The minute you enter a hospital as a patient, you change. As soon as the automatic doors slide open and you smell the whiff of disinfected floors and rubber gloves, you feel vulnerable. You want to talk to a doctor or nurse about what’s going on with your head or your leg or your insides, and you want to know that they’ll take special care of you. Political outlooks, prior convictions and hard veneers are often shed with your coat the minute you sit on a plastic chair waiting to be seen.

But, like all things, a drive to formalise, sanitise (politically) and censor the way we interact individually in the wider world has begun to spread into the sacred world of the medical ward. A hospital I used to know well – Brighton and Sussex University Hospital – has announced that its maternity unit is instituting a new policy focused on gender inclusion: “We are on a journey towards gender inclusive care for everybody during pregnancy, birth and afterwards”, they write, and “this journey is led by members of the trans and non-binary community.”

So far, this journey seems to amount to an announcement of staff member’s pronouns on the website and a rash of policies outlining that everyone from midwifes to infant-feeding specialists is on board with these changes and that language will be monitored, shaped and “updated”.

Sometimes informality is the best cure

Unsurprisingly, some commenting on this on social media have got it slightly wrong – this particular Brighton maternity unit have stressed that “staff are not being asked to stop using any language relating to women” but that the “additional wording”  like “chest-feeding” or “birth partner” is merely about being inclusive of people’s individual needs. So, no, Brighton midwives are not being forced to call women “pregnant people”. But the implication of such a grand announcement is that medical staff need to be regulated to ensure they use inclusive language when addressing the individual needs of their patients. Are we to believe that midwives in Brighton hospitals are cruelly refusing the wishes of trans patients by calling them mum when their feet are up in stirrups? Will instituting policy on inclusive language help ease the challenges staff face when making sure a lab accepts and processes blood tests from a pregnant mother whose label says “M”?

When it comes to maternity, a place where emotions and medical care interact so intensely, implementing policies that suggest staff need to be trained to talk to their patients with care and understanding is a barrier to good practice.

Sometimes informality is the best cure. As someone who is currently undergoing fertility treatment and has spent many months in nervous waiting rooms alongside other women, I know how much impact the nurses can have on my experience. In between lockdowns last year, I woke up from a minor exploratory surgery to find out what was going on to stop the magic happening. “Good news”, the surgeon said, “I can’t find anything wrong with you. So your only option is IVF.” I burst into tears, which baffled the surgeon and anaesthetist who expected me to thank them for giving me a somewhat clean bill of health. As many women who have been in my shoes will know, when you’re finding it difficult to get pregnant you can sometimes catch yourself wishing that they’d find the cause of the problem, just so you can do something about fixing it. What we don’t tell young girls enough – as they panic about getting pregnant the minute a boy takes his pants off – is that the mystery of life is called a mystery for a reason: it can actually be quite tricky to make it happen.

The desire to formalise the way we talk to each other in the name of inclusivity is a worrying trend

Silently, without making a fuss, a nurse appeared at my head and shooed the others away. She took my hand and brushed the hair out of my eyes as she spoke to me. She laughed at me and asked what a big girl like me was doing crying. She mocked me, gently, and told me she knew I’d be a mother, that I had the hips for it, and scolded me for being upset about having no problems – she’d seen many women told far worse things with their backside exposed in a hospital gown. It was so comforting and yet so unprocedural that I cried harder into her hands; but within minutes I felt much better and was wolfing down the delicious packet of biscuits I’d been offered.

A week ago, the fertility clinic held an informal meeting for patients waiting for treatment. Many London hospitals have had to close for non-elective surgeries (like egg collections for IVF) because of the number of Covid-19 patients. For women running out of time for treatment and with ticking biological clocks, this has been a psychological challenge. The head doctor and head of operations – both women – simply had a chat with us. There were no policies, no rules, no official guidelines. It was wonderful. I imagined it had the feel of the women’s meetings of the 1970s and 80s – without the bashful men in the background of the Zoom call.

Brighton and Sussex University hospital might be making a show of how brilliant they are at caring for their trans patients – that’s fine. But the desire to formalise and stiffen the way we talk to each other in the name of inclusivity is a worrying trend. Some abortion-rights activists in Ireland during the 2018 referendum were insistent that the term “pregnant people” be used while campaigning, as if the fact that women forced to become temporary émigrés to access medical care had nothing to do with them being female. In a different way, talking about women’s periods as “people who menstruate” does less to make trans women feel included and more to make women feel like they’ve been reduced to bleeding machines.

Once you get that baby in your arms, you’ve become a part of something bigger

The reason the phrase “chest-feeding” rankles most women is not because we don’t want trans people to have a happy experience when having kids, but because so much pressure is heaped upon pregnant women about the importance of our breasts and breast milk that it feels like a cheat. The feeling of being truly inclusive – of being included in the special club of motherhood – is based on an understanding of shared experience. Being an individual patient can be lonely; but once you get that baby in your arms, you’ve become a part of something bigger.

I have mixed feelings about how I’ll (hopefully, one day soon) approach the prospect of motherhood. As a good leftie, I reject the idea that childrearing is a mother’s natural job and the breastfeeding, natural-mama-obsessed trends in feminism sound more like a get-out clause for men than a benefit for children. I fully intend for my husband to get involved with bottles – he can call it chest-feeding if he likes.

I’m excited to be able to share winks and nudges with other women, and for some other midwife to take my hand once again and give me advice about what she did when her baby wasn’t sleeping well. More than anything, I want to be reassured that the staff who spend so much of their life looking after others feel free to interact with their patients in the best way they see fit – without being hamstrung by procedure. Language matters – especially when it comes to vulnerable patients – but it must be free to exist in the reality we have; not conjured up to adapt to an imagined utopia.