Sources of pregnancy advice for 21st Century women: does (grand)mother still know best?

Keywords::

• advice
• lifestyle
• pregnancy
• psychology
• work–life balance

Pregnant women (and their doctors) in the UK, in common with those in the USA and other Western countries, have become inundated, particularly over the past 10 years, by official government advice [1,101,102] regarding weight control, diet, wellbeing and lifestyle choices [1–3], including how to stop smoking and limit the intake of alcohol (e.g., [103]), as well as taboos on certain foods such as shellfish [104]. The overall advice offered to pregnant women is intended to cover normal pregnancies, as well as those at risk through physical or mental health complications such as HIV, drug addiction or ongoing medication such as antidepressants [4].

The introduction to the British Department of Health’s most recent publication, The Pregnancy Book, brought together what it considered to be “everything you need to know” to have a happy and healthy pregnancy because “it’s important to get up-to-date advice so that you can make the right decisions and choices” [1]. The same publication lists which foods and additives to avoid and which to increase in the pregnant woman’s diet. It begins:

“Your mum, colleagues, friends and relations might all be giving you advice. And then there is all the information on the internet as well as in magazines and books. At times it can feel overwhelming and it’s hard to know who is right when people say different things.”[1]

This influx of information is the result of both technological innovation and increased technological competence, leading to an escalation of studies of health benefits and hazards in pregnancy to both the woman and fetus [4–7]. However, it still begs the questions previously implied regarding where and from whom the pregnant woman should gain the best information and advice. The further implications of this being that there are, in fact, ‘right’ answers. But is this really the case?

These developments in advice-giving as set out by the Department of Health, the US FDA and other official bodies explicitly represent the contested increase in the ‘medical’ colonization of pregnancy and childbirth across the Western world [8–10] and the rise of, frequently lay, ‘pregnancy police’ whose surveillance of pregnant strangers’ as well as pregnant friends’ behaviors is a cause for consideration, if not full-blown concern [11].

To counterbalance medical advice, ‘naturalistic’ guidance on the benefits of herbs and other holistic means of ensuring wellbeing has become a growing activity. While there is evidence to show that some advice of this kind is robust, there is room for apprehension in that some resemble old wives’ tales, albeit that the websites always include some form of disclaimer to warn pregnant women to take the advice with care [12,13,105].

Managing the advice

In the 21st Century, it seems that the information explosion and self-management of health, wellbeing and lifestyle choices in pregnancy, along with professional–patient partnerships in healthcare decision-making, has replaced the notion that ‘doctor knows best’. However, some of the most up-to-date official information and advice can be contradictory. A key example is the recent change in advice from the British Food Standard’s Agency regarding peanuts in 2009 [106]. As a result of a major scientific review, they withdrew the previous advice to avoid peanuts, saying it was “no longer appropriate”. This type of action dramatically changes women’s expectations and could lead to a loss of self-confidence in the midst of such apparently contradictory information, increasing anxiety among pregnant women who fear that if they do not keep to the advice regarding taboo foods and behaviors, they might have to bear the guilt for their baby’s health status and wellbeing.

As the British Department of Health has emphasized [1], formal and informal sources of advice to pregnant women are both plentiful and potentially bewildering [14]. Even if women are experiencing a relatively normal pregnancy [15], they are likely to seek information from many sources, but how can they assess which are reliable [1]? For instance, some websites are run by lay groups, sometimes for profit, sponsored through advertisements or via a charity. For example, Pregnancy-Info.net, a US-based site, has a disclaimer that its information is intended to be educational and “believed to be accurate” but warns women to seek detailed advice or help from a qualified healthcare professional [107].

Other sites, sponsored commercially, for instance by baby food companies, stick rigorously to reiterating official advice (e.g., [108]) with additional links to their ‘experts’ who offer answers to frequently asked questions. Similarly, companion sites to magazines take advantage of advertising revenue and take a responsible line (e.g., [109]). Mostly there is little room for confusion as the mainstream advice is easy to identify and (relatively) standardized.

Mind the gaps

Historical studies of pregnancy and childbirth have shown how clinical and technological ‘fashions’ in the USA and across Europe can change, even though each era has claimed some form of evidence base [16–18]. Over the years, women have had to adjust to different expectations (medical and lay) of normal pregnancy and childbirth, some of which were precipitated by new knowledge and some by changes in approach to healthcare practice [15].

Over the last 5 years, our team in the UK has focused on women’s experiences of pregnancy advice, particularly to what extent advice is drawn from their own mothers compared with other sources, including websites, healthcare professionals and doctors [11,19]. As part of this we examined three generations of mothers; those giving birth in the 1970s, 1980s and 2000s, to see whether there was any change in the extent to which they took advice from their mothers. We found that the pregnancies of the 2000 generation were more exposed to greater public scrutiny, including comments from strangers regarding how they ought to behave. In one case a restaurant waiter refused to serve a pregnant woman with a glass of wine and in others unrequested comments were made by both strangers and friends as to what might be best for the woman and baby. This indicated that not only were pregnant women subject to information and advice overload but that the advice was becoming seen as established and explicit public ‘knowledge’.

The maternal instinct revisited

What was also important here was that the 2000 generation of pregnant women had greater and more immediate access to official government, medical and other sources of information and advice via the internet than those giving birth in the 1970s and 1980s. Women from these earlier generations relied on their doctors and mothers’ advice, alongside some printed advice manuals, to maintain a healthy pregnancy.

The 21st Century generation relied less on healthcare professionals for detailed everyday advice and more on official information. However, despite being well informed, they subtly balanced this information with advice from their mothers and grandmothers, whom they knew had had successful experiences. This was particularly true in relation to food taboos. A telling example was one woman, who was aware that the intake of too much caffeine had been identified as undesirable and who had wanted to abide by these rules. However, she had also been advised by her grandmother that a strong cup of tea before getting up in the morning provided an antidote to morning sickness, so she took this advice as well and drank her tea in the morning.

Previous generations appeared to be more sceptical, and even suspicious, about healthcare professionals’ advice at prenatal check-ups compared with advice from their mothers than did the 2000 generation. However, there is no evidence available to indicate how much the internet, and the ability to search for information themselves, would have influenced their decision-making.

There may be further to go

Pregnant women have more information and greater choice about how to live their lives than in any previous generation. There is also more pressure than ever before to use that information to enhance their health lifestyle choices. Surprisingly, though, women are rarely given advice regarding the reality of juggling a career, a relationship and motherhood. The aforementioned websites focus on the positives and fail to identify psychological and emotional hazards, such as anxiety and depression, frequently precipitated by lifestyle expectations, rather than hormones. Last year in London (UK), for instance, a successful city lawyer, Catherine Bailey, jumped to her death in the Thames because she had failed to meet her own exacting standards for being a mother, lawyer and wife [110]. There is scarce official advice to hand to help women cope with the pressures of being the 21st Century ‘superwoman’.

Equally important is evidence that domestic violence and abuse may begin or escalate during pregnancy. This rarely gets mentioned directly in information and advice directed towards pregnant women, even though in the USA and the UK research has consistently shown how difficult it remains for clinicians to address this problem with women (summarized in [20]).

In summary, more research is clearly needed into how women manage the advice they receive and particularly about how they identify the most reliable sources. Official organizations need to target advice to women at risk of lifestyle and emotional hazards, as well as those about physical health and wellbeing. Perhaps most important is that family doctors, specialist obstetricians and gynecologists also require support regarding how best to advise women about relationship hazards that might lead to stress, anxiety or partner abuse.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.