Taking a look at the "women should use pain relief with low emissions during childbirth" saga and how a press release helped make a mountain out of a niche-publication molehill.
Here's what happened:
Every two years, ANZCA, the Australia/New Zealand College of Anaesthetists release the "Blue Book," a bunch of scientific, peer-reviewed articles that cover "a diverse range of topics of interest to anaesthetists and specialist pain medicine physicians"
The most recent edition came out on November 30, 2021, over six months ago. It includes a report titled:
Nitrous oxide use on the labour ward: Efficacy and environmental impact.1
There weren't any stories about this at the time because not many journos would scour the Blue Book for details.
Sometime prior to May 30, ANZCA sent out a press release related to the report. It was sent to (seemingly select) journalists and headlined:
Carbon footprint of nitrous oxide (‘laughing gas”) should be explained to patients, anaesthetists say.
On May 30, The Age published this article headlined "Warning over climate threat from laughing gas used during childbirth" bringing the report in the Blue Book to public's attention.
It's balanced but it's a deviation from the press release headline that hints at something a little more worrying than the press release.
Worse though, was a tweet from The Age that said "The report suggests women use a pain relief option with lower emissions" -- a direct line taken from The Age article.
The tweet made people mad, and rightly so.
This tweet is asking why do “we” -- the public, mothers, families etc. -- need to think about this problem when it's such a small contributor to climate change. But the report really wasn't for the public, pregnant mothers or families.
The report does *not* suggest using low emissions pain relief. It does suggest informing women about N2O's environmental impacts.
That can be a bit blegh and still feels a little misguided, perhaps, but this isn’t a group of climate scientists doing a full accounting of the climate crisis and assessing the impacts of N2O. This is a reference book for a single profession.
So a press release goes out, gets spun up as a story, a tweet goes out that smashes all the nuance and everyone is mad. Then it continues to go further... leading to a piece on Pedestrian.TV2 and two pieces following it up in the Guardian:
The first is a straight report in which The Guardian get comment from Greenpeace:
“Rapid phase out of coal and gas, by far the biggest climate culprits, is the fastest and most effective way to tackle the climate crisis, rather than focusing on the relatively low emissions from obstetric medicine."
Which, I mean, fuck yeah? This is absolutely true.
Then a second piece dropped in The Guardian on June 1 headlined:
Linking nitrous oxide to climate risk is yet another example of the disdain shown to women’s pain
The opinion piece gets another quote, from @timinclimate: "we have to remember that the core of the climate crisis is the burning of coal, oil and gas for energy.”
Ab. so. lutely. Tim!
The responsibility for that isn't on the author's of the Blue Book report. It's on the journalists.
There is absolutely a discussion to be had about how women's pain is not taken as seriously as men's pain in health and medical care. But not from this report. Not if you go and read the original report and its conclusions which states clearly N2O use should be continued.
Gallingly, the first paragraph in the opinion piece does not link to the actual report in the Blue Book, which is readily available and free to download. Instead it links to the media release sent out by ANZCA on May 30. I don’t know why I have to say this but: That is not the “report,” that is a media release.
And therein lies the problem.
A lot of the conclusions drawn from all the pieces so far are inherently based on the framing of the original media release by ANZCA. One of the more significant elements of the report in the Blue Book is how the authors looked at the efficacy of N2O — how well it works for pain relief. But this is hardly discussed anywhere.
Instead, they all beat up the original report for raising an issue within a profession, which is exactly what good scientists should be doing. Only the original Age article gets comment from the study authors.
And those comments are super interesting!
The lead author states quite clearly that this is about offering choice based on factors important to the woman.
So… what really happened here? I have no idea if any of the journalists writing about this read the original report and I don’t want to accuse anyone of not doing so. I really hope they did! But it's hard to believe that's the case with the leaps in logic that have occurred.
To end, focus on some of the questions the Guardian opinion piece asks:
So why this this report? Why now? Why this issue above all others? Why the omission of other uses? Why did I get all those rolling eye emoji text messages?
The opinion piece also states:
Given that it’s used in such small numbers, for short(ish) durations and its minimal effect on global warming, you just wonder why this issue was raised at all.
You could wonder this — or you could ask the authors why they wrote the article for colleagues in their profession suggesting that, in antenatal classes, there’s a chance to educate people about emissions and allow them to choose a pain relief option as they please. That’s all the story is here: That women are given the knowledge to make their own choices, as explicitly laid out in the Blue Book report.
The authors suggest in the report that other anaesthetists ("we") be made aware of N2O's impacts. Surely reasonable? I think this paragraph, in particular, is really important. It shows that the authors are talking to their profession and believe helping make informed choices is positive for women.
It's great that a small community of healthcare professionals are thinking about their emissions coming from their sector and highlighting it in a publication meant for their colleagues! That is good, even if it’s a little clunky in its explanation.
One lingering issue is the bias inherent in a publication for anaesthetists, by anaesthetists. To understand this, you'd have to look much more into the efficacy of N2O beyond what’s stated in the original report in the Blue Book.
That bias is not really accounted for in any meaningful way, anywhere, across the articles written about the report. I guarantee no one writing about this has delved into the literature to see how good N2O is at providing pain relief. But, given the report clearly states women should be given the opportunity to choose, I'd say the authors aren't suggesting women use lower emissions analgesics during childbirth or poo-pooing use of N2O entirely.
It’s really quite sad how far this has gone and it sucks — because in science reporting, I see this thing happen all the time. You only really need to look back two weeks to see how a similar situation occurred around “the SIDS breakthrough”3 that was not a breakthrough.
But why even care about this? Well, It’s damaging. It erodes trust in professionals, like the anaesthetists that wrote this, and confuses the public, 99.9% of which will never read the original report.
When you see pieces like this, try and think about where they come from, where they start and what they're suggesting. Try not to be reactionary on Twitter. Read the original article, which SHOULD BE LINKED IN EVERY PIECE (hello Guardian??) and then take a little breath. Just one. Two maybe.
Just like I need to now.
A PDF of the entire Blue Book is available here: https://www.anzca.edu.au/resources/college-publications/australasian-anaesthesia-(the-blue-book)/blue-book-2021.pdf
As an aside, you can see the dangers here. Pedestrian.TV has done no extra work and then lazily slapped the headline “A New Report Has Been Slammed For Telling Pregnant Folks Their Pain Relief Hurts The Planet” — That’s not really correct but…
The Atlantic’s piece on this is really good: How a SIDS Study Became a Media Train Wreck