Moving Toward More Person-Centered Language in Maternity Care
During the recent annual convention of the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) in New Orleans, I had the opportunity to explore various resources, including AWHONN’s Maternal Fetal Triage Index (
). I carefully examined the acuity classification tool while it was displayed at the neighboring nursing education booth. The Maternal Fetal Triage Index serves as an invaluable resource to promote standardized and evidence-based care for pregnant women who seek evaluation in the triage setting. It helps nurses, midwives, and other health care providers to gather essential information during maternal and fetal assessments, make informed decisions, and prioritize appropriate interventions based on acuity.
When looking at the tool, I noticed a common medical term used to describe the primary reason for a patient’s visit or presenting concern. This term, “complains of” (or “complaint of”) abbreviated as “c/o”, specifically caught my attention in the context of women’s “complaints of” early labor signs. This editorial serves as a reflection on the use of this term in clinical language and documentation, particularly as it relates to women’s reports of signs and symptoms after the spontaneous onset of labor or during childbirth.
The use of the term “complains of” in medical terminology has deep historical origins rooted in tradition and the development of clinical language and documentation practices (
). It emerged as a concise and efficient way for health care professionals to document and present a patient’s reported symptoms or concerns during a medical encounter. However, it is important to recognize that language evolves, and certain terms can become outdated or carry unintended negative connotations that can influence perceptions and attitudes toward patients. It is worth noting the ongoing discussion and debate in the health care community regarding the appropriate language and terminology to use in clinical documentation (
;
;
). The aim is to find alternatives that are more patient-centered, empathetic, and inclusive to support the delivery of high-quality health care in which the individuality and dignity of each patient are respected.
Specifically, the term “complains of” reflects a traditional hierarchical relationship between health care providers and patients in which the provider is the authority figure and the patient is seen as complaining or being a passive recipient of care. The term might not adequately capture the patient’s experience or convey a sense of empathy and collaboration. Labeling a report of early labor symptoms as a complaint may inadvertently dismiss or diminish the significance of the patient’s experiences. In the context of shared decision making, it is crucial to acknowledge and validate the patient’s subjective experiences, including symptoms and concerns. By using more neutral or patient-centered language, such as “reports” and “describes,” health care providers can demonstrate respect for the patient’s perspective and foster a collaborative approach to decision making. For example, when recording early labor symptoms in nursing documentation, some alternatives to “complains of” include the following:
- •Reports experiencing mild contractions at regular 10- to 15-min intervals.
- •Describes lower abdominal discomfort and aching sensation.
States feeling pressure in the pelvic area.
- •Expresses mild back pain and tightening sensation.
- •Shares experiencing occasional cramping and increased vaginal discharge.
Another term that can have negative connotations is “false labor,” which may inadvertently downplay the physical and emotional discomfort that women endure during early labor contractions. It can potentially diminish the legitimacy of their pain and reduce their confidence in the physiological process of labor. Women may already feel anxious or uncertain about labor progress, and referring to contractions as “false” might make them feel invalidated or that they are exaggerating their symptoms. Moreover, the use of this term implies that the only “true” or valid labor is the active labor that leads to childbirth. In this perspective, care providers seem to overlook the fact that although early contractions might not progress to active labor, they still serve a purpose in preparing the body for childbirth. Terms such as “prelabor contractions” and “early labor” should be used instead of “false labor” to acknowledge the significance of these contractions and validate women’s experiences throughout the entire birthing process. The focus of early labor assessment should be on engaging in meaningful conversations with patients about their symptoms, addressing their questions and concerns, and jointly considering the best course of action based on the available evidence and patient preferences. This collaborative approach is more likely to lead to person-centered care in which the patient’s values and goals are actively considered in the decision-making process.
Person-centered care is based on a broader perspective in which the individual is considered as a whole person beyond the role of patient. Person-centered care includes a focus on the individual’s social, emotional, and psychological well-being as well as personal circumstances, values, and goals. When practicing person-centered care, the health care provider recognizes that each individual has a unique identity, unique experiences, and unique needs that extend beyond the individual’s interactions with the health care system and that patients are experts on their own experiences. The patient is the center of the health care process (
).
Person-centered language in maternity care involves moving away from terms that may diminish or dismiss women’s experiences, discomfort, or concerns. It means using terminology that acknowledges the range of experiences and sensations that women may encounter during pregnancy, labor, and birth. It shows respect for their personal agency and helps to ensure that they are active and informed participants in decision-making processes. It is important for nurses and midwives to discuss and explain all terms used and to provide information about the various stages and variations of labor to empower women and help them understand the childbirth experience.
Using thoughtful and intentional alternatives to traditional terms and practices in maternity care helps to support a woman’s autonomy and promote a positive birth experience. By accurately documenting the early labor symptoms, health care providers can effectively monitor progress, provide appropriate care, and ensure the best possible outcomes for women and newborns.