The use of the term ‘woman’ not patient or person in midwifery

OPINION BY DR BELINDA MAIER, QNMU MIDWIFERY STRATEGIC POLICY AND RESEARCH OFFICER

Over the past 100 years in Australia, women have been subjugated by a patriarchal society and have given birth under oppressive circumstances where they’ve lacked control over their own bodies.

Indeed, this has been occurring around the world for centuries. Obstetric violence, post-traumatic stress disorder and traumatised women and persons who have given birth are on the rise, as are interventions in pregnancy and birth.

The prevalence of transgendered people giving birth will most likely rise as gender politics changes the landscape, and health care providers support and understand the health needs of all people choosing to have babies (Reis, 2020)

Language is an important part of social empowerment and social contract, and the change to womancentered care is neither to limit the rights of transgendered people to birth nor to diminish their intrinsic value.

While the QNMU unequivocally supports any person’s rights to selfdetermination and equitable access to culturally safe, high quality health care, the term woman and woman-centered care is not intended to exclude non gendered people.

It is an essential language that supports a human-centered philosophy of midwifery care that empowers and protects all women and persons who are accessing their care.

‘Woman’ cannot again be rendered invisible in society and health care. Sensitive debate is required to successfully and safely ensure all persons have a visibility and recognition of value in maternity spaces but not at the loss of the term woman.

There is an assumption that the term woman-centered care excludes persons, however the reality is womancentered care providers (midwives) are the most likely able to effectively and safely work in partnership with persons of any gender or identity to navigate maternity systems.

The term in and of itself empowers a discourse that embraces selfdetermination and empowerment.

Most transgender people giving birth, at this time, are those born with a uterus — transgender men, nonbinary people, gender fluid people, gender queer people, and others with uteruses who don’t identify as women.

Many transgender men, and other gender nonconforming individuals, retain their ovaries and uterus as well as the capacity to become pregnant.

Being transgendered does not necessarily mean the person has body dysmorphia or rejects their body.

Transgendered persons require health care providers that understand their health care needs and their individual ways of understanding their bodies, how they choose to transition and how they identify.

Moving forward, QNMU could consider working with transgendered people’s groups to work on ways midwives could provide care that reduces the current stigma, discrimination and substantial obstacles transgendered people face in accessing reproductive health care.

This can be done without the erasure of woman (Margaret Besse, 2020).

Since the 1970s there has been a move to return birth to women through midwives.

It has been a long struggle as the powerful discourse of medicine and nursing are highly resistant to returning women’s births rights back to women through midwifery care.

In 2010 midwifery was finally returned to being recognised as a profession in its own right (that is not nursing) under the Australian Health Practitioners Regulatory Agency (AHPRA).

The midwifery profession has worked tirelessly to situate pregnancy and childbirth within a more social and woman-centered paradigm. Key to this is to make the woman center of her care and to reject being termed as patients which comes from an illness model.

Midwives are nationally regulated and accountable to provide womancentered care (Nagle & Vogt, 2018), NOT to provide patient care.

To change to a patient-centered terminology sets midwifery back into an illness model which is not appropriate and not what the profession has fought hard to shift away from.

International Confederation of Midwifery

The ICM position statement Human Rights of Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) People supports the right of all people to receive humanised and inclusive midwifery care regardless of their sexual orientation, gender identity, or gender expression.

ICM believes it is critical for midwives to honour and respect all people’s right to self-determination and their right to receive health care that is free from discrimination, homophobia, transphobia and prejudice (Midwifery, 2017).

According to the definition of the International Confederation of Midwives, which has also been adopted by the World Health Organization and the International Federation of Gynaecology and Obstetrics:

A midwife is a person who has successfully completed a midwifery education programme that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education and is recognized in the country where it is located; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and childcare.

A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

Recommendations

■ That the term patient/s be replaced with 'woman-centred or woman/women. It is inappropriate to use patient for women/ persons who access midwifery care. It was specifically targeted by the midwifery profession as inappropriate. Womancentred or woman/ women is the preferred term and sits in a ‘woman at the center’ wellness paradigm that has significant benefits for the care provision to anyone accessing midwifery care.

■ That consideration be made to add person/persons next to women/women in appropriate contexts without rendering woman invisible or affecting the regulatory, legislative, and philosophical underpinning of midwifery care that is woman-centred

■ That the NMBA Midwife Standards for Practice use the terms ‘woman’ and ‘women-centred’ rather than patient. Given that midwifery and nursing are separate professions, the QNMU should use terms appropriate to each rather than both. As the standards setting body for nurses and midwives, for the QNMU to change terminology would not only be cause for considerable distress for midwife members and consumer advocacy groups but would be potentially confusing.

There are ways the term woman can have person/s identified: woman/person, women/persons. However, woman-centred care, woman centeredness and the role of midwives providing care to women cannot be and should not be altered as these have been hard fought for changes to the return of reproductive power and control to women.

The ANMF quite clearly states that: Woman or women in these standards refers to the person giving birth. Woman or women is used to refer to those individuals who have entered into a therapeutic and/or professional relationship with a midwife

Advice for healthcare professionals

The QNMU supports the following tips for healthcare professionals and others coming into contact with pregnant women/people which are based on advice provided by Reproductive Endocrinologist Dr. Sara Pittenger Reid (as cited in Prager, 2020):

■ Ask a pregnant woman/person for their pronouns (i.e. he/him/his, she/her/hers, they/them/theirs) and consistently use the ones they tell you.

■ Ask for and use the pregnant woman/person’s preferred name, which isn’t necessarily their legal name.

■ Ask for gender identity (which is different than sex at birth or sexual orientation) on intake forms and have staff check what’s written before addressing the patient.

■ Provide single-stall genderneutral bathrooms.

■ Train all staff on the practices above and further cultural competency.

Bibliography

Besse, M., Lampe, N. M., & Mann, E. S. (2020). Focus: Sex & reproduction: Experiences with achieving pregnancy and giving birth among transgender men: A narrative literature review. The Yale Journal of Biology and Medicine 93(4), 517. Collins Dictionary. (n.d). Patient. In Collins Dictionary. https://www. collinsdictionary.com/dictionary/ english/patient

Fahy, K. (2007). An Australian history of the subordination of midwifery. Women and Birth 20(1), 25-29. Gray, M., Rowe, J., & Barnes, M. (2016). Midwifery professionalisation and practice: influences of the changed registration standards in Australia. Women and Birth 29(1), 54-61.

ICM. (2017). Core Document: Definition of Midwifery. International Council of Midwifery. https://www. internationalmidwives.org/assets/ files/definitions-files/2018/06/engdefinition_midwifery.pdf

ICM. (2017). Position Statement: Human Rights of Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) People https://www. internationalmidwives.org/assets/ files/statement-files/2018/04/englgtbi.pdf

Kuhn, S. M., & Reidy, J. (Eds.). (1975). Middle English Dictionary, University of Michigan Press.

Nagle, C., Heartfield, M., McDonald, S., Morrow, J., Kruger, G., Bryce, J., ... & Hartney, N. (2017). A necessary practice parameter: Nursing and Midwifery Board of Australia Midwife standards for practice. Women and Birth 30 10-11.

Nagle, C., & Vogt, T. (2018). Midwife standards for practice: one size does fit all. Women and Birth 31 S51.

Prager, S. (2020). Transgender Pregnancy: Moving Past Misconceptions. Healthline parenthood. https://www. healthline.com/health/pregnancy/ transgender-pregnancy-movingpast-misconceptions

Reis, E. (2020). Midwives and pregnant men: labouring toward ethical care in the United States. CMAJ 192(7), E169-E170.