The report of the Morecambe Bay investigation. 2015. (accessed 22 August 2017)

Better Births.London: NHS England; 2015

Words matter and so does evidence based thoughtful care. 2017. (accessed 22 August 2017)

The new ‘normal’

02 September 2017
2 min read
Volume 25 · Issue 9

For a language with a wider vocabulary than any other, it can be surprising when English fails to aptly communicate an intended meaning. This has certainly been the case this month, where one small word has suddenly become simultaneously complex, confounding and contentious.

In August this year, the Royal College of Midwives (RCM) answered a policy query, replying that, as of 2014, the RCM's 2005 Normal Birth Campaign had been absorbed into the Better Births Initiative (Warwick, 2017). This seemingly routine response became amplified by social, print and online media, with almost always the same conclusion: the RCM were to stop using the word ‘normal’.

The timeline of this decision did little to curb the explosion of emotion on both sides of the debate, and suddenly, ‘normal’ took on myriad meanings, from a value-laden term that judged women who gave birth with medical interventions as somehow lesser; to an innocent synonym for ‘healthy’; to an aggressive ideology supposedly pursued by midwives ‘at any cost’.

During the fiery online debates, little attempt was made to question the terms being used. The widely circulated claim that the normal birth ideology was pursued by midwives ‘at any cost’ indeed originates from the report into the Morecambe Bay scandal (Kirkup, 2015:13) in which 11 babies and one mother died as a result of widespread failings. Although this damning phrase rippled through the Twittersphere and the news outlets, few mentioned that this was a quotation collected during the investigation—from a single interviewee. Similarly, many reports (and Tweets) neglected to mention that the RCM had not changed its position: it still believes in promoting birth without unnecessary medical intervention, but instead refers to ‘physiological’ birth (Warwick, 2017).

The debate over the word ‘normal’ highlighted a disconnect between health professionals and the public. The change from ‘normal’ to ‘physiological’ because ‘we [the RCM] know what it means, but for many it has a judgmental quality’ (Warwick, 2017) is justified, but it is incredible that this realisation took 10 years to dawn. Like the once-used ‘geriatric mother’—or even ‘singleton pregnancy’—words are harmless when their definition is clear, but if not, this can cause upset. What might a woman think, when she hears her birth deviates from ‘normal’? That she or her baby is ‘abnormal’?

Women-centred care is the backbone of the National Maternity Review's Better Births document (2015), meaning that the language of midwifery needs to be seen through women's eyes to judge its suitability. Midwives, policymakers and indeed this journal all have the same goal: to support women to become healthy mothers to healthy babies, and women deserve to be trusted to make decisions that will help them to feel safe during birth. Women need to be given a genuine choice and all the facts, but this starts with objective language.