The Internet as an educational tool for the general population

Logging on to the Internet, particularly as a lay person, the sheer volume of information is alarming, and there is often no indication of how up to date it is and from which sources it was drawn. As a lay person, with no medical degree, but as editor of babyworld (http://www.babyworld.co.uk), I have been able to use my experience and that of our 54,000 members to learn how to search out the sites that genuinely offer help. The true strength of the Internet lies in the two-way communication that can be offered. At our site we offer just that: two-way communication in the form of online antenatal classes and an ‘ask-the-experts’ service, both of which are accessible only to registered members. A pregnant woman looking for answers to her questions could read a book; however, this is very much one-way communication, and unless she is going through a symptom-free pregnancy or a smooth postnatal recovery, a book will never be able to answer all her queries in detail. Similarly, she could watch a video, but unless she is able to comprehend that every caesarean section is different and every water birth is different, she will not know that her own circumstances are unlikely to be the same as those on the tape, and then where can she turn? Obviously members of the medical profession, caring for patients face to face, are the only ones who will have complete knowledge of a pregnant woman’s particular circumstances. But when all a woman wants to ask, is:

‘I’ve just had the wood in my hallway stained and the fumes are quite strong. 
Could this affect the baby? I am 20 weeks pregnant.’
‘Can stress during pregnancy harm the baby in any way?’
‘I have a day or two at the beginning of my period when the bleeding is very light, 
and then it starts properly. We are trying to have a baby and have been for a year 
and 8 months. When does my cycle start - from the first day of bleeding or the 
start of the ‘proper’ period?’

then she often feels embarrassed at asking her general practitioner, midwife or consultant obstetrician, especially when she has far more important questions she also needs to ask. This is where the Internet can step in to offer general answers to the sort of questions that women are often too embarrassed to ask face to face because they worry they are trivial. We have all heard horror stories of patients turning up with ream upon ream of paper containing information they have extracted from the Internet, convinced they have a rare disorder and with 30 pages of sources and references to back it up, when really all they have is mild anaemia, and oral iron will get them back to full health. However, information from the Internet clutched in a patient’s hand need not be a bane for medical professionals; it can be a boon.

“The Internet can offer general answers to the sort of questions that women are often 
too embarrassed to ask face to face.” 

There are three points here. Firstly, information has to be up to date, and when it is, one should make this very clear. Anyone writing for the Internet should try to have the date that the original article was published attached somewhere to the piece. This ensures that online work will be respected not only by members of the public, but also by other professionals who come across it and are able to appreciate that it was the opinion at the time, even though it may since have been superseded, rather than dismiss the writer as someone who does not keep up with current knowledge.

“If information is accurate and keeps people away from the surgery, then doctors will 
have more time to attend to those in genuine need.”

Secondly, if information is accurate and keeps people away from the surgery, then doctors will have more time to attend to those in genuine need, rather than having to deal with yet another patient with mild morning sickness. Sufferers will have found the tried and trusted, if not highly scientific, methods that can help and will not visit their doctor unless it becomes a major problem.

Thirdly, the Internet can offer support at a time when the medical profession does not. After confirmation of pregnancy, which is often done at home by a urine test kit and not repeated at the surgery, the pregnant woman is more or less cast adrift for the next 2 months before it is time to start the cycle of scans, blood tests and midwifery appointments. One of the most repeated comments by women who have just discovered they are pregnant and have joined our online antenatal classes is that there is nobody to ask between confirmation of pregnancy and the first ultrasound.

“There is nobody to ask between confirmation of pregnancy and the first ultrasound.”

Babyworld has online antenatal classes which offer weekly meetings with a National Childbirth Trust antenatal teacher, but also give women at the same stages of pregnancy the chance to discuss issues among themselves whenever they choose. It is one of the most popular functions of the site. I surveyed some of our December 2000 antenatal class members about what they think they get from being able to access information online, as they approach the end of their first trimester. Responses included:

‘Midwives and doctors are there for checking our health but I have gained most of my 
information from babyworld. The most valuable part is being able to “talk” to 
other mums-to-be who are in the same stage of pregnancy.’

‘I have been and still am appalled at the lack of care and interest from the medical 
profession during the first 12 weeks - I guess there will be more attention from their 
side as we progress, but I feel that these first weeks are so important, and there is very 
little support and help out there. This is where the Internet fills a real gap - the chance 
to speak to people in exactly the same position and to get advice on all those questions 
we wouldn’t dream of asking our grumpy GPs! I have often simply felt on an emotional 
roller coaster (especially during the very early weeks) and it was good to get support from 
other members of this club. Often I feel silly, and reading that others have the same silly 
problems/worries/questions has made me feel so much better.’

‘Essential reference because there is so much to take in as a first-time mum.’

‘Information on any concerns 24 h a day.’

‘I’ve found the medical personnel I’ve met pretty disinterested in what I’m so excited about, 
yet at the same time worried about constantly. They give the impression that it’s not worth 
getting excited until we’re further on - but the people on babyworld have been so interested 
in what I’ve said and supported me loads. I think it’s because everyone’s at the same stage, 
so have the same niggling worries, and the books don’t always cover all of these. It’s the feeling 
that we’re not alone that this site gives above anything else.’

Unless a mother-to-be has a high-risk pregnancy, even moving into the second trimester will involve only the occasional appointment for the following few months. Particularly in pregnancy, which after all is not an illness, there is a culture of offering support only when needed, which is when a mother is high risk and as the birth approaches. But during the preceding months of smooth pregnancy is exactly when women want to ask questions that may be perceived as ‘foolish’ by hard-pressed clinical staff.

If a woman can use the Internet to find detailed and up-to-date helpful information, then she will be supported when she feels she needs it, 24 h a day, without pressurizing already stretched resources. I do not see the Internet as the saviour of our health services. I do not have those kind of noble delusions of grandeur! But what I do see the Internet as, is an alternative source of information that can educate the general population. How many times must a doctor have told a patient something and known that neither she nor her partner has understood it properly? With sensible use and by using credible websites, the 24-h-a-day Internet can reduce the number of pointless appointments and help the doctor concentrate on patients in genuine need.