Mindful Language and Pregnancy
In this blog I will review the current research that highlights the vital importance that the use of language and certain terms by health professionals may have on birth outcomes. What we say to a pregnant woman can have a major impact on pregnancy and the birth itself.
Pregnancy is a period of great transition and transformation for both expectant parents as the family unit prepares to grow. The changes within a mother’s body can both be exciting and daunting as they prepare for the events to come. No two pregnancies are the same, and women often find themselves in a new world of checkups and birthing language which can prove confusing, undermining and disheartening if appropriate care is not taken.
Health providers and the general public need to have an understanding of pregnancy and birthing vernacular to support women we come in contact with by using mindful language to empower better pregnancy and birth experiences for women.
A useful framework , I use, for more supportive language during pregnancy and birth is the FREDA acronym which is based on concepts that underpin the human rights act introduced in 1998 in the UK. To simplify the main messages in the act the acronym FREDA was developed. FREDA stands for the core values of human rights- Fairness, respect, equality, dignity, and autonomy. Supportive language is inherent in each of the FREDA values.
Recently there has been greater awareness and research around human rights in pregnancy and childbirth. The words we use have been paid particular attention due to the positive or negative effects on the experiences of pregnant and birthing women. It is therefore important that we are acutely aware of the unintended ‘interference’ we may cause with our language and advice.
In 2018, Mobbs et al published an article in the BMJ opinion stating, “language signals the nature of the relationship between woman and caregiver, and can deny or respect a woman’s autonomy. Language matters as a way of respecting women’s views and ensuring that they are empowered to make decisions." Appropriate language use is an essential foundation to respectful and empowering care which invites women to participate as equals in their birthing experience.
Research has consistently shown that two of the most important factors in ensuring positive experiences of childbirth are supportive relationships with health professionals and a sense of control over decisions made during birth. If our comments create stress, fear, or anxiety they can create changes in stress related physiology. O’Conner et al (2003) reported that the effects of prenatal anxiety were a predictor of child hyperactivity, emotional problems and conduct problems at age four.
Kinsella and Monk (2009) reviewed studies showing associations between prenatal maternal psychological states and alterations in fetal behavior and physiology, as well as the two possible pathways for the ‘transmission’ of maternal mood to the fetus: (1) maternal-fetal HPA axis dysregulation and (2) intrauterine environment disruption due to variation in uterine artery flow. These studies are in-line with the growing body of literature supporting the ‘fetal origins hypothesis’ that prenatal environmental exposures, including maternal psychological state-based alterations in in utero physiology, can have sustained effects across the lifespan.
The results of a survey undertaken by the multi-disciplinary collaborative #MatExp group, a social activist campaign group with the aim to identify and share best practice across maternity services in the UK, is particularly illustrative. The study explored the language use over a three month period in maternity settings to identify how language could improve the experiences of women, babies and families. Comments received highlighted commonly used phrases and expressions in maternity care which should be challenged.
Six key categories were identified that required change:
1. Paternalistic or patronizing language
2. Language which objectifies women
3. Anxiety-provoking language
4. Dictatorial language
5. Discouraging language
6. Exclusive or codified language
Some examples of poor language included in the survey with suggested alternatives are:
· Instead of saying ‘fetal distress’ say ‘changes in the baby heart rate pattern’
· Instead of ‘labor ward’ use ‘birthing suite/room’
· Not a ‘big baby’ but a ‘healthy baby’
· Instead of ‘delivered’ say ‘birthed’
· Rather than ‘patient refused’ say ‘declined’
· Replace painful contractions with ‘strong contractions’
· Instead of ‘failure to progress’ say ‘slower labour’
While these examples are primarily aimed at midwives and obstetricians working in hospitals it is relevant that anyone engaging with pregnant women know the language women may be exposed to.
In recent years, childbirth educators and facilitators of courses such as Hypnobirthing and Calm birth have brought a more mindful approach to challenge any perceived negative language around birth and pregnancy. Replacing terms like ‘contraction’ with ‘surge’ or wave’; ‘waters breaking’ replaced with ‘membranes releasing’; ‘dilating’ replaced with ‘opening’; ‘fetus with ‘un-born’; ‘false labor’ with ‘practice labor; ‘pain’ with ‘pressure’, ‘sensation’ or ‘tightening’.
people might use language pertaining to the baby’s perceived size- ‘big’, ‘small’ or even ‘high’, ‘low’ are common comments that may alarm some women. People often make well-meaning comments without anticipating the potential impact they can have. In my practice I hear frequently that a pregnant woman is told her baby is ‘big’ or ‘small’ often without any context given. The above example of the appropriate FREDA choice of words instead of ‘big baby’ could be ‘healthy baby’.
It is critical that not only practitioners but friends and family nurture pregnant women and support them in a positive pregnancy and birth experience (whatever that may be for them). Being aware of our communication generally is of the utmost importance, but to a greater extent in relation to pregnancy.
- Julie Uren
References
Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. (2015) The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med 12(6): e1001847. https://doi.org/10.1371/journal.pmed.1001847
Kinsella, M. T., & Monk, C. (2009). Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clinical obstetrics and gynecology, 52(3), 425–440. https://doi.org/10.1097/GRF.0b013e3181b52df1
