What is normal?
It’s a question I’ve thought a lot about.
Last year I wrote about how growing up I sought to be different, thinking ‘normal’ was boring because it means conforming. After Hugo’s death, however, I would give anything to be a ‘normal’ mum – using the term ‘normal’ loosely, to mean having a baby in my arms to care for.
Besides connotations of conforming to a standard, normal can mean usual, typical, ordinary or expected.
That’s why I’ve been protesting against the concept of ‘normal’ birth – yes it means natural, unassisted, but there is so much diversity in birth experiences such a term can put unreasonable expectations on women.
There are also the cases – like mine! – where events were nothing but normal. Getting HELLP syndrome at 24 weeks’ pregnant, being cared for in two hospitals with a blue-light ambulance ride in between the two, waking up in intensive care after a Caesarean section under general anaesthetic are all extraordinary events, in the truest sense of that word.
But does being unusual mean I am not normal?
Of course not.
We need to be careful about the language we use.
A case in point was at the Women’s Safety Day at the Royal College of Obstetricians and Gynaecologists a few weeks ago. During a break out session, a topic of conversation was the care women need on the post-natal ward. It appears the focus of the discussion was on women whose births had gone to plan, so I piped up promoting the needs of women who had had a complicated or traumatic birth, and/or whose babies were in the neonatal unit.
The consultant obstetrician leading the conversation replied with a dismissive comment along the lines of making a distinction between ‘normal’ women, and the ‘complicated’ ones.
I made the tweet below partly in jest, partly in frustration.
I'm not normal, apparently. #languagematters @FWmaternitykhft @victoriaRM6 @RCObsGyn #MatExp #HugosLegacy 😁😡
— Leigh Kendall (@leighakendall) October 16, 2015
Language matters. You have to be so careful when choosing words. It is not heavy handed policing or making health care professionals so paranoid about saying the ‘wrong thing’ they feel they cannot say anything at all.
It is about recognising that every woman in that postnatal ward – whether hypothetical or real – is an individual, with her own hopes, fears, expectations, and needs.
We cannot divide them in to ‘normal’, and ‘complicated’.
We do not fit in to neat little tick boxes.
Another example is when having a recent intimate examination. The nurse was unable to find my cervix even after much jiggery-pokery (literally) with a speculum so she called in a doctor to help. Lying flat on my back on the couch and with legs akimbo it was difficult to see the doctor when she arrived in the room, but thankfully she did introduce herself before getting down to business.
She too had trouble locating the cervix: more poking ensued. Surely it must be there somewhere, I thought; it can’t have gone far. I wouldn’t have blamed it for scarpering though: it has gone through a lot the over past few years with pre-cancerous cells being lasered away, and immediately prior to Hugo’s birth being prodded somewhat painfully to see if it was open (it was shut fast, hence the C-section) as just a couple of examples.
So, I was lying back, thinking of England with two strangers exploring my personal parts, wondering where on earth my cervix had got to, and trying to not worry (surely nothing else could go wrong with my reproductive system…?). The doctor asked whether my periods are normal.
“Well, yes they’re normal for me,” I replied.
“Yes, but are they normal?” the doctor persisted.
Now I really did start to worry. Her response gave me cause to panic – what if the evidence down below suggested otherwise? What if my magic disappearing cervix meant I was deluded in thinking my periods were normal?
The panic thankfully subsided after a few moments because – phew! – the cervix was located. Hurrah!
A better approach would have been an open question: “What are your periods like?” The doctor could have then ascertained from my description whether any alarm bells needed to ring – and without alarming me (especially in my vulnerable position).
The health care professionals I describe weren’t doing anything wrong. They were doing their best to give women in general, and me in particular the best-possible care.
‘Normal’ isn’t scientific, nor can it have an evidence base because it is such a subjective term. What is normal to me is unlikely to be normal for you. As such, it should be used with caution in health care conversations.
Because what is normal anyway?