Evidence is overrated!

As a confirmed skeptic, my title is deliberately provocative, but reflects the tail-chasing propensity I have to apply skepticism to skepticism. I absolutely have to be evidence-based in my work, and I’ve completed a BA module in understanding and using research, but I still worry that I’m as guilty as the next person of cherry-picking it to suit my own views.

When it comes to birth and parenting, the quality of evidence available is not great. Much of the subject matter is undefined or too complex to boil down to a testable hypothesis, and RCTs on babies are ethically difficult. On top of that, parents being such a super marketing demographic, there are an awful lot of vested interests.

Most people working in this area are emotionally invested in some way, and not all the organisations supporting parents have a rigorous reflective practice and supervision structure, allowing them to debrief to the extent that they don’t carry any value judgement at all into their work.

This muddies our use of evidence.
There is some research on how hard it is to adopt new learning, when prior knowledge is deeply embedded. Hence out of date practices and misinformation propagated through on the job learning. If new evidence is not a good fit with what we already ‘know’, it is difficult to re-align oneself. We see this with adherents to scientifically implausible theories for example within alternative therapies, where belief is very much stronger than evidence.

There is also research [pdf] suggesting that GPs often base their breastfeeding advice on their own experience or that of their partners. In fact this rule applies to most people: if it worked for you, you may well suggest it to someone else, especially since the urge to problem-solve may be overwhelming. One GP spoke to me at length about something that she called “yeast mastitis.” A yeast infection of the breast (thrush) and mastitis are two entirely separate conditions, with different (but sometimes related) causes and different treatments. This is fairly basic stuff.

Parents are certainly titled to evidence-based information, and there are some good sources such as NHS and NCT websites; but this should include information about the limitations of the evidence, and where professionals supporting parents are unsure, untrained, or inexperienced, they should be clear about their boundaries and limitations. More damage is done by the supportive making up of answers than by handing over a reputable helpline number.

Evidence can be used as a stick to beat parents with (perfect example: “breast is best”), and then on the other hand it really is overrated as a decision-making factor compared with pressing lifestyle issues and social influences. Science journalist Linda Geddes, a busy parent of two who knows the evidence behind exclusive breastfeeding to six months, still chooses formula milk for her four month old when it is more convenient to do so. She weighs the risk, according to the evidence, but also in the balance are the fact that her two children are “simultaneously clamouring for their dinner and I don’t have time to sit and breastfeed.”

This is not a value judgement, but an excellent illustration of the way evidence is balanced and sometimes negated by parents’ lifestyle and needs, when making decisions. For me, it’s the evidence about sending a six month old to daycare that makes uncomfortable reading.

Working with parents is about providing evidenced information and decision making tools and confidence in themselves as parents. Evidence does not make something right or wrong when it comes to parenting, and we absolutely cannot use it either to dictate or to judge what parents do.