Lactivism and reefer madness

Plants 01

No, this is not a post about breastfeeding while stoned.

It’s a post about how hysterical exaggeration undermines campaigns like the War on Drugs and American lactivists’ efforts to promote breastfeeding.

According to Wikipedia:

Reefer Madness … is a 1936 American propaganda exploitation film revolving around the melodramatic events that ensue when high school students are lured by pushers to try marijuana — from a hit and run accident, to manslaughter, suicide, attempted rape, and descent into madness.

The film has become a byword for propaganda that backfires. This snippet of the plot makes it easy to see why the film ultimately accomplished the opposite of what the producers intended:

Mae Coleman and Jack Perry — a couple supposedly “living in sin,” yet sleeping in separate beds as all married couples depicted in films of the era — sell marijuana. Mae prefers to sell marijuana to customers her own age, whereas Jack sells the plant to young teenagers… Young students Bill Harper and Jimmy Lane are invited to Mae and Jack’s apartment … Jimmy takes Bill to the party. There, Jack runs out of reefer. Jimmy, who has a car, drives him to pick up some more. Arriving at Jack’s boss’ “headquarters,” he gets out and Jimmy asks him for a cigarette. Jack gives him a joint. Later, when Jack comes back down and gets into the car, Jimmy drives off dangerously, along the way running over a pedestrian with his car. A few days later, Jack tells Jimmy that the pedestrian died of his injuries. Jack agrees to keep Jimmy’s name out of the case, providing he agrees to “forget he was ever in Mae’s apartment”…

And the hit and run resulting in a pedestrian’s death is one of the least serious consequence of smoking a joint.

The film became a cult classic in the 1970’s when it was purchased and re-released by The National Organization for the Reform of Marijuana Laws (NORML). It was viewed as a comedy by people who used marijuana and recognized that the doleful consequences of marijuana use depicted in the film bore no relationship to the real, rather minimal consequences of marijuana use that viewers knew from personal experience. In other words, by grossly exaggerating the supposedly deleterious effects of marijuana use, the film sent the opposite message: those involved in the “War on Drugs” were lying about marijuana use and it wasn’t harmful at all.

American lactivists are currently running the breastfeeding equivalent of the Reefer Madness campaign. In addition to ignoring the difficulties of breastfeeding, lactivists grossly exaggerate the “risks” of formula feeding. Lactivists overstate the benefits of breastfeeding and fail to acknowledge that almost all the studies that purport to demonstrate those benefits suffer from serious methodological flaws. Lactivists demonize formula feeding using deliberately pejorative terms and suggesting that it should be available by prescription only. Unfortunately, they’ve communicated their hysteria to public officials like Mayor Michael Bloomberg of New York who has literally locked up formula as if it were a harmful substance.

But just like the Reefer Madness campaign, the contemporary lactivism campaign is a failure and for a similar reason; it bears no relationship to what we already know, through personal experience, about the purported “risks.” Most adults today WERE formula fed and are, nonetheless, healthy, intelligent and high functioning. No one knows, or has even heard about, a baby who has died as a direct result of formula feeding. Everyone recognizes that if you lined up a group of kindergarten students, no one could tell the difference between those who were formula fed and those who were exclusively breastfed. Moreover, if you lined up a group of the leaders in fields ranging from academia, to government, to entertainment to sports, no one could tell the difference between those who were formula fed and those who were exclusively breastfed.

In their desperation to promote their personal choices, lactivists have created histrionic campaigns that are foolish at best, and utter failures at worst. The claims of lactivists are completely out of line with reality. The “dangers” of not breastfeeding are exaggerated every bit as much as the dangers of marijuana use were exaggerated in Reefer Madness. Overstating the case just engenders distrust of lactivists, not an increase in breastfeeding rates.

  • Gah- I just finished 25 hours of continuing ed on breastfeeding for my hospital’s new BF push. The ‘lactivists’ (love that portmanteau) gave us so much misinformation about BF’ing, that I became alarmed. I do support BF’ing and BF all my kids. BF is best, and all women should BF- *IF* that is the best choice for themselves and their family, but there is no reason to lie about the risks/benefits.

    Things were were told: Even one bottle of formula could ‘leak through’ an infants ‘leaky gut’ and cause permanent damage to the infant’s immune system, formula is non-sterile (as is the female nipple! Oh, my! What to do about that?) and contaminated with dangerous bacteria, only one bottle of formula can be made at any time and that it must be prepared in a long and complicated (described in detail) sterile fashion, formula may be only kept for one hour, but expressed breast milk would keep for up to 6 hours, that contaminated formula is the leading cause of death of infants, that breast pumping is a poor substitute for BF which could cause life-long problems with the infant’s mouth structure, and a long discourse on what type of water is proper to use in reconstituting formula- turns out no water is acceptable! Not bottled, tap, “designer (?), carbonated ( yup), or roof run-off (for real, that was included!) amongst the many others listed.

    • FormerPhysicist

      Is there anyone non-woo that the misinformation in the class can be reported to? Even the real stuff seems very cherry-picked. Yeah, I wouldn’t use roof run-off to mix formula, but how many people are really making formula with water from a collection barrel?

  • Keeping this on the reefer subject; Does formula contain the same endocannabinoids as breastmilk? These cannabinoids, and others found in the cannabis plant, have a protective property for newborns. What LONG-term studies have been conducted comparing formula fed babies to breastmilk fed babies? Is it possible that the adverse effects of formula feeding could surface later in the person’s life? Also, why are there two different growth charts used by pediatricians? The CDC (American) that sets its growth chart based on mostly formula fed babies and the WHO (used by the rest of the world) that uses the growth rates of mostly breast fed babies as its scale. Weird. If there is no adverse effect on growth and development why are there different scales for breastfed vs formula fed?

    • TiffanyEpiphany

      Maybe I’m missing something (I’m not a doctor, so it’s quite likely that I am):

      http://www.cdc.gov/growthcharts/who_charts.htm

    • Anonomom, LLLL, IBCLC

      As a breast-feeding enthusiast, and an ardent supporter of mothers feeding choices being respected, i have to say no. Perhaps there is some long-term health benefit to breast-feeding that we are currently unaware of. On the other hand, in the long-term, Maybe formula is superior in some way that we are currently unaware of. Maybe those endocannabinoids cause Increased risk of drug addiction 20 years later. Or maybe there is absolutely no significant difference whatsoever. In any case, it’s nice that
      women are free to do what we want. It would be even nicer if people could stay out of what’s happening inside my bra.

      • I respect your, and every woman’s, right to liberty. However, those endocannabinoids are produced by our own bodies from fetus to death so I doubt they influence “drug addiction” later in life. My point in bringing up cannabinoids in breastmilk is that it is impossible for formula to contain them. No matter how great the formula is there are natural protectants that they will not contain. In time, we will discover the implications of this.

        • Anonomom, LLLL, IBCLC

          My point is that you don’t know. Even the most reasonable theories can be wrong. Our bodies are also “designed” to get infected appendixes, tooth decay, and strep throat at a very high rate. Just because something is natural in our body, does not mean it is invariably beneficial.

          In any case, since we do not know the long-term implications of breast-feeding vs formula feeding, most of us just do the best we can with the information that we have, balancing what’s best for infants, with the need to make a living, and other responsibilities we have.

          What is really to be gained by nitpicking about this stuff? I loved breast-feeding, and I spent a considerable amount of
          time helping women who want to breast-feed, but in terms of things to fret about, feeding choice is a non-issue. Not while there are things like human trafficking, rape, gun violence,
          poverty etc happening.

        • Box of Salt

          Lee, if there are endocannabinoids are excreted into the milk (and I have nothing but your word that they do – could you post a reference perhaps?) we can isolate them, identify their structures, prepare them synthetically, and find out if they do have a beneficial effect for a nursing infant. And if they do, we can add them to the formula recipes – they same way we’ve already modified formula recipes in responses to research and consumer demand.

          It’s not impossible.

          • http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2826.2008.01670.x/full

            Nothing’s impossible, right? Just curious, how effective have the synthetic marijuana cannabinoids been for patients? In every study conducted patients claimed the relief/healing they get from actual plant matter (or extractions) dwarfs the relief/healing of synthetics. You can’t create that which created you. Human beings that think they can recreate nature are the most ignorant creatures in existence.

          • Karen in SC

            I’m not sure what you mean. Reacting sodium hydroxide with hydrochloric acid does create sodium chloride – the same sodium chloride that is in the oceans and mined from the earth. An molecule synthetically made that has the same structure as a “natural” molecule is identical. I haven’t compared these cannabinoids of either type but if the synthetic is identical in formula and structure, it will be processed by the body the exact same way. Yes, it has to be that way, that is the design of our bodies aka really cool chemical processes. “Every study” you are referring too must be bunk.

  • R T

    I did not want to breastfeed after watching my SIL and several other friends struggle with low supply! Beyond that, I just didn’t find it appealing and it has been as uncomfortable as I imagined. However I was convinced by doctors, nurses and lactavist, if I breast fed it would be like “lipo” and my baby would not get sick. Well, I haven’t lost a pound and last week my baby was hospitalized at 4 months with a terrible RSV infection! I feel bamboozled 🙁

  • stephanwhite

    Except the differences aren’t “meaningless” between those options – HB
    has a significantly higher rate of perinatal mortality, for one.


    Media Monitoring

  • Certified Hamster Midwife

    I really thought that a childbirth blog run by a female OB would be the last place I’d run across mansplaining. Thanks for teaching me that anything is possible, Alan!

  • yentavegan

    A brilliant lactation counselor with an RN and an IBCLC once wrote that the history of human beings is not one of plentiful milk, eager to latch newborns or blissful birth. It is actually the opposite, we progress by adapting our behavior to overcome these life threatening inadequacies.

  • Katie

    Wow, I can’t believe this page. Comments attributed to mothers who supposedly have breastfed simply do not ring true. Anyone affiliated with formula companies please declare yourselves.

    • KarenJJ

      They don’t ring true because people like yourself aren’t listening. And if ?someone does say anything people like yourself call ‘formula shill’. Most of us have been posting here for a fair while and have told our stories previously.

      So are you the same Katie that trolls breastfeeding topics on Australian forums? Such as

      http://www.mamamia.com.au/parenting/australian-breastfeeding-association-telling-parents-formula-is-like-aids/#comments

      Because your sentence “Anyone affiliated with formula companies please declare yourselves.” sounds awfully familiar to me.

      Anyone with an affiliation with the ABA please declare yourself.

      • anonomom, IBCLC

        I’ll bite. I’m affiliated with an international breastfeeding support organization, which I won’t name because they prefer not to be involved in controversy; they focus their efforts on supporting mothers who WANT to breastfeed. Anyway, if the truth is on your side, you don’t need to exaggerate, obfuscate or mislead people in order to convince them. Let the facts speak for themselves, and let mothers make an informed decision based on the available information.

        I love breastfeeding for many reasons, including that it *contributes* to the best health you can give your baby. How big a health impact it has is debatable, but personally I don’t care that much. I like helping mothers feed the way they want to.

    • Guestll

      Which comments?
      I work for an international private development agency. I boycott Nestle and have for many years. Not affiliated with a formula company, but thanks for playing.

    • JC

      “Comments attributed to mothers who supposedly have breastfed simply do not ring true.”

      Why? Because not every mom on here is gushing about breastfeeding and their nursing experience/relationship with their babies?

      See, how it works is, this is the real world. These are real women who happen to be different from each other. Some of them had an easy time nursing; some of them had a difficult time nursing. Some of the loved the experience; some of them were ambivalent; some of them hated it. This is called life.

      But, no, your theory is probably better than mine. I am sure all these women commenting here are “affiliated with formula companies.” They troll the internet to say negative things about breastfeeding in the hopes that women will rush to their local Wal-Mart and buy a can of formula.

      • Is that really such a ludicrous suspicion, given the billions of dollars at stake? I feel sure that many and probably most people posting about this are sincere. But I am not sure that none of them are shills for formula companies. Capitalism is a much more powerful and often malignant force than most people realise, I believe.

        • JC

          I have been reading this blog for more than a year. Most of the commenters here posting about breastfeeding have posted comments about this subject before. I know I have many times. So, since I pretty much recognize all the commenters, and, they take the time to comment on many posts, not just the breastfeeding posts, I am going to go out of my way to say they are not formula shills in disguise. If so, they sure have a lot of time on their hands and dedication to comment on almost all the other posts not pertaining to infant feeding decisions.

          Now, if a bunch of Jane Does swoop in here to tell us “it’s okay to give up nursing because it’s so hard,” “formula is easier and just as good for the baby,” “I sure love Enfamil,” etc., etc., then maybe I would agree you have point. But I sincerely doubt the women commenting here have any stake in Nestle. Not to mention, many of the commenters are saying they enjoyed nursing, which was my original point. Just because they aren’t ALL positive and “rah, rah, go breastfeeding,” doesn’t mean they are promoting formula.

        • The Bofa on the Sofa

          Is that really such a ludicrous suspicion, given the billions of dollars at stake?

          Yeah, pretty much.

          Short answer: you don’t need to invoke a formula shill to account for the behavior that you see. Therefore, it’s pretty ludicrous to assume that anyone is.

          Does that mean that no one is? Of course not, maybe there is one. However, it is ludicrous to believe that anyone is.

          • Did you mean “everyone” rather than “anyone”? Your comment would make a lot more sense if so.

          • The Bofa on the Sofa

            No, I mean anyone.

            If you think that someone here is a formula shill, then who is it? Is it me? Is it Lizzie Dee? Is it Allie P?

            No, you can’t say that. You can’t point to anyone here and say, “You are a formula shill.” It would ludicrous to suggest it.

            Hence, it is ludicrous to suggest that anyone is a formula shill.

            It’s actually just probability. Always bet with the odds. Given that the chance of someone being a shill is pretty small, there is not anyone here who you should suspect of being one.

          • Sue

            Speaking of odds, what are the odds that a formula company would be wasting their money trying to con a group of people with the mindset to read a blog called “skeptical OB”? They could read a few posts, look at how we dissect messages and research, and say “Nah, we’ll stick to the advertising and the mothercraft blogs”.

          • The Bofa on the Sofa

            Of course, that leads to the alternate question: how reasonable is to think that NO ONE here is a formula shill? I think it is less ludicrous to think that no one is a formula shill is false, otoh, given sue and jc’s comments, it’s still pretty silly.

        • moto_librarian

          I wish I was a formula shill – maybe then I’d get a discount! My son’s formula is $27.93 per can, and at his maximum consumption, he was going through three cans a week! Granted, he is allergic to both cow’s milk protein and soy (which begs the question of what exactly I would have been able to eat had I been able to produce any milk) so it is more expensive than other types of formula.

          • anonomom

            I saved 15% on formula by switching to Organic Happiness Good Tumeez formula! I have some coupons I can send you!!!1!

          • moto_librarian

            That is so sweet of you to offer, anonomom! We’ve only got 2 more months left on formula, and given that he seems to just generally have a sensitive tummy, we’re going to keep him on this until he turns one. Hopefully, he will be ready for cow’s milk then (we went through the exact same thing with his older brother).

          • anonomom

            lol… I guess my attempt to sound like a covert formula shill failed 🙂

          • LOL, subtle but clevah.

    • lacrima

      I’m a formula shill. In my circumstances, exclusive breastfeeding = baby dying of dehydration before she was 3 weeks old, whereas formula = alive baby, who has just turned three and is currently dancing around with a pair of knickers on her head.
      Formula, formula, you’re so great, rah, rah, rah, gooooooooo formula!!!!
      Disclaimer: I am not affiliated with any formula companies, I just think that anything which saved my daughter’s life is freaking awesome.

      • Kalacirya

        If you aren’t affiliated, then you can’t be a shill. ^_~

        • lacrima

          In between contracts at the moment, just touting for more business 😛

    • Kalacirya

      I am a formula company. My diet consists of Ambien, Cheetos, Wonder Bread, generic brand condiments from Wal-mart, and the broken shards of compact fluorescent lightbulbs. This means that I actually lactate baby formula; it’s chemically identical to Nestle Good Start.

      • DirtyOldTown

        What? No Twinkies?

        • Kalacirya

          Given that production of Twinkies has stopped in the USA, I find that I can not afford the mark up in price from Canadian imported Twinkies. I mean, I can’t be a formula corporation if I am not using the cheapest inputs possible.

          • auntbea

            You know,you are just going to have to bite the bullet and pay if you want to ensure you are getting the most processed and artificial ingredients possible. Chemists don’t work for free, you know.

          • Kalacirya

            You bring up a good point. I’ll have to consider this in a cost analysis.

    • Susan

      Gosh I breastfed my three children well into their toddler years. I also used to take the formula out of the gift bags before sending a mom home with the bag. I love this blog….And Dr. Amy must be lying about breastfeeding her four children too?

  • Sorin

    Here’s my anecdata.

    I was born in 1973. My grandfather had just died. My mother wanted to breastfeed me, but whenever I woke up in the middle of the night, my grieving grandmother (Mom’s MIL) rushed to give me a bottle. She was clearly processing her husband’s death through my birth, and my poor mother didn’t have the guts to stand up to her MIL. Thus, she was only able to nurse me for about six weeks.

    My brother was born four years later, and my mother was determined to make a go of it. She was older, wiser, and more able to tell my grandmother to back off. As a result, she nursed my bother for a year–an accomplishment she’s very proud of.

    One of her children has rarely gotten sick and has no allergies beyond mild hay fever. The other has severe asthma, serious allergies, eczema, and is always catching whatever cold blows by. Can you guess which is which?

    Yeah, so much for breastfeeding preventing All The Things.

    When my daughter was born almost three years ago, I was determined to nurse her. And I did, but not without a tremendous amount of pain. For three months I screamed every time she latched on, and I was bleeding so badly that when my husband and mother saw my nipples, they would cringe. Lactation consultants were extremely unhelpful. One told me to put some vaseline on my nipples (yeah, that worked). Another told me that my daughter’s cranky nature was due to the “birth trauma” she suffered as a result of her C-section birth. I still want to punch that idiot in the face for reducing a hormonal me to tears.

    Only because I’m incredibly stubborn, I kept at it, and at three months, the pain went away. The only problem had been that her mouth was small, and the only solution was time. We nursed until she was about 11 months when she decided that the world was far more interesting and expressed her displeasure with my attempt to keep nursing her by biting, hitting, and pulling away. She only had one cold in her infancy, but once she started pre-school, it’s been one snotty nose after another. Surprise surprise.

    Now I’m pregnant with #2, and I’m better prepared for nursing this time. If there’s pain again, that’s fine. I do it because it’s a life experience I want to have, not because it will make my kid into a superhuman and turn me into a supermom in the process. And it is stupid and dishonest for an industry to crop up telling hormonal, emotionally vulnerable mothers otherwise.

  • Sue

    IN wealthy societies, sIx months of exclusive breast feeding reduces respiratory and gastrointestinal infections by a small amount in the first year of life. This effect is overshadowed by other factors, like the presence of older sibs in the household or exposure to child care.

    Should we warn the community that having brother and sisters in the household “kills babies”?

  • Guestina

    This isn’t about the health of babies. It’s a moral panic that uses breastfeeding as a proxy for socioeconomic status and (to a lesser extent) race. It’s very similar to the panic over obesity. Despite the mounting evidence that weight alone is a very poor indicator of a person’s overall health and life expectancy (google Kathryn Flegal), we still have public health campaigns against obesity and a relentless drumbeat of shaming by the media and medical establishment. The poorer and less educated you are, the more likely you are to be overweight and the less likely you are to breastfeed (with certain exceptions based on ethnic group). By focusing on breastfeeding and obesity, you can nurture your biases without ever owning up to the fact you’re classist and a bigot.

    • auntbea

      BAM! Nailed it. (Although I do think the bias is more severe in breastfeeding than obesity. You may disagree.)

    • DTLAFamilies

      Grr, I hate misspellings: Google Katherine Flegal, not Kathryn. Or, follow this link: http://healthland.time.com/2013/01/02/being-overweight-is-linked-to-lower-risk-of-mortality/.

    • DirtyOldTown

      BIngo bango bongo. Which is to say, spot on. I would also extend this to argument to include organic foods and the endless hand-wringing and tearing-of-hair over any cheap, plentiful food, which we all know is basically just poison that only uneducated (read “poor, stupid” people) eat.

      • anonomom

        >tearing-of-hair over any cheap, plentiful food

        OT, but cheap plentiful sugar and highly processed starch is causing epidemic rates of diabetes and obesity in adults and children, which victimizes people who have less money to spend on food.

        If people were instead eating cheap, plentiful minimally processed varieties of said sugar and starch (including the fiber and other components that come directly with the plant), they would not be suffering in record numbers from a life- and limb-threatening metabolic disorder. (source: pretty much every nutrition expert)

        • Couldn’t agree more.

        • DirtyOldTown

          Right. I was thinking primarily of things like foreign-grown gmo apples laden with pesticides (i.e. apples), or hormone laced factory farmed meat (i.e. meat), but I take your point.

      • The Bofa on the Sofa

        Bingo bango bongo.

        add Irving and you have The Mosquitos from Gilligan’s Island

    • An Actual Attorney

      Standing Ovation.

  • Dr Kitty

    I was at a Breastfeeding talk last week with some local statistics.
    The areas of my city with high breast feeding rates are middle class. The areas with low Breastfeeding rates are some of the most deprived areas in Western Europe. Higher drug use, mental illness, smoking, chronic illness, substandard housing, unemployment, dysfunctional families, child abuse, lower education attainment and life expectancy in the areas with lowest BF rates.

    Any observational study on Breastfeeding which didn’t take those factors into consideration would be meaningless.

  • Kalacirya

    Hey girls:

    I’d like to let you finish, but I must stop you first to let you know how utterly correct I am about this and how utterly wrong you are. My credentials include that I was the head of the debate team in high school, and that this one time I got a 100% on my “The Fountainhead” essay in grade 10 literature. My wife’s breastfeeding brings all the boys to the yard and thus, ipso facto, it’s better than yours.

    • Guestll

      You win the internets for the day. No, the month. Screw it, the quarter.
      🙂

    • Jen

      I heart you.

    • Funny! See, Dr. A., *this* is how to get in a good burn on me. I just don’t think you have the knack, but fortunately you have loyal minions to step into the breach on your behalf. 😉

      • Kalacirya

        I know Alan! I am such a silly-nilly girl. All that graduate school and all I’ve accomplished is being a blog “minion”.

        • C’mon, you can’t blame a guy for getting in a little return fire. Don’t worry, yours was better, I will fully admit. Uncle! 🙂

        • AmyP

          Work a little harder and you can become a henchman. (Henchwoman? Henchperson? Hench?)

    • Durango

      The “ipso facto” is a particularly nice touch.

      • KarenJJ

        I bow down to your superior knowledge of the foreign languages.

    • Certified Hamster Midwife

      Now I have a craving for milkshakes. THANKS A LOT

  • Guestll

    In my neck of the woods, breastfeeding is de rigeur. I nursed my daughter well into toddlerhood, in private, in public, without a cover, and nobody ever shot me so much as a questioning glance. Everyone assumes you’ll breastfeed. Giving it the old college try is not enough — if there’s a problem, you can fix it. Nobody I know chooses to formula feed. The journey to formula for my friends and family who ultimately went that route was a sad and tearful trek, replete with guilt, misgivings, and shame.
    My mother was an L&D nurse who helped many women start to breastfeed, yet she chose to formula feed her own children. Why? Because she wanted to. No more, no less. And no one ever said shit to her about her choices, either.
    We’ve arrived at our current polarized state not because breast is better (it probably is, but in the grand scheme of things, not by that much) but because the desire to judge now rules. We want to judge mothers who don’t nurse, we want to judge mothers who nurse into toddlerhood and beyond, we want to judge mothers who nurse in public without a cover, we want to judge mothers who choose to cover up, we want to judge mothers who wean their babies, we want to judge mothers who let their children wean on their own. We want validation and approbation and we want to feel superior to women who make choices that differ from ours.
    I’m no exception to the judgement game, truly, but there are WAY more important issues facing mothers and infants in the developed world than breast vs. formula. It just doesn’t matter all that much in the end.

    • DirtyOldTown

      Good points, but I’m not sure I agree that the desire to judge has increased necessarily, only that we now judge about other women based on an entirely different set of behaviours and values. Now, instead of judging who doesn’t iron their husband’s shirts well enough, it’s who doesn’t have enough wooden toys in their kid’s toy box. Nobody cares if you’re living in sin, but God forbid that apple pie you made from scratch isn’t organic. (And sugar free. And is actually a kale pie. With no gluten.) Judging other mothers, sadly, is something that never seems to go out of style…

      • Guestll

        I don’t think mother-judging is a new thing, but I think it’s reached an apex when it comes to competition. Honestly, I actually envy my mother and her friends, because they really didn’t give a flying fuck about any of this. They judged, to be sure, but not, seemingly, to the same extent.

        • Lori

          I think the difference is judging in private vs openly showing your disdain for another’s choices.

      • Charlotte

        I used to want wooden toys for my baby, but now that I know she eats them, it’s plastic all the way, baby! She can’t be anywhere near wooden blocks, wooden end tables, church pews, you name it, she will literally chew and swallow it.

        • DirtyOldTown

          I know! We just took a set of wooden blocks away from our baby that somehow developed splinters on every surface. And oh how the paint chips. Not to mention how hard the darn things are. It’s much more pleasant to be hit in the face by a toddler wielding plastic than a toddler wielding wood. This, I know from bitter, bitter experience.

          • Durango

            ah, but wait until you step barefoot on a lego. The pain of childbirth pales.

          • TiffanyEpiphany

            I love a good laugh in the morning.

    • So you disagree with Dr. Amy’s assertion that “just like the Reefer Madness campaign, the contemporary lactivism campaign is a failure”? Sure sounds like it’s working like gangbusters where you live!

      • BCMom

        Bit of a jump there Alan. Sounds to me like she probably lives in a white middle class neighbourhood as described by Dr. Kitty above. To say that these women must all be breast feeding due to the success of the lactivism campaign is a joke and completely ignores the real socioeconomic reasons that contribute to successful breastfeeding. Things like being a SAHM, paid mat leave, flexible work hours, ability to afford pumps and consultants, adequate nutrition, or, ahem, a high enough income to enable dad to stay at home to take care of the household.

        • If you are implying what you seem to be: Our income is not very high (remember, our kids are on CHIP and I am uninsured), and my wife got her pump from WIC.

          • BCMom

            I am not implying, I am saying there are socio-economic factors that boost the odds of successful breast feeding. You implied that it was the successful lactivist campaign. If your wife earned minimum wage, like many people who don’t live comfortably middle class, I doubt you could be a SAHD.

            Many women posted here on another bf thread awhile back that they found one of the biggest barriers to bf was lack of standardized mat leave for women in the US. Removing barriers, not shaming, is the answer to encouraging women to bf.

          • Catching up with other countries on mat/pat leave and other aspects of work/life balance is probably the single issue I am most passionate about. I dispute that it needs to be set up as a dichotomy (what you call “shaming” I would obviously characterise differently, as education, public health advocacy, etc.); but we clearly have a huge area of agreement despite that.

      • Guestll

        Alan, I live in a white suburb of a wealthy North American (Canadian, actually) city. I’m educated and solidly middle class, as are most of my contemporaries. We get a year’s worth of mat leave here, Alan. When you don’t have to worry about going back to work, either because of generous mat leave policies or because you can afford to not work, it makes a difference.
        Lactivism is a failure, Alan. Lactivism is behind the ideology that motivated my then-infant daughter’s GP and NP to disparage formula, and encourage EBF, despite the fact that my supply was so pitiful, I required 14 months (yes, months!) of an off-label drug beginning at 10 weeks postpartum, in order to breastfeed at all.
        Lactivism, the ideological failure, prompted our then-GP and NP to say it was just fine that my daughter dropped from the 80th to the 50th to the 25th to the 5th percentile, all in about four months. Lactivism said I had to continue EBF, despite not sleeping for more than 3 hours at any given time for almost 9 months — because, you see, my child was so very hungry.
        Lactivism said “try Fenugreek” (mmm, nice to smell like a pancake house, and it was useless). Lactivism said “eat more protein, drink more Gatorade”. Lactivism said, “are you co-sleeping, babywearing, skin-to-skin?” (we were — it didn’t matter — my period still came back at 10 weeks postpartum).
        Lactivism said, formula is bad. Ignore the baby! Who gives a fuck about her. Just keep doing what you’re doing, Mama. That’s what lactivism said.
        Lactivism is a failure and a giant fucking bad joke.

        • JC

          This is one of the most honest responses I’ve ever read. And you are exactly right.

        • What about in Norway, are you familiar with the success they have had there?

          • Sue

            Alan – do you have some form of Asperger’s syndrome?

          • Lol, no…people with Asperger’s have trouble understanding humour, are awkward in social situations, and particularly struggle with flirting. None of those are remotely true of me. I do have Inattentive ADHD though.

            The best, most uncannily accurate assessment of my psyche that I have ever come across is this description of my Myers-Briggs type, ENTP:

            http://www.typelogic.com/entp.html
            ——–
            ENTPs are usually verbally as well as cerebrally quick, and generally love to argue–both for its own sake, and to show off their debating skills. ENTPs tend to have a perverse sense of humor as well, and enjoy playing devil’s advocate. This sometimes confuses, even angers, those who don’t understand or accept the concept of argument as a sport.
            ENTPs are as innovative and ingenious at problem-solving as they are at verbal gymnastics; on occasion, however, they manage to outsmart themselves. ENTPs can be prone to “sharp practice” – especially cutting corners without regard to the rules if it’s expedient – or, their juggling acts may simply be so over-ambitious they collapse.

            Both at work and at home, ENTPs are very fond of “toys” — physical or intellectual, the more sophisticated the better. Once these have been “solved” or become too familiar, however, they’ll be replaced with new ones.

            ENTPs are basically optimists, but in spite of this (perhaps because of it?), they can become petulant about small setbacks and inconveniences. (Major setbacks they regard as challenges, and tackle with determination.) ENTPs have little patience with those they consider wrongheaded or unintelligent, and show little restraint in demonstrating this. In general, however, they are genial, even charming, when not being harassed by life.

            In terms of their relationships with others, ENTPs are capable of bonding very closely and suddenly with their loved ones. Some appear deceptively offhand with their nearest and dearest; others are so demonstrative that they succeed in shocking co-workers who’ve only seen their professional side. ENTPs are also quick to spot a kindred spirit, and good at acquiring friends of similar temperament and interests.

          • Sue

            You flatter yourself, Alan. GuestII posts a painful story about how lactivists have her hell, and you come back with the success of Norway (!). And then, in defense, a long dissertation about how “cerebrally quick” you are on the basis of a relatively simple classification scale?

            If not Apsergers, I call some combination of lack of insight, narcissism and inferiority complex. (On the basis of your posts, of course, never having met you).

          • Thanks for the diagnosis, Lucy; here’s your nickel.

            That profile is not all flattery. I cop to the negative parts of it as well as the positive:

            “ENTPs tend to have a perverse sense of humor as well, and enjoy playing devil’s advocate. This sometimes confuses, even angers, those who don’t understand or accept the concept of argument as a sport…on occasion, however, they manage to outsmart themselves…their juggling acts may simply be so over-ambitious they collapse…they can become petulant about small setbacks and inconveniences…ENTPs have little patience with those they consider wrongheaded or unintelligent, and show little restraint in demonstrating this.”

          • TiffanyEpiphany

            I like you, Sue.

          • Lori

            Regarding Norway, I went there last summer to travel still BFing my then 11 month old and was sort of surprised that all of the “mother’s lounges” had a pic of a baby bottle on the door. Here in Canada it is always that mother cuddling the baby and putting a bottle on a breastfeeding lounge would be a faux pas. I admit I was surprised at that, and also wondered if we would get any flack for asking hotel staff to stick our daughter’s “bottles” in the fridge for us and we never did. (I put bottles in quotes because Norway is very, very expensive and my husband and I just had regular cows milk in the bottles and used it for our coffee and cereal in the am to save money rather than eat at pricey cafes.) Three weeks is not long enough to make any definitive statement on the breastfeeding culture of Norway but my short observations there was that I don’t think you would be shamed for formula feeding. It should be noted also that no one ever batted an eye at public breastfeeding during our time there either. Also, unrelated to the topic of debate, but put this place on your bucket list if ya have not ever been there, it is probably the most beautiful place I have ever been.

          • Cool, my wife is half Norwegian (both her grandfathers grew up speaking Norwegian) and I would love to visit.

        • suchende

          This sounds like my story.

          • KarenJJ

            Mine too.

        • Eddie

          Maybe I am wrong. I suspect Alan’s point was that lactivism is so successful — despite the lack of evidence and wrong statistics — that they have successfully browbeat quite a few people into trying very hard to do things their way. I don’t think he meant he agreed with them.

          I find it curious just how different regions are in this way. With our youngest, my wife universally received advice to *try* to BF for six months, *if* possible. We didn’t get any of the horrible pressure you and so many others are subject to. We live in a middle class ‘burb in the US Midwest. I was waiting for lactivists to tell us what we HAD TO DO, and was pleasantly surprised to not run into any histrionic nonsense. We were only given facts, benefits as currently known — as others have said, evidence of some immune benefits in the first year — and were not browbeat by anyone.

    • Lori

      Agreed! I was endlessly amazed at how everyone felt like they could suddenly weigh in on what I was doing with my life once I got pregnant. From my friends mom asking me if I would vaccinate (I was just finishing my first trimester) to a sort of rude comment from my uncle stating he, “never thought (I’d) be the type of mother to leave my kids to go back to work,” to lectures on caffeine by a 19 year old woman working at Tim Horton’s I really was shocked at how suddenly no one even bats an eye or even counters with an, “I know its none of my business but…” before barging in with their comments and advice.

      • Suzi Screendoor

        Ugh, isn’t it annoying? “Are you sure it’s safe to take Tums?” “You’re eating too much salt, that’s why your feet are swolen.” “You shouldn’t be riding your bike.” GAH!

  • Mrs. W

    My son has decided bottles aren’t his thing – doesn’t even care if it’s breastmilk in the bottle, and I’ll be honest I’m feeling a bit booby trapped and very thankful to be starting solids (he’s now 5.5 months old) for no other reason than the little bit of freedom it will offer. That being said, I’d be overjoyed if he changed his mind on the whole bottle issue – and maybe as he begins to want to play more, he’ll also recognize the wonderful freedom that comes from being able to drink milk and explore at the same time.

    Hyperbole does no favours – not when it comes to breastfeeding, birth mode, patient autonomy, or healthcare sustainability. Widespread reefer madness indeed.

    • DirtyOldTown

      “Booby trapped” – love it!

  • Gentry

    Fantastic post. As someone who has attended ‘education’ courses on breastfeeding ( getting my IBCLC for work) I can tell you first hand the ‘studies’ that are referenced are flawed. I mean they actually referenced some BS study indicating a 21% increase in death by using formula. Completely made up. Of course, many of the others in attendance at this course were doulas, lay midwife students, etc. They accepted this at face value. There was an OT and myself, ( a RN) the only two who questioned the ‘data’ before us. It was pretty nauseating. Instructors also advised us ‘lactation educators’ to coerce women into BF. My favorite was “you’ve made your decision not to BF this time, but I’ll be asking you again next time.” Sick. Another great recommendation was that maternal rest was not needed in the post patrtum period- NO bottles should be given ( at all, by dad, or anyone else, during this ‘special time’) new mom’s have some special coping mechanism which makes rest completely unnecessary.

    I’m happy to be able to help women who want to breastfeed do so. I’m more about straight mechanics though. I would never knowingly lie to a patient with overstated benefits or inflammatory ‘risks’. Nor would I ever ( ever!) tell a new mom that her sanity was not as important as breastfeeding. The week long course was definitely an eye opener into the ‘birth junkie’ community.

    • sleuther

      Gentry – I hired an IBCLC to assist me with feeding my younger daughter. She was very helpful. I ended up (mostly) formula-feeding due to supply problems. The LC was nothing but supportive and she was the first one to confirm that “first of all, the baby’s got to eat.” In the end I was glad I hired her, because I knew I’d given it my best shot – but I also knew when enough was enough and it was time to stop trying and start living.

      It’s demeaning to mothers to lie to them about infant-feeding choices (whether it’s an overstatement of benefits, overstatement of risks of FF, or just lies-by-omission). It’s very Orwellian, actually, to see facts distorted in this way, as though the ends justify the means. (They don’t.)

      • gentry

        I hope I’m helping women as much at this LC did. I think you can be an IBCLC and not be a total jerk. That’s my goal!

    • Katie

      Gentry, you did a 1 week course on breastfeeding and you are an expert? Give me a break.

      • moto_librarian

        So what have you done that makes you such an expert, Katie? Have you done any studies in epidemiology, biology, pharmacology, or even history?

      • gentry

        Nope. Never claimed to be an expert. It’s an area that really doesn’t require expertise, in my opinion. I’m an RN, I help women w/ breast feeding a lot for my job, I also help with formula feeding. The only thing that actually matters is that the baby gets fed.

    • The idea that women don’t need rest after performing a physical marathon (whether from vag birth or c-section) in terms of energy is crazy, yet nurses, especially lactivists act like women don’t need sleep or rest after a baby is born. I had my daughter and was barely able to walk or bend over (c-section) and my nurse refused to take the baby so I could get some sleep. If a baby needs a bottle from dad so mom can get some sleep thats just the way it is. I am so sick of people dictating to women and shaming them, and bullying them at a time when they are most vulnerable and in need of the most support and rest. Instead they are treated like machines with no feelings or needs other than pushing a baby out naturally with no pain medication and BFing it at all costs.

      • Amen!

      • If you are “sick of people dictating to women and shaming them, and bullying them at a time when they are most vulnerable” you came to the wrong site sister.

        • TiffanyEpiphany

          Why do you say this? The posts on this site are honest and direct. If a person feels shamed or bullied after having read something here, it’s not because of how information was presented.

          Amy was talking about the vulnerable time right after giving birth when support and rest are needed most and when the pressure to breastfeed isn’t particularly helpful, especially if a woman doesn’t want to BF.

          • auntbea

            This person is suggesting that this site exists for the purpose of hunting down homebirth loss mothers and terrorizing them for their choices.

          • Bombshellrisa

            Nah, we have less accomplished people terrorizing vulnerable women (think of a vocal and misinformed public health scholar)

          • Box of Salt

            Yes, but this person was attracted here by the word “Reefer” in the title and isn’t actually interested in the issues presented on this site.

          • auntbea

            Boobs AND bongs?!?! Score!

          • yeah, us pot heads are all just stoopid morons. None of us have ever accomplished anything in the history of anything.

          • Box of Salt

            Lee G. Leissett, I was making an observation based on the fact you dropped two meaningless comments on this post and this post only, and when I click on your name Disqus reveals your comments on other sites (psst, they’re not about women’s and specifically birth issues).

          • Box of Salt

            I have to correct myself: I was presenting a hypothesis based on the observations cited above.

          • Eddie

            It’s extreme to call birth issues “women’s issues.” Men have a legitimate interest in the same issues. The woman’s body is (obviously) more involved, so I’m not going to suggest that the big strong man gets to tell his little woman what to do, or anything stupid or insulting like that. However, calling these “women’s issues” is going too far to the other side.

            Isn’t there a healthy balance somewhere in the middle where the father and mother have a discussion like adults and reach a joint consensus based on love and respect for each other, and not where one “side” is just dismissing the involvement and interests of the other?

          • Bombshellrisa

            I think that if there was a “middle ground” in birth issues, it would be easier to have both sides feel their concerns were addressed. But so much about pregnancy and the birth process deals in absolutes. It starts with you will be pregnant or not, no middle ground with that one. Same the location of birth (it will be in a hospital or not, a birth center run by homebirth midwives is NOT middle ground), or having pitocin or AROM or a C-section. You either will or won’t. The sickest thing I ever heard was a man badgering his wife who was dying of lymphoma about breastfeeding their newborn. He wanted to ask a few of the women from church to breastfeed the baby because he felt strongly that ‘breast is best’. He also felt that homebirth and midwives and herbs for illness was best. I would have loved to have his” involvement and interests” dismissed!

          • Eddie

            I hear what you are saying, but you are missing my point. By middle ground, I don’t mean, “Let’s compromise on what reality is.” What I mean is described in the last paragraph of my response you replied to. Agreed, a man badgering his wife dying of lymphoma about BF their child is unconscionable. But then, it would be just as unconscionable for her own mother or her MIL to badger her about that, yeah?

            My point is that both father and mother naturally and reasonably have the interest of the child in mind. The mother does not “own” the interest of the child. She does “own” her own bodily interests, many of which seem to be ignored or swept under the rug by home-birth advocates, but some of which are also ignored or swept under the rug at some hospitals.

            Let’s say, for the sake of argument, that a woman wants a home birth and her husband does not want to take that small risk of not only losing his child, but his wife. By your argument above, it appears that his wife should get 100% say, period, end of discussion. (?) How would you resolve this disagreement?

          • Bombshellrisa

            “The mother does not “own” the interest of the child” I agree with that. But it’s a slippery slope. A man can’t stop his wife from having a home birth, no matter how legitimate his concerns are. But he also can’t order her to use or not use birth control, can’t order her to terminate or continue a pregnancy. I have seen plenty of men who were terrified of their partner’s plans to birth at home. Not one of the women changed her plan because of her partner’s concerns.

          • Wrong. Have two sons. Both were born at home because my wife didn’t want to be an experiment.

          • LibrarianSarah

            Oh look another man coming here to explain to all us little ladies how we are doing it wrong.

          • TiffanyEpiphany

            !!! Yeah, oops! I don’t know why I get sucked in to conversing with these people. Like if I break it down, they will see reason. Ha! New leaf a-turning.

          • Victoria

            I think this is Lee’s second visit to this site. I don’t remember his first visit going so well. And Lee – you condescend to Tiffany: “Seeing as you are not a statistician I’ll try to make my response as straight forward as possible” – so Lee – are you a statistician?

          • Eddie

            I’ve noticed that many responders here are noticeably more hostile to men who disagree with them than with women who disagree with them. Why is that? If you want to claim that men cannot possibly know anything authoritative about any of these topics because, well, that pesky Y chromosome, then you’ve lost a lot of credibility. Not that you should care what I think.

            Men have every right to be interested in the welfare of their children. Women bear the child, not men, of course, but this fact does not remove men from responsibility nor from decision making. My wife and I are partners. Neither one of us is the boss over the other and we make decisions jointly. For childbirth and breast feeding, we made the decisions together. If my wife were not interested in BF, then I would have encouraged her to try for at least the first few month,but I would not have “forced” her (as if I would be able to) nor would I have shamed her. But it was a decision we made together as parents responsible for creating our baby and interested in her welfare.

            The hostility toward men at this site — by a subset of the regulars — is off-putting.

          • anonomom, LLLL, IBCLC

            You haven’t been here long enough. Bofa on the Sofa (Pablo) is a man, and is a respected regular poster. There have been guest posts by men that were very well received. I do share your dismay at the gender-based insults. A doofus is a doofus; their sex doesn’t matter. That said, I do understand some women being a touch offended when a man purports to tell us what we should do with our breasts or vaginas; I imagine you’d have the same response if this blog were about prostates, penises or scrotums and women parachuted in to “educate” the male readership about how they should use these body parts.

          • Eddie

            > You haven’t been here long enough. Bofa on the Sofa
            > (Pablo) is a man, and is a respected regular poster.

            Fair enough. My impression was not that men were outright unwelcome, but that disagreeable men were much less welcome than disagreeable women. For visitors, however, it does create a hostile impression. I appreciate your response.

            If I was posting in a forum on “men’s issues” and ignorant women started posting, telling me what to do with my body, I would treat them the same as ignorant men posting the same nonsense. And if I failed to do so, I would hope to be called on it.

            It depends on what your goal is. If your goal is to persuade others, then hostility hurts your cause. Hostility attracts trolls and drives away people who might otherwise learn. My impression is that a goal of this site is to present the scientific evidence to help persuade people to make more informed choices, smarter choices. Maybe I’m wrong, but that appears to be a primary goal of this site and it’s one I heartily support. Hostility works against that goal, which is why I wanted to speak up.

          • anonomom, LLLL, IBCLC

            A lot of people have had that criticism (that hostility causes people to ignore the research Dr. Amy presents)… but I’m not so sure that’s true. Dr. Amy recently posted her stats for the year, and she found that people usually tend to stick around. People love controversy, and they love trying to persuade homebirth infidels of our wrongheadedness. Hence, overall more are reeled in and caught than flounce out of here in disgust. Dr. Amy’s sarcastic mocking tone has earned her infamy on the internet among NCB bloggers, leading to increased traffic. I think it’s a brilliant strategy, though it can certainly be cringe-inducing at times.

          • TiffanyEpiphany

            Respectfully, I would say that she was, in fact, an experiment. And she and her/your sons were fortunate to have emerged from the homebirth experience unscathed.

            One of the studies examined on this site shows triple the rate of infant death at homebirths that were considered low-risk, as compared to infant deaths as a result of a hospital birth, which includes both low- and high-risk births.

            The people in charge of the largest database we have relating to homebirths (MANA, supposedly 27,000 low-risk births reported?) have refused to release their death rates. Makes you wonder, doesn’t it?

            Since I am not a statistician, I might not be relaying all of the data exactly correctly, but the gist of all this is something I learned off this site. It seems to me that those involved in homebirth seek to perform their own life/death experiment, while perpetuating an unhealthy fear of modern medicine and a distrust of doctors who have dedicated their lives to helping others.

          • Seeing as you are not a statistician I’ll try to make my response as straight forward as possible. Hospital birth – 99% effective. 1 out of 100 babies die. Home birth (according to your response “triple the rate of infant death at homebirths”) 97% effective. 3 out of 100 babies die.

            Obstetricians love to focus on effectiveness and ignore efficiency. This is why sites like this one exist. Home birth is shunned by the medical industry because it illustrates how inefficiently the medical industry identifies between babies that need saving and babies that don’t.

            In order to save those extra two babies in a hospital setting there should be roughly two intervening procedures out of one hundred, right? Oh wait, I forgot about all the high risk pregnancies. We all know hospital births include high risk pregnancies which account for a whopping 6-8% of all births (I’ll give you 10%). In order to save those 12 extra babies out of 100 (2 from the difference in the homebirthers + 10 (10% of 100 births for the high risk) our obstetricians perform 33 cesareans and 67 unplanned medical interventions.

            Ignore the medical interventions and just look at the cesareans. You’ll see that obstetricians are only correct about half of the time (33 procedures for 12 babies saved). These procedures effect a woman’s ability to have future children (studies suggest 10 times the likelihood of complications in substantial pregnancies after cesarean) How many obstetricians do you know that would recommend a VBAC?

            From a business perspective the hospital birth is sheer genius. For 33% of the clientele return business is clenched (assuming they want more kids). 67% of your clientele is your best advertisement. These people are the same people who believe they bought the winning lottery ticket (until the numbers are drawn). These people tell everyone their birth horror stories and praise the obstetricians for their wonderful work. “My baby would have died if it wasn’t for Dr. Smith” Actually, statistically speaking, it probably wouldn’t have died. It probably would have been just fine. I do think obstetricians can do some pretty amazing things and I will give them credit where it’s due but they are just not very efficient at their jobs.

            My wife and I refused to be a guessing game. We refused to risk our chance of future offspring on a 50/50 chance. Dr. Amy would say we made our choice for a selfish experience. I think we did it to avoid being part of the experiment.

          • KarenJJ

            First time mothers don’t have a 33% chance of a c-section. It’s more 10-20%.

          • TiffanyEpiphany

            Thank you for the education. I am indebted.

            My question for you, since you sound pretty knowledgeable, is this: What about fetal distress? Isn’t it beneficial for the baby to have monitoring during labor and delivery? Homebirthing uses the head-scope thingy (told you I wasn’t a doctor), which isn’t always used as often as it should be (every 5 minutes? emergencies can arise in less time than that, right?).

            Do enlighten me if you would.

          • Victoria

            “they are just not very efficient at their jobs”
            “Obstetricians love to focus on effectiveness and ignore efficiency”
            What? So the outcome doesn’t matter? They are effective at getting babies out safely but that is not efficient? Is efficiency about saving money? Not a single, possibly unnecessary, intervention? Of course the opposite side of not performing the intervention might be death of the baby and so? You and your wife were part of a guessing game. You gambled on a more risky situation and your children came through fine. You are the same as those you deride then – the people with birth horror stories who came through and praise their obstetrician – you took a risk and praise your midwife? Or did your wife UC? If the babies of those hospital birth stories didn’t really need the intervention and probably would have been fine then why does anyone need another person attending the birth to help? 50/50 chance in hospital? I think Lee that you are probably not a statistician.

          • Box of Salt

            Lee: “it illustrates how inefficiently the medical industry identifies between babies that need saving and babies that don’t.”

            Exactly how does home birth identify between babies that need saving and babies that don’t?

            Identifying them in retrospect – especially after they have died or been damaged – doesn’t count

          • lacrima

            Do please explain how “efficient” is more important than “effective” when it comes to a dead baby? I, for one, am more than happy to run the oh-so-dreadful risk of being the subject of an intervention which later proves to be unnecessary, in compliance with policies which may lead to another 12 women with living babies in their arms instead of dead babies.

          • Dr Kitty

            Lee, I do not think you understand the concepts of number needed to treat and number needed to harm.

            When the potential harm is great a large NNT is perfectly acceptable, since we are currently without technology which allows us to look into the future.

            See statins for high cholesterol, warfarin for atrial fibrillation, any anti hypertensive medication of your choice and most public health initiatives.

          • I don’t think this site exists for the purpose of “hunting down homebirth loss mothers and terrorizing them for their choices” I believe this site shamelessly promotes itself off of the tragedy of others. Either way, it’s a despicable example of “progress” in obstetrics.

          • TiffanyEpiphany

            Right. And I’m suggesting to him that he’s wrong.

          • auntbea

            Sorry! Thought maybe you hadn’t encountered this particular troll trope before!

          • TiffanyEpiphany

            🙂 Getting to know them slowly but surely. Thank you for looking out for me. 🙂

          • Are you kidding me? The abrasive nature of this site make me sick. When facts are presented in a condescending manner the target audience will refuse to listen. Gee, I wonder why. This site is all about self promotion and has nothing to do with any so-called progress in obstetrics.

          • TiffanyEpiphany

            Nope, I’m not kidding you. I took you seriously and responded in form.

            I certainly accept your opinion. But, as someone who chose to listen to the actual facts and alter my course of action on homebirth and exclusive BFing at all costs, I do not see this site as abrasive, condescending, or self-promoting.

            Just wanted to share what I thought, not attack you or even try to change your mind.

          • Victoria

            Which is why on the latest post there is a discussion about a study regarding the risks and benefits of cesareans. Cesareans are not a sign of progress in obstetrics, increasing safety of the procedure is clearly not a sign of progress in obstetrics. How many joints are you smoking a day and are you stoned right now?

        • ratiomom

          Is this alan’s alter ego?

      • gentry

        We can thank the baby friendly movement for that one. I had a similar experience, and will be more assertive this time.

  • “Most adults today WERE formula fed and are, nonetheless, healthy, intelligent and high functioning.”

    Fallacious reasoning, similar to the anthropic principle. When I was a kid, the same could have been said about homebirth. You still hear some people say things like this about the days before car seats or even seatbelts.

    “No one knows, or has even heard about, a baby who has died as a direct result of formula feeding.”

    Also fallacious, because dietary contributions to mortality, whether among infants or adults, are never listed as the cause of death on death certificates or even openly acknowledged socially about specific individuals. They are almost always only discussed in societal, aggregate terms.

    • T.

      You really have a lot of time at your disposal, don’t you?

    • Andy

      How refreshing this Alan guy is!

      • LibrarianSarah

        Yeah a man with absolutely no qualification trying to lecture women most with far more medical qualification than him about birth and breast feeding. You would find that refreshing eh Andy?

        • Kalacirya

          I find it about as refreshing as curdled breastmilk.

          • KarenJJ

            Nothing refreshing about having women’s issues mansplained to me, unfortunately. Same old, same old.

      • Sue

        Andy and Alan could get together on a Boys’ Own blog and slap each other on the backs about how they defeated all those girlie arguments. Might not stay “refreshing” for long, though.

    • Karen in SC

      Also contributing to mortality are myriad genetic and environmental factors. I have diabetes Type II in my family. My grandmother and mother had the brittle version and died young. My maternal aunts did not develop the disease at all, nor my uncle. All were BF and ate the same type of diet. My mom just got the “bad hand” of genes. Or it was the water in our county?

      Aware of this genetic legacy, I am now a vegetarian and taking metformin. So far so good. But I won’t blame formula if I get diabetic later.

      • auntbea

        Do any of these studies indicate what the parents are feeding instead of breastmilk, or are they assuming it is correctly prepared formula? I suspect that a number of women who have trouble keeping their babies full (can diabetes manifest as hunger even in infants?) may not only switch away from EBF, but also mix overconcentrated formula or sneak cereal into the bottle. There is also the possibility that breastmilk is being replaced with juice or even soda. In any of these cases, the apparent increase in diabetes (or whatever else) may not be caused by the different between breastmilk and formula, but between breastmilk and something a lot worse.

        • fiftyfifty1

          There is some evidence that some of the genes associated with type 2 diaetes are “appetite genes”. They cause an increase in diabetes through an increase in obesity. But some of the risk genes don’t seem to be about appetite.

          • It’s starting to look more and more that obesity is not directly causative of diabetes, despite the correlation. Which is a point that should cheer those here who have been cautious about inferring causation in other areas.

          • fiftyfifty1

            Actually the genetic work IS supporting that obesity is directly causative for most of the risk of DM2. Most of the genes they have found so far are appetite genes. It situations where the appetite genes cannot lead to obesity (in situations of food shortage), diabetes does not result.

          • And that’s the only way to interpret that? How about if I just change it slightly:

            “In situations where the appetite genes cannot lead to high consumption of sugar (in situations of food shortage), diabetes does not result.”

            Gotta be careful to make sure you’ve eliminated other possibilities, and this one, as I said, looks like a strong one:

            http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057873
            “Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.”

          • fiftyfifty1

            This paper looks to explain the differences in DM2 in patients who are NOT obese. That is very different than saying “obesity is not a cause, it must be sugar instead”. Your argument is one used by the tobacco industry. Imagine a study that says “Differences in Radon exposure explain variations in lung cancer rates at a population level that are not explained by smoking”. Your take away from this would be “Ah ha! so smoking doesn’t cause lung cancer after all!”? Really Alan?

          • No, your analogy does not hold, for multiple reasons.

            First, there is no “obesity industry” to have a huge financial interest in obscuring the truth. There is however a huge sugar industry, which is already known for having a lot of lobbying power in Congress.

            Second, high sugar consumption obviously can have obesity as a common side effect. For your analogy to work, radon exposure would also have to have tobacco exposure as a common side effect. Obviously, that is ludicrous.

            Third, there is a highly plausible reason to look at sugar as being the true smoking gun, considering that we are talking about blood sugar levels and insulin resistance, not some wildly unrelated concept.

            When two things can easily and plausibly both be effects of a single cause, we must be careful not to assume one of the effects causes the other effect. That is I believe what has happened with obesity and diabetes, though I acknowledge the case is not completely closed.

          • Certified Hamster Midwife

            Of course there’s an obesity industry: the diet industry, which profits from people attempting weight loss, 95% of them failing, and then them starting again. If Weight Watchers really worked, people wouldn’t have to keep rejoining.

            Not to mention bariatric surgeries: and worse, bariatric surgery mills.

          • Bombshellrisa

            Don’t forget all the herbal supplements and weight loss pills

          • Certified Hamster Midwife

            Ah yes! And scummy acai and green coffee extract vendors.

          • Bombshellrisa

            Dr Oz mentioned raspberry ketones (so I have heard, I don’t watch his show) and suddenly they are EVERYWHERE.

          • And they are funding these studies?

          • Certified Hamster Midwife

            Couldn’t tell you specifically. I do know a lot of researchers in obesity-related fields take money from Big Food.

          • But Big Food uses plenty of sugar.

          • Certified Hamster Midwife

            They’re getting on the low-carb bandwagon, though. Look how fast they took out trans fats. And they love a good artificial sweetener.

          • True, although they game the transfat thing with serving sizes, and they still use LOTS of sugar.

          • Sue

            “I acknowledge the case is not completely closed.” Still LOLing…

    • Sue

      “When I was a kid, the same could have been said about homebirth. ”

      LOL, Alan. “Cos the mothers and babies who died during childbirth were in the cemetery. You do get that, don’t you?

      • SMH. That was exactly my point! LOL, did you think I was advocating eschewing seat belts and carseats? Maybe you should look up the “anthropic principle” and rethink this for a minute or two, then slowly remove your foot from your mouth.

        • Sue

          Very amusing. Go back and read your “dietary contributions to mortality, whether among infants or adults, are never listed as the cause of death on death certificates or even openly acknowledged socially ” and remove your own foot. Which “dietary contributions”, other than starvation, do people die from, Alan?

          • Uhhh…srsly? Consumption of sugar, transfats, nitrites and nitrates are a few that come to mind.

            And c’mon: just admit that you totally missed the point of that paragraph referring to the anthropic principle.

          • anonomom

            Re nitrites and nitrates: these are naturally occurring in everything that grows in the ground. Celery contains high levels, but no one is freaking out over celery consumption. Yet another example of ignorant fear-mongering that otherwise smart people get suckered into.

            Sources:

            http://ajcn.nutrition.org/content/90/1/11.full
            and http://culinaryarts.about.com/od/seasoningflavoring/a/nitrates.htm

          • Dr. Andrew Weil has advised against eating celery for years, and I don’t touch it.

          • Certified Hamster Midwife

            Me either. Because it’s gross.

          • That too, LOL.

          • Sue

            Yep – a dietary zealot. Do you also think that “fructose is poison”, Alan?

          • Yes, when processed out of whole foods and used as an additive.

          • Sue

            (Thought so)

          • Sue

            And Alan, what is its mechanism of “toxicity”?

          • Sue

            Oh – you mean Dr Weil of “Dr Weil’s 5 Holistic Health Secrets”? Of “Weil”(TM) and “Your Trusted health Advisor” (TM)? The Weil who’spublished lots of books and opinion articles but no actual research? THAT Weil? LOL.

          • Bombshellrisa

            You know, with as much $$$ as Dr Weil is making with his skin care crap at Sephora (as in part of the LouisVuittonMoetHennesy group better known as LVMH) I wouldn’t think someone who is worried about how much OBs make would want to listen to him.

          • Eddie

            Complications from Type II diabetes are pretty common cause of death. I thought it was widely recognized that in addition to exercise (or lack thereof), diet was an important factor. Diet strongly influences diabetes, heart disease, cancer, and many other leading causes of death. Were you suggesting otherwise?

  • The Bofa on the Sofa

    I wonder what the “formula is evil and will cause all kinds of problems for you baby” crowd thinks about adoption? Do they expect adoptive parents to use donor milk? Or are they just opposed to adoption?

    I have friends who are expecting an adopted baby early next month. Personally, I find it absolutely joyous that they are able to provide a loving home for the baby, and that the mother is willing to make this sacrifice to benefit her child and the adoptive parents. The idea that someone would harsh that buzz by criticizing the fact that the child will be formula fed is pretty friggin obnoxious, but that is exactly what they are dong, wittingly or not.

    • sleuther

      In my experience, hardcore lactivists have no problems exhibiting obnoxious behavior. Particularly online.

    • auntbea

      If that birth mother was REALLY a generous person, she would not only give up her baby, but pump for that baby and give the milk to the adoptive parents.

    • That’s silly. Is Michele Obama’s initiative to get kids up and moving insensitive to parents of quadriplegics? Are campaigns to produce more math and science college graduates insensitive to the mentally retarded? You do what you can with what you have.

      • sleuther

        Alan, should I take this comment to mean that you count yourself as part of the “formula is evil and will cause all kinds of problems for your baby” crowd?

        • Uhhh…how about just counting me as part of the “finds the AAP policy statement convincing, but ultimately believes it has to be the (preferably informed) choice of the mother” crowd?

          • sleuther

            Okay, well as DiomedesV already said elsewhere in the discussion, no one (including Dr Amy) is disputing that breastfeeding has benefits. The point is that hardcore lactivists tend to vastly overstate said benefits and vastly overstate the risks of using formula. Many even go so far as to lie about formula-related risks, all in the name of “informing” the mother.

            Do you agree, Alan, that there is a point at which “informing the mother” becomes obnoxious?

          • I could have sworn Dr. Amy said the differences were so small as to be meaningless. Which is it?

          • sleuther

            I will ask again: Do you agree that there is a point at which informing the mother becomes obnoxious?

          • I don’t think we’ve come anywhere near that point on a societal level, though it is certainly possible that it has happened on an individual level.

          • sleuther

            Well, you come across as somewhat tone-deaf in your comments on this site. I think I will ignore you from here on out.

          • Okie doke.

          • anonymous

            Ah, I missed this before when I posted re. auntbea’s suggestion above. Sorry. 🙂

          • Guestll

            …yet you post below that it was awkward amongst some of your crunchier friends when your wife chose to wean one of your children at 13 months, and felt compelled to keep pointing out to them that she’d nursed well beyond the national average.
            Certainly not an obnoxious level of informing the mother.

          • Not to them, to her.

          • Guestll

            It’s obnoxious, full stop. Why are these people your friends?

          • I am also friends with devout Christians and other diverse folks. Everyone is wrong about something. Even me, on occasion! 😉

          • Guestll

            It’s not about being wrong, or having differences of opinion, it’s about being friends with people who make your wife feel awkward and with whom you feel compelled to justify how you feed your child.
            Why do you have any time at all for these people?

          • We are unfortunately the only people we know in what I would call the “Goldilocks zone” between uber-crunchy and mainstream. So it is a “pick your poison” situation. Everyone pretty much thinks we are hippie freaks or mainstream sellouts, I’m afraid.

          • moto_librarian

            Or perhaps they simply find your know-it-all attitude to be extremely unpleasant. When no one wants to interact with you, maybe the fault lies not with them, but with you.

          • The point was that we are friends with them anyway. And people not on the parenting continuum find me the life of the party, ’cause I am. 😛

          • anonymous

            sleuther, auntbea suggested yesterday that we stop replying to Alan and remind each other if we forget ourselves and do so anyway. 🙂

          • Amy Tuteur, MD

            Nah, I count you as part of the blowhard crowd, busily pontificating about anything and everything, regardless of the fact that, as you admit, you actually have no idea what the scientific evidence shows about anything.

            Blowhards are great for blog traffic, so please keep “educating” us benighted women, including the doctors, lawyers, economists, etc. among us.

            I will say this: I worry about your children. If you are this disrespectful to adults who have far more professional knowledge than you do, how will they ever get you to respect their ideas if they disagree with yours?

          • Glad to see you at least acknowledge that my presence here benefits you.

          • Andy

            My wife, a psychiatrist, says Amy is the queen of “psychological projecting”. There are so many of Amy’s responses that make me agree with this.

          • TiffanyEpiphany

            Just wait until you get to know Alan better. He’s being very transparent about the fact that he has an inferiority complex, which negatively affects his ability to play with others.

          • Amy Tuteur, MD

            Do tell.

          • disqus_61tNDsHTqn

            The “queen,” really? Sounds like your wife the psychiatrist is either prone to hyperbole or doesn’t interact with very many people. – S

          • suchende

            Does your wife, who is a psychiatrist, always do diagnosis via blog authorship? If so, do me next!

          • MikoT

            But don’t you see, you can’t hold *him* accountable for these words because his wife, the psychiatrist, said it.

          • Mo

            So, Dr. Amy, Do you disagree with the AAP policy statement? I’m a new mom and have been basing my infant feeding decisions off of it. Is it bunk?

          • Amy Tuteur, MD

            Which part of the policy statement?

          • Dr. Amy believes we should listen to medical authorities, except when, like the AAP or ACOG, they say things she doesn’t really groove on. Then we should just listen to her, because one retired obstetrician beats the AAP, the NIH, the WHO, and HHS.

      • The Bofa on the Sofa

        So are you suggesting that the lactivists then admit that whether “breast is best” depends on the circumstances?

        As I indicated, it is possible to give an adopted baby breast milk (donated). However, it is very, very difficult.

        But if the BF whackaloons concede that you can give an adopted child formula because the alternative is too impractical, then this whole discussion is over. They have just admitted that formula feeding is OK in some circumstances. Now the only question that remains is where you draw the line of what is too impractical, and at that point, the AAP guidelines tell you nothing, because everyone will have their own opinion on when it becomes too impractical for them. There are indeed women who believe that relying on donated milk is not too impractical for them, whereas others feel the normal process of BFing is too impractical for their situation. Who’s to say either is wrong or right?

        You do what you can with what you have.

        Exactly. And if a mom does not have the motivation to go through what she feels are hassles involved with breastfeeding, she can just use formula, right?

        • Yes, she can. How about the mom who does not have the motivation to go through what she feels are hassles involved with hospital birth?

          “But if the BF whackaloons concede that you can give an adopted child formula because the alternative is too impractical, then this whole discussion is over.”

          Ignoring your ad hominem, this is no more relevant that is the fact that if I were trapped in a cabin deep in the Alaskan wilderness with no hope of rescue for six months, I would gladly eat the Saltines and beef jerky stored there rather than starve.

          • Poogles

            “if I were trapped in a cabin deep in the Alaskan wilderness with no hope of rescue for six months, I would gladly eat the Saltines and beef jerky stored there rather than starve.”

            So a baby getting formula instead of breastmilk for six months is like surviving on only beef jerky and saltines for six months, in your opinion? That’s certaintly what it sounds like you’re saying. I believe a person surviving on nothing but beef jerky and saltines for six months would have some serious deficiencies at the end of that time – not so a baby fed formula instead of breastmilk.

          • Reductio ad extremum.

          • Jen

            Wingardium Leviosa

          • LOL

          • Poogles

            “Reductio ad extremum.”

            Did you by chance mean “Reductio ad absurdum”? Either way, I’m sorry, I don’t know how that answers my question.

          • Sue

            “I would gladly eat the Saltines and beef jerky stored there rather than starve.”

            Wow! What about white bread?

          • I almost used that, but then I considered that to be less likely to be stored in a cabin. 🙂

      • Dr Kitty

        Dude, we don’t say retarded anymore.

        Have you missed the memo, or are you being deliberately unpleasant?

        • My wife is a special ed teacher, and I worked with mentally retarded individuals less than 10 years ago. So I guess we both missed this memo, or more likely the “memo” was not distributed in this part of the country.

          What euphemism do you favour, just out of curiosity? You do realise the nature of stigma of being what it is, that term will itself be seen as offensive eventually. And then you’ll have to move on to something else.

          • Dr Kitty

            Learning Disability, not my “euphemism”, the current accepted medical term, and has been since I was at medical school, lo, these many years ago.

            http://www.mencap.org.uk/all-about-learning-disability

            So I’m voting for “deliberately unpleasant”.

            I need to go and sit in the corner to teach me a lesson about responding to you, because, frankly it’s beginning to becoming reminiscent of the adage about wrestling a pig.

          • LD and MR are different things.

          • disqus_61tNDsHTqn

            Dr. Kitty, i’ve mostly heard it called “developmental disability” or “intellectual disability” in the U.S. To us, “learning disability” is what you call “learning difficulty,” i think (i’m not familiar with the latter term).

            I used to volunteer at a residential facility that employed QMRPs (qualified mental retardation professionals) as caretakers; i wonder if Alan is referring to something like that. I’m not in that field, but it looks like that term is slowly being phased out, switched over to “qualified intellectual disability professional.” Anyway, yeah, we don’t say retarded in the U.S. either. – S

          • Dr Kitty

            Ah, so LD here is DD or ID with you. LD is the recognised UK term, as per my link.

            Learning difficulties to me means dyslexia, which is an educational psychology diagnosis, not a medical one.

          • Bombshellrisa

            My dad works for NISH and with NIB and Ability One-they say “persons with disabilities”, as in they are people first and the disability (whatever that is) is secondary. Many of the (truly amazing) people he works with have family members who have intellectual disabilities, they usually refer to them as “my special son” or “special daughter”.

          • Okay, but what about a more detached discussion like this one, referring to people generally with this diagnosis?

          • Bombshellrisa

            If it’s in general, it’s always “people with disabilities”.

          • I wasn’t talking about disabled people in general. And I’m sorry: but after having worked in the field, I have lost patience with the old “euphemism shuffle”. We called the people we worked with “consumers”, after “clients” fell out of favour. How ridiculous is that?

          • Bombshellrisa

            the agencies are comprised of and work for and with people with a range of disabilities, I guess just using the term “people with disabilities” works well for them.

          • auntbea

            I know that “mental retardation” is still used as a diagnosis in US government services and in jails, etc and, as it is specifically to do with an IQ below a certain level, is something quite different from a learning disability (or “learning difference” in the terminology I am familiar with.) I was surprised to say the least to hear my very sensitive friend nonchalantly use the term to describe some of her patients. I don’t know if it’s being phased out, though; I should ask her.

          • Looks like it is indeed being phased out. My lurking wife informs me that they have in fact switched to normally referring to such kids as “people with exceptionalities”; when it is important to make a distinction between kinds of exceptionalities (which can include autism and giftedness), what was formerly called mental retardation is now called “intellectual disability” or ID. Which makes me roll my eyes for multiple reasons: we already have this initialism used for “identification”; now in a few years people will complain that it is hurtful to call someone ID. Oy.

          • DirtyOldTown

            Oh, your wife is a special ed teacher? Well that makes it ok then. Go ahead. Use offensive language all you like. We can only hope your wife is also a Jewish African-American transgendered person, so you can feel free to enjoy a diverse and colourful offensive slur bonanza with complete impunity for many years to come.

            https://www.youtube.com/watch?v=T549VoLca_Q

          • I think you missed the subtle distinction made in that PSA. She said not to call her a “retard” (noun), and not to use the adjective (or participle, if you’re picky) “retarded” in reference to people who are not MR. I agree with all that. If they wanted to convey that the girl sitting there should not be described as “mentally retarded” in a non-derogatory context, I think they’d have said so (and changed the DSM terminology).

          • DirtyOldTown

            The DSM is being changed. Knowing what a big fan of Wikipedia you are, I’m quite surprised you aren’t up to date on that yet. Isn’t it great how much smarter and knowledgeable we can all be now that we know how to Google?

          • “Is being changed”, present tense. Yet it was treated as something that was WAY out of date, like calling African Americans “Negroes”. Pfffft.

          • So we all missed the subtle distinction? That she wouldn’t mind being called by a term dictionaries list as “derogatory” ..if she was retarded, but finds it offensive because she isn’t? I thought it was a long way from subtle, myself.

            You are digging yourself a bit of a hole here, Alan. And I don’t think your indignant defense of your wife will get you out of it. If both of you work or have worked in Special Ed, and are unaware that many people find the term offensive then that does indicate, at the very least, a lack of sensitivity and awareness.

          • No. The “she” refers to the girl, not Jane Lynch. Watch the PSA again, reread my comment, then maybe watch the PSA one more time. If you still don’t get what I’m trying to convey, I’m not sure what else I can do to explain it.

          • theNormalDistribution

            “You do realise the nature of stigma being what it is, that term will itself be seen as offensive eventually.”

            You’re right. If you think it’s okay to use dehumanizing terms like “the mentally retarded” to label a person by their disability, then ya might as well pick one, because it makes no difference what you call them.

            Luckily, we don’t all see it your way. They are *people* who have disabilities, Alan. People first. I would say I’m surprised that someone who claims to have worked with people with special needs still doesn’t understand that, but it’s an unfortunate fact that a good majority of educators, like your wife, have still not caught on to the fact that their students are people.

          • I don’t anger easily, even when I’m faced with multitudes of people trying to insult me; but you’ll definitely arouse my ire if you try to suggest something like that. To accuse my wife of not valuing her students as people is vile slander that you can shove right up your fucking arse.

          • DirtyOldTown

            You used your wife as a shield to deflect from your usage of an outdated term you refuse to admit is no longer acceptable. So you can’t really complain too loudly when she draws fire.

          • theNormalDistribution

            If you and your wife need a memo (your words, mind you… Funny they were meant to be derisive but only succeeded in demonstrating your ignorance.) to know what to call people with special needs, then I’m sorry: You (both) clearly do not understand what the difference is between the names you used, and the right thing to say. It’s neither vile nor slander to point that out to you.

          • Charlotte

            I have a special needs child, and if you and your wife honestly don’t care that the R word is no longer used or understand why, and you aren’t just claiming you don’t to be deliberately offensive, your wife doesn’t deserve to be a special ed teacher. No good and caring teacher would be so ignorant and thoughtless at best, and deliberately cruel at worst. I am sincerely glad my child’s therapists and teachers have more respect for her than you and your wife do for the special children and their families you encounter. Even if you don’t agree that the R word should not be used, a caring person would not use it out of respect for the people and families who do find it offensive.

          • My wife has informed me that she does NOT use it, as I posted already elsewhere in the thread. Which I think is pretty fucking R…ahm Emanuel, but w/e.

        • anonymous

          Dr. Kitty, auntbea suggested yesterday that we stop replying to Alan and remind each other if we forget ourselves and do so anyway. 🙂

    • Bombshellrisa

      Well, remember the poster the other day who only wanted women who had “birth experiences” at her baby shower? Sick.

      • Yeah, that was sick.

        • Sterrell

          Hardly as sick as you saying an infant with an HIE was a “good candidate for euthanasia, frankly.”

          • disqus_61tNDsHTqn

            =( I was kind of glad that one got buried. – S

          • Bombshellrisa

            I was accused of cherry picking when I posted the pics of the little girl whose traumatic birth by CPMs left her unable to lift her own head-but I would do it again, as it gives a name and face to those who would call ending her life compassionate (also gives a real life look at how much damage a CPM at a homebirth can do)

          • Just generically, any CPM? And no OB has ever been at fault for a bad outcome, that it?

          • Bombshellrisa

            I was accused of cherry picking when I posted the pics of the little girl whose traumatic birth by CPMs left her unable to lift her own head-but I would do it again, as it gives a name and face to those who would call ending her life compassionate (also gives a real life look at how much damage a CPM at a homebirth can do)

          • I read that already the first time you posted it.

          • Bombshellrisa

            “Bombshellrisa Alan • 2 hours ago

            “I was accused of cherry picking when I posted the pics of the little girl whose traumatic birth by CPMs left her unable to lift her own head-but I would do it again, as it gives a name and face to those who would call ending her life compassionate (also gives a real life look at how much damage a CPM at a homebirth can do)”

            “Alan Bombshellrisa • 2 hours ago−

            Just generically, any CPM? And no OB has ever been at fault for a bad outcome, that it?”

            The little girl http://balmainphotography.com/diagnosis-unknown.html
            the midwives http://www.birthcenter.com

          • And that answers my question how?

          • Bombshellrisa

            “Bombshellrisa Alan • 2 hours ago

            “I was accused of cherry picking when I posted the pics of the little girl whose traumatic birth by CPMs left her unable to lift her own head-but I would do it again, as it gives a name and face to those who would call ending her life compassionate (also gives a real life look at how much damage a CPM at a homebirth can do)”

            “Alan Bombshellrisa • 2 hours ago−

            Just generically, any CPM? And no OB has ever been at fault for a bad outcome, that it?”

            The little girl http://balmainphotography.com/
            the midwives http://www.birthcenter.com

            “Alan Bombshellrisa • 12 hours ago−

            And that answers my question how?”

          • Okaaayyyy…you doing all right over there?

          • Bombshellrisa

            I have realized that perhaps instead of imagining that you are able to read and comprehend and therefore all your answers that meander about and seem hostile are ON PURPOSE…that perhaps it is not within your ability to reason and comprehend. And you may not be in control of how you answer. And that would make it cruel of us to be answering you the way that we have. Maybe you have had a traumatic brain injury, or a CVA and you are now about on par with Dori memory wise (Finding Nemo). So if we simply repeat ourselves patiently and be willing to cut and paste so you can read and reread the comments until you understand, for instance, that CPMs as used in my answer didn’t mean the entire population of CPMs in North America were present for the birth of Camille Coppernoll.

          • KarenJJ

            The photo with her father (? I”m guessing) is just beautiful. She’s a gorgeous girl 🙂

          • Not ANY infant with an HIE, but a specific case described as being so severe as to be the equivalent of Terri Schiavo: vegetative brain state, no chance to lead any kind of meaningful life. To me, that’s not cruel, it is merciful.

          • Because the specific baby described sounded like s/he had about as much of a real life to live as Terri Schiavo. Ending that kind of existence is merciful, not cruel.

          • But who gets to decide?

            And as far as I remember your argument was cost effectiveness, not mercy.

          • When both interests align rather than oppose each other, it just makes for a stronger combined case.

          • Were you talking in general terms about children who have a very poor quality of life – or in more specific terms about THIS child? Does it occur to you that a brief article and some photographs might be rather slender evidence to act as judge and jury and decide on death?

            There were two children in my daughter’s class with severe quadraplegic CP. They were loved and cared for by devoted parents – not an easy task. They were NOT vegetables. They could laugh, respond with pleasure and excitement to things they enjoyed, give and receive love.communicate in various ways.. I never felt I was an expert on their quality of life – but certainly their parents felt it was worth it. Sadly, those with very severe disabilities are vulnerable and can have a limited life expectancy. Both of these died in adolescence. Is it really beyond the rest of society to cherish them, if that is what their parents choose? No parent would want to prolong a life of suffering, I don’t think – but the assumptions of those who don’t know what they are talking about are a bit much.

          • I was going based on what my impression was of the information provided; but certainly if the children can laugh, be loving, etc., I am not advocating that their existence be ended. As you say, if it is either mainly a life of suffering, or just no real cognitive existence at all, that to me is not something that should be heroically extended.

            I meant no offense to anyone who has a child with a disability whom they cherish, and I apologise if I upset anyone.

          • Durango

            Considering it was a list of expensive things with nary a word about quality of life, you once again made a hasty assumption.

          • Maybe so.

      • Charlotte

        What? Whoa, I totally missed that one. Where was that said?

        • Bombshellrisa

          This is on the thread from the last post-an adoptive mother wasn’t invited to a baby shower, as the honoree wanted only women who had experienced birth to be there.

          • ratiomom

            Just…wow! Who needs enemies if you have such friends!

    • Allie P

      They are obnoxious and give you all kinds of “education” about inducing lactation with off-label drugs you buy from Canada off the internet.

      The breastfeeding idiots are what drove me to question the woo in the first place. My pediatrician is an adopted parents and countered every bit of woo the breast is not just best, but the only acceptable option people.

      Breast is best, but that’s like saying bread right out of the oven is better than bread from the grocery store. The latter is just fine for all your bread needs, and if you don’t have an oven or time to make your own bread, it’s an acceptable alternative.

      • Certified Hamster Midwife

        No, I’m pretty sure I read everywhere on the Internet that wheat is poison.

        • Bombshellrisa

          Yep, it gives you “leaky gut syndrome”. But there are chiropractors and naturopathic docs who can help you with that.

        • anonomom

          My homemade bread contains extra poison (gluten). Yum.

  • sleuther

    Thanks Dr Amy – comparing the lactivists’ crap to ‘Reefer Madness’ is VERY accurate and appropriate. These people DO lie about the risks of formula-feeding and the benefits of breastfeeding, and bravo to you for calling them on it.

    I wasn’t able to BF either of my kids, and for a long time I felt guilty about it. Now (as the mom to a 6- and 8-year old) I realize how unimportant it was in the grand scheme of things (for us, anyway.)

  • kumquatwriter

    Next I hope we get Gerber Madness: The Musical

    • “Oh so mad!” I love that musical. “Romeo and Juliet” makes me laugh every time.

  • Meerkat

    My husband’ s late father used to say that you shouldn’t escalate anything to the level of idiocy. He was Rissian, so I am not sure if this is the most eloquent translation, but it gets the point across.
    I hate that instead of making a good thing like breastfeeding even better by providing real help for new mothers, these groups create fake controversy.
    I have to say thank you to Dr. Amy. I wrote about this before, but I will repeat myself.
    She initially wrote about formula lock up sometime last summer, before I had my baby. The whole issue pissed me off. I didn’t know it then, but my hospital was “baby friendly.” I can’t really complain about them. They were lovely. I wanted to breastfeed, and the nurses were very supportive, helpful and encouraging. They even offered my son a formula cup feeding so I could heal my sore chewed up nipples, which was a great help.
    As I was being discharged I remembered the article and all the fee swag my friend got from a neighboring regular hospital. I asked if I could have some formula, just in case. I was told they didn’t have any. So I put on a little performance and said very dramatically that my husband worked long hours and what if my milk didn’t come in? I just had a C- section, I had no strength to to to the pharmacy, and my precious baby would starve!
    The nurse returned with a 4 pack of ready to use baby formula.
    I will admit that I did it for the principle, but we ended up using the formula that very night, because I had to go to emergency room. I had no milk yet, so I couldn’t pump, even if I wanted to. Everything turned out ok, my son was full and content, I was fine, and my milk came in the next morning, in abundance. I am still breastfeeding him 6 months later. Nope, he wasn’t poisoned by formula, no nipple confusion. I am glad that I insisted on that formula, so my poor distraught husband didn’t have to frantically run around CVS isles with a shreaking infant, trying to find formula.

  • I’m one of those perfectly healthy, well-adjusted, and exclusively formula-fed adults. I hope to breastfeed so long as it is cheap and easy. But if it becomes to difficult for me, I have zero qualms about going to formula. I personally find the breatfeeding martyrdom off-putting to say the least.

    • Amy M

      That’s how I felt. I think there is a subset of the lactivist population that really wanted to breastfeed and had to overcome some difficulties to succeed. Some of the women in this particular subset seem to promote BFing martyrdom (great description) because they must convince themselves that what they did was worth it. If someone comes along and says, “Well, here in the developed world, assuming clean water and proper preparation of formula, it really doesn’t matter much if you BF or not.” these women will not accept that, and try very hard to 1)convince others of their extreme view and 2)bully women who choose to do it differently.

      • The bullying is what gets me. And it seems even when a woman tries but is not successful it is still not good enough. I’m not a masochist. I’m not going to put myself through the ringer to prove myself mother of the year, especially when I turned out just fine from formula sold in the early 80s.

        • Elle

          Not to mention the 80s vaccines! 😀

    • Sue

      I like to tell my story periodically when lactivism comes up. I am the daughter of southern Italian migrants to AUstralia. From that background, I had always assumed that I must have been breast-fed forever and that, along with my mediterranean diet, must contribute to my glowing good health.

      It was only when I had my own daughter that my mother told me my own history. I cried “all the time”, and the clinic nurse advised her to put me onto formula – after only about six weeks.

      Of course anecdotes don’t trump data. But the data do show that BF makes some difference to infection rates in the first year (which are low any way) and not much else after that.

  • Klarastan

    In the NCB community here in the Twin Cities, I’ve heard that formula feed ring causes autism. Like, right away. Within minutes. Someone knows someone who saw it happen.

    Sigh.

    • DirtyOldTown

      Autism. If the vaccines don’t get you, the formula surely will. Is there no end to the ways one can acquire this dreadful malady? It’s gotten to the point that I’m afraid to sit down on public toilet seats.

      • Kalacirya

        DOT, toilet seat germs are natural, you should embrace them.

        • DirtyOldTown

          True. Maybe if I licked one, I would develop an immunity that I could pass along in my breastmilk! (This is actual advice from a doula-type I used to know when I mentioned I hated taking baby to emergency because of all the germs from the other sick kids. “Just lick one of them,” she said, “and you’ll develop antibodies you can pass along in your breastmilk and BabyOldTown won’t get sick!” Extending this to toilet seats does seem like the next logical step…)

          • Kalacirya

            I’d stick with licking dirty children, the toilet seat won’t have as high of a yield.

  • E151

    I nursed three babies to 18 months each. I fought hard for it and I’m so glad I did. My ten year old still sometimes sneaks into my lap and places her head against my chest the way she used to, and I love that our bodies remember that time, and that she still seeks comfort in the echoes of it.

    But so many of my friends hated nursing or couldn’t make it work — or just plain didn’t want to. And why the hell should they? They found their own family’s ways of nurturing, feeding, comforting.

    One of my friends had a lactation consultant stare at her naked breasts and tell her they were too small. Another one had an LC tell her it was equivalent to child abuse to not breastfeed. Who are these horrible people?

    My sister-in-law was struggling in the early weeks of breastfeeding and called a visiting LC. The woman told my sister-in-law she wasn’t trying hard enough and made her cry. My awesome brother threw the LC out of the house and told her never to come back. They were a formula family ever-after, and I even got to give my nieces bottles. Lucky me!

    • KarenJJ

      My formula fed boy climbed on to my lap and cuddled up to my chest and fell asleep yesterday on the train ride home from visitting granny. It’s such a beautiful moment.

      • Eddie

        My partially BF, mostly FF daughter often climbs in my lap, cuddles up to my chest, and falls asleep. It’s a beautiful thing, isn’t it? My wife BF when she could, and I FF when she couldn’t, when she wanted to sleep, and so on. I’m 100% FF myself, slowly approaching 50, and the healthiest person in my family.

  • TiffanyEpiphany

    I’ve really “latched on” to something Dr. Amy has said before about breastfeeding vs. formula, that the difference is meaningless. This really puts things in perspective for me.

    During the nursing years of my first baby, there was always a little part of my brain that was like, “Thank goodness I have enough milk and that I’m not having any problems,” as if formula would have poisoned him.

    Give me a break.

    The F in formula stands for Freedom.

    • JC

      I like this! It’s also interesting to me that I know moms who nursed for a year but hated it. You never hear these stories. I have a friend who had NO problems at all but she couldn’t wait until her baby turned a year old so she could quit breastfeeding. She only continued because her pediatrician told her it was best to do it until 1 year old. She had to pump while at work and she talked about how time consuming it was, what a hassle it was. And she didn’t seem to think much more of actually feeding the baby from her breast. I know some moms love nursing and really treasure that time with their babies/children. But some moms don’t feel the same way and this seems to get overlooked by many.

      • auntbea

        I would estimate that 80% of my close friends breastfed for a year+, all while feeling entirely “meh” about the whole thing.

      • Lena

        A good friend of mine had a baby who refused the bottle, and she describes that first year as “hell on earth.” And by “refuse,” I mean that she–at 8 weeks old–cried hysterically out of hunger for 4 hours until her mother rushed back home to feed her. She had avoided bottles until then to avoid “nipple confusion.”

        When her second baby, she supplemented with bottles from the day he was born so there would be no nasty surprises.

        • quadrophenic

          This is why I’m not even sure if I want to try if I have a second baby. My daughter wouldn’t latch and I exclusively pumped for 12 weeks then had to stop so I could start my meds again. What if my next baby latches perfectly and refuses bottles and formula? Then what would I do when I had to stop? I have to come up with a plan once I’m pregnant again. I went through so much hell the first time I’m just kind of over breastfeeding.

          • ratiomom

            Just don’t start breastfeeding and give formula straight away. You can go right back to your meds, problem solved.

          • quadrophenic

            Yeah, I’m considering it. I’ll decide when the time comes. Thing is I probably won’t actually need meds for about 6-8 weeks after birth so if I can save money breastfeeding and get that tiny benefit I may do it. I’m not going to torture myself about it next time, that’s for sure.

      • Awesomemom

        My sister weaned her son at six months because she hated doing breastfeeding. I will admit to feeling envious that she could so easily nurse(I struggled so hard and ended up formula feeding my kids) and judged her a tiny bit because she gave up so soon but that was before I started reading here and got a better perspective on things. She didn’t nurse her second son a full year either I think she went right to formula.

        • SF Mom & Psychologist

          I am BFing my 7-month old baby (and supplementing with formula) while working outside the home 4 days a week, and I just need to say that I would not characterize weaning at 6 months as giving up “so soon.” She chose to stop (doesn’t sound like “giving up”) and she lasted half a year. I am not trying to attack you, particularly as you are making the point that you are more open minded now. But I will probably stop BFing soon (baby losing interest, low supply, tired of pumping, ready to have my body, sleep and hormones back to normal), and I feel like I worked my ass off to go this long. Nobody else is up with me at 2am, nobody else is pumping while I’m at work, nobody else found me a replacement pump when mine unexpectedly died at work, etc. I have worked hard to make it this long, and I am sensitive to the notion that it is still not quite enough.

          • Awesomemom

            I said so soon because the AAP recommends nursing for a full year and nursing six months is less than a year. I was just adding her story in as an illustration that some women hate nursing not as a judgment of her or anyone else that chooses to stop nursing for what ever reason. Yes I was envious that she nursed so effortlessly. Yes I was a wee bit judgy about her stopping but that was all internal and I did not say a negative word to her about it nor would I say a negative word to anyone that stopped whenever they decided to. I didn’t get a choice to stop because my body never started and I can’t help but be a bit envious of those with a choice.

          • DiomedesV

            It is enough. You’ve done a terrific job, that sounds like an incredible investment of time and energy. Honestly, I’m awed by that kind of work.

      • My wife enjoyed it for most of that year with her first, but then started feeling pain near the end and so weaned abruptly at 13 months, something that was awkward among her crunchier friends even as I kept pointing out that she had gone far longer than the national average.

      • Elle

        Yep… just like there are many people who go for a “natural” birth and end up hating it, but you don’t hear those stories anywhere either, because they don’t work so well as propaganda. Although I have to say, props to the mothers who genuinely dislike breastfeeding but do it anyway because they still believe it’s best for their family. It’s unfortunate to not enjoy it, but hey, everyone will have things like that that they decide are important to do without being fun. No mother should feel guilty for not feeling like she’s on cloud 9 every time she breastfeeds!

    • Olga Mecking

      I breastfed both of my children for a year, but I did it because of “duty”- I didn’t enjoy it, I didn’t hate it. It was just a way to feed my babies. Now, expecting my third soon, I am considering formula-feeding him, either just formula or supplemetnging breastmilk.Somehow I was so proud that I had enough milk to feed my children, but does it matter? Not really.

    • Elle

      It’s terrible to guilt a mother for using formula if it is what works best for her family. On the other hand, if the difference is meaningless, would you tell a mother who is making a lot of sacrifices to breastfeed that she’s wasting her time and effort? Either can be best in different circumstances… we can avoid putting a guilt trip on one group of mothers, without minimizing the sacrifices of another group.

      • TiffanyEpiphany

        I absolutely see your point and agree with you. The sacrifices a family makes to breastfeed a child is never for nothing, and it’s certainly not a waste.

        I took the “difference is meaningless” phrase as a way to keep things in perspective for myself. I’m a supporter of BF, always wanted to do it, loved it, will do it again. I had a shift in attitude over the last few years about it, though.

        At first, I thought that I would be somehow less of a good mother if I didn’t BF my baby until he was old enough to tell me that he didn’t want to do it anymore.

        Now I realize that BF is truly a woman’s choice. She has the freedom to do it or not do it, and it doesn’t reflect whatsoever on her ability to earn the “Good Mother” badge. (Nor does her decision grossly impact the development of her child, while still acknowledging that breastmilk does have beneficial properties that formula simply doesn’t have.)

        So in the end, the difference is truly meaningless. A woman can still be a good mother either way she goes, and her child will still grow up healthy and happy, no matter what the feeding preference was.

        • Elle

          Yes, that makes sense… and I agree! The difference is more “meaningless” when considered *between* different families rather than within one.

      • Daisy

        It’s terrible to guilt a mother for having a c-section if it is what works best for her family. On the other hand, if the difference is meaningless, would you tell a mother who is making a lot of sacrifices to have an unmedicated birth or home birth that she’s wasting her time and effort? Either can be best in different circumstances… we can avoid putting a guilt trip on one group of mothers, without minimizing the sacrifices of another group.

        • Elle

          Eh… I think that’s apples and oranges. Does breastfeeding kill as many babies as homebirth?

          • Daisy

            I’m trying to point out that we don’t have to pretend something is vital just because a number of people have suffered and struggled to do it. Unmedicated childbirth is unnecessary and there’s no reason to refrain from saying that, even if you’re talking to a woman who has chosen to have five babies without an epidural. Her suffering was needless and should be avoided for future women, not perpetuated as some sort of tribute to her. Just because a lot of women sacrificed and suffered to breastfeed, it does not mean that we have to pretend that their children would not have been just fine on formula.

          • Elle

            I know what you mean… if one woman says that going unmedicated was a good choice for her, then it’s easy to take it as an insult if you didn’t. But it’s not. Just like medicated is the right choice for some women, unmedicated is the right choice for others. It can go both ways… it doesn’t have to be either/or, just like the method of feeding doesn’t have to be exclusive.

          • Eddie

            You’re missing one point: an epidural is not without risk. If there were no risk whatsoever, then indeed, the suffering was not needed, but maybe even there, provided some emotional value to that specific person. If a woman decides she does not want to take that (very small) risk of injury from an epidural, no-one should criticize her.

            My wife quite enjoyed the relief from pain she got from an epidural, but I would never have told her she was doing something that should be criticized if she judged the risk was not worth it to her. Each person should be able to judge for themselves — with fully informed consent — what risks they wish to take, or not. Without judgement by others.

          • Bombshellrisa

            But then again, pregnancy and birth are not without risk either.
            Gotta say though, I have seen women who refused an epidural for their second labor after having had one with their first. The side effects were not something they were comfortable with again and that was enough information for them to make the choice against one.

          • Eddie

            You are correct. Pregnancy and birth are not without risk. Does that mean we disregard added risk? Well then, why not have a birth at home? After all, pregnancy and birth are not without risk.

            If a woman decides she doesn’t want to take the admittedly VERY small risk of an epidural, or if for some reason she finds the pain of childbirth empowering somehow (in some way that I do not understand), then I am happy for her to make an informed choice about her own body.

            My wife had 100% natural labor when her first children were born in a poor European country where only the rich could afford pain relief; the government-provided health care had no interest in the expense of “unnecessary pain relief.” (barbaric.) She greatly enjoyed the relief from pain the epidural gave her when she gave birth in the US. I encouraged her to get the epidural, not that any encouragement was needed.

            I’m never going to discourage anyone from seeking pain relief. All I am saying is that if a woman decides she does not want to take that risk — or if the finds a natural childbirth empowering — I will not judge that choice. If her husband (or mother or doctor or …) refuses her pain relief, I will judge that choice unless there is a truly compelling reason.

          • Bombshellrisa

            Informed consent by a professional is very different from the talk you will get from a CPM about homebirth. I am not talking about homebirth where it’s part of the healthcare system, those midwives risk women out.
            I don’t judge people for their choices regarding pain either, I would be a pretty lousy nurse if I did.

          • Eddie

            > Informed consent by a professional is very different from
            > the talk you will get from a CPM about homebirth

            I’m not willing to throw all CPMs under the bus, but otherwise point taken. If I knew someone bound and determined to have a home birth, I would strongly encourage them to get a CNM involved. Having known many nurses in my life, I strongly respect the education you know any nurse has to have had to call herself a nurse.

            When I refer to informed consent, I mean with the facts as best identified via scientific methods. When some practitioner gives “facts” that are provably wrong, that is not informed consent.

          • Bombshellrisa

            Thanks! I did train to be a CPM, I followed some of the most well known CPMs around. Trying to get the education so I could get my midwifery degree (nothing to do with nursing) I started nursing school and tried to work both sides of the fence. It didn’t work, what I had been taught in woo world was very different than what I learned in my clinicals. I had been accused of being “too clinical” and “making clients nervous” because there were things that I would see and call out and my preceptors’ “trust birth” thing wasn’t working for me.
            I do still believe that home birth can be a option, there just has to be a better system for that to happen. Making sure that the only midwives attending those births are CNMs is a good start.

        • Poogles

          Except the differences aren’t “meaningless” between those options – HB has a significantly higher rate of perinatal mortality, for one.

          • Yup, about the same level of increased mortality risk you’ll inflict on your child if you move three miles farther down the road from their school, supermarket, etc. Big whoop.

          • Poogles

            “about the same level of increased mortality risk you’ll inflict on your child if you move three miles farther down the road from their school, supermarket, etc.”

            I really doubt that that is true – want to share how you arrived at that?
            Bofa on The Sofa has posted numbers multiple times to show that drunk driving is safer than HB in the US (as it is now) – perhaps he would be willing to do so again?

          • Okay: the figure bandied about here, which I’m accepting without argument, is 1/1500 risk over and beyond that of hospital birth. This is, according to the NHTSA, about the mortality risk incurred by riding in a motor vehicle for 40,000 miles.

            My scenario envisions the family staying in that home until the child is 18 years old, and having the child ride round-trip five days a week for school or day care, plus three additional roundtrips per week for other purposes. Even if you dispute details of the premise, it is only going to change the scenario to 4 miles or 5 miles; the principle is the same in that no one would bat an eye if parents made this choice (even though it also increases their own mortality risk, potentially leaving the children parentless; it also contributes to climate change for that matter).

          • Amy Tuteur, MD

            No, the figure is at least 1/1000 and probably substantially more.

          • 1/1000, “2/3 of whom could be saved in the hospital”. 1/3 of whom could not and are thus not applicable to a discussion of risk differential. Hence 1/1500. I was accused of being “bad at fractions” when I made this point before, but it’s really just basic math.

          • Amy Tuteur, MD

            No, Alan. The difference between 1.5/1000 and 0.5/1000 is 1.0. The ones that can’t be saved in the hospital comprise the 0.5/1000.

          • The way I remember it being presented was “1 in 1000 HB’d babies die, 2/3 of whom could have been saved in the hospital.” I don’t have time to go look for it now, but I bet if I do so later, that is the verbiage I will find. If not, I will adjust my figures.

          • Okay, I will concede this one. (Drat! LOL)

            I can’t find erroneous statements on this in a cursory review of your recent posts; and I did Google and find a link backing up the 1/1,000, actually even 1/900:

            http://dhmh.md.gov/midwives/Documents/Wax-etal.pdf

            Which as they say may be conservative.

            So, okay, this does edge up to a risk level I start to find somewhat uncomfortable. If I had it to do over again and had this information, I might rethink the idea of attempting two homebirths. But while I think there needs to be more awareness about this risk, I still think the level of hyperbole on this blog is extreme. After all, the point I made about someone moving 3 miles farther from town can now be replaced by “5 miles farther from town”. Or if the risk is a bit higher still, maybe it is six or seven miles. Point is, who could violently denounce someone for putting their children’s lives at risk that way, without pretty universally being dismissed as a member of the lunatic fringe?

            I also wonder why you don’t promote birth centers as a compromise more. I saw that you do have one post acknowledging their safety, but in other posts, you generally seem to mention hospital and home as the two options.

          • AllieFoyle

            The distinction you always seem to miss when you trot out this tired old analogy is that, in general, people choose to live where they can minimize their driving time. Yes, driving is dangerous, but it’s also more or less necessary, depending on where you live, and provides tremendous benefits in terms of being able to access goods and opportunities. Generally speaking, people don’t buy a house that’s farther from school because they want “the driving experience”–it’s usually a compromise between what is available, what they can afford, and distance to a number of destinations. You choose a house that’s closer to one child’s preschool but further from the other children’s elementary school or the grocery store or grandmas house or whatever. Most people are motivated to minimize driving time but are simply constrained by real life factors.

            In contrast, there is really no compelling reason for anyone to take on the increased risk of HB.

          • “The distinction you always seem to miss when you trot out this tired old analogy is that, in general, people choose to live where they can minimize their driving time.”

            Um, no. This is the goal of a minority of people who subscribe to the school of “new urbanism”; but the majority of Americans pay little heed to minimising driving time. A quick Google search finds that it is even worse than I thought:

            http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/05/commuting-in-the-u-s-is-long-and-hellish-but-at-least-it-hasnt-gotten-worse/
            “The average commuter in the United States travels about 25 miles each way to work.”

            Ugh, that’s disgusting…depressing.

          • AllieFoyle

            That’s pretty rich, coming from someone who has the luxury of not having to commute.

            Why is a 25 mile commute “disgusting…depressing”? I know you’re a smug arse, but the idea that “the majority of Americans pay little heed to driving time” is ridiculous. Do you think people enjoy commuting? Why do you think real estate in cities is so expensive? What do you think “location, location, location” means?

            New urbanism has advantages in theory, but it’s not accessible to that many people right now, and requires substantial outlays in planning and infrastructure before it becomes so.

            I know you take great pride in feeling superior to others about your lifestyle choices, but honestly, I find your lack of insight into what motivates other people just as disgusting and depressing as you find the fact that some people have to drive to work to support themselves and their families.

          • This is getting pretty far afield, way off topic, but I just note that your previous comment and this one do not strike me as consistent. And your indignance really proves my point: you wouldn’t blink an eye if you heard of someone buying a house that was 5, 6, 7 miles away from their work and the children’s school; but that adds the same risk of death to their children’s existence as does a homebirth.

            ETA: It presumably adds more risk than that if it is also farther from the hospital and the ER (we live a half mile from ours).

          • AllieFoyle

            The point is that most people are constrained by real world factors that keep them from buying a home closer to their children’s school. There are no comparable pressures or advantages for choosing a HB over a hospital birth. It’s unnecessary risk without compensating benefits or reasonable justification.

          • Right, they “have to”. Because everything closer in is a toxic wasteland or costs millions of dollars. I just don’t believe that, not in most parts of the country. I think it’s mostly trying to stay away from the ookie dark people, or wanting a bigger house and bigger yard for their money, or both.

            And clearly other people do value benefits of homebirths which you did not. I by contrast would never ever choose to live 25 miles or more out into the exurbs. People have different things they value and whether they can justify them is not up to you or to me.

          • LukesCook

            Nothing wrong with forming an opinion about people’s choices, especially if the judgements we make help us to better inform our own. The issue is if and when it is appropriate to share those opinions with the people concerned.

          • AllieFoyle

            Did you miss the quote in the article you linked?

            “I can’t afford to leave this job, and I can’t afford to move,” said Barber, 46, who has been making the commute for nine years. “I have a good job, it’s just 74 miles from home.”

            I’m not sure why we’re exclusively focused on long commutes here (though it amuses me that in your infinite wisdom and progressiveness you ascribe other people’s choices to greed and racism. Interesting how it always seems to come down to you making smart choices and other people being too dumb to do the same).

            Your original argument was that choosing a home a few miles away from your child’s school represents a risk comparable to HB. Living in an urban center is simply unaffordable for many people, and it involves a number of tradeoffs in terms of living space, access to the outdoors, to schools and recreational programs, cultural opportunities, job opportunities, exposure to crime, pollution, good restaurants, etc.

            HB has no real benefits and there is no compelling financial or logistical reason to choose it.

          • Schools are all in urban centres? Really? (And btw there are lots of cheap places to live in mosturban centres anyway.)

          • AllieFoyle

            Yes, that’s exactly what I said. But please, tell me more about all these cheap places to live in urban centers…

          • Try the places the aforementioned dark-skinned folks live. HTH

          • AllieFoyle

            No, sorry, it doesn’t. Could you be more specific?

          • Fine, name the urban centre and I will.

          • AllieFoyle

            Happy to go with DC, in keeping with article you posted.

          • I have lived in several large cities, never in the ‘burbs, and my rule of thumb is to go where the immigrants settle. So Adams Morgan would be my focus.

          • AllieFoyle

            Dude, you have four kids and live on a special ed teacher’s salary, right? What could you afford to live in there?

          • What could I afford to live on in Arlington or elsewhere in the metro?

          • AllieFoyle

            No idea, though I suspect you might have to compromise some elements of your commitment to new urbanism.

          • So to compare like to like, my point stands for someone who now commutes 25 miles to a job in DC.

          • AllieFoyle

            Your point still stands? Which point was that? You said that there are lots of cheap places to live in most urban centers, but the one example you give me is clearly out of your price range.

          • So would the suburbs be. I think it was clear that I was saying people who choose to live far from their work could live closer. I have a zero mile commute, and my wife’s is one mile, so we are not the ones driving the stat I called “disgusting”.

          • AllieFoyle

            A zero mile commute? That’s one way of putting it.

          • Poogles

            “1/1500 risk over and beyond that of hospital birth. This is, according to the NHTSA, about the mortality risk incurred by riding in a motor vehicle for 40,000 miles. ”

            I think there is a big difference between a 1/1500 (or 1/1000) risk of death over 18 YEARS and the same risk of death for a single event that only lasts 4-24 HOURS (generally).

          • The single event is closing on the house that is five or six miles farther from school etc.

          • Poogles

            “The single event is closing on the house that is five or six miles farther from school etc.”

            Um, it doesn’t work that way. The risk is during the actual driving, over 18 years – the risk isn’t applicable at all during the actual closing of the house, assuming someone isn’t closing on a house while driving with their child, LOL.

          • One thing necessarily leads to the other. And the results are the same for the kid: dead is dead. I suppose you could argue that on average, the child will get nine years of life before dying in the other case, but I’m not sure that’s really much comfort.

          • suchende

            I don’t have any problem taking up anti-car arms. It’s amazing to me that this isn’t already the subject of debate. I put my child in cars as infrequently as I can manage, because they’re incredibly dangerous. Far more dangerous than formula.

          • You undoubtedly have a good point, especially as I learned today that the average commute is an astonishing 25 miles in the US. But we both know that does not face the kind of social disapprobation that homebirth does.

          • LukesCook

            Except that the choice of where to live and how often to drive may have significant and recurrent long term implications for a family’s finances, standard of living (better to live on a busy road right between school and supermarket or a quiet road 3 miles away?), socio-economic status or plain old convenience. The choice to give birth in hospital is one day of trivial inconvenience.

          • For many people, it is a much deeper philosophical issue than that.

            Look, I will say it again if I had it to do over again with what I know now, I would not be in favour of trying for a homebirth. It does not rise to the level of saying it is not a valid choice for others, especially if we going to give a pass to people who needlessly drive their kids around a lot.

          • LukesCook

            Just because there isn’t a rational basis for a particular personal preference doesn’t confer upon it the status of “deeper philosophical issue”. And just because someone is entitled to make a particular choice without any rational basis doesn’t make it a “valid” choice worthy of respect.

      • ratiomom

        It’s only a ‘sacrifice’ if there is a substantial advantage for the baby. Otherwise it’s pointless self-flagellation.
        Women who put themselves, their partner and their older children through hell for breastfeeding at-any-cost are either deep in the woo or do it for the bragging rights/martyrdom.
        We shouldn’t burden women who make a rational decision to lay their priorities elsewhere with guilt because of this phenomenon.

        • Elle

          You’re right, we absolutely shouldn’t burden women with guilt. But if it’s horrible to tell a woman that she “didn’t try hard enough” (which it is), I think it’s equally bad to tell another woman that she is engaging in pointless self-flagellation for something that is important to her and does have advantages for her child and her family budget. Unless she’s being an attention hound about it. Then it’s just annoying. But it’s not my job to judge whether one woman is engaging in purposeful “sacrifice” any more than it’s my job to judge whether she tried hard enough. It goes both ways.

          • This is what I see as the real dilemma for lactivists: the CW impels delivering a mealy-mouthed message that “breast-feeding is really important, but if you don’t do it it doesn’t matter”.

          • Elle

            Exactly… it must be a difficult balance to keep, but I admire the women who are able to do it with love rather than condemnation. I think the most important thing is to focus on supporting the *woman* and her family more than trying to get a desired outcome.

          • suchende

            The problem is using science as a weapon. I could write a book about how much I love nursing without a single footnote. The science is bad and needs to stop being wielded by incompetents.

        • Charlotte

          I struggled through pain and tears and guilt and sleepless nights and clogged ducts and pumping to breastfeed my two kids for a total of 6 months, and yes, it was all a huge freaking waste of time for the most part. There are many reasons to breastfeed, but if your primary purpose is that you think it will make your baby smarter/healthier/more successful 20 years down the road, it is a waste of time for you too and I wish that fact was more readily put out there. It would have saved me so much guilt and frustration. I will attempt to breastfeed my next baby (if I have one) solely for the potential money savings on formula, but if it even starts to get hard I am ditching.

    • theNormalDistribution

      “The F in formula stands for Freedom.”
      Love it!
      My spouse and I have already decided that when we have children, they will not be breastfed.

    • Katie

      Strange kind of freedom having to rely on a company to produce a concoction that doesn’t even come close to the original. Especially as that concoction of artificial ingredients is the baby’s only source of nutrition for 6 months.

      • The question is:

        Does it work?

        If you can prove that formula doesn’t work, feel free to present your evidence.

        • Katie

          Depends what your definition of ‘it works” is. And no Anj Fabian, the onus is on you to prove that formula, the non biological norm, does no harm.

      • KarenJJ

        Not 6 months. Current recommendations are to start solids at 4-6 months. Both my kids started solids at around the 4-5 month mark.

      • Sue

        “Doesn’t come close to the original”, Katie. Please explain the differences.

      • LukesCook

        Do you grow, gather or kill all your own food or do you rely on one or more companies to produce a concoction or two for you?

      • anonomom, LLLL, IBCLC

        Actually it does come quite close to the original, since it is modeled on it to the best of nutritional experts’ abilities. Obviously it’s not an exact copy of a mother’s own breastmilk, but nothing is, not even donor human milk. Luckily, formula is good enough to enable babies to do very well.

        I don’t have enough schadenfreude to hope that you will have to someday eat your own words (due to low milk supply for a future baby or a grandchild who is formula fed), but you might very well be. And then believe me, you will be grateful for that artificial concoction that enables a baby to thrive.

  • Ibanezsrx

    I always say that if you have to tell lies to get a point across, there was no point to be made in the first place.

  • anonomom, LLLL, IBCLC

    I would looooooove to see someone fluent in statistics deconstruct the article in AHRQ by Ip et al. (2007): http://www.ncbi.nlm.nih.gov/books/NBK38337/

    This is the go-to document about the health effects of breastfeeding vs formula feeding on babies and mothers. I’d love to be able to understand the clinical significance of the increased risk of formula feeding, especially on serious illnesses like Type 1 and 2 diabetes, obesity, and childhood leukemia.

    I recently had a patient who had serious post-partum anxiety and low milk production. She was terrified that her child could get diabetes and it would be “her fault” for not producing enough milk. I wanted to be able to put the science in real terms, to hopefully make her understand that (for example, numbers pulled out of nowhere) maybe 1 in 500,000 exclusively BF kids would get diabetes, versus 2 in 500,000 for exclusively FF kids, and that this is possibly not even sufficient evidence due to confounding factors and imperfect recall.

    But alas, I can’t math, and all I could do was reassure her that diabetes is very rare, she was producing a significant amount of milk for her baby, and the post-partum anxiety can cause irrational, catastrophizing thoughts, which mental health treatment can really help her with. I have taken a statistics class at the graduate level, but true understanding eludes my brain.

    • Amy Tuteur, MD

      This is the key sentence in the document:

      “Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings.”

      In other words, the studies show associations, but there is no evidence that the method of feeding caused the results.

      • anonomom

        Yes, but it doesn’t rule out causation, and isn’t it true that it would be difficult if not impossible to find strong evidence of causation? If we assume causation for the sake of argument, I would just like to understand in real terms how big of a risk are we talking about for serious illnesses like diabetes.

        • DiomedesV

          ” isn’t it true that it would be difficult if not impossible to find strong evidence of causation?”

          Why?

          • suchende

            Because you can’t have a control group.

          • DiomedesV

            There are challenges to inferring causality when you can’t do invasive, random-assignment studies. But it is not completely impossible. First, the PROBIT study in Belarus is, as far as I know, as close as we can come to this, via assigning mothers randomly to support. Second, it is possible to do research in model organisms and thereby develop a working model for how these posited improvements over formula fed infants come about. I don’t know how difficult that would be for breastfeeding because I don’t know how close the working animal models would be.

            I see little evidence that avenues for getting more causative data have been completely explored. I attribute this to the fact that researchers and the public have decided to accept causality anyway and thus feel no impetus to do more research on how, for example, breastmilk supposedly reduces incidences of allergies. But to claim that there is no research we can do that would provide evidence of causality is wrong.

          • I just have to note that when people on one side of an argument have to constantly cite one study in Belarus of all places as the exculpatory evidence for their case, it comes across as a little bit desperate, like a tobacco company spokesman weakly protesting “but the fishermen of Novgorod…”, LOL.

          • DiomedesV

            Actually the Belarus study demonstrates significant benefits of breastfeeding. I think it’s great because its design is so good and it’s very large. Well designed studies are a beauty to behold.

          • DiomedesV

            Not only that, I have never argued that breastfeeding is not superior to formula.

          • Fair enough, and you do make some good points. I wonder though about the absence of such studies funded by the formula industry. Is it because they are afraid of what they would find?

          • Susan

            I think breastfeeding is superior to formula too. I think the message is that the magnitutude of superiority is often overstated. I haven’t seen Dr. Amy say that breastfeeding isn’t a little healthier. However, I would prefer formula over pot smoking teens any day!

          • DiomedesV

            If you ever get a chance to read the several studies that came out of it, you should. The IQ one is especially interesting. They were able to separate out bias in estimation, for example, and still found an effect. What I think is unfortunate is that they did not control for sibling order. There is some selection bias still present (though greatly reduced) and I wonder about the effect of having many older children on the willingness to follow through. I also think that sibling order and outcomes is, in itself, rather interesting.

          • auntbea

            The obvious confounders are in any BF study are SES, sibling order, maternal education and health, pregnancy/birth complications …and what else? And why do so few studies seem to control for all of these? Lack of data? Intentional model-mining?

          • DiomedesV

            “Belarus of all places”

            Thanks for letting us know what you think about Eastern Europe.

          • I spent three weeks in its neighbour, Ukraine. Interesting place, but not really very similar to the US. Still, at least Ukraine has made the news fairly often over the years. Belarus is just so obscure, it sounds funny to keep trotting it out. (Not a scientific point, I acknowledge.)

          • DiomedesV

            “(Not a scientific point, I acknowledge.)”

            Ya think? Belarus is a good choice for a number of reasons, some logistical, some scientific. Breastfeeding rates there are (or were) very low.

          • AmyP

            I like Eastern Europe (I know Russian and am married to a Pole), but Belarus is kind of a hellhole, even if Alan says so.

          • Lol! Nice burn.

          • Sue

            Alan – I suggest you take a break from proclamations about the research until you have read and critically analysed some yourself. There are various papers about the health outcomes of BF in developed countries. You need to read the entire paper to analyse their methodology and findings. Then you can join the discussion with some credibility.

            I’ll get you started:

            Quigley et al Paediatrics Pediatrics. 2007
            “Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study.”

            This UK study used data extracted from a population-based survey (the UK MiIlennium cohort study). They looked at outcomes at 8 mths of age, comaparing never BF with any BF up to 4 mths and exclusive BF for six moths (only 1.2% of the cohort.

            In the entire study population – of whom only 1.2% were exclusively BF for 6mths or more, only 1.1% of the total were hospitalised for diarrhoeal illness in the first eight months. IN other words, the overall incidence of the condition was very low – very few of the formula-fed babies were hospitalised for gastro illnesses, and only slightly more for respiratory infections (most likely to be viral bronchiolitis).

            Even though the percentage reductions in these two conditions sound significant, they are reductions from a tiny number to an even tinier number.

            There you do. Not even from Belarus.

            Want to look at some others?

          • “Even though the percentage reductions in these two conditions sound significant, they are reductions from a tiny number to an even tinier number.”

            But that is also true of the HB vs. hospital stats, no?

          • NZ lurker

            “But that is alo true of the HB vs. hospital stats, no?”

            True of the numbers but not the consequences. Not BF might cost a couple of IQ points; not hospital birthing might cost one or two lives.

          • Per the AAP, If all women or at least 90% of mothers breast-fed exclusively for six months, 900 American babies’ lives per year could be saved. We have already quibbled about this in the past, but it looks kind of convenient to dispute this finding while latching on to the ones about homebirth. Personally I accept them both.

          • AllieFoyle

            Do you understand that that number is only an estimate from an extrapolation of a model that makes assumptions about causation? You change some of the assumptions and numbers going into the model and you come up with a completely different number. That figure has been widely criticized and there is simply no reason to take it at face value.

          • How is the same not true about the studies on HB mortality? Actually, I have been derelict in not posing this question to Dr. Amy. She says that diet studies are “crap” because they’re all associational; but the same is true for the mortality research on HB! As far as I know no one is doing randomised trials for prospective study of this question either.

            Oh SNAP, that’s check and mate, I’m afraid. 🙂 I just need to save and repost this comment, and I’ve won this blog (in its present form anyhow).

          • AllieFoyle

            You are so utterly and profoundly wrong.

            The 900 deaths a year thing is not even associational–it’s a made up number, based on a model that estimates the inputs and importance of different factors. Get any of the input variables wrong and the number is essentially meaningless. There are no 900 infant deaths a year in the US from lack of breast milk. They don’t exist.

            HB, on the other hand? Numerous accounts of real babies dying preventable deaths at HB. A number of studies showing a significantly increased mortality rate.

          • Whatever, leave aside the breastmilk issue and the HB study is still associational, “crap” as Dr. Amy characterised those types of studies. No prospective, randomised trials.

          • AllieFoyle

            Leave the breastmilk issue aside? What a shame, but ok.

            And no, there will never be (hopefully) truly randomized studies when it comes to HB, but that doesn’t mean people can’t use the evidence that is available to make some kind of determination of approximate risk. Associational studies are not ideal, but they’re the best we have in many cases, and with judicious use of analysis and critical thinking they provide one way of getting at the truth. Otherwise we’re just willfully closing our eyes and groping around in the dark.

          • And in fact, the breastfeeding vs. formula feeding mortality deal IS based on “real babies dying”:

            http://pediatrics.aappublications.org/content/113/5/e435.full.pdf
            “Nationally representative samples of 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly or malignant tumor (cases of postneonatal death) and 7740 children who were still alive at 1 year (controls) were included.”

          • Sue

            Alan – did you even read the paper that you cited? Yes – these are “real babies dying” – but not “real babies dying who would have been saved by breast feeding.” Since intra-partum death in hospital is vanishingly rare, we know that HB deaths WOULD (almost certainly) have survived in hospital. Get the difference?

            Let’s look at what that paper you cited actually says:

            “The children who died had a higher birth order and were more often male, black, and of low birth weight. There remained an excess of children with congenital anomalies among the cases, although children who died by 28 days or who died of their congenital anomaly or a malignant tumor were excluded. Age at death is shown in Fig 2. Most children who died did so before they had completed 4 months of life.”

            and
            “It may be that breastfeeding represents a package of skills, abilities, and emotional attachments that mark families whose
            infants survive and that it is these factors that produce the benefits seen, rather than breastfeeding or breast milk per se. “

          • “It may be that choosing hospital birth represents a package of skills, abilities, and emotional attachments that mark families whose infants survive and that it is these factors that produce the benefits seen, rather than hospital birth per se.”

            I don’t believe that, to be clear; but we cannot prove it is not case. I believe the mortality association is showing something real in both cases. You believe one but not the other out of pure, blatant confirmation bias.

          • Sue

            No, Alan, let’s try again – slowly. (Listening?)

            Home birth: intra-partum death, occurring purely as a result of lack of intervention for cord compression or “stuck” baby (eg shoulder dystocia). Does not happen in hospital because intervention is available. Also, no impact from “skills, abilities, and emotional attachments” – or any other factor. Just pure hypoxia from mechanical complications. (With me so far?)/

            Contrast: infectious deaths in infancy. (We’re talking about properly made formula with clean water). The infection is neither transmitted nor promoted by the formula. It cannot be traced to a specific episode of feeding. Breast milk might protect some, but breast-fed babies still die of infection. Having infectious contacts increases the risk of getting an infection, and rarely dying – whether you are BF or FF.

            If you genuinely can’t see the difference, no amount of SAT score or Myers-Briggs special pleading will redeem you.

            If you can see it but are just being bloody-minded for your own amusement, maybe your baby needs more of your attention.

          • Ah, my little runaround Sue.

            We each insist the other is being thick-headed about this, each essentially characterise the other as being on the left edge of that graph Dr. Amy posted the other day. (We don’t both feel the need to hurl ad hominem abuse; but I’m happy to leave that prerogative to you.)

            I’m satisfied with the explanations I have offered upthread, and that until Dr. Amy accepts the validity of what she calls associational, I call retrospective, and the 1957 Surgeon General’s Report called epidemiological research, she will be in a sticky wicket trying to argue the validity of the homebirth mortality differential when there has never been–and never will be–a randomised trial of homebirth vs. hospital birth.

            It seems you intend to be persistent in pretending (or perhaps even believing) that I’m the one being obtuse; thus I shall likely have to simply copy and paste this response in the future rather than continue to waste my time with your obfuscatory nonsense.

          • AllieFoyle

            Sorry, try again. Those 1204 infants died of a variety of causes from meningitis to SIDS to accidents, not one of which was directly linked to not breastfeeding. They were looking for an association and found one, but they failed to adequately control for the SES variables for which breastfeeding status is most likely a proxy. They found associations with maternal age, education, birth weight, WIC status, maternal smoking, race, multiple gestation, and infant gender, but they failed to control for them. In addition, they admit that there is likely an element of reverse causality in which infants that are already medically compromised are less likely to be breastfed and also at greater risk for mortality.

          • But the HB study was perfectly controlled in every respect?

            What about Dr. Amy’s previous insistence that retrospective–or is she calls them, associational–studies are “crap” (including nearly all dietary studies)? Can you be less stubborn and/or obtuse than Sue, and acknowledge that any comparison of homebirth and hospital birth is necessarily retrospective, and that we can never be certain we are comparing like with like? (Again, I don’t want to throw out retrospective studies en masse; I accept them as being legitimate public health tools despite their inherent limitations. But it is rather convenient to accept the ones that reinforce your biases and reject those that do not.)

          • AllieFoyle

            It’s called critical thinking, Alan.

            You have studies showing HB results in a higher death rate, even though the population that chooses HB is much lower risk in general than the hospital birth population. You also have a plausible mechanism for which those deaths can be attributed to HB (i.e. lack of access to emergency intervention). And you also have actual cases of deaths that are clearly related to birth location.

            Contrast that with what we know about BF: there’s an association with increased mortality, but that can be completely explained by the numerous other factors that also covary with feeding method. There is no need to imply causality because the other factors can account for it. There is also no direct evidence to suggest that it has anything to do with any infant deaths, nor is there a plausible mechanism that would explain why it would.

            The study you cited included deaths due to, among other things, accidents and meningitis. Are we supposed to believe that BF is protective against accidental death? There’s an association there, but common sense keeps us from inferring causality.

            Maybe you should check for confirmation bias a little closer to home.

          • “Maybe you should check for confirmation bias a little closer to home.”

            How do you figure? I’m the one saying I would not seek a HB if I had it to do over, given this research. I accept the likely validity of BOTH findings, and I do not see “common sense” pointing at all toward formula being equally likely to sustain an infant’s life and health. Rather, I see the mortality as being far lower than I would expect. The number given by Chen et al amounts to 0.02%. That’s an increased risk, going back to my driving analogy, commensurate with buying a house just ONE mile farther from school.

            If that were all that was involved, I’d consider the choice trivial. But the impact on health and especially development is far more compelling IMO.

          • AllieFoyle

            But again, you’re inferring causality just because you believe it should be the case.

            Your driving analogy is crap.

          • It really isn’t; and by your strict standard (overly strict IMO), how are you not making an unwarranted inference of causality re: the HB stats “just because you believe it should be the case”? Commence petard hoisting!

          • AllieFoyle

            Reread my previous post.

            Without analysis, statistics are just numbers.

            HB research: increased death rate, clear mechanism for causation, numerous actual cases in which causation is clear.

            BF research: increased death rate, many confounding factors that are sufficient in and of themselves to account for the increased rate, no plausible mechanism for causation, no evidence of direct link.

          • Sue

            What a narcissistic lack of insight (or is it very clever irony?). The studies on HB mortality are not theoretical estimates, Alan, they are real reported cases. Intra-partum death of previously healthy fetus is almost unheard of in hospital.

            There are no infectious deaths of formula-fed babies where one could be confident they would not have died if they were breast fed.

          • The Chen study also uses real cases of mortality. And it is impossible to know which one out of the three cases of mortality at homebirth would still have died in the hospital. So no, no difference.

          • Sue

            That is not “per the AAP”, Alan, it is the AAP citing a dubious theoretical study. I suggest you dig out the study and tell us what you think about the methodology.

          • I have skimmed through the full text of the Chen study, and I will keep that suggestion under advisement.

          • Sue

            To help you along, here’s a paper on critical review of medical research that you can also skim:

            http://www.aafp.org/fpm/2004/0500/p47.html

          • Sue

            Alan – we are comparing hospitalisations with deaths…get it?

          • DiomedesV

            Inferring causality does NOT require random assignment trials. It does require more than just an observational study where you can’t even control the basic demographic profiles of the persons included. It is possible to study how some feature of nutrition affects health by integrating observational data, intervention trials, and animal models. To infer causation, what you really need (at least the standard in other, better executed fields of science) is some model for how an effect is produced.

            If I wanted to posit that a gene caused mice to grow fat, ultimately, the gold standard of research would require me to create knockout mice and measure their weight. Even further, I would want to characterize the product of the gene of interest, its interaction with other genes, etc. Evidence for HOW something happens allows us to infer causality.

            My impression is that there is little interest in studying HOW these differences come about. Few creative attempts (except by Kramer) to really delve into these issues. It’s a failure of imagination and determination. Anyone who follows nutrition science knows that these are in short supply in that field anyway, but I would posit that there is even less impetus to get at the heart of mechanisms by which breastfeeding improves outcomes because fundamentally, the persons involved in this research 1) don’t care, 2) don’t care to acknowledge the cost of breastfeeding, which would require them to make an evidence based argument for its continuance, and all of this boils down to the fact that they 3) don’t value the intelligence and time of the women who engage in it.

        • suchende

          The sibling studies do a pretty good job shining light on what’s mere correlation, don’t you think?

        • Same is true about nearly all dietary studies, and tobacco studies. So by the same reasoning, one might as well be sanguine about smoking a pack a day and enjoying a diet filled with Wonder bread, donuts, and Big Gulps. Good luck with that.

          • DiomedesV

            Exactly. Nearly all dietary studies are not of high quality.

          • Sue

            No, Alan – there is a big difference between dietary studies and smoking studies. The toxins and pathology of smoking damage are well-defined. Suggest you read up some pathophysiology (amongst other things).

          • The Surgeon General’s warning came out long before those in vivo and in vitro studies were done.

          • Amy Tuteur, MD

            Wrong again, Alan. Hill and Doll’s studies were done in the 1950’s. The first Surgeon General’s warning on tobacco was in 1964. According to a history of the report, the authors reviewed over 7,000 papers on the topic before issuing the report.

          • I distinctly remember when it was touted as breakthrough research showing the actual mechanism of how tobacco causes cancer, as opposed to just showing a correlation. And I was not around in 1964. Another item to look into later when I have more time.

            I also notice no one is disputing that “almost all” dietary research is indeed retrospective/associational.

          • Amy Tuteur, MD

            Didn’t you say that the Surgeon General’s warning came out long before in vivo and in vitro studies? That’s wrong.

            Almost all dietary research is crap precisely because it is associational.

          • Seeing as it’s nigh unto impossible for me to prove a negative assertion (what would I say, “Nope, I checked: those don’t exist”) why don’t you link me to some such pre-1964 study? TIA

            Those who utterly dismiss mountains of diet data because it’s retrospective need, I think, to come up with a plausible alternate hypothesis especially when the same associations are repeatedly found across diverse regions and cultures..

          • I found this, from a Surgeon General’s report in 1957:

            http://www.traumaf.org/Lung%20Cancer%20and%20Excessive%20Cigarette%20Smoking.pdf
            “Many independent studies thus have confirmed beyond reasonable doubt that there is a high degree of statistical association between lung cancer and heavy and prolonged cigarette smoking.
            Such evidence, of course, is largely epidemiological in nature. It should he noted, however, that many important public health advances in the past have been developed upon the basis of statistical or epidemiological information.”

            That last line sounds exactly like my argument, and in direct opposition to yours, no?

    • auntbea

      Do you just want help interpreting the odds ratios? (P.S. to researchers: Odds ratios are stupid.)

      • Anonomom

        Interpretation in any meaningful terms would be much appreciated.

        • auntbea

          In the paper, the odds ratio for Type 1 diabetes was about 1.3. All that means is that a FF baby has 1.3X (or 130%) the risk of diabetes as a BF baby. Whether this additional impact is big or small, however, depends on the base risk for the BF baby (130% of a base risk of 1% is a lot less increased risk than 130% of a base risk of 10%). So to get the actual magnitude of the risk, I checked the incidence of diabetes in the US and found about 20/100,000 or 0.02%. This times 1.3 is 26 per 100,000 or 0.026%. So really not a big effect in absolute terms, and still unlikely to happen to her baby whether she breastfeeds or not, especially without a family history.

          • Anonomom

            This is great, thank you. Care to write an article doing the same thing for all the diseases mentioned in the report? A lot of work, certainly, but women really need to have this kind of information. Otherwise when we hear things like “130% higher risk of diabetes,” it is terrifying.

          • auntbea

            Well, I’m sort of busy writing articles on the things I actually study (do your clients need any information on political behavior in East Africa?) But you don’t me, just a spreadsheet. Find the odds ratio from the article, do a google search for incidence of that condition in the population, and multiply. It will be a rough estimate, but almost definitely more accurate that whatever drastic effects your clients are coming up with.

          • auntbea

            Also, unless your patients’ doctors are giant jerks, they should know the absolute risk and be happy to explain it.

          • Keep in mind that what she says about an additional percentage increase in a risk that is small to begin with also applies to homebirth vs. hospital birth.

          • NZ lurker

            just responded to your earlier comment but it is so far away I will repeat: the consequences of being on the losing end of the statistics for HB are death and disability. You are setting up false equivalencies.

          • My response to your response is similarly far away, so:

            Per the AAP, If all women or at least 90% of mothers breast-fed exclusively for six months, 900 American babies’ lives per year could be saved. We have already quibbled about this in the past, but it looks kind of convenient to dispute this finding while latching on to the ones about homebirth. Personally I accept them both.