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Editorial: Words matter; language matters

      For decades, many authors have suggested that the language and terminology we use in practice makes a difference to the experience, perceptions and outcomes for childbearing women [
      • Cyna A.
      • Andrew M.
      • Tan S.
      Language and the subconscious.
      ,
      • Bastian H.
      Confined, managed and delivered: the languageof obstetrics.
      ,
      • de Crespigny L.
      Words matter: nomenclature and communication in perinatal medicine.
      ,
      • Stapleton H.
      • Kirkham K.
      • Thomas G.
      • Curtis P.
      Language use in antenatal consultations.
      ,
      • McCourt C.
      Supporting choice and control? Communication and interaction between midwives and women at the antenatal booking visit.
      ]. More than 20 years ago, Nicky Leap wrote a paper called The Power of Words which has been one of our go-to pieces of writing for practice, teaching and research [
      • Leap N.
      The power of words.
      ]. She updated the paper in 2012 [
      • Leap N.
      The power of words revisited.
      ] but essentially the same issue remains – language matters. These papers clearly highlight the importance of language. In reading, doing, writing and talking about midwifery research and practice, especially in this journal, it seems evident that language also matters.
      Recently, with a group of students we spent a day together reading papers as part of screening for a systematic review on pain in labour. We were somewhat horrified with the language used in many of those papers – language which was often disregarding of women, of their experiences or outcomes. We found multiple examples where women’s perceptions of pain were belittled and women’s experience of discomfort or pain was considered to be due to her ‘mood’ and (lack of) ‘emotional stability’. Several papers described women’s responses to pain as ‘noisy’, ‘hysterical’ and even ‘obstreperous’.
      Inappropriate language or terminology use is one of the key reasons for rejection of articles submitted to Women and Birth. We want to promote positive and empowering language in all of the papers published. Our Instructions to Authors highlight that we require that authors use woman centred language, such as, referring to births rather than deliveries, to give birth rather than deliver and women rather than patients or even just as pregnancies. Papers that do not adhere to these guidelines will not proceed to peer review.
      We also require the use of language that acknowledges diversity, conveys respect to all people, is sensitive to differences, and promotes equal opportunities. Articles should make no assumptions about the beliefs or commitments of any reader, should contain nothing which might imply that one individual is superior to another on the grounds of race, sex, culture or any other characteristic.
      We have been challenged lately about our use of the words woman and women as it is potentially non-inclusive of gender-diverse peoples. We recognise and respect the increasing rejection of a binary approach to both sex and gender. We also recognise that Trans people face substantial injustices, including violence and discrimination and as a journal, we do not want or mean to add to this. However, because women are also marginalized and oppressed in most places around the world, we have chosen not to erase the terms “woman,” “mother,” or “maternity” in our journal. When we use these words, it is not meant to exclude those who give birth and do not identify as women, for whom the honouring principles of respectful maternity care described here are equally important.
      For us, being inclusive means the use of both gendered and gender-neutral terms to represent the full diversity of people who experience pregnancy, birth and breastfeeding. Some authors will choose to use terms like “pregnant person”, “childbearing people”, and “parent” to avoid always gendering birth and those who give birth as feminine, however we must ensure that women per se are not made invisible and we will continue to support and promote use of the words woman and women. On an individual level, it is appropriate for all maternity care providers to use pronouns and words that are acceptable and preferable to the person for whom they are providing care [
      • Allen J.
      Midwifery continuity of care for specific groups.
      ].
      We are all socialised into and immersed in a particular culture which includes ways of talking and writing about midwifery, childbearing and women. We are also experiencing a rapidly changing socio-political landscape which calls into question some of our foundational structures such as binary thinking. We know it is hard to change the words we use when they seem ingrained and conventional in the language of academic writing. While it can be difficult to step outside of our accepted norms to see our use of language with fresh eyes it is important to examine this critically because language is powerful; it not only reflects our reality, but creates it.
      Nicky Leap and others have challenged us as midwives to explore the cultural and political underpinnings of language as she identified that these will inevitably provoke for each of us a myriad of meanings that compel us to question our values, our belief structures and ultimately, our interactions with women [
      • Leap N.
      The power of words revisited.
      ]. In translating that into the world of academic writing, we encourage all authors to engage with the importance of woman centred, respectful language and consider the impact of our words on the page.

      References

        • Cyna A.
        • Andrew M.
        • Tan S.
        Language and the subconscious.
        in: Cyna A. Andrew M. Tan S. Smith A. Handbook of Communication in Anaesthesia and Critical Care A Practical Guide to Exploring the Art. Oxford University Press, Oxford2011
        • Bastian H.
        Confined, managed and delivered: the languageof obstetrics.
        Br. J. Obstet. Gynaecol. 1992; 99: 92-93
        • de Crespigny L.
        Words matter: nomenclature and communication in perinatal medicine.
        Clin. Perinatol. 2003; 30: 17-25
        • Stapleton H.
        • Kirkham K.
        • Thomas G.
        • Curtis P.
        Language use in antenatal consultations.
        Br. J. Midwifery. 2002; 10: 273-277
        • McCourt C.
        Supporting choice and control? Communication and interaction between midwives and women at the antenatal booking visit.
        Soc. Sci. Med. 2006; 62: 1307-1318
        • Leap N.
        The power of words.
        Nurs. Times. 1992; 88: 60-61
        • Leap N.
        The power of words revisited.
        Essentially MIDIRS. 2012; 3: 17-21
        • Allen J.
        Midwifery continuity of care for specific groups.
        in: Homer C. Leap N. Brodie P. Sandall J. Midwifery Continuity of Care. 2nd Edition. Elsevier, Sydney2019