Remembering Your Humanity: The De-medicalization of Language

In Memory of Sheila Kitzinger, 1929-2015
Legendary Anthropologist & Birth Activist

Learning to function in a clinical profession means not only the study of scientific principles and the navigation of new social structures, but also the acquisition of a dialect of Medical English. This dialect, with its strange combination of Latin and Greek sources combined with 20th century secretarial shorthand, serves numerous purposes: to provide legitimacy to the clinical fields through their distinctiveness; to distinguish the speaker as an “expert,” a person worthy of respect in a social and professional hierarchy; to aid in accurate diagnosis and treatment by requiring great specificity; to distance the speaker from her subject; to save time. These purposes are variously beneficial and nefarious. Beneficially, for instance: I can draw no clinical conclusions from a woman’s report that she has “heart palpitations,” but were I to know that she has atrial fibrillation as a result of third degree heart block, I would be able to understand her treatment options and the risks she is facing to her health.

Where Medical English becomes dangerous is where it distances the care-giver from the cared-for. When a midwife sees 35 pregnant women per day in a clinic setting, for instance, those women are already in danger of losing their individual humanity in the midwife’s eyes because of their sheer volume. When those women lose their names, with each becoming the seemingly endearing “Mama” or “My love” (or “the ‘primip’ in Room 3,”), each is in fact one step closer to having her agency and power in the birth process removed from her. To name a woman is to know her, and when you know her it is hard to mistreat her. But when a birth becomes “a delivery” (with its connotations of saving, rescuing, or handing over) and a death becomes “a bad outcome” the midwife puts herself in danger of forgetting the unique role that she occupies: a guide through that liminal space of pregnancy before the act of birth, miscarriage, or abortion; a witness to joy and grief in life’s most intimate moments; a guardian of the power of women in times of vulnerability. A midwife is a psychopomp in the world of the living, and any language that seeks to shield her from that truth diminishes her, and diminishes those for whom she cares.

My last few weeks of midwifery training were particularly difficult, and I began to fall back on the distancing language of medicine in order to move through it all. I am grateful that I was gently reprimanded for this by a midwifery professor, after which I wrote the following journal entry. A brief glossary can be found at the end of the post.


This week I am working on human words:

I could tell you that the first thing to occur that day was an NSVD: this week I am remembering that it was a birth. The birth of a girl child.

The day became late, and I could tell you than a G6 P4104 came in, or I could tell you that a woman named Daniela came in laboring, about to give birth to only her fifth child. I could tell you that she was not giving birth to her sixth child because she had been thrown down the stairs by her ex-husband during a previous pregnancy, and that the baby had not survived.

I could tell you that Room 2 arrived shortly thereafter with the FOB, or I could tell you that a woman named Selina came to us in labor, having been physically abused by the man who accompanied her, her husband. The same man who had thrown the previous woman, Daniela, down the stairs years ago.

I could tell you that I delivered both of them within minutes of each other, or I could tell you that I attended Daniela’s birth, ran to Selina to attend her birth, and then ran back to Daniela to repair her wounded vagina. I could tell you that they both had PPHs, or I could tell you that they both kept bleeding and bleeding, and while my preceptor did not want to use these words, I said out loud that they were hemorrhaging blood and needed medication to stop it. I could tell you that Daniela had a second degree laceration, or I could tell you that she was seriously injured while giving birth, that I tried to numb her vagina with lidocaine but didn’t do a good enough job, and that I caused her enormous pain while repairing that most sensitive area of her body. I could tell you that I haven’t thought about her since, haven’t wondered how long she will have pain, haven’t wondered if she will have numbness or have pleasurable sex again — but those would be lies.

I could tell you that the next marker of the day was a patient who came in with an IUFD: I have said that several times. I am working on saying that she was a woman named Katherine and that her baby had died. That it had been alive the day before when she entered the hospital and was diagnosed with a simple infection, and left with a prescription, hysterically crying, blaming herself for her infection. But when she returned today having not felt the baby move since 1am, and labored up and down the hall, and then received an epidural, and then labored down, what happened next was the stillbirth of her baby, a boy child. An IUFD has no qualities, does nothing; this baby that died had an unnaturally open mouth, and skin that came off when its paltry blanket was adjusted.

I could tell you about the two other patients who came in with PTL at 0230, or I could tell you about the two women who arrived in the middle of the night in labor too soon, whose cervices were dilated too far to be stopped, whose babies would arrive after seven months in the womb instead of nine months, who would likely live but with uncertain futures. Unequipped to handle more complication and trauma, we sent them to a nearby high-risk maternity unit by ambulance immediately.

I could tell you that I am almost a clinician, a healthcare provider, a CNM, or I could tell you that I am almost a midwife, and let it linger on the tongue.


  • NSVD: Normal, spontaneous [not extracted with instruments like forceps], vaginal delivery.
  • G6 P4104: Gravida 6 [6 pregnancies, including the current one], Para 4104 [four births after pregnancies of least 37 weeks, 1 early birth (between 20-37 weeks), 0 miscarriages/abortions before 20 weeks, 4 living children. If all 5 previous pregnancies had produced living children, this last number would be a 5].
  • FOB: Father of the baby.
  • PPH: Postpartum hemorrhage.
  • 2nd degree laceration: a tear of the vaginal skin, mucosa, and certain muscles of the perineum.
  • IUFD: Intrauterine fetal demise.
  • PTL: pre-term labor (labor that begins before 37 weeks of pregnancy).
  • CNM: Certified Nurse-Midwife. That’s me.

Staying Married

Today is my parents’ 30th wedding anniversary. In case you’re wondering what they looked like celebrating their engagement, wonder no further:

When I was a small child, I didn’t understand how I was meant to celebrate their anniversary and didn’t quite know what it had to do with me. Now that I am getting married myself, I see the fact that I didn’t understand their anniversary’s significance as really good sign: I never thought that there was any reason that they shouldn’t be married. I assumed that marriage was their normal state, as was staying married forever.

It so happens that I don’t think that simply having been married a long time is a great reason to stay married if things are truly and irredeemably terrible. I do think that to get married you have to be an optimist, and to stay married you have to be a fighter. I count myself lucky that I come from people who value fighting for their marriage over fighting in it, and who know what real commitment means.

(And in case you should think it’s only on my side: RP’s parents just celebrated their 34th anniversary! If they would like to supply me with a fresh-faced photo of themselves from the late 1970s I would be happy to post it here as well…)

So today I’m raising a glass to another 30 years for my parents, congratulating them, and wishing I could celebrate with them. Love to you, Mom and Dad!


And now for the interactive portion of the show: today I’m also taking that advice that you’ve always wanted to give but worried might make you seem overbearing and self-righteous! I’ve heard lots of advice on what it takes to stay married, ranging from “Don’t go to sleep angry” (which I totally don’t subscribe to…I believe in the healing effects of a night of sleep) to things that are not fit to print on a blog that my parents read.

Tell me, dear reader: what do you think it takes to stay married?

Reality Check

Tonight was the annual gala for my mother’s theater, Classic Stage Company. She has just been made President of the Board (i.e. Queen of New York and Also the Rest of the World) and was the picture of grace at the big event tonight.

As at every gathering of more than 2 people I have attended recently, I spent a lot of time explaining what RP and I will be up to in Kunming. This has got RP in a pretty bad mood recently – all of this chatter and praise and questioning, without us having actually accomplished anything yet. Nonetheless, everyone is so genuinely excited for us that it’s hard for me to begrudge people asking the same questions over and over…and occasionally someone does say something unexpected:

OLD FAMILY FRIEND (OFF): I think it’s so great what the two of you are going to do.

ME: Well we’re pretty excited.

OFF: I mean, [husband] and I had such a wonderful experience when we were living in Japan.

ME: Yes, of course!

OFF: The whole experience will either bring you so close together or completely break you apart. That’s what living in a foreign country does. [Swift exit to the bar.]

Gulp. Thanks, OFF. I’ve been so distracted recently with moving out of our apartment and worrying that I’m not qualified for my new job that I had totally forgotten about the explosive potential of China to end my relationship! Ahaha!

I’m not actually worried about this – I think. RP and I have taken a long time building our relationship and, when we make it to Kunming, will have moved our lives through 5 cities and 3 countries in 5 years. And although the last time we were in China together was a very shaky time for us, I like to think that it was nothing to do with China and everything to do with the fact that I was kind of a lunatic at that point in my life – three years ago and a world away from where we are now.

I think this is the beginning of a totally new phase of life for us; a break from a series of moves and jobs and undertakings that haven’t been what one or both of us wanted. This is us being brave, and being together.

Pastoral Detroit

Pastoral Detroit. (Courtesy of RP)