“Your cervix is in danger of effacing. You’ll be tremendously lucky if your baby makes it to 24 weeks.”
I was staring at the doctor who had just delivered this news, but I was having trouble processing what she was saying. She nonchalantly added something about my “incompetent cervix.” A wave of devastation swept over me and my face flushed with humiliation. My first thought was, “Did I somehow cause this?”
Medical terms should be factual and educational, as they almost always are for men. For example, “immunologic infertility” is a clinical descriptor that doesn't sound personal.
Just the day before, I had been standing in front of an ornate mansion in New York City admiring an abundance of yellow daffodils when I felt a sharp pain in my lower belly. I was four months pregnant and hardly showing my baby bump. My husband and I had been walking around for hours, and I thought perhaps I had overdone it.
On the ride back to our Hudson Valley farmhouse, the pain persisted, so I called my OB-GYN. The nurse dismissed me outright, telling me that aches and pains were normal and that I should wait for my scheduled appointment the next evening to address any concerns. By the time I walked into the doctor’s office, it felt like a stack of bricks was bearing down on my uterus.
An emergency sonogram showed that I had three unusually large fibroids — noncancerous tumors made up of smooth muscle cells — and one was pressing against my cervix, causing early effacement (meaning my cervix was shorter than normal and not strong enough to stay closed during my pregnancy as it needs to).
After the doctor delivered her devastating diagnosis, she told me to spend the remaining five months in bed, keep my hips elevated and stay that way until the baby started to crown. With no other information forthcoming, my husband, my incompetent cervix and I all drove home in silence.
According to the Cleveland Clinic, 1 in 100 pregnant women are diagnosed with an incompetent cervix, which occurs when a pregnant woman’s cervix begins to soften, shorten and dilate before the baby has fully gestated, which can cause miscarriage or preterm labor. A quick search of synonyms for “incompetent” offers a list of terms like “bungling,” “useless” and “ineffectual,” none of which is going to make a woman feel very good about herself. The condition is also known as “cervical insufficiency,” hardly a less offensive term.
It didn’t take long for me to become familiar with a whole slew of inappropriate descriptions associated with the health of pregnant women or women trying to get pregnant, ranging from “barren” to “habitual aborter.” These terms are not only obnoxious, but they convey a sense of shame. I felt as though I had somehow put my unborn child at risk, even though there was no medical evidence to suggest that the long walk I'd taken had caused the problem, and my diagnosis was likely inevitable.
Women who have difficulty conceiving or experience high-risk pregnancies should never be made to feel like they’re at fault. Using offensive language increases embarrassment and self-doubt during an already vulnerable time; as it is, we are constantly scrutinized for how our behavior affects the health of our fetuses. In few other medical circumstances are victims blamed for their maladies in this way. Modern medicine needs to step up and get with the times.
Particularly troubling is that these insulting terms apply to relatively common problems. Twenty percent of women are diagnosed with the almost laughably coined “hostile uterus,” a label used when people have difficulty getting pregnant because their cervical fluid is too thick and “hostile” for sperm to penetrate. When a woman ovulates, the fluid is supposed to become thinner and watery, but sometimes it doesn’t. The cervical mucus can become so thick that it destroys the sperm. (Perhaps we should actually consider this an empowered uterus that makes its own decisions on whom and what it will support.)
Many terms also carry the stigma of ageism, insinuating that women waited too long to have a child. The archaic “geriatric” pregnancy is the term for any pregnant woman over the age of 35. With the rate of women ages 40 to 44 becoming pregnant for the first time more than doubling from 1990 to 2012, the distasteful use of the word “geriatric” should be retired once and for all. Recently, the medical community has started to use the phrase “advanced maternal age” without seeming to understand that this is not much better.
Fortunately health care providers are slowly moving away from other absurd terminology. In the original “Sex and the City” back in 1999, Miranda is told she has a “lazy ovary,” which means one of her ovaries no longer produces typical amounts of estrogen or releases eggs regularly. In a later episode, Charlotte is diagnosed with vulvodynia, also known as a “depressed vagina,” which is chronic vulva pain. The show makes light of these conditions, but nevertheless opens up the discussion about how women feel when their body parts are characterized this way. Maybe that’s why these specific terms seem to be used much less frequently these days.
It is long past time that the health care community change the dialogue — literally. During the five months I was on bed rest, my mental health declined rapidly as I struggled with prenatal depression and anxiety. The doctor had slapped a high-risk label on my uterus and highlighted it with the word “incompetent,” and that was exactly how I felt. So I took back my power by writing in a journal, which I then turned into a comedic memoir called “Knocked Down” about marriage, motherhood and my high-risk pregnancy, which came out Tuesday. I want other pregnant women to know they are not alone, that they need to advocate for themselves when it comes to their health and that they shouldn’t feel defined by terms that are symptoms of gender-based medical bias.
Instead, medical terms should be factual and educational, as they almost always are for men. For example, “immunologic infertility” is a clinical descriptor that doesn't sound personal. Above all, women should not be left wondering if conditions they have no control over — unlike behaviors such as smoking or drinking — are directly related to something they did, which risks them internalizing their pregnancy complications and blaming themselves.
After 22 life-changing weeks in bed, my son was born healthy. I guess my cervix was up for the challenge.