience: for example, NICE guidelines are not so nice when it is unclear what they are! National Institute for Health and Care Excellence (NICE, 2014) guidelines are an example of how the language may inadvertently affect the reader. Midwives are not the only readers of the British Journal of Midwifery. In choosing to use abbreviations in an article it is necessary to write in full the words and follow with the abbreviation. Many authors recognise the need to identify and clarify abbreviations but missing the definitions may be another reason for an article being returned for ‘revisions’.
Changing how midwives communicate is essential if we are to provide quality health care to childbearing women. The language used in the writing of care plans, records, reports and articles matters as they are communicating to a varied audience the values, beliefs and attitudes held by the author. Our words should be clear and concise so that meaning is easily understood. Written words can be seen as a reflection of care, compassion and commitment to health and wellbeing of women and their families.
Conclusion
The British Journal of Midwifery wishes to uphold the use of language associated with a culture of shared understandings. So while it may be perfectly acceptable to use terminology, common words ('delivery', ‘patients’, ‘husbands’, ‘under the consultant’) and abbreviations (B/F) in some arenas, the language used in your article is important as words are powerful and need to be chosen with care. When you are submitting to the British Journal of Midwifery you should ‘mind your language’ as the impact of the words used may disempower, confuse or send mixed messages. Raising the status of the midwifery profession will be achieved when language is clear, words say what they mean and the specific skills of being ‘with woman’ birthing a baby is understood.