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Thoughts, articles and occasionally explainations
Communicating with women - Is language important?
Posted 16-Jan-2009 at 18:53 by TallPoppy
The language that we and other clinicians use when interacting with our clients, in my view, is very important. I recall the feeling of deep nausea I felt when a woman I was caring for was almost berated for 'having' a retained placenta. After trying everything we could to help her deliver the placenta it was decided the only way was via a manual removal of the placenta in theatre.
She had been taken from the delivery room, her baby and her partner to a sterile, brightly lit theatre. As she lay utterly exposed before us in the lithotomy position a clinician (not a midwife I hasten to add), who I think intended a joke, said ‘You are naughty hanging on to that placenta! What are we going to do with you? What are you like?!’. I saw the woman look even more uncomfortable and apologise for her placenta and her body. I felt uncomfortable with this as I felt there may be a psychological aswell as physiological reason why she had retained placentas with all 3 of her births. I had read her notes and seen that there was a history of sexual abuse, I understand that this information was also handed over before we got to theatre. I assume the clinician was attempting to 'make light' of the situation - maybe that was their way of trying to make her feel more comfortable. But it didn't feel right to me. Her reaction - her apology didn't feel right to me. Why was she apologising? she was not responsible for her physiology in my view. I tried to turn the situation around and remove the blame that she was obviously feeling and said it wasn’t her fault, it was just one of those things and not to worry and we will do all we can to help the placenta be delivered. I held her hand and she squeezed mine back so tightly.
My instinct dictates that women feel vulnerable before, during and after giving birth, therefore how we interact with them and the language we use is of great importance. How can we expect women to believe in their bodies and their ability to birth if we talk to them negatively? Mainstream midwifery literature suggests that women who are made to feel they are 'coping' well will usually continue to 'cope' well (Bennett and Brown, 1996).
For me, positive verbal and non verbal communication and support is core to midwifery. As the god that is Mavis Kirkham (2000) states ‘Confidence is infectious and very easily transmitted’. I would also suggest that the reverse is the same. How can you empower a woman if you don't use empowering language? What is empowering language? What if your praise of 'Well done' after she has pushed with all her might is felt as patronising to your client? How will you know she feels this way? Women will give you clues, but you will have to look for them.
Knowing what is appropriate is different for each woman you care for. You will only know by watching, listening and not assuming that what you have to say by way of encouragement is right for every client you will ever have. Be measured in your verbal language and look for non verbal cues.
'Mayes' style midwifery underlines the idea that the midwife can instil confidence and therefore progress, in labouring women through praise, the tone of voice, and the quietness of manner (Sweet and Tiran, 1997). Sometimes saying nothing is more powerful than the relentless use of the same phrase. Who has heard a women praised with 'good girl' over and over? I know I have and I know it didn't feel right to me. If it doesn't feel right when you hear others say certain phrases, then dont use them. You may think you are supposed to because your mentor does, or someone else you admire and respect uses them but stop and think about it. It is here in this thought process where your own style as a future midwife is born and develops while you are a student. Do you want to be a clone? Or do you want to be your own person? Take the positives and negatives from everyone you will ever work with, not only as a student but as a qualified midwife and decide for yourself what feels right.
She had been taken from the delivery room, her baby and her partner to a sterile, brightly lit theatre. As she lay utterly exposed before us in the lithotomy position a clinician (not a midwife I hasten to add), who I think intended a joke, said ‘You are naughty hanging on to that placenta! What are we going to do with you? What are you like?!’. I saw the woman look even more uncomfortable and apologise for her placenta and her body. I felt uncomfortable with this as I felt there may be a psychological aswell as physiological reason why she had retained placentas with all 3 of her births. I had read her notes and seen that there was a history of sexual abuse, I understand that this information was also handed over before we got to theatre. I assume the clinician was attempting to 'make light' of the situation - maybe that was their way of trying to make her feel more comfortable. But it didn't feel right to me. Her reaction - her apology didn't feel right to me. Why was she apologising? she was not responsible for her physiology in my view. I tried to turn the situation around and remove the blame that she was obviously feeling and said it wasn’t her fault, it was just one of those things and not to worry and we will do all we can to help the placenta be delivered. I held her hand and she squeezed mine back so tightly.
My instinct dictates that women feel vulnerable before, during and after giving birth, therefore how we interact with them and the language we use is of great importance. How can we expect women to believe in their bodies and their ability to birth if we talk to them negatively? Mainstream midwifery literature suggests that women who are made to feel they are 'coping' well will usually continue to 'cope' well (Bennett and Brown, 1996).
For me, positive verbal and non verbal communication and support is core to midwifery. As the god that is Mavis Kirkham (2000) states ‘Confidence is infectious and very easily transmitted’. I would also suggest that the reverse is the same. How can you empower a woman if you don't use empowering language? What is empowering language? What if your praise of 'Well done' after she has pushed with all her might is felt as patronising to your client? How will you know she feels this way? Women will give you clues, but you will have to look for them.
Knowing what is appropriate is different for each woman you care for. You will only know by watching, listening and not assuming that what you have to say by way of encouragement is right for every client you will ever have. Be measured in your verbal language and look for non verbal cues.
'Mayes' style midwifery underlines the idea that the midwife can instil confidence and therefore progress, in labouring women through praise, the tone of voice, and the quietness of manner (Sweet and Tiran, 1997). Sometimes saying nothing is more powerful than the relentless use of the same phrase. Who has heard a women praised with 'good girl' over and over? I know I have and I know it didn't feel right to me. If it doesn't feel right when you hear others say certain phrases, then dont use them. You may think you are supposed to because your mentor does, or someone else you admire and respect uses them but stop and think about it. It is here in this thought process where your own style as a future midwife is born and develops while you are a student. Do you want to be a clone? Or do you want to be your own person? Take the positives and negatives from everyone you will ever work with, not only as a student but as a qualified midwife and decide for yourself what feels right.
Total Comments 11
Comments
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Inspiring as always TP
xxPosted 16-Jan-2009 at 19:09 by KarrierBag
- TP I think you're absolutely right. I'm waiting to start my own training so am not developing my own style yet. But I have experienced 3 births of my own children-where the choice of words and style of language and context are replayed endlessly in my head! It really does make a massive difference... e.g. with non-verbal cues, her body language (I can't remember whether there was an audible 'tut' or not!) etc the midwife who delivered my first conveyed her disapproval and disappointment at some of my choices, which has left me with a haunting sense of failure ever since! I truly believe that while we may not be able to change the entire system and get everybody breastfeeding, not smoking and having normal deliveries in an upright position with no epidurals
we can make a massive, important and long lasting difference through the small things we do and say...Posted 16-Jan-2009 at 19:16 by Guest2571 -
Absolutely spot on as always TP, it matters so very much...particularly when we are the person these women are supposed to trust enough to deliver their precious baby in to our hands!!
If i don't have something constructive/useful or pleasant to say...i say nothing at all, sometimes the language of looks and touch is infinately more important!
Thankyou for an inspiring and thought-provoking entry. xx
Posted 16-Jan-2009 at 20:06 by Butterfly -
Thanks lovelies. Oldie but goldie your words ' a haunting sense of failure' are so poignant - its exactly that that I feel is so important to avoid. These feelings last lifetimes, they overshadow birth experiences and influence future birth anxieties. They are passed between friends in folk tales and can influence generations - because the magnitude of the event of birthing can never be underestimated. Its never just a job, it cant be.Posted 16-Jan-2009 at 20:38 by TallPoppy - Exactly.Posted 17-Jan-2009 at 13:44 by Guest2571
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HI TP great blog, the situation you described seems a bit horrific, a women w/ history of Sexual abuse could have possibly been treated with greater sensitivity? Also i get the feeling that writing "failure to progess" on a persons notes is kind of wrong...failure??? it's such a -ve word!
Thanks for reminding us that some of the small things we do or don't do may have HUGE implications for the people we care for.Posted 27-Jan-2009 at 19:26 by rachaeljay -
A totally inspiring post! And just spot on in every way!Posted 05-Mar-2009 at 19:12 by Planet Midwife - that was brill, i can totally relate to it, i as a person am a people pleaser,but in child birth you really need positive people around you being at the most vunerable state imaginable, getting the sense of the midwife not liking your choices, is in my expeirence totally uneccesary, a gd midwife will empower the mother to be focused and deliver her baby her way, midwifes provide the service, the mums need support, confidence, and an ability to know she is doing wellPosted 10-Mar-2009 at 18:50 by Irish mum
- Any suggestions of what to use instead of failure to progress??Posted 02-Jul-2009 at 10:31 by Kelbell
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I prefer delay in first / second stage, Kelbell
Thank you so much for this, TP. I especially like the way you've introduced references... one of my favourite quotes is, "the less we do, the more we give" (this link goes to Soo Downe's 1997 article with that title)
I'm a big fan of sensitive language, and I'm hyper-sensitive to what I say now after making a throw away comment once that was completely inappropriate (I still cringe when I think about it now - PM me and I might be brave enough to tell you about it!), and by being berated to the point of tears by a mentor who said my use of the platitude "honey" was offensive and patronising. Now in retrospect I can see some merit in what she was saying to me, just not how she said it!Posted 31-Jul-2009 at 02:14 by Bunny - TP, you have just given me such inspiration. I'm just finishing up my first degree in linguistics, although I badly want to be a midwife. I was trying to think of how my first degree could help my achieve my dream, and you've just explained it to me. I know exactly how language can affect a situation (indeed, I've spent 4 years studying it!). Now I realise that this experience will help me to become a more sensitve and careful midwife. Thank you so much, I'm feeling a lot more confident about my application and potential abilities if (fingers crossed!) I get in.Posted 22-Feb-2010 at 17:00 by CellistMidwife
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