Trying to find the ‘right’ words: why it matters

Maddy is a mum to two boisterous, bouncy and beautiful boys: Alex and Ted. She shares her two birth experiences and reflects on how language and communication played a big part in those births. But also how they set the scene for, and influenced her early postnatal experiences, which were strikingly different. Maddy believes there are a number of unchangeable reasons for that, but language is the one thing that can be changed. 

PLEASE NOTE: This blog post is written as part of our #everywordcounts campaign, which we launched on 3 May 2021 in honour of Maternal Mental Health Awareness Month. You can read more about it here. 

TRIGGER WARNING: Please read this story with care. If you’re finding the content challenging, please give yourself permission to step away. If you need support click here, if you need urgent help click here.

‘You learn a lot about yourself when you have a baby’. No kidding! While there was no time to shower, dress properly, read, or reply to friends after I had my eldest Alex in May 2017, I found plenty of time for self-reflection. Before and during pregnancy, I had thought I knew myself pretty well. I was confident; a contemplative extroverted introvert (they do exist!). I felt successful and in control. After we came home with Alex this changed dramatically. I felt like a failure; a rubbish mummy, a depressed anxious wife, and I wasn’t living up to my own expectations. The tendency to overthink, a pre-occupation with what others think of me, and perfectionism were always there; in retrospect I now recognise that these traits have been popping up throughout my life. The traumatic experience of my labour with Alex triggered these tendencies into overdrive. I would never suggest that language and communication caused this trauma – but some of the interactions I had with healthcare professionals contributed to how I reacted to what happened, exacerbating it.

‘You’re only one centimetre dilated’
We waited until I’d been having the right number of contractions for the right length of time before heading to hospital around 1am. I was chuffed. On paper (and in my head) I would have a straight-forward labour. I was very healthy, had a smooth pregnancy, and was full-term. When I was examined on arrival, the midwife told me I was ‘only’ one centimetre dilated. I was crushed, felt that I hadn’t coped well enough and was wasting her time because I shouldn’t have come to hospital. Little did we know that I had actually coped well with my contractions, as much later we found out that Alex was flexing his head, causing my cervix to swell and preventing it from dilating despite strong contractions. Changing this statement to ‘You’re one centimetre dilated, but I can see that you’re coping with strong contractions’ would still have been disappointing, but would have made me feel like I was doing a good job. Even removing ‘only’ would have felt very different.

“It felt like a judgement of me, not my cervix”

‘We’re short-staffed’
I spent my first few hours in the midwife-led unit. I was in more and more pain. To the extent that during contractions, I was screaming so much that I couldn’t breathe. Between contractions, I was drowsy with exhaustion. I had pain in my abdomen and my back (Alex was pressing on my nerves) and the pressure was excruciating. I was panicking and losing control. I had been waiting for two hours for an epidural. My midwife disappeared for what felt like long periods of time and told me that the department was short-staffed. This horrified me and I felt unsafe. Which in turn made me panic even more and lose all of my focus, truly believing that I might die from the pain. If she had told me that she had to pop away, would be back soon and that I was safe, I would have felt more reassured. 

‘You’re not progressing’
Eventually I got my epidural and went to the ward around breakfast time. After another twelve or so hours, I had a final examination by the surgeon as I was being considered for an emergency C-section. Without making eye contact, the surgeon stated ‘You’re not progressing’. I hadn’t dilated enough, my body was tired, and Alex was showing signs of distress. In my exhausted and emotional state, this felt like a judgement of me, not my cervix. 

Total failure
On her first home visit after Alex arrived, my community midwife was amazing. She had taken the time to understand me and knew that I would be unhappy with how things had turned out. I was sore, exhausted, and felt cheated of the ‘normal’ birth I fully (perhaps naively) had expected. Sometimes public perception is that a C-section isn’t giving birth, which can feel like a judgement, too. I was so angry and disappointed with my body. I didn’t feel connected to Alex, who was (in my midwife’s words!) a fussy baby. Breastfeeding wasn’t working. This was a disaster for me. Again, I had imagined it would all be fine –boob+baby=breastfeeding. I didn’t feel like Alex liked me, and I felt like he knew I was frustrated and that he deserved a happier better mummy. All-in-all, I felt like a total failure. Each night when I went to bed, my labour played over and over in my head and I cried. 

“I burst into tears because for the first time since having Alex, I felt so proud of myself”

Help
I had help from my GP to get support for my diagnosis of postnatal depression and anxiety. Talking therapies helped me enormously. They addressed my negative thought patterns and helped me to see the good things in each day, and signs that Alex loved me. Group talking therapy was also fantastic. I felt understood and part of a community by sharing with other parents who had struggled for similar, or even different reasons. But it wasn’t until I used the birth afterthoughts (BA) service* 5 months after Alex was born, things really changed. The BA trained midwife was just brilliant. She explained everything that had happened, reassuring me that no matter what I did, it wouldn’t have been physically possible for me to give birth to Alex ‘naturally’. She told me that I had coped with an extraordinary amount of pain, a long wait for pain relief, and that not only had I been in labour for a very long time, but I had endured a C-section too. She suggested that perhaps breastfeeding success was never likely because of the issues around bonding (in turn arising from a traumatic birth and C-section), the hormonal imbalance caused by the effects of artificial oxytocin and the procedure itself disrupting the usual hormones. I burst into tears because for the first time since having Alex, I felt so proud of myself. SO proud. The midwife reassured me that I would not be put through the same experience again. This validated my trauma. Alex will be four in May this year. In the spring-time each year I get a dose of the same feelings, and whenever I hear one particular song that I had in my head in hospital, it all feels very real again. But Alex and I did bond slowly, and I’ve forgiven him for causing such strife! 

The birth of Ted
At first I was apprehensive about labour with Ted who arrived in January 2020, but I kept reminding myself that it was very unlikely that I would endure the same situation. I reflected a lot on the impact that words had had on my experience and how swiftly I had lost control. I read a hypnobirthing book, practised positive thoughts/visualisations and developed strategies that I’d use to cope in labour, including particular phrases to use in my head. Gradually my confidence grew, and I was actually looking forward to labour. The experience was immediately different. On being examined, the midwife told me I was ‘labouring three centimetres’; so not in ‘active’ labour in clinical terms, but experiencing significant enough contractions and pain to be considered (and treated) as being in labour. This explanation told me that I had done well. Everyone was smiling and relaxed on what was a quiet shift, which made me feel calm and happy. 

Approval
I remember my midwife saying ‘you’re doing so well’ and ‘you’re coping really well’ a lot during my labour. This made me feel so positive and I never lost control of my breathing; riding the contractions. I was under the care of a consultant who commented during one of her observations: ‘That was a really good push’. I’m not an elitist but there is something very powerful about a senior medic telling you that you’re doing well! This appeased a very personal need to feel approval. I gave birth to Ted in theatre with the aid of forceps. As soon as he was placed onto me I felt connected to him. He was my baby and I gave birth to him vaginally. The elation and empowerment of this for me can’t be overestimated. I was immediately proud of my body, my mind and felt bonded to him. I have no doubt that this was related to the birth experience, itself affected – not entirely – but in part, by the communication and language used during my labour.

“It is very easy to unintentionally derail trust and self-belief through language”

Getting it right
I suspect that it’s not a coincidence that things went more smoothly during a quiet shift. Perhaps there is more time and headspace to think about the birthing person’s experience, appropriate language, and to check in with how they are feeling. Midwifery is an intense profession, with immense pressure and I want to say that I have always felt cared for and that my midwives were striving to do their absolute best. But perhaps the constraints in time and resource make this very difficult to achieve. And language is not perfect. Often there are no ‘right’ words or phrases. Or – the ‘right’ words and phrases for one person in one set of circumstances may not work for them at another time, or for another person. But that’s not to say that healthcare professionals shouldn’t try to get it right for their patients. At this crucial time, it is very easy to unintentionally derail trust and self-belief through language.

Vulnerable times
Language may not change an outcome, but it can influence the birth experience, which itself can set the scene for early parenthood. The increasing popularity of hypnobirthing techniques involving use of phrases and language illustrates that we already know how important words are in this period. Pregnancy, labour, and early parenthood can be vulnerable times for people, triggering perhaps buried aspects of personality to come to life, where attention to language can empower, reassure and reduce the immediate and longer term impact of traumatic perinatal experiences.

* The birth afterthoughts service (also known as birth reflections, birth debrief or birth stories) provides you with an opportunity, following your birth experience, to have any questions answered that you may not have previously asked. Please be aware that going to such a debriefing service at your hospital could bring back memories and emotions, so please go gently. You can read more about options you have post-birth on our page here.