Harmful pregnancy terms like 'incompetent cervix' and 'lazy uterus' need a rebrand

No need to beat around the bush: Doctors can be confusing. Medical jargon can be daunting. Add in institutionalized, gender-based medical bias and outdated terms that often stigmatize infertility and pregnancy loss, and you've created an environment that isn't always very welcoming to those who want to become parents or are expecting children.

The social networking app Peanut, which seeks to create safe spaces for parents and expecting mothers to connect and share their stories, hopes to change that. It's launched a virtual social media campaign called the Renaming Revolution, a movement to address the ways medical language can be harmful to pregnant people. On April 13, the campaign released its new Motherhood and Fertility Glossary — a list of replacement terms for medically outdated or insensitive phrases used to refer to pregnant people, based on suggestions by Peanut app users and reviewed by a group of consultants, including an OB-GYN, a linguist, and therapists.

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The new reference tool, released Tuesday and available online, reflects a desire to destigmatize the language surrounding pregnancy, fertility, and birth, and replace it with inclusive, medically-descriptive terms, says Dr. Somi Javaid, a board-certified OB-GYN and founder of Cincinnati-based women's health center HerMD who was one of the consultants. “When a woman hears a diagnosis with very unfavorable terminology, it puts up another barrier to healthcare, and we make patients invisible,” she said.

Much of the current terminology — phrases like inhospitable womb and unfavorable cervix — are the product of a historically male-dominated field, Javaid said. "There was just an under-representation of women in medicine, making decisions and bringing attention to these types of things — that this language can actually be offensive."

Dr. Kathryn Menard, physician and representative of the American College of Obstetricians and Gynecologists (ACOG), who wasn't involved in creating the glossary, reviewed Peanut's newly-released terms at Mashable's request. She said she's already witnessed physicians phasing out much of the offending language, like lazy uterus and shy cervix. In 2017, Menard led ACOG's ReVITALize initiative, a coalition of providers, insurance representatives, patient advocates, and others in the medical field, that creates its own database of medical terms for both obstetrics and gynecology. She explained that ReVITALize's hope was to advocate for patients and to standardize the language used across medical departments to better promote public health and clear medical data. "If everyone is speaking a different language, how are we going to move forward?" she said.

Javaid and Menard both say that the complex medical databases used by physicians and medical staff perpetuate the dated language, reinforcing the offending terms with each use. "It's in our medical software and ICD 10 codes, which are diagnostic codes used to get insurance coverage," Javaid explained. Even when physicians and providers use new, inclusive language, these codes repeat old views on fertility and pregnancy.

None of this is helped by the fact that the field is still dominated by men in positions of power. "There's not a lot of female leadership. Women aren't making decisions in the healthcare space, even though we outnumber men three to one in the workforce," she said. A 2019 report on women in healthcare leadership by research consulting firm Oliver Wyman found that women comprise only 33 percent of senior leadership positions among healthcare providers and insurers, even though they make up 80 percent of healthcare buyers and 65 percent of the healthcare workforce.

There’s also institutionalized discrimination against women patients. On average, they have to undergo multiple doctor's visits and wait longer periods of time before receiving a diagnosis versus men, Javaid explained. Women and minority groups are 20 to 30 percent more likely than white men to be misdiagnosed, according to Healthline. In 2018, TODAY reported that women were twice as likely to experience chronic pain than men, but much more likely to be dismissed when reporting said pain.

Peanut announced the Renaming Revolution campaign in March, after one of the app's users, T, posted a video about her doctor using the term "geriatric pregnancy," which she said made her feel “inadequate” and “guilty.” The video was shared by Chrissy Teigen on her (now deactivated) Twitter account; Teigen has since become a spokesperson for the Renaming Revolution campaign.

Peanut's founder and CEO, Michelle Kennedy, took the comments to heart and asked users to share other terms they found harmful, discouraging, or just plain offensive. The glossary is a select set of 63 terms pulled from more than 200,000 user stories. Javaid and the rest of Peanut's consulting team used the user-generated list of terms to create a new vocabulary to be shared with both patients and physicians.

Notable changes to current language include replacing geriatric pregnancy with 35+ pregnancy, removing harsh adjectives like lazy, shy, or failing from medical terms, and using the term birther rather than birth mom to be more inclusive to surrogate parents, those placing newborns up for adoption, and transgender parents. "Peanut’s glossary is the first step in transforming some of the negatively-charged terms that are too often used during the most sensitive and vulnerable times in women’s lives," Kennedy wrote in the glossary's announcement.

“It's going to bring to the forefront, for physicians and providers, that that language is not acceptable anymore. It also gives patients a tool, so they can take it to their doctor's office to begin a discussion about diagnoses and language and understanding what's truly going on with their body,” Javaid said.

After reviewing Peanut's glossary, Menard said that the list presents "nice alternatives" to the dated language, and is reflective of a larger movement to bring more positive language into obstetrics and gynecology. She also said it was surprising to hear that many of these terms were still being used by providers.

In her own work, Menard sees a strong effort by providers to eradicate the older language. She explained that while birther isn't common among her colleagues, there's already a movement to use birthing person as a more inclusive term. And she agrees that terms like irritable uterus (which she does see commonly used) and phrases that use the adjective failing, need to be replaced with something more positive.

The glossary attempts to strike a balance between replacing terms with more humanized language, like using birth difference instead of birth defect, while also being more medically direct. For example, morning sickness is replaced simply with pregnancy nausea — a clearer descriptor for feelings of nausea that can appear at any time during the day and at varying degrees.

Javaid also explained that many medical terms referring to pregnancy loss seem to place blame on the pregnant person, which only further isolates patients. In the new glossary, recurrent pregnancy loss replaces the outdated phrase habitual aborter. "I feel like that is a very problematic use of terminology in the medical world," Javaid said. "Here we have a patient who's already going through something devastating, repeatedly, and then we label that patient as a habitual aborter, which sounds like we're blaming the patient as if she's choosing to do this," Javaid said. The term recurrent pregnancy loss "is much more descriptive" and doesn't carry weighted connotations.

Patients should feel empowered to share resources like the glossary with their physicians, Javaid said, and medical professionals can begin to encourage and collaborate with their colleagues. Alongside the digital release, Peanut has pledged to circulate physical copies of the glossary with offices, clinics, and classes year-round. You can also request a physical copy of the glossary from Peanut directly.

Javaid told Mashable she thinks inclusive resources like Peanut’s glossary should be included in updated, ongoing medical education as well as a way to make more institutional change. "In medical school and residency, there's no sensitivity training given to people who are studying to become doctors or nurse practitioners. No one says, 'there may be this diagnosis, but that's not the terminology or vocabulary that you use with patients.’ It's not empowering to them. It's not educational. And in fact can be harmful in their medical care," she warned.

What's most difficult in this renaming journey is getting everyone in the medical world on the same page, according to Menard. "In order to do this, you need everyone that teaches to use a different term, everyone who documents medical records to use a different term — it's a big deal to implement this, but I do think that it is worthy," she said.

The glossary is a simple first step in what'll be a long effort to make lasting changes. The new reference tool will have to work alongside other education efforts, Menard said. And Javaid hopes it will encourage the broader public to demand changes from their own physicians. Indeed, on the ground level, Peanut's Renaming Revolution seeks to encourage a public dialogue that will affect change from the individual outward, starting with equipping pregnant people with a vocabulary that's empowering.

But the movement can't be the sole responsibility of patients and providers — there needs to be institutional changes: Both Javaid and Menard reiterated the importance of getting insurance providers to change offending terms, and the need for medical educators to begin instituting these changes from the beginning of a doctor's education.

For the organization's work as a community hub, the glossary is also a welcome addition to its calls for overarching mental health support for parents and pregnant people — Peanut reports more than half of its members were struggling with mental wellness concerns, which it argues are exacerbated by unsupportive medical language. The glossary is the beginning of the organization's recognition of Maternal Mental Health Month in May.

Javaid hopes that the new language, which covers many different stages of pregnancy, from fertility to pregnancy to birth and even pregnancy loss, inspires more conversation that can help with that mental health push. "What [Peanut] wants to accomplish with this glossary is allowing women to take ownership back of their healthcare and their bodies, and be devoid of any shame or stigma," Javaid said. Medical language should be as descriptive and educational as possible, without losing a sense of empathy for patients going through possibly life-changing medical situations.

Reflecting on her own career, Javaid says that most medical professionals are open and willing to make changes like these, changes that foster a more inclusive medical environment, and, ultimately, stronger relationships between a physician and a patient. “Physicians are inherently good people that go into medicine to make a difference. Sometimes they are slow to change or to evolve, but it's definitely possible, especially when patients bring it into our offices and to the forefront,” Javaid said.

The new glossary is available online or on the Peanut app, available for both iOS and Android.