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Janae Pierre: Welcome to The Takeaway. I'm Janae Pierre in for Melissa Harris-Perry.

“Incompetent,” “hostile,” “failure,” these are words that might belong in a really bad argument with a partner or colleague, but if you're pregnant, you might be hearing these from your doctors, and they might be talking about your uterus.

Rachel E. Gross: The hostile uterus refers to a uterus that doesn't really want anything to do with sperm. Chemically, it's maybe not as amenable to sperm implantation. Hi, my name is Rachel E. Gross. I'm a science journalist and the author of Vagina Obscura.

Janae Pierre: Rachel recently explored the strange medical lexicon of pregnancy. Her article in The Atlantic is called Don't Call My Cervix Incompetent.

Rachel E. Gross: In the older medical language, an incompetent cervix is a cervix that basically opens too early in the pregnancy process, and that can cause a lot of problems with the pregnancy so we need a term to refer to that.

Janae Pierre: But why does that term have to be incompetent? That doesn't sound very scientific, it sounds downright mean.

Rachel E. Gross: I would totally agree with you, Janae. Interestingly, most doctors did not really notice those connotations that you and I are picking up on when they first learned the terms. Another example of that I was often given was failure to progress, which is talking about when you're in labor and it's going more slowly than usual, or failure to thrive, which applies to an infant who's having struggles.

Doctors often just equated that with heart failure, kidney failure. It's just this neutral and objective term, whereas a lot of moms and people who were pregnant were feeling pretty judged by these terms, feeling like they were very harsh. Medicine has been a very patriarchal institution for a very long time and its language are really slow to change, so it's not really surprising we'd have this kind of hangover of sort of dismissive and rude terms to describe patients.

Janae Pierre: How does this language impact those patients who are diagnosed with such conditions, like how does it make a pregnant woman feel?

Rachel E. Gross: Oh man, I talked to quite a few women, especially ones who had been called geriatric pregnancies. It's a weird term where it's not like geriatric mother, it's like geriatric pregnancy. The medical term on their files was usually elderly primigravida, essentially the same thing. They told me that it really heightened their anxiety during their pregnancy, and essentially, they were 35 or older when they got pregnant. Many of them had very healthy and problem-free pregnancies, but when they heard that term, they felt a lot more worried.

Janae Pierre: Now, aside from how these terms make patients feel, what's wrong with these terms in the first place?

Rachel E. Gross: Besides the super weird implication that your organs are sort of characters that are malfunctioning or just like employees that are failing their annual exam, they're actually not very precise medical terms, so they're not that useful to doctors. I give the example of geriatric pregnancy, which, again, it stems from the 1970s. It basically came from this calculation about the risk of amniocentesis to a fetus versus the risk a fetus would be born with a certain genetic abnormality. At around 35, we thought that the risk was equal so anyone over 35 would fall into this category that got called geriatric pregnancy.

Nowadays, first of all, that calculation is not accurate, it's not relevant, it's pretty arbitrary. Second of all, using purely age and lumping a huge swath of people into this category is really vague and is not the best way to assess medical risk. It's also the case that more and more people are getting pregnant after this age, so one in five pregnancies in the US is a person who's 35 or over.

That's not some niche small category. That's a huge portion of pregnant people. Another example is the failure to progress. A lot of people in Nursing and Birth Education say that often what's really happening is a failure to wait, so there's a debate over whether that term makes it sound like it's the birthing person's fault and that you need to take immediate intervention when in some cases you might not, so it kind of muddies the water.

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Janae Pierre: More on this after the break. It's The Takeaway.

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Janae Pierre: We're speaking with science journalist Rachel E. Gross about the strange and sometimes dehumanizing medical language around pregnancy. She explains how terms like geriatric pregnancy aren't just hurtful to patients but also lack specificity that can help direct appropriate medical care.

Rachel E. Gross: There are other terms in, for instance, women's health that are pretty vague. One that I hear about a lot is vulvodynia which generally just means long-lasting pain in the vulva region so in the female genitals. The term is a diagnosis, but it doesn't give us any information about the cause of that pain, the mechanism, how to treat it, so it's sort of like a non-diagnosis in the weight space.

I had an adolescent pediatrician talk to me about why obese is first of all, so many problems with the BMI, but second of all, obese is again this huge catch-all that captures a huge range of people with different health risks. Whereas if you talk about like you're in the 90th percentile of weight for your age range, then that is a more precise way of looking at risk and category.

Janae Pierre: The last time you spoke with us on The Takeaway, we talked to you about your book Vagina Obscura. During that conversation, we learned about how many terms for vagina and related body parts, those kind of stem from shame, is that also an undercurrent with this medical terminology?

Rachel E. Gross: Yes, I would say so. Right, we talked about a term that was in use for a long time for the vulva or female genitals called the pudendum, which means the part for which you should be ashamed, and there's a bunch of other terms like that. The word Schamlippen in German means shame lips, and that's labia, so there is this tendency to attach shame to that part of the female body.

When I looked at the language we used for pregnancy, there were similar connotations, but I think I would say it's more like blame. There's sort of this active blame that's being put on the person who is pregnant and this implication that their body or parts of their body are malfunctioning and aren't working as they're supposed to, and that's where weird terms like incompetent cervix come in that sound like your cervix had one job and it isn't doing it, so maybe we should bring this up in its next annual review.

Janae Pierre: I'm thinking about the ways that Black women in particular experience harm in OB-GYN medicine. We can trace it as far back as slavery with Dr. J Marion Sims. How might such language compound that harm?

Rachel E. Gross: I actually spoke to a vice dean at Columbia Medical School about this. She herself researches equity, inclusion, and also as a Black woman who gave birth after the age of 35. She was faced with that geriatric pregnancy label. At the same time, she was really concerned about the ways that she was going to be sidelined in her own care. She knew the stats about Black maternal mortality. She was dealing with fertility issues. It did sort of add this complication where she felt like, in a way, her authority was being undermined yet again, and she was working really hard to have a voice in her own pregnancy plan.

She also mentioned that there are stereotypes for Black women about being super fertile, and so things like infertility problems can really fall through the cracks. Basically, she was juggling all of these different perceptions about Black women within Medicine as somebody who was exquisitely aware of the impact of these things and doing her best to be super prepared for it. I think that talking to her made me realize that if you are not yourself in Medicine and have these levels of authority and are going through this experience, it would be so much more confusing and easier to get slotted into these stereotypes.

Janae Pierre: You spoke with some people about how this language actually deeply impacted their medical treatment itself. Can you tell us about one of them?

Rachel E. Gross: Yes, I spoke to a few women from some pregnancy and motherhood groups. One of them was 37 when she became pregnant for the first time. It was a completely healthy pregnancy, but she was termed a geriatric pregnancy.

Basically, what she said is she really appreciated that these terms trigger the medical apparatus to add extra monitoring, extra testing, and have insurance often cover these things because you're considered higher risk. At the same time, she wasn't worried before. She was in this blissful new state of being newly pregnant and having these pieces come together in her life, and now suddenly she was thinking about all this risk she was incurring and feeling very blamed as someone who hadn't made the right choices or had things line up for her in her life.

After her first pregnancy, actually went totally smoothly, she really wanted another, but she wavered for about four years because she was so worried that like in her words, lightning wouldn't strike twice or that it would be selfish to want another healthy baby after the age of 37. Eventually, it did happen for her, but she said if she wasn't so worried about the risks, she would've just had another child immediately after the first.

Janae Pierre: Why have some medical terms evolved and others haven't?

Rachel E. Gross: Yes, that was sort of the central question of this piece. The two examples that I focused on were geriatric pregnancy is mostly recognized as a pretty inappropriate and kind of patronizing term that just sounds absurd these days given the age that people give birth. The other one is pregnant people.

There was a really big push in the past year for a ton of different organizations, including pregnancy, medical organizations to switch from pregnant women to pregnant people, and part of that was the fall of Roe v. Wade and the rise of attacks on transgender health care made it clear that we need to be inclusive and accurate when we talk about who gives birth, who uses health care that's often called women's health care and who can and does get an abortion. This language is still under debate, but it moved really quickly within Medicine, which is very rare.

I think there are also some good efforts to be specific. If a journal is talking about a study that talked to a hundred pregnant people who are all identifying as women, then it uses pregnant women if they're not sure how people identify using pregnant people as the more inclusive and accurate term. These words did evolve, and I think it's just because they got this public spotlight.

They became enmeshed in these huge public debates and kind of the squeaky wheel gets the grease. These were the words that floated up to the public consciousness, and other ones like incompetent cervix really just have kind of flown below the radar even though they're much overdue for a retooling. I think as we become aware of more of these terms, probably Medicine will react at their normal pace but as quick as they can.

Janae Pierre: Rachel E. Gross is a science journalist and the author of the book Vagina Obscura: An Anatomical Voyage. Her recent piece in The Atlantic is called Please Don't Call My Cervix Incompetent. Rachel, thanks for coming back.

Rachel E. Gross: Thanks so much, Janae.

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