Published on May 13th, 2016 | by Kimberley Lipschus0
EXCAVATE MY CONTENTS: Kimberly Lipschus Investigates the Damage Done by Clinical Language Around Labor
“I hereby agree to the excavation of contents.” Now, please sign here.
Although it sounds rather like a building site, in Australia it’s a clinical term for a curette or D&C. Otherwise known as the scraping away of the womb lining after an “incomplete miscarriage.” To have one done, you need to sign the form to agree to have your contents “excavated.”
Here’s my story: It’s D-Day, my partner, I and have been waiting for our “excavation” for eight hours. The form had been signed approving my surgery. That was at seven in the morning. I’ve known about my dead baby for a week. I’ve carried it around, talked to it, grieved, and then ordered it to leave me. But it won’t let go. It’s 3:59pm. The second hand clicks its last second journey towards the hour and I’m starving with hunger, having not been permitted food or water since last night.
4pm. The porter clatters in with his trolley bed and another woman hoists herself on. Her partner trots next to her as they lead her away, a rushed kiss planted before she disappears through the double doors.
4:45pm. The waiting room is empty. Everyone’s been seen but me. My partner has stepped out for air. I lift myself from the chair, my skin sticking to the not-so leather seams. I wander to the desk again. “Excuse me. Do you know if it will be soon? I’ve noticed the other women have come and gone and…” The nurse is apologetic and not unkind.
“I know you’ve been here since first shift this morning.”
She’s starting to swim before my eyes. I’m hungry and so thirsty and my body still thinks it’s pregnant. Pregnant women need to eat all the time.
“I am really sorry, there have been a lot of unscheduled caesareans. I know you don’t want to hear this but your situation isn’t considered life threatening.” She’s apologetic.
5:50pm: Suddenly I feel the rush. Cramps, coming fast and furious and a gush of hot blood. Bloody hell, my body has started to do what I’ve been waiting over a week for it to do. It is excavating my contents, and it’s beyond anything I’ve ever felt. I groan and instinctively double over as my partner walks back in to find me wound like a wire around the large day surgery chair; whipping and writhing in agony.
“Is she okay? What is going on?” His voice has this panic to it, which makes me turn from my curled position and grab his hand.
“It’ll be okay.” I mutter.
The nurse clocks the scene, and swivels in her chair, phone in hand. In quiet tones she says, “Yes, yes, she’s been here since 7am and she’s having contractions.” Silence in the empty waiting room as she listens into the phone; I moan and writhe. I can hear her frustrated exhale. “I know but she needs attending to.” Then conspiratorially with the theater nurse or whoever she was talking to… “I know. You guys must be under the hammer. This place. I throw my hands up.” She hangs up and signals that it won’t be long. And then we are left alone. I’ve now bled through the gown, over the chair and I’m making a god-awful lot of noise. I’m braying like a beast.
Today, I am a reproductive psychotherapist and counselor and I am struck as women and their partners share experiences, just like mine. During my research for this subject—yes it has turned into a book—I recently composed a quick call out on social media, mainly within Australia. I wanted to know, do any women recall a medical term that stuck out for them, whilst they were enduring a medical situation related to pre-pregnancy, pregnancy or birth. If so, how did it make them feel? Within thirty minutes I had sixty-seven responses. After twenty-four hours there were hundreds. The tone of the responses went from smarting, to sarcastic, to down right enraged. Some of these women referred to their experience years (and in two cases decades) earlier.
I have to preface this next part. Some of the following phrases are colloquial, some clinically used, some no longer used. Women reporting to me primarily came from Australia or Great Britain and a few from the USA. But here’s the important part—every woman claims the term was by a medical practitioner of some sort. Some of the terms the women shared with me are:
- Unviable or non-viable pregnancy: a pregnancy that shows no heartbeat.
- Geriatric Mother: a pregnant woman over thirty five years of age (otherwise known as Advanced Maternal Age, AMA)
- Incompetent cervix: if a pregnant woman’s cervix begins to dilate and thin before she has reached full term of pregnancy
- Operation Kangaroo: a slang term to remove the joey from the pouch. In other words implement a dilation & curettage
- Boggy Uterus: a uterus than is more “flaccid” than it “should” be.
- Blighted Ovum: when a fertilised egg attaches itself to the uterine wall, but the embryo does not develop despite pregnancy symptoms
- Incompatible with Life: a term given when a baby’s condition is unlikely to survive after birth
- Poor maternal effort: a term used when a woman needs assistance during labour
- A Lazy Uterus: a uterus that isn’t contracting “correctly” during birth
- Hostile Womb or Uterus: when the cervical mucus has incorrect PH for conception.
- Naughty Breathing: a colloquial term for a newborn baby who is having trouble breathing unassisted.
- An uncoordinated uterus or Uterine inertia: when a birth process is prolonged or contractions double peak
- Non Milker: term given for women who have trouble breastfeeding (and yes this was put on one woman’s bed head after a long and arduous labor which left mum and baby exhausted)
- High Risk: not to be confused with the high-stakes tests children will suffer under in schools, this “threat level” is broadly applied for any deviation from a “normal” pregnancy.
In my practice, I find these kinds of phrases come up, not as a part of a client’s story, but often as a lead character in their story. The impact of hearing such jarring language has a profound impact on a vulnerable woman. So much so, that they can overtake the real grief or loss from the particular situation. Claire is an example of one such story (she is a composite of clients and this is not her real name). She has experienced a premature birth experience and explains,
“Going into a dangerously early labor is terrifying. I needed support to accept where I was at quickly, so I could remain as calm as I could. But to hear a part of my body labeled as incompetent, offended my very sense of self. It turned my premature labor into a trip to hell, not just because I heard myself and my body being labeled as useless, but also because it was bandied about over my head, as if I wasn’t there. I felt like deaf beast at the vet.”
Part of my work with someone like Claire is to reunite her with what she lost that day—her right to grieve that moment so that she could move on and mother her little baby, which fortunately did survive.
I recall my own shock at seeing the words, “excavation of contents” hovering before my eyes and weeks later, the same words, same typeface persistently floating before my eyes. It created a feeling of being split into two—one part of me shaking my head at the phrase, like a disbelieving child who had been bullied in the playground. But there was the other side, which fantasized about storming back into that day surgery to declare to all and sundry, “My baby was not a content to be excavated (stamp of foot). She was not that. She was mine to name, not yours.”
Secondary victimization is a term used when victims of violence, are responded to insensitively by institutions and individuals who should be providing care and support to the victim. This includes inappropriate behaviour or victim blaming from officials, which fail to take account of the victim’s experience and perspective. Some victims of crime have commented to support networks globally that the repercussions of this can be more harmful than the original crime itself. Transferring this from a crime forum into a reproductive one has been helpful to use in my practice as it’s not uncommon for a client to describe anger about how they felt their experience was handled by key people from whom they expected compassion and care. Grasping this concept can be a key in unlocking a client’s inability to move on from the traumatic event.
The impact of hearing labels such as these can feel nothing short of brutal. Of course these clinical terms are short cuts and serve a purpose for time poor medical teams. But surely it is not too much to ask a clinician to be mindful of their patient and to exercise compassion when and how they use such terminology. Because at the end of the day, there is an intelligent, feeling and often hurting, vulnerable person at the receiving end. Because they can hear everything that is said.
This article is a result of research from Kimberley’s forthcoming book, The Space Between.
Kimberley is a reproductive psychotherapist and counselor. If you feel you could benefit from support from wherever you’re at in the fertility spectrum, head to the website www.fertileminds.com.au