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Photo: Getty Images; additional design by Tina Tiller.
Photo: Getty Images; additional design by Tina Tiller.

OPINIONSocietyNovember 18, 2021

Why mothers turn to Facebook for medical advice

Photo: Getty Images; additional design by Tina Tiller.
Photo: Getty Images; additional design by Tina Tiller.

Spoiler alert: it’s not because they’re stupid, says Emily Writes.

This post was first published on Emily Writes Weekly.

The other week, The Spinoff shared a first-person account of someone who fell down the anti-vax rabbit hole and managed to get out again.

I thought it was a really brave piece, but also a really useful one in helping us all understand how some mothers become anti-vax.

The writer explains how her traumatic birth left her with PTSD and postnatal depression. “My confidence in my ability to care for my son was destroyed by this experience,” she said.

It was in this vulnerable place that she was exposed to anti-vaccine rhetoric through a workmate’s wife.

In the absence of other supports, this new and vulnerable mum was “bombarded…with Facebook messages filled with links proclaiming the dangers of vaccines for babies. Every new claim or ‘study’ seemed designed to instil fear and play strongly to my insecurities as a new mother.”

She joined an anti-vax group and said it made her feel empowered instead of “helpless and inadequate”.

Eventually, the insular and selfish nature of anti-vaxxers meant this mother found it wasn’t the right community for her. She says she found a new community that helped her to eventually change her mind on vaccines.

“Funnily enough, it was another Facebook group that finally persuaded me to trust vaccines. I discovered Vaccine Talk, a group dedicated to fact-based discussion and co-founded by California-based mother Kate Bilowitz who had an experience similar to mine while seeking vaccine information on Facebook.”

Soon after reading her story I saw comments on the article as it was shared around Facebook and Instagram. They were overwhelmingly misogynistic and cruel. The mother was a “dumb bitch” and a “fucking moron” apparently. Childless men seemed to be behind most of the vicious comments that mocked her for seeking support (and yes, medical advice) from Facebook.

Their comments showed that they fundamentally misunderstood what it is like to be a mother seeking medical advice.

Here’s the reality: It can be fucking BRUTAL. And that’s the simple reason why some mothers turn to Facebook.

Emily and Eddie in the maternity ward. (Photo: supplied)

When my baby was born nine years ago, my midwife helped support us for longer than the usual four-to-six weeks. This would have been unpaid for her. She helped us navigate the new life we were facing with a baby that was clearly going to have medical complexities. We didn’t know then just how bad it would be.

When she had to stop her visits, I started to see just how protected I’d been by her care. I began to see how some in the medical establishment treat mothers.

As a whānau, we learned early on that my husband had to come to medical appointments in order for us to be taken seriously. If I went alone, I was treated as if I was a fretful first time mum who couldn’t tell a sneeze from respiratory distress.

When my son was hospitalised, a male doctor made a joke about how the ED is full of “hysterical mothers” before saying “it’s good you came in because there actually is something going on here”.

I had a locum tell me my anxiety as a new mother was to blame for my son’s breathing difficulties because he was “picking up on (my) nerves”. I was told repeatedly that my son had already been seen and didn’t need to be seen again – that was until he went into emergency surgery and ICU because as I knew he could not breathe.

My husband was astonished at how I was treated. But I wasn’t, as every one of my mum friends who had a child who had been hospitalised or needed medical attention had gone through the same thing.

A little while back I saw a GP and I figured since it was for a simple referral my husband wouldn’t need to attend. I was wrong. I had to call my husband and have him on speaker phone in the appointment. I now make sure I ask for a woman doctor every time I book an appointment for myself or my kids. Having my husband on the phone during appointments is still a hard habit to break though.

I went to the GP twice when my son became sick again two years ago. This time it was assumed he had anxiety (caught from me?) Nope, it was type one diabetes. He went into a diabetic coma. Spent two months in hospital. He almost died.

Getty Images

Mothers are often treated as hysterical, overwrought, naive and simple when they seek medical advice for their babies. This is why some women don’t mention they’re a “first time mum” so they don’t get treated like one.

Stereotypes about mothers and women are behind so much of the sexism we face when seeking medical advice. From an analysis of studies on gender bias in healthcare: “A 2018 study found that doctors often view men with chronic pain as ‘brave’ or ‘stoic’, but view women with chronic pain as ’emotional’ or ‘hysterical’. The study also found that doctors were more likely to treat women’s pain as a product of a mental health condition, rather than a physical condition. A 2018 survey of physicians and dentists arrived at similar conclusions: Many of these healthcare professionals believed that women exaggerate their pain. This was true even though 40% of the participants were women.”

These studies were in relation to women’s own care. But the treatment they experience is often the same when seeking care for their children, as they’re the ones describing symptoms.

Postnatal care is another way women experience the gender bias of the medical system. More than 55,000 people signed a petition calling for better postnatal care and rehabilitation in New Zealand last year.

The physical toll on mothers after birth is enormous. It is estimated that one in three women who have carried a baby will suffer urinary incontinence, 50% will live with some degree of prolapse and one in four live with bladder and/or bowel incontinence. One in five women report pain during sex, and the prevalence of urinary incontinence is even higher in adult Māori women at 47%.

Women who have grade 3-4 perineal tears will be referred to DHB physiotherapists for rehabilitation. However, other injuries attained in childbirth, such as during long pushing stages, or intervention (use of forceps/ventouse), tailbone injuries and pelvic floor avulsion are unlikely to be covered by ACC for rehab for those sustained injuries. These are injuries that impact women for the rest of their lives – physically, financially and mentally.

When you’re physically recovering from birth and have few options to address your injury, where are you getting emotional support?

An estimated 14% of New Zealand women will develop depression, anxiety or other mental health issues after birth. So if that’s the case – and the Ministry of Health acknowledges that – what is being done to support these mums emotionally and physically as they navigate the medical system for themselves and their children?

The pandemic has only made all of this worse. Joanne Rama, a mother of seven, a grandmother, and a proud activist in the area of Māori maternal mental health told The Spinoff last year that Covid-19 has been tough on the women she works with. She said she is used to seeing mental health disorders in roughly 10-20% of her clients; in the last lockdown she thinks that number leaped to more like 95%.

What is being done to address misogyny in the system? Have we properly looked at how mothers are treated by medical professionals? What is being done to address trust in the system?

We know we cannot rely on Facebook to remove misinformation from their platform. So what can we do? How can we protect mothers from being exploited by anti vaxxers when anti-vaxxers are filling a gap that has been left by an under-resourced and under-funded healthcare system in this country?

As a staunch pro-vaxxer who desperately needs people to vaccinate so I can protect my baby, these are the questions that keep running through my mind.

If mothers have been treated so badly by mansplaining doctors and GPs who roll their eyes at them and joke that they have “first-time-mum-itis” then why wouldn’t they turn to Facebook?

Isn’t it inevitable?

The blame here isn’t with mothers whose questions were ignored. It’s with those who wouldn’t even hear the questions to look for answers.

Anti-vaxxers will always exist, but we can change the environment that sends mothers into their clutches if we acknowledge and accept that it starts at birth, and we demand action to address it.

Keep going!
In Auckland, St John is facing extra stress and pressure as a result of rising Covid cases. (Photo: Supplied)
In Auckland, St John is facing extra stress and pressure as a result of rising Covid cases. (Photo: Supplied)

SocietyNovember 18, 2021

‘Hard, scary and unknown’: Ambulance crews confront growing Covid threat

In Auckland, St John is facing extra stress and pressure as a result of rising Covid cases. (Photo: Supplied)
In Auckland, St John is facing extra stress and pressure as a result of rising Covid cases. (Photo: Supplied)

As Covid case numbers grow and with thousands now isolating at home while positive, St John is dealing with a marked increase in call-outs and preparing plans for potential surges in infection rates.

As waves of Covid have surged around the world, health systems have been strained to breaking point. Ambulance services have not been spared. The American Ambulance Association last month declared a crisis born of Covid-19 and a “crippling workforce shortage”. Recent weeks have seen the army called in to drive ambulances everywhere from Scotland and Wales to the Australian state of Victoria.

The military are not yet on standby in Aotearoa, but the country’s biggest ambulance operator does have plans in place should demand surge as delta spreads in Auckland and throughout the country.

Already, St John is facing a marked growth in demand because of Covid-19. The last three months has seen about 1,600 calls a day for ambulance assistance to 111, an increase of about 100 a day. Last week that leapt to more than 1,900 a day, said Dan Ohs, deputy chief executive of ambulance operations. “It’s much higher than expected,” he said, but “still within what we would call our upper limits of workload at this time of year”.

Ambulance crews are attending about 25 Covid cases a day. “That may not sound like a lot,” said Ohs. “But because we have to wear a lot more PPE, they take a lot more time. Following the deaths of some patients that’s been widely reported in the media we’re working with Whakarongorau [telehealth service] to make sure that with anyone who’s got a clinical concern who is being managed in the community, we will pop around. So that’s generated a bit of extra workload as well. But overall, it’s not necessarily the volumes – though they are higher – that have been affecting us. It’s been the very long time it’s taking us due to the PPE and the increased pressure at the hospitals.”

In Auckland, St John is facing extra “stress and pressure”, with turnaround times at hospitals much longer than normal owing to added protocols when bringing patients to hospitals, including the rapid antigen testing sometimes required before patients can be taken out of the ambulance. “Last week in Auckland, there was almost 300 hours of excess ambulance time spent at EDs,” said Ohs. “Obviously if ambulances are tied up at EDs they’re not not available to go into the community.”

Plans for an ‘extreme environment’

With case numbers and hospitalisations only going in one direction in the short-term, plans are in place should the pressure grow further. “We have a scaled system,” Ohs explained. “Firstly, we’ve got what we call ‘Covid casuals’, volunteers who we’ve employed, who can come in in order to increase the number of ambulances on the road. We’ve also got arrangements to ensure that we have access to tertiary students if we need them. And if we got into an extreme environment – and this would only be in absolute extreme circumstances, in the kind of events that have been seen in the UK or what happened in Victoria where they called in the military – our equivalent of that would be bringing in ambulance assistants. We’d take someone like a first aid tutor, and we would train them up to be able to drive the ambulance in non-emergency conditions, to be able to lift the patient for CPR, wear PPE and that sort of thing. That would be the last resort.

“The other thing is that we have the ability, provided that the [outbreak] continues to be geographically isolated, to move our own people around. So we’ve got those sorts of surge plans in place.”

There are other strategies available, including boosting the triage capacity at the emergency communication centre, “both by putting on additional call handlers, but also putting on additional paramedics, who can help us to triage patients who might not necessarily need a face-to-face ambulance”.

Another initiative being developed is video assessment. “We’re working on a new piece of technology which would enable us to send to a mobile phone a link, so that we can visually see the patient, which means that our paramedics in the comms centre might be able to assess them on the phone to determine whether or not they need an ambulance. That would mean we can make sure we give people the same advice that we would if we were at the scene. It makes it quicker, but it also means that potentially we can work with people without putting our paramedics at risk by sending them into a Covid environment.”

‘People aren’t always giving us adequate information’

In late August, 93 St John staff went into isolation after potential exposure to a Covid-positive patient. That prompted the service to issue a public plea for people to be honest with operators about their potential exposure to the virus. “Early in the delta crisis there was a lot of fear,” said Ohs. “And people were worried that we wouldn’t be giving them treatment, or that we might withhold treatment or care from them if they declared that they were at risk of Covid.”

Following the public appeal “we saw things get a little bit better for a while”, he said. “But we are finding now that people aren’t always giving us adequate, accurate information when we get to the scene. Not giving us accurate information is often through concern that either we might leave, which of course we’d never do, or that there might be some other procedure that has to happen as a result of them having had Covid exposure. And that’s just not the case, obviously. We’re trained to work with people who have infectious disease and it only alters the way that we would approach them. But ultimately, as a result of that most of our crews are electing to wear full personal protective equipment all the time. And that’s just to keep them safe.”

All ambulance crews are now required to be fully vaccinated.

The growth of the outbreak has seen a shift in approach that means people who test positive for Covid are by default isolating at home rather than in a quarantine facility. As of yesterday, 2,210 Covid-positive people were isolating at home in Auckland and Waikato. Three deaths of people self-isolating within a week, together with a string of media reports about slow or insufficient clinical care prompted the health and disability commissioner to write to the director general of health seeking “urgent attention” to the concerns.

Ohs says he is satisfied with the public health coordination with ambulance services in managing people isolating at home.

“We’re very clear on what our role is,” he said. “We have been invited to participate in a clinical advisory group at the Ministry of Health, which is advising on how people will get managed in the community. And so as part of that we’ve got a clinical procedure and guidelines for how to keep people safe in the community. We’ve got a partnership with Whakarongorau where they can refer to us if they have clinical concerns about a patient in the community. So from a St John perspective we’re feeling fairly well connected.”

‘A horrid working environment’

The circumstances ambulance crews face are exceptionally challenging, Ohs said.

“Our ambulance crews, particularly in Auckland, but in all areas where there are lots of Covid patients, are doing an absolutely fantastic job. They’ve got a pretty horrid working environment at the moment. You can imagine as a frontline ambulance officer in Auckland, you’ve got the unknown of who’s got Covid, who hasn’t, and obviously the design of an ambulance is such that in order to make it aerodynamic and able to move quickly, it means that it’s relatively small. So our crews are in close proximity to patients in the back of the ambulance. They’re having to wear personal protective equipment all the time.”

They face added risk because they are working in ambulances fitted with ventilation systems that were “designed pre-pandemic”, said Ohs. “Now that we’ve got droplet screens to stop aerosol from getting into the front means that the air conditioning in the back isn’t as good. Our staff are working very hard, scary and unknown environment. They’re getting really hot. And they’re doing an amazing job. We recognise it’s an uncertain and uncomfortable environment for them. But they’re doing a great job of making sure that people get the right level of care and that standard of care is maintained.”