 is now in session, and I'm very delighted to welcome Laura Godfrey Isaacs. Laura is an artist, midwife, and feminist, academic, and activist. She spent over 20 years in the arts, training in visual arts, working as a feminist, academic, and running the Radical Live Art and Performance Company Home Live Art, and that's available online at homeliveart.com. In 2016 she graduated as a midwife from King's College London in the UK and now works at King's College Hospital. She aspires to bring her knowledge and experience in the arts together with midwifery to bring fresh interdisciplinary perspectives to inform education, practice, and research. She is currently a research associate with Digital Institute for Early Parenthood, an ambassador for Procreate projects, and is the co-chair of the Health Policy Committee for the Women's Equality Party. It gives me great pleasure to welcome Laura Godfrey Isaacs, and it's over to you Laura. Thank you so much. Thank you. Good evening everybody from London. This is my first experience of presenting an online conference, so it's a bit of an experiment for me and maybe for you as well if it's your first time. So hopefully we're going to have an interesting time together. This presentation I've given a few times now in different contexts. I was very delighted to present it in Scotland last weekend at the MAMA conference, but I'll be really interested to get responses from what is now an international audience from all of you that are listening. So this presentation is really based on some research that I undertook when I was still training as a midwife, and as Jane was saying with the introduction, my background is in the arts, and in that capacity I worked quite a lot as a feminist academic and was very interested in the way that women's bodies were framed within art, particularly from a feminist perspective. And I found as I was training as a midwife, these kind of views about how that informs midwifery practice was maybe slightly missing from the training, which is one of the reasons I decided to do this as my dissertation and now develop it as a sort of bigger presentation for conference contexts. So I really undertook a multi-disciplinary literature review from around 1980 to 2017, and I was really trying to investigate how birth in the media depicts the body, depicts birth, depicts pregnancy, and how that would affect women's expectations and experiences of childbirth. You can see two images there. For instance, on the left-hand side might be familiar to you. It's an image by the photographer Annie Livovitz of the movie star Demi Moore from 1991. And this is really cited in a lot of the literature as being a sort of key iconic image where pregnancy and by extension birth was sort of glamorised for the first time in the media, possibly even fetishised. And it's seen as a sort of key moment. And that image has been plagiarised and parodied by many people. It still seems to have power. And I think what's interesting on the right-hand side is nearly 30 years later is an image by Beyoncé by a male photographer called Awell Ikenwou. And this is interesting because it seems to reference the Demi Moore image. But Beyoncé, it could be suggested, is very much more in control of how she is being portrayed as a potential mother. She takes a lot of care over the way that her body is portrayed in the media. And you have an image that is quite complex. It portrays her almost like a sort of Madonna, an idolised mother, but also it's quite sexualised with the underwear. And it's quite a contentious image. It's had a lot of sort of conflicting readings. So I just wanted to start with those two images really, one that in a way kind of has started this kind of fetishisation of pregnancy and birth in the media. And one very up-to-date one that in a way suggests how problematic it still is in terms of how it's portrayed in the media. So I'm just going to go on to the next slide. And I think what's interesting to consider at the moment, and I'm talking mostly in a sort of Western context here, is how we really are bombarded with images of birth. And in a way that our unprecedented representations of birth in the media now. Mary Ann, for instance, would suggest that we live in an electronic age where there is a convergence of media, including reality TV, Hollywood rom-coms, new media, internet, at social media. And Fleming et al. talks about how women will have a media-informed birth. And some of the research in the box at the bottom really seems to stress this. 82% of American first-time mothers in childbirth connections access media content weekly. And this is often daily as well. They're getting often daily updates, texts on their phones. They're using apps daily. Furthermore, an international survey of 24 countries found pregnant women use the internet up to 10 times during their pregnancy. And that's probably quite a conservative estimate. And a European survey found that 71% of all internet use was for so-called health-seeking behavior, which you could perhaps put this in the category of. Therefore, this idea that women will have a media-informed birth, I think, is really quite highly substantiated by this research. And again, if you look at the two contrasting images on the right-hand side, you have one at the bottom, maybe from around the 50s, where birth is seen as a kind of quite a sterile. It's a very controlled environment. The first birth in the UK on the BBC was in 1957, and that was described as disgusting and tasteless. Whereas if you contrast that with, for instance, the above image, which is from a Hollywood rom-com film called The Backup Plan with Jennifer Lopez. These images now are really ubiquitous in the media and are often seen as funny, they're comedies, they're highly mediated, and they're highly dramatized. So what I wanted to do now was to sort of look at how mainstream media tends to depict birth. And really what seems to happen is that mainstream media tends to reinforce and normalize certain dominant ideologies around birth. Furthermore, information is fragmented in consistent, weekly linked and poorly referenced, as is suggested in research by Fleming et al. in 2014. And so what we've got, again, if we go back to the research around the amount that women are referencing images and information in the media, is an awful lot of information that women are trying to wade through and make sense of and find their own route through. So what I want to do now is sort of look at what are these dominant ideologies around birth that the mainstream media depict. Now, unfortunately, we can't show video in this presentation, so if you have access to a good internet connection, it'd be really interesting if you could go to this link. It's an episode of an American hospital drama called ER, with the first really big showing of George Clueley, the film director, film actor. And this particular episode in 1995 was directed by the film director Quentin Taratino, who's a very sort of famous Hollywood director. And what's really interesting about this episode is that it starts with a four minute sequence showing a birth. And it's been talked about by quite a few of the studies I've looked at, that in a way it kind of epitomizes the way that the mainstream media depicts birth. It's a four minute sequence from the beginning of contractions to the birth of the baby. So it's highly dramatic. And what we're going to do now, even though we can't look at it, is just look at some of the themes that come through very strongly from this particular depiction. The first one being fear, danger, speed and pain. Now that might ring bells for you in terms of how birth is depicted in films and TV particularly. This sequence, the woman is rushed into hospital in the car, she's having contractions in the car, she's rushed into the hospital. Immediately rushed into a clinical room, legs up in lithotomy, the doctor comes in, delivers the baby. It's a highly kind of medicalized situation. She's screaming, she's screaming for drugs. It all happens incredibly quickly. She's depicting incredible sort of pain and like she's not in control. And so these themes of fear, danger, speed and pain are really reinforced. In a study by Morrison McInty in 1910, looking at USA reality TV, they talk about how reality TV depicts women as powerless, physicians as in control, and technology as the saving grace for women's imperfect bodies. And that again is very much stressed in that particular sequence from ER and would be in programs such as One Board Every Minute, as you can see from the image there. The second theme that comes out very strongly from the research is the medical model of birth. And Kitzinger in 21 talks about how this normalizes a medical narrative and therefore encourages women to submit to this potential scenario. So if that's what's being depicted, perhaps that is a way of almost conditioning women to expect that kind of a birth and therefore more willingly go along with that scenario, even if it's not appropriate for them. Now again, a video that some of you might be familiar with, which is quite relevant at this point, is by Monty Python from even further back in 1983 called The Miracle of Birth. And this is a parody of a highly medicalized birth and also talks in a way also about the woman's experience being very sort of minor, and also talks about all the equipment and the sort of systems and structures around the birth. If you're not familiar with it, I would suggest you have a look at it. It's very funny and also rather disturbingly accurate, not only for 1983, but I would suggest for 2017. But again, it kind of parodies this extreme kind of medicalization of birth in the media. So another theme to look at is how in these representations there are very few examples of the midwifery model of care. The one that some of you might be familiar with from the UK is called Midwife, and this is a picture here. But these depictions tend to be quite historical, nostalgic even, almost looking back to a bygone age that this is how birth was. Relational models of care, midwifery models of care were in the past and quite old fashioned. And there are few depictions of a sort of contemporary context with a very positive midwifery model of care. And furthermore, the way that midwives and midwifery is portrayed maybe more in newspapers and reports is often, unfortunately, very negative. BIC in 2010 talks about in her article, media portrayals of birth and the consequences of misinformation, how there is a use of experts to analyze negative outcomes who do not give a balanced view. Also, if we look at recent scandals, for instance, in the NHS in the UK, such as in Morgan Bay, midwives are often singled out for particular scrutiny. And even more so, the tabloid press in the UK is unfortunately often in the business of vilifying midwives. This is a quote from a tabloid newspaper The Daily Mail from 2011. If you don't hurry up, I will cut you what one woman was told at NHS Trust where five died. So there you have a compilation of perhaps very poor and abusive midwifery care even linked to the idea of baby death. Another theme that comes out strongly from these mainstream media portrayals is women's diminished autonomy and agency. Media texts tend to promote, for instance, dominant social constructs around femininity, the good woman, and by extension, the good obstetric patient. You can see celebrity magazines here and the sort of textual narratives around them. For instance, OK in the middle, Jessica Ulber being a mum is a miracle. On the right hand side, Miranda, I thought I was going to die. And so these kind of messages of these kind of valorised mothers, idolised mothers who have very little autonomy and agency themselves tends to be very much depicted in these types of magazines. You can also see that it tends to be very few women of colour are also depicted in these mainstream media representations and also it's very heteronormative. So always couples and no discussion around LGBT and different types of families. Now what I want to look at now in a way in contrast to these mainstream media portrayals is what happens with new media. So in a way it's quite a different story and that new media does provide opportunities for women to create their own content, to interact with each other, to learn from each other, to even campaign against mainstream media depictions that they feel unhappy with and to share information, which can be empowering. But again, there can be enormous amounts of information which again provides a kind of a challenge for women. So for instance on this slide, there is a website in the UK called Mumsnet by parents for parents. And there there's a lot of online parent forums where people can share information. At the bottom with the cross there is the positive birth movement, which again has a strong online presence for information and networking and contact. But also in the real world has support groups all over the world now for women to learn from each other and support each other. I would suggest also at the bottom with Twitter that a lot of women are using Twitter now for information, getting research, networking with each other. And you can see the large image in the middle where a woman has used, I think she set up a Facebook group and it's very easy to set up petitions now. So she set up a petition, I believe it was against Channel 4 and their depiction of birth in One Born Every Minute. So in that slide she's saying women deserve the truth about childbirth, not a version made for TV. It's time for us to reclaim birth as a magical, a beautiful magical event. Now not everyone necessarily thinks or wants birth to be a magical, beautiful event, but through the internet, through new media, that woman has been able to campaign and probably exert some influence over the media. In relation to that I think it's also quite interesting to look at media theory. For example, media theory in its inception was more around this idea of the hypodermic needle theory. So the idea was that we as consumers of media were quite passive that messages such as the dominant messages that I've just been talking about in the mainstream media would be received passively by the audience and therefore they would take that on board. Whereas new audience research, more contemporary media theory, tends to suggest that audiences interpret media text due to their own social and cultural context and that we as consumers of media or makers of media content ourselves can take a dominant, negotiated or oppositional stance to media text. So we can agree with it, we can take a negotiated or we can take an oppositional stance to it. And I think that's important to remember is that mainstream media is very powerful, but nevertheless we ourselves have the power to interpret those texts and decide how we position ourselves against them or with them. I think also regulators and the NHS in the UK are also realising how important media messages are. For instance, the Department of Health in the UK has a document, The Power Information, which talks about how important the information we give as health professionals is, and how important also other sources of information are in health-teaching behaviour by people that we look after. The NHS on its website has an area called behind the headlines, and this is where they specifically unpack media stories. So for instance, you can see a tabloid newspaper there from the UK, The Daily Mail, and that story, 82% more chance of dying in surgery at the weekend. Now that was a media story, but I believe that has now been refuted. It was not good evidence and it was overblown claim. And it's stories like that that will be specifically deconstructed in the area behind the headlines, so the NHS itself. In the UK, we also have guidance on using social media responsibly from the Nursing and Midwifery Council. So all health care professionals have some guidance on how to use social media themselves responsibly and how to respond to it. Also in the UK, there was a very big inquiry into the press, the Leveson Inquiry in 2012, which was around the press abusing their position in many different ways and intrusion into people's private lives. And that is called for increased press policies and regulation. So I think people in the NHS, health care professionals themselves and women clients, are increasingly aware of the power of the media and the need to deconstruct these messages. So where does that leave us in terms of what sort of practice recommendations might there be from this research if you work directly with people who are pregnant or going through birth? And I think really the main message is to try and support women's autonomy and decision making in birth. And Higgins et al. talks about how important it is to acknowledge health-seeking behaviour to discuss with women, even at the booking appointment, what need are you looking at? What books have you got? What films are you watching? What apps are you using? Women will often have apps now, pregnancy apps, and to guide to have a whole lot of recommended sources that you can guide women to. And also to recognise that there is also, due to this phenomenon, a shifting balance of power. Women are coming in often well-informed or needing guidance about how to access information and how to sift through this avalanche of information. Furthermore, the code which all nurses and midwives ascribe to in the UK itself talks about how important it is to promote partnership working, the importance of communication, and again to recognise the contribution people make to their own health. And a National Maternity Review that we had in England in 2016 also talked about, as an aspiration, the idea of every woman having a personalised comprehensive digital tool. So that could be a place, it could be an app, or it could be some facility that they could access where all of this digital information could be compiled for them and that might include their own electronic notes. So I think, you know, there's a recognition from regulators, from policymakers that this is something that we all need to be engaging with and taking forward. Furthermore, as midwives or as birth workers, we can get involved, we can get connected with each other. We can be involved in creating positive content around birth. Dennis Wolcher, a well-known midwife in the UK, talks about, you know, should midwives become film directors? Well, some of the images there you can see are of midwives in the UK who have set up blogs, websites, other websites such as Tell Me a Good Birth Story where women are sharing positive birth stories, Birthing for Blokes, which was set up by a male midwife in the UK, Mark Harris, which is a space to specifically support men in birth, a midwife in the UK called Clemi Hooper, who has a great blog called The Gastonair, they're on the bottom of the right-hand side, where she also has asked the midwife facility. So I think whereas midwives used to be very scared of being involved in the media, now increasingly midwives are recognizing the importance of putting out evidence-based information, positive information, creating spaces and forums for women to connect, but also for within the profession for midwives to connect with each other and birth workers to connect with each other and learn from each other and support each other. I just put up this slide, which I know is possibly quite a shocking image because it's an image of a maternal death, actually. But the reason I put it up is it's from a film called Marina and Adrienne, which was directed by Lucy Campbell for the British Film Institute Shakespeare's sister programme, which was about supporting women directors for Shakespeare's birthday last year. And the actress in the back holding the woman is actually my daughter, to Lula Hasen, and she's quite young, she's 20 years old, and she was to be the birth partner for this woman who was having an unassisted birth. It's quite a long story, but nevertheless she came to me and asked me, well, what do I do to support a woman in labour? What sort of noises does a woman make when she's in labour? And talking to her, as her mother, I was trying to give advice and help, but then I also realised, God, this is a really important situation where I can possibly influence how this birth, not the outcome, because that was part of the narrative, but nevertheless how that woman was labouring, I could influence that and try to create a more realistic, perhaps, experience for those that would be watching the film. So that was just an example of how there are opportunities often in your own life. There are professional contexts and opportunities, but often there are also quite unexpected personal situations where you can intervene or interact with something in the media. So I think I'm going to leave it there with just a couple of images again from celebrity magazines with probably two of the most famous women that have been pregnant recently, certainly in America and England. So we have Kate on the right-hand side, again dramatising delivery room drama, whereas actually she, by all accounts, has had two really great midwifery-led births, but nevertheless the way that the media is reporting it as a drama. And on the left-hand side, rather unfortunate kind of body-shaming around King Kardashian and her, perhaps, struggles or experiences through pregnancy. So I'm going to leave it there and I would love to take any questions that you might have. This is Jane, I think that was an expert box. I couldn't hear you very well. Are you in the other room? No, I'm just here and seeing other questions in the chat box. So we've got an echo somewhere on it. I think, do you want me to answer the question that's typed? Yes, please. Okay, so Lindsay, making effective films needs skills. I know I tried to script bilingual health education videos. Should midwives not be building creative relationships with those artists who are experiencing the field of film creation so we get our messages across so they're useful for women and families? Yes, but I think both. I think that there are midwives such as myself who have an arts background who might well want to use those skills in midwifery. I also think it's so much easier now to create content online. There's online editing facilities. I think a lot of midwives that are setting up blogs and websites are doing it in a way that we couldn't have done that. We couldn't have had exposure or got messages out in the way that we can probably even five years ago. So I certainly agree with you that collaborating with filmmakers and artists absolutely and profiling work that depicts birth in different ways. Absolutely. But I also think anyone that wants to should have a go and there are ways to do it now which they didn't used to be so easily. Any other questions? Someone's talking about... Yeah, in the show, they had women having horrible difficult buzz all the time in the emergency room. I think that goes back again to the sort of drama. If you think about Quentin Tarantino directing that episode, it's probably not surprising that he would try to make birth the most dramatic version that he could imagine. Though he's probably again informed by past media representations not probably by his own experience. That's my assumption. And also what I was going to say about that it's quite difficult talking about that video without actually being able to show it. So I was going to say is that obviously anyone that's been involved in birth or had a baby themselves knows that it's generally very, very slow and yet the way it's depicted is always fast emergency scenarios. Linda talks about lots to learn on Call the Midwife. Yes, I agree. I mean, I think that even though it is a sort of nostalgic depiction in many ways, they do actually tackle some really interesting issues. And you can see in a way the sort of history of midwifery practice through it. Many of the echoes of which we still experience now. They have dealt with some really difficult issues. They dealt with FGM, for instance. They've dealt with domestic abuse. They have episodes that talk about the advent of contraception being available. So I'm not negative about Call the Midwife. I was the point I was making was that that depiction of midwifery as a sort of relational practice tends to be seen as something that happened in the past, not something that is happening now, unfortunately. For a little idea, you're right, that was also depicted. So Susanna talks about the information about childbirth in media is very full of bias and the public take that information as a true fact. I mean, I think that I was trying to sort of explore that to a certain extent in the presentation looking at sort of media theory, which tends to refute that to a certain extent. I mean, I think it's a mixed picture. I think that media representations are incredibly powerful. But I also think we as consumers of that are probably the most informed kind of consumers there have ever been. And therefore, as some of that media theory was suggesting, can take a different position towards those messages. And that will very much depend on our particular position personally, culturally, and also on our sort of degree of media literacy in a way. Do we know if there was a complete turnaround of presentation of birth? Would we see a cultural change for people's expectations? I think, again, going back to the power of media, and I think that's why it's interesting to look at what's happening with new media. And I think that the sort of increasing power of social media is changing things. I think the way that women activists, birth activists are chipping away at things and websites and movements such as the positive birth movement tell me a good birth story. I think those can be incredibly influential. What I'd really like to see is a change in the mainstream media. And I'm hoping that that is going to happen with the sort of increasing power and influence of social media. So many times I've talked to friends and they've fully brought into the dominant media messages around birth. How does one go about challenging that perspective, respectfully? Yeah, I mean, I think respect is really important. I think it comes back again to what I was saying about trying to guide pregnant women. It's about maybe suggesting other sources of media, excuse me, that they could be looking at around birth. So guiding them to things like the positive birth movement, tell me a good birth story, looking at various different apps which take you through pregnancy and birth. And I think also maybe challenging those people in a respectful way, excuse me, and asking them where are you getting these ideas from and trying to explore that with them. In the same way that you might with a pregnant woman, ask them what images have you been looking at, what films have you seen and try to open up a conversation with them, but in a sort of non-confrontational way. Yes, I agree. The best USA mainstream media is the Ricky Lake film. Yeah, the business of birth. That's a very, very interesting sort of exploration of the sort of private health care and business of birth in the States. Susanna, yes, it would be interesting to know what was happening before and after Call the Midway show. Do you mean in terms of the depictions? And as I was saying at the beginning, the first actual birth on the BBC in the UK was 1957 and that was described as being revolting and tasteless. So we've come a very long way from there, whereas now it's just kind of routine to see births on the TV, particularly and in films as well. And again, if you go on to YouTube, you will find thousands of people have actually posted their own birth videos onto YouTube. So there's no lack of images, that's for sure. Not reading the USA, but what to expect when you're expecting. Yes, I mean, I think there are some great books that have come out in the UK recently. One is by the midwife that I was saying with her blog Gatinaire called How to Grow a Baby and Push It Out, afterwards by Clemi Hooper, which is a really great guide to pregnancy by a midwife. And also there is the positive birth book, again, coming from the positive birth movement. So I think there is some, again, I would be suggesting those publications for women to be looking at. I think there is, you know, there's some great information out there, but it's helping women to or guiding them, suggesting the ones that you think have the most balanced and sort of positive versions of information. And I suppose as a midwife are going to be depicting midwifery care in a positive way. I'm just reading some of these other questions. That's good to know. The NPR blog online about called Midwife is a really good follow up too. Okay. Yeah, I mean, as I said, I think there's a lot of good information out there. Perhaps if the only thing you've seen is a sort of Hollywood Ron Conn film or One Born Every Minute, you're not going to have a very balanced view of birth. But I suppose the hope is that for someone who is preparing for birth now, they will search more widely and the facility to do that is so much easier now. Are there any other questions? Epic journals. All right. Epic journals. Thank you so much. Thank you so much. I'm just going to see if I... I don't know if you're... Are you using a headset? I am. Yep. Okay. I'm not sure why I'm getting this horrendous echo. Hey, you... Well, thank you so much. Thank you so much. It was a really great presentation. It really...it was a really great and very stimulating talk about portrayal of birth in the media. And we look forward to changing hearts and minds as we proceed. Having been a midwife for 27 years, I have seen a huge improvement in the way women's and baby's lives are and family lives portrayed in the media, even if we've still got a long way to go. So thank you so much. And yes, I'll find the link for the Call the Midwife blog as well for that. So I'm going to go ahead and turn off the record button. And before I...