I was really struck recently by something that Helen Salisbury, a British GP, wrote in the British Medical Journal. Although she was talking about doctors, I think this applies to many other people who work in the fields of health and birth as well.
“Most doctors,” she wrote, “would like to think that they practise evidence based medicine, but it’s difficult to avoid being biased by our own experience.” (Salisbury 2019)
She describes noticing how a good many GPs tend to not recommend statins (perhaps, she suggests, because they see many people experiencing the side effects of this medication) while cardiologists not only recommend statins but take them themselves, perhaps because almost all of their patients have the sorts of problems that statins are given in the hope of reducing. Both positions are understandable, given the everyday experience of each of those groups.
This isn’t dissimilar to how viewpoints differ in relation to birth. As an experienced home birth midwife, I’ve watched the miracle of physiological birth so many times and I have a deep trust that, most of the time, women’s bodies work really well. My job, as I see it, is to support that and to sit on my hands and stay out of the way as long as all goes well. Only if I see or suspect a problem emerging do I get out all of my emergency skills. But I have a clear understanding of why some of my obstetric or hospital-based colleagues have a very different view of women’s bodies and the safety of physiological birth: they don’t see the women having physiological births at home or in midwifery-led birth centres; they see the women who have problems and need the emergency caesareans. It might be a self-fulfilling prophecy, but it’s still what they see.
As Helen Salisbury wrote:
“As scientists we’re all empiricists, basing our beliefs on observations. However, when the evidence is conflicting, sometimes what we’ve experienced ourselves, or what we’ve seen our patients experience, carries more weight than a meta-analysis we read last week. One unexpected diagnosis can skew our investigations and referrals for months, even though the likelihood of it turning up again hasn’t increased. These reactions are normal and probably unavoidable, which is why self scrutiny—asking “what could be affecting my decisions?”—is so essential.”
We are all biased by what we see. It’s just a question of direction.