Birth professionals (midwives, doctors, L&D nurses) will speak of a woman’s obstetric history using a variety of terms and “short-hand” words or acronyms.
Because “gravida” refers to pregnancy (as in hyperemesis gravidarum being loosely translated as “really bad vomiting during pregnancy”)…
- nulligravida refers to a woman who has never been pregnant (or gravida 0)
- primigravida refers to a woman who is pregnant for the first time or who has been pregnant once — in other words, from the time a woman gets pregnant the first time until she gets pregnant the second time, she can be referred to as a primigravida (or gravida 1)
- multigravida means a woman who is currently pregnant or who has been pregnant two or more times (gravida 2, gravida 3, etc.)
- “elderly” in obstetric-speak refers to women who are over the age of 35 (doesn’t that make y’all feel old?!), so an “elderly primigravida” is a woman who gets pregnant for the first time after she turns 35
- multiple pregnancies (twins, triplets, etc.) are still just one pregnancy, regardless of the number of babies
But not every pregnancy is carried to term, so the number of pregnancies a woman has in her lifetime is not sufficient information. A woman can have spontaneous abortions (more frequently called miscarriages), induced abortions, preterm births, or term births.
“Parity” refers to the number of times a woman has given birth. And here is where it starts to get a little interesting. Different countries use different definitions for this term. Typically, a woman is considered to have “officially given birth” if having had a baby (whether stillborn or live-born) after the age of viability, which varies from country to country — either because of the legal definition, or because of the state of their ability to keep very premature infants alive. In short, a baby that viable in the U.S. would not be viable in the back-side of Sierra Leone, simply because that country does not have the technology and available resources we have here. In America, if a woman carries a pregnancy to 20 weeks or more, then she is considered to have given birth (to be “parous”); in England, which probably has just as much technology as we do, the official age is pregnancy reaching at least 24 weeks. I believe that 24 weeks is the latest time in England at which a woman may have an abortion, or at least an “abortion for any reason”, so that may be part of the rationale behind using 24 weeks there. So…
- nulliparous or para 0 is a woman who has never given birth
- primiparous or para 1 is a woman who has given birth one time
- biparous or para 2 is a woman who has given birth two times
- multiparous is a woman who has given birth two or more times
- grand multipara refers to a woman who has given birth five or more times — at least in America; I saw that in England, it’s 4 or more times, whereas the WHO official definition is six or more. There are other terms I’ve seen, like “extreme grand multipara” and “great-grand multipara” and “grand-grand multipara”, but I haven’t found a definition of those terms. I assume that they are all variations of the same idea, even if the exact number of births varies, depending on the doctor or country — that is, one doctor may call a woman who has had 10 children an “extreme grand multipara” while another doctor might call her a “great grand multipara”; and another doctor may use the same term(s) for a woman who has had 8 children. (Although it’s possible that some people use one term for a woman who has had 7-9 births and another term for 10+ births — I just don’t know.) The same website that said that “grand multip” in England was 4 or more, said that “great grand multip” there referred to 7 or more births. I suppose it somewhat depends on the average number of children a woman has in the country of her residence. At my grandfather’s funeral, an aunt introduced my set of cousins who were 3 siblings as “a large family”, while the 4 of us siblings (my brother, two sisters and I) thought, “if 3 is large, 4 must be huge!” In a country where 1.7 is the norm, 3 may be large and 4 “grand”; but when 3 or 4 is normal, perhaps 5 is considered “grand”, and 8-10 is considered “extreme grand”.
- the birth of multiples (twins, triplets, etc.) is still just parity 1, regardless of the number of babies
“Aborta” refers to the number of times a woman has had either a miscarriage or an induced abortion — essentially, the total number of pregnancies minus the number of times she has given birth. Again, since “miscarriage” is a subjective term, and varies from country to country, and even from one era to another, what some doctors might consider an “aborta”, other doctors might consider a “parity”. My neighbor referred to her loss of a 7-month old fetus some 25 years ago as a “miscarriage”; it would now be considered a stillbirth, and she would have added 1 to her parity in today’s terms; perhaps at the time she lost the baby, it was considered officially as adding 1 to “aborta”.
Some women have abortions after 20 weeks — sometimes purely for “social” reasons (don’t want a baby and don’t realize how far along they are, or just don’t care; broke up with the baby’s father, and don’t want to give birth to his child), and sometimes for more “medical” reasons (baby has some sort of abnormality, or lethal congenital defect or something). I’ve recently read frequent stories on L&D nurses’ blogs about women having induction abortions from 20-30 weeks. I’m unclear whether these would be considered, in obstetric short-hand, as abortions or parity. The induction process is not that different at 24 weeks from 42 weeks; the only difference is that the purpose of the induction at 24 weeks is to end in the death of the baby (either from natural processes related to labor and birth on so fragile and tiny an infant; or if the baby is born alive, to allow it to die and not intervene with the tremendous amount of technology we have available designed to help these very premature infants survive an unintentional birth). The same induction drugs are used; the baby is born vaginally, just like in a successful induction — just the length of pregnancy is different. But had the woman not been induced at 24 weeks, the baby likely would have made it to term; and had the woman gone into labor prematurely and had the baby naturally (as opposed to being induced/aborted), it would have been counted as “parity”. So, I just don’t know. It may be that in an abortion facility, it would count as an abortion, but in a hospital, it would count as a birth. But I don’t know.
Many times “aborta” is left off, and a woman is just referred to with just gravidity and parity noted (typically in cases of women who have not had any miscarriages or induced abortions. When “aborta” is used, I don’t think it is noted whether the abortions were natural (miscarriages) or induced. Probably somewhere in the woman’s chart it would be specified, but not in the obstetric short-hand of G/P or G/P/A. This can cause some confusion. I can easily see that the term “abortion” is so strongly associated with induced abortion — the deliberate killing of the baby — that women who have had natural miscarriages would shrink back from the connotations of the term being applied to the loss of a much-wanted baby. Also, I know of two cases in which women died after a miscarriage, but when their families saw the term “abortion” on the death certificate, they assumed that the women had died of an induced abortion. This was in the 50s or 60s, and the woman’s survivors in these two cases became strong proponents of legalized abortion, under the assumption that these women would have survived had their abortions been legal. The only problem was, the death certificates showed that it was actually a “spontaneous abortion” — a miscarriage — which was implicated in the death of these women, not an induced abortion, legal or otherwise. So, obstetrically speaking, it is important to know whether “abortion” refers to a spontaneous miscarriage or an induced abortion.
Finally, when referring just to parity, the TPAL shorthand system is often used:
- T stands for “term” or the number of babies the woman has given birth to from 37 weeks onward
- P stands for “preterm” or the number of babies the woman has given birth to from 20 weeks, or 24 weeks, or whenever the current local “cut-off time” for parity is
- A refers to abortions — either miscarriages or induced abortions
- L refers to the number of living children the woman has, regardless of when they died or how old they were
Now, I’ll plug in some numbers of some women whose obstetric history I know. (I’ll put hyphens between the numbers for clarity, but they’re not always put in.)
- Me — I’ve had two pregnancies and two term births, so I would be G2P2 (“aborta” would likely be left off in my case, since I’ve not had any miscarriages nor induced abortions); in TPAL format, I would be 2-0-0-2; putting it together, I would be G2P2-0-0-2; were I to get pregnant again, until the time I gave birth, I would be G3P2-0-0-2
- My oldest sister had three miscarriages prior to the births of her two living children, so she would be G5P2A3; or G5P2-0-3-2
- My other sister had three pregnancies and three term births, so she would be G3P3, or G3P3-o-o-3
- My sister-in-law’s mother gave birth to six children, one of whom died of a heart defect; she also had two miscarriages I’m aware of: G8P6A2, or G8P6-0-2-5
- Another sister-in-law has 4 children, all born at term, and has had 1 miscarriage, so she would be G5P4, or G5P4-0-1-4. Her younger sister has never been pregnant, so she’s a G0P0. Her older sister is currently pregnant with her tenth baby (all singletons born at term), and has had two miscarriages, so she is G12P9, or G12P9-0-2-9.
- Bobbie McCaughey, mother of the McCaughey septuplets, had one child prior to the birth of the septuplets, and as far as I know, no miscarriages or other births before or after, so she would be G2P2, or G2P1-1-0-8 — I assume her first baby, a singleton, was born at term; I know the septuplets were born preterm; I assume she had no miscarriages or induced abortions; and has 8 living children — the older daughter and the septuplets. Despite having 8 children, she is not a grand multipara, having only given birth twice… even though one of those times it was to seven children at once.
- I’ve heard of a woman who had 16 miscarriages before finally calling it quits, getting her tubes tied, and looking into adoption; she would be G16P0, or G16,P0-0-16-0
- A friend of mine has the following obstetric history: first pregnancy was ectopic, so it ended in the removal of the affected fallopian tube, an induced abortion; her second pregnancy ended in the first trimester with a miscarriage, a spontaneous abortion (the doctor tested the fetus and found that it had major genetic defects incompatible with life, which was the cause of its intrauterine demise); her third pregnancy ended in the term birth of her only living child; she has been unable to get pregnant again: G3P1A2, or G3P1-0-2-1
- My neighbor I mentioned earlier had 3 term births, 3 living children, and one preterm stillbirth (which she called a miscarriage at the time), so she would be G4P4, or G4P3-1-0-3; but if at the time of her stillbirth it was officially deemed a miscarriage (since “viability” at the time may have been considered to start a week or so after her baby died in utero), she may have been considered a G4P3, or G4P3-0-1-3
- A woman in my church has had 6 children (all term), with 1 miscarriage prior to the birth of her last child; her 5th child died 4 years ago at the age of 20, so she would be G7P6, or G7P6-0-1-5
- Michelle Duggar recently gave birth to her 18th child; she has two sets of twins; as far as I know, she’s never had a miscarriage, all the births were at term (but I’ll say that both sets of twins were prior to 37 weeks, just because I can pretend that for these purposes), and all children are living, so she’s G16P16, or G16P14-2-0-18
- I remember reading a few years ago about a family who was involved in a car wreck that claimed the lives of most if not all of the children; while I can’t remember with certainty the details, I know it was a large family, with 6 or 7 children. I’ll assume that there were 7 children who all died in the crash, and she had had no miscarriages, and all the births were term. One minute prior to the crash, she would have been a G7P7, or G7P7-0-0-7; the next day, she would have still been a G7P7, but her TPAL would have changed to G7P7-0-0-0. A year or two after the crash, she was in the news again, having given birth to another baby, so she would then be G8P8-0-0-1.
When obstetric history is pretty straightforward (like mine), there is no difficulty in using this short system to keep track of things. But when you throw in all abortions, whether induced or spontaneous, things can start to get a little sticky, because it is unclear from the shorthand whether a woman is a serial miscarrier or a serial aborter, or both — all of which can be extremely important from an obsetetric standpoint. If I were an obstetrician, I would want to know whether a G5P0A5 had been unable or just unwilling to carry a pregnancy to term. My sister’s three miscarriages were caused by a septum in her uterus and/or low levels of progesterone. After her third miscarriage, her insurance company finally allowed her to be transfered to a high-risk specialist who discovered the septum, but also thought the progesterone levels might be a problem; so he removed the septum by surgery and when she became pregnant gave her a prescription to increase her levels of progesterone. Had her 3 abortions been induced instead of spontaneous, she may not have actually had any difficulty in getting nor staying pregnant — but that status cannot be properly determined by just saying she was an “aborta 3″ — it’s just unclear. (Of course, previous abortions may cause problems with future fertility and also may lead to future spontaneous miscarriages or preterm births. Techniques or technology may have improved the risk of this happening, but I’ve heard of many women who had an abortion in the past, when they got pregnant when they did not want to have a baby, assuming they could always have another baby, only to find out years later that the D&C had scarred their fallopian tubes shut.)
Also, as the last few examples using the TPAL system show, it does not reliably distinguish between children who did not survive the birth, or those who died in early infancy, and those who died later in life. While in some ways it is important to know whether a woman has experienced the loss of a child — whether through a miscarriage, an abortion, stillbirth, infancy, childhood, adolescence, adulthood or in old age — obstetrically speaking, I have to wonder why it is important to list how many living children a woman has, when the cause had nothing to do with pregnancy or anything remotely associated with obstetrics or birth. I can see it being important if the child was stillborn, or died because of some genetic condition or congenital deformity, or possibly even if he or she died of SIDS; but to die in a car wreck, or as a result of a plane crash, or some freak accident, or a stray bullet?
There are advantages and disadvantages to both the G/P/A system and the TPAL system. But it does leave out some very important facts, including the difference between a miscarriage and an induced abortion; whether the deaths of any of the children were due to factors in any way related to obstetrics or not; any reason behind any of the abortions; any reason for any preterm births, etc. It also doesn’t show how many C-sections or vaginal births a woman has had, which may be important for future considerations, since the risk of complications in birth (particularly hemorrhage and hysterectomy) or future pregnancy (especially placenta problems) increase with the increasing number of C-sections a woman has had. Nor does it show why a woman had C-sections, or if they were in fact unnecessary. Some C-sections are necessary; I know numerous examples of C-sections that were probably or definitely not medically necessary. I think these things would be important to know. But you can’t get them from G/P/A nor TPAL.
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