The way someone talks about your miscarriage can unravel its reality

...and now research shows just how important the right language can be

After my third miscarriage, there was paperwork: a consent form for surgery, and then another document to sign stating my wishes for what was to be done with the pregnancy tissue.

The kind doctor who’d broken the news that my pregnancy had ended – that the baby I’d thought I was having no longer had a heartbeat – warned me about the words that would be waiting at the top of these forms. Words such as ‘evacuation of retained products of conception’ and ‘sensitive disposal of pregnancy remains’.

She apologised for how abruptly clinical the terminology would feel. Just hours earlier, I’d been reading about what size my ‘baby’ was that week. Now, it wasn’t a baby – even a tentatively imagined future baby – it was only ‘products of conception’.

The language struck me as cold and pitiless when I read it, but at least I’d been braced for it. 

At the time, I didn’t realise what a stroke of luck it was to be seen by someone who specialised in early pregnancy and miscarriage and who knew the emotional terrain. Many women and people going through a miscarriage aren’t met with anything like this understanding. Many find the language used by healthcare professionals only adds to their distress, research published last month by UCL has highlighted.

The study, led by Dr Beth Malory, a sociolinguist specialising in reproductive health communication, was based on survey responses and interviews from nearly 300 women and non-binary people who had lived experience of pregnancy loss, as well as 49 healthcare professionals who care for people during or after pregnancy loss. It concluded that language choices have a ‘huge impact’ on someone’s experience of loss and their subsequent mental recovery and wellbeing.

Readers of this newsletter, I’m sure, will not be all that surprised that language matters. We’ve discussed before how the words we use around pregnancy are complex and intricately personal. Our linguistic preferences are as unique as we are as people, informed by myriad different factors, quirks, and specifics of circumstance that combine in our personal stories of loss.

I know firsthand how the way someone talks about your miscarriage can unravel the reality of what your body had started to make, what you had already begun to love. It can make you question your right to grieve, your right to ask for support or even talk about how you feel.

As the UCL researchers concluded: ‘Ultimately, much of the language used around pregnancy loss seems to cause a fundamental, and often distressing, disconnect between how someone going through pregnancy loss conceptualises their experience internally, and the way that language seems to represent that experience externally.’

A key theme was how blamed people feel by much of the language commonly used around pregnancy loss, terms such as ‘incompetent cervix’, ‘failing pregnancy’, ‘blighted ovum’, or ‘missed miscarriage’ – which, as one participant told the researchers, feels like it implies that you missed something that was happening in your pregnancy. 

Others highlighted how language used by healthcare professionals can be confusing and unclear. This was true if overly clinical terms are used but not explained fully; in the case of phrases such as ‘empty sac’ (when an ongoing pregnancy cannot be seen on a scan), that can sometimes generate false hope. However, euphemistic language such as ‘just let nature take its course’ was equally misleading, with people not understanding that a doctor meant that they would miscarry.

‘Missed miscarriage’ implies you missed something

This latest piece of research is not the first time there have been calls for more sensitive language around pregnancy loss. In 2022, the parenting app Peanut launched its Renaming Revolution campaign, offering a new glossary of alternatives to outdated and misogynistic terms used around pregnancy and fertility, such as ‘miscarriage without symptoms’ to replace ‘missed miscarriage’.

Back in 1985, leading obstetricians wrote to The Lancet medical journal arguing that the profession needed to stop using the clinical term ‘spontaneous abortion’ to refer to miscarriage, because of the distress this caused patients. The term – highly emotive because of the stigma that unfortunately exists around abortion – still finds its way into medical journals and, sometimes, patients’ medical notes.

In 2022, the Royal College of Obstetricians and Gynaecologists circulated language guidelines recommending changes such as ‘surgical management of miscarriage’ rather than ‘evacuation of retained products of conception’.

These suggestions tend to be based on what experts think would be best. The new UCL study, however, aimed to provide solid evidence as to what language people going through experiences such as miscarriage, ectopic pregnancy, termination for medical reasons and stillbirth prefer to better inform what language clinicians should choose. 

There are some surprising findings from the research. For example, while guidelines to doctors have generally recommended the word ‘miscarriage’ to describe a loss before 24 weeks, it was a term disliked by many participants on the basis that it implies that someone mis-carried. As one person told the researchers: ‘I’ve always hated the word miscarriage because it sounds quite blamey.’

But, above all, what became abundantly clear from the new research is that there is no universally acceptable language. ‘What we found was there is no one size fits all,’ explains Dr Malory.

For example, while many people prefer the term ‘pregnancy loss’ over miscarriage, others feel it doesn’t do justice to what happened to them – suggesting they lost only an ambiguous, anonymous pregnancy, rather than a very real baby. Or that ‘loss’ has connotations of carelessness. As one participant told the UCL researchers: ‘I know where my baby was. I didn’t lose my baby.’

Likewise, when it came to termination for medical reasons, some people found having to use the word ‘termination’ or ‘abortion’, or seeing it on their medical notes, deeply upsetting when their baby had been very much planned and wanted. They preferred proposed alternatives such as ‘compassionate induction’.

Others, though, wanted to use the word ‘termination’ on principle, as a reminder to others that termination is healthcare, needed in many different scenarios and not only when a pregnancy is unintended. 

The only way around all this, the UCL researchers concluded, is to use personalised language around pregnancy loss wherever possible. Medics need to ask patients about how they’d like their miscarriage or pregnancy end to be discussed.

‘It really helps people when the language they prefer is used,’ says Dr Malory. ‘And it’s really harmful when language is used that doesn’t align with their conceptualisation of what’s going on – especially when someone refuses to use the kind of language that someone has stated they want to be used.’

Unfortunately, this happens more than you might think. ‘We had one person who went to their GP and was talking about how their baby died, and the GP said: “You know, you might find it more helpful if you don’t think of it as your baby dying, but your pregnancy ending”.’

Using sensitive, preferred language is ‘fundamental’ to improving pregnancy loss care, argues Dr Malory.

‘One of the reactions that we’ve had [to our research] is that you can’t make this situation better by using pretty words. And I think that’s a fundamental misunderstanding, because language can be completely pivotal. It’s undermining or supporting somebody’s understanding of what’s happening.’

As for what happens now, Dr Malory would like to see a pilot trial set up to test how evidence-based best practice on language could be established across the NHS, such as creating systems that allow patients to state their preferences on their notes. She also hopes that the research will help the wider public understand how there are different ways to talk about pregnancy loss – and to appreciate the nuances.

‘It applies equally to people outside clinical settings,’ she says. ‘For example, if somebody at your workplace loses a baby and you’re not sure how to talk about it, that doesn’t mean you shouldn’t talk about it. It means you could ask: “How do you want me to talk to you?”

‘Anecdotally, people are often corrected by their friends and family, who say things like “Well, don’t think of it that way”, which isn’t helpful.’

Personally, I find it comforting to know that however you feel about different words connected to pregnancy loss, you aren’t the anomaly. There is no right or wrong. Ultimately, language is what we have to understand each other – and however your pregnancy or baby’s life ended, you get to decide what it is you need other people to understand. 

• A version of this post was originally published by Stylist magazine.