When it comes to patronizing language, midwives have merely replaced the patriarchy with the matriarchy

Doctor is checking a patient

Justine van der Leun’s recent piece in The Guardian has received a fair amount of attention in the childbirth community. It’s  ‘I felt I was being punished for pushing back’: pregnancy and #MeToo and subtitled ‘Pregnant women are still being patronised, blamed for our bodies’ failings, and made to feel guilty about our choices.’

Van der Leun experienced a very complicated pregnancy a few years ago:

Why have midwives replaced the factual ‘vaginal birth’ with “normal birth’ and replaced the factual ‘pain relief’ with ‘intervention’?

I spent one third of 2015 – about 120 days – on bed rest. I moved only to visit a hospital or doctor’s office, where I was scrutinised and presented with a list of concrete and potential deficiencies. There was certainly something wrong with my cervix, likely something wrong with my hormone levels, probably something wrong with my placenta, and possibly something wrong with my baby’s heart. Every time I was examined – which was constantly – a new potential problem surfaced. Having already lost two pregnancies, I was overcome by the looming possibility of catastrophe. I refused to prepare for anything more than a week in advance, as if hope were interchangeable with hubris and therefore deserving of punishment.

The outcome was a healthy baby girl:

That panic ended two years ago, replaced by the more welcome panic of how to care for a baby. After so much dread, not a single could-go-wrong went wrong. I will never know if the precautions helped, or if everything was fine all along. My daughter, born healthy at full term …

Now Van der Leun is pregnant again and this is also a high risk pregnancy. But this time she is whining:

At my 20-week check, the ultrasound technician informed me that, while my baby was in perfect condition, my cervix – the portion of the uterus that stands between the baby and the world – was shortening prematurely, the condition that had caused me much grief two years earlier. The official diagnosis is “incompetent cervix”. In a “competent” female body, the cervix stays long and closed until full term, and then dilates. But in an “incompetent” female body, the buffoonish cervix can shorten and open early, allowing a baby to tumble out. The “incompetent cervix” joins a number of curious obstetric diagnoses: the “inhospitable uterus”, “hostile uterus”, “hostile cervical mucus”, “blighted ovum”. Meanwhile, men experience “premature ejaculation” and not “inadequate testicles”; “erectile dysfunction”, but never a “futile penis”. They exhibit problems, but their anatomy is not defined as lacking. Pregnant women over 35 are of “advanced maternal age”, just a slight improvement over the previous term, only recently defunct: “elderly”. Those who have suffered more than two miscarriages are known as “habitual aborters”. We experience “spontaneous abortions”. A bad habit, that impetuous self-aborting: if only we had the self‑control to stop.

Oh, grow up! It’s hard to imagine anything more immature than facing a life and death situation and whining about the language that doctors used to describe it. Van der Leun seems to believe that this both patronizing and misogynistic:

The expectations placed upon women by the obstetric establishment – especially if our pregnancies don’t follow a perfect course, and often even when they do – are presented as normal. The field of obstetrics requires women to enter into an absurd realm, or perhaps to simply remain within the absurd realm in which we already exist. We’re subjected to methods that verge on Victorian: to remain prone, and in extreme cases tilted on a hospital bed at an angle for months at a time; to forgo work, pleasure, money; to allow painful interventions and invasive procedures; to agree to major abdominal surgery. We’re told it’s for baby’s sake; anything other than blind acceptance is selfish at best, murderous at worst.

I take that back, it’s even more immature to be so self-absorbed with pregnancy as to forget about the many non-pregnant people who struggle with kidney failure, heart failure, liver failure, and other failures of vital organs such as the pancreas in diabetes. No doubt they’d trade a lifetime of death defying struggles — dialysis, insulin, transplant surgery or heart surgery — for a few months of lying in a hospital bed forgoing work, pleasure and money and ending up cured. Sadly for them, their struggles are often permanent, lasting until an early death.

Where did Van der Leun get the idea that pregnant women are uniquely patronized by medical language? From midwives, of course:

Decades ago, a group of midwives, frustrated that pregnancy was treated as a condition and women as incapable children, created an empowering birth ideology, encouraging women to be confident about their bodies’ life-giving abilities…

Van der Leun doesn’t stop to ask herself why it was providers of care who insisted that the existing language was patronizing, and why it was these same providers whose concern for patronizing language did not extend to non pregnant women; they weren’t equally upset about devastating language like premature ovarian failure. If she had, she might have concluded that complaints about language were midwifery marketing tools, crafted to claw back patients from obstetricians, not to improve patient care.

Had Van der Leun really thought about it, she might have wondered why those same midwives proceeded to exchange purportedly patrionizing obstetric language for equally patronizing midwifery language like replacing the factual ‘vaginal birth’ with “normal birth’, or replacing the factual ‘pain relief’ with ‘intervention’. She might have realized that while obstetricians used what she considered objectionable language to promote the best possible outcome for mother and baby, midwives deploy patronizing language to leverage guilt and shame in an effort to increase their employment prospects.

In the ultimate irony, Van der Leun resorted to patronizing, misogynistic claims about female obstetricians, dismissing them with:

Women now make up more than half of obstetrician-gynaecologists, but the field was designed and dominated by men for centuries.

Architecture was designed and dominated by men for centuries but no one accuses female architects of knuckling under to men when they employ the exact same principles of structural engineering. The ministry was designed and dominated by men for centuries but no one implies female ministers are knuckling under to men when they preach about the exact same God. So why should female obstetricians be cavalierly dismissed as incapable of making their own decisions? Because there is no equivalent in those professionals to midwives who want their clientele for themselves.

Is the language of medicine patronizing?

I suppose it is if you think your self-worth resides in your organs. Fortunately, no one thinks their self-worth should be based on the function of their kidneys, liver or even their heart, yet women like Van der Leun think it ought to reside in their uterus and vagina.

That’s misogyny not on the part of doctors, but on the part of midwives and others like Van der Leun who reduce women to the function of their reproductive organs.

  • Beatrix S.L

    I do have to admit that the first time I heard the term “incompetent cervix” I had to laugh. I thought to myself that I have IBS, but have never heard anyone call my colon incompetent…

  • Shawna Mathieu

    I know I was off-put by seeing “geriatric pregnancy” when having my son at 36, and the first time my doctor referred to my first pregnancy as a “missed abortion”. Then I asked the doctor WHAT, exactly, those words meant in this case.
    Hearing about possible complications, and going, “Those words make me feel bad, it must be a deliberate attempt to oppress me,” is selfish as hell. Pissing on about being inconvenienced when her kids came out healthy because of those actions and interventions is also selfish.

  • AnotherOor

    I must admit I was a bit miffed to be referred to as a “geriatric pregnancy” at 38.

    • Daleth

      Sorry to hear that! I wasn’t, at 43. Let’s be honest with ourselves: women’s reproductive years run from approximately 13 to 40, maybe 45 at the outside (a few freaks of nature might reproduce beyond that without using donor eggs, but it’s very rare–literally the oldest successful own-egg IVF in history was 47 years old, using an egg created when she was 46).

      So. Where on that 13-45 spectrum are you if you have a kid at 38 or 40 or 42? The young end or the old end? Um… yeah.

      • AnotherOor

        Being near the end of your reproductive years makes the word “geriatric” appropriate? Is it used to describe anyone younger than a senior citizen in other scenarios?

        • Daleth

          Is there any other biological function that normally stops working–that is, completely ceases happening–long before old age? If there were, then people whose age put them at the end of the normal span for that function might well be referred to as geriatric.

          But there’s not, so the only term we have is geriatric pregnancy. Which just means “old age for pregnancy.” Which, when you’re 38 or 40 or 45, is absolutely true. And it matters, because the medical risks of pregnancy are different and greater at those ages than earlier.

          Is there any reason other than having a chip on your shoulder to be bothered by that term? If you’re sensitive about the fact that you’re pretty old to be pregnant, then of course you’re going to be bothered by that term. But then again, you’d be bothered by any term that truthfully stated the fact that, for a pregnant woman, you’re old.

          If you disagree, can you suggest some word other than geriatric that you’d prefer for describing
          people who are, for a pregnant woman, old? I mean, do you think the
          people who dislike “geriatric” would be okay with “old” or “elderly” or
          “overmature” or “perimenopausal” or “gettin’ up there in years” or… what?

          • AnotherOor

            These days they seem to refer to it more often as being of “advanced maternal age”. I do find that less jarring.

          • Daleth

            Yeah, fair enough. If that makes people happier then let’s go with it.

          • ACOG’s style guide removed “geriatric pregnancy” some years back. As far as I know, “advanced maternal age” is still in use.

          • momofone

            Mine said “elderly.” I did a double-take but it was accurate.

          • Allie

            I was trying to think of something, but all the terms for being old carry a negative connotation. No one wants to get old, and older people are subject to a lot of negative stereotypes that are harmful. We should work on that.

          • Who?

            No one wants to get old, until they consider the alternative…

          • namaste

            That’s what my dad keeps telling me.

        • DT35

          When I worked in maternal-child health outreach in the early 1970’s, a woman conceiving her first child in her late 30’s was referred to as an “elderly primip.”

    • Allie

      Meh. I was okay with advanced maternal age, especially when abbreviated AMA. Just happy with the result – a healthy singleton baby at age 42 with IVF. We sure beat the odds.

  • Kim

    Language does matter, though. Why do maternity services continue to infantilise women? A recent article in the BMJ suggested alternatives to some commonly used terms – I don’t agree with all of them, but many of the suggestions are good ones. http://blogs.bmj.com/bmj/2018/02/08/humanising-birth-does-the-language-we-use-matter/

    • CanDoc

      Agree! It’s simply good practice to be cautious in the language we use, and I really like this BMJ post. Will bring it to the attention of my learners. Not to be followed by rote, but as a reminder. Thanks for the post.

    • mabelcruet

      Whilst I agree with some of that paper, some of the suggestions are misleading and incorrect. Take the suggestion of replacing ‘big baby’ with ‘healthy baby’ . A big baby isn’t necessarily healthy-in fact, a big baby (fetal macrosomia) may require intervention by forceps or section to be born safely, so it makes no sense to say to a woman ‘your baby is healthy so we might need to consider a section’. It has the potential to lead to confusion. There was some discussion on this board before about changing language used-replacing ‘painful contractions’ with other terms like surges or pressure undermines the woman’s experience-if she says her contractions are painful, correcting that to ‘strong’ only serves to diminish her and underplay her pain. We need to be guided by the language that she herself uses.

      • Kim

        I agree completely about “healthy baby”. I was surprised they included it, because a big baby could so obviously not be healthy. And in any case, “big” and “healthy” aren’t synonyms. It seems as if they’re trying to protect the mother from the fear of learning she might have a big baby. I think you’re right about compassionate induction too. But some of the other suggestions are good.

        • Abi

          I wasn’t surprised at all. I saw the names associated with that piece, and suspect that any words likely to steer a woman towards choosing “interventions” would be verboten.

    • mabelcruet

      I agree with some of those, but the suggested alternatives risk placing emotional overtones which might not reflect the woman’s view, especially the suggestion of replacing abortion with compassionate induction of labour. I do a lot of work with a miscarriage charity, and their director says that we have to be aware of individual responses to miscarriage-for some women, they may have been ambivalent about their pregnancy, or actively seeking a termination because the pregnancy wasn’t wanted, so if they miscarry, one emotion they might be dealing with is guilt. By calling it ‘compassionate induction’, that implies that it’s a really sad event, and actually, a woman who decides to seek a termination for a pregnancy with a fetus with lethal abnormalities may not see it as that, to her it might simply be a logical choice. So why not just call it ‘induction of labour’ and leave the value judgement of ‘compassionate’ out?

      • Dr Kitty

        “Compassionate Induction” is very much the term the vast majority of Irish and Northern Irish women ending pregnancies with foetal abnormality want to be used. “Compassionate” because it re-iterates that their choice is one made out of kindness and not selfishness…which is how it is often painted.

        “Early induction of labour” was what Northern Irish hospital used to code TOP, specifically in order not to use the “A” word.

        • mabelcruet

          Which is why I think we should be asking women what terms they would prefer. If they were told ‘X is the medical term, would you be happy with us using that or would you prefer a different term to be used?’ I think making a blanket decision of ‘we are not using this word because it upsets people’ is risking being seen as patronising.

          A woman I dealt with put in a formal complaint about the consent forms we used whenever an early miscarriage (less than 12 weeks, 1st trimester essentially) occurs. The form asks for permission to examine the tissue and asks for her decision on disposal-they can either collect it for family disposal or the hospital arranges communal cremation (at the crematorium). She complained because the form said ‘signature of mother’. She said she wasn’t a mother and she hadn’t had a baby and the form should say patient, not mother. And she insisted that the tissue was disposed of in the way in which we dispose of all other surgical tissues-all the colons and breasts and bits of skin, she didn’t want any special treatment for her tissue. She might be at one end of the spectrum (and I’ve had plenty of others at the other end of the spectrum wanting to arrange naming ceremonies, blessings and proper funerals for a 5 week miscarriage) but we try and accommodate them all, we have to be flexible and demonizing some words making value judgements on what we as health care providers think isn’t being flexible.

          • Allie

            Good point. Everyone is different and deals with things in their own way. When I had an 11 week miscarriage, I went to emergency hoping against hope the pain and bleeding was not going to result in pregnancy loss. They did an ultrasound and told me the news. After that, everyone who spoke to me kept telling me it was nature’s way, there was something wrong with the pregnancy, it wasn’t meant to be. In what universe that is a comfort I have no idea, but I was practically walking out the door while they were taking the IV out just so I wouldn’t have to hear it again.

        • mabelcruet

          I have to say though, I’m probably a bit sensitive about language at the moment. I’m doing a locum session in a different region. This week I’ve had a couple of full term stillborn babies for an autopsy (consented by parents) and I get copies of the notes. There are entries stating things like ‘gently asked XXX if she would like a cup of tea’, ‘compassionately offered XXX some toast’, ‘sensitively gave husband directions to the canteen’. Seriously?? Just because you write sensitive doesn’t necessarily mean it was perceived as sensitive. Medical/nursing notes are meant to be an accurate and contemporaneous record of events. Instead every single time anyone spoke to the woman it was recorded as ‘condolences offered, then checked lochia/BP/temp’. When something becomes as routine as this seems to be, it’s going to be perceived as false and unconvincing.

  • The Computer Ate My Nym

    Might there be a compromise to be had? Would a patient accept it if their OB said, “I have to call it an incompetent cervix on your chart because otherwise no one will know what I’m talking about and that could be dangerous if you need emergency care, but I’m happy to not use the term in your presence, but please don’t take it personally if I forget sometimes.”?

  • Box of Salt

    Why are we ignoring this part of her piece?

    “I do know that medical restrictions can radically affect a woman’s life,
    and because of this, the choice of how to proceed should not be a
    doctor’s to enforce. A woman should be able to choose how to conduct
    herself, rather than do it under threat. She must not be asked to pay a
    ransom of her own movement and free will.”

    I think it’s a much more fundamental issue than whether or not medical terminology sounds demeaning.

    • Who?

      Hasn’t she framed medical advice-which is what she got-as some kind of personal assault though? The bottom line, as with all medical care, is take the doctor’s advice, or don’t. Continue consuming alcohol despite your dodgy liver, and this is what you can expect; continue smoking, and this is what you can expect. These are not threats, or assaults, but simple statements of likely outcomes of a course of action.

      Bedrest was prescribed because the doctor believed it was the best idea, not because the doctor wanted to hold her movement and free will to ransom.

      She had the absolute right to decide how to conduct herself. What I hear her expressing is a desire to either be told only what she wants to hear, or to be made to feel good about a decision to ignore the advice, and about anything that might happen after.

      • Box of Salt

        “Hasn’t she framed medical advice-which is what she got-as some kind of personal assault though?”

        I didn’t read it that way. Personal insult, yes, personal assault – no.

        I read it as her lens changed. She’s no longer taking every recommendation as gospel, and she wants the person who makes that recommendation to understand why not.
        “Bedrest was prescribed because the doctor believed it was the best
        idea,” but is it? It’s not as clear cut as “quit drinking before your
        liver fails.”

        My take is that she thinks the specialist perceives her as a uterus, and she wants to be seen as human being.

        And that is something I think is worth talking about.

        • Who?

          I think it is, but I’m not sure we will land in the same place.

          The specialist’s job is to give her the best advice on what’s going on with her uterus.

          Could the specialist have been more nuanced? Should the initial advice have been ‘well this is a toss-up, my best suggestion (which might or might not make a difference) is to spend plenty of time lying with your feet up until the little one is cooked enough to safely deliver’? Would she have been happy with that?

          I’m very uncomfortable with framing an interaction as ‘patriachal’ or ‘disrespectful’, or framing women (or anyone really) as being ‘forced’ or ‘held to ransom’ when they are offered a free choice, including actual or potential consequences.

          My take is she wanted to have a normal, healthy pregnancy, which her good brain should have told her was vanishingly unlikely. And now she’s blaming one of the messengers for all the natural anxiety and stress such a difficult situation engenders.

          • Abi

            Your last paragraph is key. And unfortunately the NCB movement are constantly fanning the flames of this irrational, though entirely understandable desire for things to be straightforward.

          • Mdstudentwithkids

            That is how I interpreted it as well. She is very upset about the situation (understandably) and it sounds like she is channeling those feelings towards the words and not the reality of the situation as a coping mechanism. Perhaps too her particular physician wasn’t a great personality match for her or was brisk and it toned the conversation.

    • AnnaPDE

      I really don’t know what she means with that though. Doctors aren’t enforcing any choices – they’re giving the woman information and assistance on the options.
      Don’t like how your shortening cervix and gravity interact, and want to keep the baby in? Here’s a bed to lie in upside down. Don’t want that? Sure, stand up all you like, but be aware that there’s a good chance of your cervix not holding up for much longer. That’s no threat, it’s informed consent.

  • MaineJen

    I guess the reason that I’m particularly irritated with this one is: you don’t have to read between the lines very carefully to realize that this woman went into pregnancy with perhaps-unrealistically rosy expectations.

    She’d already lost two pregnancies, so she knew it didn’t always go to plan. She’d invested SO MUCH in her body’s eventual ability to have a baby, that every time a problem cropped up, she took it personally. She started to blame the doctors who were treating her and trying to save her baby’s life. She heard some scary-sounding terms that she didn’t understand, and she told herself that…what? Things would have been better under the care of midwives, who maybe wouldn’t use such technical terminology, but may still have prescribed the bed rest she loathed?

    I guess I just don’t know what she’s looking for, here. Does she NOT want the doctors to intervene and save the baby? Does she somehow magically want the problems to go away without treatment? I understand “My doctor put me on bed rest, I’m so scared for my baby’s safety and I’m not thrilled about being in bed for months.” I DON’T understand “My doctor put me on bed rest. How DARE he think that my body can’t do this. He does nothing but find problems every single time I visit.”

    • Casual Verbosity

      I thought that was really bizarre. The “obstetric establishment” recommending bed rest during the pointy end of a high-risk pregnancy isn’t imposing Victorian era methods on women; it’s trying it’s hardest to keep your baby alive. If they had a better method, then they would certainly use it. (And just as certainly, midwives would decry the new, less limiting method as unnatural and go on prescribing bed-rest.)

      • Abi

        Indeed. I know someone who had to undergo the same process. The weird thing is it’s far from being a high tech medical intervention, and surely any competent midwife would recommend exactly the same course of action. It strikes me as being more akin to the sort of active birth exercises (though with the opposite aim in mind) so beloved of the NCB crowd in fact.

  • Casual Verbosity

    I can see the problem with “habitual aborter”. Even if you could exorcise the (unjustly) negative connotations that the word “abortion” has acquired, the term would still be stigmatising because of the “er” suffix, which makes it about the person rather than the function of their reproductive organs. It implies that it’s something that they are doing. When people use an “er” or related word, it’s usually a marker of identity. “I am a singer”, “We are go-getters”, “You are a manipulator”. Identity-based language is rarely neutral, so it’s best to steer clear of it in potentially negative contexts. So “habitual aborter” is definitely a stigmatising term.
    However, I think that the OP’s response to terms describing the dysfunction of female reproductive organs says more about the problematic way in which society views women than it does about the terms themselves. If we take “incompetent cervix” for example, “incompetent” is closely semantically related to word a like “failure”; they both relate to the inability to perform an intended function. Yet as abstruse as terms like “heart/liver/kidney failure” may be, most people would not interpret these terms as at all stigmatising. This is not because “failure” is some how more neutral than “incompetent”. In fact, I venture that if we changed “incompetent cervix” to “cervical failure” this wouldn’t mitigate the perception of stigma at all, the reason being is that the stigma is not in the semantics but in the social context. To a large extent, our society still ascribes a significant portion of a woman’s value to the function of her reproductive organs. As much as we may value having a working heart or liver, we don’t tend to judge people by the robustness of these organs, thus saying that these organs are failing to adequately perform their intended function does not have a stigmatising effect. Thus it is a failure of how we value women rather than a failure of language. Someone else mentioned the case of changing “impotence” to “erectile dysfunction”. “Impotence” was stigmatising for the same reason that “incompetent cervix” is; society largely judges men by their virility. “Erectile dysfunction” is certainly an improvement as the term “impotence” is too easily transformed into the adjective “impotent” which can describe the person and verge into identity language again. Still, I doubt many men would feel confident in publicly confessing they have “erectile dysfunction”, because the greatest portion of stigma resides in society’s values rather than in language. Changing stigmatising language is definitely a start, and it’s certainly faster and easier than changing the values in a society, but it’s only a tiny part of the picture. Changing language is to removing stigma as taking the stairs is to large-scale weight-loss; it’s an important step, but there are other steps needed to make significant improvements.
    I agree with the OP that changing language is necessary, but I certainly wouldn’t look to midwives as a model for non-stigmatising language.

    • Tigger_the_Wing

      Indeed, without changing the underlying societal prejudices, any new term will acquire identical stigmatising effects as the original term. One only has to look at the language surrounding intellectual disabilities to see how, each and every time the official term was changed, the new term became a term of abuse.

      • The “euphemism mill,” yes.

        • fiftyfifty1

          Yes, but the alternative is to be a dick. How hard is it really to respect people’s wishes and change terminology? Even if they ask for a change more than once. Yep, the term used to be n—–. Then it went through a variety of changes: colored, negro, African American, black etc. What am I going to do, be a jerk and say n——– because “euphemism mill”?

          • MaineJen

            No, you’re going to say it because you’re ‘edgy’ and ‘politically incorrect.’ /sarcasm

          • Whoa. I am not advocating for calling anybody something offensive. However, Tigger was describing a known phenomenon.

          • fiftyfifty1

            I know you are not. But I think the general principle holds. When people tell us a term is offensive (and many women feel that these terms are), then why not listen to them?

          • I’m not disagreeing with you. Tigger and I were just noting that terms introduced to stop causing offense often, themselves, become sources of offense.

      • Casual Verbosity

        I have similar thoughts whenever the matter of banning size 0 comes up. You could replace all sizes with punctuation marks, but people would still figure out that the semi-colon garments were the smallest and aspire to be a semi-colon. We like to target language because it’s a relatively easy way to feel like we’re improving things, but if we don’t work towards changing attitudes and values we’re basically just rebranding our stigma.

        • fiftyfifty1

          I disagree. I think there are just some words that are “stickier” than others. Moron was the technical term, and then it got replaced with mentally retarded, and that was a bit better but still resulted in “retard.” So then person first terminology was invented and it really does seem a lot better. I have yet to hear somebody be able to turn “person with an intellectual disability” into a taunt. Sure, it’s not like it makes people want to have it, but at least it’s more respectful.

          And I do think that size 0 is “sticky”. Yes, people are going to figure out what any size system means. But with a size 0 it fuels perfectionism, which is something many people with anorexia already battle. Size 0 gets associated with perfect, zero flaws, zero fat, zero points deducted from your score. Obviously banning size 0 isn’t going to cure eating disorders, but it would be an improvement. I think the best method would be to go with a objective measurement like cm or inches, like men’s clothes.

    • CanDoc

      I haven’t heard the term “habitual aborter” in almost 20 years. It’s called RPL now, “recurrent pregnancy loss”. I suspect she used Google to come up with some of her examples.
      Cervical failure and cervical incompetence are different things. Failure is worse: the cervix failed and the baby delivered in the mid-second trimester. Cervical incompetence first, with the cervix shortening and dilating, but may in fact stabilize with a stitch in the cervix (cerclage) or observation. But again, cervical incompetence is often replaced now with the term “Short cervix in the second trimester” or “premature dilation” or “premature cervical change”.

  • PickAUserNameForDisqus

    So, should we call Brooke Shields a whiner because of this passage from her book ‘Down Came the Rain’ (which I believe is a personal, empowering story of her overcoming postpartum depression): “As a result, the entrance to my uterus had become severely impeded, making it very difficult for me to get pregnant. In the process of removing the precancerous cells, the surgery also removed the cervical glands that secrete the mucus necessary to transport the sperm. Without this bodily fluid, the “little spermies,” as one of the nurses affectionately called them, couldn’t swim upstream. I said, “No wonder it hasn’t been working—not only is the door closed, but the poor guys have been jumping into a pool with no water!” Dr. Vargyas reassured us that this was one of the easiest fertility issues to overcome, though she did mention the possibility of my cervix becoming incompetent during pregnancy and prematurely opening up. After hearing the word “incompetent,” I couldn’t help feeling like damaged goods. With a very serious expression, Chris said to my physician, “Please, Doctor, we don’t like to use the word ‘incompetent’ in our house. Could you just say she has a ‘special’ cervix, or that she is simply ‘cervically challenged’?””

    • Heidi

      I’m not calling her whiny. She didn’t like a word, she requested in her case to refer to it as something else. But how is special cervix or cervically challenged any better for most people? Who is to say another woman won’t feel like damaged goods when a doctor tells her she is “cervically challenged”?

      • PickAUserNameForDisqus

        My point was that this is a not a new critique from a patient communication and respect. Down Came the Rain was published in 2005. At several maternal mental health conferences I have heard the critique of judgemental medical language with vulnerable patients. Just because we don’t like the messenger, or other messages that a anti-medical blogger writes, doesn’t mean we should call her a whiner for making the same critique as others. Especially, when the SOB made a very similar argument about “artificial milk” being dismissive and shaming just yesterday.

        • Amy Tuteur, MD

          But I did not make the same argument. The author of the piece is complaining about medical terminology. Artificial baby milk is not medical terminology. It was chosen by lay people to shame other lay people.

          • fiftyfifty1

            Artificial baby milk was chosen by lactation consultants. You may regard them as lay people, but patients don’t know this, they see them as medical professionals. And I realize that LCs chose the terminology on purpose to shame women, while doctors do not use terms like incompetent cervix with an intention to shame. But patients don’t know the distinction, they just feel the shame. They are telling us they feel shamed, and I think we should listen.

    • Who?

      I get between spouses deciding to call something they don’t like the name of, something more palatable. ‘Tricky cervix’ for instance. We say that our dog doesn’t go to a kennel, he goes to ‘puppy camp’: given that he’s 14 it’s probably really dog retirement home, but why change now? It’s a euphimism that works for us, and hurts no one.

      Medical care, like legal advice, is different. Technical words matter. As doctors here have said, they need to explain what it means and walk back the misconceptions and fear the words can create.

      If the person in the room who knows of what they speak is using words that accurately, in that room and rooms like it, for the purpose they are all there, describe what is going on, then those are good words. As my daughter would say, time to put on your big girl pants.

      I wonder if Brooke and Chris teach their children special words for their sexual organs? Or is that different?

      • AnnaPDE

        Ugh. To your last question, way too many people do that and think it’s a good thing. My brother in law’s daughters seriously called their genital area “front bum” – I hope they have finally learned the proper words now that they’re teens.
        And on my dad’s side of the family, we have cousins in whose sons didn’t even know any words for their genitals at primary school age (let alone girls’ ones). Their mum is a child psychologist and kind of a big deal in super conservative catholic parenting circles in Hungary. That family decided to never meet mine again because my mum accidentally taught the kids the the child-friendly but correct names for genitals, when they asked her questions that seemed like jokes as she changed my baby sister’s nappy.

  • MaineJen

    Oh FFS. “Incompetent cervix?” It really is childish to hear that phrase and think it has any bearing on you as a person. The cervix is an organ (a band of tissue, really) and, as such, is subject to occasional failure just like any other organ.

    No wonder these people think that inability to breastfeed (or birth “naturally”) is a personal failing. To them, bodily function = moral worth?

    Instead of being happy that modern medicine can intervene and save her children (when 100+ years ago they would surely have died), she complains about medical terminology she doesn’t fully understand.

  • mabelcruet

    The cervix is an organ (well, a bit of an organ) like any other-people get heart failure, respiratory failure, renal failure, liver failure. We don’t imbue those terms with emotional overtones. The body isn’t perfect, it doesn’t need to be perfect, it just needs to be good enough. Unfortunately, some cervixes aren’t up to scratch, but it’s not a reflection on your womanhood or your worth as an individual. Thinking that way is just an extension of the train of thought that lactivists use-not being able to breast feed, or needing or wanting a section means that you aren’t a real woman or a real mother, or you haven’t really given birth. It’s profoundly anti-feminist, it’s placing value solely on your physical, biological and anatomical attributes, not on you as an individual.

    • fiftyfifty1

      Actually heart failure is a horrible term. Patients never know what it means. They think it means that their heart is actively failing and is going to stop. As a primary care physician I can assure you the term totally freaks them out. Some of them hear it in the hospital and assume they are going to die, and then when I see them in hospital followup I have to explain “Heart failure doesn’t mean your heart is going to FAIL, it’s not going to stop, it’s just that the pump muscle is weak and sometimes the circulation goes slow because of it.” It’s an awful term and I wish we would change it.

      • Who?

        I didn’t know it was an actual medical term. Around here it can be an expression for getting a shock, but in a bit of a jokey way ie ‘I nearly had heart failure when I saw the dust bunnies under the kitchen table/when I realised my favourite tv show had finished.’

        Kidney failure or liver failure on the other hand sound BAD.

      • Merrie

        I agree, it’s not a good term.

      • mabelcruet

        I can understand that, but I was thinking of it slightly differently-a woman with heart failure isn’t going to think of herself as a lesser being or a failure as a woman because she has heart failure, whereas in the article, the author appears to think she’s being considered less of a woman or an incomplete/inadequate woman because she has ‘cervical failure’.

        • fiftyfifty1

          I agree that people react to reproductive medical terminology in a much different way than they do for their other organs. Kidney failure doesn’t produce the same shame as ovarian failure or incompetent cervix or failure to progress. But from what I have seen as a doctor it’s not just this author or women infected with NBC who feel this way. It’s many, many women. A friend of mine just gave birth to a micropreemie due to incompetent cervix, and she is the least woo-prone person ever. And she still felt it was shaming, and that the term contributed to her feeling like she had failed her baby. And something similar is true for men. Impotent was a medical term, and men felt shamed. When the term changed to erectile dysfunction, it made a huge positive difference.

          • mabelcruet

            I agree with attitude deviant below-in an ideal world we would accept that words are just words with a specific meaning and no emotional overtones should be implied, and no offence taken. But then I do the same-when I’m writing autopsy reports I’m very aware that the family might read it, so I never use the term abortion (it’s either ‘induction of labour’ if the pregnancy was ended because of fetal anomalies, or I say ‘the baby was miscarried’) I don’t use the term ‘stillbirth’, I say ‘the baby was stillborn’. I’m doing a locum job at the moment, and their system automatically labels the babies as ‘Foetus of X’. I hate the word foetus, it’s an abomination coming from the same etymological root as ‘foetid’. The correct spelling is ‘fetus’, coming from the Latin meaning ‘offspring’. But try telling English people that, they all think it’s an upstart American spelling. The secretaries keep changing my reports and I keep changing them back again. I really hate that spelling. In fact, the way I’ve got round it is calling them ‘Baby of ‘ regardless of gestation. After all, a mum miscarrying at 16 weeks isn’t going to say she’s miscarried her fetus, she’ll say baby so I do too. But what is that if it’s not imbuing language with emotional overtones?

      • Dr Kitty

        CCF has a horrible mortality rate, worse than many cancers.
        Sometimes people hear the “oh it’s not really going to fail” and take it as “your heart is fine”.

        Saying “Heart Failure means the pump isn’t working, it often gets worse with time, despite medication and it is likely to reduce both your quality of life and your life expectancy” is true, but a harder conversation.

        As for “incompetent cervix” I don’t really see an alternative.
        “Overly relaxed cervix”
        “Laid back cervix”
        “Excessively elastic cervix”
        “Cervix with performance issues”.

        “Cervical Dysfunction” would be a possible alternative, but probably isn’t specific enough.

        Anyway- the patients that *I* admit to having preconceived and probably stereotyped and judgemental feelings about based on their diagnoses are ones patients are usually quite happy with!
        Fibromyalgia, Chronic Fatigue, Emotionally Unstable Borderline Personality Disorder, Myofascial Pain, Irritable Bowel, chronic non-migrainous headache etc.

        • Allie

          Ooh, I like “laid back.” I’m picturing a cervix with Bob Marley dreads smoking a doobie : )

  • OttawaAlison – In Seattle

    I guess for myself if I was diagnosed with an incompetent cervix, I wouldn’t then think of myself as being incompetent, just a part of my body not cooperating. Hence why I also think women who term themselves as failures (which I was guilty of) when breastfeeding doesn’t work or when labour doesn’t work out are being way too hard on themselves. Sometimes our bodies just don’t cooperate, it doesn’t mean we have failed since we didn’t do anything to cause it.

    As for Artificial Milk – that’s replacing the language of the people who use the product, to me that’s why it is so condescending. For those of us who used milk based formulas, it’s altered milk, as it is still a milk product derived from milk.

    • Tigger_the_Wing

      Except when it isn’t. One of my babies was on a milk-free formula because of lactose intolerance.

  • Empress of the Iguana People

    Going against best medical practices because of the -words- used is foolish. Being annoyed about words that are kind of insulting is less so. There is a portion of our culture who already think some women make a habit of having abortions, so “habitual aborter” is going to sound insulting to us non-professionals.

    • Heidi

      I can understand changing the language around miscarriages. Abortion today means purposely terminating a pregnancy. And when a pregnancy was wanted, I can understand seething at such a description.

      However my opinion on “incompetent cervix” is that honestly it’s too kind for the heartache it can bring. My mother has an incompetent cervix and lost two babies due to extreme prematurity. No medical professional called my mother incompetent. I’m trying to think of any accurate yet less offensive way to describe a cervix that doesn’t work in a way to sustain pregnancy.

      • attitude devant

        Heidi, I’m going to gently push back on your first paragraph. The demonizing of the word ‘abortion’ is the problem. We have called pregnancy lost before 20 week ‘abortion’ since the beginning of medical care. It’s a technical term, it has a meaning, and there are codes in our billing that use it. There is no value judgement in the word—it simply is the term used for over one hundred years. Abortion is any loss before 20 weeks. Period. I think we should not accept the demonization of the term.

        • Tigger_the_Wing

          Yes, the intentional ending of a pregnancy used to be called ‘elective abortion’, but at some point in the past, the word ‘elective’ was dropped – possibly for propaganda purposes. Almost every woman trying to get pregnant will have at least one miscarriage (spontaneous abortion) during her reproductive years, and some of the (dis)information I’ve seen bandied about online with regard to elective abortions evidently intends to conflate the figures for that with the figures for elective abortion for emotive reasons.

    • MaineJen

      Yes, “missed abortion” or “spontaneous abortion” sounds pretty alarming until you realize they mean miscarriage.

    • Gene

      Or “threatened abortion”. In the ED, spotting or bleeding in early pregnancy can be a sign of impending miscarriage. The medical term is “threatened abortion”. After the umpteeth patient (or family member) freaked out at the thought that we or someone else was threatening to terminate their pregnancy, I began preemptively telling them the diagnosis and exactly what it meant and that I wasn’t planning to threaten anyone or end a pregnancy myself.

      • fiftyfifty1

        Yes, and wouldn’t it be nice if the official medical term was different so you didn’t have to give the preemptive explanation each and every time? Or that the term wasn’t “incompetent cervix” so that we didn’t have to spend precious time handing Kleenex to a crying woman, apologizing that “I know it’s a crappy term, it does NOT mean you are incompetent, yes I know you feel you failed your baby, blah blah blah.” Because you know, as a primary care doctor, I’ve had this conversation plenty of times. I had it again just a couple of weeks ago. The patients may not fall apart for the OB, but they spill their true feelings with me, because I am their long-term doctor.

  • Sheven

    Medical language, like all language, evolves. I think making it less brutal for a patient to hear, so long as it remains perfectly clear to physicians, is probably a good thing.

    That being said, a cervix that makes pregnancy more difficult is bad. You aren’t bad for having it, but no one wants it. Doctors could call it a “cuddle rainbow” and eventually “cuddle rainbow” is going to become a scary and hurtful term–because it describes a bad thing.

  • Sheven

    Micropenis

  • CSN0116

    I hated being labeled, where I could hear and read, a “habitual aborter” as I went through tests and treatments after two miscarriages. I was already in a state of helplessness and confusion. The term didn’t help.

    • MaineJen

      Couldn’t they say “multiple miscarriage” instead? I think I’ve heard that term, I admit I have never heard Habitual Aborter and that does indeed sound terrible.

    • Dr Kitty

      “Recurrent Miscarriage” is the current NHS term for people who have 3 or more miscarriages.

  • fiftyfifty1

    Meh. I actually am all for renaming a lot of medical terms. It’s our job to communicate with our patients and bad terminology gets in the way of that. Whether the terms are rude (incompetent cervix), confusing (borderline personality disorder) or just impossible to pronounce (guillain-barre), I say change ’em!

    • Sarah

      Same.

  • Abi

    This used to confuse the hell out of me, because I couldn’t see why anyone would give a stuff if the inner workings of their body was described in this way. Unless they were daft enough to believe that their body’s unconscious actions were somehow a reflection of their own efforts or worth as a person, of course.

    I now realise that this is clearly just another objection from the NCB mob to using any medical terminology in the birth room whatsoever. And by extension, to it even being viewed as a medical phenomenon. Let’s not forget that these same people don’t even like terms they can’t pretend to ascribe moral value to (‘contraction’ for example) because they make birth seem medical rather than magical – these ‘pejorative’ ones are just an easier target.

    Never mind that they are undermining all of feminist philosophy in doing so – by making out that any physical difficulties ARE indeed the fault of the woman – let her think that and feel crappy about it if it helps the cause, eh?

  • PickAUserNameForDisqus

    So, I usually agree with you, but I think you can’t complain about “artificial milk” on the one hand, and then say she is whining about “incompetent cervix” on the other.

    • Heidi

      But the cervix is actually incompetent when it is labelled as such. It’s not based with the intention of fear-mongering or trying to make someone feel inferior so I’m going to disagree with you about what Dr. Tuteur has the right to complain about.

      • PickAUserNameForDisqus

        And, artificial milk (which I LOVED that I had to feed my two babies) is artificial. I have also heard from multiple women in PPD support groups that the medical language used does have an emotional impact on them. I think we do need to listen to patients about how the medical language feels, and that comments about “incompetent” cervices and “failure” to progress, while medically accurate, also do all have a patina of defeat, disappointment and negligence. I also don’t think that the midwife-preferred reductive language is the right answer, and I don’t think women are so stupid they need euphemisms for their body parts or conditions. There is middle ground, and it is hypocritical to say that the term “artificial milk” is causes real harm to women who are/were struggling with breast feeding, but saying that we shouldn’t complain about other negative-connotation terms.

        • The Bofa on the Sofa

          And, artificial milk (which I LOVED that I had to feed my two babies) is artificial.

          a) What does that even mean, “artificial”? and
          b) It’s not milk

          • The Bofa on the Sofa

            Mel can correct me with the modern approach, but I remember growing up, when we fed the calves we fed them “milk replacer.” No one suggested it was milk, and, as the name says, it REPLACED milk.

          • PickAUserNameForDisqus

            Yep, I will give you that almond milk isn’t “milk” either. Or could we agree they are all artificial milks? Would you say that “artificial flowers” aren’t flowers so we should call them something else?

          • The Bofa on the Sofa

            Are they pretending to be flowers?

            Formula is not pretending to be milk.

          • AnnaPDE

            Um, yes it is, in fact that’s the whole point of having it: Something that is functionally as close to breast milk as possible without being produced by a woman’s breasts.
            It’s made from milk most of the time, too – cow’s milk, processed to be more like human milk.

        • Amy Tuteur, MD

          There’s an important difference between terms like incompetent cervix and kidney failure on the one hand and artificial milk on the other. The former are medical terms that have been used by medical professionals since they were discovered; they were never meant to be emotive. Artificial milk, in contrast, was made up recently with the express purpose of shaming women who formula feed.

          • InfiniteSovereign

            I like “milk replacer” or “replacement milk” or maybe even “substitute milk” i agree with Dr. Amy about the way the term “artificial milk” is being used, but it does have the advantage of being more descriptive than the word “formula,” which can only be understood contextually. Maybe we should reclaim “artificial milk” from lactivists or just start calling it “amazing science milk”

          • Heidi

            I like amazing science milk. And unless breastfeeding mothers aren’t taking any vitamins, aren’t eating any produce grown from fortified soil or eating animal products from supplemented animals, the nutrition from their breast milk is “artificial” to some extent.

          • Who?

            Or ‘food for infants’ which is what it is.

          • PickAUserNameForDisqus

            Does that actually make it better, or worse? The longer I think about it, it seems worse for the real, medical, technical language for two reasons 1) it is more likely to be stated from a position of authority, and 2) people with these conditions are the ones hearing these terms most often so they are not frequently heard unless the object of the language is in a vulnerable state. Many pregnant mothers have already numbed themselves to the breast vs. bottle debate. And maybe even reason 3) the idiots spewing their “artificial milk” judgement can be dismissed more easily because they also say a bunch of other stuff that sounds just “off” enough that a critical thinker can move past the judgement, but from a doctor, “incompetent”, “failure”, “blighted” etc have added oomph. I guess I am saying that in both instances the connotation and denotation are important. It doesn’t serve you well to make arguments within 24 hours of each other that in one of these situations the mother is a whiner and in the other she is a victim.

          • mdstudentwithkids

            But kidney failure, incompetent cervix, anembryonic pregnancy are in fact sad/bad states and events and the language reflects that, unlike “artificial milk” which is meant to leave a negative impression but is actually a good thing. I do believe words are important, but in that so is giving a realistic picture of what is going on. From my still somewhat limited experience (med student), physicians don’t just tell patients the diagnosis and leave it at that. If they do, the problem isn’t the name of the diagnosis it’s the physician and their bedside manner. I don’t even disagree that some names could change (and outdated terms like habitual aborted should not be used) but believing that changing the name of a devastating diagnosis to be more positive will make much of a difference is probably unrealistic. “A loose cervix” or “a cervix that won’t stay closed” would not change the fact that some women will lose their babies.

            I would also strongly disagree that it is easy to dismiss the shaming of women who bottle/formula feed.

          • fiftyfifty1

            Nobody thinks that renaming a difficult diagnosis will magically make it a happy diagnosis. What we are hoping is that it will remove insulting, confusing or even just distracting overtones. “Incompetent” in the real world is a seriously insulting word. So why use it as part of medical technology? Why not change it to “Premature cervical dilation” or “Compromised cervical containment” and shorten it to CCC or some such? You will still be very sad and scared to be told you have it, but you won’t have to struggle with also feeling like you have been demeaned.

            If it will make the experience even a little less bad for patients during these stressful situations, I say it is worth it. And I predict it will also make our lives easier as doctors because we won’t have to waste time doing damage control, emotional detox, preemptive explaining etc.

        • Allie

          Is it “artificial” though? We have developed some strange ideas about what is “artificial” versus what is “natural.” Formula, at bottom, is food (not artificial food, like wax apples, just food). It is formulated to provide adequate nutrition for babies, hence the name, but I fail to see what is “artificial” about it. When a woman can’t or doesn’t wish to breastfeed, it is a substitute milk formulated to serve the purpose.

      • swbarnes2

        Though one might argue that “incompetent” is kind of broadly nonspecific as to the actual problem, at least to the layperson who doesn’t know that it means a specific issue.

        A term like “prematurely dilating” or something a little more specific and descriptive might have made this woman feel better, and helped her to understand a bit better what the actual problem was.

        She struggled with infertility, and she probably did feel like it was her fault. But that’s from everywhere, not OBs in particular.

        • Heidi

          Well, from my understanding an incompetent cervix is a cervix that is compromised. Prematurely dilating may not necessarily caused by something wrong with the cervical structure itself. Anyway, I gotta go get ready for a haircut but perhaps her doctors were lacking in the whole explaining what was happening.

    • Abi

      I see what you’re saying, but the difference is that ‘incompetent cervix’ is a medical term that was presumably coined as a description of a particular condition, whereas ‘artificial milk’ is specifically designed to induce guilt and deliberately conveys the notion of unnaturalness. It’s the difference between a neutral scientific term and a marketing term.

    • CSN0116

      I completely agree. Formula IS artificial milk, per definition. It is man-made. One could argue that any breast milk production that is influenced by eating/avoiding certain foods, more water, supplements, teas, a pump, or other interventions is ALSO “artificial,” per the same definition, but.

      The reason that lactivists intentionally use the term “artificial milk”
      to describe a product well-known to be called “baby formula” is to evoke an emotional response. Arguably, some of what this author writes about regarding HER experience is doing the same. I get where she’s coming from.

  • Mel

    Personally, I get the feeling that the author has some lingering anxiety or depression or something from her first daughter’s birth that is bleeding all over her next pregnancy.

    I’m scared at the idea of trying to conceive again once Spawn’s 18 months old or so. Rapid-onset severe pre-e + HELLP syndrome beat up my body pretty badly. Having a baby in the NICU for 4 months was an emotional roller-coaster. The first few months he was home made me feel like I was on alert every hour I was awake and in the house. Keeping him in isolation for the first few months he was home + RSV season this winter meant that I spent something like 9 months on house arrest with an infant.

    Things have smoothed out now. I’m looking at restarting my grad program. I know the chances of having pregnancy end the same way is less under extensive monitoring (plus it’s not the first pregnancy which bumps the risk up).

    I know this – but I know very literally what can go wrong, how rapidly it can go wrong and how lingering the effects of a pregnancy gone wrong can be. That’s what scares me.

    So, I talk to my therapist and my husband and my girlfriends and my online preemie moms and my real life mom…and then I talk some more about my feelings.

    I don’t want to confuse shitty bedside manner by a MFM with a decades-long battle over the semantics of describing the current state of a cervix…so I talk about what’s really worrying me.

    • Megan

      I have the same fear about PPD. It was crippling last time. We literally still have a hole in one of our doors from me throwing a jar of peanut butter. I’m still terrified it will happen again. The saving grace this time is that unlike last time, I am on medication already and willing to change it if need be. I am already set up with a therapist and can go as often as I need. My husband and I are both better at recognizing it (you’d think that since I can easily diagnose it in a patient that I’d recognize it in myself but insight is hard to come by in the throes of PPD) and my doctor knows to be on the lookout. My husband has also made arrangements to work from home the one day of the week I’m normally home by myself with the kids for a while because I have a specific (and somewhat irrational) fear that I will get angry and hurt them. Every pregnancy really is different and at least you would be armed with the knowledge of your risk. Also, your doctor would likely place you on an aspirin for a subsequent pregnancy to reduce your risk. I totally understand your fear though because I have it too, though about a different pregnancy-related issue.

      • BeatriceC

        I run a large online peer support group for people with PPD/A and other postpartum mental health issues. Many of our members report that things were far more manageable the second time around when they were proactive about treatment before and immediately after childbirth. It’s not always the case, but it does seem to up the chances of a smoother recovery.

      • Empress of the Iguana People

        It really helps when you know about it and are already taking steps to deal with it.

      • Tigger_the_Wing

        My PPD was worst after my third. I’m impressed that you had enough self-control to throw only a jar of peanut butter – I threw an upholstered rocking chair, and knocked the door off its hinges.

  • The Bofa on the Sofa

    I’m not sure how premature ejaculation can be considered “inadequate testicles.” Orgasms don’t originate from the testicles. In fact, premature ejaculation says nothing about the testicles (you’d have to check the sperm count to know if the testicles are working, but even then, you can’t tell because there could be a problem outside the testicles, like with the vas deferens (which could be deliberate, as in my case))

    And for “penis failure”, when it comes to ED, the penis is fine. The erection is the problem, to the point of being disfunctional. The lack of erection is not a penis problem, it’s a blood flow problem. That’s why vasodilators help. Note they don’t solve the problem by fixing the penis, they do it by fixing blood vesicles.

    Meanwhile, all sorts of diseases are described as body failures – liver failure, kidney failure, heart failure, etc.

    • fiftyfifty1

      Actually, erectile dysfunction can be due to a direct problem with the penis. Poor blood flow is only one of the many causes. And note that we are calling it erectile dysfunction. It used to be called impotence, but that was deemed too stigmatizing and so now it’s ED.