Over many years there has been questioning of the use of language across maternity services, particularly in relation to birth. The Royal College of Midwives (RCM) undertook a widely consultative project to establish the best choice of language that would provide clarity. Dr Mary Ross-Davie, Director of Midwifery at NHS Greater Glasgow and Clyde, Director of Professional Midwifery at the RCM and lead for the Re:Birth project until June 2022, with co-authors Dr Juliet Rayment, RCM Re:Birth research fellow and Dr Sara Webb, RCM head of MIDIRs and research, discuss the outcomes of the project.
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What’s in a word? The importance of language in midwifery care
Language is something that is very much alive and evolves rapidly. Any of us who are parents know this, as each generation seems to develop their own new lexicon – words like ‘sic’, ‘lit’, ‘salty’ or ‘snatched’ have taken on new meanings in recent years.
We also know that language has an impact on how people feel. It has been important for minoritised people to take control of the language that is used to describe them –we have seen this for LGBTQI+ people and Black, Asian and other ethnic people – where language has evolved rapidly. It is clear that language is powerful and is significantly related to how people feel – regardless of whether the intention of particular language was negative. We know that not everyone in a particular community will have the same view about their preferences around language. For example, we know that some Black, Asian and ethnic people do not like the use of the acronym BAME, while others feel comfortable with it.
It feels to me that it is now much more widely acknowledged that people should be asked about the language used to describe them and their lives and that society should endeavour to reflect this language back to them in individual interactions.
We also need to have some agreed language for when we are writing or talking more generally. For this, we rely on relevant national evolving guidance on language. Some examples are the UK Government guidance on writing about ethnicity from December 2021: and the NHS guidance on talking about sex, gender and sexuality from September 2021.
The language we use in maternity services also needs to evolve, to ensure that it continues to feel appropriate to those who are impacted by it – so maternity service users, but also maternity professionals and other birthworkers.
Over several years, since the Kirkup report of 2015, it became clear that the use of the term ‘normal birth’ to describe a labour and birth without medical interventions was contentious. Some have argued that the use of the term ‘normal’ brings with it a sense of judgement – that anything else is ‘abnormal’, that it gives women a sense that a normal birth is preferred by midwives particularly. For many of us working in maternity services, this debate has felt difficult – for us, the term ‘normal birth’ didn’t have any sense of judgement attached, it was simply a description of a normal physiological process. We use the term ‘normal’ widely in many parts of healthcare: normal temperature, normal blood pressure. But, even if our intention with the language we commonly used was not meant to do harm, we needed to stop and listen to those that are telling us that it was causing distress.
The Royal College of Midwives (RCM) decided to address this issue, through a carefully constructed consultative project. We called this the Re:Birth project. We worked with a wide range of stakeholders from across the maternity community to develop a way of hearing as many different perspectives as possible and seeing if we could arrive at a shared common approach to what we call different types of birth. As the RCM project lead, I worked closely with Dr Juliet Rayment, who was appointed as the Research advisor for the project and our large project oversight group, to develop guidance that we hope will be meaningful and helpful to maternity professionals and others. You can see who was on our project oversight group here: What is the RE:Birth project? (rcm.org.uk)
You can read about the methods we used and our findings here: Re:Birth summary 2022 (rcm.org.uk). Over the coming weeks and months, the RCM will also be producing more detailed information about the project methodology and results and also pocket guides and posters for use in maternity care settings to help guide practice.
Fundamentally, what we heard from the 8000 participants in the project, is the importance of listening to women and birthing people – and then personalising the language we use to their preferences when we are talking with them. To support midwives, student midwives, obstetricians and others to do this when having conversations with women during pregnancy about birth, we developed the 5As :
Acknowledge
If the woman has had a previous birth, acknowledge this as a birth (independently of mode of birth), or if this is her first time. If she has had a previous loss, that should also be acknowledged.
Ask
How would the woman describe a birth she has had or would like to have? Her feelings are just as important as the technical description, so listen to how she talks about that experience.
Affirm
Check with the woman the language used in your notes to describe any previous birth. Does that description feel right to her? Is there another term she would prefer to describe it?
Avoid
Try not to make assumptions about her choices – for example if there was a previous caesarean birth. Don’t make your own interpretation of what you think her experience might have been or impose terminology on her.
Annotate
Record the woman’s own description of her previous experience of birth as fully as possible, and her preferences on language and terminology.
The second key output from the project, was to provide maternity professionals with guidance about the terms that were preferred by participants to describe different types of birth in notes, reports, audits, and professional conversations. The overarching term preferred to describe all types of birth was ‘birth’ rather than ‘delivery’. Then, beneath this, the preference was to talk about ‘vaginal births’ and ‘caesarean births’. The other preferred terms were spontaneous vaginal birth; birth with forceps or ventouse; induced or augmented labour; planned caesarean birth and unplanned caesarean birth. Though these terms don’t cover every possible type of labour and birth, we feel that now we all have some steer of the principles to apply when choosing how to describe labour and birth: non hierarchical or value laden, specific, descriptive and technically accurate.
I am proud of the collaborative robust approach we took to this piece of work. I am immensely grateful to all the members of the Project team and project oversight group who approached it with open minds and helped us complete such a complex piece of work in a year. I am also hugely grateful to those who attended the listening groups and who listened so carefully and respectfully to perspectives that differed from their own, as well as sharing their own views honestly. I hope that the outputs of the project will help guide positive changes in the language used in maternity services, so it really reflects what the people we serve need, while also enabling us as health professionals to have a shared common language that works.
As I have now left my role at the RCM, the ongoing lead for the Re;Birth project is Dr Sara Webb, so please do send any enquiries or feedback about the project to her at sara.webb@rcm.org.uk
The RCM information about the Re:Birth project:
New maternity lexicon puts personalisation of care front and centre (rcm.org.uk)
What is the RE:Birth project? (rcm.org.uk)
Media reports about the Re:Birth project:
Is the term ‘normal birth’ upsetting for some mums? (yahoo.com)
Language around birth should be less judgemental, midwives’ report says – BBC News
Fact: There Is No Such Thing As A “Normal” Childbirth | British Vogue
Dr Mary Ross-Davie, Director of Midwifery at NHS Greater Glasgow and Clyde, Director of Professional Midwifery at the RCM and lead for the Re:Birth project until June 2022,
Co-authors: Dr Juliet Rayment, RCM Re:Birth research fellow and Dr Sara Webb, RCM head of MIDIRs and research,
2 comments
Glad the article still uses she/her/woman
Very much agree with Lucy
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