One might hope that the doctor’s office, a site of reason and science, would be an island of support and empathy amid the sea of judgment. So often, it’s anything but.
These are all actual, official medical phrases used by doctors to speak to pregnant people as well as those struggling with conception. And, trust me, they’re not any more tolerable when spoken out loud.
This spring, Peanut decided to try to help. Its staff convened a panel including a linguist, obstetrician and two psychologists and tasked them with rewriting the phrases used to describe pregnancy and early parenthood.
The new vocabulary
A few highlights from Peanut’s new glossary include replacing “biological clock,” with all its ticktock neurosis, with “family planning.”
“Hostile uterus” has become “uterine lining implantation struggles” because we aren’t talking about a marital spat here. We’re talking about tissue.
“Incompetent cervix” has become “early cervical dilation.”
“Habitual aborter” has become “recurrent miscarriage,” referring to pregnant people who have had three or more pregnancy losses before 20 weeks of gestation.
“Insufficient milk supply” has become “low milk supply.”
Stay-at-home-mom has become “full-time childcarer.”
The widely disliked “geriatric pregnancy” has become “35+ pregnancy.”
When pregnant people miscarry but their bodies don’t discharge all the tissue naturally, doctors must intervene. This is referred to as “evacuation of retained products of conception.” The panel suggests “compassionate removal” instead, which honors that “products of conception” can feel a little clinical and cold to those whose miscarriage has brought them grief.
While writing the new terms, the panelists often went in two different directions, said contributor Amanda Montell, feminist linguist and author of “Wordslut.” With some phrases, it was better to be more specific. Why call a uterus “inhospitable” when instead you can just tell a patient what, exactly, is wrong with it?
Other times, like with “compassionate removal,” sensitivity won out.
“Language has incredible power to legitimize and delegitimize our experiences,” Montell said. As such, she and her fellow panelists attempted to come up with vocabulary that would minimize the potential for grief and self-blame.
An ongoing movement
The new glossary also swaps “breast is best,” for “fed is best,” a phrase that has been promoted by baby-feeding activists in recent years.
Instead of putting all the focus on whether the baby is consuming exclusively breast milk, which can make parents who struggle with breastfeeding feel terrible, “fed is best” puts the emphasis on whether the baby is getting enough nutrients and calories.
This shift has happened alongside a slower-moving one in doctors’ offices toward more sensitive language.
Going all the way back to the 1980s, doctors and researchers began pushing for the use of “miscarriage” instead of “spontaneous abortion” in medical literature.
Dr. Kara Goldman, a reproductive endocrinologist and assistant professor of obstetrics and gynecology at Northwestern Medicine, said that a rising number of physicians are aware of the problems and are using more compassionate language with patients and colleagues.”
For example, many of her colleagues now use more neutral phrases such as “ovarian insufficiency” and “cervical insufficiency” instead of “premature ovarian failure” and “cervical incompetence.”
“We know that infertility and pregnancy loss are often accompanied by deep feelings of inadequacy, shame and guilt, and (the) last thing a patient needs to hear is that she is somehow a failure or part of her body failed her or is incompetent,” said Goldman, who was not involved with the Peanut glossary.
“The words we do really do matter, patients hear them and process them on a deep level.”
Why change is slow
While few doctors want to make their patients feel bad, Goldman said that old habits die hard. The root of the problem, she explained, lies with the way pregnancy and infertility is coded in medical records and communications with insurance companies.
Doctors have to be more deliberate about toggling between what they say out loud and what they write on the form, she said.
“I imagine this will take an organic and grassroots movement,” Goldman said.
Women have had enough
Michelle Kennedy, founder and CEO of Peanut, believes women are ready for it.
“I was called geriatric when I was pregnant with my daughter at age 35 (in 2018),” she said. “At that point I just thought, ‘that’s stupid’ and had a little chuckle around it. But later I realized, it is not funny. We don’t have to say it is OK, and we have the ability to change it.”
She said the conversations on Peanut have helped her see just how damaging these phrases can be to women’s mental health.
“This is an inflection moment. We are talking more about the mental health of women, and that includes talking about this terminology and how it affects our mental health,” she said.
How to bring it up with your doctor
The first step is to take the new glossary, or a couple of preferred phrases from the glossary, into a medical provider and explain why you like them better, said Javaid, the OB/GYN.
Javaid wants women to remember that the medical system has been biased against women on a number of fronts — including who is studied, what is funded and how things are discussed — for a long time. This is not, she noted, in anyone’s head.
“It’s not too much to ask to have women’s point of view honored,” she said. And she believes many providers will agree.
“Tell them you understand that some terms are used for insurance purposes, but you prefer that they not be used in conversation. Most providers will be open to this,” Javaid said.
“What makes the glossary so great is that it gives patients and doctors somewhere to start the conversation, a way to meet in the middle and communicate.”