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Abstract: Background: The media both creates and reflects public opinion. The way in which health professionals are depicted in the media is likely to influence views held by and about different health professions. The aim of this study was to examine how midwives and obstetricians are reported in English language web-based news reports from around the world.
Methods: News alerts from the Internet search engine Google were created to search for the terms “midwife,”“midwives,”“midwifery,”“obstetrics,” and “obstetricians.” These alerts were received over a 12-month period (May 1, 2006–April 31, 2007), downloaded, and analyzed using quantitative content analysis.
Results: A total of 522 web-based news reports for midwifery and 564 for obstetrics (n = 1,086) were found. Dominant categories for midwives were: “mainstreaming midwives” (models of care/rise of midwifery) (28%); “the Cinderella of the maternity care” (workforce/industrial) (27%); “delivering the baby with your hands tied” (funding, insurance, and legislation) (21%); “ask the expert” (education, research, and health advice) (8%), “recognizing midwives” (awards and announcements) (7%), “unsafe midwives” (litigation) (6%); and “the art of birth” (books, film, and photographs) (2%). Dominant categories for obstetricians were: “ask the expert” (research and advice) (26%); “doctors are heroes amongst us” (awards and announcements) (19%); “obstetric workforce woes” (workforce/industrial) (19%); “new frontiers” (trends in care and new technology) (17%); “the disappearing obstetrician” (insurance and litigation) (10%); and “human-interest news reports” (9%). Obstetricians were more likely to be recognized as experts on pregnancy and birth and receive public recognition compared with midwives. Midwives were more likely to be depicted as struggling to be a mainstream option while being hampered by lack of funding, insurance, and legislative barriers.
Conclusions: Although midwives have rising acceptance, they still struggle with recognition. Obstetricians have both acceptance and recognition. Countries where midwifery is a mainstream option have more news reports related to midwifery than obstetrics. Different issues appear more dominant in some countries, such as work force in the United Kingdom and funding, insurance, and legislation in the United States. (BIRTH 39:1 March 2012)
The media plays a major role in both reflecting and creating opinion when it comes to health professionals and their recognition as legitimate care providers. It has been argued that the nature of midwifery practice, involving culturally important symbols such as motherhood and babies, lends itself to media coverage (1). The media can portray midwives in a positive and negative light, and it has the ability to instill fear or confidence into the public with respect to certain birth choices and health professionals (2,3). However, it is unknown how the media currently portray midwives, especially now that the Internet has changed the speed in which media can influence the community.
New forms of media such as the Internet enable people to have access to instant information. Consumers are now able to find a rich collection of information about health issues, and their choices and views can be shaped by such resources (4). Media depictions can influence ideas on health and how health practitioners should behave (4). For example, in the top three medical television dramas in the United States, “ER,”“House,” and “Grey’s Anatomy,” 24 of 25 of the leading characters are doctors. Doctors are often the focus in medical dramas because they are seen as making life and death decisions (4).
Particular interest groups seeking to exert influence over consumers can also use the media effectively. Media depictions are partial truths at best and have the ability to create a false reality, which in turn, can become the accepted truth. Governments in many democratic countries are sensitive to depictions in the media about health and often react with policy change when an issue gets “too hot” politically for them (5). Midwifery tends to be affected more than medicine when this happens because of the medical voice being dominant in health care (1,6). The media can also play a strong role in marketing fear through how it represents childbirth and the health professionals involved (2,7,8).
With these issues in mind, we undertook a study to explore the way in which midwives and obstetricians, as the dominant providers of maternity care, are depicted in the media. In particular, the aim of this study was to examine how midwives and obstetricians are reported in English language, web-based news reports from around the world, and whether this reporting differs between the professional groups.
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Over a 12-month period (May 1, 2006–April 31, 2007), Internet alerts from a commonly used search engine, Google, were received on a daily basis by the first author. The search terms used were “midwife,”“midwifery,”“midwives,”“obstetrics,” and “obstetricians.” We originally also tried using the search terms “doctor,”“nurse,”“general practitioner,” and “family physician” because these health professionals also can provide maternity care; however, little information related to maternity care was forthcoming.
The search engine allows an option called “Google News alerts.” Once this option is selected, the terms to search for are added, and then an option is listed to create an e-mail alert for that particular subject. Relevant details are then completed, including the search term or terms, the type of information required (e.g., news, web, news and web groups); how often it is required (e.g., once a day, as-it-happens, once a week); language (English); and a contact e-mail address. When these details are complete, an alert is created and an e-mail is sent to the named contact, who will verify the request. An e-mail is then sent to the named e-mail account with a series of hyperlinks to articles that have been identified as containing the requested term or terms.
We used the Google search engine because of the ability to have news alerts sent to the first author’s e-mail address every day. We cross-checked with the search engine Yahoo and no additional information was forthcoming so we felt satisfied that we were obtaining most of the web-based media reports.
Web-based news alerts reported on a variety of media, such as newspapers, television, radio, and magazines. Some of the articles were only a few lines, and others were several pages. Although the reports came from countries around the world, because they needed to be in English, they tended to come most from the United States and United Kingdom, Australia, Canada, and New Zealand. Each of the articles was accessed, read, and saved in separate files for the subject (e.g., midwives, midwifery, midwife) and month (e.g., May, June, July).
A quantitative content analysis was used to analyze the data. This form of analysis has been used for analyzing the media for more than 20 years (9). Stemple described content analysis as “a formal system for doing something we all do informally rather frequently—draw conclusions from observation of content” (10, p 209). Holsti described content analysis as “any technique for making inferences by objectively and systematically identifying specified characteristics of messages” (11, p 14). Content analysis has also been described as “a research technique for the objective, systematic and quantitative description of the manifest content of communication” (12, p 18). Other writers have stated that content analysis should be treated as a method of observation akin to observing people’s behavior or asking them to respond to scales, except that the investigator “asks the questions of the communications” (13, p 525). Most of these definitions could refer to either qualitative or quantitative content analysis. Quantitative content analysis is the systematic and replicable examination of symbols of communication that have been assigned numeric values (14).
We used Krippendorff’s quantitative approach to content analysis (14). The approach was to 1) identify the topic: midwives, obstetricians represented in web-based news reports; 2) determine the unit of analysis: web-based media reports (English language); 3) determine the unit of observation: daily Google news alerts for selected terms; 4) sample: over a 12-month period; 5) examine content: manifest content, using some quantifying of data (what, how, and where); and 6) undertake subject matter analysis: provides the frequency with which certain persons, things, groups, or concepts are referred to (14).
Each article was downloaded daily and saved as a web archive. Notes were made of the article title and main issues raised (e.g., workforce and research), country of publications, and terminology used to refer to midwives and obstetricians. As more and more alerts were received, categories became evident and news reports began to be grouped under these categories. The categories were refined and reduced as the year went on.
Ethical approval was sought from the university but considered to be unnecessary because the media being considered was in the public domain and fully accessible.
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A total of 1,086 web-based news reports were analyzed (522 for midwifery and 564 for obstetrics) in a 12-month period from May 1, 2006, to April 31, 2007. Reports for midwives were highest in the month of May when International Midwives Day falls (Fig. 1). The primary countries from where the reports came included the United States (obstetrics = 373, midwifery = 172), followed by the United Kingdom (obstetrics= 35, midwifery = 188), Australia (obstetrics = 31, midwifery = 28), Canada (obstetrics = 24, midwifery = 26), New Zealand (obstetrics = 11, midwifery = 51), and then other countries (obstetrics = 83, midwifery = 51) (Fig. 2). Most of the news reports about midwives came from the United Kingdom and those about obstetricians came from the United States.
Each of these categories is explored next for midwives and obstetricians in order of prominence. In web-based news reports sometimes no author or title was given.
Primary Categories: Midwife/Midwifery/Midwives
There were seven primary categories for web-based news reports for midwife/midwifery/midwives (Table 1).
Table 1. Main Categories for Midwifery, Midwife, Midwives
|Mainstreaming midwives (models, rise of midwifery, stories)||145|
|The Cinderella of maternity care (workforce/industrial)||143|
|Delivering the baby with your hands tied (funding, 14; insurance, 15; legislation, 78)||107|
|Ask the expert (education, 32; research, 9; health advice, 2)||43|
|Recognizing midwives (awards and announcements)||35|
|Unsafe midwives (litigation)||31|
|The art of birth (books, film, photographs, and plays)||12|
“Mainstreaming midwives” (models of care/rise of midwifery)
The category of “mainstreaming midwives” was the largest, with 145 (28%) news reports; “mainstream” refers to the dominant or usual system of care. These reports were most prolific around International Midwives Day. Classically, the category comprised stories that explained midwifery and described the emerging role of midwives or midwifery models of care in contemporary maternity care provision. The stories largely came from the United States or Canada, and often consisted of a midwife explaining what is unique about the profession of midwifery and how it is different from obstetrics. A woman giving a testimonial about care from a midwife often followed:
The biggest part is building a relationship with the women, Rousseau said. The doctors are high-tech. We’re low-tech, high touch (midwife). (Cuda A. Midwives offer women special deliveries. New York Times May 11, 2006)
I think you get amazing one-to-one contact with a midwife. Simner said. She was with me the whole time, from when the contractions started to be regular to the delivery (woman). (Cuda A. Midwives offer women special deliveries. New York Times May 11, 2006)
The mainstreaming of midwives and emerging role of midwifery in maternity care was demonstrated in this extract:
The nurse who brought midwifery to Hamilton (Canada) talks about taking it from the back rooms to the mainstream. The profession that once provoked disapproving head shaking now can’t keep up with the growing demand .… The ease with which people talk about midwives. It’s just part of the scenery. (Hamilton Spectator, July 26, 2007)
“The Cinderella of maternity care” (workforce/industrial)
The category, “the Cinderella of maternity care,” was mainly composed of news reports about workforce or industrial issues affecting midwives and was the second biggest, with 143 (27%) articles. These news reports were predominantly from the United Kingdom and usually had quotations from the Royal College of Midwives, the professional college of midwives in the United Kingdom:
Midwifery services are fast becoming the Cinderella of the NHS [National Health Service], with staff shortages and cuts, the Royal College of Midwives (RCM) warned today. A survey of midwifery heads across the UK paints a depressing picture of cuts, job freezes, shortages and financial crises, it said. (Land J. Back to Health, January 8, 2007)
“Delivering the baby with your hands tied” (funding, insurance, and legislation)
The category, “delivering the baby with your hands tied,” was the third largest, reported 107 (21%) times. These news reports were mostly about funding, insurance, and legislation; they came largely from the United States:
You can’t deliver a baby if your hands are tied. That’s how certified nurse midwives in South Dakota view a restriction on their profession. They hope to change state law—untying their hands, if you will—through a House bill that goes before the Health and Human Services Committee on Friday. (Callison J. South Dakota Nurse Midwives Seek Independence. Back Hills Today, February 2, 2007)
Overt political activity dominated in this category, with rallies and protests often reported as a result of a piece of legislation before a government committee or because a midwife was being prosecuted for practicing somewhere where midwifery was illegal:
It was an uncommon sight in Harrisburg Friday: scores of Amish and Mennonites rallying on the steps of the Capitol rotunda in support of a Strasburg lay midwife. (Lindt S. Get your doctors off my birthing: Hundreds rally in support of midwife. Intelligencer Journal, January 27, 2007)
“Ask the expert” (education, research, and health advice)
“Ask the expert” was a small category with only 43 (8%) news reports in which a midwife was sought for professional comment or was discussing education or research. The reporting of midwifery research was low, with only one study receiving several reports during the 12-month period. When midwifery advice was sought, it was often about everyday activities such as diaper changing or bathing.
“Recognizing midwives” (awards and announcements)
The category, “recognizing midwives,” was also small, with 35 (7%) news reports. These awards often coincided with International Midwives Day. Midwives who were recognized frequently took the opportunity of receiving public attention to make political points about the invisibility of the profession:
This registered midwife of 42 years has from 1964 to 1999 delivered 3,047 babies … She enjoyed her career but is saddened by the fact that midwifery as an aspect of the nursing profession is not given the recognition it deserves. Jamaica hardly gives recognition to midwives and we are the main nation builders. There are no short cuts to our jobs yet we are seen as glorified nannies and technical supporters. (McPherson M. Nurse Nightingale of St Thomas—Delivered more than 3,000 babies, Jamaica Gleaner, May 1, 2006)
“Unsafe midwives” (litigation)
The category of “unsafe midwives” reported on cases before the courts that involved midwives. Of the 31 (6%) articles, three centered on individual legal cases. The news reports were often serialized, and the same story appeared over days and weeks in news reports. The cases did not always involve professionally trained midwives but lay midwives (untrained and unregistered midwives) or family members who attended a birth; however, they were referred to as midwives. For example, the title of the following article was “Women get prison time in state’s first midwife case”:
Convinced they were following a divine plan, Tanya McGlade and her mother-in-law, Linda McGlade, defended themselves against charges of unlicensed midwifery. The case arose after a 25-year-old relative died two days after the McGlades aided her in childbirth in 2004 … Neither of the McGlades ever professed to be a midwife, the defendants told the jury. (Michael A. Women get prison time in state’s first midwife case. Sarasota, Herald Tribune, June 17, 2006)
The news reports were often sensationally and dramatically written, leaving one with the impression that it was a fiction novel rather than a news report. Midwives were often represented as irresponsible and unscientific, as illustrated in the following news report. The title read, “Midwife crisis: It was supposed to be a peaceful home birth. Then the baby got stuck”:
The screams rushing up the steps from the basement echoed in the snow-blanketed front yard and filled the small ranch house in North Canton…. Brenda Scarpino, a slender woman with amber hair and electric-blue eyes, whose T-shirt bore the words “Addicted to Jesus,” screamed from between Kelly’s legs, Push! (Klaus J. Midwife crisis. Cleveland Scene Weekly, June 28, 2006)
“The art of birth” (books, film, and photographs)
Twelve (2%) news reports were about books, films, or photographs involving midwives. Midwives were very positively portrayed in these news reports, often with great nostalgia and again coinciding with International Midwives Day.
Main Categories: Obstetrician/Obstetrics
Seven main categories were devoted to web-based news reports for obstetricians/obstetrics (Table 2). They are each explored next in order of prominence.
Table 2. Main Categories for Obstetrics and Obstetricians
|Ask the expert (research, 106; pregnancy advice, 40)||146|
|Doctors are heroes among us (announcements and awards)||107|
|Obstetric workforce woes||106|
|New frontiers (trends in care, 75; new technology, 19)||94|
|The disappearing obstetrician (insurance, 20; funding, 3; litigation, 31)||54|
|Human interest stories||48|
“Ask the expert” (research and advice)
The category, “ask the expert,” was the largest, with 146 (26%) news reports that comprised news reports on research or doctors giving advice on certain matters related to pregnancy and birth. They came largely from the United States, for example,
Dr Romero, chief of the Perinatology Research Branch of the National Institute of Child Health and Human Development, a division of the National Institutes of Health, in the US, spoke on the topic, ‘The Child is the Father of Man.’“Several epidemiological, animal and clinical studies indicate that insults during the earliest stages of life can profoundly affect our health as adults,” he explained. (Expert highlights risk posed by bodily “insults” in early stages of life. Gulf Times, February 26, 2007)
“Doctors are the heroes among us” (awards, announcements, and celebrity births)
The category, “doctors are the heroes among us,” was the second most common, with 107 (19%) news reports that often described awards, announcements, and celebrity births that recognized the obstetrician—presumably as a heroic figure in the community. Some reports were about everyday events, such as the local obstetrician’s daughter getting married or the appointment of a new obstetrician to the local hospital. The following news report illustrated the link often found between celebrity births and accolades for obstetricians:
During Shiloh’s birth the couple’s obstetrician from Los Angeles, Jason Rothbart, M.D., was assisted by the local staff of the Cottage Medi-Clinic Hospital. Angelina underwent a scheduled cesarean due to breech presentation, Dr. Rothbart tells PEOPLE exclusively. The baby was a healthy 7 lbs. Brad was with Angelina in the operating room the entire time and cut the umbilical cord of his daughter. The surgery and birth went flawlessly. (Angelina and Brad thank obstetrician after daughter’s birth, Egypt Election, May 31, 2006)
“Obstetric workforce woes” (workforce/industrial)
The category of “obstetric workforce woes” was the third largest, with 106 (19%) news reports on workforce and industrial issues:
Since losing its last obstetrician five years ago, this city of nearly 32,000 in rural northern Japan has been desperately seeking a replacement. So desperately, in fact, that it recently promised a horse to any obstetrician willing to come here. There have been no takers yet. (Onishi N. Japan’s Obs shortage. New York Times, April 2, 2007)
“New frontiers” (trends in care and new technology)
The category, “new frontiers,” comprised 94 (17%) news reports on trends in care or new technologies that obstetricians were pioneering or using. “Miracle” births, especially of tiny babies, were among these news reports, as were those such as the one given next about increasing numbers of obstetricians working in the cosmetic surgery industry.
Christopher A. Warner says he considers himself something of a maverick, a caring physician willing to challenge medical orthodoxy in order to help women. That’s why the 39-year-old board-certified obstetrician-gynecologist recently opened the Laser Vaginal Rejuvenation Institute of Washington … use a laser to enhance sexual gratification by repairing tissue damaged by childbirth, to give women a youthful aesthetic look or to make those who are not appear to be virgins. (Boodman S. Cosmetic surgery’s new frontier. Washington Post, March 6, 2007)
The disappearing obstetrician (insurance, funding, and litigation)
Of 54 (10%) news reports about insurance, funding, and litigation, most came with a key message that these pressures on obstetricians were leading to obstetricians leaving the profession. The numbers of reports about litigation involving midwives and obstetricians were the same (31). However, the reports were phrased very differently. Whereas approximately three separate legal cases for midwives appeared to be serialized over days and weeks, the reports about obstetric legal cases generally appeared once only and in objective, factual terminology, as is represented next:
Yesterday, Judge David Foskett QC guaranteed Luke millions of pounds in compensation after ruling that his injuries were the result of the negligence by Mr Moors. Despite being an extremely competent doctor, praised by colleagues and who has never before been accused of negligence, the judge said Mr Moors had made a wrong judgment when he delayed birth by making a final attempt at forceps delivery… . Had Mr Moors abandoned his attempts at a forceps delivery just a few minutes earlier, the judge said the baby would have escaped permanent brain damage. (Millions for birth blunder. thisishamshire.net, January 19, 2007)
“Human interest stories”
Human interest stories included those news reports (48 [9%]) that caught the public interest and were generally bizarre, dramatic, or about celebrities. For example,
In her role as Bree Van de Camp on the hit ABC series Desperate Housewives, actress Marcia Cross has certainly experienced her share of plot twists. Now in a real life twist of fate, Cross, who is 44 and pregnant for the first time, has been ordered by her doctor to stay in bed for the remainder of her pregnancy. The actress is expecting twins in April … Why would the actress’ doctor take such a measure? It’s probably because Cross’ pregnancy is considered high-risk because of her age and because she is carrying multiple babies. (Alvarez M. Desperate housewife’s pregnancy plot twist. Fox News.com, January 12, 2007)
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Several significant differences were observed in the media reports about midwives and obstetricians when common categories were compared (Fig. 3). They included: ask the expert, workforce, public recognition, litigation and funding, and insurance and legislation.
It was clear that obstetricians were consulted far more as experts in pregnancy and birth than midwives. This recognition given to obstetrics allows the biomedical voice to remain dominant, and biomedical hegemony is central to the idea of authoritative knowledge (15). Jordan said the power of authoritative knowledge is not that it is correct but that it counts (6). Not only is the fact that obstetricians are consulted as experts in pregnancy and birth more than midwives shaping the public’s view of the professions, but the discourse of medicine, with a disease focus and language of risk, is very different from that of midwifery. Birth is therefore reinforced in an illness and risk paradigm with obstetricians as the essential experts. However, it was interesting to note that the proportions of media reports about the two professions in each country seemed to depend on the recognition and position of the profession within that particular country.
Workforce issues dominated in this study for midwives, and most of these reports came from the United Kingdom. “The Cinderella of the maternity service” was a term used by the Royal College of Midwives to symbolize the disadvantaged state in which midwifery found itself in the United Kingdom. The rising birth rate in much of the developed world during this period would have had an impact on this reporting. For example, in the United Kingdom the birth rate has increased during the past decade by 19 percent, whereas midwife numbers have increased by 12 percent, leading to an estimated shortage of 3,500 midwives (16).
In Australia in 2002 (the last report available), an estimated shortage nationwide of 1,847 midwives was reported (17). Workforce issues continue to be a major concern for midwives, with an estimated worldwide shortage of approximately 150,000 midwives and wide acceptance that this deficit needs to be rectified urgently to enable the Millennium Development Goals four and five to be addressed (18,19).
Obstetricians in this study were more likely to receive public recognition than midwives and often for minor issues, demonstrating again the prominence of the profession. It was interesting to note that awards and recognition for midwives occurred mostly around International Midwives Day, as did news reports about mainstreaming midwifery. It was apparent from the largest number of web-based news alerts in May that this day of recognition for midwives internationally has had a positive impact on lifting the profile and recognition of midwifery. More effort needs to be expended by midwifery professional organizations to maximize the opportunity to profile and acknowledge the contributions of their members. Moves such as those undertaken by the Australian College of Midwives to call for a midwife of the year nominated from the profession and a midwife nominated by women has had significant impact on positive news reports about midwifery in the media.
Although medical-legal litigation was reported equally for midwives and obstetricians, the way it was reported differed. Often the legal cases involving midwives were serialized and dramatized, reading like a novel and depicting midwives as a nonscientific, uneducated, and alternative to doctors. These three legal cases involved births at home. Not all were planned homebirths attended by professionally trained midwives, with the most prominent case involving a mother and daughter with no midwifery training. The tendency to sensationalize home birth and confuse free birth with planned home birth has been reported previously and is highly damaging for the profession of midwifery (3). Media reporting on legal cases involving obstetricians were much more objective in their language, dealing with facts and amounts awarded in the payouts. The reports also leave readers with the impression that had a cesarean section been performed, the tragedy may have been avoided. This coverage reinforces normal birth as dangerous and technology and hospitals as essential to safe birth. As has been pointed out, humans are good with stories and bad with numbers, emphasizing sensational stories more than is warranted (7).
Funding, insurance, and legislation appeared to have a much greater impact on the profession of midwifery in a number of reports in the web-based media compared with those for obstetrics. The United States was the country most associated with these issues of recognition for midwives, particularly relating to legislation restricting midwifery practice. Direct entry midwifery, for example, is still illegal in approximately 10 states in the United States (24), whereas it is now the main route of education in the United Kingdom and New Zealand. It appeared that the higher the recognition of the profession within the country, the less the focus on issues of funding, insurance, and legislation. These issues are of primary importance when it comes to the recognition of a profession.
The United States is not the only country with such barriers to midwifery practice. A large study undertaken in Australia showed that many midwives leave the maternity service disillusioned by the lack of recognition of their skills and potential role. Midwives were seen to be made invisible by the overriding culture of the acute services system and payment systems, education, and regulation that create barriers to their practice (20).
It was clear in this study of representations of midwives and obstetricians in the web-based media over 12 months that midwives, although gaining acceptance still lack recognition. Obstetricians appeared to have both recognition and acceptance. Throughout the media reports, the terminology illustrated a dichotomy between the two professions. Midwives were depicted as old-fashioned, uncontrolled, risky, tactile, lovely ladies, luddites, spiritual, into nature, alternative, woman-focused, a minority group, needing to be rescued, uncertain, and invisible. Obstetricians, on the other hand, were seen as high-tech, safe, controlled, learned gentlemen, new and scientific, baby-focused, traditional, certain, a majority group, rescuer, and highly visible. Although terms used to describe midwives were certainly not all negative, they contrasted with depictions of obstetricians as scientific and technological, which hold greater sway in a world that values these attributes. This subtle but powerful portrayal of the professions cannot help but have an impact on the way the professions are seen by the general public and how relevant midwives are perceived to be to childbearing women.
Midwives need to become much more aware of the potential to work with the media. Twenty-seven years ago, Kingdon (1984) stated that midwives were now in a position professionally to respond to what has been described as “focussing events” (21). Midwives have been slow to take up this challenge. Important events that serve to draw public attention to an issue can be used by advocates to advance a cause (1). For example, midwives have the opportunity to personalize government reports and research by focusing on real people and producing the information in a way that the public can understand. Midwives also seem to be effective in harnessing the support of consumers with their real-life stories (22), which lend a sense of drama and contribution to the meta-narrative that runs through contemporary media (4). This use of consumers was almost never seen in media reports about obstetricians, other than celebrity birth reports. The medical profession seems to have recognized the potential of the media to influence public perception, and professional organizations employ more media advisors and consultants to get the message into the media in the most effective way. Midwifery as a profession needs to become much more skilled at using this medium to engage with consumers, policy-makers, and their own profession (1).
Much work is left for midwives to fight the “demidwification” (23) of the profession. Although the number of news reports has increased about the rising acceptance of midwifery as a mainstream model of care, midwives are often still associated with home birth and natural birth in web-based news reports, which may lead many women to believe that midwives are not relevant to their needs. For example, midwives working in hospitals are not often profiled, yet most midwives work in this environment. Learning how to reframe midwifery as highly relevant and acceptable to most women is a challenge for the profession. The Center for Nursing Advocacy, founded in 2001, was a Baltimore-based nonprofit organization that sought to increase the public understanding of the central, front-line role that nurses play in modern health care. Its focus was to promote more accurate, balanced, and frequent media portrayals of nurses and increase the media’s use of nurses as expert sources. It is disappointing to see that the center closed recently. Midwifery needs to take a similar approach through professional organizations and the use of skilled media advisors and spokespersons.
This study has some significant limitations. Only English language media was analyzed, excluding several countries where midwives have high profiles and strong recognition (e.g., Sweden and the Netherlands). Likewise, other countries with strong obstetrics domination in childbirth (e.g., Brazil and Italy) are not represented. Not all news is available on the web, and most radio interviews, television, and magazines are still not available in this medium. Countries such as the United States and United Kingdom obviously dominate in the media reports. As the issues vary across countries, the high number of reports in a specific category from a specific location may not reflect a “universal” picture about midwives or obstetricians. Some of the maternity care contexts also change and have changed since this study, and these variations may not be picked up in a 12-month study. A follow-up study is planned to see whether changes in web-based news reports occur in relation to the two professions. The use only of the search engine Google may have provided other limitations, of which we are unaware, in accessing relevant news reports.