Speaker 1: Welcome to the Kick Your Expert led podcast, helping you
Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming
Speaker 1: a parent.
Speaker 2: On the podcast and our online pregnancy program grow My Baby,
Speaker 2: we share my experience of helping more than four thousand
Speaker 2: babies to be.
Speaker 1: Born and our experience of running a women's health clinic
Speaker 1: and parenting for boys.
Speaker 2: We're here to help everyone to feel empowered in pregnancy
Speaker 2: and birth with real life, practical information.
Speaker 1: Well, welcome everyone. I'm Bridgid Millenni.
Speaker 2: And I'm obstatrician doctor Patrick.
Speaker 1: Maloney, and we've just come fresh off a very exciting
Speaker 1: night where we did a big presentation to a group
Speaker 1: of GPS.
Speaker 2: Yeah. It was about our new collaboration with Monash IVF, Yeah,
Speaker 2: to bring IVF services to our clinic.
Speaker 1: Yeah. It was very very interesting and actually we covered
Speaker 1: things like PMOS, We cover fertility work up, what a
Speaker 1: fertility consult looks like, the role of endometeorosis infertility, and
Speaker 1: Pat introduced the concept of endometriosis surgery with a robot.
Speaker 2: Yeah. I couldn't help you love it because I'm that's
Speaker 2: my major professional interest at the moment, and I just
Speaker 2: thought i'd throw that in there even though it was
Speaker 2: mon Ash's night.
Speaker 1: No, I know.
Speaker 2: Then.
Speaker 1: My favorite thing that you said that night was that
Speaker 1: when you're doing surgery on a using a robot, it
Speaker 1: feels like you're a little con gynecologist inside.
Speaker 2: Just you've been shrunk down and you're inside the inside
Speaker 2: the pagient operating with your real hands. That's kind of
Speaker 2: what it feels like. Yeah, yeah, yeah, I also got
Speaker 2: a good laugh about my nun joke.
Speaker 1: Oh yeah, that's right. Tell our audience about why.
Speaker 2: I'll tell you quickly. So, our main private hospital here
Speaker 2: Invalerate is called Saint John of God. It's a church
Speaker 2: run a church run hospital, which is for our international listeners,
Speaker 2: is common in Australia that a lot of the early
Speaker 2: private hospitals in Australia were run by the Catholic Church
Speaker 2: and still are in some way. And our robot is
Speaker 2: called Sister Joan, and Sister Joan was the last of
Speaker 2: the Saint John of God nuns to actually work in
Speaker 2: the hospital. And there are there aren't any nuns in
Speaker 2: the hospital these days. And I just told a gag
Speaker 2: that when I was in primary school, I wasn't a
Speaker 2: massive fan of nuns that ran that ran the school,
Speaker 2: and I just said, I would have liked it if
Speaker 2: someone had told me back then that nuns would eventually
Speaker 2: be replaced by robots. Had got a good laugh.
Speaker 1: I'm laughing now and I've heard it about three times.
Speaker 2: So yeah, it was a really good night, really really interesting,
Speaker 2: and a pleasure to bring people up to date on
Speaker 2: what we're up to.
Speaker 1: Yeah. No, no, it was just exciting. So you know,
Speaker 1: we've got a buzz, We've got a buzz about us,
Speaker 1: and we're going to do a podcast. You know, it's
Speaker 1: a little bit different from the information laden podcast that
Speaker 1: we do, but we see it as a big problem,
Speaker 1: and that is people being able to discern whether the
Speaker 1: advice they're seeing on their social media is evidence based
Speaker 1: or it's just simply loud. So, you know, I don't know,
Speaker 1: I thought it was. There's so many examples that we
Speaker 1: can bring up, but the first one that sprung to
Speaker 1: mine was remember the United States Health Secretary Jay Kennedy,
Speaker 1: I think, said that panadol, taking penadol in pregnancy causes autism.
Speaker 1: And I think that just shocked every person that had
Speaker 1: been pregnant or was currently pregnant, because I don't know
Speaker 1: what the stats would be but I reckon nearly everybody
Speaker 1: would have taken padal.
Speaker 2: And so that wasn't actually a question up for broad
Speaker 2: clinical debate. That the fact that that panetole does not
Speaker 2: cause autism is is abundantly clear. It's been proven time
Speaker 2: and time again, and there is no data suggesting a
Speaker 2: link there other than the tired old problem which we
Speaker 2: know leads to wrong conclusions, which is that association and
Speaker 2: causation aren't the same thing. So panidole doesn't cause autism
Speaker 2: any more than wearing pants causes autism.
Speaker 1: And I'm pretty sure most people have got pants on.
Speaker 1: So yeah, Yeah, it's a bit that is complex, and
Speaker 1: we're going to get into, you know, the simplicity that
Speaker 1: comes across in social media and why that's so easy
Speaker 1: for people to absorb. You know, it's a very simple message.
Speaker 1: You can't do a complex message well on social media.
Speaker 1: You just can't keep people's attention for that long. Yep.
Speaker 2: It doesn't help when the advice leaps over the barrier
Speaker 2: from social media into the real world and senior people
Speaker 2: who should know better start saying things that are patently untrue.
Speaker 1: Yeah. So the other one, I just was shocked to
Speaker 1: my core with was there was a very big influencer,
Speaker 1: a woman in her early or late twenties who was pregnant,
Speaker 1: and she was taking a supplement and she said, so,
Speaker 1: you know, I really wanted to find out whether I
Speaker 1: should be taking this supplement or not. So I went
Speaker 1: to my ob was an American. I went to an
Speaker 1: ib and she said that, you know, I didn't need
Speaker 1: to take this supplement. But then, you know, my Instagram
Speaker 1: feed is full of people saying I should take this
Speaker 1: supplement because otherwise I'm going to cause like horrible consequences
Speaker 1: to my child. And then she finished the real with
Speaker 1: so who am I to believe?
Speaker 2: It's posed to flip? Yeah, yeah, that I remember that
Speaker 2: looking at that and thinking this is really the problem,
Speaker 2: or for that person at least, is really a big one,
Speaker 2: because if they think that those are too equally valid
Speaker 2: and equally equally accurate sources of information, then who is
Speaker 2: she supposed to believe? I guess the doctor in me
Speaker 2: has always thought that the advice that we give to
Speaker 2: the best of our ability is not just something we
Speaker 2: made up. It's something based on years of cumulative research
Speaker 2: and knowledge and the so we do we have been
Speaker 2: perhaps coasting along, thinking that the advice that we have
Speaker 2: been given would outweigh the advice that somebody got off
Speaker 2: some randos on the socials. But maybe for some people
Speaker 2: that's not true.
Speaker 1: No, this woman was genuinely anxious about it, Like you know,
Speaker 1: it wasn't It wasn't tongue in cheek or satire or
Speaker 1: anything like that. She was. She was genuinely confused who
Speaker 1: she should believe, So, you know, and I get it
Speaker 1: in certain generations as well. It's gone really from my
Speaker 1: doctor said, so therefore it's true too. I'm not sure.
Speaker 2: Yeah, I'm not sure.
Speaker 1: They might.
Speaker 2: There might have once upon a time been too much.
Speaker 2: As the doctor told me to do this stuffing, and
Speaker 2: I didn't even stop to think why, Which is you
Speaker 2: know that that can't be a good thing. If we're
Speaker 2: asking people to put something in their bodies or do
Speaker 2: something with their bodies or whatever, that that should should
Speaker 2: have an evidence base that's beyond they're there. I told
Speaker 2: you to do it, and just do it.
Speaker 1: Could you imagine actually having that flight in your consultations?
Speaker 2: Not anymore? Doctor knows best. I don't think you wouldn't
Speaker 2: get away with it for long?
Speaker 1: No, No, and not no, you should so you know.
Speaker 1: That's what our pregnancy podcast is about, So informing you
Speaker 1: with the information that's you have a conversation with your
Speaker 1: doctor about, you know, different methods of treatment and plans
Speaker 1: at the risk of.
Speaker 2: Being overwhelmed by emails. If you think I have said
Speaker 2: something in the podcast that is inadequately explained, then I
Speaker 2: think you feel free to get in touch and say
Speaker 2: what's your data?
Speaker 1: Yeah, need something more there. But the things on Instagram
Speaker 1: that I really wanted to point out are the things
Speaker 1: that say you know and you see it. They scream
Speaker 1: at you never do this in pregnancy, or always do this,
Speaker 1: or you know. One of our favorite things is these
Speaker 1: are things your doctor never wants you to know.
Speaker 2: That's my personal favorite. Let's deal with that one up front.
Speaker 2: There is nothing that your doctor doesn't want you to know.
Speaker 2: Nothing that's true. Yes, of all the true things in
Speaker 2: the universe, there isn't one of those that your doctor
Speaker 2: does not wish you to know. So anything on the
Speaker 2: socials that mentions that you can safely ignore upfront, yep,
Speaker 2: that is based one hundred percent in an effort to
Speaker 2: drive a wedge between you and good advice, and that
Speaker 2: can't be a great place to start.
Speaker 1: The other thing is the doctors don't want you to know,
Speaker 1: or the big farmer doesn't want you to know, implying
Speaker 1: that there's kickbacks, and apart from a pen that I
Speaker 1: have on my desk, yeah, we have never received a kickback.
Speaker 2: Don't even anything. Don't even really get pens anymore. No,
Speaker 2: so the kickbacks, like the social sometimes will tell you
Speaker 2: that they're literally cash cash, money changes hands, and that
Speaker 2: has never been part of our medical culture in Australia
Speaker 2: and is specifically illegal. Even things which was sort of
Speaker 2: a version of money changing hands, like a company paying
Speaker 2: for you to go on a holiday or for you
Speaker 2: to have to go somewhere nice in the sun and
Speaker 2: you just had to go to ten minutes of their
Speaker 2: conference in the morning and then you could go to
Speaker 2: the beach for the rest of the day. That's all
Speaker 2: gone as well.
Speaker 1: Yeah, and we're only speaking from an Australian perspective. You know,
Speaker 1: there might be other countries where that isn't the case,
Speaker 1: but that is for us. And it is also for
Speaker 1: doctors selling things such as supplements or whatever like in
Speaker 1: Australia you can't do that either.
Speaker 2: Very tightly controlled. Yeah, very very tightly controlled.
Speaker 1: If you're are pro registered, you just can't do it.
Speaker 1: So you know, I know have quite a few very
Speaker 1: very famous instagrammers for menopause who are doctors in other
Speaker 1: parts of the world and they can sell whatever they like.
Speaker 1: So you know, that is also a bit of a
Speaker 1: red flag for.
Speaker 2: Me in Australia. It is by as far as we
Speaker 2: can tell, when we look at what goes on other countries,
Speaker 2: we're extremely tightly control. And that's not just with you know,
Speaker 2: the the selling of things, but even advertising. Yeah, yeah,
Speaker 2: we can't really advertise.
Speaker 1: We can't say that you know, we're the best, or.
Speaker 2: Certainly can't say that you're better than anybody.
Speaker 1: Else, or you could expect better our outcomes by coming
Speaker 1: to see us, or you know, we no doctor can
Speaker 1: actually say that.
Speaker 2: It's I remember visiting the US years ago and just
Speaker 2: seeing seeing a post I was on the ferry to
Speaker 2: go out and look at the statute of limiting. This
Speaker 2: a poster on the ferry that says I am the
Speaker 2: best cardiac surgent.
Speaker 1: I love it.
Speaker 2: Yeah, and I just thought, wow, I've never seen anything
Speaker 2: like that. Yeah, so yeah, beware, beware things. Let's say
Speaker 2: that that that this is a secret that the system
Speaker 2: doesn't want you to know.
Speaker 1: So I want to delve into why pregnancy, Why does
Speaker 1: it attract so much conflicting advice.
Speaker 2: I think that it it's very pregnancy is a time
Speaker 2: when people can be very easily influenced out of fear.
Speaker 2: So that for the first pregnancy in particular, is a
Speaker 2: scary time for people, and they are often overwhelmed with
Speaker 2: a sense of responsibility to do the best they possibly
Speaker 2: can for the outcome of the pregnancy and the safety
Speaker 2: of themselves, but more in their mind is the safety
Speaker 2: of the baby. And so that's a population that is
Speaker 2: relatively easy to exploit with fear based arguments.
Speaker 1: I think also that it's you know, yeah, you're right,
Speaker 1: it's absolutely high stakes, but it's also the time in
Speaker 1: a woman's life that she is she doesn't have tons
Speaker 1: of control, you know. So it's this juxtaposition where you
Speaker 1: you it's high stakes, but you know, you can control
Speaker 1: what you eat and you control the exercise that you
Speaker 1: can do, but you know, there's lots that you can't control.
Speaker 1: It's baby behavior, or it's your genes, or you know,
Speaker 1: it's just something that you've got to accept and roll
Speaker 1: with the punches a little bit.
Speaker 2: Yeah, So if we look at the advice that's given,
Speaker 2: you know, accurate advice might say care subtle, fairly nuanced
Speaker 2: things that might be different for you as an individual
Speaker 2: compared to another person as an individual. Whereas if we're
Speaker 2: going to really try and influence the behavior of someone
Speaker 2: by exploiting her lack of control and exploiting her vulnerability
Speaker 2: to fear based arguments, then then we make broad statements
Speaker 2: that are inaccurate but go right to the heart of
Speaker 2: that fear. And that's that's a lot of what we
Speaker 2: see on the socials.
Speaker 1: The other thing that is common is, you know, there's
Speaker 1: so many people that have had a baby, you know,
Speaker 1: so then they have their own experience, in their own
Speaker 1: personal sort of take on things.
Speaker 2: Yeah. Yeah, so that is that is really interesting because
Speaker 2: the medical world looks at something like risk from a
Speaker 2: community level. You got to you've got to zoom out
Speaker 2: and say such and such an intervention, if it's done,
Speaker 2: will will will result in better outcomes. Per one hundred
Speaker 2: thousand women, one extra baby will survive, one extra woman
Speaker 2: won't get hypertension. But people who've been through a pregnancy
Speaker 2: before and having another one that they are mostly focusing
Speaker 2: on themselves and their own personal risk, and therefore it's
Speaker 2: easy to say, well, I did this last time at
Speaker 2: worked fine, so that'll work fine again. Now that the
Speaker 2: person who's thinking that way, that are wrong. But they're
Speaker 2: just not answering the same question as the medical world
Speaker 2: is answering when they when we talk about safety.
Speaker 1: And that is hard because you know, especially say in
Speaker 1: a family or whatever, and your sister might have had
Speaker 1: one experience and you want that same experience, but your
Speaker 1: experience ends up being different. Like, you know, you sort
Speaker 1: of that's that's your frame of reference. You're you're sort
Speaker 1: of looking within a very small sample size.
Speaker 2: Yeah, and then and then nuance is hard to get across,
Speaker 2: Like your sister might have done very well with treatment xyz,
Speaker 2: but she may be an entirely different which category to yourself.
Speaker 1: I want to talk about a little bit about how
Speaker 1: sometimes really confident posts like seven seven things you must
Speaker 1: do to ensure you get a vaginal birth, or you know,
Speaker 1: really confident posts sounds sometimes a bit more convincing than evidence.
Speaker 2: Yes, yes, So the first thing I think of when
Speaker 2: I see those is, if it was that easy, why
Speaker 2: wouldn't we have.
Speaker 1: Done it like a practitioner.
Speaker 2: Wh yeah, so that's my practice with my practitioner's hat
Speaker 2: on thought, Oh my god, there's only seven things, fantastic,
Speaker 2: I've better read this because here am I thinking there's
Speaker 2: hundreds of factors. But if there's only seven, sit down,
Speaker 2: get a coffee, I'm going to read it. So maybe
Speaker 2: it comes down to this idea that humans are wired
Speaker 2: to trust. You know, if we if somewhere in our
Speaker 2: prehistoric selves, if someone if the if the chief of
Speaker 2: our clan said we're going to go and we're going
Speaker 2: to up and move to the other side of the
Speaker 2: of the plane where there's more food. All right, great,
Speaker 2: let's do it. So I think we are wired to
Speaker 2: take on advice and not necessarily think stuff through for
Speaker 2: ourselves every single time. Our brains are also wide for shortcuts,
Speaker 2: and so we love a confident We love confident.
Speaker 1: And we like personal stories like who doesn't love a
Speaker 1: personal story? Like it's something that you know, I mean,
Speaker 1: I don't love listening to birth stories, but it is
Speaker 1: one of the most popular podcasts. People love listening to
Speaker 1: personal stories. But every single personal story is a sample
Speaker 1: of one. And you know, going back to your taking
Speaker 1: a bird's eye view and looking at it from a
Speaker 1: statistical point of view. Like I've read some of those reports.
Speaker 1: I've read lots of those sort of research papers, and
Speaker 1: it's very hard. It's very dense reading. It's very hard
Speaker 1: to understand the statistics. Yes, And you know, even though
Speaker 1: I've read lots and I've actually done REDS search as
Speaker 1: a university subject. But I come back and I say, oh, Pat,
Speaker 1: did you know that blah blah blah and this amount?
Speaker 1: And you and then you you help me. We know
Speaker 1: that sounds funny, but you know, you help me understand
Speaker 1: that statistic more meaningfully. It's really hard to interpret them.
Speaker 2: It is, and it's hard. It is hard to especially
Speaker 2: for non medically trained people, to understand what the hell
Speaker 2: we're talking about. Some of the time. I think that
Speaker 2: another problem that's going on in the background is that
Speaker 2: as human beings, we hate to feel anxious. We hate
Speaker 2: to feel that that that we need to make a
Speaker 2: decision between two big options, and it's we can't think
Speaker 2: of anything else, and it's really really upsetting us. So
Speaker 2: sometimes we'll choose the comfort of a decision having been
Speaker 2: made over it necessarily being the right.
Speaker 1: Decision, and that's why you know we talk about a
Speaker 1: birth plan or a birth map. You know it's not
Speaker 1: step one, step two, step three. Yeah, it's about sitting
Speaker 1: with the anxiety around that it's unpredictable and like you've
Speaker 1: got to be You've got to have the knowledge to
Speaker 1: know if it goes down one particular path, you've got
Speaker 1: to make decisions yes, or if it goes down another
Speaker 1: particular path, that's another set of decisions. And so you
Speaker 1: know that is so nuanced and complex that you cannot
Speaker 1: get that small little SoundBite on social media.
Speaker 2: Know that the whole problem with social media is that
Speaker 2: the message needs to be very brief.
Speaker 1: And when I listened to you and actually from the
Speaker 1: Monash talk that we just did, and you were saying
Speaker 1: that you were all excited when the new endometriosis guidelines
Speaker 1: came out and then you said, you know, finally I've
Speaker 1: got something I can go Okay, I can hang my
Speaker 1: hat on this is how we're going to do endometriosis.
Speaker 1: And yet the guidelines are still like.
Speaker 2: Oh they're disappointing.
Speaker 1: Yeah, they've been disappointing. They're about like, while it's pens, there's.
Speaker 2: A lot of it depends. Yeah, and there's a lot
Speaker 2: of we think it's probably the best thing to do this, yes,
Speaker 2: and then and then reference down the bottom level of
Speaker 2: evidence low. Yeah, So that is that certainly is a problem.
Speaker 1: And often that's what good medicine looks like, doesn't it.
Speaker 1: You know, it's sort of like if you're if you're
Speaker 1: hoping for a very very strong, definitive this is the answer.
Speaker 1: Lots of medicine can't put its whole claim on that
Speaker 1: because there hasn't been an RCT, you know, there hasn't
Speaker 1: got the level of evidence. Yeah.
Speaker 2: Yeah, and so as you as you said accurate, accurately,
Speaker 2: just now, good medicine is new once.
Speaker 1: Which you know is the opposite of a very confident
Speaker 1: these are seven mistakes you should never make in your pregnancy.
Speaker 1: You know, like it's very very different. Now it's hard
Speaker 1: hard to get that message across. All right, Well, what
Speaker 1: about those postpat that look like their research driven? They say,
Speaker 1: the people say, oh, research says, how can a participator
Speaker 1: in social media actually work out whether the research that
Speaker 1: they say that they're referencing is any good? Yeah?
Speaker 2: Great questions. So you can call anything research.
Speaker 1: My Google, I call that research.
Speaker 2: Yes, A distressing number of people call the call their
Speaker 2: looking at social media research. Yeah, where it's not what
Speaker 2: I mean by research. But that's that's all right. We
Speaker 2: can both use the term but the but but I
Speaker 2: think people should be roughly aware of what your doctor
Speaker 2: means by research and what and what he or she
Speaker 2: might be has he or she might prioritize the confidence
Speaker 2: that we can have in the conclusion because of the
Speaker 2: study that's been done. And so, you know, put briefly,
Speaker 2: be systematic. What are called systematic reviews are published from
Speaker 2: time to time by collectives like the Cochrane Database, and
Speaker 2: the point of those is to take a bunch of
Speaker 2: reliable studies, combine them in a way that is legitimate
Speaker 2: for research purposes, and add them together to increase the
Speaker 2: confidence that we can have in their conclusions. So you
Speaker 2: might put together a series of studies that were done
Speaker 2: in various countries that were all quite similar, and they
Speaker 2: issue statements which are among the very best evidence that
Speaker 2: such and such is true. And there are you know,
Speaker 2: the Cochran it's not for everybody, but the Cochran database
Speaker 2: is free. You get on an avelock and it's amazing
Speaker 2: some of the things that they've looked at, and sometimes
Speaker 2: it's they are health issues that you might have thought
Speaker 2: were relatively trivial actually have a clear internationally respected cockin
Speaker 2: review on whether or not bananas help with night cramps
Speaker 2: in pregnant women.
Speaker 1: Wow, did they know?
Speaker 2: Then there's and then there's individual randomized control studies, which
Speaker 2: are thought to be the best trial design, so that
Speaker 2: if we take a hundred thousand people and give them
Speaker 2: one treatment, and one hundred thousand people and give them
Speaker 2: the other treatment, ideally with none of those people knowing
Speaker 2: which treatment they've got, and none of the people running
Speaker 2: the study knowing at the time which which treatment they've got,
Speaker 2: observe who does the best, and then and then de
Speaker 2: blind the study and have a look and see and
Speaker 2: see of the people who did the best, which which
Speaker 2: treatment they have. Those are the ones that we find
Speaker 2: the most persuasive.
Speaker 1: They're very few and far between in the pregnancy will though,
Speaker 1: aren't they It's hard. It's hard, like could you imagine
Speaker 1: saying yes when you're pregnant to a trial. You don't
Speaker 1: know what it is, you don't know what it's going
Speaker 1: to affect you, don't you know, I just don't know
Speaker 1: how they get any of those up.
Speaker 2: There are serious ethical problems with doing RCT's randomized control
Speaker 2: trials when you are next to certain of the answer already,
Speaker 2: and so what you're theoretically doing is exposing half the
Speaker 2: half the group in your trial to to a treatment
Speaker 2: that you honestly already believe is inferior. And it's another
Speaker 2: reason why not necessarily open the vaccine discussion. But it's
Speaker 2: a problem with RCTs being done now for various vaccines
Speaker 2: that have been ought to be extremely safe and effective
Speaker 2: for many years, because how would it be ethical to
Speaker 2: deny that vaccine to half the group. And so there
Speaker 2: are similar problems in pregnancy when we're next to certain
Speaker 2: that something is already the right way.
Speaker 1: To go, and the.
Speaker 2: Hierarchy of studies just goes rapidly down from there. Okay,
Speaker 2: there are sort of observational studies where you just you know,
Speaker 2: you have someone with an own problem, you give them
Speaker 2: a known treatment and just watch them and see how
Speaker 2: it goes. That's not as good as a blinded study.
Speaker 2: And then right down the bottom is port expert opinion,
Speaker 2: which is just what someone says because they've got a
Speaker 2: gut feeling.
Speaker 1: Oh, I reckon, there's another one, and that's the influencer anecdote. Anecdote, Yeah, yeah,
Speaker 1: you know, they pin themselves next to the expert opinion.
Speaker 2: Occasionally, when we look at well constructed public health messages,
Speaker 2: often I don't know if people have seen this, but
Speaker 2: for example, if they say if they talk about a
Speaker 2: disease affecting one percent of people, a well constructed public
Speaker 2: health message will often have a poster with a one
Speaker 2: hundred people on it, and one of the one hundred
Speaker 2: little people all the rest of read and the other
Speaker 2: one's green. And it's just these are ways of trying
Speaker 2: to help educate people, not what one percent means. People
Speaker 2: understand that that's one in a hundred, but give a
Speaker 2: visual message to say that that's rare ish but by
Speaker 2: no means rare, rare, rare. You know.
Speaker 1: Yeah, if it was one in one hundred that your
Speaker 1: chance of winning tats looto, you would buy a ticket.
Speaker 2: Yeah, yeah, exactly. So there are a number of known
Speaker 2: ways to try and help take some of the emotion
Speaker 2: out of it. And one of the problems with anecdotal
Speaker 2: evidence from the Internet. I did this, and I did well.
Speaker 2: By far the most common that we've seen, I guess is,
Speaker 2: here's the ticket to a vaginal birth. I did this
Speaker 2: and I had an easy vaginal birth. And this is
Speaker 2: complete rubbish. Yeah, yeah, you don't hear me. Make too
Speaker 2: many there are. There is no validity in this statement whatsoever. Firstly,
Speaker 2: if that was a thing, we just do it for everybody, right,
Speaker 2: nobody's happier than us when someone has a uncomplicated vaginal birth.
Speaker 2: Instantly we should be skeptical of such a claim, but
Speaker 2: it's it is not. You know, there's a there's a
Speaker 2: well known psychological experiment where if you tell a child,
Speaker 2: a young child, I can't remember the exact age, but
Speaker 2: if you tell a young child a story about a
Speaker 2: boy goes to the shop and steals a bunch of lollies,
Speaker 2: and halfway home he falls off a bridge into a
Speaker 2: river and nearly drowns. And then and the little will
Speaker 2: go on, well, of course me tale. And then you say,
Speaker 2: what if you went to the shop and didn't steal
Speaker 2: the lollies. At a certain age of development, the job
Speaker 2: will say, well, you won't fall.
Speaker 1: Off the bridge.
Speaker 2: Yeah, right, But I think when we get to about four,
Speaker 2: we stop being fooled by that, and we should be
Speaker 2: looking at this data and saying there is no connection
Speaker 2: between what you've proposed and the outcome that you've claimed
Speaker 2: on the basis of it. We got to do better
Speaker 2: than that.
Speaker 1: I can't help but think that people who pick up
Speaker 1: this episode, we're preaching to the converted. Yeah, maybe I
Speaker 1: don't know how to get it to people that sort
Speaker 1: of still think that you'll fall off the bridge. All right,
Speaker 1: So I want to talk about the next thing, which
Speaker 1: is what should somebody do if the advice about pregnancy
Speaker 1: comes from two different birth experts but they differ. And
Speaker 1: the reason why I'm saying this is because recently, I
Speaker 1: don't know whether it was you know, we recently did
Speaker 1: a podcast on caesarean rates rising, and another really popular
Speaker 1: podcast got on to her socials and said this. It
Speaker 1: was her pov. You realize that women are at more
Speaker 1: risk dying from a caesarian compared to a vaginal birth,
Speaker 1: and that the cesarean rates are increasing for no good reason,
Speaker 1: which means more women will die for no good reason. Yeah.
Speaker 1: Now this went viral. It thousands and thousands.
Speaker 2: Of you who were sucked in by that.
Speaker 1: Ye, thousands and thousands of likes, thousands of comments like
Speaker 1: and I.
Speaker 2: Just went yeah, because it sounds a little bit true,
Speaker 2: doesn't it. If you're more likely to die from a section,
Speaker 2: then the more sections we do, the more people die.
Speaker 1: Yeah.
Speaker 2: And the only problem is that it's not true. Again
Speaker 2: that the problem here is that association is not causation,
Speaker 2: and the women in the CAESAR group who die they
Speaker 2: didn't die because of the caesar. So caesarian section is
Speaker 2: actually extremely safe operation. And the reason why. Firstly, we
Speaker 2: have to be very careful about drawing conclusions from rare outcomes,
Speaker 2: So very very very very few people diees resolve their
Speaker 2: pregnancy in Australia. Of those that do, there are often
Speaker 2: people who are so sick for other reasons that their
Speaker 2: baby is born by sas air insection for reasons related
Speaker 2: to whatever was wrong with them, not not the caesar itself.
Speaker 2: Does that make sense? So, for example, in the worst
Speaker 2: part of the COVID epidemic globally, pre vaccine pregnant women
Speaker 2: were showing a distinct susceptibility to becoming particularly unwell if
Speaker 2: they got full blown COVID, and they were coming into
Speaker 2: hospitals internationally with bilateral pneumonia and circulatory collapse and a
Speaker 2: complete complete life threatening disaster related to having COVID. Now,
Speaker 2: sometimes when they admitted to the hospital, their babies would
Speaker 2: be examined and found to be in big, big trouble
Speaker 2: because the woman's lungs weren't working well enough to get
Speaker 2: oxygen through the baby. So they would say, right, even
Speaker 2: though this baby's premature, going to get out anyway, because
Speaker 2: if baby stays inside this mum on this occasion, the
Speaker 2: baby won't survive. Fine, so we'll do a caesar to
Speaker 2: get the baby out. Well, baby comes out, goes well,
Speaker 2: mum succumbs to COVID. Did she die from the caesar? No,
Speaker 2: she died from COVID. So that's a good example that
Speaker 2: the association she had a caesar and then died is
Speaker 2: not causation. She didn't have a caesar that caused her death,
Speaker 2: so that this argument fails immediately on that baby.
Speaker 1: But it sounded very confident, and it was coming from
Speaker 1: a birth expert.
Speaker 2: Sounded good but was completely wrong. And the birth expert
Speaker 2: who made that statement that this is inexcuse what they
Speaker 2: should have known that that was incorrect.
Speaker 1: And also, you know, it speaks to everything. It speaks
Speaker 1: to the fear and anxiety women having pregnancy. It speaks
Speaker 1: to people saying that cesareans are on the rise and
Speaker 1: they are on the rice. And if you're interested in
Speaker 1: really delving into that topic, we've just done a two parter.
Speaker 1: Please listen to that. We talk all about why and
Speaker 1: you know, the people like to, I don't know, guild
Speaker 1: people for having caesareans, So, like, you know, it just
Speaker 1: spoke to all the emotion that people have around vaginal
Speaker 1: birth versus cesarean birth. But it's confusing. So how would
Speaker 1: you advise people to look at information like that?
Speaker 2: I think the first thing that we should probably be
Speaker 2: looking at is a concept of face validity sometimes in
Speaker 2: Australia called the pub test. Does that sound true on
Speaker 2: the basis of it, because I think we can knock
Speaker 2: some of these things down just because they sound like
Speaker 2: complete rubbish to start with. And there are certain people
Speaker 2: in the global political environment that if their lips are moving,
Speaker 2: just don't worry because absolutely, yeah, if we're flicking through
Speaker 2: the socials good medical advice, whether it's from obstetrician GP,
Speaker 2: obstitution midwife, even a quality influencer who was dedicated to accuracy,
Speaker 2: it doesn't include things. It doesn't include big broad statements
Speaker 2: to grab your immediate interest, like words like always a never,
Speaker 2: there's no always, and there's no never, things being toxic, harmful, harmful.
Speaker 2: These are invariably designed to get your attention or to
Speaker 2: sell you something.
Speaker 1: Yeah, because you know, and I hope people hear it
Speaker 1: from us, that good medical advice. On the flip side,
Speaker 1: you know we're not that we say on the one hand,
Speaker 1: in certain populations, you know, it's not a panacea, Like
Speaker 1: we don't say this affects everybody.
Speaker 2: Yeah, And if someone's looking for a two second grab,
Speaker 2: I can't. I can't give a two second and grab
Speaker 2: on a complex issue and remain accurate. You might just
Speaker 2: have to engage in the complexity with me. And I
Speaker 2: think that's why we made our My Baby program. It's
Speaker 2: why I made this podcast, because the complexity it's it's
Speaker 2: not boring.
Speaker 1: It's it's it's it's obviously not boring because like our
Speaker 1: podcast has been downloaded like I don't know, twoo point
Speaker 1: five million.
Speaker 2: That is awesome. That's that's that's that is the evidence
Speaker 2: that it's not boring, and that and why not come
Speaker 2: along on the ride of the complexity. You don't have
Speaker 2: to agree with me, but you but but but we'll
Speaker 2: have a better conversation if you're if you are happy
Speaker 2: with delving into complexity.
Speaker 1: All right, everyone. I think the only other point I
Speaker 1: would make is sometimes you've just got to bypass stuff
Speaker 1: that isn't relevant to you, Like if somebody is talking
Speaker 1: about the fact that they had I don't know, something
Speaker 1: some rare occurrence, or you know, they're they're trying to
Speaker 1: do a different type of birth than you, or I
Speaker 1: don't know, like you know, sometimes just protect yourself a
Speaker 1: little bit, yes, by saying does this apply to me?
Speaker 2: Yeah, So that it's a lot of doctors say don't
Speaker 2: don't google stuff. I don't do that. I think that
Speaker 2: that's they will. Yeah, So I try and take a
Speaker 2: different approach. I'm not sure if it's working it or not,
Speaker 2: but I try and take a different approaches. I tell
Speaker 2: people to limit the amount of time that set themselves
Speaker 2: clear boundaries, to limit the amount of time that they
Speaker 2: can scroll and worry. So fifteen minutes a day of
Speaker 2: that and that'll satisfy your need to do it.
Speaker 1: But but.
Speaker 2: I've found personally I get it anxious about things if
Speaker 2: I if I give it more time than that there
Speaker 2: are other issues I'm weirdly interested in other things that
Speaker 2: that get me anxious when I read, we.
Speaker 1: Better tell people in case I think they're weird.
Speaker 2: I'm weirdly interested in US politics, which is which is
Speaker 2: something that I have no business being interested in control
Speaker 2: and con over it. But when I when I when
Speaker 2: I read about the sort of socials, I get this.
Speaker 2: I get it's probably skewed idea that what I'm reading
Speaker 2: represents the views of ordinary people, which probably only represents
Speaker 2: the views of people who want to say things loudly
Speaker 2: on the socials. But I know that the key to
Speaker 2: controlling my anxiety about it is to limit the time.
Speaker 2: So I try and say that to people. And the
Speaker 2: other thing I asked I say to people is don't
Speaker 2: be embarrassed if you've seen something on the socials or
Speaker 2: on the Internet that you think needs my explanation about
Speaker 2: why I have recommended something completely different. Yeah, come on in, Yeah,
Speaker 2: bring it in.
Speaker 1: Yeah, talk to your practitioner about that, talk about it, yeah, exactly.
Speaker 1: They should be able to say, well, you know, this
Speaker 1: is why this is what I'm recommending.
Speaker 2: Yeah, don't just do it.
Speaker 1: Yeah, come and talk to me. The additional thing that
Speaker 1: I do is I've started a separate Instagram account which
Speaker 1: is total I don't know what you call it, like
Speaker 1: an anonymous one, and I only follow my hobbies yep.
Speaker 1: And it's really lovely. It's golf, doesn't it doesn't angry
Speaker 1: at my blood. And I also still limit myself on
Speaker 1: that because even now it's worked out, how old I
Speaker 1: am where I live, like, so now I'm getting all
Speaker 1: these menopause things and I'm like, go away. This is
Speaker 1: supposed to be my happy place.
Speaker 2: So what's on the art and golf?
Speaker 1: Art and golf and some gym stuff, So you know,
Speaker 1: maybe that's a That's another thing. If you're feeling like
Speaker 1: your pregnancy laden social media is getting you down, sick
Speaker 1: of scene, the influences and all the wacky things they're
Speaker 1: doing with their pregnancies, have a different account that you
Speaker 1: flip into and just feel at peace.
Speaker 2: That sounds like very good advice. I'm going to take
Speaker 2: that advice.
Speaker 1: You do that, Pat sick if you being on my
Speaker 1: Instagram account and skewing it with all your us points.
Speaker 2: Good?
Speaker 1: All right? Well, I enjoyed talking about that, because you know,
Speaker 1: Pat and I talk about this all the time. We
Speaker 1: sort of have this fascination and we find things on
Speaker 1: the internet we go, oh my god, Pat, did you
Speaker 1: see this? And sometimes I can't actually show you because
Speaker 1: you get too angry, So I know, I sort of
Speaker 1: have to pick my moment and go, oh, what should
Speaker 1: what do you think about this pattern?
Speaker 2: Good?
Speaker 1: Tell us how you go? What are you doing to
Speaker 1: help you discern your good information? Just come into our
Speaker 1: Instagram DMS. We'll have some posts up about this so
Speaker 1: we can start the conversation because I think it's a
Speaker 1: really vital one and it's a vital one for everybody's
Speaker 1: psychological health. So you can grow your babies in with
Speaker 1: some calm and some confidence and a bit of peace.
Speaker 1: If you enjoy our podcast, we would really like to
Speaker 1: ask you to do two things. One is share it
Speaker 1: with a friend, and the second is is to give
Speaker 1: us a five star review on Spotify or Apple or
Speaker 1: wherever you listen to us. That really helps to push
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Speaker 1: You get a week by week newsletter telling you what
Speaker 1: happens at each stage each week of your pregnancy. All
Speaker 1: right until next week, Keep well, keep growing those babies,
Speaker 1: and we'll see you next week.
Speaker 2: Thanks for listening, everybody, Bye for our Hey.
Speaker 1: Even though doctor Pat is well a doctor and we
Speaker 1: get lots of other doctors and other experts on our podcast,
Speaker 1: I just need to remind you that this podcast is
Speaker 1: for informational purposes only. We share lots of medical insights
Speaker 1: and experience, but everything we talk about is general in
Speaker 1: nature and may not apply to your specific situation. Please
Speaker 1: always consult with your own healthcare provider for your individual
Speaker 1: medical advice when you grow your baby,