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Why One Mom Battles to Change the Term "Incompetent Cervix"

Shifting medical language from shame to accuracy.

Key points

  • Madeleine Michalik and others are now using the term "Early Cervical Opening" instead of the prevalent term "Incompetent Cervix."
  • The campaign underscores the shame and blame inherent in historical terms like "incompetent cervix" or "cervical incompetence."
  • Medical diagnoses often rely on terms that frame female/women's bodies as weak, broken, or failed.

Did you know that some people are diagnosed with the term “incompetent cervix?” We have been following Madeleine Michalik on Instagram, who, after her diagnosis, is working to change the term to “Early Cervical Opening” (ECO) to destigmatize and better reflect the nature of cervical issues during pregnancy.

Currently, an “Incompetent Cervix” is defined as “A cervix (the structure at the bottom of the uterus) that is incompetent is abnormally weak, and [its opening] can gradually widen during pregnancy … can result in repeated pregnancy losses or premature delivery” (Davidson, 2015). Typically, the cervix closes in early pregnancy and does not open until labor begins. Early Cervical Opening occurs without contractions or other signs of labor and will result in premature labor, premature birth, or cervical loss (Davidson, 2015; Neveu et al., 2017).

Michalik knows this heartache too well because it was what brought her into motherhood. She shared, “My first pregnancy ended in unexplained premature birth at 25 weeks gestation. I alerted my provider to the lower back pain I was experiencing because, thanks to a handout from the office, I knew back pain was a potential indicator of ECO. My provider determined this was “normal” back pain and did not check my cervical length. Shortly after, I landed in the hospital 3-4 cm dilated, fully effaced, waters bulging, and delivered five days later.”

Madeleine Michalik, Used with Permission
Madeleine and her daughter Lidia, who was born at 25 weeks
Source: Used with Permission

She continued, “During my second pregnancy, I was considered high-risk and had transvaginal ultrasounds to check my cervical length during my second trimester. At 22 weeks gestation, my cervical length shortened past the point of safety, and the physician turned to me and said, “You have an Incompetent Cervix.” I had an emergency cerclage placed the next day, and as a result, I delivered full-term. Despite the happy ending, I continued to feel the guilt imparted by that diagnosis.”

And how did Michalik come up with the term Early Cervical Opening? “The shock and insult I felt from the moment the provider called my cervix “incompetent” never left me. I enrolled at UNC Charlotte as a communication studies major and adopted feminist lenses (that allowed me to perceive my body as a whole) through which I could analyze my lived experience with this diagnosis; I gathered tools that enabled me to understand and challenge this problematic language.”

Afterward, she decided to put her research in a more public place. “I started the Instagram account to spread awareness and gather support for a replacement term. Through social media, there is potential to connect with providers and patients who can adopt the term ECO ... I can also collaborate with other individuals that are raising awareness about this diagnosis. The ECO account also aims to be a space for those who wish to share their own story or commune with people that share this diagnosis.”

Finally, she noted that there are individuals with this diagnosis that don’t find the term “Incompetent Cervix” problematic. They feel it accurately represents the diagnosis and don’t want it to change. However, I want to create a space for those that, like me, dislike the term “Incompetent Cervix.” It is also important to note that the term ECO is open for discussion as well, and that feedback and constructive discourse is always appreciated.

Suggested solutions

Michalik offered some advice for medical practitioners:

  • Replace the term “Incompetent Cervix.”
  • Develop protocols and standards of care for patients that present with ECO symptoms.

  • When a pregnant patient speaks, listen and act.

  • Ask yourself, what will I do/what do I do when a patient presents with these symptoms?

  • Have this conversation with your colleagues:

    • Challenge yourself and your colleagues to practice narrative medicine to include patient voices in your notes, research, etc.

    • Place yourself in your patient’s shoes; seek out stories of those who bravely share their experience with this diagnosis.

We asked Michalik if she had advice for family members, friends, colleagues, and acquaintances:

  • Be mindful of the impact language has.
  • Use the term Early Cervical Opening.

  • Seek to understand how the diagnosis impacts the individual.

    • It might seem obvious to some that ECO is not the individual’s fault, but those who live through it often experience feelings of guilt and failure. Listen and support them without minimizing or erasing their experience.

Finally, we asked, how can readers follow your work and get involved in shifting the language?

  • Follow @Early_Cervical_Opening on Instagram or Facebook.
  • Use the term ECO or share what term you think best describes this diagnosis while removing blame from the individual.

More from Margaret M. Quinlan, Ph.D., Bethany Johnson MPhil, M.A.
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