Loaded Terms

June 7, 2017

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Words have meaning. As someone who writes, even if just as a hobby like this blog, I know that. But words have great important to me in my day job too. As a medical librarian, I speak daily in the language of MeSH, or medical subject headings. MeSH is just one example of a controlled vocabulary, and there are lots of them in medicine alone. Controlled vocabularies ensure that everyone is speaking the same ‘language’, so we’re all clear on what we’re talking about. They also show relationships to other concepts and can demonstrate how two ideas are linked together. If you’re a word nerd, this kind of thing is fascinating! The words we use are one way to frame people’s thoughts about an idea.

Let’s talk about three words that mean the same thing:

  • Miscarriage
  • Spontaneous Abortion
  • Early Pregnancy Loss

All these terms are talking about the same thing: “The expulsion or removal from the womb of a developing embryo or fetus, spec. (Med.) in the period before it is capable of independent survival, occurring as a result of natural causes.” Or “The spontaneous expulsion of a fetus from the womb before it is viable; an instance of this.” Or at least, those are the Oxford Dictionary’s definitions.

I’m willing to bet each of these terms evoked a different emotion in you, and you probably have your own term that you prefer to use. What are the pros and cons of each term?

  • Miscarriage

Miscarriage is usually the one most laypeople use, and for many it is the preferred choice. When you tell someone you had a miscarriage, they understand and are familiar with what you’re talking about. The downside to this term is that it minimizes the seriousness of what is taking place, and puts all the blame on the mother. She “miss-carried”, or didn’t carry her baby properly. Using the term miscarriage can lead to people thinking that pregnancy is something wholly within the mother’s control.

  • Spontaneous Abortion

Spontaneous Abortion is the preferred medical term, and is different from the term Induced Abortion. Because of this, a lot of women, especially those who identify as pro-life, hate this term. Of course, that can also be a benefit, because from a physiological perspective, there isn’t a difference to your body. Spontaneous abortion also sounds like serious medical issue, in ways the other two terms are not. Even the word spontaneous has positives and negatives. The positive is that it doesn’t blame the mother. If it happens ‘spontaneously’, it can’t be controlled.

On the downside, because it is ‘spontaneous’, there isn’t much you can do to prevent it. It feels a little like shrugging your shoulders and giving up. The term spontaneous abortion also reflects the historical difficulty in classifying abortions before they became legal. A woman who came into the emergency room bleeding from a pregnancy loss, she would likely say it was spontaneous, even if that wasn’t true, to avoid being prosecuted. Doctors would not always be able to tell the difference (remember, from a physiological perspective, your body goes through the same thing). However, over the past 20 years, increasingly doctors and midwives are moving away from using this term, and are choosing to use miscarriage.

  • Early Pregnancy Loss

Early Pregnancy Loss is the last of the three terms, and my personal favourite. Just like spontaneous abortion, it doesn’t suggest that the mother caused the pregnancy to fail. The words “pregnancy loss” gives a sense of continuity with later pregnancy loss rather than abortion. You have a lot of similar feelings when your pregnancy fails, whether it is at 10 weeks or 39 weeks. (I had both, and they were very different experiences!) The downside to this term, much like miscarriage, is that it tends to minimize the seriousness of the issue. Loss is something that happens to car keys, or your phone, not your baby! But despite this downside, it is the term I find most comforting.

I decided to write to the National Library of Medicine to see if they were willing to change the term. As proof, I explained that doctors and other health professionals are moving away from spontaneous abortion and calling it miscarriage. I also explained that women may not like the term miscarriage because of the suggestion that miscarriage is their fault. And I got a response. In 2018, they will change the term.

This isn’t a moment too soon. For perspective, it was only in 2010 that they changed the term Conjoined Twins. Before, we called them Monsters.

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