To tell you a story quickly before we dive in...
I have a good friend who is a midwife doing amazing things in the world. Recently, she was attacked on a certain media platform.
The criticism was emotional and not evidence based. But the distressing thing is many people are reading it and getting a poor idea about midwifery and this friend of mine in general.
This kind of thing happens regularly. It's damaging and demoralising for midwives and often scares women.
But midwives (and women) have never been good at just believing what they're told!
Remember that the media exists to sell itself and will often publish what sells regardless of the truth. I thought I'd share my ways of assessing what I'm hearing.
5 Simple Tests To Help You Assess Midwifery In The Media
When you watch, read or listen to something in the media about midwifery or birth, ask...
1. Does the article, blog or program use a learning culture or a shaming, blaming culture to convey information?
If there's very emotive language like 'NHS blunder' or 'repeated scandals', or even 'blood on their hands', etc. the author may well be trying to use shame to try and gain attention (or to change things).
Midwives and other professionals are always trying to improve care. See more on this here.
But there's evidence to say blame culture and shaming doesn't help improve clinical care or workplace culture. I steer clear of media like this.
Name calling of any kind is also a good indication the author doesn't know how best to teach or convey information.
2. Does the author have a bias and it in the best interests of the article, program or blog to cause panic?
Does this panic prompt people to click on their blog and generate money through advertising? If tragedy is being used to motivate you to read on, it's often not an ethical or reliable media source.
Online, this sort of strategy is known as 'click bait'.
3. If you check a reference, is it correct? Does the link go where it says it's supposed to, in the case of blog articles? Sometimes a quote will say something like 'according to the Guardian' and then link to the Daily Mail!
Or a study will be misquoted in terms of where or how it was put together. We all make mistakes, but frequent spelling or grammar errors or not getting researcher or other names correct is a sign of not taking much care.
4. Does the author sound totally certain about what they're saying?
Or are there counter arguments they have examined? Very few things in life and in midwifery in particular have clear cut answers. An angry, hateful piece of writing with no room for uncertainty is often a sign the information is not evidence based.
5. Does the article, blog or program attack an institution that's usually well thought of, in a way which ties in with their particular cause?
For instance, the Cochrane Collaboration is a not for profit organisation that systematically reviews research and is highly regarded in medicine and midwifery. It's not perfect, nothing is, but it's some of the best medical evidence available worldwide. If a media source seems to be attacking such an organisation without an exceptional reason and balanced argument, you can usually be sure there's something amiss.
For The Geeks Like Me - 5 Advanced Questions To Help You Assess The Evidence Presented In The Media
1. Has the story linked back to the original research?
If the article, program or blog is truly trying to help and educate, it will do this. References are important.
2. Does the media source present an easy, simple answer to a complex, long-term problem?
The media loves breakthroughs and miracle cures but not much in science is as straightforward as this.
To use a non-birth example, many newspapers reported for a long while that antioxidants had been found to be protective against cancer.
But it's very difficult to separate out the people who eats lots of fruit and veg or who supplement with antioxidants from their good jobs and good overall lifestyles, and what effects these lifestyles have on health and cancer.
Perhaps it's people who are not so financially stressed who are at lower risk?
Right now, there simply isn't the evidence to say antioxidants protect against cancer.
Causes of cancer remain complex but if a media source suggests any one thing causes or prevents any disease or outcome, you can usually be sure it's not very evidence based.
NB: I've seen media recently that suggests midwives and pushing too hard for normal birth is a cause of Mums and babies dying and must be stopped. This is a huge and complex question, but from what I can see, there isn't good evidence to suggest this, quite the reverse in fact (see Cochrane review).
3. Have the statistics been massaged or misrepresented?
Start by asking if the study being discussed has a very small sample size. For instance, the original study that looked at the MMR vaccine being linked with austism contained just 12 children.
The type of study was a 'case series', which as far as I understand it, doesn't offer causation anyway. But 12 people in a trial is too small to prove anything as big as a vaccine causing autism.
Also, ask yourself whether the article outcomes might have been planned in advance.
If it's a small survey type study about opinions on something to do with birth, it may well be the outcome was a foregone conclusion to fit with the style of the newspaper or article.
Or the author of the survey chose an unusual sample group. Like we might expect women who are asked via the comments section on a blog article on homebirth to have a better than average understanding of the pros and cons than a survey of the general public on the street. We have to take this into account when assessing any source.
4. Have the statistics been cherry picked?
This means that certain information or trials have been purposely left out.
For instance, if there is just one trial or statistic named, you can usually be sure it's there for a reason and the author might be trying to convince you of something that's not proven.
Midwifery and obstetric research moves forward slowly with lots of evidence coming to light and building up a picture. It's also informed by other fields and themes emerge over time.
As I mentioned before, big, sweeping answers based on one study are not likely to be good science.
So a statistic like 'cerebral palsy rates have increased by 1/3 in the last decade and this is due to poor midwifery care in labour' is really hard for me at least to assess without more information on the rising birth rate, health of mothers, how many women are actually attending for care, and so on. More on this here.
5. Are they trying to confuse the reader by presenting statistics in a way that's hard to assess?
This is brilliant: you can be surer of a media source if the author has chosen to use 'natural frequencies' to help you understand what's going on.
All this means is they have chosen to say, 2/100 people as opposed to 2%. This is because percentages quickly get confusing. They're not intuitive.
For instance, in 2009, the Daily Mail reported on the increased risk of having a baby with Down's Syndrome for women in their forties. They said it was '16 times as likely' to happen as for women in their twenties.
But the NHS website puts it into 'natural frequency' form, i.e. 'a woman who is 20 has about a 1 in 1,500 chance of having a baby with the condition, while a woman who is 40 has a 1 in 100 chance.'
You can be confident the author is trying to communicate well, instead of going for big scary numbers, if they put things in this real world way.
And that's it for now! With these tools you're better equipped than almost everyone I know to assess what the media is wanting you to believe about midwifery and birth.
I highly recommend Ben Goldacre's book for more help on understanding science in general.
The problem with certain media sources that come across as furious or certain is that they're very appealing. It's much easier to tune into someone having a big rant or attacking something than it is to slowly, carefully assess evidence and think things through.
But when the anger wears off you're left worrying about whether it was all more complicated than you thought.
In the end it's far more satisfying to have that gut feeling of questioning and growing being the right thing to do. It's hard work but it feels good.
I want to leave you with an amazing song lyric from an artist I really like. It sums up how I feel about the media, research and midwifery:
Felix Rieble: It’s so hard to find truth in this chaos / For chaos in truth is so certain it bears / But of this I am sure we are given a purpose / And choice is a wonder familiar and rare / And they’ll steal all your love if you don’t stand there
Let me know what you think of this blog post! What's the most important thing you learnt? Leave me a comment, I love that.
Thanks for reading, hope this helps and thanks for doing what you do. When you see something horrible in the media, don't let it steal your midwifery joy x