Interview with Dr. Mary Sawdon and Remarks from Dr. David Hutchon
This post is to raise awareness for National Infertility Awareness Week to empower you and change the conversation around infertility.
All medical journals, articles, and magazines are cited at the bottom of this post.
I was visiting New York with my husband riding the escalator down to the National September 11 Memorial and Museum when I felt liquid in my underwear. I closed my eyes and whispered prayers all the way to the bathroom. I experienced two miscarriages within a year, and I was praying it was anything but blood. To my horror, it was blood. I lined my jeans with toilet paper, wiped the tears from my eyes, and took a deep breath before exiting the stall. My husband and I were soon riding the escalator back up to the noisy streets, searching for the nearest ER.
I’ll never forget what the overworked and tired doctor said to me. “I detect a heartbeat but don’t get your hopes up. This looks like a threatened miscarriage, and with your history, you need to prepare for the worst.” I thought her use of ‘threatened miscarriage’ was callous. At the time, I had no idea that ‘threatened miscarriage’ was a term used every day in English-speaking hospitals around the world. One of many terms that I personally feel has no place in physician-patient conversations.
Offensive Medical Terminology for Miscarriage and Pregnancy Loss
I’d like to know who comes up with the medical terms that describe the varying types of pregnancy loss. Whoever they are, they definitely don’t have a sense of humor. At best, I’d say they are out of touch with reality. At worst, they are flat-out cold-hearted.
The Worst Terms Associated with Miscarriage and Pregnancy Loss
I’ve discovered the meanest, most misleading vocabulary ever to hit the ears of women going through miscarriage or pregnancy loss.
Conversations around us and about us need a makeover because they are desperately outdated. That’s why I’ve created a mini-medical terminology dictionary. On a scale from one to ten, I reveal my top ten most offensive terms. I also share my initial thought after checking the books (I did my best to add a little humor, which is extremely hard, might I add). Since medical language is also confusing, I provide my straightforward English definition. And to wrap it all up, I give a less offensive term you can ask your provider to use during your next conversation about your loss. I did this because you matter, your story matters, and your unique loss matters.
On a scale from one to ten, below, you will see are the most offensive medical terms associated with pregnancy loss.
Mini-Medical Terminology Dictionary
Offensive medical term: Inevitable Miscarriage
Sounds like: You’ve misquoted Lloyd Christmas from Dumb and Dumber, “So you’re telling me there isn’t a chance?”
What it is: When the cervix dilates, there is bleeding, and the process hasn’t started yet, but doctors say it will soon.
Layman’s term: An unavoidable loss or a loss out of your control
Offensive medical term: Nonviable Pregnancy
Sounds like: My embryo’s credit card got declined at the exclusive Uteruo Prego Spa and Resort.
What it is: When doctors tell you that your baby has no chance of surviving or being born alive.
Layman’s term: Pregnancy loss
Offensive medical term: Complete Abortion
Sounds like: I can’t remember my grocery list or why I even entered a room, but my lady parts can do whatever they want without my permission. Fan-freakin-tastic.
What it is: The complete passing of tissue and blood after a horrible loss you didn’t choose to have.
Layman’s term: Miscarriage
Offensive medical term: Spontaneous Abortion
Sounds like: My uterus thought it would be a good idea to run away with Kevin Federline to Las Vegas.
What it is: A loss you didn’t choose to have.
Layman’s term: Miscarriage
Offensive medical term: Pregnancy Failure
Sounds like: Embryo 13: “Houston, we have a problem.” My Uterus: “Er, good luck.”
What it is: A pregnancy that won’t carry to term, and it’s not because you failed.
Layman’s term: Miscarriage or stillbirth
Offensive medical term: Incompetent Cervix
Sounds like: My directionally challenged cervix is steering my pregnancy, and Joey Tribbiani is in the back seat crying about his meatball sub with marinara sauce that blew out the window.
What it is: Cervical tissue that is too weak to carry a baby full-term.
Layman’s term: Miscarriage or stillbirth
Offensive medical term: Septic Abortion
Sounds like: I need a tanker to come and remove the sewage from my vajayjay.
What it is: A severe infection of the uterine content that led to miscarriage and required immediate care. And no, it’s not always due to a sexually transmitted infection (STI).
Layman’s term: Miscarriage or stillbirth
Offensive medical term: Habitual Abortion
Sounds like: My uterus ran away from home, used a dirty needle from South Bronx, and now she’s a “regular” on Asylum Street. Oh, and she changed her name to “YOO-TEE.”
What it is: When a woman experiences three consecutive miscarriages in a row.
Layman’s term: Recurrent miscarriage or recurrent pregnancy loss (RPL)
Offensive medical term: Intrauterine Fetal Demise
Sounds like: My uterus will NOT self-destruct in five seconds, you son-of-a-biscuit!
What it is: The loss of a fetus during gestation due to fetal pathology (ex: genetic disorder), maternal pathology (ex: infection), or placental pathology (ex: abnormal placenta).
Layman’s term: Delayed or silent miscarriage
Offensive medical term: Fetal Death in Utero (FDIU)
Sounds like: My alter ego will forever be Sadness from the Disney Movie, Inside Out. Can I just touch all the balls and make them blue forever?
What it is: The loss of your beautiful baby after 20 weeks of pregnancy.
Layman’s term: Stillbirth
Why We Have Offensive Terms
1. The Need for Accurate Statistical Data
The American Academy of Pediatrics says the correct use of medical terminology to describe different fetal deaths is imperative for collecting and analyzing accurate data. While this sounds nice, history has proven this is a difficult task.
Volume 30 of Human Reproduction tells us there is a problem with inconsistent terminology. An established set of rules and strict definitions are nonexistent for the varying adverse pregnancy outcomes. The lack of consistent naming systems makes it difficult to compare data across the board.
Medical terminology about pregnancy loss and miscarriage has changed over the years, and there is no consensus concerning nomenclature for differing data sets to be compared. The endless amount of data collected is useless if it cannot be adequately translated.
Changing offensive terms won’t break the medical data dictionary. If anything, it may provide clarity and consensus to a highly debated topic for both practitioners and women experiencing loss. The refinement of medical language concerning fetal loss would allow for accurate data comparisons and better patient care.
2. Comfort and Preference of Providers
Doctors, nurses, and medical professionals study medicine their entire lives. One can assume journals and medical dictionaries provide clarity in a very complex field. Just because doctors know medicine doesn’t mean they are experts in other areas such as therapy or counseling. It may be difficult for providers to switch from non-medical speak to medical terms throughout their day. The constant back-and-forth may cause stressful and added challenges for the provider.
3. It’s Hard to Find a Suitable Replacement
A suitable term to replace abortion and other offensive words is hard to come by. Replacement terms can’t provide the same clarity or needed description of the loss for records purposes.
A Push for Change
Progress Being Made in Medical Terminology
There has been a push for a change in early pregnancy loss terminology. Many studies conclude specific medical terminology such as ‘abortion’ and ‘fetal demise’ are distressing for patients. Terms like ‘abortion’ are widely perceived as a choice to terminate a pregnancy. The average couple is unaware a doctor can use a phrase like ‘habitual abortion’ to describe multiple unwanted losses.
Dr. Hutchon, a retired UK obstetrician and gynecologist, says miscarriage has mostly replaced the term ‘abortion.’ However, some professionals trained outside the UK still use abortion and other offensive words, even in 2021. Dr. Hutchon also points out that the Royal College of Obstetricians & Gynecologist (RCOG) recommends miscarriage terminology. He and other practitioners are taking steps to change the conversation around fetal loss. Before his retirement in 2010, he contacted authors and journal editors who continued to use abortion in miscarriage publications to demand change.
There are many examples of the slow but beneficial change in terminology. According to Beverly Chalmers’s research, many medical journals started using miscarriage and abortion synonymously in the late 80s early 90s. This spike in synonymous use eventually led to broader acceptance of the word miscarriage. In 1997, an NIH study concluded that ‘spontaneous pregnancy loss’ should replace ‘abortion’ in all medical literature. More recent studies have identified terms like ‘early fetal demise’ as distressing. Suggested replacements are the terms’ delayed miscarriage’ or ‘silent miscarriage.’
History has proven a change in medical literature must happen first, and then everything else follows suit. But sometimes, a change in medical literature starts with the woman who talks honestly with her doctor. Over the years, many study groups have recommended new medical terminology to avoid words such as ‘abortion’ and ‘early fetal demise.’
Don’t underestimate the power of your voice.
Terminology in Other Languages
The challenges with medical terminology are not the same outside of the English language. Terms that describe a ‘termination’ and ‘pregnancy loss’ are entirely different in the French and German languages. It is quite frankly impossibly for doctors or patients to confuse the two terms.
More than Words
It will take more than words to improve care for women who experience pregnancy loss or miscarriage. There must be a cultural change. And I think it’s happening right now as we speak.
While Dr. Hutchon understands it’s challenging to change the conversation, he believes raising awareness is as effective as anything. Even though doctors won’t be reading my blog post, you are. And your understanding and choice to help change the conversation make a difference.
A Doctor’s Perspective
Interview with Dr. Mary Sawdon
I asked my friend, Dr. Mary Sawdon, to answer a few questions for me concerning offensive medical terms. For a more in-depth look at our conversation, you can visit her Fertility Stories podcast and listen to our full conversation.
What advice would you give a professional to better approach a conversation that may include a potentially offensive term?
Miscarriage is hard. Going through a miscarriage is emotional. It can be an overwhelming, anxiety-provoking, and painful experience. I have heard from my patients how they were handled by other health professionals when going through a miscarriage. Many of my patients have had poor experiences. They have not received proper explanations of what to expect or how to handle their unique loss. They felt very ill-prepared. I personally have gone through two miscarriages, and I have been fortunate that the doctors and nurses that provided care were empathetic, caring and provided me with adequate information despite my medical background.
My Advice for Professionals. I would advise any health professional faced with a patient going through a miscarriage to take their time to sit with the patient, hold space, and listen to her concerns. It is essential to talk about the loss and show empathy. Avoiding medical terms like fetus or embryo may be helpful because to the woman, she may have established that early maternal connection already and considers this her child. Miscarriage is common, but that doesn’t make it any easier on the patient or us. Acknowledge their pain and encourage them to grieve. Reassure them that they are not at fault. We can’t ‘fix’ their miscarriage, but our patients need our compassion more than our medicine at the time of pregnancy loss.
What are a few ways a woman can get calm and confident after a bad experience at the doctor's office?
It’s okay to Be Upset. Going through a miscarriage is an emotional time for both the woman and her partner and taking time to heal is essential. Doctors mean well and are eager to “fix” things, but you may have had a bad experience at the doctor’s office due to varying bedside manners. It’s okay to feel upset about this.
Give yourself time to heal and grieve. Just remember that the emotions you are experiencing are natural and justified. Your feelings are personal, and everyone grieves differently. Journaling may help you process your feelings. Talking about your loss is also useful.
Don’t pressure yourself to get over your loss quickly or within a specific time frame. Healing will be more productive if you deal with your emotions as they come. You may want to take time off work to acknowledge and accept what you have gone through and give you a chance to process what happened.
Get support. Seeking support from family, friends, and professionals such as a therapist/counselor is important. Joining a miscarriage support group can also do a world of good for your emotional healing. Support and communication help you come to terms with your loss, and hearing stories from people who have gone through the same thing will help you feel less isolated and alone.
If you’re religious, ask your pastor, priest, rabbi, or spiritual leader for guidance. Perhaps you’ll find closure in a private ceremony with close family members or just you and your partner.
I want my readers to know I didn’t miscarry in the New York Emergency Room. Nor did I miscarry a week or a month later. My ‘inevitable miscarriage’ never happened. Instead, I gave birth to a beautiful baby girl six months later.
Sometimes doctors are wrong in the way they speak to their patients. It’s not because they are cold-hearted or mean. It’s because fetal loss terminology is outdated and requires a twenty-first-century makeover.
Let’s talk about these terms so we can get them changed. Because your body isn’t broken, your cervix isn’t incompetent, and you haven’t failed at anything. You are a strong woman going through a traumatic life event. And the least the medical world can do is stop using these ridiculous terms.
~ Traci, Amazon Best Selling Author