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The Power in a Word

In no field of scientific medicine is sexism so entrenched as in the language used in women’s health.

dr. keefer

Dr. Keefer

In no field of scientific medicine is sexism so entrenched as in the language used in women’s health. 

We find phrases like “estimated date of confinement” to describe the due date as if a laboring woman was a criminal or a wild animal needing to be caged up.

We label a women’s cervix “incompetent” or “unfavourable” when it is too loose or too tight.

We “allow” a woman a “trial” of labour and then “C-section” her when she “fails,” or doesn’t progress according to our schedules.

However there is one term that I come across on almost every shift as an emergency department doctor that I hate using it: “miscarriage.”

We know that up to 31% of all pregnancies end in miscarriage. Many women miscarry so early in their pregnancy that they are not even aware that they were pregnant.

Of women who know they are pregnant up to 20% will suffer a miscarriage in the first trimester. Why is this so common?

Early pregnancy losses occurring before 8-12weeks are most frequently due to a genetic abnormality of the fetus. This does not imply a problem in either mom or dad’s genes but rather that the coming together of the genetic material (chromosomes) of the mother and father is a very complex process that has many opportunities to go wrong.

Down’s syndrome is perhaps the most common chromosomal abnormality, in which there are three chromosome #21 instead of two. It most often leads to a fetus, which survives, and becomes a baby. However there are a host of other chromosomal mismatches, deletions and duplications that result in the creation of a fetus that cannot survive to full term in the uterus or in the outside world.

This results in a complex signaling between the fetus and the mother leading to the fetus leaving the mother’s body.

In counseling a young woman about the early loss of her pregnancy it is essential to communicate that she did nothing wrong to cause the miscarriage. Of course trying to lead a healthy lifestyle by avoiding cigarettes, alcohol and drugs and eating a healthy diet as much as possible, will bear fruits in every aspect of your overall health including fertility.

However, the very term miscarriage implies that the woman has made a mistake. That her grip was not strong enough, or that her body not a welcoming enough space for a little one. And this is not true!

There is power in a word! Miscarriage is common. It is not the fault of the mother. It’s time to move past the stigma and shaming. It’s time that doctors find a better way of speaking with their female patients. I am told that the word for miscarriage in Kanien’kéha is Wa’akowiron:ti: “she lost a baby”. It is a simple phrase that acknowledges the loss and hopefully doesn’t imply blame. I will start communicating better with my female patients by using words like “you have suffered an early pregnancy loss” instead of the word miscarriage.

Communicating with patients is an art and it does require endless practice and benefits from feedback. If you have any suggestions for how to better communicate with patients or for other topics you would like to see addressed in the Two Row Times health section please write to chris.keefer@tworowtimes.com

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4 Comments

  • Lia Tarachansky
    June 13, 2014, 2:26 am

    Dead Dr. Keefer,
    Thank you for writing this encouraging column, I wish more doctors thoughts deeply about sexism and terminology. In your next column maybe you can talk about your experiences working in high-violence centres such as Gaza and Baltimore?

    REPLY
  • An Opinion
    June 12, 2014, 9:41 am

    in the 20s when sciences wanted to become “serious” the first thing they did was get rid of the women. The book “Arrowsmith” by Sinclair Lewis illustrates this period of history.

    So men had to rediscover slowly what midwives had known for centuries and introduced strange practices to make it more convenient for the male doctor instead of for the patient.

    REPLY
  • Rahmat Costas
    June 12, 2014, 8:15 am

    This is a great article. It
    not only reflects on how women get treated clinically, but also how most
    doctors see their patients in general. Proper communication, interest and
    caring when treating patients is paramount for the true doctor. This is what we
    don’t see often, but this is what we all need in the medicine arena. Thank you for writting this article!
    Rahmat.

    REPLY
  • seanda wilkins
    June 11, 2014, 11:08 pm

    I work for Bereaved Families of Ontario-Southwest Region. Many of our clients are bereaved Mothers (and their partners) that have experienced the death of their early term baby. I have posted this article to our FB wall as I think that this provocative perspective of language will enable healing…words are powerful and the terms used to express this kind of painful loss should reflect compassion and understanding. Thank you for writing and posting this article!

    REPLY

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