July 10, 2003

"Minifisms"

This wonderful term was first brought to my attention by my colleague Lynne Staff. She had come across it in a book entitled "Behind the Screens - Nursing, Somology and the Problem of the Body" (Churchill Livingstone, 1991). Lawler offers this defininition:

"Minifisms can be verbal and/or behavioural techniques which assist in the management of potentially problematic situations by minimising the size, significance, or severity of an event involving a patient. They are also methods of bringing a situation under control..." p 166

I was reminded of this useful term when I was talking to a colleague who described a class she had attended facilitated by a midwife. Parents were told that an episiotomy is "just a little cut - nothing to worry about" and that "if you need a little bit of help, then forceps or a vacuum may be used". I wonder what impression these deliberate minifisms created in these vulnerable women's minds?

I have heard midwives say to women "you've had a bit of a bleed", "just going to have a little feel", "you've made a bit of a mess", "just have to give you a bit of help with these contractions" during labour. The idea is to try an reassure the woman about a problem that is causing concern, or to spare her a perceived embarrassment. This result might be achieved or the opposite could occur, where false hope is created, a serious situation is misunderstood, or an alarming outcome is covered up.

If the baby is in trouble, the situation changes, and instead of using minifism, a "maxifism" (not sure of this term, so my creation this time) may be employed to get the woman's compliance. The initial comment "Just a bit of a dip in the baby's heart rate" might be followed by "we have to get this baby out right now" or "we have to do ... now - you don't want to jeopardise your baby, do you?" What was seen as a "bit of a problem" becomes a major crisis in the next minute.

What's wrong with good plain English and straight up honesty in our dealings, in particular with labouring women? It is hard to be the bearer of bad news but women have the right to know what is happening and might welcome some straight talking, especially if there is a genuine problem. Given the desire to be "helpful" "caring" and "woman-friendly", we seem to have developed a whole second language of (almost) baby-talk, platitudes and minifisms that coat our messages in a layer of obfuscation that may hinder rather than help.

We have to learn better communication if we are to be effective with our messages, especially in educational settings with expectant parents. They need to know the truth and we have an obligation to give it to them.

Posted by andrea at July 10, 2003 05:14 PM

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