A collaborative project led by the Royal College of Midwives (RCM) has developed guidance to support maternity professionals and women using maternity services to develop a shared language for pregnancy, labour and birth. The project, called Re:Birth, worked with representatives from across maternity care, including staff, advocacy groups and service users, to build a new lexicon that reflects the needs and asks of women and families, and puts personalisation of care front and centre.

Re:Birth, which began in 2020, sought to bring together those providing maternity care as well as those receiving it in order to find a shared language that improves communication within maternity services. While consensus was difficult to find, one thing became clear: listening to women and using and respecting the language she chooses helps build trust.

Gill Walton, Chief Executive of the RCM, said:

“The relationship between a midwife and the women in her care is an incredibly intimate one. The role of the midwife is to advise and support women, to listen to them and to advocate on their behalf. To do that successfully, we have to share a language. That is why Re:Birth is so important. It puts women’s choices at its heart, so that they are in the driving seat when it comes to how their labour and birth are described.

“We know that, particularly in England, there has been an increasingly heated debate around the term ‘normal birth’. Whatever your personal perspectives, it’s clear that when describing labour and birth, the term means many different things to different people, which has caused misunderstanding, confusion and upset. These public conversations have raised questions about all the terms we use to describe different types of birth. How can we ensure that the language we use helps support safe and high quality care? Which terms serve our maternity community best? Many of us involved in maternity care, including the Royal College of Midwives, believe that this language needs to be reviewed and, in a sense, reborn. Hence, Re:Birth.”

Re:Birth – which received input from thousands of people, including nearly 1,500 who had given birth in the past five years, advises that midwives and obstetricians put the needs and wishes of women at the heart of all conversations about their care. It recommends that maternity staff should follow the Five As:

Acknowledge
If the woman has had a previous birth, acknowledge this as a birth (independently of mode of birth), or if this is her first time. If she has had a previous loss, that should also be acknowledged.

Ask
How would the woman describe a birth she has had or would like to have? Her feelings are just as important as the technical description, so listen to how she talks about that experience.

Affirm
Check with the woman the language used in your notes to describe any previous birth. Does that description feel right to her? Is there another term she would prefer to describe it?

Avoid
Try not to make assumptions about her choices – for example if there was a previous caesarean birth. Don’t make your own interpretation of what you think her experience might have been, or impose terminology on her.

Annotate
Record the woman’s own description of her previous experience of birth as fully as possible, and her preferences on language and terminology.

Shirley Cramer CBE, the independent chair of the Re:Birth project, said:

“Pregnancy and birth are extraordinarily personal, and personalising care is central to good outcomes and experience. There has been a great deal of debate in recent years about the language around birth, and the impact it can have. During this project, for example, women were keen to tell us how terms such as ‘failure to progress’ or ‘lack of maternal effort’ can contribute to feelings of failure and trauma.

“In every aspect of our lives, language matters – and in health and care settings, it’s even more important. How we communicate with each other can determine the quality and impact of the care given and received, which is why developing a shared language is so important. How we use language inevitably evolves over time, but we hope that the Re:Birth project will help to embed a shared, respectful way of discussing birth.”

The project sought to identify what language all of those who responded to the final survey thought should be used in maternity notes, audits and reports to describe different types of birth. It was clear that the term ‘birth’ was preferred to describe all types of birth, rather than, for example, ‘delivery’. Caesarean birth was chosen as more popular than operative birth or caesarean section. Spontaneous vaginal birth was chosen more frequently than alternative terms such as normal or natural birth, unassisted birth or birth without interventions.

The RCM is sharing its findings with NHS Trusts and Boards across Britain and Northern Ireland, and with stakeholders in maternity care. It is hoped that this approach, which has been developed as a collaboration by all those with an interest in maternity care, will be adopted across services, ensuring consistency of personalised care for women and families.