Saturday, January 29, 2011

Is Facebook replacing midwives?

I have been following the blog of an Australian midwife and midwifery educator, and getting rather jealous of the response to her blog posts. MidwifeThinking, aka Rachel Reed, has been writing very thoughtful, informative and provocative posts about birth and getting heaps of comments - 75 comments at the last my average of two/three comments per post...hands down.

Birth stories
Once I got over my blog envy, I was fascinated to see how women had responded to Rachel's latest post; The Anterior Cervical Lip: how to ruin a perfectly good birth with so many birth quite a lot of detail.

Storytelling and social media
We know women love to tell their birth stories and debrief, and that it is very beneficial. But I have been left wondering how well we midwives support women to do this? As I read the birth stories on Rachel's blog and on Facebook pages I am wondering if this form of story telling is replacing the face-to-face discussions midwives have with women?

In other words is blogging...Twitter...Facebook...replacing midwives?

What do you think? What is your experience of telling birth stories as a midwife and/or as a birthing woman? Have you put your birth story out on Facebook or a blog? Why did you do it? Did it replace face-to-face discussions with your midwife? What did you get out of telling your story on Facebook or the blog?

Image: 'homebirth in a hippy shirt...'


Anonymous said...

Sarah I am flattered at your blog envy. You were the person who inspired me to start my blog... so I think you can take some of the credit :)
I think women are reclaiming the ancient method of learning through story-telling. They are sharing their experiences with each other via social media and building a network of knowledge. The role of the midwife as the information gateway is over. In the system midwives have so many tick boxes of information to give they are often not able to meet individual needs. There is little face-to-face time and midwives are constrained about what information they can provide. So, women get it elsewhere. Even with my practice (ie. plenty of time to talk during visits) women will have already accessed information and not require me to 'cover it'.

Sarah Stewart said...

There are 2 issues here...obtaining information and telling you own story.

There's heaps of evidence that women and families are going to the Internet for information. But I don't know how/if women are using social media to tell their debrief...I'll have to ask my Internet scholar friends what they think.

Loo said...

We are facing stringent financial cuts in public service here in the UK. One of the things that was proposed is that people should be charged for parenting ed £100.

One of my colleagues chortled and said,'well most of what women want is on the net anyway.......'
I was stunned most of them cheerfully have disapproved of what I do on the net.

I am very careful not to break the confidences of my clients and my NHS trust so do not post much regarding personal midwifery actions.

I also am cautious about the nature of many of the postings that have invaded the net in the past, as they have been radical, extremist, and I wonder if encourage women to take unnecessary risks.

However, there is much more available with professional quality to empower women to make appropriate decisions regarding their own care. UK we have the DR Foster hospital guide, NICE guidelines, CNST standards, RCM, RCOG, MIDIRS, ARM, to name but a few. All accessible for women to read.

Midwives will always be needed to help make sense of all this information overload.

Regards, Lorraine (aka Sufia)

Anonymous said...

Midwives in the system don't have time to listen to stories. Having just completed research using told birth stories I know that birth stories can last anything from 20mins to 2.5 hours.
Maybe you could do some research into social media and birth stories?

Sarah Stewart said...

Hi Lorriane

another thing I have been interested to observe is how quickly activists have taken to social media because it works so well to run campaigns of information etc. I have to say...I do not envy women trying to sort through all the information that is available online. How do you know if something is "main stream" or "extreme"? But...the bottom line is...they still need some sort of support/advocate when they go into hospital, in labour. And that is our job.

@midwifethinking Yes, I have been thinking about researching women's birth stories and how they tell them online for years...wanted to do it for my PhD back in 2004 but got talked out of it by my supervisor. I will do it one day, if no-one beats me to it.

Pamela Harnden said...

I am just a little 'wary' of the telling of birth stories without the aid of some sort of 'neutral facilitator'.

I gaine a reputation alongside Chris of working with women suffered 'pot traumatic stress' following a previous birth experience.

These women required very intensive emotional support and required a great deal of time investment in their emotional well being through their next pregnancies.

The main thing I noticed that their stories varied greatly and their was no absolute traumatic event which occurred the same in each case. Their 'traumas' were all very varied and to most professionals were trivialised, especially with obstetricians who believed that they should just be very grateful that they were healthy and that their babies were healthy.

I always listened to the women's stories, reassuring them going over the tiniest details with them during their recollections. I often then would sit down with the notes and look at what was documented. Often the facts as the women recalled them were not as they were documented in the notes and so there often appeared to be a vast difference between 'fact' and feeling perhaps influenced by the women's detachment and unawareness of 'real' time when in labour.

I have also been on the receiving end of someones perception of labour. Having birthed a 9 and a half pound baby with minimal medication in an upright position I felt it had been a fantastic achievement and I was both very proud and pleased for the woman involved. However she told her next midwife that I had traumatised her and that she found it the most traumatic experience which I was shocked and hurt about.

So really all I am really trying to say that there are some dangers of 'sharing' birth stories ad hoc and I am rather cautious about it.

Sarah Stewart said...

@Pam The question that comes to mind immediately is...what do we do (if anything) if a woman leaves a birth story on our blog that leaves us feeling that woman has issues that need to be addressed?

BTW...loving the idea of 'pot traumatic stress' LOL

Pamela Harnden said...

LOL, yes Sarah what a typo to make! I am still becoming accustomed to this new keyboard!

Yes I would be unsure as to what to do if a woman left a traumatic story via facebook or my blog, but there again I do recall a case where I felt compelled to direct the woman to the college of midwives and the resolutions committee so that she could gain some closure.

I think that where we refer to the oral sharing of stories in the past they have often been within women's circles some of those in quite the literal sense of sitting around in a group sharing.
The danger of doing it in the social media context is the possibility of a woman still feeling she is telling her story in isolation and doesn't necessarily get that immediate comfort of a possible sympathetic ear or warm hug.

I suppose this where the ethics aspect of birth story telling comes in within a social media setting.

Cassandra said...

I guess I'm not sure what you mean by replacing face-to-face conversations. Do you mean confronting the midwife about any problems that occured?

For me I felt a need to share my story for pure posterity so that it might be read by my daughter at a later date. Details were still fairly fresh in my mind within a couple weeks, things I might not remember in 5 years. It was also nice for my own emotional health to just reflect on the huge event I had gone through. Sharing it publicly was a sort of favor to others. My birth story is my most viewed posting right now. During my pregnancy, I would sit down with a great big glass of water and just read birth stories for hours. I didn't know what birth was like and I wanted to read about all the various different views of what it was like, almost fantasizing. There were a lot of positive, feel good vibes in birth stories that made me more confident in myself. I considered the conception, sustained, healthy pregnancy and natural childbirth of my daughter to be nothing short of miraculous. I felt there might be other women out there who could benefit from reading my entire story the way I had benefitted from reading them.

Sarah Stewart said...

Thank you, Cassandra. Have you found the birth stoires to be mostly positive. What do you od as a pregnant woman when you read a "horror" you leave it or do you read it? What is your reaction?

Cassandra said...

I made it a point during my particular pregnancy to stay away from horror stories. My birth center actually has a Yahoo group for families who had gone there to keep in touch, as a resource for help and such. I went there asking for stories, good or bad, as long as it had a positive side. A few responses were from women who had stillborns. Those were still good because of the way the women viewed their births and because they were able to heal from that trauma through sharing with others. It helped prepare me for that possibility as well. Those were not "horror" stories. The ones about hospital births gone wrong, or hospital transfers, or terrible care from providers, I stayed waaaay away from those. The extreme amount of stress I faced during my pregnancy from family members was actually causing complications in pregnancy - high blood pressure, problems sleeping, difficulty controlling blood sugars - so I went out to read birth stories that were positive, in one way or another, as a way to take my mind off of other things and focus on the amazing journey I was on.

Sarah Stewart said...

Thanks Cassandra. I guess what the Internet does is provide a venue for all sorts of stories. That does leave us readers with the issue of working out what we want to read...and believe, and what to avoid.

Kristine Andrews said...

This is one of the reasons that I choice to have my son at a Birth Center with midwives instead of at the hospital. I thought that they understood the importance of taking time to talk to woman and help them through the transition. Instead, I was in labor for 46 hours. My midwife was abrupt and annoyed when we would try to call her because it was a holiday and she had a young child of her own. My son ended up in the NICU for weeks with HIE and has developmental delays and disabilities. He was not able to breastfeed and was in extreme pain and discomfort for the first 8 months of his life. My midwives were extremely uncomfortable and I think worried about accusations of misdoing. I had nightmares and flashbacks of my birth for months. My midwives would only brush these things off and avoided us. They even told me that I must have done something earlier on in my pregnancy to cause the problems my son has. If it had not been for information and validate on the internet I don't think my family would have made it.

Sarah Stewart said...

Hi Kristine, Thanks for dropping by. I am really sorry you have had such a poor experience working with midwives. It goes without saying that no family should have to resort to the Internet for information in situations like that you find yourself in. The lesson for me as a midwife is nothing can replace honest and individual communication with women :)

Sarah L said...

I am just now realizing the wide range of care providers that are lumped under the heading "midwife," so I will specify that I had three home births in the USA with a professional home birth midwife. One of the difficulties I found in discussing my birth story with my midwife is that I hadn't really processed it in the time I was under her care. I have some questions about my last birth, but since my daughter is now 2 years old, I don't have contact with my midwife and I think it's unlikely that she would remember the details anyway.

I think one of the reasons that MidwifeThinking's post received so many comments and stories is that it brought up the idea of "what if" in a lot of women. Apparently many, many women were diagnosed with the anterior lip that she discusses in her post, and were subjected to a lot of painful and potentially detrimental interventions. For many of them, it looked like they were telling their birth stories as a way to speculate on why things didn't turn out the way they had hoped. I also noticed that many women were looking for information to affect their upcoming labor choices. All that to say, I think this particular post sparked a huge response for a particular reason, and not just because women are hungry to share their birth stories (although I have seen that urge, too).

Sarah Stewart said...

Thanks Sarah L. Interesting to hear your perspective...that women are not only using the Internet to find information but also to process their thinking. I am sure someone will be doing a PhD on this somewhere :)

Anonymous said...

Hi Sarah,

I guess I'm doing as you suggested and writing under the guise of anonymity in the internet world as a way to, perhaps, process or vent about my first attempted homebirth and subsequent transfer with my 5th child. Without taking up oodles of comment space sharing the specifics of my story, I will say that, sadly, being able to talk about and process any sort of trauma with a trusted midwife has been impossible in my town. In my experience, and we can speculate as to why, the midwives are very "clicky", and behave as some sort of symbiotic blob. Assuredly, they are reacting to what they view as hostility from outsider prospective, namely from the medical community, and work to effectively silence any questions or suggestions of "malfeasance". This "pearl in the oyster" preservation mode I understand, but it never allowed me to process my story with another local midwife when assessing my decision whether to try another homebirth with my current pregnancy without feeling the daggers of the "mean girls". I feel as if midwifery really should be about the women they serve rather than the collective preservation of the art of midwifery and the group of women that encompass it, which is no different than political parties who behave in their own best interest rather than those whom they were elected to serve. I ended up choosing my former OB/GYN (whom I adore) and who had seen me through my prior 4 babies, who doesn't care about my birth story/attempted homebirth, to be quite honest, but was a way better option than the highschool click of women claiming the title of midwife in my town.

Lastly, I LOVE birth and am good at it :) and feel entirely comfortable with our decision, I'm just disappointed with our one and only midwife experience.