The Power of Language in Hospital Care for Pregnant and Birthing People: A Vision for Change.
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
01 10 2023
01 10 2023
Historique:
received:
14
04
2023
accepted:
25
05
2023
medline:
25
9
2023
pubmed:
8
9
2023
entrez:
7
9
2023
Statut:
ppublish
Résumé
Language is commonly defined as the principal method of human communication made up of words and conveyed by writing, speech, or nonverbal expression. In the context of clinical care, language has power and meaning and reflects priorities, beliefs, values, and culture. Stigmatizing language can communicate unintended meanings that perpetuate socially constructed power dynamics and result in bias. This bias may harm pregnant and birthing people by centering positions of power and privilege and by reflecting cultural priorities in the United States, including judgments of demographic and reproductive health characteristics. This commentary builds on relationship-centered care and reproductive justice frameworks to analyze the role and use of language in pregnancy and birth care in the United States, particularly regarding people with marginalized identities. We describe the use of language in written documentation, verbal communication, and behaviors associated with caring for pregnant people. We also present recommendations for change, including alternative language at the individual, clinician, hospital, health systems, and policy levels. We define birth as the emergence of a new individual from the body of its parent, no matter what intervention or pathology may be involved. Thus, we propose a cultural shift in hospital-based care for birthing people that centers the birthing person and reconceptualizes all births as physiologic events, approached with a spirit of care, partnership, and support.
Identifiants
pubmed: 37678895
doi: 10.1097/AOG.0000000000005333
pii: 00006250-990000000-00888
pmc: PMC10510792
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
795-803Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
Financial Disclosure The authors did not report any potential conflicts of interest.
Références
American College of Obstetricians and Gynecologists. Inclusive language, statement of policy. Accessed April 14, 2023. https://acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2022/inclusive-language
Sister Song. Reproductive justice. Accessed April 14, 2023. https://sistersong.net/reproductive-justice/
FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18:19. doi: 10.1186/s12910-017-0179-8
doi: 10.1186/s12910-017-0179-8
Bray SRM, McLemore MR. Demolishing the myth of the default human that is killing Black mothers. Front Public Health 2021;9:675788. doi: 10.3389/fpubh.2021.675788
doi: 10.3389/fpubh.2021.675788
Livingston G. Hispanic women no longer account for the majority of immigrant births in the U.S. Accessed March 16, 2023. https://pewresearch.org/fact-tank/2019/08/08/hispanic-women-no-longer-account-for-the-majority-of-immigrant-births-in-the-u-s/
Mathews TJ, Hamilton BE. Educational attainment of mothers aged 25 and over: United States, 2017. NCHS Data Brief 2019;332:1–8.
Brown HK, Chen S, Guttmann A, Havercamp SM, Parish SL, Ray JG, et al. Neonatal outcomes of mothers with a disability. Pediatrics 2022;150:e2021055318. doi: 10.1542/peds.2021-055318
doi: 10.1542/peds.2021-055318
Martin JA, Hamilton BE, Osterman M. Births in the United States, 2020. NCHS Data Brief 2021;418:1–8.
Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: final data for 2021. Natl Vital Stat Rep 2023;72:1–53.
Driscoll AK, Gregory EC. Increases in prepregnancy obesity: United States, 2016–2019. NCHS Data Brief 2020;392:1–8.
Heideveld-Gerritsen M, van Vulpen M, Hollander M, Oude Maatman S, Ockhuijsen H, van den Hoogen A. Maternity care experiences of women with physical disabilities: a systematic review. Midwifery 2021;96:102938. doi: 10.1016/j.midw.2021.102938
doi: 10.1016/j.midw.2021.102938
Nguyen TT, Criss S, Kim M, De La Cruz MM, Thai N, Merchant JS, et al. Racism during pregnancy and birthing: experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern women. J Racial Ethn Health Disparities 2022;[epub ahead of print]. doi: 10.1007/s40615-022-01475-4
doi: 10.1007/s40615-022-01475-4
Mehra R, Boyd LM, Magriples U, Kershaw TS, Ickovics JR, Keene DE. Black pregnant women "get the most judgment": a qualitative study of the experiences of Black women at the intersection of race, gender, and pregnancy. Womens Health Issues 2020;30:484–92. doi: 10.1016/j.whi.2020.08.001
doi: 10.1016/j.whi.2020.08.001
Mossey JM. Defining racial and ethnic disparities in pain management. Clin Orthop Relat Res 2011;469:1859–70. doi: 10.1007/s11999-011-1770-9
doi: 10.1007/s11999-011-1770-9
Hall J, Hundley V, Collins B, Ireland J. Dignity and respect during pregnancy and childbirth: a survey of the experience of disabled women. BMC Pregnancy Childbirth 2018;18:328. doi: 10.1186/s12884-018-1950-7
doi: 10.1186/s12884-018-1950-7
Hoffkling A, Obedin-Maliver J, Sevelius J. From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy Childbirth 2017;17:332. doi: 10.1186/s12884-017-1491-5
doi: 10.1186/s12884-017-1491-5
Alpert JM, Morris BB, Thomson MD, Matin K, Geyer CE, Brown RF. OpenNotes in oncology: oncologists' perceptions and a baseline of the content and style of their clinician notes. Transl Behav Med 2019;9:347–56. doi: 10.1093/tbm/iby029
doi: 10.1093/tbm/iby029
Himmelstein G, Bates D, Zhou L. Examination of stigmatizing language in the electronic health record. JAMA Netw Open 2022;5:e2144967. doi: 10.1001/jamanetworkopen.2021.44967
doi: 10.1001/jamanetworkopen.2021.44967
Beach MC, Saha S, Park J, Taylor J, Drew P, Plank E, et al. Testimonial injustice: linguistic bias in the medical records of Black patients and women. J Gen Intern Med 2021;36:1708–14. doi: 10.1007/s11606-021-06682-z
doi: 10.1007/s11606-021-06682-z
Fernández L, Fossa A, Dong Z, Delbanco T, Elmore J, Fitzgerald P, et al. Words matter: what do patients find judgmental or offensive in outpatient notes? J Gen Intern Med 2021;36:2571–8. doi: 10.1007/s11606-020-06432-7
doi: 10.1007/s11606-020-06432-7
Weiner SG, Lo YC, Carroll AD, Zhou L, Ngo A, Hathaway DB, et al. The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder. J Addict Med 2023;[epub ahead of print]. doi: 10.1097/adm.0000000000001145
doi: 10.1097/adm.0000000000001145
Park J, Saha S, Chee B, Taylor J, Beach MC. Physician use of stigmatizing language in patient medical records. JAMA Netw Open 2021;4:e2117052. doi: 10.1001/jamanetworkopen.2021.17052
doi: 10.1001/jamanetworkopen.2021.17052
Barcelona V, Scharp D, Idnay BR, Moen H, Goffman D, Cato K, Topaz M. A qualitative analysis of stigmatizing language in birth admission clinical notes. Nurs Inq 2023:e12557. doi: 10.1111/nin.12557
doi: 10.1111/nin.12557
Beach MC, Inui T. Relationship-centered care: a constructive reframing. J Gen Intern Med 2006;21(suppl 1):S3–8. doi: 10.1111/j.1525-1497.2006.00302.x
doi: 10.1111/j.1525-1497.2006.00302.x
Hardeman RR, Karbeah J, Kozhimannil KB. Applying a critical race lens to relationship-centered care in pregnancy and childbirth: an antidote to structural racism. Birth 2020;47:3–7. doi: 10.1111/birt.12462
doi: 10.1111/birt.12462
Grant R, Sueda A, Kaneshiro B. Expert opinion vs. patient perception of obstetrical outcomes in laboring women with birth plans. J Reprod Med 2010;55:31–5.
Afshar Y, Mei J, Fahey J, Gregory KD. Birth plans and childbirth education: what are provider attitudes, beliefs, and practices? J Perinat Educ 2019;28:10–8. doi: 10.1891/1058-1243.28.1.10
doi: 10.1891/1058-1243.28.1.10
U.S. Department of Health, and Human Services. Century Cures Act: interoperability, information blocking, and the ONC health IT certification program. Accessed April 14, 2023. https://federalregister.gov/documents/2020/05/01/2020-07419/21st-century-cures-act-interoperability-information-blocking-and-the-onc-health-it-certification
Biringer A. Language in obstetric care: what do we really want to say? Can Fam Physician 1994;40:880–2.
Batra K, Pharr J, Olawepo JO, Cruz P. Understanding the multidimensional trajectory of psychosocial maternal risk factors causing preterm birth: a systematic review. Asian J Psychiatry 2020;54:102436. doi: 10.1016/j.ajp.2020.102436.
doi: 10.1016/j.ajp.2020.102436
McLemore MR, Altman MR, Cooper N, Williams S, Rand L, Franck L. Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth. Social Sci Med. 2018;201:127–35. doi: 10.1016/j.socscimed.2018.02.013
doi: 10.1016/j.socscimed.2018.02.013
Thomas SP. Street-race in reproductive health: a qualitative study of the pregnancy and birthing experiences among Black and Afro-Latina women in south Florida. Matern Child Health J 2021;26:700–7. doi: 10.1007/s10995-021-03188-2
doi: 10.1007/s10995-021-03188-2
Wang E, Glazer KB, Sofaer S, Balbierz A, Howell EA. Racial and ethnic disparities in severe maternal morbidity: a qualitative study of women's experiences of peripartum care. Womens Health Issues 2021;31:75–81. doi: 10.1016/j.whi.2020.09.002
doi: 10.1016/j.whi.2020.09.002
Alio AP, Dillion T, Hartman S, Johnson T, Turner S, Bullock S, et al. A community collaborative for the exploration of local factors affecting Black mothers' experiences with perinatal care. Matern Child Health J 2022;26:751–60. doi: 10.1007/s10995-022-03422-5
doi: 10.1007/s10995-022-03422-5
OjiNjideka Hemphill N, Crooks N, Zhang W, Fitter F, Erbe K, Rutherford JN, et al. Obstetric experiences of young Black mothers: an intersectional perspective. Social Sci Med 2023;317:115604. doi: 10.1016/j.socscimed.2022.115604
doi: 10.1016/j.socscimed.2022.115604
Canty L. The lived experience of severe maternal morbidity among Black women. Nurs Inq 2022;29:e12466. doi: 10.1111/nin.12466
doi: 10.1111/nin.12466
Bohren MA, Berger BO, Munthe-Kaas H, Tunçalp Ö. Perceptions and experiences of labour companionship: a qualitative evidence synthesis. The Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012449. doi: 10.1002/14651858.CD012449.pub2
doi: 10.1002/14651858.CD012449.pub2
Kozhimannil KB, Vogelsang CA, Hardeman RR, Prasad S. Disrupting the pathways of social determinants of health: doula support during pregnancy and childbirth. J Am Board Fam Med 2016;29:308–17. doi: 10.3122/jabfm.2016.03.150300
doi: 10.3122/jabfm.2016.03.150300
Mallick LM, Thoma ME, Shenassa ED. The role of doulas in respectful care for communities of color and Medicaid recipients. Birth 2022;49:823–32. doi: 10.1111/birt.12655
doi: 10.1111/birt.12655
Chor J, Lyman P, Ruth J, Patel A, Gilliam M. Integrating doulas into first-trimester abortion care: physician, clinic staff, and doula experiences. J Midwifery Womens Health 2018;63:53–7. doi: 10.1111/jmwh.12676
doi: 10.1111/jmwh.12676
Jou J, Kozhimannil KB, Johnson PJ, Sakala C. Patient-perceived pressure from clinicians for labor induction and cesarean delivery: a population-based survey of U.S. women. Health Serv Res 2015;50:961–81. doi: 10.1111/1475-6773.12231
doi: 10.1111/1475-6773.12231
Bonsack CF, Lathrop A, Blackburn M. Induction of labor: update and review. J Midwifery Womens Health 2014;59:606–15. doi: 10.1111/jmwh.12255
doi: 10.1111/jmwh.12255
Smith BEY, Bartz D, Goldberg AB, Janiak E. “Without any indication": stigma and a hidden curriculum within medical students' discussion of elective abortion. Social Sci Med 2018;214:26–34. doi: 10.1016/j.socscimed.2018.07.014
doi: 10.1016/j.socscimed.2018.07.014
American College of Obstetricians and Gynecologists. ACOG guide to language and abortion. Accessed March 30, 2023. https://acog.org/contact/media-center/abortion-language-guide
Jeffers NK, Canty L, Drew M, Grayson N, Amani J, Marcelle E, et al. Beyond "patient-provider race matching”: Black midwives clarify a vision for race-concordant care to achieve equity in Black perinatal health: a commentary on "Do Black birthing persons prefer a Black health care provider during birth? Race concordance in birth”. Birth 2023;50:267–72. doi: 10.1111/birt.12720
doi: 10.1111/birt.12720
Dawley K. The campaign to eliminate the midwife. Am J Nurs 2000;100:50–6. doi: 10.1097/00000446-200010000-00054
doi: 10.1097/00000446-200010000-00054
Luke JM. Delivered by midwives: African American midwifery in the twentieth century South. University Press of Mississippi; 2018.
Noyes CD. The midwifery problem. Am J Nurs 1912;12:466–71. doi: 10.2307/3404589
doi: 10.2307/3404589
Hatlie MJ, Nahum A, Leonard R, Jones L, Nahum V, Krevat SA, et al. Lessons learned from a systems approach to engaging patients and families in patient safety transformation. Joint Comm J Qual Patient Saf 2020;46:158–66. doi: 10.1016/j.jcjq.2019.12.001
doi: 10.1016/j.jcjq.2019.12.001
Center for Consumer Engagement in Health Innovation Community Catalyst.Developing a plan for engaging consumers. Accessed April 4, 2023. https://healthinnovation.org/change-package/planning/developing-a-plan-for-engaging-consumers
Horner-Johnson W, Dissanayake M, Marshall N, Snowden JM. Perinatal health risks and outcomes among US women with self-reported disability, 2011-19. Health Aff (Millwood) 2022;41:1477–85. doi: 10.1377/hlthaff.2022.00497
doi: 10.1377/hlthaff.2022.00497