Ethics in the Childbirth Blog-sphere

I’m a continual learner. I devour books, articles, websites and other online media related to birth. As a doula and childbirth educator my experience has taught me discernment when it comes to interpreting articles, blog posts, and other sources of childbirth related information. As a birth professional I realize that not everyone has learned those skills.

As an avid reader of many blogs and Facebook fan pages I often find myself needing to ask for resources/citations for claims that are made either in the body of the blogs/articles or in the comments by authors or readers. Personal experiences are often held out as data, actual studies are often discredited because they don’t agree with the author or reader’s personal experiences, or it’s stated outright that data can be manipulated, thus it must all be invalid.

On the internet, blog posts and articles spread like wildfire. Social media sites like Facebook only enhance this process. It is the responsibility of the author to make sure that information presented as fact is indeed fact and provide a reference for the information provided. It’s equally as important to make it clear when an author is speaking solely from their own personal experiences. Like it or not misinformation can hurt others. If your goal is to educate and help your readers find their own power you must give them the tools to aid in the process.

Recently I’ve seen quite a few statements made about stillbirth rates. Many claim that the stillbirth rate at 42 weeks is the same as the stillbirth rate at 38 weeks. When asked for a reference for these claims the universal answer is “I read it somewhere, I’ll get back to you with the source.” I have yet to have anyone actually provide a source for this claim. (If you as a reader have it, please give a shout out in the comments, I’d love to have it!)

What I do have is a source from the BMJ dated February 12, 2000 that says that the risk of stillbirth at 38 weeks gestation is .52 per 1000. The stillbirth rate at 42 weeks is 1.55 per 1000. I have a handout that I often refer clients to written by Kim James, a fellow doula. Understanding Obstetrical Risk This handout addresses the stillbirth rates, and explains a bit about relative risks and absolute rates and how to interpret the data presented. It also gives readers a model to assess interventions and a mnemonic to help us glean more information upon which an informed decision can be made. For the sake of this blog post I’ll refer readers back to that handout if you wish to explore the topic and process further.

As a birth professional and birth advocate I am held to a high standard by both my certifying organizations and my own moral/ethical compass. If I make claims as fact, I need to back them up with facts. If I’m speaking from personal experience then I must make it clear that it is just that, personal experience.

When we proclaim ourselves as experts, by certification or opinion (blogs) we are responsible for our words. We have an obligation to our clients and/or readers to provide accurate information and to disclose our bias. When we conduct ourselves as experts in a particular field many followers of that field will trust what we say and take it as fact. While I don’t disagree that readers have the obligation to do their own research and make their own informed decisions that doesn’t absolve the birth advocate/blogger of the responsibility for their own words and how they are presented.

One of the hardest questions I’m asked by clients is “What would you do?” They are looking to me as their personal birth expert for answers that I can’t provide and am obligated to withhold. At the end of the day I am not the one who has to live with the consequences of the decisions my clients make. But that doesn’t absolve me of responsibility, it adds to the weight of responsibility I carry to my clients. My personal framework for risk assessment is mine alone. My personal thresholds for risk will be different from that of my clients. My job is not to help them have the birth I would want to have, but to help them have the best birth possible given the circumstances and to make the best decisions they can given information available to them.

As a blogger we are being viewed as and often are presenting ourselves as online birth experts. Our words hold much weight, our opinion the power to sway and our readers are inclined to trust us. The more popular we are, the more blindly we will be followed. We must not only be mindful of what we post, but how we post it. While we sit behind our computer screens and tap away at our newest blog post our readers are forming opinions and making decisions based upon our words.

Recently the creator of a site I follow posted the following:

I am not responsible for your birth. You are. Own it. Make informed and educated choices and get the right support…you know…IN REAL LIFE. Bloggers, blogs, Facebook pages and the internet can’t make choices for you and definitely can not birth for you.

I replied:
I don’t disagree that we as bloggers, FB page hosts, participants in these discussions can’t/don’t make choices for others. That said there’s a glaring lack of attention in the blogsphere as to how bloggers and all the aforementioned participants do influence others choices when we hold ourselves out as experts in any given topic. If the goal wasn’t to influence (inform) and educate then there wouldn’t be any reason *to* blog or otherwise participate in these discussions in the first place.

These forums have become a part of the information gathering process for consumers. We are responsible for what we say and the accuracy of the information we present.

Shortly after I posted my reply the author replied with a statement that informing was not making choices for others. I decided to not comment further because clearly the author just doesn’t understand what I’m driving at with my comment and previous attempts to engage in a similar conversation met with the same results. Within an hour the author went back and deleted my comment above entirely.  (*Update* The author has now blocked me from commenting on her Facebook page completely.)   Frequently, dissenting opinions are deleted from blogs and other online media, further controlling and distorting the information provided to suit the author’s own agenda.

I was talking with a fellow blogger about this issue while in the process of writing this post and she sums up what has taken me many paragraphs to express in just a few sentences:

“Bloggers are responsible for their words, therefore they should choose carefully. While each woman is ultimately responsible for her choices, they are greatly influenced by what she reads on the Internet, from mothering boards (where many, if not most, women hold themselves up as experts) to informative sites and blogs, the information can be (and is) taken as fact all too often.

“Perhaps what many of us should be saying is ‘Take what you read on the Internet with a salt lick because what you accept as fact might, in fact, be the exact opposite of safe.'”

~Navelgazingmidwife~

So what do you think? As a blogger? Mother? Other birth professional?

13 thoughts on “Ethics in the Childbirth Blog-sphere

  1. Pingback: Ethics in the Childbirth Blog-sphere - AllDoulas.com

  2. As a Childbirth educator in my area I believe 100% in what you are saying. I’m routinely scream at all the “reality” birth shows on TV because there is a extreme bias going on main stream. That being said, I have a hard time finding creditable sources; Thankfully I teach The Bradley Method (who does a lot of Medical/Statisical research for us) but am also guilty of sharing blogs without resources that mimic what I am approved to teach. I love Blogs, but have a HUGE problem with bloggers or FB pages who choose what comments to showcase.

  3. Pingback: Ethics in the Childbirth Blog-sphere | doula2you | ChildBirth 101

  4. Absolutely! Along the same lines, I recently wrote http://vbacfacts.com/2012/01/16/myth-risk-of-uterine-rupture-doesnt-change-much-after-a-cesarean, http://vbacfacts.com/2012/01/16/myth-unscarred-mom-induced-as-likely-as-vbac-mom-to-rupture and http://vbacfacts.com/2009/08/18/lightning-strikes-shark-bites-uterine-rupture. Ridiculous that any of this has to be explicitly written about, but these birth myths are believed, repeated, and defended in the complete absence of any data supporting them.

  5. Good on you for saying this!

    I see time and time again, women being cultured and led into risky decisions and then abandoned when things go horribly wrong.

    Of course, the deletions / blocking don’t help voices of reason to bubble through.

  6. I should add that the terrifying thing about that particular blogger is her complete lack of qualifications or medical knowledge. She wouldn’t even qualify as a hobbyist.

    Women like this need to be held to some account for creating a culture of risky behavior.

    • Snorkel, it’s really unfortunate. I’m a firm believer in not only being accountable, but being humble. If I’m wrong about something there is no harm in admitting that I’m wrong, in fact it’s a learning opportunity. You can bet that I’d know the correct answer the next time!

      I’d really hoped to have a dialogue with the individual mentioned in my post, however several attempts resulted in deleted posts and eventually being blocked entirely. And to be fair the example above was just one of many that I’ve seen recently so it’s just not that one individual, it was merely the most recent example.

  7. My thoughts are very similar. I enjoyed reading this post very much. I am also a birth doula and I think DONA training clearly describes how doulas should behave ethically. I am constantly saying to other doulas that I know have strong opinions: Your job is not to sway a client towards your personal choices—-your job is to advocate for what they want and to make sure they have access to good information to make informed choices. It is the couples birth, not yours. So, your writing resonated for me. I am glad to know you are out there……doing good work!

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