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Whether it comes from friends, bloggers or influencers, social media is a huge source of pregnancy and birth information – both positive and negative.

And, because midwives don’t often use social media to communicate with mothers-to-be, it means a lot of childbirth-related discussions take place online without any expert guidance.

Until now, there has been little research into how this content affects birth and decision-making around it.

But research by Anna Marsh, a midwife at University College London Hospitals NHS Foundation Trust, has found that midwives on Instagram – one of the most popular apps for women of childbearing age – largely promote a one-sided, idealistic view of childbirth, which could affect a woman’s perception and expectations of birth.

Using Instagram as a prenatal communications tool

Marsh and her team analysed hundreds of posts by some of the most popular midwives, known as ‘midwifery influencers’, on Instagram. They chose 20 accounts to observe in total; five each from the UK, New Zealand, USA and Australia.

The aim was to look at how midwives working in different healthcare systems were posting about birth on Instagram and if influences from these different health systems could be reaching pregnant women.

The research, which was co-funded by Wellbeing of Women, the Royal College of Midwives and the Burdett Trust for Nursing, analysed 918 Instagram posts in total, including 1,218 images and videos.

Most midwives identified for the study were white (90%) - just one midwife from the UK and another from the US were of a different ethnicity. And 17 of the 20 had a private business providing antenatal or postnatal education.

Researchers discovered:

• Midwives from the USA posted about birth substantially more than anyone else, mostly sharing birth stories
• In the UK and Australia, midwives were more likely to publish educational posts
• ‘Birth positivity’ was the most common theme among midwives’ Instagram posts in New Zealand
• Healthcare professionals were rarely featured in images or videos.

Marsh and her team also found that a natural, unmedicalised birth was overwhelmingly promoted by midwives and images mainly included white women. Only the midwives from USA and the UK included Black women in their imagery.

Anna Marsh says:

“Pregnancy can be a confusing time for many women – you may feel excited, nervous and even scared about becoming a mother, sometimes all at the same time. You’re also confronted with lots of information and well-meaning advice from all sides, including midwives, GPs, family members, friends and sometimes even random strangers.

“It’s natural for women to want to find out what to expect during pregnancy, childbirth and beyond, and Instagram has become a popular place to do that. It’s a perfect opportunity for midwives to share their knowledge and help others."

“By promoting natural and unmedicalised births, this may be skewing a woman’s expectations. We must be careful not to suggest that there is a ‘perfect’ or ‘normal’ way to give birth. What’s most important is that women have a safe birth and their choices are at the centre of their care.”

How to improve the presence of midwives on Instagram

Marsh’s findings highlight an opportunity for midwives to ‘claim their space’ on Instagram and increase their engagement and communication with women and their families.

In the initial search to find popular midwifery accounts to analyse, researchers discovered that midwives were underrepresented on Instagram. Earlier research found a common theme of fear of professional retribution for saying or doing the wrong thing.

Marsh recommends tailored training packages for midwives and student midwives, which will

• target the perceived fear of reprisals
• tackle the inaccurate use of social media to ensure women of all ethnicities feel included and all types of births are represented
• empower midwives to use social media to build engagement and conversations with women and their families.

Next steps

Marsh recognised there were limitations to her study – all midwives selected for the research were chosen for their high follower counts on Instagram, but this resulted in the cohort being predominately white. The study also focused on westernised, English-speaking countries.

The research also did not investigate the motivation of midwives behind their posts or look at how pregnant women and new mothers receive information through social media.

Marsh recommends further research to include a more diverse group of midwives and explore their motivations for posting on Instagram. She also recommends investigating the effect of social media on women, particularly looking at how a woman’s health and wellbeing may be impacted by birth expectations not being met.

Other research studies funded by Wellbeing of Women to improve care and health outcomes during pregnancy and birth includes:

• An investigation by Dr Matina Iliodromiti into how we can identify health risks in babies too small or too large during pregnancy
• Dr John Allotey’s work to reduce the rate of stillbirth by understanding early pregnancy risk factors
• Dr Shuby Puthussery exploring ways in which we can remove barriers to antenatal care for Black, Asian and minority ethnic women, and those from socioeconomically disadvantaged backgrounds
• Dr Emily Cornish’s project to understand what causes three rare placental disorders that can cause pregnancy loss and potential new treatments.