The programme consisted of a series of NHS Twitter stars – people like Teresa Chinn (@agencynurse) and Kath Evans (@KathEvans2) – talking about the power of Twitter and why it is important to people in the NHS. I spoke about blogging and how this can take Twitter to the next level, particularly when ‘140 characters are not enough’.
Today’s guest blog by Jen Phillips is an excellent example of this.
I posted a tweet on 12 February about negative language used in maternity services – language such as ‘failure’ – and how it can make the mother feel inadequate and depressed.
It sparked a huge debate on Twitter that ran for about a week as more and more Mums joined the conversation giving examples of language and how it had made them feel. Here are just a couple of examples:
Improving language in maternity care is one of the eight specific actions we have included in our NHS Change Day campaign - you can find out more about the #MatExp campaign here and join the action.
Jen Phillips joined the conversation. She is, among other things, the lay chair of the North Staffs MSLC. She asked if anyone had written a summary of ‘what professionals say’ and ‘what women hear’. She emailed me some examples and I thought it was brilliant so I invited her to write a guest blog:
I do not think it means what you think it means
It was 4AM. I was 37 weeks pregnant and a day and a half into an unplanned and unexpected induction. I’d been in hospital since my midwife had sent me for tests four days previously. Everything had been taken out of my hands by the needs of my medical situation and I didn’t think things could get much worse. That’s when the bombshell landed.
I’d only fallen into fitful sleep out of exhaustion. I was woken by a team of people standing around staring at me. I could barely focus on their shapes and have no recollection of them even having faces, I just remember the words:
“Your baby is showing signs of distress. You need an emergency caesarean.”
What they meant was that they needed to intervene to keep us both safe. What I heard was something very different. The fog of waking up left instantly, replaced with nightmarish visions of me lying on an operating table in a pool of blood, or worse: of my child dying inside me.
Words can be far more powerful than we give them credit for. We use them all day every day, letting them fall from our mouths and fingers like rivers, but they can cut like knives. Midwives are, on the whole, excellent communicators. They have to form close bonds quickly with a huge variety of women and their partners. They know when to tell a mum she’s doing great, how to tell her there’s a problem, and when to fade into the background. But sometimes they slip up; they’re only human. They also suffer from the same problem as any highly trained professional in a specialised field: they learn and use a whole language of their own that sounds like English but is somehow not. Stock medical terms are entirely ordinary to midwives, but they can sound scary and incomprehensible to untrained ears.
Sometimes, what a midwife says and what a mum thinks when she hears it can be two very different things.
It’s not recommended I’m insane for thinking about it
We don’t just pluck ideas out of the air. We think, feel and research. Dismissing what we ask for dismisses all of our thoughts and feelings. It’s important to find out why we want something done a certain way – and accept that those reasons are important to us even if they seem small to you.
There are risks My baby is in danger
Healthcare professionals talk about risks all the time. They understand the full and varied implications of the word, how risks need to be considered and mitigated. Parents tend to see them as something to worry about. I for one would rather talk about putting plans in place “just in case.”
Are you having pains? This is supposed to hurt. A lot.
Telling someone labour will hurt is a self-fulfilling prophecy. There’s nothing wrong with giving contractions their proper name, but I quite like “tightenings” for a word that’s descriptive and tame.
You are not in established labour I’m pathetic and wasting their time
When a woman hears this, she’s basically being told that she’s wrong, that someone else knows her body and her pain tolerance better than she does, and that things are going to get a lot worse. It can be disheartening and deflating. I’d much rather be told I’m doing well and don’t need midwives fussing round me yet.
Progress is slow I’m wasting everyone’s time, I have to hurry!
Getting a labouring woman stressed is a good way of slowing things down even more. Because of specific medical problems I was closely monitored. Every few hours someone would tell me that I hadn’t made any progress since the last check. Instantly, I felt my stress levels jump up and I had to fight hard to regain my calm. Just as I felt like I was getting back to it and things were going well, it was time for the next check. My progress was continually undermined by telling me something I didn’t need to know. If no action was to be taken beyond leaving me alone for another couple of hours, they could have just left me alone for another couple of hours.
You are failing to progress / dilate I have failed, I can’t do this
Dilation isn’t something women have any conscious control over, so telling us we’re failing to do it isn’t going to help anything. Thankfully this phrase is falling out of use, with it now being referred to as “a delay” which doesn’t come across as an accusation.
You need to… My choice and consent are irrelevant
Sometimes, in extreme situations, she really does need to follow a particular path. I really did need that caesarean. But if it’s not one of those situations, please don’t disempower us. “Perhaps we should think about..?” is a much better way to suggest things.
Emergency caesarean If I’m not under the knife in two minutes my baby will die
Despite my introductory paragraph, this one is a good news point. More often I hear people talking about an “unplanned” caesarean. It doesn’t conjure up the same blue lights, shouting and fade-to-white that “emergency” does. Unplanned implies not being what we set out for, but an acceptable destination reached by mutual discussion and consent.
There is an abnormality My baby is hideously deformed and may die
To a healthcare professional the word “abnormality” is a very broad term that could be as insignificant as a birth mark. To a parent it’s long term disability, special schools, being stared at in the street, maybe even a tiny coffin. See also “there’s something wrong.” We wouldn’t worry so much over something “slightly unusual” or “a minor thing we need to take a better look at.”
Yes, words can be devastating. But they can be uplifting and restorative, too.
After my second unplanned (not emergency) caesarean I lost a lot of blood. I was sent back to labour ward so I could be treated and monitored. Stationed in my room was the same student midwife who had spent the previous night watching over me in labour. At one point, after everything had calmed down and I was feeling a little more stable, I asked her to hold my baby while I used the bathroom. She said that she’d love to, that she didn’t often get to hold the babies she saw being born and it was wonderful to have the chance. And with those words, with the simple pleasure expressed in them, the upset and worry of the previous few hours faded away. I was finally given permission to enjoy my newborn.
Thank you Jen for writing this extremely thought-provoking blog – a real challenge to health professionals to realise how language is perceived and how negative language sticks with women, in some cases forever.
Join our NHS Change Day #MatExp campaign and sign up for a specific action that will make a difference.
Watch out for our NHS Change Day special, as part of the 12 hour ‘Changeathon’, live from Kingston Hospital on 11 March, with Florence Wilcock (@fwmaternitykhft) and I doing some rather exciting stuff … ;-)