Re: Supporting the stillbirth journey at BC Women’s Hospital and Health Centre

We are writing in response to the article by Gill and colleagues[1] on supporting bereaved parents who have experienced stillbirth. We were impressed with the care taken to involve those with personal experience in research to inform improved care. However, it was noticeable that the article avoided using terms such as “women,” “mothers,” “men,” and “fathers” that would make the sex of the people involved clear. This avoidance of referencing sex (desexed language) when sex is important has increasingly occurred as the cultural salience of the concept of gender identity has risen, but it presents a variety of difficulties,[2,3] and this article is no exception.

When a stillbirth occurs, both mothers and fathers can be said to have experienced the stillbirth of their child, but they have not had the same experience. A pregnant woman whose fetus dies late in pregnancy or during birth and gives birth to a dead baby does not have the same experience as a father who observes this process, even though he also grieves. However, this article makes it difficult or impossible to determine whose experience is being described. In summarizing the research, “people” is used to refer to mothers only; to mothers and fathers; and to mothers, fathers, and extended family. One has to read each reference to know. Similarly, it is sometimes difficult or impossible to distinguish whether the study findings refer to mothers, fathers, or both. The same is the case with quotations.

The article notes there is sensitivity around language in relation to stillbirth and explains that the term “bereaved parents” is used “to reflect the preferred language of our study participants.” However, this does not appear to clearly be the case. One study participant is quoted as saying she would have “appreciated being treated like a mom. . . . It would have helped me to have felt cared for and treated like a mom” (emphasis added). And the words of another study participant were altered, perhaps to avoid “women” or “mothers”: “[There is a need to] create a network of [parents] who have been through it” (emphasis added). Further, fathers are sometimes referred to as “partners,” and in this way their relationship to their child is marginalized. This is even in a sentence noting their marginalization: “Partners often face the erasure of their status as grieving parents.”

The potential for causing distress by not recognizing the different stillbirth experiences of women and men and not accounting for this in the care provided to them and the language used needs to be appreciated. The second author of this letter has extensive experience providing peer support to women who have experienced stillbirth (including in Canada) and emphasizes the importance that many women place on being referred to as mothers.

Of course, we understand the authors’ intent to ensure language is sensitive to the needs of individuals who prefer their sex not be referred to due to their personal experience of gender identity. We agree there should be sensitivity to individual patient language preferences[4] even while recognizing their sexed experiences.
—Karleen Gribble
School of Nursing and Midwifery, Western Sydney University, Australia
—Ciara Curran
Little Heartbeats

This letter was submitted in response to “Supporting the stillbirth journey at BC Women’s Hospital and Health Centre.”

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References

1.    Gill V, Kreim S, Pederson A, et al. Supporting the stillbirth journey at BC Women’s Hospital and Health Centre. BCMJ 2024;66:340-345.

2.    Gribble KD, Bewley S, Bartick MC, et al. Effective communication about pregnancy, birth, lactation, breastfeeding and newborn care: The importance of sexed language. Front Glob Womens Health 2022;3. https://doi.org/10.3389/fgwh.2022.818856.

3.    Kinney R, Praamsma N, Malinowski A, et al. Testing inclusive language revisions of the Breastfeeding Attrition Prediction Tool using cognitive interviewing: A pilot study. J Hum Lact 2023;39:529-539. https://doi.org/10.1177/08903344231174221.

4.    BC Reproductive Mental Health Program, Provincial Perinatal Substance Use Program, Perinatal Services BC. Best practice guidelines for mental health disorders in the perinatal period: Substance use disorders. May 2023. Accessed 13 January 2025. www.bcwomens.ca/Professional-Resources-site/Documents/BC%20RMH%20PPSUP%20PSBC%20Best%20Practice%20Guideline%20Substance%20Use%20Disoder%20Perinatal%20Management%20FINAL.pdf.