Ask questions…

It can be challenging to separate a truth from a half-truth or indeed an out and out lie in some media stories. I’m not talking about fake news here, but simple carelessness or personal bias. But when you think about this challenge in relation to women trying to make decisions regarding their birth, it is more than disconcerting, it is alarming.

Rightly or wrongly, news reports, blogs, TV dramas, each others’ birth stories are all absorbed and digested, feeding our perceptions of what is ‘normal’, what is best for the baby, what is safe and what is not etc.

As I researched my book it became disappointingly apparent that media reports frequently look only as far as the Abstract of a research paper, and then make broadbrush statements that fit their intended message. On reading the papers themselves it is in fact sometimes the case that the reporter has misrepresented or over emphasised the significance of the findings. Yet it is often these media stories, not the research papers, which form the basis of what many women believe to be true and on which we understandably base our own decisions.

Added to this, uptake of antenatal education is only around 60% and significantly lower for women that have already had one baby, (according to a UK Maternity Survey Report by the National Perinatal Epidemiology Unit, 2010). Important information doesn’t always get through, so questioning the truth of what we read elsewhere is important.

Personal bias, political or economic bias can all impact the truth of a report or blog and indeed the advice being given by health practitioners. Really it is only in reading around a subject – going to the original research papers, indeed more than one, that we can start to uncover the detail behind headlines. For example, often a research paper contains caveats – some of which can render a result interesting but very far from conclusive. Yet the media may report the results of that same research paper as beyond a shadow of a doubt – caveats rarely make it into an Abstract.

But a single research paper is a single viewpoint, a single investigation, a single set of conditions and single point in time. It is often possible to find papers that expand upon an idea or indeed completely contradict it – see below – and it is only in reading around, asking questions and questioning the agenda of the author, the researcher or the doctor that we can start to formulate our own position.

This all sounds very scary. How can we know that what we are hearing or reading is reliable. In reality we don’t, but by reading around an issue we stand a greater chance of knowing what questions to ask, it makes us more able to determine what is fact and what is a current best guess, what is a trend and what is plain persona, political or economic bias.

With a background in research I am used to reading research papers and statistics and I will never forget reading a published paper which claimed caesarean section caused obesity in children. It’s good headline fodder and no surprise has been covered time and again in the media. However, in this particular instance, on reading the full paper, I discovered the researchers failed to accommodate several important variables, in particular familial obesity. The presence of such a relevant, confounding variable renders the finding highly questionable. Being unable to rule out the impact of family patterns of behaviour with regards attitudes to food and eating habits makes it impossible to say with any degree of certainty that caesareans cause obesity.

An illustration of how media bandwagons often create more problems…

For quite some time, studies have been talking about the benefits of breastfeeding for babies born by caesarean. Research, suggesting composition of gut bacteria is subtly different according to whether the baby is born vaginally or by caesarean section, this study for example, typically finds caesarean babies breastfed for at least the first 4 weeks will demonstrate broadly similar gut bacteria to babies born vaginally by the time they are 8 weeks old (with implications for immunity systems). In other words, breastfeeding may mitigate the potential impact of a caesarean birth – with regards immunity. Naturally this has fed into the ‘breast is best’ campaign – no bad thing (assuming it is not used to guilt trip mothers about breastfeeding).

But media spin on such studies have on occasion also gone on to suggest – with regards immunity that caesarean born babies are at a significantly disadvantaged adding risks of obesity and asthma to the mix. All of which can understandbaly scare the pants off those women facing an unplanned or unwanted caesarean.

However, in 2017 yet another study, published in Nature Medicine, investigated levels of microbiota found in several locations around baby’s body and found that regardless of age at delivery ALL babies developed very similar levels of microbiota by the time they were 8 weeks old. Indeed by 6 weeks old the microbiota had expanded (and diversified) across ALL infants regardless of their mode of delivery.

The researchers said “We conclude that within the first 6 weeks of life, the infant microbiota undergoes substantial reorganization, which is primarily driven by body site and not by mode of delivery.”

In other words – the link between caesarean delivery and an increase in immune disorders is far from confirmed. Despite this, the media continue to generate emotive headlines, particularly when attempting to regurgitate old myths about the selfishness of women too posh to push, blaming caesareans for all sorts of childhood issues. As you might expect, in line with such scare mongering there has been an increase in the number of women asking about vaginal seeding when told they will need a caesarean delivery as a means of combating their worries about immunity complications. Ironically these women are asking for a procedure far less researched and far less understood than the caesarean itself.

As an aside – please note – the current stance of the UK’s NHS  is “vaginal seeding has unknown risks and is not recommended.”

While in the US ACOG state “At this time, vaginal seeding should not be performed outside the context of an institutional review board-approved research protocol until adequate data regarding the safety and benefit of the process become available.”

Such incomplete articles lead some women to actually consider adding procedures to their birth experience which are in fact far from proven and may actually prove to be harmful to their baby.

It is my intention with this post to draw attention to the challenges women face when trying to make informed decisions. Newspapers print the story that increase readership or reflect the bias of their readership and the onus really has to be on us to conduct our own investigations, asking lots of questions. Most articles name the study or author and with the Internet it is quite easy to get to the source to see what the researchers have actually said.

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