Since 2023, researchers at University College London have been investigating the language used in UK healthcare settings in caring for those who experience pregnancy loss. In this article, Dr Beth Malory Lecturer in English Linguistics at University College London, Founder of the Reproductive & Sexual Health Communication Alliance and Dr Louise Nuttall Postdoctoral Research Assistant at University College London describe what has been learned so far and the next steps that are needed.
Why does language matter?
For many years now, it has been recognised that the language we use to communicate around pregnancy loss can have a significant impact on those who experience it. Clinicians have made multiple calls for change in the terminology used. The first was probably a letter published in The Lancet over 40 years ago calling for the phrase spontaneous abortion to be replaced by miscarriage due to the distress the former caused to patients (Beard et al., 1985). While this language change has (mostly) now taken effect in UK clinical settings, other terminology identified as potentially distressing, misleading or “inappropriate” – such as incompetent cervix, blighted ovum and pregnancy failure (Cameron & Penney, 2005) – continue to be identified as problematic ways in which pregnancy loss is talked about clinically in the UK, and internationally (Silver et al., 2011).
Calls for change are also seen in conversations around pregnancy loss language in public forums. The Peanut Renaming Revolution: The Motherhood and Fertility Glossary – a crowdsourced list of terms around pregnancy, loss and motherhood experienced by thousands of the Peanut app’s users – represents one attempt to tackle terminology that makes individuals “feel shamed, judged, and ultimately, unsupported” (Peanut, 2021).
These issues around language and communication have resulted in the publication of multiple sets of official language guidelines, created by expert-led panels (e.g. Kolte et al., 2015; Johnson et al., 2020) and organisations such as the Royal College of Obstetricians and Gynaecologists (2022). These aim to provide clarity and consistency and to ultimately support clinicians to provide fair, inclusive and sensitive care for patients. However, the recommendations made in the different statements do not always match: for example, one recommends anembryonic pregnancy be used (Kolte et al., 2015), but another recommends it be avoided (Johnson et al., 2020). Since these documents are not based on empirical research with patients, it has been difficult to know what language is actually in use and how people with experience of pregnancy loss feel about it.
This need for evidence-based recommendations around language use, or a standardised set of terminology chosen to cause the least harm and confusion for patients, is what motivated the research we have carried out at University College London since 2023.
The research so far:
The ‘Linguistic Challenges in Communicating about Pregnancy Loss’ (EstELC) Project heard from 339 participants from across the UK who had experience of accessing or delivering healthcare for pregnancy loss (Malory, 2024). In addition to the written testimonies they provided, 42 of these participants took part in a focus group. Eight lived experience focus groups allowed participants who had experienced similar types of loss to discuss the role language played in their experience of care. Two other focus groups brought together healthcare professionals whose roles involve providing care during or after pregnancy or baby loss to discuss their perceptions of language impact. In these testimonies and discussions, we found evidence of multiple recurring issues, including:
1. “cold”, technical language which caused confusion and/or a perceived lack of empathy;
2. language which was felt to suggest blame, culpability or negligence on the part of the mother or birthing parent;
3. language which was felt to invalidate or gaslight (for example, for losses in early pregnancy) or which misrepresented the physical and emotional trauma involved.
Participants also reported the positive, sometimes transformative, effects of sensitive communication by professionals involved in their care, describing the validation they felt when words were used that reflected their own conceptualisation of their experience, and their baby. Another key aim of the research was to explore those communicative strategies that could best support individuals and families in this context. The healthcare professional focus groups provided valuable insights in this respect, and combined with suggestions from lived experience participants, gave rise to several practical strategies for one-to-one interactions with patients.
These evidence-based recommendations are aimed at midwives, student midwives, and others involved in caring for those experiencing – or who have previously experienced – a pregnancy loss. They are freely accessible in both the EstELC project report, and, more recently, an accredited short CPD course: Effective Communication for Pregnancy Loss Care, which can be accessed for free via Futurelearn, for a two-week period.
No “one size fits all” approach:
The main, overall recommendation of this research is that there is no “one size fits all” approach to pregnancy loss communication, and that the language we use to talk to those experiencing loss should take into account their individual preferences and needs, wherever possible.
However, there are many “mass communication” contexts in which such individualised communication is unfortunately not possible. These include policy and public health information contexts such as websites, leaflets – and articles such as this one! In these contexts, informed language choices are needed which will cause minimum hurt or distress for as many people as possible. The second, more recent, phase of our research – ‘Acceptability in Pregnancy Loss Language’ (SuPPL)— has focused on identifying those terms which are felt to be ‘acceptable’ to a majority of people who have recently experienced pregnancy loss in the UK, and those that are felt to be ‘unacceptable’ to a majority. A pilot study consisting of a large-scale survey of nearly 400 respondents provided statistical data on how various terms currently in use are perceived. Two findings of note are that the terms pregnancy loss and baby were consistently considered acceptable by a majority of respondents who had experienced a loss across all stages of pregnancy – except for losses occurring after 40 weeks’ gestation in the case of pregnancy loss. Other terms such as miscarriage and fetus received much more mixed responses (Malory & Nuttall, 2024). While pregnancy loss and baby will not feel right to everybody who experience a loss, we have some evidence that these may be the best available options at present. As well as informing our own language choices in carrying out and reporting this research, these initial findings provide a basis for developing a standardised terminology for use in mass communication contexts around pregnancy loss (Malory, Nuttall & Heazell, 2025).
Next steps for the research:
We are working with an Expert Advisory Group with members from healthcare, academia, policy and the charity sector, to implement ways of translating these empirical findings into policy and practice. In 2025, the Reproductive & Sexual Health Communication Alliance was established as a step to bringing about real change. The perspectives of people with lived experience of pregnancy loss remain at the heart of this research via a Patient & Public Involvement and Engagement Forum of over 50 volunteers, who direct the next steps taken through monthly meetings. A public roundtable on ‘Improving Communication during Adverse Gestational Events’ will be held at University College London on the 13th April.
If you are interested in becoming involved in this research, please get in touch with Beth and Louise using the contact details below.
References
Beard, R.W., Mowbray, J.F. & Pinker, G.D. (1985). Miscarriage or abortion. The Lancet, London, Eng., Nov 16;2(8464):1122–3. https://doi.org/10.1016/s0140-6736(85)90709-3.
Cameron, M.J & Penney, G.C. (2005). Terminology in early pregnancy loss: what women hear and what clinicians write. Journal of Family Planning and Reproductive Health Care, Oct 1;31(4):313–4. https://pubmed.ncbi.nlm.nih.gov/16274558/.
Johnson, J., Arezina, J., Tomlin, L., Alt, S., Arnold, J., Bailey, S., et al. (2020). UK consensus guidelines for the delivery of unexpected news in obstetric ultrasound: The ASCKS framework. Ultrasound, Nov;28(4):235–45. https://doi.org/10.1177/1742271X20935911
Kolte, A.M., Bernardi, L.A., Christiansen, O.B., Quenby, S., Farquharson, R.G., Goddijn, M, et al. (2015). Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Human Reproduction, Mar 1;30(3): 495–8. https://doi.org/10.1093/humrep/deu299
Malory B. (2024). Linguistic Challenges in Communicating About Pregnancy Loss: Full EStELC Project Final Report [Internet]. Survey of English Usage, University College London.
Malory, B. & Nuttall, L. (2024). Acceptability in Pregnancy Loss Language: Final SuPPL Project Report [Internet], Survey of English Usage, University College London.
Malory, B., Nuttall, L. & Heazell, AEP. (2025). Acceptable nomenclature for pregnancy loss care: A cross-sectional observational survey. BJOG, Oct 11. https://doi.org/10.1111/1471-0528.70057.
Peanut. (2021, April). Renaming revolution: The motherhood and fertility glossary. Peanut. https://www.peanut-app.io/blog/renaming-revolution-glossary
Royal College of Obstetricians and Gynaecologists. (2022). RCOG Language Guide. Royal College of Obstetricians and Gynaecologists.
Silver, R.M., Branch, D.W., Goldenberg, R., Iams, J.D. & Klebanoff, M.A. (2011). Nomenclature for pregnancy outcomes: Time for a change. Obstetrics & Gynecology, Dec;118(6):1402–8. https://doi.org/10.1097/AOG.0b013e3182392977.
About the authors:
Dr Beth Malory is a Lecturer in English Linguistics and a health communication specialist at University College London. Her research focuses on the effects of linguistic choices around pregnancy loss in particular and is motivated by lived experience of recurrent second trimester loss. She has worked with clinicians, academics from other disciplines, and third-sector organisations to better understand the roles language plays in experiences of pregnancy endings and public understanding of such experiences.
Email: b.malory@ucl.ac.uk;
Instagram: @drbethmalory
Dr Louise Nuttall is a Postdoctoral Research Assistant on the ‘Supporting Policymakers to Negotiate Communicative Challenges Around Pregnancy Loss’ Project at University College London and a former Senior Lecturer in English Language and Linguistics at the University of Huddersfield. She works with Dr Beth Malory on projects seeking to increase awareness of the impact language has in contexts of loss during pregnancy.
Email: louise.nuttall@ucl.ac.uk
Dr Beth Malory, Lecturer in English Linguistics at University College London, Founder of the Reproductive & Sexual Health Communication Alliance;
Dr Louise Nuttall, Postdoctoral Research Assistant at University College London.
April 2026