WEBVTT - 204. Is Pregnancy And Birth Advice On Social Media Evidence-Based Or Just Loud? 0:00:04.360 --> 0:00:07.400 Welcome to the Kick Your Expert led podcast, helping you 0:00:07.480 --> 0:00:11.879 explore and learn everything about getting pregnancy, birth, and becoming 0:00:11.920 --> 0:00:12.319 a parent. 0:00:12.680 --> 0:00:16.400 On the podcast and our online pregnancy program grow My Baby, 0:00:16.600 --> 0:00:19.520 we share my experience of helping more than four thousand 0:00:19.600 --> 0:00:20.280 babies to be. 0:00:20.239 --> 0:00:23.200 Born and our experience of running a women's health clinic 0:00:23.320 --> 0:00:24.560 and parenting for boys. 0:00:24.800 --> 0:00:27.760 We're here to help everyone to feel empowered in pregnancy 0:00:27.920 --> 0:00:30.760 and birth with real life, practical information. 0:00:33.280 --> 0:00:35.360 Well, welcome everyone. I'm Bridgid Millenni. 0:00:35.479 --> 0:00:37.600 And I'm obstatrician doctor Patrick. 0:00:37.280 --> 0:00:40.720 Maloney, and we've just come fresh off a very exciting 0:00:40.840 --> 0:00:44.320 night where we did a big presentation to a group 0:00:44.360 --> 0:00:45.360 of GPS. 0:00:45.680 --> 0:00:51.599 Yeah. It was about our new collaboration with Monash IVF, Yeah, 0:00:51.640 --> 0:00:54.200 to bring IVF services to our clinic. 0:00:54.400 --> 0:00:57.520 Yeah. It was very very interesting and actually we covered 0:00:57.520 --> 0:01:02.400 things like PMOS, We cover fertility work up, what a 0:01:02.440 --> 0:01:08.160 fertility consult looks like, the role of endometeorosis infertility, and 0:01:09.760 --> 0:01:15.040 Pat introduced the concept of endometriosis surgery with a robot. 0:01:15.560 --> 0:01:19.440 Yeah. I couldn't help you love it because I'm that's 0:01:19.480 --> 0:01:22.320 my major professional interest at the moment, and I just 0:01:22.360 --> 0:01:26.319 thought i'd throw that in there even though it was 0:01:26.400 --> 0:01:27.240 mon Ash's night. 0:01:27.800 --> 0:01:28.120 No, I know. 0:01:28.400 --> 0:01:28.520 Then. 0:01:28.600 --> 0:01:31.560 My favorite thing that you said that night was that 0:01:31.640 --> 0:01:35.920 when you're doing surgery on a using a robot, it 0:01:35.959 --> 0:01:39.200 feels like you're a little con gynecologist inside. 0:01:39.520 --> 0:01:42.440 Just you've been shrunk down and you're inside the inside 0:01:42.480 --> 0:01:44.679 the pagient operating with your real hands. That's kind of 0:01:44.680 --> 0:01:47.560 what it feels like. Yeah, yeah, yeah, I also got 0:01:47.560 --> 0:01:49.360 a good laugh about my nun joke. 0:01:49.480 --> 0:01:52.320 Oh yeah, that's right. Tell our audience about why. 0:01:52.360 --> 0:01:58.160 I'll tell you quickly. So, our main private hospital here 0:01:58.160 --> 0:02:01.000 Invalerate is called Saint John of God. It's a church 0:02:01.080 --> 0:02:06.200 run a church run hospital, which is for our international listeners, 0:02:06.280 --> 0:02:08.680 is common in Australia that a lot of the early 0:02:08.760 --> 0:02:11.760 private hospitals in Australia were run by the Catholic Church 0:02:11.800 --> 0:02:16.360 and still are in some way. And our robot is 0:02:16.480 --> 0:02:20.480 called Sister Joan, and Sister Joan was the last of 0:02:20.520 --> 0:02:22.920 the Saint John of God nuns to actually work in 0:02:22.919 --> 0:02:25.799 the hospital. And there are there aren't any nuns in 0:02:25.840 --> 0:02:29.720 the hospital these days. And I just told a gag 0:02:29.760 --> 0:02:33.320 that when I was in primary school, I wasn't a 0:02:33.360 --> 0:02:36.639 massive fan of nuns that ran that ran the school, 0:02:37.120 --> 0:02:39.640 and I just said, I would have liked it if 0:02:39.680 --> 0:02:42.240 someone had told me back then that nuns would eventually 0:02:42.280 --> 0:02:45.200 be replaced by robots. Had got a good laugh. 0:02:46.480 --> 0:02:48.520 I'm laughing now and I've heard it about three times. 0:02:49.760 --> 0:02:53.160 So yeah, it was a really good night, really really interesting, 0:02:53.360 --> 0:02:55.280 and a pleasure to bring people up to date on 0:02:55.320 --> 0:02:55.840 what we're up to. 0:02:56.040 --> 0:02:58.160 Yeah. No, no, it was just exciting. So you know, 0:02:58.400 --> 0:03:00.519 we've got a buzz, We've got a buzz about us, 0:03:00.560 --> 0:03:05.200 and we're going to do a podcast. You know, it's 0:03:05.240 --> 0:03:09.600 a little bit different from the information laden podcast that 0:03:09.639 --> 0:03:11.640 we do, but we see it as a big problem, 0:03:12.440 --> 0:03:15.680 and that is people being able to discern whether the 0:03:15.760 --> 0:03:20.680 advice they're seeing on their social media is evidence based 0:03:20.919 --> 0:03:25.400 or it's just simply loud. So, you know, I don't know, 0:03:25.520 --> 0:03:28.520 I thought it was. There's so many examples that we 0:03:28.560 --> 0:03:30.600 can bring up, but the first one that sprung to 0:03:30.840 --> 0:03:37.400 mine was remember the United States Health Secretary Jay Kennedy, 0:03:37.400 --> 0:03:42.960 I think, said that panadol, taking penadol in pregnancy causes autism. 0:03:43.920 --> 0:03:48.440 And I think that just shocked every person that had 0:03:48.520 --> 0:03:53.560 been pregnant or was currently pregnant, because I don't know 0:03:53.640 --> 0:03:57.760 what the stats would be but I reckon nearly everybody 0:03:57.800 --> 0:03:59.120 would have taken padal. 0:04:00.280 --> 0:04:03.160 And so that wasn't actually a question up for broad 0:04:03.160 --> 0:04:07.600 clinical debate. That the fact that that panetole does not 0:04:07.840 --> 0:04:14.040 cause autism is is abundantly clear. It's been proven time 0:04:14.080 --> 0:04:20.240 and time again, and there is no data suggesting a 0:04:20.320 --> 0:04:26.159 link there other than the tired old problem which we 0:04:26.279 --> 0:04:30.040 know leads to wrong conclusions, which is that association and 0:04:30.120 --> 0:04:36.360 causation aren't the same thing. So panidole doesn't cause autism 0:04:36.880 --> 0:04:39.760 any more than wearing pants causes autism. 0:04:40.440 --> 0:04:42.440 And I'm pretty sure most people have got pants on. 0:04:42.560 --> 0:04:47.000 So yeah, Yeah, it's a bit that is complex, and 0:04:47.000 --> 0:04:49.719 we're going to get into, you know, the simplicity that 0:04:49.800 --> 0:04:52.320 comes across in social media and why that's so easy 0:04:52.400 --> 0:04:56.919 for people to absorb. You know, it's a very simple message. 0:04:56.960 --> 0:05:00.000 You can't do a complex message well on social media. 0:05:00.360 --> 0:05:03.400 You just can't keep people's attention for that long. Yep. 0:05:03.640 --> 0:05:06.360 It doesn't help when the advice leaps over the barrier 0:05:06.400 --> 0:05:08.840 from social media into the real world and senior people 0:05:08.839 --> 0:05:12.080 who should know better start saying things that are patently untrue. 0:05:12.160 --> 0:05:15.120 Yeah. So the other one, I just was shocked to 0:05:15.160 --> 0:05:18.560 my core with was there was a very big influencer, 0:05:19.480 --> 0:05:23.719 a woman in her early or late twenties who was pregnant, 0:05:23.760 --> 0:05:27.919 and she was taking a supplement and she said, so, 0:05:28.160 --> 0:05:29.719 you know, I really wanted to find out whether I 0:05:29.720 --> 0:05:33.719 should be taking this supplement or not. So I went 0:05:33.800 --> 0:05:36.719 to my ob was an American. I went to an 0:05:36.760 --> 0:05:39.720 ib and she said that, you know, I didn't need 0:05:39.760 --> 0:05:42.200 to take this supplement. But then, you know, my Instagram 0:05:42.240 --> 0:05:45.240 feed is full of people saying I should take this 0:05:45.279 --> 0:05:48.760 supplement because otherwise I'm going to cause like horrible consequences 0:05:48.800 --> 0:05:51.320 to my child. And then she finished the real with 0:05:51.880 --> 0:05:52.960 so who am I to believe? 0:05:53.000 --> 0:05:58.000 It's posed to flip? Yeah, yeah, that I remember that 0:05:58.520 --> 0:06:01.599 looking at that and thinking this is really the problem, 0:06:02.000 --> 0:06:04.800 or for that person at least, is really a big one, 0:06:05.480 --> 0:06:10.120 because if they think that those are too equally valid 0:06:10.600 --> 0:06:15.479 and equally equally accurate sources of information, then who is 0:06:15.520 --> 0:06:21.000 she supposed to believe? I guess the doctor in me 0:06:21.040 --> 0:06:27.159 has always thought that the advice that we give to 0:06:27.240 --> 0:06:31.080 the best of our ability is not just something we 0:06:31.200 --> 0:06:37.880 made up. It's something based on years of cumulative research 0:06:37.920 --> 0:06:44.040 and knowledge and the so we do we have been 0:06:44.080 --> 0:06:49.440 perhaps coasting along, thinking that the advice that we have 0:06:49.600 --> 0:06:56.080 been given would outweigh the advice that somebody got off 0:06:56.160 --> 0:07:00.240 some randos on the socials. But maybe for some people 0:07:00.279 --> 0:07:00.800 that's not true. 0:07:01.040 --> 0:07:04.000 No, this woman was genuinely anxious about it, Like you know, 0:07:04.080 --> 0:07:07.720 it wasn't It wasn't tongue in cheek or satire or 0:07:07.720 --> 0:07:10.280 anything like that. She was. She was genuinely confused who 0:07:10.280 --> 0:07:12.480 she should believe, So, you know, and I get it 0:07:12.960 --> 0:07:17.880 in certain generations as well. It's gone really from my 0:07:17.960 --> 0:07:21.400 doctor said, so therefore it's true too. I'm not sure. 0:07:21.680 --> 0:07:22.320 Yeah, I'm not sure. 0:07:22.440 --> 0:07:22.800 They might. 0:07:22.960 --> 0:07:25.320 There might have once upon a time been too much. 0:07:25.720 --> 0:07:27.960 As the doctor told me to do this stuffing, and 0:07:28.000 --> 0:07:31.440 I didn't even stop to think why, Which is you 0:07:31.480 --> 0:07:33.640 know that that can't be a good thing. If we're 0:07:33.680 --> 0:07:35.720 asking people to put something in their bodies or do 0:07:35.800 --> 0:07:38.040 something with their bodies or whatever, that that should should 0:07:38.120 --> 0:07:41.280 have an evidence base that's beyond they're there. I told 0:07:41.320 --> 0:07:42.640 you to do it, and just do it. 0:07:43.600 --> 0:07:47.920 Could you imagine actually having that flight in your consultations? 0:07:47.960 --> 0:07:52.200 Not anymore? Doctor knows best. I don't think you wouldn't 0:07:52.200 --> 0:07:53.080 get away with it for long? 0:07:53.200 --> 0:07:55.440 No, No, and not no, you should so you know. 0:07:55.480 --> 0:07:58.240 That's what our pregnancy podcast is about, So informing you 0:07:58.280 --> 0:08:01.240 with the information that's you have a conversation with your 0:08:01.280 --> 0:08:05.840 doctor about, you know, different methods of treatment and plans 0:08:06.960 --> 0:08:07.640 at the risk of. 0:08:07.640 --> 0:08:12.760 Being overwhelmed by emails. If you think I have said 0:08:12.840 --> 0:08:18.080 something in the podcast that is inadequately explained, then I 0:08:18.120 --> 0:08:20.040 think you feel free to get in touch and say 0:08:20.800 --> 0:08:21.880 what's your data? 0:08:21.960 --> 0:08:25.240 Yeah, need something more there. But the things on Instagram 0:08:25.240 --> 0:08:27.440 that I really wanted to point out are the things 0:08:27.480 --> 0:08:29.480 that say you know and you see it. They scream 0:08:29.480 --> 0:08:32.880 at you never do this in pregnancy, or always do this, 0:08:33.400 --> 0:08:36.160 or you know. One of our favorite things is these 0:08:36.160 --> 0:08:37.880 are things your doctor never wants you to know. 0:08:38.400 --> 0:08:41.800 That's my personal favorite. Let's deal with that one up front. 0:08:42.400 --> 0:08:45.360 There is nothing that your doctor doesn't want you to know. 0:08:46.520 --> 0:08:50.320 Nothing that's true. Yes, of all the true things in 0:08:50.400 --> 0:08:53.520 the universe, there isn't one of those that your doctor 0:08:53.559 --> 0:08:59.440 does not wish you to know. So anything on the 0:08:59.480 --> 0:09:03.520 socials that mentions that you can safely ignore upfront, yep, 0:09:04.200 --> 0:09:09.280 that is based one hundred percent in an effort to 0:09:09.360 --> 0:09:13.360 drive a wedge between you and good advice, and that 0:09:13.400 --> 0:09:14.760 can't be a great place to start. 0:09:15.600 --> 0:09:19.400 The other thing is the doctors don't want you to know, 0:09:19.640 --> 0:09:23.400 or the big farmer doesn't want you to know, implying 0:09:23.440 --> 0:09:28.160 that there's kickbacks, and apart from a pen that I 0:09:28.160 --> 0:09:31.720 have on my desk, yeah, we have never received a kickback. 0:09:31.520 --> 0:09:34.280 Don't even anything. Don't even really get pens anymore. No, 0:09:35.360 --> 0:09:39.440 so the kickbacks, like the social sometimes will tell you 0:09:39.480 --> 0:09:43.440 that they're literally cash cash, money changes hands, and that 0:09:44.480 --> 0:09:47.920 has never been part of our medical culture in Australia 0:09:48.280 --> 0:09:55.600 and is specifically illegal. Even things which was sort of 0:09:55.640 --> 0:09:59.840 a version of money changing hands, like a company paying 0:10:00.320 --> 0:10:02.199 for you to go on a holiday or for you 0:10:02.240 --> 0:10:07.079 to have to go somewhere nice in the sun and 0:10:06.760 --> 0:10:08.480 you just had to go to ten minutes of their 0:10:08.480 --> 0:10:09.959 conference in the morning and then you could go to 0:10:09.960 --> 0:10:11.800 the beach for the rest of the day. That's all 0:10:11.840 --> 0:10:12.560 gone as well. 0:10:13.000 --> 0:10:16.160 Yeah, and we're only speaking from an Australian perspective. You know, 0:10:16.200 --> 0:10:18.560 there might be other countries where that isn't the case, 0:10:18.640 --> 0:10:21.120 but that is for us. And it is also for 0:10:23.120 --> 0:10:27.320 doctors selling things such as supplements or whatever like in 0:10:27.360 --> 0:10:29.240 Australia you can't do that either. 0:10:29.240 --> 0:10:32.439 Very tightly controlled. Yeah, very very tightly controlled. 0:10:32.480 --> 0:10:35.280 If you're are pro registered, you just can't do it. 0:10:35.360 --> 0:10:39.200 So you know, I know have quite a few very 0:10:40.320 --> 0:10:46.240 very famous instagrammers for menopause who are doctors in other 0:10:46.280 --> 0:10:48.280 parts of the world and they can sell whatever they like. 0:10:48.600 --> 0:10:50.240 So you know, that is also a bit of a 0:10:50.240 --> 0:10:51.199 red flag for. 0:10:51.240 --> 0:10:56.160 Me in Australia. It is by as far as we 0:10:56.240 --> 0:10:58.480 can tell, when we look at what goes on other countries, 0:10:58.679 --> 0:11:05.079 we're extremely tightly control. And that's not just with you know, 0:11:05.160 --> 0:11:10.920 the the selling of things, but even advertising. Yeah, yeah, 0:11:11.000 --> 0:11:12.559 we can't really advertise. 0:11:12.760 --> 0:11:15.200 We can't say that you know, we're the best, or. 0:11:15.440 --> 0:11:17.600 Certainly can't say that you're better than anybody. 0:11:17.320 --> 0:11:20.000 Else, or you could expect better our outcomes by coming 0:11:20.000 --> 0:11:22.440 to see us, or you know, we no doctor can 0:11:22.480 --> 0:11:23.240 actually say that. 0:11:23.760 --> 0:11:27.520 It's I remember visiting the US years ago and just 0:11:27.559 --> 0:11:30.079 seeing seeing a post I was on the ferry to 0:11:30.080 --> 0:11:31.360 go out and look at the statute of limiting. This 0:11:31.400 --> 0:11:33.199 a poster on the ferry that says I am the 0:11:33.200 --> 0:11:34.960 best cardiac surgent. 0:11:35.200 --> 0:11:35.679 I love it. 0:11:35.800 --> 0:11:39.120 Yeah, and I just thought, wow, I've never seen anything 0:11:39.200 --> 0:11:45.680 like that. Yeah, so yeah, beware, beware things. Let's say 0:11:45.679 --> 0:11:49.840 that that that this is a secret that the system 0:11:50.240 --> 0:11:51.319 doesn't want you to know. 0:11:52.840 --> 0:11:57.320 So I want to delve into why pregnancy, Why does 0:11:57.320 --> 0:11:59.360 it attract so much conflicting advice. 0:12:00.920 --> 0:12:07.320 I think that it it's very pregnancy is a time 0:12:07.400 --> 0:12:11.480 when people can be very easily influenced out of fear. 0:12:12.640 --> 0:12:15.400 So that for the first pregnancy in particular, is a 0:12:15.440 --> 0:12:20.080 scary time for people, and they are often overwhelmed with 0:12:20.200 --> 0:12:24.439 a sense of responsibility to do the best they possibly 0:12:24.480 --> 0:12:28.920 can for the outcome of the pregnancy and the safety 0:12:29.080 --> 0:12:32.400 of themselves, but more in their mind is the safety 0:12:32.440 --> 0:12:37.760 of the baby. And so that's a population that is 0:12:37.800 --> 0:12:43.439 relatively easy to exploit with fear based arguments. 0:12:44.520 --> 0:12:47.120 I think also that it's you know, yeah, you're right, 0:12:47.160 --> 0:12:50.480 it's absolutely high stakes, but it's also the time in 0:12:50.520 --> 0:12:54.680 a woman's life that she is she doesn't have tons 0:12:54.720 --> 0:12:59.240 of control, you know. So it's this juxtaposition where you 0:12:59.240 --> 0:13:02.400 you it's high stakes, but you know, you can control 0:13:02.440 --> 0:13:04.640 what you eat and you control the exercise that you 0:13:04.679 --> 0:13:07.120 can do, but you know, there's lots that you can't control. 0:13:07.200 --> 0:13:10.440 It's baby behavior, or it's your genes, or you know, 0:13:10.480 --> 0:13:13.880 it's just something that you've got to accept and roll 0:13:13.880 --> 0:13:14.880 with the punches a little bit. 0:13:15.520 --> 0:13:18.600 Yeah, So if we look at the advice that's given, 0:13:20.320 --> 0:13:26.760 you know, accurate advice might say care subtle, fairly nuanced 0:13:26.800 --> 0:13:29.520 things that might be different for you as an individual 0:13:29.559 --> 0:13:33.920 compared to another person as an individual. Whereas if we're 0:13:34.040 --> 0:13:39.760 going to really try and influence the behavior of someone 0:13:40.960 --> 0:13:44.880 by exploiting her lack of control and exploiting her vulnerability 0:13:44.920 --> 0:13:50.400 to fear based arguments, then then we make broad statements 0:13:50.440 --> 0:13:53.080 that are inaccurate but go right to the heart of 0:13:53.080 --> 0:13:55.600 that fear. And that's that's a lot of what we 0:13:55.600 --> 0:13:56.440 see on the socials. 0:13:57.320 --> 0:14:01.960 The other thing that is common is, you know, there's 0:14:01.960 --> 0:14:03.720 so many people that have had a baby, you know, 0:14:03.800 --> 0:14:06.360 so then they have their own experience, in their own 0:14:06.400 --> 0:14:08.120 personal sort of take on things. 0:14:08.240 --> 0:14:13.120 Yeah. Yeah, so that is that is really interesting because 0:14:13.400 --> 0:14:20.920 the medical world looks at something like risk from a 0:14:21.040 --> 0:14:24.720 community level. You got to you've got to zoom out 0:14:25.920 --> 0:14:30.640 and say such and such an intervention, if it's done, 0:14:31.240 --> 0:14:35.760 will will will result in better outcomes. Per one hundred 0:14:35.800 --> 0:14:40.480 thousand women, one extra baby will survive, one extra woman 0:14:40.720 --> 0:14:47.960 won't get hypertension. But people who've been through a pregnancy 0:14:47.960 --> 0:14:52.000 before and having another one that they are mostly focusing 0:14:52.040 --> 0:14:57.560 on themselves and their own personal risk, and therefore it's 0:14:57.640 --> 0:14:59.480 easy to say, well, I did this last time at 0:14:59.480 --> 0:15:03.920 worked fine, so that'll work fine again. Now that the 0:15:04.000 --> 0:15:07.520 person who's thinking that way, that are wrong. But they're 0:15:07.680 --> 0:15:12.680 just not answering the same question as the medical world 0:15:12.880 --> 0:15:15.280 is answering when they when we talk about safety. 0:15:15.960 --> 0:15:18.440 And that is hard because you know, especially say in 0:15:18.480 --> 0:15:20.280 a family or whatever, and your sister might have had 0:15:20.320 --> 0:15:24.200 one experience and you want that same experience, but your 0:15:24.240 --> 0:15:26.760 experience ends up being different. Like, you know, you sort 0:15:26.760 --> 0:15:29.320 of that's that's your frame of reference. You're you're sort 0:15:29.320 --> 0:15:32.240 of looking within a very small sample size. 0:15:33.400 --> 0:15:36.600 Yeah, and then and then nuance is hard to get across, 0:15:36.680 --> 0:15:39.280 Like your sister might have done very well with treatment xyz, 0:15:39.640 --> 0:15:42.920 but she may be an entirely different which category to yourself. 0:15:44.800 --> 0:15:47.200 I want to talk about a little bit about how 0:15:47.400 --> 0:15:54.720 sometimes really confident posts like seven seven things you must 0:15:54.720 --> 0:15:57.400 do to ensure you get a vaginal birth, or you know, 0:15:58.000 --> 0:16:03.560 really confident posts sounds sometimes a bit more convincing than evidence. 0:16:04.280 --> 0:16:10.600 Yes, yes, So the first thing I think of when 0:16:10.640 --> 0:16:15.040 I see those is, if it was that easy, why 0:16:15.120 --> 0:16:15.920 wouldn't we have. 0:16:15.840 --> 0:16:19.200 Done it like a practitioner. 0:16:19.200 --> 0:16:22.400 Wh yeah, so that's my practice with my practitioner's hat 0:16:22.440 --> 0:16:25.400 on thought, Oh my god, there's only seven things, fantastic, 0:16:25.400 --> 0:16:28.520 I've better read this because here am I thinking there's 0:16:28.600 --> 0:16:32.920 hundreds of factors. But if there's only seven, sit down, 0:16:34.160 --> 0:16:39.360 get a coffee, I'm going to read it. So maybe 0:16:39.360 --> 0:16:41.400 it comes down to this idea that humans are wired 0:16:41.440 --> 0:16:45.320 to trust. You know, if we if somewhere in our 0:16:45.480 --> 0:16:50.280 prehistoric selves, if someone if the if the chief of 0:16:50.280 --> 0:16:51.800 our clan said we're going to go and we're going 0:16:51.840 --> 0:16:54.800 to up and move to the other side of the 0:16:55.640 --> 0:16:59.040 of the plane where there's more food. All right, great, 0:16:59.520 --> 0:17:03.360 let's do it. So I think we are wired to 0:17:03.400 --> 0:17:09.600 take on advice and not necessarily think stuff through for 0:17:09.680 --> 0:17:14.480 ourselves every single time. Our brains are also wide for shortcuts, 0:17:15.640 --> 0:17:20.360 and so we love a confident We love confident. 0:17:21.840 --> 0:17:25.119 And we like personal stories like who doesn't love a 0:17:25.160 --> 0:17:28.480 personal story? Like it's something that you know, I mean, 0:17:28.560 --> 0:17:32.960 I don't love listening to birth stories, but it is 0:17:33.000 --> 0:17:35.399 one of the most popular podcasts. People love listening to 0:17:35.440 --> 0:17:39.439 personal stories. But every single personal story is a sample 0:17:39.480 --> 0:17:43.040 of one. And you know, going back to your taking 0:17:43.040 --> 0:17:44.800 a bird's eye view and looking at it from a 0:17:44.840 --> 0:17:49.000 statistical point of view. Like I've read some of those reports. 0:17:49.000 --> 0:17:52.479 I've read lots of those sort of research papers, and 0:17:52.520 --> 0:17:55.960 it's very hard. It's very dense reading. It's very hard 0:17:56.000 --> 0:17:58.639 to understand the statistics. Yes, And you know, even though 0:17:58.680 --> 0:18:00.399 I've read lots and I've actually done REDS search as 0:18:00.400 --> 0:18:04.040 a university subject. But I come back and I say, oh, Pat, 0:18:04.400 --> 0:18:06.959 did you know that blah blah blah and this amount? 0:18:07.000 --> 0:18:09.840 And you and then you you help me. We know 0:18:09.880 --> 0:18:12.119 that sounds funny, but you know, you help me understand 0:18:12.560 --> 0:18:16.399 that statistic more meaningfully. It's really hard to interpret them. 0:18:16.600 --> 0:18:22.360 It is, and it's hard. It is hard to especially 0:18:22.400 --> 0:18:27.920 for non medically trained people, to understand what the hell 0:18:27.960 --> 0:18:31.960 we're talking about. Some of the time. I think that 0:18:33.000 --> 0:18:36.760 another problem that's going on in the background is that 0:18:36.760 --> 0:18:38.720 as human beings, we hate to feel anxious. We hate 0:18:38.760 --> 0:18:43.399 to feel that that that we need to make a 0:18:43.400 --> 0:18:46.720 decision between two big options, and it's we can't think 0:18:46.760 --> 0:18:49.000 of anything else, and it's really really upsetting us. So 0:18:49.040 --> 0:18:52.360 sometimes we'll choose the comfort of a decision having been 0:18:52.440 --> 0:18:55.159 made over it necessarily being the right. 0:18:55.000 --> 0:18:58.000 Decision, and that's why you know we talk about a 0:18:58.160 --> 0:19:01.480 birth plan or a birth map. You know it's not 0:19:02.880 --> 0:19:07.399 step one, step two, step three. Yeah, it's about sitting 0:19:07.440 --> 0:19:11.960 with the anxiety around that it's unpredictable and like you've 0:19:11.960 --> 0:19:14.320 got to be You've got to have the knowledge to 0:19:14.359 --> 0:19:16.399 know if it goes down one particular path, you've got 0:19:16.440 --> 0:19:18.520 to make decisions yes, or if it goes down another 0:19:18.520 --> 0:19:21.600 particular path, that's another set of decisions. And so you 0:19:21.640 --> 0:19:26.200 know that is so nuanced and complex that you cannot 0:19:26.200 --> 0:19:29.080 get that small little SoundBite on social media. 0:19:29.440 --> 0:19:32.040 Know that the whole problem with social media is that 0:19:32.080 --> 0:19:33.679 the message needs to be very brief. 0:19:35.840 --> 0:19:39.240 And when I listened to you and actually from the 0:19:39.440 --> 0:19:42.720 Monash talk that we just did, and you were saying 0:19:42.760 --> 0:19:46.080 that you were all excited when the new endometriosis guidelines 0:19:46.119 --> 0:19:49.400 came out and then you said, you know, finally I've 0:19:49.440 --> 0:19:51.199 got something I can go Okay, I can hang my 0:19:51.240 --> 0:19:53.160 hat on this is how we're going to do endometriosis. 0:19:53.760 --> 0:19:56.680 And yet the guidelines are still like. 0:19:56.680 --> 0:19:57.520 Oh they're disappointing. 0:19:57.560 --> 0:20:01.640 Yeah, they've been disappointing. They're about like, while it's pens, there's. 0:20:01.440 --> 0:20:03.760 A lot of it depends. Yeah, and there's a lot 0:20:03.920 --> 0:20:09.359 of we think it's probably the best thing to do this, yes, 0:20:09.680 --> 0:20:12.359 and then and then reference down the bottom level of 0:20:12.400 --> 0:20:17.000 evidence low. Yeah, So that is that certainly is a problem. 0:20:17.200 --> 0:20:20.240 And often that's what good medicine looks like, doesn't it. 0:20:20.320 --> 0:20:22.680 You know, it's sort of like if you're if you're 0:20:22.840 --> 0:20:26.880 hoping for a very very strong, definitive this is the answer. 0:20:28.440 --> 0:20:31.399 Lots of medicine can't put its whole claim on that 0:20:31.440 --> 0:20:34.440 because there hasn't been an RCT, you know, there hasn't 0:20:34.480 --> 0:20:35.919 got the level of evidence. Yeah. 0:20:36.000 --> 0:20:39.639 Yeah, and so as you as you said accurate, accurately, 0:20:39.720 --> 0:20:42.399 just now, good medicine is new once. 0:20:43.480 --> 0:20:48.000 Which you know is the opposite of a very confident 0:20:48.400 --> 0:20:51.280 these are seven mistakes you should never make in your pregnancy. 0:20:51.320 --> 0:20:53.880 You know, like it's very very different. Now it's hard 0:20:54.000 --> 0:20:56.560 hard to get that message across. All right, Well, what 0:20:56.640 --> 0:21:00.800 about those postpat that look like their research driven? They say, 0:21:01.040 --> 0:21:06.040 the people say, oh, research says, how can a participator 0:21:06.119 --> 0:21:09.600 in social media actually work out whether the research that 0:21:09.640 --> 0:21:12.480 they say that they're referencing is any good? Yeah? 0:21:12.600 --> 0:21:16.800 Great questions. So you can call anything research. 0:21:17.960 --> 0:21:19.679 My Google, I call that research. 0:21:19.800 --> 0:21:24.680 Yes, A distressing number of people call the call their 0:21:24.760 --> 0:21:27.560 looking at social media research. Yeah, where it's not what 0:21:28.280 --> 0:21:31.159 I mean by research. But that's that's all right. We 0:21:31.200 --> 0:21:33.639 can both use the term but the but but I 0:21:33.680 --> 0:21:38.119 think people should be roughly aware of what your doctor 0:21:38.160 --> 0:21:42.480 means by research and what and what he or she 0:21:42.600 --> 0:21:49.000 might be has he or she might prioritize the confidence 0:21:49.040 --> 0:21:51.679 that we can have in the conclusion because of the 0:21:51.720 --> 0:21:58.080 study that's been done. And so, you know, put briefly, 0:21:59.720 --> 0:22:06.400 be systematic. What are called systematic reviews are published from 0:22:06.560 --> 0:22:11.600 time to time by collectives like the Cochrane Database, and 0:22:12.200 --> 0:22:14.920 the point of those is to take a bunch of 0:22:15.000 --> 0:22:20.440 reliable studies, combine them in a way that is legitimate 0:22:20.720 --> 0:22:26.080 for research purposes, and add them together to increase the 0:22:26.119 --> 0:22:29.480 confidence that we can have in their conclusions. So you 0:22:29.520 --> 0:22:32.600 might put together a series of studies that were done 0:22:32.680 --> 0:22:36.760 in various countries that were all quite similar, and they 0:22:37.480 --> 0:22:43.760 issue statements which are among the very best evidence that 0:22:43.920 --> 0:22:49.399 such and such is true. And there are you know, 0:22:49.440 --> 0:22:51.800 the Cochran it's not for everybody, but the Cochran database 0:22:51.920 --> 0:22:56.360 is free. You get on an avelock and it's amazing 0:22:56.640 --> 0:23:01.040 some of the things that they've looked at, and sometimes 0:23:01.119 --> 0:23:04.560 it's they are health issues that you might have thought 0:23:04.560 --> 0:23:11.439 were relatively trivial actually have a clear internationally respected cockin 0:23:11.600 --> 0:23:17.680 review on whether or not bananas help with night cramps 0:23:18.119 --> 0:23:19.040 in pregnant women. 0:23:19.400 --> 0:23:22.080 Wow, did they know? 0:23:23.040 --> 0:23:27.240 Then there's and then there's individual randomized control studies, which 0:23:27.280 --> 0:23:31.000 are thought to be the best trial design, so that 0:23:31.359 --> 0:23:33.480 if we take a hundred thousand people and give them 0:23:33.480 --> 0:23:35.719 one treatment, and one hundred thousand people and give them 0:23:35.720 --> 0:23:39.680 the other treatment, ideally with none of those people knowing 0:23:40.040 --> 0:23:42.600 which treatment they've got, and none of the people running 0:23:42.640 --> 0:23:46.200 the study knowing at the time which which treatment they've got, 0:23:46.560 --> 0:23:49.920 observe who does the best, and then and then de 0:23:50.040 --> 0:23:52.239 blind the study and have a look and see and 0:23:52.280 --> 0:23:54.560 see of the people who did the best, which which 0:23:54.600 --> 0:23:59.920 treatment they have. Those are the ones that we find 0:23:59.920 --> 0:24:01.520 the most persuasive. 0:24:02.520 --> 0:24:05.000 They're very few and far between in the pregnancy will though, 0:24:05.000 --> 0:24:08.200 aren't they It's hard. It's hard, like could you imagine 0:24:09.480 --> 0:24:13.800 saying yes when you're pregnant to a trial. You don't 0:24:13.800 --> 0:24:15.000 know what it is, you don't know what it's going 0:24:15.040 --> 0:24:18.879