It pays to be aware that language can obscure choice.
I have written and lectured about language for more than thirty years, and one of the key reasons for my interest is the way that language can be used as a tool to exercise power.
Often in subtle ways that aren’t easily spotted unless you’re looking.
The three decision making fudges
Over the years, while I’ve been researching different topics for my books, lots of women have told me things that professionals or care workers have told them, and there are three particularly problematic themes that arise over and over again.
I see these same issues reflected in the medical literature. And even though many guidelines now pay lip service to the notion of informed decision making, they are sometimes worded in such a way that make it simple for professionals to push the option that they prefer.
Not every professional does this, of course. And some do it without realising. But these happen, regularly, and it’s worth knowing about them.
Let’s look at what they are, where you can see examples, and how you can learn to deal with them.
The inappropriate use of the absolute
The first issue is where practitioners use language to imply that something is absolute, inevitable, or far more likely than it is in reality (and research).
We see this a lot in induction of labour, where women and families are often told that something is almost inevitable, when actually the chance of it is slim. Or the chance of an unwanted outcome happening isn’t much more than if they carried on and let things run their natural course, but there are potential unwanted outcomes from the intervention that is being offered instead.
I have loads of blog posts which talk about this, if you’d like to know more. Here’s a resources page listing them all.
Another good example of this occurs for women who are larger than average. To hear some practitioners speak, you’d think we were constantly at death’s door. The reality is very different. Here’s a link to my book on this topic, and you’ll find more resources linked from that page too.
Language which is used to scare
There’s no excuse for this, but it happens all the time. Again, it’s often seen used in induction and with women who have a higher BMI, but that’s not where it ends.
I’ve heard many practitioners use fear-filled words like ‘haemorrhage’ or ‘death’ when they are wanting to push interventions that they believe in, and which women and families are questioning. We call it shroud-waving, or ‘playing the dead baby card’, and it’s despicable.
I believe that part of the problem we are currently facing as a society occurs at the junction of public health messaging and individual agency, which is where people respond to these inappropriate persuasion tactics. That is, governments often use ‘nudging tactics’ to get people to do things that want. This includes agreeing to interventions that medical authorities see as beneficial on a population (or routine) basis, as well as to economic decisions like getting people to pay taxes, or save for retirement. But people can see through this, and some become so fed up or angry with the idea that they are being manipulated that they may start rejecting things that they might otherwise have chosen.
Whether or not it’s used in a deliberate way, using scare tactics to persuade people to make a particular decision isn’t ethical, kind, or fair. More on that and how to deal with it in this blog post about vitamin K.
I would also like to share this thought with health professionals and birth workers.
Language that obscures the existence of a choice
I also frequently encounter women who don’t realise that some decisions are even theirs to make, and it is no wonder when one considers just how often information is presented in the form of ‘you will be given this’ rather than ‘you will be offered this’.
Or, ‘you need this’ rather than ‘you may wish to have this‘.
Sometimes words aren’t even used. A health professional will just reach for our hand, wrist, or arm, and we hold it out, obediently, without necessarily knowing what is being tested, and why. For many of us, this is what we were trained to do, as children.
If we question what is being asked for, or decline what they want to do, we may be treated poorly, even by untrained people. I write from experience. But it’s important to know that you have rights, and to not allow yourself to feel cowed or intimidated in the presence of health professionals or caregivers.
Here’s the irony
Here’s the irony though, and there’s a parallel with what I wrote above about government messaging.
In some cases (and Anti-D is a good example from my own research portfolio), the vast majority of women are likely to want to have the intervention anyway, and saying or writing offer instead of give is unlikely to change their decision.
But the act of highlighting that it is the person’s decision to make is a vital important acknowledgement of the fact that we are all independent agents who have the right to make decisions about our bodies.
Which is an idea that we should be strenuously promoting rather than trying, even unwittingly, to conceal.
You’ll find more on this, and many other topics, in my upcoming book on midwifery knowledge.
I’ll be sharing more details in September, and my email subscribers always get the earliest, juiciest, and most extensive details!
If you’re not on my email list and would like to be, sign up here, and then check for the confirmation email.
My single achievement
If you have heard me speak on this topic, you might have heard the story of how my single achievement after a number of days of research, writing, and committee work (the latter of which I find an enormous challenge, as it involves sitting still in a chair, not speaking too much AND following convention all at the same time) was to secure the changing, throughout a rather key and influential document relating to a particular area of practice, of the word ‘give’ to the word ‘offer’.
On one level, and particularly for someone who sees that we have SO far to go in regards to the information that is offered to women, this didn’t feel like much to show for my efforts.
On the other hand, and as those who hear my story often point out, this is quite a huge achievement because that single word changes so much.
It’s what we should be hearing all the time, and it’s what we should be demanding from those who care for us.
How to find out more
I have a couple of other blog posts that have been written to help women and families understand these issues, and ask the questions that will help you get the information and care you need:
And you might want to read What’s Right For Me? Making decisions in pregnancy and childbirth.
I wrote it in order to help women better understand the decisions that they might want to make during their pregnancy and childbirth journey.
About the Author: Dr Sara Wickham is an author, speaker, and researcher specialising in pregnancy, birth and maternity care. Her work focuses on evidence-based, woman-centred information and informed decision-making, drawing on more than 30 years of midwifery knowledge and experience.
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