Despite all the proven advances of modern medicine, some people are drawn to alternative or “natural” cures and practices. Many of these do no harm. As the cancer specialist Prof Chris Pyke noted last year, people undergoing cancer treatment will often try meditation or vitamins as well. When such a change is in addition to, and not instead of, evidence-based treatment, this is usually not a problem. If it reduces distress, it can help.
But the proliferation of online health influencers poses challenges that governments and regulators in many countries have yet to grasp. The Guardian’s investigation into the Free Birth Society (FBS), a business offering membership and advice to expectant mothers, and training for “birth keepers”, has exposed 48 cases of late-term stillbirths or other serious harm involving mothers or birth attendants who appear to be linked to FBS. While the company is based in North Carolina, its reach is international. In the UK, the NHS only recently removed a webpage linking to a charity “factsheet” that recommended FBS materials.
Giving birth without medical assistance, or free birth, is legal in countries including the UK and US. The risks are not well understood due to a lack of data. “Across whole populations, going through labour and birth without professional support is associated with higher levels of risk for mother and baby,” according to Soo Downe, professor of midwifery at the University of Lancashire.
Childbirth can be a frightening prospect, and high-quality care is far from guaranteed. In England, a shocking recent report found two-thirds of NHS maternity units to be unsafe or in need of improvement. In the US, births must be paid for either by individuals, insurers or Medicaid. Criticisms of medical systems and specific, longstanding issues with maternity care are in many cases justified. Most of the women interviewed for the Guardian’s investigation and podcast series had previously undergone traumatic births.
But while distrust of institutions may be based on experience, it has also proved to be a fertile ground for other influencers seeking converts to their unorthodox methods and DIY ethos. During the pandemic, a “wellness” industry supposedly focused on healthy living was implicated in spreading lies about vaccines and fuelling paranoia about official advice. Concern is rising that such ideas are gaining more general purchase. One paper given at a cancer conference in July focused on misinformation, which it said had “acutely worsened in the past decade”. Our FBS investigation shows that behind the image of an anti-establishment sisterhood lies an enterprise that trains women as social media influencers as well as birth attendants. FBS does not claim to be a qualified medical provider.
There is no turning the clock back to a time when doctors were presumed to know best. Vast quantities of scientific research are published online and many people use these to beneficial effect. But there is also a need for safeguards from poor advice. It is well known that the algorithms used by tech companies reward more extreme content.
In the UK, improvements to NHS maternity services cannot come soon enough. They should include the option of home birth and the provision of data to support women in making decisions. Ministers and bodies including the World Health Organization should also develop strategies for the information ecosystem so that evidence-based healthcare is not undermined.
