The husband and wife medics working to spread reliable parenting truths to counter the online noise

It is time to push back against judging over breastfeeding and birthing, say medical couple

Where new parents might have once had bits of conflicting advice about their baby from extended family members to contend with, now they can be bombarded with disparate views on every internet search and foray into social media.

Frazzled, sleep-deprived parents struggling with an unsettled baby might hope that a solution is only a click away. But the torrent of “content” that can be unleashed with a simple online query on “the best way to...” can be overwhelming.

Paediatrician and neonatologist Dr Afif El-Khuffash, who works in the Rotunda hospital in Dublin, has seen a pattern of increasing confusion among new parents over contradictory information they are getting on how to care for their newborns. “Doctors are often shy of having a presence on social media, and for a very long time I was as well. What struck me was that, if we are not there to spread information, then misinformation and disinformation will prevail.

“That disinformation can come from, sometimes, a well-meaning parent where something random has worked for their child – and then literally everybody follows it. Or it could be an influencer advertising a product that has no evidence base behind it; or somebody advertising services with no background to support the service they are providing.”

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Determined to pitch a voice of medical reason into misleading and exploitative chatter, El-Khuffash entered the social media fray and then last year started a podcast, The Baby Tribe. He records and edits it in a studio he created in the garden room of his south Co Dublin home. A certified lactation consultant himself, he invited a like-minded colleague in this field, paediatric nurse Katie Mugan, to co-present.

Both work to support breastfeeding, but they don’t denounce baby formula in the process, preferring to recommend to parents what’s best in their individual circumstances. He knows to his cost that occupying the middle ground in the divisive realm of breastfeeding politics does attract the ire of online commentators.

He sees women carry much guilt into his clinic due to having given their baby a bottle, because otherwise they find they cannot continue breastfeeding. “They are convinced they are harming their baby.”

He is quick to reassure them that breastfeeding “is not the be all and end all of how a child develops”.

The aim of the podcast was initially, he says, to relay information to new parents in an accessible, digestible, easy-to-understand way. Now evolving to cover later stages of childhood, it is still a labour of love that he fits around his busy day job and family life with his wife, Dr Anne Doherty, also a medical professional, and their two children, Maggie (15) and Faisal (13). (There’s also, not to mention, a very miniature Yorkshire Terrier called Buddy, who makes up for what he lacks in stature with charming chutzpah.)

“I can’t just sit down and ‘be’ – it’s probably a problem,” Kuwaiti-born El-Khuffash says with a smile, as the couple talk to The Irish Times about maternity matters as both practitioners and parents.

“I can – the kids know where to find me,” laughs Doherty, who is from Ballina, Co Mayo. They met while medical students, he in Trinity and she in UCD, and got married in 2007. “He’s go, go, go; I’m at a slower pace. That’s fine, it works well.”

Bear in mind that her “slower pace” encompasses a very demanding job as a consultant anaesthesiologist, working primarily in the Rotunda too, but also one day a week in the Mater.

The yin of his cerebral intensity is balanced by the yang of her grounded compassion. It works not only for their marriage but is now being harnessed for their latest collaboration – a spin-off podcast from The Baby Tribe, which has joined the HeadStuff stable for its third season.

Humorously called “Keeping up with the Khuffashians”, this add-on is a more relaxed ramble around medical matters, intertwined with their own professional and personal experiences. The idea came to El-Khuffash after he had Doherty in as the final guest on season two of The Baby Tribe, and it proved to be the most popular episode of the entire two seasons. “I got a huge response on Instagram, saying ‘We want more of Anne’, and it was, ‘Oh God, here we go’,” he says with a mock sense of rivalry. “She doesn’t try.”

What we’re seeing is a lot of people who work in the homebirth industry are really trying to scare women from going into hospital to give birth

—  Dr Afif El-Khuffash, paediatrician and neonatologist

A natural talker, she was surprised at the reaction, because she thought everybody would just presume El-Khuffash must have been really stuck for a guest if he was calling his wife in.

The new project at least gives her the chance to sit down and chat to her husband for an hour a week, she jokes. But she shares El-Khuffash’s view that there is a need not only to counter medical misinformation and reclaim the middle ground, but also to show that doctors are human too.

“The middle voices are lost because moderate isn’t cool. Black and white is cool,” she points out. “That is one thing we can do – stand and be balanced and moderate, and have the evidence and healthcare behind it to really help validate that.”

Both dive deep into research studies before discussing what lies beneath the headlines.

While El-Khuffash sees fallout from what she terms the “breastfeeding Olympics”, in her area of expertise, obstetric anaesthesia, it’s the “birthing Olympics”.

Doherty reckons it’s time for a push back against both.

Women can feel bad about taking an epidural, but her response to that is, isn’t it wonderful that we now live in a world of options? You can’t deny yourself something that you need, she suggests, because a month ago when you were planning for this, you didn’t know what you were going to be going through. “Every labour is different; every labour in the same woman is different.”

She is a cheerleader for every one of us “warrior women” who “sacrifice a huge amount physically, mentally, financially, socially to do what we do, and it’s a job that men cannot do. I think the recognition of that is empowering – not being told what is or isn’t an ‘appropriate’ experience.”

Both Doherty and El-Khuffash are keen to challenge a belief that maternity hospitals are intent on medicalising a physiological process. “What we’re seeing is a lot of people who work in the homebirth industry are really trying to scare women from going into hospital to give birth, because of the insinuation that they will be disempowered,” says El-Khuffash.

While Doherty agrees this is a strong narrative, she attributes it less to homebirth advocates and more to legacy issues linked to historic attitudes to pregnant women and female healthcare in Ireland. “We work in a hospital where we endeavour to always listen to what our families and women want for their labour and delivery. I have seen women determined that they would rather take on the risk that has been given to them in terms of a risk assessment and to continue on in labour and see how things go. That is never disrespected, but they are updated on how that risk-benefit decision is weighed at various times,” says Doherty, in what is, by its nature, a dynamic situation.

There is no low-risk pregnancy, she says – rather, there is normal risk and increased risk. “People don’t like thinking about that. It can change from normal to increased risk at any time of pregnancy and definitely around the time of delivery. That is why maternity hospitals exist – it is that simple. It is a way to put in one building all the specialities that you may need should your status change.”

That change of status could involve the onset of seizures, pre-eclampsia, massive haemorrhage – “all those scary things that no one wants to think about. They are our bread and butter.”

Yet, she readily admits that she was “shook” to be on the other side of the maternity system. Both of the couple’s children were delivered by Caesarean section when her labours failed to progress due, frankly, to an unco-operative cervix. But it was “losing that sense of self” in first-time motherhood that she found most difficult.

“I used to feel I was squished into a tiny part of my brain and the baby took over everything else.”

She also talks about going from talking to 50-100 people a day to being at home, just herself and her baby. “That change, that sacrifice – it is very stark I think for some people.”

El-Khuffash says the biggest change for him when their daughter was born “was going from being relatively carefree to being very anxious about everything to do with safety and around raising her. It is funny because I thought that being in paediatrics would probably help. But being forewarned was probably too much, and I was over-interpreting things.”

However, he adds, “the ironic thing is that we didn’t recognise our daughter had reflux until months later. Even though I would go to work and manage kids with reflux.”

She used to have bouts of screaming and was inconsolable. “It’s totally different when it’s yours,” says Doherty. “We had to learn not to be our kids’ doctors.”

It is said that children of doctors are “either over-investigated or under-diagnosed, but never appropriately managed”.

In the juggling of frontline jobs with parenting, both of their offspring, says Doherty, “had the experience of being the sick, crying child, and the parent they were clinging to literally peeled them off, handed them over to the other one and walked away because we had to get into the hospital”. Faced with having to ask a colleague to cover a shift if they couldn’t go in, “we have been the guilty parents who double dose the kids”. But having a childminder in their home at times was key for meeting their hospital responsibilities.

Working in the pressurised and precious world of maternity and newborn care, how do they handle knowing that, as humans, it is inevitable they are going to make mistakes?

“It is not actually the mistake that is the problem, it’s what you do with the mistake that is the problem,” says Doherty. “It will either make it or break it. You’re not a good doctor because you never make a mistake. You’re a good doctor because you’re human and you care.”

There is nothing more reassuring to a woman having a C-section on the table than when I go, ‘I have totally been where you are. I hated it. I hated feeling sick’

—  Dr Anne O'Doherty, consultant anaesthesiologist

As she tells trainees: “You will make a mistake and when you do, it’s what you do next that makes you a good doctor, so decide. It’s not about you, it’s what you do next, what you do for the patient.”

El-Khuffash believes owning up and apologising is the best approach. It is important “to demonstrate to the patient you are doing your utmost to, number one, ensure that they are safe, and then that you have taken steps it will never happen again. But if you start trying to cover it up or maybe say ‘It’s not my fault, it’s the system’, that’s when problems arise.”

Doherty continues: “It is pretty much never just one person at fault.” It tends to be a sequence of events and “the question is, how did those few things align? What was it in the system that let those healthcare providers down to the point that they made a mistake and the patient suffered?

“I have told on myself if I got a medication wrong. Even if it was not administered, you still have to tell on yourself.” Openness seems to come naturally to the pair but do they worry about having to give a lot of themselves in a chatty podcast?

“I do this at work all the time anyway, I constantly chat to people,” replies Doherty. “There is nothing more reassuring to a woman having a C-section on the table than when I go, ‘I have totally been where you are. I hated it. I hated feeling sick. I hated my legs feeling like lead. I felt too warm, I felt disoriented. I thought the whole thing was a bit ick’.”

The pair are happy too to give insights into what it is like being an intercultural family. They reckon they were both raised with very similar core values by relatively strict parents – she lived her childhood under the threat of the wooden spoon, for him it was the threat of the slipper.

Their own children “very much identify with being Arab and Irish”, says Doherty, and they enjoy visiting Kuwait, where El-Khuffash’s parents, both paediatricians, live. His father is a Palestinian from the West Bank who went to Egypt to practice medicine and never got home after the 1968 conflict. The family later lived through the Iraqi invasion of Kuwait in 1990, when El-Khuffash suffered some hearing loss from a shell that landed outside his window.

Right now, with the Gaza war continuing, the couple worry about extended family members living in the West Bank. El-Khuffash has worked with some paediatricians and other healthcare workers to raise more than €180,000 towards getting medical aid into Gaza.

El-Khuffash, whose prolific CV includes working as a digital artist, says he would not have had the time for podcasting five years ago when their children were younger. But he clearly delights in being able to speak beyond the hospital walls where “you can have one-on-one interaction with people and talk to them, but that doesn’t really spread the knowledge”.

“It’s your passion,” says Doherty, adding jokingly: “He found a half an hour when he thought he was going to have to sit down and twiddle his thumbs.”