Episode 40: Words and Labels in Medicine

I will never forget the moment I found out I was losing my first pregnancy. I was 6-8 weeks pregnant. I was thrilled to be pregnant. I had been having spotting for a few days, which all books told me could be normal. I was on call in the NICU, taking care of other people’s babies, and the bleeding was getting worse. I found some time to head over to Labor and Delivery, and one of the High-Risk OBs did an ultrasound. There was not a baby. I was pregnant. There is a placenta and a sac. But no fetal pole or heartbeat. I was told it was a “chemical pregnancy”.

A chemical pregnancy — what? I certainly felt pregnant. Blood tests confirmed pregnancy hormones in my system. I was in love with the idea of being pregnant, grateful for this life growing in me, and anticipating the new role of mom I was gearing up for.

Chemical pregnancy is the medical term. A term that suggests there is no baby, no pregnancy, nothing to grieve. But there I was, taking care of other people’s babies, as I was facing the loss of my own. I hate that term - chemical pregnancy. It is a loss. I felt a loss. I imagined who that child was, how I would change as I became a mother, and dreamed of what was to be. It was an early pregnancy loss.

Medical language has long used terminology and language that places guilt and shame on the patient. This is particularly pervasive in the world of maternal and infant care. Women are inundated with phrases like incompetent cervix, geriatric pregnancy, spontaneous abortion. Medical phrases that demean their body and place blame on the woman.

This type of shaming medical terminology can be devastating. The language places blame on the patient, as if they are choosing this outcome. Take the medical term “habitual aborter” for example. While it may seem antiquated to us, it still exists in medical writings and texts. A woman surviving the loss of a pregnancy is going through something emotionally painful, and then we label her with the diagnosis of habitual aborter. This diagnosis all but blames her for what she is going through as if she wanted it. Instead, using descriptive medical diagnoses like “recurrent early pregnancy loss” describes what is medically happening without introducing blame and shame for the women.

Here are a few more examples of old medical terminology related to pregnancy and delivery, and more appropriate descriptive terms:

Incompetent cervix —————Early Cervical Opening

Geriatric Pregnancy ————— 35+ Pregnancy

Spontaneous Abortion ————— Pregnancy Loss

Failure to Progress ————— Slowed Labor

This problem with terminology is not just limited to women and pregnancy. We see it with judgments related to how a woman is mothering, as well as infants and children.

Funny Looking Kid (FLK) ————— Multiple Congenital Anomalies

Wimpy White Boy —————— Premature Male Infant

Failure to Thrive —————Slow Growth

Breast Is Best ————— Fed is Best

Stay At Home Mom ————— Full Time Care Giver

And finally, we enter into terminology that is even more personal. Labels like disabled, handicapped, and special needs are often used interchangeably. However, people living with a disability and their family members often have strong opinions about what words feel best to them. It is our responsibility to be respectful of the options, and ask them what terms they prefer.

Here are a few suggestions about how to approach words and labels.

1. Be mindful of the impact language has.

2. Seek to use terminology that describes WHAT is happening instead of outdated language placing blame and/or shame on the patient.

3. Use narrative medical language in charting and notes, actively using patient voices.

4. Seek to understand how each diagnosis impacts the individual.