The Power in a Word

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