When the subject “Submission to Birth” appears on the inbox of my computer screen, it signals the beginning of the publication process—as Editor, I am about to start mothering a manuscript. The journey is one of discovery and responsibility. Does the paper have publication potential? What new information will it offer readers? How will publishing this study influence practice and benefit mothers and babies?

Since I became Editor 21 years ago, the publishing business has been through many changes. Submissions to Birth have greatly increased in recent years (250 in 2009, 275 in 2010), making it necessary for us to be more selective about those papers we can accept, and knowing that this quarterly is constrained by a yearly page limitation, with enough room for only 36 research articles. Although it is a peer-reviewed journal, unfortunately not all articles can be sent for a full external review. As Editor, I serve as “gatekeeper,” to make the initial decision about whether a paper will be accepted for review or rejected, sometimes in informal collaboration with a member of the Editorial Board.

One of the first and most important criteria for selection is to make sure that the content of the submission matches the scope of Birth. Sometimes I suspect that the author simply is not familiar with the journal. Indeed, more than once an author’s cover letter accompanying the manuscript has been addressed to the Editor of another journal. Careless indeed! Did the Editor of that other journal receive a cover letter addressed to me? Authors also can be careless about failing to send the entire article—on occasion forgetting to attach the title page, or the Abstract, or tables and figures.

If the problem being studied is important to Birth readers, some general issues need to be considered at the outset—the clarity of writing, a tone that is unbiased and impartial, a description of limitations, and whether the authors have followed the style guidelines for this journal. The reference styles of other journals are very familiar, and authors often use a “cookbook” approach—one style serves for submitting the same paper to different journals.

If the standard of language is very poor but understandable and the study quality is good in other respects, a paper can be considered for peer review. On the other hand, because poor English can negatively affect a referee’s assessment of the paper and reduce its chance of being published, we suggest to authors that it would be helpful to have the manuscript edited by someone for whom English is the first language. Publishers, including Wiley-Blackwell, offer professional English-language editing services to authors for a fee.

Reasons for rejection of a study can include one or a combination of factors: insufficient new information; overlap or duplication with other publications from these authors or others; important terms are not defined; previous research is not described; ethical issues, informed consent, and institutional review board approval are not described; the sample population is too small; participant response rate is low; sampling method is not appropriate; study design does not match the problem; flaws in methodology; lack of statistical power; validity and reliability are not established; data gathering and statistical analysis are inadequate; results, tables, and figures lack clarity and relevance; references are outdated or missing.

Writing a rejection letter to an author is never easy. If a paper has gone through the double-blind, peer review process for Birth, and both referees recommend rejection, I attach the verbatim comments by the anonymous referees (edited for courtesy if needed). If the referees disagree (i.e., one recommends revision, the other rejection), sometimes I break the deadlock and side with one referee or the other; or I may ask the negative referee to reconsider; or I may send the paper to a third referee.

If the final outcome is rejection, does the author ever appeal the negative decision? Yes, indeed—we (i.e., the editor and the referees) can be wrong. I consider that this dialogue is a continuation of the peer review process (1), and in such cases I will ask the authors to revise and resubmit the paper for a second review, and advise them that acceptance for publication will be contingent on a positive review. A paper may go through two or three revisions before final acceptance or rejection. Rarely, and with permission from both parties, I have suggested that the primary author and referee communicate directly with each other about the revision—so far, always a positive experience and outcome for the author.

Once a paper is accepted, my “mothering” of the manuscript revision process really begins. My standard reference books are a Webster’s dictionary (2), Dorland’s Illustrated Medical Dictionary (3), The Chicago Manual of Style (4), and the American Medical Association Manual of Style: A Guide for Authors and Editors (5). I expect authors to follow the guidelines of the International Committee of Medical Journal Editors (ICMJE) and the Consolidated Standards of Reporting Trials (CONSORT) statement to help with manuscript preparation and improve the quality of their reporting.

Every journal has its own style developed over time by various editors, of course, and each editor has her or his idiosyncrasies. One of mine is a general dislike of abbreviations and acronyms. I have to admit, however, that I use certain organizational abbreviations, spelled out at first mention, such as WHO, ACOG, RCOG, ACNM, NIH, CDC, and a few others. It took a while, but I finally succumbed to VBAC (but not to all the other related acronyms with “-AC” endings), and I also accept abbreviations for some well-known survey tools, such as the EPDS. I avoid abbreviations for diseases and medical conditions, but I have made exceptions with HIV, spelled out at first mention. Another idiosyncrasy is my dislike of online tracking because when papers are revised and changes made by author and editor, confusion arises about whose tracking belongs to whom and which track is the most recent. And everyone seems to have trouble permanently erasing the tracking to obtain a clean copy.

I have preferences for clarity in writing. One principle is that shorter and simpler are better, for both words and sentences. Authors quickly discover that I change “utilize” to “use,”“prior to” to “before,” and “majority” to “most”; I avoid using “there is/are” and “there was/were”; and I search for a noun to follow “this,” because authors often scatter “this” around, referring to something—I cannot be sure what—in the preceding sentence. I dislike jargon, “medicalese,” and some clichés such as “state of the art” and “cutting edge.” I prefer writing to be vigorous, in the active tense if possible, and without unnecessary words (6). In my final editing of a paper, however, I try to keep most of the authors’ wording style—after all, it’s their article, not mine.

Authors can improve their papers by following a few key steps. Look at each sentence and ask yourself how you can state it more concisely. Study the introduction and discussion sections, omit unnecessary words and redundant material, and make sure the content is focused and well organized. Do not duplicate details of the results in both the text and tables, or in the discussion, and check that the description of methods is in the methods section, and results are in the results section. References are frequently full of careless errors—numbers not in consecutive order in the text, authors’ names misspelled, American spellings for British journal articles (and vice versa), omission of volume or page numbers, omission of publishers and their locations, unavailable websites, and more.

Some authors are naturally good at writing—their manuscripts are clear, lively, and they flow. They are a joy for any editor to read, but authors who do not write well can greatly improve with practice. So … start writing! And, a final reminder to every author who submits a paper to Birth or any other scientific journal, the word “data” is a plural noun.


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  2. References
  • 1
    Hames I. Peer Review and Manuscript Management in Scientific Journals: Guidelines for Good Practice. Malden, MA: Blackwell Publishing, 2007.
  • 2
    Merriam-Webster’s Collegiate Dictionary, 11th ed. Springfield, MA: Merriam-Webster, Inc., 2009.
  • 3
    Dorland’s Illustrated Medical Dictionary, 29th ed. Philadelphia: W.B. Saunders Co., 2000.
  • 4
    The Chicago Manual of Style, 16th ed. Chicago: University of Chicago Press, 2010.
  • 5
    American Medical Association. American Medical Association Manual of Style: A Guide for Authors and Editors, 9th ed. Chicago: Author, 1998.
  • 6
    Strunk W, White EB. The Elements of Style. New York: MacMillan Co., 1979.