Elsevier

Midwifery

Volume 79, December 2019, 102537
Midwifery

Review Article
What's wrong with using the F word? A systematic integrative review of how the fetus is talked about in situations of fetal demise or high risk of fetal loss

https://doi.org/10.1016/j.midw.2019.102537Get rights and content

Highlights

  • The 23 included studies represented the voices of women, their partners and allied health professionals.

  • The term ‘Baby’ is the most widely recognised word used in instances of fetal loss and high risk of fetal demise.

  • Gender identification- naming the fetus in utero.

  • Medical diagnosis or terminology used to label the fetus instead of using the word fetus or baby.

  • Euphemisms to name the fetus.

  • Parents and health care professionals distancing themselves by using words that are non specific or not naming the fetus at all.

  • This review contributes new insights into our understanding of the term ‘fetus’.

  • Need for further research into the way the fetus is addressed and dealt with in instances of fetal loss or high risk of fetal loss within Maternity care practices.

Abstract

Background

Limited research exists that investigates the language parents and health professionals use when faced with a high-risk likelihood of fetal demise or an instance of fetal loss. This review examines the language used when referring to the ‘fetus’ in these cases to better understand the meaning different groups might ascribe to the fetus and how their word choice may reflect their strategies for managing in these situations.

Methods

An integrative review of primary, peer-reviewed research was conducted. A systematic search of seven databases was undertaken, articles critiqued and summarised using the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA). The comprehensive process of data analysis and synthesis followed a constant comparison approach.

Results

The 23 included studies represented the voices of women, their partners, obstetricians, nurses, midwives and allied health professionals. Five major themes emerged with the main finding being that the term ‘Baby’ is the most widely recognised word used in instances of fetal loss and high risk of fetal demise.

Conclusion

History, science and law all influence how the fetus is understood and discussed within society. This review contributes new insights into our understanding of the term ‘fetus’ emphasizing the need for further research into the way the fetus is addressed and dealt with in instances of fetal loss or high risk of fetal loss within Maternity care practices.

Introduction

‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I use it to mean—neither more nor less.’

Lewis Carroll, Through the Looking-Glass, and What Alice Found There, 1871.

Originating from the Latin expression ‘feto’, meaning ‘I breed’ or ‘offspring’ (Aronson, 1997) the term fetus has evolved in its use and meaning throughout history. Initially labelled as the most appropriate word to refer to ‘offspring’ within the maternal landscape, this seemingly innocent phrase has since become entrenched in controversy. Argument stems from what the fetus has come to represent in relation to modern expectations of gender roles, personhood and politics (Dubow, 2010).

Commonly deliberated in the context of abortion legislation, the way the fetus is dealt with and discussed globally differs depending on the laws that govern each country as well as the moral norms of its people (Loi and Nobile, 2015). Despite western society embedding the fetus within social context, under current commonwealth common law, the foetus is not a legal ‘person’ or ‘human being’ until it completely exits its mother's body by being born alive (Dickens and Cook, 2011). Fetal rights laws differ globally however the most controversial legal developments can be seen within the United States of America (USA) (Loi and Nobile, 2015). Article 4 of the American Convention on Human Rights (ACHR) states that the rights to life must be protected ‘in general from the moment of conception’ (Copelon et al., 2005). As a result, certain states within the USA have begun to protect the fetus from viability or at an early gestation. The construction of the fetus as possessing human existence establishes it is as a ‘who’ not just a ‘what’, and as such warrants legal, ethical discussions and debate in relation to maternity care practices internationally.

The worldwide use of obstetric ultrasound in pregnancy is also contributing to a cultural and political shift that recognises the fetus as independent of its mother (Dubow, 2010, Keane, 2009). In essence, ultrasound technology enables parents to enlist others into the social construction of their ‘baby’ that bestows the public identity required for the attainment of personhood (Keane, 2009). Publicly available images of the fetus are widespread, and society has started to see the fetus as an icon, ‘person’, public entity, or a source of cultural entertainment (Mitchell and Georges, 1997; Gerber, 2002; Roberts, 2012; Shrage, 2002). The right to know is now conflated with the right to see in a consumer driven fetal world.

Due to our human ability to speak we can transmit our ideas across vast reaches of space and time. Language both reflects and gives shape to our reality and understandings, this becomes apparent when we look at the separation of woman from fetus. The language we use to describe the fetus can change significantly when recognition of personhood and social power is awarded or not awarded to it. The intimate relationship between language, the ultrasound image and the putative parents acquires great significance in the context of fetal demise, high risk of fetal loss and still birth.

Herein lays the issue for maternity care providers and their practice environments. Healthcare workers are often called upon to care for women who have experienced a fetal loss or still birth; comprising of an intrauterine or intrapartum death, be it a fetal death from natural causes or a practitioner instigated event following the diagnosis of an abnormality (Moore et al., 2011). Fetal death is an incomprehensible loss that can have devastating effects on the parents and health care professionals (Gold, 2007, Simwaka et al., 2014). The support that women receive during the time of bereavement following a fetal loss or still birth is crucial in the prevention of anxiety, depression, relationship problems and attachment difficulties in subsequent pregnancies (Hughes and Riches, 2003) as well as ongoing long-term psychological effects such as complicated grief and posttraumatic stress disorder (Malm et al., 2011; O'Connell et al., 2016; Pullen et al., 2012; O'leary and Warland, 2013). It is expected that health care professionals will work with the bereaved parents in a sympathetic manner whether they feel suitably prepared or do so or not (Gold, 2007; Pullen et al., 2012; Gardner, 1999).

Language is significant when discussing the fetus due to its already stated literal and figurative power. The aim of this review is to understand how the fetus is talked about by parents and health professionals in cases of fetal loss, still birth or high risk of fetal demise to provide insight into the ways the fetus is constructed in these situations, including our understanding of the word- fetus. This review examines the language used when referring to the ‘fetus’ in these situations to better understand the meaning parents and healthcare professionals might ascribe to the fetus and how the word choice might reflect their strategies for managing in situations of fetal demise, still birth or high risk of fetal loss.

Section snippets

Methods

The integrative review method described by Whittemore and Knafl (2005) was selected as the framework for this study that was guided by the question of; How do parents and health professionals talk about the fetus in situations of high-risk likelihood of fetal demise or an instance of fetal loss? This type of review allows the simultaneous synthesising and critiquing of findings from both qualitative and quantitative research to offer greater insights into intricacies of differing perceptions

Results

This integrative search and critical appraisal of the literature identified twenty-three relevant studies (20 qualitative, 2 quantitative and 1 mixed methods) that were included in this review (summarised in Table 1). Most of the studies were conducted in industrialised nations including the United States of America (USA) (5), Sweden (8), Ireland (3), The United Kingdom (UK) (2), Australia (1) and South Africa (1). One study came from Iran, one from Ethiopia and one from Somaliland. Based on

Discussion

This integrative literature review provides evidence of the change in the past two decades associated with societies perception and use of the word ‘fetus’. The purpose of this review was to explore how it is spoken about by parents and health professionals in cases of fetal loss or high risk of fetal demise. Obstetric ultrasound means that the fetus, which was previously ‘invisible’ by being concealed and unreachable within their mothers’ body, is now observable, visible, palpable and operable

Conclusion

The word ‘fetus’, once used to represent the body located deep within the maternal landscape, now seems to have evolved into a word, if employed in a non-medical context; can be interpreted as manipulative, offensive, dehumanising, and prejudicial (Finnis, 2010). It has become a symbol subjected to the prejudices and preferences of popular political and societal movements and has become a cold, sterile and medicalised term that modern day society now seems reluctant to use. Through analysis of

Ethical approval

Not applicable.

Funding source

Not applicable.

Declaration of Competing Interest

Non declared.

References (60)

  • O O'Connell et al.

    Caring for parents at the time of stillbirth: How can we do better

    Women Birth

    (2016)
  • HM Osman et al.

    Women's experiences of stillbirth in Somaliland: a phenomenological description

    Sex. Reprod. Healthc.

    (2017)
  • DM Puia et al.

    Experiences of obstetric nurses who are present for a perinatal loss

    J. Obstetr. Gynecol. Neonat. Nurs.

    (2013)
  • I. Rådestad

    Being alone in silence – mothers' experiences upon confirmation of their baby's death in utero

    Midwifery

    (2014)
  • Z. Alstin

    Pro-choice paradigm lacks compassion on Zoe's law

    Eureka Street

    (2013)
  • J. Aronson

    When I use a word...Oe no

    Br. Med. J.

    (1997)
  • RD Boss et al.

    Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns

    Pediatrics

    (2008)
  • JL. Callahan

    Constructing a manuscript: distinguishing integrative literature reviews and conceptual and theory articles

    Hum. Resour. Develop. Rev.

    (2010)
  • S. Dubow

    Ourselves Unborn a History of the Fetus in Modern America

    (2010)
  • J. Finnis

    The other f-word.(fetus)(morality concept in abortion)

    Hum. Life Rev.

    (2010)
  • JM Gardner

    Perinatal death: uncovering the needs of midwives and nurses and exploring helpful interventions in the United States, England, and Japan

    J. Transcult. Nurs.

    (1999)
  • EG Gerber

    Deconstructing pregnancy: RU486, Seeing "Eggs," and the Ambiguity of Very Early Conceptions

    Med. Anthropol. Q.

    (2002)
  • KJ. Gold

    Navigating care after a baby dies: a systematic review of parent experiences with health providers

    J. Perinatol.

    (2007)
  • AEP Heazell et al.

    Sharing experiences to improve bereavement support and clinical care after stillbirth: report of the 7th annual meeting of the international stillbirth alliance

    Acta Obstet. Gynecol. Scand.

    (2013)
  • E. Hofverberg

    Abortion Legislation in Europe. Vol 2018: The Law Library of Congress

    (2015)
  • P Hughes et al.

    Psychological aspects of perinatal loss

    Curr. Opin. Obstet. Gynecol.

    (2003)
  • H. Keane

    Foetal personhood and representations of the absent child in pregnancy loss memorialization

    Feminist Theory

    (2009)
  • MC Kelley et al.

    Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis

    BMC Preg. Childbirth

    (2012)
  • CH. Kroløkke

    On a trip to the womb: biotourist metaphors in fetal ultrasound imaging

    Women's Stud. Commun.

    (2010)
  • E Lakasing

    Death's worsening taboo: is hampering the provision of high quality palliative care

    Br J. Gen. Pract.

    (2014)
  • Cited by (0)

    View full text