Ad Mominems: Hateful, hurtful and potentially deadly

Ad Mominem

We need a term for the subtle and not so subtle put downs favored by lactivists and natural childbirth advocates to assert their superiority over other mothers.

I suggest ad mominem.

Ad mominems are hateful, hurtful and potential deadly claims made by individual mothers, mommy bloggers and, unfortunately, professionals such as midwives and lactation consultants, as well as the organizations that represent them.

Classic ad mominems wielded by individuals include:

Infant formula is poison.

Epidurals cause babies to be drugged.

Women who have C-sections can’t bond to their babies, and haven’t given birth in any case.

Apparently, the current ad mominem of choice is to give the side-eye to women bottle feeding their babies or, better yet, approach them to evangelize on the benefits of breastfeeding.

Although these are outrageous, and deeply upsetting in the moment, most of us recognize that while they are hateful and hurtful, they reflect the insecurity of the women uttering them. Those who casually drop ad mominems are deeply insecure about their own parenting and make themselves feel better by disparaging others.

What about mommy bloggers?

It takes a special kind of narcissism to imagine that the world is waiting for your advice on parenting, and that you should set up a website where you display your children, violate their privacy, and dispense your special brand of wisdom. Mommy bloggers are virtuosos of the ad mominem.

Consider:

The Feminist Breeder

I am brave (foolish) enough to admit that while I totally and completely support any woman’s right and choice to feed her babies however she needs to, I still, deep down in a place I don’t like to admit, don’t really “get” it when a woman chooses, without any medical or social barrier, not to breastfeed. To me it’s sorta like deciding not to take prenatal vitamins because you just don’t wanna, without recognizing that they do help build a healthier baby. I will NOT be all sanctimonious about it, I’m just saying I’m human and that one’s a head scratcher for me. We have lactating boobs for a reason: to feed the babies we make.

The Alpha Parent

The Feminist Breeder is a rank amateur when compared to The Alpha Parent, master of the graphic ad mominem:

formula feeder excuses

Mamabirth

Blogger Mama Birth is master of my favorite form, the meta ad mominem, where the blogger attempts to blame women for feeling bad after she shames them. A shining example is I Can’t Make You Feel Ashamed of Your Birth (Unless You Really Are Ashamed of It):

Shaming is a hot topic in the birth world though, isn’t it? If you are dumb enough to have an opinion and share it then you are undoubtedly going to be accused of shaming somebody who did otherwise. If you state that formula is a poor substitute for breast-milk or mention that the cesarean section is a perverse form of birth control … or (gasp) talk about how much you loved your natural birth, then stand back. Because what happens next is you will be accused of shaming people.

Many mommy bloggers are bullies and like most bullies, they have extremely fragile egos. That’s why most have to delete and ban anyone who disagrees with their ad mominems and then, in a feat of magic worthy of Houdini, claim that everyone else is bullying them.

But the greatest damage, pain and suffering occurs at the hands of the professionals who casually drop ad mominems to fragile new mothers, and the organizations that represent them, which use ad mominems to market themselves.

Lactation consultants

Emily Wax-Thibodeux, who survived breast cancer and endured a double mastectomy, was subjected to ignorance and cruelty for bottle feeding her newborn son:

“You really should breast-feed,” the hospital’s lactation consultants, a.k.a. “lactivists,” said.

When I simply said, “I’m going to do formula,” they didn’t want to leave it at that.

So holding my day-old newborn on what was one of the most blissful days of my life, I had to tell the aggressive band of well-intentioned strangers my whole cancer saga…

“Just try,” they advised. “Let’s hope you get some milk.”

“It may come out anyway, or through your armpits,” another advised later …

The Royal College of Midwives

The RCM’s Campaign for Normal Birth is unprofessional, unethical and unsafe. It relies on the ultimate ad mominem, that unmedicated vaginal birth is safest for babies (it isn’t). It has given British midwives license to bully women out of effective pain relief, and life saving interventions.

“Most women, in every country across the world, would prefer to give birth as physiologically as possible. For most women and babies, this is also the safest way to give birth, and to be born, wherever the birth setting. If routine interventions are eliminated for healthy women and babies, resources will be freed up for the extra staff, treatments and interventions that are needed when a laboring woman and her baby actually need help. This will ensure optimal outcomes for all women and babies, and sustainable maternity care provision overall.”

No, most women would NOT prefer to give birth without technology interventions. Most MIDWIVES would prefer it, because that allows them to maintain control over patients.
It is NOT the safest way to give birth, as the deaths of 11 babies and one mother on the altar of natural childbirth at Morecambe Bay demonstrate.
Resources are NOT “freed up” for when they are needed; they are DENIED to babies and women when they are needed.
This does NOT ensure optimal outcomes for women and babies. It ensures optimal outcomes for MIDWIVES.

The RCM Campaign for Normal Birth is an abomination. It kills babies; it kills mothers and it has become an all purpose excuse for midwives to bully patients. It should be disavowed immediately.

The Baby Friendly Hospital Initiative

Even its name is not so subtle ad mominem, but if there’s a bigger oxymoron in contemporary health care, I’m not aware of it. This campaign to promote breastfeeding (and, not coincidentally, lactation consultants) is not friendly to babies, and is cruel to mothers. There is nothing baby friendly about efforts to promote breastfeeding to the exclusion of a mother and baby’s actual needs. There is not, and there can never be, anything “baby friendly” about destroying the confidence of new mothers and making them feel guilty about a decision with trivial consequences.

And it is literally deadly, as detailed in the paper Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards:

Although bed sharing with infants is well known to be hazardous, deaths and near deaths of newborn infants while bed sharing in hospitals in the United States have received little attention … These events occurred within the first 24 h of birth during ‘skin-to-skin’ contact between mother and infant, a practice promoted by the ‘Baby Friendly’ (BF) initiative … We report 15 deaths and 3 near deaths of healthy infants occurring during skin-to-skin contact or while bed sharing on maternity wards in the United States. Our findings suggest that such incidents are underreported in the United States and are preventable…

Ad mominems are hateful, hurtful and deadly.

It’s time to put an end to them.

  • MHAM

    HOLY CRAP to the bed-sharing deaths! What the actual fuck???

    I had both of my children at a Baby Friendly hospital. They did encourage rooming in. But in the same sentence, they made sure to remind me that the nursery was available at any time and I was more than welcome to make use of it. I was also very severely cautioned that bed-sharing was not an option and would not be tolerated. While recovering from my c-section, I was also further advised that (due to all the pain medication) I needed to have my husband or a nurse or another adult with me at all times during my hospital stay and I was not to attempt to pick up the baby by myself without someone present to assist if I became dizzy or what-have-you. Those nurses would have shit a brick if somebody had attempted to sleep with their baby skin to skin.

    I can’t believe it. 15 healthy, term babies. That is appalling.

  • Lauren

    “It takes a special kind of narcissism to imagine that the world is waiting for your advice on parenting, and that you should set up a website where you display your children, violate their privacy, and dispense your special brand of wisdom.”

    HELL. YES.

  • Heather

    After reading this, I checked the hospital where my son was born in 2007 to see if they became “baby friendly.” I took full advantage of the nursery, figuring I would have plenty of time to get to know my wailing bundle of joy when we got home. They have not made the switch.

    Then I checked another local hospital, where my current OB delivers (I’m not planning on having another child, but who knows!). This system recently opened two integrative medicine practices, so I wasn’t surprised to see that they are trying to become baby friendly. The information on their page is ridiculous.

    And the links they provide for more information- Lamaze and KellyMom, an
    “evidence-based” site that uses resources such as the trusted, reputable MDC.

    I’m really wondering who wrote this.

    http://www.hunterdonhealthcare.org/maternity-breastfeeding

    • Young CC Prof

      “Often when babies sleep
      next to their mothers at night, they can continue breastfeeding without
      either the mother or baby completely awakening”

      Did they just condone bed-sharing in the hospital? Nope nope nope, hospital beds and a deeply exhausted postpartum mother is about the most unsafe way to bedshare there is.

      And then we have this: “A mother’s chest warms to the exact right temperature that her baby needs to keep him or her warm. And a mom who has twins on either side of her chest will warm each half of her chest differently, according to the needs of that baby! Dad’s chest will warm also, but since his regulation thermostat isn’t quite as fine tuned, he will continue warming and he and his baby might feel too warm!”

      That… sounds like something a LLL member with no training in basic biology made up.

      You might want to mention this to someone. It’s pretty silly, and I doubt a doctor ever saw it before it was posted.

      • toni

        yeah that’s got to be total bollocks. I just this afternoon fell asleep cuddling with my one year old and when I woke up he was lying across my chest sweating.

        • Ardea

          I’m sure the problem is that you were both vaccinated. I hear that vaccinations cause trouble with thermoregulation and lead to a really difficult menopause, you know, whenever that rolls around, among all the other problems they cause, so that’s probably why your body was not fine-tuned enough to your one-year old. Maybe you should eat some more kale.

          • Lauren

            HAHAHAHAHAHAAHAHAHAHAHAHAHAHAHAHAHA

          • FrequentFlyer

            We laugh, but I wouldn’t be surprised if some of those lunatics took that seriously.

          • anotheramy

            They’d call it their “research”.

      • araikwao

        Yeah, sure a newborn with no head control will just latch right on. That must mean lactation consultants are hardly ever necessary, too.

        • Mattie

          Well, babies can latch themselves on after birth, but that doesn’t mean it always happens. I don’t think bed sharing is a good idea, although I quite like those co-sleeper cots (think there’s talk of bringing those in to hospitals). Also, the mum warms to the right temp is a load of rubbish, I looked after one lady who had a BBA at home, when we got there baby was skin to skin but mum was cold…surprise so was baby, we took them in to hospital and got baby under the lamp on the resuscitaire and baby immediately relaxed and stretched out and colour improved. Mum felt better after a shower and cup of tea and toast too.

          • araikwao

            Maybe it’s my lack of familiarity with the biomechanics of enormous breasts (I don’t have them!), but my own neonates were nowhere near able to attach themselves when we were lying down.

          • Mariana

            I am very familiar with the biomechanics of huge breasts… And yes, my babies could nurse with me lying sideways next to them! Very relaxing too… But I’d only do it when I had someone with me to chat… So I would not fall asleep… The baby slept great after that, I could just pick them up and put in the crib

      • Allie P

        Wait, my chest is a sleep number bed?

      • Amy M

        Are we birds or are we reptiles? First we hear about how its so key to have skin-to-skin immediately after birth, otherwise the child won’t imprint on the mother, and will grow up thinking its a goose. Now, according to this nonsense, we are cold-blooded, but Dad’s ability to maintain temperature homeostasis isn’t as good as mom’s, so he needs a heat lamp and an ice block on hand, so he can send his temperature in whichever direction it needs to go.

    • VeritasLiberat

      I decided not to give birth at that hospital based solely on their webpage, which stressed how awesome and homelike the rooms were. I chose another local hospital, whose webpage promoted all the resources they had for saving babies in trouble, like access to specialists and the ability to call in even more special specialists if necessary.

    • Nick Sanders

      After reading your post, I decided to look up Lamaze, since I know very little about it, and don’t usually have cause to think about it. I was dismayed to see that the Wikipedia article about it was just a short piece of woo, that linked out to more woo cloaking itself under the guise of “evidence-based” care,

      • Allie P

        I mistakenly signed up for a Lamaze class during my 1st pregnancy, thinking it just meant a “childbirth” class. I was treated to some premium grade A quality BS, including being told to LIE to my doctor about my medical condition (“don’t tell your doctor if your water has broken, as they will make you come into the hospital and ‘start the clock’ to your c-section”) and shown propaganda videos about the perils of epidurals, complete with horror movie-style dripping blood red font. In one such propaganda video, we were shown a hired doula and nurse who conspired to lie to both the medical staff of the hospital by not telling them of the patient’s fervent wish for pain relief, and to the patient by telling her that the doctor was unavailable to place an epidural. When she ended up having the child, sans pain relief, they show her beaming into the camera and saying, “I can’t believe I did it naturally.” The Lamaze instructor, a doula constantly shilling her own services, asked what we’d learned from this piece of garbage video. (Obviously, the answer was even people who think they want pain relief can do without it — duh, that’s why we used to have sticks to bite on!) I raised my hand and went, “this patient now has video evidence to use in her malpractice case against these providers.”

        • Nick Sanders

          Geeze-louise. Until today, I never even knew that it was woo, let alone such strong woo…

          • Young CC Prof

            Back in the day, specifically, the 70s and 80s when Twilight Sleep was out of fashion and epidurals weren’t yet an option most places, Lamaze classes were different. They taught a mental technique to cope with the pain, and they taught what childbirth was about. My mother said her instructor calmly told the class that some of them would wind up needing c-sections, here’s what a c-section involves.

            There weren’t any safe ways to avoid the pain, so learning to get through it was just practical.

            But at this point, epidurals are routinely available in the USA, with very strong evidence of safety. Most women just opt for the epidural. So, the childbirth classes that emphasized natural coping had to start demonizing epidurals and elevating natural coping to a moral good, just to stay in business.

        • Susan

          What did the instructor say to that?

  • Allie P

    WOW. I had no idea that those were the requirements of the BFH. My hospital has “achieved” this dubious distinction between the birth of my last baby and my current pregnancy. Guess i’m packing my own bottles and formula to stave off jaundice as I wait for my milk to come in?

    • Cobalt

      And an extra adult if you think you might want any sleep or need any help with baby care. Mandatory rooming in means you only have help while the nurse is actually in the room.

      • Bombshellrisa

        Having a support person to stay with you was on brochure about what to have with you after baby. It is a baby friendly hospital. The nurses couldn’t understand why my husband went home every night and there was nobody in the room with me (we had to stay three nights). There really wasn’t anyone who could do that for me three weekday nights, and I don’t imagine most people can afford to hire someone to come in as a support person for three nights either (post partum doulas run up to $27 an hour here)

        • Cobalt

          The 24 hour support person was mentioned heavily on my hospital maternity tour. Oddly enough, after my hernia surgery I wasn’t expected to bring my own support staff, even though the physical demands and limitations were similar.

          • JJ

            I know. For some reason women are expected to sometimes forgo pain relief and help from others when they have a baby but when it is other medical situations we all see how abusive that is!

          • Bombshellrisa

            One of the nurses tried to praise me for turning down the norco in favor of the ibuprofen. I just didn’t like feeling dizzy on top of everything else after birth and the ibuprofen worked well for me. If it hadn’t worked, I would have asked for the stronger pill. The medication is prescribed for a reason!

          • anotheramy

            Ugh, After my last delivery I KEPT asking for more ibuprofen & ice packs & they said “it isn’t time for ibuprofen. I can give you some at ___ time.” NO offer of anything stronger & I didn’t know that was allowed. I stayed a day longer than usual (still covered by insurance) because of pain. Finally, about an hour or so before discharge, the nurse saw me walking very slowly around the room, in pain, & offered me something stronger for pain! I think that if I received proper pain relief I would’ve went home a day earlier, saving me & my insurance company lots of dough. I am still annoyed (3 months later) that during 3 days in the hospital only one nurse bothered to let me know something stronger was available.

          • toni

            Don’t you get an automatic prescription from your doctor for percoset or something? I think that’s what happened at my hosptial but it seemed that the timing and dosage were at the nurses’ discretion because each nurse gave it to me at differently i.e. one gave me two with a motrin every 6 hours (most effective for me), one gave me one percoset every six and the motrin every 4 (not to0 great) and one gave we just one percoset with motrin every 6 (pretty good) one gave me just one percoset every eight hours and a motrin every six (ouch) and so on throughout my stay. Never occurred to me at the time to ask why they kept changing it

          • anotheramy

            That’s the problem: there were standing orders for something stronger, but since the nurses never offered anything stronger til the end of my stay, I didn’t know Percocet or something like it was allowed/available.
            It did make me wonder how homebirthers cope with the pain after birth, because damn! I hurt and the Motrin/ ice pack wasn’t helping.

          • toni

            yeah i was not prepared for those afterpains! i think i coped well with the labour pain partly because of the anticipation of meeting the baby but when the second nurse came on and lowered my dose and I realised i was still having these dull annoying contractions i was like uh no. more drugs plz! but for whatever reason I guess she thought two percoset was too much. she had asked me how my pain level was and i said good so then she lowered my dose. wtf. I had no stitches so maybe she thought I shouldn’t need it. wasn’t really in a position to argue then but next time I’m going to firmly tell them what works for me. i would have been miserable with just motrin, that was cruel not to tell you you could have something better. I take motrin for a mild headache ffs

          • Cobalt

            I found afterpains to be worse than contractions and I think that’s a really stupid way for a uterus to operate. When it’s over it should be over, dammit!

          • Somewhereinthemiddle

            In the event that there is a next time, take your own ibuprofen. That was one of the biggest things I learned after my first two babies is to bring my own damn ibuprofen. The nurses were annoyed with me when I mentioned that they probably wanted to put it in my chart. They told me I wasn’t supposed to take my own meds but they didn’t confiscate it or mention it again and I didn’t have to wait for pain meds again. 😉

          • Ceridwen

            Interestingly at my hospital they give you a bag full of OTC meds you are likely to need after birth (colace, ibuprofen, etc) and you are expected to manage taking it all on your own. They ask when and what you took from the bag, and they provide some instructions about what you are likely to need when (such as strongly advising you to take quite a bit of colace during the first few days), but they don’t monitor each dose. And I was only charged $12 for the whole bag which is less than I’d have paid to get the stuff myself at the pharmacy. Overall I was pleased with that system.

          • Somewhereinthemiddle

            Really? That sounds like a GREAT solution. Are you in the US or elsewhere?

          • Allie P

            My insane LC told me that my milk production was low BECAUSE I took ibuprofen for my episiotomy stitches. Of course, I was probably also to blame for the episiotomy. Or the tearing that would have alternately occurred had my “evil” doc not cut one at the last minute. Not enough olive oil massages of my perineum, I guess. Had absolutely nothing to do with my spawn’s 99% head. All my fault.

          • Kelly

            My nurse the second time, told me that I might want to have it just in case the pain came later and so that I would already have pain management in place. I always had to tell them my pain level was at least a one. It almost became a joke. I loved the nurses and doctors at both of my deliveries at two different hospitals.

        • Mattie

          See I thought that was what the nursing staff were for, obviously they couldn’t be 1:1 for 24 hours, but they should be there when you need them.

      • Allie P

        Luckily, we have parents in town to watch our child so my husband can stay with me.

      • Wren

        Be grateful it’s an option. Over here in the UK they room in unless the baby needs to go to the NICU and fathers (or other help) cannot stay overnight. Awesome when I had a c-section.

        It likely does save money because I went home the evening after having my second (not a c-section) in part to avoid being alone, well, alone except for the other mum and new baby in the room.

        • Mattie

          Wouldn’t you be on a ward though, after a c-section, so have ward staff to help? In my local trust the postnatal ward is well staffed and c-section ladies get a lot of help and support (Baby Friendly Hospital). Obviously the issues with wards is it becomes difficult to get much sleep, but that’s the case with most wards =/

          • Joy

            It took at least 20 minutes for the ward staff to respond. And if you had to go to the bathroom at night, the response was, open the curtains around your bed, leave your baby crying while 5 other mothers and babies in your wing gave you both death stares.

          • Sarah

            I may have been unusually lucky, but during both my stays on the postnatal ward, midwives offered to take the baby for a few hours overnight while I got some sleep. I did have two pretty brutal births though, so they probably took pity, and they weren’t overcrowded either time so staffing presumably allowed for it.

          • Joy

            They were really overcrowded, which is why I assume I had to feed my baby through the NG tube myself after 3 days of almost no sleep. There were some nice midwives, most were very overworked.

          • Elizabeth A

            Gaaaahhhhhh!!! That’s a dangerous level of understaffing.

          • Wren

            I was in a side room, of 2 women plus our babies, both times. The ward staff was too busy to help much apparently. Actually, only a few of them were. The others were lovely. Of course, being spread over the entire ward they couldn’t really help everyone as needed.

          • Dr Kitty

            I ended up in the window bed of a six bedded bay which had been constructed out of an old Nightingale ward. There were three other six needed bays, the dining room, and the old nursery between my bed and the nurses station, which was at least 150m away.

            You wanted help, you had to push the bell. The medication round took about 45 minutes to reach me, and apart from somebody popping up to have a look every hour or two we were left pretty much to our own devices.

            My bay is apparently where they put the formula feeding multips who were unlikely to need help at night. And me, apparently because I’m a Dr and also, therefore unlikely to need help, even though it was my first baby, I’d had a CS , was BF and because of my other medical issues I was catheterised and on bed rest for longer than usual post op.

          • Montserrat Blanco

            Have you considered changing countries for the delivery??? I am really lucky but I had an individual room, bathroom for myself AND there was an extra bell at the wall, so you could thouch it easily if you were standing. Plus two electrical switches for the bed, one at the pillow, one at the feet. Top NICU, ICU for moms, a very safe hospital.

          • Wren

            I was in a side room with one other mum and her baby both times. Most of the staff was good, but a few definitely were not, and more of those seemed to be on the night shift. They seemed out out at asking for help despite me being unable to get up to get my baby myself.

      • Kelly

        So thankful that both of the hospitals I delivered in had nurseries. After I told the nurse that I had nursed the baby every hour for the last three hours, she asked if she wanted to take the baby to the nursery and give her a bottle so I could sleep. I thankfully said yes and got three hours of sleep. My husband was there with both kids but he needs sleep too.

    • My motto is to hope for the best but prepare for the worst. Call the hospital and let them know your situation and ask what supplies to tuck into your bag, that way there’s no surprises.

      Gratz on the incoming babby. 🙂

    • Mattie

      Out of interest, do you formula feed before your milk comes in? We used to advise mothers (who were breastfeeding) not to worry as jaundice was incredibly common and often nothing to worry about, the colostrum was usually sufficient until day 3/4 when the milk came in. Obviously if the jaundice was severe, and baby was sleepy/not feeding then we would advise formula or re-admittance to hospital. This advice may have been wrong, but I very rarely saw a baby who had to be readmitted to hospital for jaundice or weight loss, so I’m interested in others’ opinions.

      • Allie P

        I know what people are told and what staff at BFH’s are forced to tell women, and I also kind of don’t give a shit what an ideology-driven lactation consultant or nurse at a baby friendly hospital says to me this time around. I listened to them last time and both me (sleeplessness, punishing feed/pump/bottle feed/clean/start over again) and my baby (jaundice, FTT, weight loss, too sleepy/weak to feed on breast, constant screaming with hunger) paid for it. A few weeks into her life, I started combo feeding and had a thriving healthy baby who breastfed for 10 months.

        And my mom, who I had always idolized for “breastfeeding” was like, “OMG, of course you have to give them formula until you’re making enough milk. Didn’t they tell you that?”

        My new motto is “no hungry baby.” Oddly enough, lots of cultures condone and even encourage early formula feeding and find it doesn’t hurt the establishment of breastfeeding one teeny tiny bit. Turns out babies who are strong and energetic are better at breastfeeding. Imagine that.

        http://ideas.time.com/2013/05/13/viewpoint-the-breastfeeding-police-are-wrong-about-formula/

        It’s a huge shame that the method of encouraging breastfeeding in America is demonizing formula and the women and babies who use it. Formula SAVED my nursing.

        • Mattie

          Yeh, that’s totally reasonable, thank you for sharing 🙂 when I first stumbled on this site I was very pro NCB/Breastfeeding, I guess I still am…for myself in the future, but only if it all works out and I’m fortunate if it does not ‘better’ than anyone else. I’ve learnt so much from Dr Amy, and also all the great commenters. Congratulations on your pregnancy, and good luck for the birth 🙂

          • Allie P

            I’m very pro breastfeeding too. I went to insane lengths to establish it last time and I really want to do it this time, too, hopefully without the pain, suffering, and guilt trips. And maybe my new baby and I won’t have the same problems as last time. Or maybe we’ll have different problems. Like my last baby had no nipple confusion, but it could totally happen with another child, so we’ll see!

        • KeeperOfTheBooks

          Thank you for posting this. My story is similar, though I never produced enough to completely breastfeed, and stopped after numerous infections. This sort of story is what will allow me to give nursing a try next time–with the caveat that DH will do some early nighttime bottles so I can get enough sleep that I’ll have a prayer of a) avoiding severe PPD and b) getting a decent supply.
          I wonder, is there a non-crazy nursing forum/board out there somewhere? It seems like most of the mainstream BFing boards are overridden with insane lactivists–rather scary to those of us who want solid information about nursing, but aren’t going to Nurse No Matter What, Mom And Baby’s Health (mental and otherwise) Be Damned.

      • fiftyfifty1

        “but I very rarely saw a baby who had to be readmitted to hospital for jaundice or weight loss, so I’m interested in others’ opinions.”

        At the hospital in my system, they don’t readmit babies with jaundice or excessive weight loss. They don’t want to bring babies back from the outside to L&D because of contamination/ infection from outside concerns. And the regular peds part of the hospital isn’t set up for tiny babies, so they can’t go there either. So they get sent to the Children’s Hospital. Almost all of the local hospitals work on this policy. Close outpatient follow-up of breastfed babies after discharge and a policy of supplementation at 10% loss can help babies stay out of the hospital. But it still happens. At least one out of 20 women will experience lactational failure. Two of my colleagues from medical school ended up at the Children’s hosp for that very reason. The problem with newborn dehydration is that its signs are non-specific (sleepy, temp dysregulation etc) and could also indicate infection. So the babies need the full septic work-ups and this includes blood draws, blood culture draws (taken from a different site than the regular blood draw) and often lumbar puncture.

        Lactivists love to push the ideas of breastfeeding purity and demonize supplementation. But a policy of routine supplementation at 10% loss keeps babies out of the hospital and has been proven to *increase* the rate of women who continue breastfeeding.

        • Ash

          I imagine it’s also hard to determine excessive infant weight loss because it’s hard to weigh them! Parents don’t have a home scale with sufficient precision for weighing babies.

          • Mattie

            Yeh definitely, I’m in the UK and midwives do the postnatal care (usually at women’s homes) so they take scales and do temp, observe feeding etc… usually women will be visited on day 1, 3 and 5. Unless the woman requests more frequent visits, it’s not enough IMO it used to be twice a day for a few days, then every day for I think 2 weeks. Although home visits are helpful to new mums as it means they see a care provider without having to go to the clinic. We have a 10% loss admittance policy, usually to NICU, but obviously parents can (and do very rarely) decline, in which case visits will be daily to check weight and wellness.

          • Ash

            That’s really nice. USA doesn’t have the same robust health visitor based program as the uk.

          • Joy

            Yeah, except we were discharged at day 5 and didn’t see a HV until day 12 because we were in the hospital for the other appointments. At which point the HV realised my baby was still losing weight. Instead of saying she was calling the midwives to start close monitoring she breezed out telling me to have a nursing weekend and see what my baby weighed at the discharge clinic on Monday. We hired our own LC who told us to start topping up with formula, since I reported zero breast changes. As it turned out she had told someone and they showed up about 48 hours later. If I had been in the US, I would have been demanding to go to weigh ins at my ped’s office and we would have known a lot sooner.

          • Dr Kitty

            You could have asked for your GP to weigh your baby.
            Yes in the UK you have MWs and HV who visit at home, but GPs are still there too.
            Don’t forget that.
            Even if the baby isn’t registered yet and you don’t have a birth certificate.

            I see newborns all the time- I’ll write in their mother’s notes and issue scripts in her name if the baby isn’t registered.

            To be honest, I mostly see well newborns with toxicum or tongue tie or something minor that the parents need reassurance for. Personally, I like babies and small children and will happily squeeze in extra patients if they are sick kids.

            Five minutes to strip, weigh and quickly examine a baby is perfectly do-able, and certainly a nice change from verrucas, ingrown toenails and head colds!

            If your own GP practice doesn’t bend over backwards for sick children, get a new one. There is nothing to be lost by seeing kids if their parents are concerned. Not sick- everyone rests easy, sick and it can be sorted out.

          • Joy

            Well, that would have been good to know. All either of us knew was midwife and if there were issues to call the hospital. Which we would have done, but we didn’t know there were any issues until she was weighed.

          • KeeperOfTheBooks

            To be specific, we don’t *have* a health visitor program. At all. Moms are generally expected to drive themselves to the doctor’s office for postpartum/pediatrician checkups.
            Why yes, as a matter of fact, this does suck in various and sundry ways.

          • Bombshellrisa

            This just brought me back to hauling myself and my six day old son to the LCs and then to the pediatrician. I was severely engorged and baby couldn’t latch. I had a crappy pump and had to end up renting a pump in the boutique at the hospital. I cried so hard when the sweet, practical LC told me I needed a glass of wine and to lay in bed for the rest of the day. I wish everyone could have come to me, instead of driving and every bump in the road making my stitches ache.

          • Who?

            Oh that had to be rotten. Sounds like you did well to even get out the door, let alone keep two appointments.

            Everyone needs an LC like that one.

          • Bombshellrisa

            I cannot say enough good things about this LC. Yes, it was a baby friendly hospital but she was mother friendly and was formula and nipple shield friendly. She told me both of those things can save breast feeding for a lot of moms. She was also realistic about what pumping can and can’t do and honest about how hard it can be. What I loved the most was how she emphasized that I needed to be rested and ask for (then accept) help. She was amazing!

          • D/

            And from my LC perspective I’ll second your wish! Most days working in the hospital setting leaves me on the verge of crying and feeling the need for wine and bed myself when it’s over.

            Helping a mother at home, for me, is the best of all worlds. Saves them the trip and I see exactly why things aren’t working in their own space with their own stuff. It lets me just focus on actually helping the family in front of me for more than 15 minutes, and what’s not to love about working shoeless. I always claim a concern of messing up carpet … But the truth is, I just hate shoes 😉

          • KeeperOfTheBooks

            See, that would be awesome! When I’d go in to see someone to help me with BFing, which just wasn’t working at all, they’d ask a million questions about my setup at home/schedule/etc, and I’d get so flustered from being on the “hot seat,” plus be so freaking tired and hurting so badly that I got to a point of giving them my best guess as to answers and then refusing to think about it any further. Not really helpful for me, and no doubt frustrating for them.
            I’m seriously considering hiring a postpartum doula next time around for just this reason. There’s one in the area who explicitly says on her site that she has a lot of experience with breastfeeding but also can help with feeding schedules/formula/bottle stuff, too, which suggests to me that she’s not, well, rabid. :p

          • Who?

            When I had my two they came every day for the first 10 days, then as needed after that until baby regained birth weight. I loved it. Mind you I was out of hospital in no time with both so it was good to have someone close by.

      • Keri

        Not enough are educated about this. Drs rush to formula instead of having mum breastfeed.

        • Kq

          Hi.

          Fuck you.

          Signed, a mother who breastfed effortlessly but still thinks you’re full of shit for your ignorant comment.

          • Mishimoo

            Co-signed, a mother whose milk came in within 36 hours but actually has empathy for hungry babies.

          • SporkParade

            Also co-signed, a mother whose newborn was clearly dehydrated, and whose concerns were greeted by the hospital staff with gaslighting.

        • KarenJJ

          Those doctors know nuthin.

        • Elizabeth A

          Co-signed.

          Have never had a baby without hemorrhaging.
          Have never had a baby without jaundice.
          Milk always came in around 60 hours post-partum. Babies get hungry.

          • Keri

            So sorry about the hemorrhaging.
            That’s a normal time frame for milk to come in though. Unless there’s a complication, babies are just fine on colostrum until milk comes in, which can take a week. That is something else women aren’t told, and they stress out, think they aren’t making milk, start offering formula, don’t pump, or pump and milk isn’t in yet, especially with a cesarean, and end up with supply problems or not breastfeeding, and feeling like a failure. All due to misinformation or lack of information and no support.
            What do we tell those women? Who were told thier baby was hungry, so instead of breastfeeding because milk wasn’t in yet, to give formula. its amazing the number of mums who don’t know that breastfed babies need to eat frequently, it’s normal. They are not told this.
            Regarding jaundice, women are told all the time by their doctor or even nurse at the hospital to give formula because the baby was jaundice, instead of working with them to breastfeed, to get baby’s bowels moving, to even sun the baby. These women struggle to breastfeed or gave up. Women aren’t told that jaundice is normal. they think its thier milk and a lot end up on a roller coaster of latch and gut problems, lacking trust and confidence in themselves.
            What are we to tell these women, when they find out the dr was in the wrong, other than it wasn’t thier fault.

          • Elizabeth A

            What’s your qualification, exactly, Keri? Are you a medical professional of any kind? Do you have children? Have you ever spent a week in the same house as a hungry newborn? Babies may be “fine” on colostrum for up to a week, but they aren’t happy about it.

            Despite the fact that breast feeding ultimately went well for me, both of my children lost worrying amounts of weight after birth, and both of them had worsening jaundice. DD got TPN for reasons relating to her prematurity, had bili-lights over her isolette, and started on colostrum as soon as she was cleared to do her own digesting. DS was a healthy newborn with some signs of mild jaundice noted a few hours after birth, and increasing jaundice remarked by 24 hours pp. There was nothing wrong with my milk. It just hadn’t arrived yet.

            “Working with a mom to breastfeed” doesn’t do any damn good if her milk isn’t in yet. It doesn’t matter what you do, sometimes you just have to wait for things. It makes sense to feed the baby a food that you HAVE, rather than strapping a pump on and working your nipples bloody in the hopes of acquiring a platonic perfect food that might or might not come through for you right away.

            Which is what happened to me and my son, btw. A lactation consultant sent me home with a breast pump and instructions to use it every 2 hours, round the clock. This was, I guess, her version of “working with me to breastfeed.” Two days later, I was sleep deprived, blistered, and possessed of chronic oversupply that did indeed cause latch and gut problems. The formula didn’t hurt us, and letting well enough alone until my milk came in of its own accord probably wouldn’t have hurt us either. All that pumping caused serious problems. When my daughter came along, I put limits on my pumping, and insisted that I get at least some uninterrupted sleep.

            What I would say to women is: We always try to at least do well enough, and we won’t make the perfect the enemy of the good. There are lots of things to consider in feeding a baby, and the most important one is what the baby needs. If we don’t address the short-term, we can imperil the long-term ultimate goal of a healthy child. Many women give formula early on, and move to breast milk when their milk comes in, and there is some evidence to suggest that this is helpful in establishing breast feeding (http://pediatrics.aappublications.org/content/early/2013/05/08/peds.2012-2809.abstract). We can’t predict how things will go for any individual family, we just have to respond to the needs of each moment as it arises, and hope for the best.

          • Julia

            I had a similar experience. I was breastfeeding round the clock, but baby was HUNGRY. As in, a 5-day old screaming bloody murder for hours on end despite being offered to nurse non-stop. Finally, in a moment of clarity amidst my new-mom sleep-deprived hormonal fog, I sent hubby to buy formula. One bottle later, screaming miserable newborn was transformed into peacefully sleeping newborn. I will never forget how happy I felt knowing in my heart that, despite all the pro breastfeeding indoctrination, I had done the right thing: I had fed my hungry baby. And by the way, a few days after that, my milk was in, and I was able to breastfeed my son for a year.
            I think guilt-free supplementation should be encouraged, and it is perfectly compatible with later successful breastfeeding. (And if breastfeeding doesn’t happen, it’s not the end of the world either.)

          • KarenJJ

            I was miserable and exhausted at around day 3 with a screaming unsettled baby that was feeding for an hour and a half and sleeping for 20 minutes. I sent my husband to ask for a bottle of formula and the nurses refused. I should have sent him to the shops instead.

          • Chi

            Oh my god. Julia you just described EXACTLY what happened with me and my DD. She lost more than 15% of her birth weight in the first 2 weeks, then finally started gaining then started losing weight again and seemed to be ALWAYS hungry.

            My lead maternity carer took one look, told hubby to go get formula. Just like you, one 120ml bottle and suddenly this unhappy, screaming, clingy newborn was sound asleep in her bassinet.

            And I got to go have a bath. And it was miraculous. If you discount the fact that I was crying the entire time at ‘failing’ to breastfeed. The fact of the matter is that my supply was good – my DD just never got the hang of suckling so she wasn’t getting to the hindmilk and getting what she needed. And because I have a history of depression, I knew that if I tried to chain myself to a pump in order for her to still have breastmilk that would cause even more problems because I wouldn’t get any rest and would just wind up resenting her.

            She’s 11 months old now and thriving. I call that a win.

          • anonmom

            But, but, baby wasn’t hungry, baby was fine! You we’re TOLD your baby was hungry, brainwashed!
            Seriously, why does the baby need to cry from hunger? True the colostrum is enough, and the baby is fine if she loses some weight, but why does she (and mom who is listening to the crying) need to be miserable? We have access to formula. Give an ounce after a couple of feeds and take a nap!

          • Elizabeth A

            YES!!

            And bring Mom Banh Mi and raspberry seltzer.

          • demodocus’ spouse

            I nursed my baby from hour 1 way past the point of bloody nipples. A year later, it’s still scarred! He developed jaundice and lost 15% of his body weight by day 3 anyway. My milk didn’t really come in until day 5 or 6. The nurse practitioner told us to get some formula and supplement after nursing. We used about half a package then exclusively bf’d until he started grabbing food off my plate at 4 months.
            However, on behalf of my sister and all the other women who choose formula for whatever reason: Bite me.

          • Young CC Prof

            Why is it that every time someone pops up to talk about how dangerous untreated neonatal jaundice can be, or about hyponatremic dehydration, someone pops up to claim, without evidence, that these problems are myths invented by stupid pediatricians?

            Jaundice is normal. And 1-3% of the time, it’s severe enough to cause brain injury or death.

          • Allie P

            My baby WAS hungry, my baby WAS jaundiced, and I was NOT pushed formula or even told to supplement with formula. Instead I was put on an exhausting, punishing, grueling and torturous feed/pump/wash/begin-again schedule with a crazy, impossible to clean tube system to help avoid nipple confusion, that allowed me hardly any time to sleep or even nourish myself, whilst being bombarded with messages that it was MY fault for taking advil for post-partum pain and stitches, MY fault for not eating enough oatmeal, MY fault for not taking enough off-label possibly dangerous breastfeeding drugs that were apparently so much better than a few ounces of formula into my exhausted, starving, jaundiced baby.

            And then you wonder why I wasn’t producing enough milk and why my baby was too tired to suck up enough to increase my supply?

            Pumping is NOT a magic bullet. Pumping doesn’t even work for some women who can otherwise breastfeed. You know what worked, in the end, after fighting this crap for weeks? Giving the baby some formula so she got better and stronger and I got some rest. And then nursing worked great, after I got the crazy ideologue LCs out of my hair.

          • Elizabeth A

            It is a never-ending amazement me to me how hard we ask women to work to nourish their infants with nothing but their bodies, and how people are somehow surprised when this doesn’t work out.

            You know what I wonder?
            Suppose you have a new mom who is having trouble breast feeding. She has tried what she can think of, baby is hungry and screaming, she is exhausted and just at her wits end – what happens if you come into the room, and recommend as a first intervention, an ounce or two of formula for the baby, and a shower, a nap, and a good meal for Mom? Like “I think you should all take a rest, recharge all the batteries, and give it another go later this afternoon.” Is this potentially an effective intervention? How does the wash-sandwich-cake-nap progression compare to the nurse-pump-wash-repeat cycle? (Assuming a good sandwich. None of this hospital cafeteria tuna salad crap – we’re feeding a baby here.) The W-S-C-N route certainly has some interesting potential social and medical advantages for the family unit.

            (The hospital where I had my second baby had a post-partum unit snack cart with cake. It was the best thing ever. I am sure it helped me recover from surgery faster, and increased milk production later on. Later on, I had a co-worker who described deciding against “my” hospital because “It seemed too much like a resort! The whole thing where they bring you cake…” All I could think was “What the hell is wrong with feeling like you’re at a resort? You just had a baby! They should bring you cake.”)

          • KeeperOfTheBooks

            Hell, I want to deliver at a hospital with a cake cart! Where’s my cake, darn it?
            In addition to a pot of soup or casserole, I always make something cake-y to bring to new moms of my acquaintance in those first few days home. There is nothing, and I mean NOTHING, more awesome than being able to grab a hunk of cake/banana bread/figgy pudding (okay, that last is me, I love that stuff!)/whatever before a nursing session, especially those late-night ones. Tea makes it infinitely more awesome, of course, but if baby is shriekingly hungry and you haven’t time to make a cuppa, then I find most moms will generally “settle” for a slice of their favorite cake on its own. 😉

          • Elizabeth A

            Somewhat a propos of this general discussion – The Toast ran an article today entitled “The Comment Section for Every Article Ever Written About Breast Feeding.” http://the-toast.net/2015/03/09/comment-section-every-article-ever-written-breastfeeding/

            The comments are also fantastic.

          • Young CC Prof

            That is so, so right.

          • The Bofa on the Sofa

            From the comments…

            “Have you tried leaning over the baby on all fours and dangling your nipple in her mouth? I call that position the Pornstar, and it always worked for me, especially in public.”

          • FEDUP MD

            Well, I guess those two kids I have seen with kernicterus were all imaginary. I should have just told them to get out of their wheelchairs and walk, because clearly jaundice is not a problem per someone on the internet.

      • Puffin

        When we have our next, I’ll be giving formula whilst in hospital. My youngest was readmitted for most of her first two weeks for jaundice and she nearly needed a transfusion. My oldest probably should have been, but the midwives – who sent me home from hospital four hours postpartum despite enough blood loss that I technically hamehorraged – didn’t even test his bilirubin and told me it was normal for him to be orange, and we suspect that his developmental delays now may be due to the fact that he had untreated jaundice for a month, but that’s an aside.

        Being re-admitted with my youngest was hell. Here I was, days postpartum, in the paeds ward with my newborn. I had to sleep in a chair after a very difficult delivery. The hospital didn’t have biliblankets so she was either strapped to a bilibed or in an isolette and I got chewed out when I took her out to nurse “off schedule.” It was the most horrible two weeks of my life. I couldn’t hold her or nurse her when she needed. She was getting multiple daily heel sticks for bloods. Had I just given her formula for a couple of days and pumped, we likely could have avoided this, but I was so damned stubborn and so indoctrinated into thinking that formula was poison and would ruin her gut forever.

        Next time, we will be using formula for a few days.

        • Young CC Prof

          My son was also readmitted for jaundice, though he recovered more quickly. I am so sorry for what your babies went through! Was there ABO blood incompatibility?

          I think, anyone else feel free to jump in, but I think the right way to supplement a newborn you plan to breastfeed is to put baby to breast whenever she is hungry, at least every three hours, and have her nurse for a good while, then offer formula after. I found this great chart for making sure intake is sufficient during the first few days of life: https://www.newbornweight.org/

          • Puffin

            No incompatibility. I’m A+, husband is O- so there’s nothing there that would cause issues. My husband is from a race that sees much higher incidence of severe neonatal jaundice, so we’ve chalked it up to that since we’ve pretty much excluded G6PD deficiency as a possibility already. We know to expect it next time, at least.

            Breastfed both kids for 2 years each without anything more than minor annoyances, though I will be continuing my studies without interruption when we have kid 3, so I’m sure we can get off to a good start even with a few days of formula. Thank you for the reference – I’ve bookmarked it. 🙂

        • momofone

          We won’t be having any more babies, but we would do the same thing if nursing were an option. We had ABO incompatibility, and I am so glad we had excellent doctors and nurses who assured me that I could still nurse, but we had to get his very high bilirubin down before that became a priority. I pumped every hour and a half and he was given that as well as formula.

      • Allie

        Our LO, after 2 days, was jaundiced, lethargic and losing too much weight. My husband was very concerned and refused to eat until she did. A wonderfully practical RN suggested we try supplementing and brought us some ready-to-feed formula and a bottle. It was like watering a droopy houseplant – she instantly perked up, her colour improved and she had the energy to keep trying to learn the trick of latching. We went on to breastfeed very successfully for over 21 months, so take that, lactivists who insist supplementing is a slippery slope.

        • toni

          Yes! my experience was quite different and still I think that formula saved our ‘breastfeeding relationship.’ He was eating plenty and I made lots of milk but it HURT and he was wanting to nurse every hour or so for the first week or two. I gave him a bottle of formula on the third night to give my, er, self a break! he slept for like six hours right afterwards. I slathered on the aquaphor and got a nice stretch of sleep and some respite from the sheer agony. I did that a few times in the first month and still managed to breastfed him for well over a year.

  • Tosca

    I consider myself incredibly lucky that I had my kids over 20 years ago, when NCB was on the lunatic fringe where it belongs, and midwives were skilled medical professionals who gave ideological-free care.

    An enduring memory of my first baby…she was only about 8 hours old and I was still in hospital. She’d woken up, screaming with hunger and a nappy full of meconium, at 2am. I was exhausted from the birth, and looked at the road tar covering this little baby, and thought, “God, do you really expect me to deal with *this*? *Now???”. In the silence God replied “Yes”, and that moment (not when my daughter left my body) was when I became a Mother. So I began poking ineffectively at the horrible mess with wet cotton balls (hey, that’s what the hospital had recommended and I didn’t’ know any better).

    That was the moment an angel appeared, in the form of a midwife who’d been alerted by the screams. She took in the scene at a glance and asked “Would you like me to take her up to the nursery and clean her up?” I nodded gratefully, handed her over and went back to sleep. About 20 minutes later, a clean baby was returned to me for feeding.

    Now THAT was a Baby-Friendly hospital.

    • Ash

      I’m sure that was a big relief!

    • Nick Sanders

      Sounds like a mother-friendly hospital, too.

    • Elizabeth A

      Tackling meconium with wet cotton balls – you poor thing. What a lovely midwife.

      And what she did for you bloody well *should* be on standard offer.

    • That’s what I think of when I think of a good midwife, someone who supports the mother by caring for baby and offering comfort, not an obstetrical witch doctor/herbalist.

  • JJ

    Was the standard for being a “good mother” this high in the past?

    I never hear my mother talking about how she felt pressure/guilt to do anything. We were raised very mainstream. My mother had unmedicated births but she had very fast ones. She had her babies in the 80s and 90s. My grandmother seems the same way. I felt lots of pressure once I became a mother and have finally been able to totally let go of those unhealthy feeling in the past 2 years. I love being a mother now! I feel upset about those years I wasted trying so hard and exhausting myself.

    Can the combination of NCB+internet be blamed primarily for these new “standards”? I am thinking so.

  • Julia

    Gah, the feminist breeder, alpha parent — I think the best way to deal with their “ad mominems” is to just ignore them. I’m afraid that giving them airtime just validates their overblown sense of self-importance.
    I think the statements coming from the royal college of midwives or through the baby friendly hospital initiative are much more dangerous.

  • Guesteleh

    OT but interesting, sad: Study Says Pregnant Women in India Are Gravely Underweight

    http://www.nytimes.com/2015/03/03/world/asia/-pregnant-women-india-dangerously-underweight-study.html

    Turns out India has a much higher rate of malnourished infants and children as well as underweight women than Sub-Saharan African nations despite being much wealthier. The reasons why are a combo of poor sanitation and social factors.

  • Amy Tuteur, MD

    Birthrights.org perpetuates the self-same lie that led to the deaths at Morecambe Bay. Unmedicated vaginal birth is NOT safer.

    http://www.birthrights.org.uk/2015/03/kirkup-report-inhuman-healthcare/

    • nomofear

      I felt so brainwashed after I found out that so much of their “literature” was lies. In order to avoid those dastardly “interventions,” I chose a freestanding birth center for the birth of my first daughter. The pain of second stage pushed me to a non-logical, non-reasonable fugue state, and it took me three hours to push her out. I don’t remember much, except actively ignoring contractions instead of working with them, because it hurt so much! Yet that was supposed to be the “safer” choice. Nope, this time I’ve read stuff from people who actually know what they’re talking about, and I’ll take the epidural, thank you!

      • Cobalt

        This reminds of something I saw on FB recently about epidurals and tearing. The gist of it was that epidurals increasing the odds of tearing because descent isn’t painful, so the mom pushes harder and delivers faster. Feeling the unmediated pain of descent lengthens the pushing stage because pushing hurts so much, so moms hold back. I don’t know if it’s true for tearing (it sounds somewhat plausible but there are too many other factors for it to be so simple), but it makes a lot of sense that severe pain would reduce pushing efforts.

        • Mattie

          I thought that the idea that epidurals can increase the risk of tearing came from when a woman doesn’t have sensation and has to have directed pushing, which doesn’t always work with her body, but then that doesn’t happen all the time *shrug* more research before that can be stated either way I think. Although from my extremely limited experience women did hold back with pushing, especially when trying to avoid the ‘ring of fire’ that is just a natural response to pain I think, so it would make sense that better pain relief would help

          • nomofear

            My mom and I tend to have fast labors – even including three hours of pushing, it was just under six from the first real labor pain at home to her birth. My mom’s first labor was the same time frame. I don’t know how long pushing took her, but she was in an actual hospital with actual medical professionals, so it couldn’t have been that long. She speaks of it like I did while I was still brainwashed, though, “it wasn’t that bad” “it hurts but at the end you get a baby” – now that I’m out of NCB mindset, no it was awful, yes a broken femur or something would probably hurt more, but I’d get pain meds for that, too! My mom’s second labor was just under three hours, and led to major tearing, and I understand why – if I was doing it without drugs again, I’d be telling myself JUST PUSH baby’s in danger if you do like you did the first time and sit here for three hours! And then baby shoots out with such force that it splits you open! so my main concern is getting an epidural FAST, or convincing doc to induce before spontaneous so we have more control. And, epidural or not, episiotomy? YES PLEASE. Spare me third and fourth degree tearing!

            Besides, I don’t remember much from the first labor fugue state, but part of it was the midwife down there doing something with warm towels that hurt like the dickens, and her saying something weird to my husband about it after – so she was doing her own style of episiotomy without informed consent, and that was beyond not cool.

          • Kelly

            I thought for some it helped them not tear because they could control the pushing. Either way, pain relief is important. It gives the mother so much more control. I could not even spell my daughter’s name out for them before my epidural. I just kept telling them, “it is not spelled with a y.”

        • Medwife

          Well, that makes no sense, as epidurals lengthen the second stage. They can’t have it both ways!

  • Taysha

    Motherhood is smelly, ungrateful and hard work. So instead of accepting it and providing mothers with support and understanding, we have chosen to elevate it to the heights of achievement. Motherhood has been lifted to be the one and only thing that will make you special, because if we tell people they’re supposed to be supremely happy and on top of everything, we don’t have to acknowledge that they need help. After all, moms are the modern superheroes in this narrative.

    When the narrative fails the internal monologue, the only way out for some women is to step on the heads of others to push themselves above the surface. Bullying comes in many disguises.

    “Of all tyrannies, a tyranny sincerely exercised
    for the good of its victims may be the most oppressive. It would be
    better to live under robber barons than under omnipotent moral
    busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity
    may at some point be satiated; but those who torment us for our own
    good will torment us without end for they do so with the approval of
    their own conscience. They may be more likely to go to Heaven yet at the
    same time likelier to make a Hell of earth. This very kindness stings
    with intolerable insult. To be “cured” against one’s will and cured of
    states which we may not regard as disease is to be put on a level of
    those who have not yet reached the age of reason or those who never
    will; to be classed with infants, imbeciles, and domestic animals.” – C.S. Lewis

  • Sarah

    There is not and has never been any kind of reliable survey of what all the women of the world want from their childbirth experiences. We are particularly ignorant of the desires of the poorest women from the remotest communities. Therefore, co-opting them and presuming to speak for them is disgusting. It is violence, with more than a tinge of racism. Nobody has the right to make claims about whether most women want physiological birth in any country, let alone all of them.

    • Daleth

      Absolutely right.

    • MaineJen

      I would hazard a guess that most women want to survive childbirth, and to have their babies survive. Beyond that, it’s all speculation.

    • Neya

      In not-so-remote Italy, Brazil, Venezuela, for example, most women prefer C-sections… If you were to mention vaginal birth, women would very rapidly leave your practice…

      • Roadstergal

        I think it’s been mentioned in the past in the comments that when men are facing medical decisions that might impact their future sex life, that’s taken into consideration in the consultations. Is women’s sexual function part of the discussion of the pros and cons of vaginal delivery? If not, it speaks to some deeply sexist issues.

      • Dr Kitty

        In China, where you’re probably only going to have one baby, a CS if you can afford it makes a lot of sense.
        Why risk a potentially catastrophic birth injury for your only child?
        You’re only going to do this once-why not plan it for when you can have the most family support around and the most auspicious day?
        Why leave anything to chance?

  • kmz

    This is a little off topic, but I am a physician and had my first baby via cesarean about a month ago, and I am looking back at my time in the hospital thinking about how dangerous the “baby friendly” initiative can be. My baby came a little early so my husband had to leave to go do a few things and I was left completely alone with the baby in a little crib beside me, in severe pain, and a first time mom who had no idea how to care for a baby. I found myself falling asleep with the baby in my arms (thank goodness he didn’t fall or get trapped next to me) and when I tried to put him in the crib I couldn’t reach it well and my IV was tangled up and the call bell fell out of reach and I was surprised at how helpless and alone I felt. I should have made them take the baby but there was this unspoken feeling that the baby should be in the room with me the whole time or else (maybe I wouldn’t bond or something?). And when I took the percocet to help with the pain that was another safety issue all together.

    It made me really think that having the nursery more available (and offered!) is more safe. Of course, if mom has the help in the room or feels well and wants baby in the room the whole time that should be available too. More options for everyone!

    Thanks so much for this blog which makes me feel like it is ok to admit this.

    • Ash

      This is a great opportunity to talk to Patient Relations. Who knows, if enough people bring up this issue, they may bring back the well baby nursery (I assume it was eliminated or is now discouraged)

    • Laura

      I totally agree with you! I loved the baby nursery when I had each of my 6 kids. I never had a C-section, either, so I can only imagine the pain of turning over to pick the baby up by yourself. I am a big proponent of the baby nursery as needed.

    • Lisa C

      KMZ – I am sorry that you felt so alone. I can empathize,
      I had a c-section too and was on a some sort of IV pain killer (not sure which one) after which made me incredibly sleepy. Thankfully the nurses kept baby in the nursery the first night except for feedings which were supervised. I was unprepared for how much pain I was in after the surgery and it took a few days to fully get my mobility back.

      I don’t understand why people think babies can’t spend the first two or three nights in the nursery. We will have them for the next 6550 nights :).

    • Gretta

      I have three kids and thinking about a fourth. With each one, I have been more willing to ask for and accept help…starting at birth with the nursery. If there is a new Mom out there, I want shout from the rooftops “It’s ok! Ask for help! Take the help! And don’t be afraid to speak up if your are uncomfortable!”

      • Ceridwen

        Numerous times when I have spoken up about this issue and stated that I sent my child to the nurses station overnight (after more than 40 hours of labor and a PPH) I have been shamed for it. It’s such total bullshit. It’s perfectly reasonable to be comfortable placing your child in the care of highly trained individuals that you are paying to care for them whether you take advantage of it or not. I wish more women were told *that* and not that they are terrible mothers if they ever wish to be separated from their child.

    • Mel

      I’ve never had a baby, but the process of gestating and delivering a baby sounds exhausting.

      Having a hospital nursery where the baby can be cared for and watched over by trained medical professionals is a brilliant idea and should be available to all moms and babies if they want it.

      Kinda related/Off topic: In cows, a not-infrequent cause of death in births of twins – but especially the rare triplets or quadruplets is crushing by the dam. The dam can lose track of where the calves are and lay down on top of one. (We actually lay newborn twins next to each other simply to make it easier for the mom to keep track of them until they can walk a bit better.)

      Sow crates – which I don’t like, but understand the rationale – were created because a major cause of piglet death was maternal crushing.

      So, yeah. If you have a size difference between mom and baby, crushing and smothering is a big risk.

    • MaineJen

      I agree that keeping the baby with you at all times is less of a rule and more of an unspoken “strong suggestion.” As in, during the hospital tour: “Well, MOST MOMS like to keep their babies in the room with them, so the well baby nursery is usually pretty empty!” In other words: if you are the one mom who sends her baby to the nursery, you are an anomaly. My hospital had a nursery, but it was indeed fairly empty. And I had a vag birth, I can’t imagine trying to recover from a c section and being a new mom alone with a baby, as you were. I remember feeling fairly overwhelmed at times.

      • Ash

        Some hospitals have eliminated well baby nurseries. There is discussion abotu this in some previous comment threads in posts about Baby Friendly Hospital Initiative.

    • Neya

      Unfortunately, yours seems to be a common experience… I wish that CNMs would be required to have more training before attending births, would give you pain relief as soon as you need it, and would not make it sound like such a big chore when you ask them to help you with the care of the baby. No other patients are expected to so much after surgery…

    • Dr Kitty

      I came back from my first post partum shower, 24 hrs post CS, still catheterised and only supposed to walk short distances, to find that my bed had been changed and made, but helpfully set to the neurosurgical height (House of God reference) with both the bed controls and the call button in the middle of the pillow…which I couldn’t reach.

      I knew to pull the arrest lever on the bed to make it drop like a stone, but I think anyone else would probably have faced a choice between bursting stitches trying to climb onto the bed, walking 150m to the nurses station, or shouting for help.

      Again, a small thing, but no-one who had personally had abdominal surgery would have left the bed like that. You can’t just boost yourself up onto a very high bed with a fresh incision!

    • Who?

      I was left in a nursing chair less than 12 hours after delivery with a 3.6kg baby in my arms and found I couldn’t stand up to get out of the chair, couldn’t reach the bell and couldn’t raise any help by calling out. And I really wanted to go to the loo.

      Someone came along after a while and rescued us, it can’t have been very long (maybe half an hour?) but it was very lonely and I was scared.

    • KarenJJ

      I had the choice of two hospitals. One with a 24 hour well baby nursery if you wanted it and one without where you had to buzz the nurses at night if you needed help. No regrets at all about choosing the one with the well-baby nursery. Baby spent most of the time with me, but when I needed the well baby nursery I was able to use it.

    • FEDUP MD

      Not alone. I am a physician as well and a pediatric subspecialist. I have had similar experiences. My first child was born after a 30 hour induction that failed, bad mec and late decals necessitating very urgent c-section, and my epidural was insufficient for the c-section and I got crash general anesthesia when I could feel them cutting me open. My son had a crappy 1 minute Apgar (1) and required intubation and suctioning multiple times. I was made to feel badly by anesthesia about pain control (ie when I got my epidural for 24 hours of back labor, I got told “well you’re not very dilated, it will just get worse” and being told pressure was normal during c-section and to stop complaining). When I woke up in recovery, they finally brought my son back to me after much crying by me (worrying about him with the low Apgars, of course). When they finally brought him and I tried to hold him, I was so shaky and weak from general that I honestly felt like I was going to drop him, and told the nurse so. She nastily told me it was my job to do so from now on, since it was my baby, and she wouldn’t help. So my husband had to hold the baby in one arm and my breast in the other so I could nurse him – a man who had never held a baby before. You can actually see me in the video he took afterwards where I am slurring and I keep falling asleep with my head dropping.Afterwards, it became apparent that after that first sleepy feeding my son had a very significant oral aversion, likely due to the intubation and suctioning. He wouldn’t nurse at all (would just cry and flail when you tried) and only one lactation consultant knew what it was and reassured me he would get over it in time (and she was right). So he kept losing weight, including past the 10% mark and just screamed constantly. By this point in time I had been up for 48+ hours and asked if they could please take the baby to the nursery so I could sleep for a few hours before trying the next time to nurse. The nurse told me they didn’t have a nursery and we had to have the baby in our room. By this point I was sobbing from the lack of sleep, pain, and stress of a baby who was wasting away and not eating and seeming to reject me, and even my husband, who I have never seen cry more than once before, was close to tears ( and did cry the next morning to his parents when I was recovered and he felt it was safe). My husband again saved the day by arguing with the nurse and working out where he could walk the floor in circles pushing the baby in a bassinet. The next day, it became clear he was weakening, and the lactation consultant, pediatrician, and I concurred he needed formula, since my milk was not yet in. When the nurse brought it, she made a comment about how she never had to give any and how it would ruin our breastfeeding relationship, and it wasn’t needed. Well, lo and behold, after a grand total of 30 mls over two feeds he perked up, my milk came in, and the next day he started nursing, which we did exclusively until 10 months thereafter, when he self weaned. In short, I did not get a ton of support, other than from the pediatrician and lactation consultant, and my husband is the hero of this tale. But if I had not had my husband with me, I am not sure what I would have done. I certainly could not have cared for my baby safely, and the expectation was that I could do so alone, despite the fact I had just woken up from general anesthesia, then was bed bound with a Foley and a large abdominal wound, had not slept in 2 days, and had a very neurologically irritable baby. What would I have done if my husband were deployed, or I was single?

      Of note, with my second child I was much more demanding and cared less. It was a planned repeat csection with actual adequate anesthesia! Hallelujah! Where it did just feel like pressure, not like someone slicing me with a sharp instrument. And I was much more awake and aware to hold my baby. Of course, we had our own issues with her (LGA, jaundice, and hypoglycemia) but when we had to give formula to her to prevent hypoglycemic seizures, when the nurse said something about formula I told her too bad, the pediatrician and I had made a medical decision. She got 15 mls, perked up, and we have exclusively nursed since (she is 1). When I was tired and they told me there was no nursery, I insisted and one of the nurses kept her in a bassinet at the nurses station, as they did on my insistence when my husband had to go home to our eldest and I was stuck in bed with a Foley.

      • fiftyfifty1

        Yes, it’s amazing how postpartum moms can be treated under this Baby Friendly philosophy. And if they treat us MDs that way, I worry it might be worse for a typical patient. My CS occurred during the day after only 1 hour of labor so I was in good condition, but it was still very challenging to care for my baby without any help during the first 24 hours. My husband had to go home to care for our oldest, so caring for my baby was 100% on me. The well nursery has been effectively done away with, and if you do have the nurses watch your baby, there are so many rules in place (no more than 2 hours, and baby will be brought back sooner if it cries or shows signs of hunger) that there is hardly a point in having them “help”.

        I think it all goes back to NCB philosphy. Pregnancy and Birth are not diseases, don’t you know, and a healthy woman delivers vaginally and hops right up afterwards, and WANTS her baby with her every minute because she has BONDED and wants the BEST START for her baby.

    • kmz

      Thank you all for the support – I am sad that so many people have had similar experiences! I will talk to the nurse manager, this is one of the good things about working at the same hospital that I delivered. We should be more supportive of women and babies during the postpartum period!

  • Ash

    OT: visited the Midwifery Today FB page today. 2 posts about hemorrhage. I noticed that the only commenters that promoted active management of the 3rd stage were midwives not located in the USA.

    Unfortunately this was one of the stupid comments. From a MW in Australia

    ” learnt from another midwife, as rub the fundus I look into the womans
    eyes and firmly but reassuringly tell her to stop bleeding. That is my
    first step, as with everything else in birth I believe there is a
    mental and emotional component to PPH.”

    • Lisa C

      Maybe if I stand in front of
      the mirror and tell my eyes to start working correctly again they will and I won’t need my glasses anymore.
      Oh wait, that’s stupid and so is telling someone who is hemorrhaging to stop bleeding.
      🙂

      • Mel

        That would cause me to freak out (panic) if I was the person bleeding.

        Because clotting cascades have NOTHING to do with personal wishes, wants or desires.

        • Dr Kitty

          I blame all those medical shows on TV where the doctors are shouting “Dammit, stay with me! Hold on buddy! Don’t you dare die on me!” during a cardiac arrest, and lo and behold, the patient listens to them and is successfully resuscitated.

          That only works on TV.

          • Tsu Dho Nimh

            “behold, the patient listens to them and is successfully resuscitated.”

            It actually works to delay the onset of shock … the effort it takes to talk to the rescuer keeps the blood pressure up. If you let them relax and stop focusing on you the BP drops.

            But that’s only until you can fix the real problem causing the shock. It’s not curative.

          • Dr Kitty

            And it doesn’t work once they’re in cardiac and respiratory arrest!

    • Daleth

      Oh my fucking god. Excuse me but… oh my fucking god. THAT is how she manages a possibly life-threatening hemorrhage?!?!?!!

    • Maria

      Seriously? That is some of the stupidest stuff I have ever read!

    • MLE

      Also, clients who don’t eat well are more likely to hemorrhage AND tear!!!!!

    • Julia

      Aha— so then if the woman doesn’t stop bleeding, it must be her fault because she didn’t want to listen to the midwife.

    • JJ

      I hemorrhaged badly after a miscarriage and I would be enraged when I was bleeding do death if someone wasted time telling me to stop! It is scary bleeding to death and I am glad I was in the presence of a real doctor when it happened to me.

      Let me guess, step two is homeopathy!
      Step three, knit for a while and repeat positive affirmations?
      Step four, call ambulance when mom blacks out.

      • EmbraceYourInnerCrone

        Ditto, my first miscarrige I hemorrhaged and went into shock. Really glad I was at the ER. All I could think about before I passed out was I couldn’t decide if I wanted to passout or throw up more. If some idiot had told me to Stop Bleeding I would have thrown up on her. I really do not subscribe to the Tinker Bell school of medicine (You just have to BELIEVE! Clap harder and everything will be OK!) Yeah…no

      • Bombshellrisa

        Step two (according to the elder midwives Facebook page) is for the midwife to put some cinnamon candy in her mouth and blow in the mother’s face. Not making this up. Can you imagine?

        • JJ

          It would be nice if that worked! It would have saved me a lot of time and expense. The EMTs were not that opened minded though and did not “trust natural miscarriage” enough.

          • Bombshellrisa

            I was taught that cinnamon thins the blood, there was something in the birth contract my preceptors had that stated cinnamon was prohibited during the last two weeks of pregnancy.
            That must have been terrifying for you. I am sorry.

          • JJ

            That’s interesting and something I have never heard. I still don’t know how thinning out blood could help a hemorrhage? I guess the candy could help one enjoy the experience more.

          • Amy M

            It can’t–thinning the blood would make a hemorrhage worse. People who are scheduled for surgery aren’t supposed to take medications that act as blood thinners for x amount of time prior to the surgery, to reduce the blood loss.

      • Amy M

        I had a pph, luckily, when a nurse was standing in front of me, and she immediately called for help. They got it under control in a few minutes and I narrowly avoided a transfusion. If she had taken the time to tell me to stop bleeding, and berate me about my poor nutrition, I certainly could have bled out. Dr. Amy has posted stories here before about women bleeding to death after a homebirth in the US, no thanks to these charlatans.

    • Dr Kitty

      Never mind the three Ts- you just need someone to admonish the patient and ask her to pull herself together and activate her damn clotting pathways already!

      I mean that’ll obviously work regardless of whether she has a big laceration, or a chunk of placenta adhering to her uterus, is in DIC, or has uterine atony!

      I’m pretty sure the traditional birth attendants who watch women die from PPH every day in the developing world have already tried this approach, along with begging G-d to stop the bleeding, and I’m almost certain it doesn’t work very well.

      • fiftyfifty1

        “as with everything else in birth I believe there is a mental and emotional component to PPH”

        Big laceration= sexually uptight, and so tore
        Adherent placenta=unwilling to “let go” of pregnancy because of all the attention she’s been receiving
        DIC=so hysterical that her emotions have even affected her at the level of her blood!
        uterine atony= lazy

        See, no matter what the pathophysiology, the bleeding woman needs to be shamed out of it.

    • FrequentFlyer

      I read this to my husband, we’ll call him the FireCapt, and asked him what would happen if he goes to work tomorrow and tells his medics to try this if they respond to a car crash. A person bleeding to death on the side of the road doesn’t need them to waste time with all that nonsense they learned in their paramedic training right? They just need to be told to stop. Problem solved, or does this special magic only work for birth related bleeding?

    • Medwife

      Well, reasonable American midwives don’t spend time on that page 🙂

      I think it’s more emotionally supportive to calmly tell a woman all the things you and the staff are doing to get the bleeding under control. If I told a patient to “stop bleeding” her emotional response might be, “I thought that was your job, I’m not bleeding for fun”. Cue panic.

    • fiftyfifty1

      “as with everything else in birth I believe there is a mental and emotional component to PPH”

      Yep. That’s their justification for bullying women for all sorts of birth “failures” from needing an epidural, to arrested descent, to needing a CS, to stillbirth, to tearing, to not producing enough milk. You name it. Basically it wouldn’t have happened to you if you didn’t secretly want it.

      No wonder some women go to the ends of the earth, putting their babies and themselves at risk to prove that they aren’t one of “those” nasty, unnatural, psychologically screwed up women that NCB philosophy makes women out to be if they have needed any intervention.

  • The Bofa on the Sofa

    Can Dads do ad mominems, too?

    I remember one comment that set me off. A guy said, “I don’t want my son wearing pink because I don’t want him to have problems with gender confusion.”

    So many things wrong with that statement, but as a parent who had a son who wore pink as a baby (and as someone who has had a bunch of pink shirts over the years) I took that as a serious personal insult.

    • moto_librarian

      Our five year-old son adores his stuffed pink piglet. He has had him since birth, and carries him everywhere. No signs of gender confusion yet.

      Did you happen to remind this guy that during the 19th century, pink was associated with boys, and blue with girls? Apparently, blue was once considered effeminate.

      • The Bofa on the Sofa

        Did you happen to remind this guy that during the 19th century, pink was associated with boys, and blue with girls? Apparently, blue was once considered effeminate.

        No, I called him a sexist, homophobic asshole and if his kid is anything like him, to keep him away from mine.

    • Mel

      My husband’s uncles used to throw fits that my husband and his two brothers used to play with baby dolls because that would make them gay.

      • Roadstergal

        There was a question on the Not My Job section of Wait Wait, Don’t Tell Me a few weeks ago where they claimed that GI Joe was invented because boys were playing with their sister’s dolls. Dunno if that’s true, but I can at least say that in my circle of friends growing up, boys playing with dolls and girls playing with Transformers, and vice versa, were common occurrences.

        That must be why I’m bisexual. :p

        • Amazed

          I shot half the world dead with my brother’s gun back in the day. He was my baby when he was… well, a baby and then when I wanted him to play the baby. He was my puppy sometimes – the barking was impressive.

          I still identify myself as female. And I even escaped jail time. He grew up and guess what? He didn’t get a species confusion either. But then, he never had it even then. He switched between human and puppy really fast.

        • KarenJJ

          I had a brother a similar age to me and we shared toys.

          I’m heterosexual, but then again I’m an engineer so maybe it doesn’t count.

    • Bombshellrisa

      The only time I have given an opinion about a guy wearing pink was when the guy asked if I thought the particular shade was flattering. It wasn’t, so we found one that was. I can’t believe someone would believe gender confusion comes from the color shirt a child wears! And I wonder what he would make of the single mother at church who let her son wear his sister’s old cheerleading outfit to church so he would stop throwing a fit (it got them out the door on time and with three kids)?

      • The Bofa on the Sofa

        My older son entered the Dorothy look-a-like contest at the Chesteron, IN Wizard of Oz festival in 2011 when he was 3 years old.

        I got really pissed off at the judges when he didn’t win. He should have. They said they weren’t sure it was his idea. I told them, if they would have heard him argue when we suggested he take off the ruby slippers afterward because they were giving his feet blisters they wouldn’t have had any doubts.

        • Bombshellrisa

          I would be pissed too, don’t they think someone can just really enjoy a movie an like the costume? I didn’t dress up as Princess Laya for the Star Wars party, I was Darth Vadee (complete with face mask that quoted Darth and the coolest Light Saber)

    • demodocus’ spouse

      I joke that pink is a boy’s color in our house. It’s my husband’s favorite color and my least favorite. (He can see bright colors)

      • Nick Sanders

        I’ve read that pink was once considered a boy’s color, because it was close to red, which was masculine because it was the color of blood. Times change, but some people never grow up.

  • Amy M

    Just this week, I was involved in a discussion online, with some friends. One posted something (blogpost?) which was a nice piece with the message: “Don’t walk up to parents and tell them they are doing it wrong, because you never have all the information and its really obnoxious.”

    In our discussion of the article, we all agreed that it is human nature to judge and form opinions, but the difference between being human and being an ass is keeping your opinions to yourself. I also said that since I am pretty non-confrontational, I would never just get in anyone’s face and disparage their choices, but that I hoped that I would help if I saw real danger. (I was thinking like that Similac commercial, if I saw a stroller rolling away, I’d try to catch it.)

    My friends agreed, but then one added “Exactly. For example, formula isn’t dangerous.” The other woman in the conversation and I (and both of us formula fed) both chose to interpret that as a joke that came out wrong (no tone on the internet and all), and ignored it. However, it could have been interpreted as this woman judging formula feeding, immediately after we discussed keeping our opinions to ourselves.

    • JJ

      I am tired of it too. As my children grow, I have been able to see how different they are even though they are raised by the same parents. I realized I don’t have control over many things I thought I did and I actually makes me feel better.