Saving babies’ lives. What’s breastfeeding got to do with it? Not much.

Indian woman washing her baby

On Friday I wrote about the Lancet series on breastfeeding. The authors claim that exclusive breastfeeding around the world could save 800,000 babies each year. I pointed out a paradox that undermines the authors’ contention: the countries with the highest infant mortality rates already have the highest breastfeeding rates.

We shouldn’t be surprised. There once was a time that breastfeeding rates were 100% everywhere and the infant mortality rate was … hideous! If breastfeeding didn’t protect babies for most of human existence, why would it suddenly start protecting infants now?

Increased breastfeeding rates might theoretically decrease infant mortality, but I can’t find any real world evidence that it does.

In other words, there’s no real world evidence for the purportedly lifesaving benefits of breastmilk. So what are the authors’ basing their claim upon? They base their claims on projections from data gleaned in small studies. Indeed, as far as I know, every assertion that increasing breastfeeding rates will save lives or money is based on projections, never on actual experience. Indeed, as far as I can determine, there is no real world evidence that breastfeeding saves lives or money on the scale estimated by certain researchers.

That’s an important point because there is considerable evidence that other parameters and public health measures do do result in decreased infant mortality.

Here’s the scatter chart of breastfeeding rates vs. infant mortality that I presented on Friday. It is based on data from 121 low and moderate income countries.

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As you can see, as the breastfeeding rate rises, the infant mortality rate not only doesn’t fall, it actually rises, too.

Now let’s look at the impact of per capita GDP (gross domestic product), a measure of income, on infant mortality in these same low and middle income countries.

image

The scatter chart looks very different. It is easy to see that as income rises, infant mortality rates fall. It’s the exact opposite of what we see with breastfeeding rates.

How about the impact of relatively clean water (including public taps, protected wells, and rainwater)? Here’s a scatter chart of access to clean water vs. infant mortality. As access to clean water approaches 100%, infant mortality drops precipitously. That’s also in direct contrast to what we see with breastfeeding.

image

Finally, let’s look at access to modern contraceptive methods. The scatter chart below plots the proportions of sexually active women using modern contraception vs. infant mortality. Yet again we see that as access to contraception rises, infant mortality falls.

image

No doubt access to clean water and access to modern contraception are, in part, a function of per capita income, but they are certainly more firmly tied to reducing infant mortality than breastfeeding.

There’s nothing wrong with breastfeeding, of course. But it’s not a magic lifesaving elixir, no matter how much lactivists insist that it is. While increasing breastfeeding might theoretically decrease infant mortality, I can find no real world evidence that it actually does.

That’s not what I thought prior to reading the Lancet papers, but that’s actually what the data shows. Increasing breastfeeding rates are actually associated with INCREASED infant mortality.

It’s not because breastfeeding causes infant deaths; it doesn’t. It’s because babies die due to malnutrition (of themselves or their mothers), vaccine preventable illnesses, lack of medical care and war. Breastfeeding can’t fix those things and it is foolish (or worse) to pretend that for women living in abject poverty, their babies’ survival depends on breastfeeding.

  • BeatriceC

    And NPR wrote an article on the “study”. Is anybody surprised that they wildly overstated what the study actually said?

    • demodocus

      sadly, no

    • Megan

      Not surprised in the least. That’s why they no longer get my money.

  • SporkParade

    Here’s my nitpick: The breastfeeding rate has never stood at 100% anywhere at any time. There is a long and storied history of breastmilk substitutes that killed many of the babies they were given to, but were still used because that’s an improvement on certain death due to insufficient supply. I mention it because it seems particularly cruel to tell women who have no supply in places where breastfeeding is a matter of life or death that their babies would be fine if they would just breastfeed.

    • crazy grad mama

      Yup. I always bring this up when people insist that birth is natural! breastfeeding is natural! They are, but so is dying in childbirth, and so are high infant mortality rates. Evolution in no way requires that every member of the species survives to old age.

  • Amazed

    https://bfmed.wordpress.com/2016/01/31/of-goldilocks-and-neonatal-hypernatremia/

    Enjoy Dr Steube, especially in the 13th comment in the line, looking as if butter would not melt in her mouth trying to claim that she called a fellow MD whose child was damaged for life because of the ideology she promotes just “the mother” and didn’t provide a link to her story just because she didn’t want to dissect the details of “the mother’s” experience but focus on the system that failed her.

    Ha! As if! Her true purpose shines for miles. The woman is only concerned that such stories emerging would undermine her personal milking cow – breastfeeding. She didn’t link to the story because she didn’t want people to see that such a thing can happen to a doctor, someone who, by definition, knows more than most people about those things, so they might be scared into not ignoring their babies’ hunger and give them formula. She’s shitting herself with fear because more and more mothers are speaking up – and she’s taken out the heavy weapons. She’s comparing formula to antibiotics, FFS.

    The Steube woman makes me throw up in my mouth the way Biter and Fischbein do. Each time I see a doctor disregarding patients’ wellbeing and very life for their cherished ideology or self-confidence, or own desires, I see red. Those are the people we trust with our health and they spit on it why?

    The Steube creature is an asshole.

    • Amy M

      Ugh. The part that disgusted me was where she stated that a supplemental bottle of formula could directly CAUSE a GI infection, SIDS and a couple of other health problems. Really?!!? And then a pediatrician in the comments said that formula causes autism. That’s crazy. If a doctor told me something like that, I’d be pretty skeptical and seek another doctor. But there are probably families that would just accept it and not question it and these doctors are making stuff up to prevent a drop of formula from getting past the kid’s lips. That’s really unethical—could patients complain to local medical boards about that kind of thing?

      • Amazed

        Bob Sears is still a MD after causing a mini measles epidemics a few years back. I suppose patients can file a complain but it’ll be a study in futility. If Steube and the rest of them knew they’d be held responsible for the garbage they’re spewing, they would have been minding said garbage but alas, that’s not to be.

        • Amy M

          yeah…but a girl can dream, right? 🙂 Seriously, its just that when people in positions of authority abuse their authority like that, it makes me so angry. I wish it were easier to hold them accountable.

      • CSN0116

        How does formula feeding ever cause SIDS? I never got that…

        • AirPlant

          Formula babies are supposed to sleep deeper and longer. The light, breastfed baby sleep is supposed to promote frequent waking which is protective against SIDS.
          I have literally no idea if this is true or not, but the last study that I read claimed that there was no difference in sleep patterns between breast and formula so… Shrug?

          • Madtowngirl

            I wish someone would tell my formula-fed infant that she’s supposed to sleep for longer.

          • Joy

            But bf babies sleep better because hormones and co-sleeping. But ff babies sleep better because they are drugged. But…

          • AirPlant

            I think we can all agree that whatever direction the difference is it can be interpreted to mean that breastfeeding is the only loving choice that a mother can make.

        • Roadstergal

          I think the idea is more that BF is protective against SIDS. However, so is pacifier use, and I have no evidence that it’s inferior to BF in its protective effect, and it’s certainly more widely implement-able. Yet you don’t hear the “BF protects against SIDS” crowd promoting pacifier use and contributing to programs to get pacifiers for low-income working mothers, which should tell you everything you need to know about how much they actually care about protecting babies from SIDS.

    • fearlessformulafeeder

      Honestly though… Steube is the best of them. She at least acknowledges that sometimes breast isn’t best. As lactivists go, I don’t mind her, overall. That doesn’t mean I agree with 70% of what she says, because I don’t, but the other 30 ain’t so bad.

      I did think it was kind of gross to not give the name of the physician in question (someone I consider a friend, no less). I am *trying* to convince myself that she did so in an attempt to save that physician from being trolled, but I’m having a hard time doing so. 🙁

      • Amazed

        Yeah, that’s what I’ve seen this far as well. She’s the best of them and that’s the thing. It’s just so sad. THIS is the best they have to offer? This asshole? What should I name the others? Triple-assholes?

        I can’t believe she did it for the physician mother’s wellbeing either. The lady in question is already trolled enough. And lactivists never acknowledge that they pile on someone. They just whine that thanks to some isolated accidents, the whole movement have found itself on an umflattering magazine cover. That’s what they care about. They’re very happy to direct their followers to troll people.

    • Margo

      Dear me! Amazed! So angry!Blah blah blah, you are predictable and as boring as all hell.

      • Amazed

        Margo the Midwife, always classy. Do you wear high heels while killing babies?

      • The Bofa on the Sofa

        Amazed! So angry!

        Maybe so. And? What’s wrong with that?

        If someone does something that is harming others, what’s wrong with being angry about it? More people should be angry about it.

  • CSN0116

    Beautifully written. I’m so glad you brought in charts of per capita income, clean water access, and modern contraceptives. It really adds to the overall picture.

    But at the end of the day this is one of those things that shouldn’t need saying. It’s absolutely bizarre to me that one can look at all of this and come to the conclusion and presentation of the work that the author’s did. And it is utterly embarrassing and offensive to talk breast when things like clean water access trump the entire conversation. How can one be so callous and dismissive? How can the listed authors – MDs and PhDs who claim to care about population health – be so callous and dismissive? For the sake of a bleeding heart (non) cause? Pathetic. They knew exactly what was going to happen the second this paper came out – attention to the beloved breast, thus diverting much-needed attention away from everything else that’s actually worth a damn.

    • AirPlant

      I have a theory and I am not sure if there is anything to it, but it seems like a big part of this all natural movement is the idea that women should just get on with the women’s work of reproduction and child rearing without bothering people or needing any resources dedicated to them. The ideal for women and children is still to be invisible, and when you hear stories about them suffering and dying for lack of clean water and medical resources that horrible, pernicious ideal seems to click into peoples minds and they say shit that seems to boil down to “if you would just do your job as a woman and stop bothering the world with your concerns things would turn out just fine.” I think that is how you get from “we are dying and our children are dying because there is no food and our water is dirty and hard to come by” to the solution of “breastfeed more”
      Then there is the problem of smug women in developed nations telling the world that they did their womanly duty and are therefore absolved of all blame.

      • Roadstergal

        Excellent points.

      • swbarnes2

        Gender essentialism is a big part of this…woman have always been judged not by what they do with their hands, and head, and heart, but by what their uterus and vagina and boobs are doing; if a woman can’t do “womanly” things like carry and push out a baby and feed it, how else is she supposed to be counted as a good person?

        • AirPlant

          And the most pernicious part to me is that all the work is supposed to be done invisibly. Your baby cries in public and all of a sudden you are a bad person again.

          • guest

            I have internalized this message so much. Thank you for the clarity in this comment. Mine are three year olds, and although I can sit here and type that I don’t give a f$#@ about what other people think, the fact is that when they act up in public I feel withering glances and judgment from all corners, because there’s just so much expectation that parents raise their children “right,” and that generally seems to mean that children are always quiet and perfectly behaved when any other adult is around to witness them, and this is impossible.

          • AirPlant

            It is so hard! In your mind it is easy to remember that kids are kids and one meltdown doesn’t make you a bad mother but we are social creatures and public disapproval hurts. Nobody wants to be the blithe horror parent who sits by as their kids wreak havoc in the world, but meltdowns happen and you can’t always predict when and sometimes parenting moments have to happen where the kid doesn’t get everything that they want even if they scream full volume.
            The only thing I can think to do as one person is be kind. I distract kids in the checkout line, and I try to smile and say kind things and I really really hope that the world is like inspirational facebook memes and kindness is contagious and being kind makes the world an easier place to be. Also I live in hope that with more men taking an active parenting role the world in general will start cutting caregivers some freaking slack. It will literally be the best thing patriarchy has ever done for me.

          • Kelly

            The way that I have dealt with it is to not look around when my child is doing that. If I don’t see their glances or their stares, it helps me to not care. I still got a nice glare when I told someone that I let my daughter go to the bathroom by herself while I stood outside with my other two. The only thing she can’t do by herself is to wash her hands and I have hand sanitizer for those times.

          • Megan

            The looks can be difficult to deal with. My daughter is usually great in restaurants but she is a toddler and they are unpredictable. I feel like people have unrealistic expectations of what children are and are not capable of emotionally. They have only certain ways to communicate and when they’re frustrated it’s even harder for them to utilize socially acceptable ways of dealing with it. I try my hardest to ignore people’s glares and I do my hardest to distract and calm my daughter down. If she’s bad enough we get our food to go. What frustrates me the most though is that I’m always the one who gets the dirty looks. It’s never my husband. It does vary by location too. In my home area people seem much less bothered by it than say, when I was at a restaurant near an affluent Baltimore suburb a few weeks ago. Apparently money is supposed to buy you better behaved children.
            I try to do what AirPlant below said and remember that parents do not have complete control over how their kids act. I try to treat fellow parents with kindness and treat other children with distracting silliness or at least a friendly smile.

          • AirPlant

            Honestly what saves my bacon in restaurants is asking for the bill right after ordering. That way the second the kids get worked up you can completely peace out of there. It really minimizes the glaring and you don’t get stuck hostage with the credit card machine.

          • Megan

            That is a good idea. I also ask the waiter to bring my daughter’s food out as soon as it’s ready, even if ours isn’t. This way she gets her food faster and she is more likely to be calmed down by the time I get my food so I can enjoy it more (and I’ve already done all the cutting up of her food so it’s just a matter of dishing out more if she needs it).

          • AirPlant

            GENIUS. I can’t believe I never thought to do that! I might actually get hot food that way too 🙂

          • The Bofa on the Sofa

            Personally, I think a good server would be offering to do that in the first place

          • Megan

            Actually, that’s who I learned the strategy from, a really good server at our favorite pub. (He probably didnt want our daughter crying any more than we did!) Now I just routinely ask.

          • Megan

            The other thing we like to do is go to a place with a salad bar. That way DD can get food as soon as we sit down (the snow peas are her favorite). I have devised many a way to get to eat my meal at least warm, if not hot. 🙂

          • The Bofa on the Sofa

            Our younger guy likes the buffet because he is SOOOOOO hungry and can’t wait for food.

            So he’d rather drive 25 minutes to a buffet where we can get the food right away than drive 10 minutes to a place where we have to wait 15 minutes for our food.

          • BeatriceC

            You’ve never had a server offer to bring out the kids food first? I worked several waitressing jobs in my university days and we were always trained to ask parents if they wanted the kids’ meals brought out as soon as they were ready or with the family meal. That was 20 years ago. Maybe they don’t train servers to do that anymore.

          • Roadstergal

            We do that even without kids. It just makes it easier for us to leave at the time we’re ready to.

            The waiters don’t like it because it means we’re not buying booze all night, but oh well.

          • The Bofa on the Sofa

            And what about desert? Hmmmmm?

          • Roadstergal

            They give us water. 🙂

            (Puns aside, we rarely have dessert, and when we do, we like to walk somewhere else. Dinner in the Castro means Hot Cookie is the dessert, no matter where we ate.)

          • The Bofa on the Sofa

            If she’s bad enough we get our food to go.

            We did that once in an Ethiopian restaurant in Boston. Offspring (we only had one at the time) was crankier than hell, so we left.

            Our favorite story: local Mexican place, we frequent often. My wife gets off work so child and I plan to meet her there. She gets there 15 minutes before us, orders for us all. We pull in, sit in the booth, food arrives, we eat, and off we go, leaving her the check to finish up. Full meal, and it was a total of about 20 minutes in the restaurant (pay attention to it, you realize that the amount of time eating in a restaurant isn’t huge)

            No, not a sit and relax and chat meal, but then again, no kid problems either

  • demodocus

    It must be so hard to be a parent especially but anyone truly, in a place when and where so many things i can take mostly for granted just aren’t available.
    One thing i like living on my latitude is that mosquitos DIE. For months! Don’t like small bitey things.

    • CSN0116

      Yes, things like this really make me want to slap myself in the face. My problems are so trivial.

      OT: This weekend I met, and we had a playdate with, a little boy and his mom. Little guy (2 years) is battling neuroblastoma. As I talked with mom I could see and feel the anxiety seeping through her eyes, just radiating. He’s due for scans next week and the initiation of a vaccine trial. Her whole life is waiting of the results of some images. I recognized her anxiety; I’ve felt it too. But I feel it when my kids’ temps hit 103, or they vomit for the second day in a row. All the while I know, completely, that in a few short days it will all be OK and life will go on. But this woman, *she* is waiting for literally life or death. Again, I left with the urge to slap myself in the face :/

      (Shameless plug: We met through the local pediatric cancer community, because my seven-year-olds decided they wanted to request money for their birthday, instead of gifts, to use as a donation for somebody in need. In the end they raised $715 for little guy and made him a bunch of cards! The family is using the money to fund the trip to NYC for scans and the vaccine trial. So proud of my kiddos 🙂

      • Sarah

        You should be.

      • demodocus

        That is so kind of your kiddos. Good luck to the little guy. He’s my boy’s age, and childhood cancer is one of the things that scare the crap out of me.

        • CSN0116

          I have an almost two-year-old boy too. In fact, as my girls played with him they kept commenting on how much he looked like their baby brother 🙁 We have two very close friends whose kids have been diagnosed with cancer. Both are now in remission and doing great, but that shit seriously keeps me awake at night.

        • BeatriceC

          Childhood cancer still terrifies me, and my kids are all teens. One added stress I have is the MHE. In general, the osteochondromas are benign, with a <1% chance of becoming malignant, but that tiny chance is still enough to stress me out from time to time, especially when one of the osteochondromas start growing rapidly.

      • Amazed

        You should be proud. Fingers crossed for the little guy!

  • fiftyfifty1

    This is my take home from the first graph: A country can have a low infant mortality rate with a very high (95%+) breastfeeding rate. A country can also have a low infant mortality rate with a very low (30% or less) breastfeeding rate. That tells me that breastfeeding’s contribution to mortality rate in general must be being dwarfed by other factors. Now this doesn’t mean that for an *individual* baby, breastfeeding might not make a big difference. My mothers from Africa all know this. The ones who are planning to travel back to Ethiopia, Somalia etc. are all very motivated to breastfeed and they can tell you why: access to formula and clean water is not reliable in their rural hometowns. But even when they breastfeed they know that traveling with their babies back home is not safe. It’s not safe for them or their older children either. War, traffic accidents, vaccine preventable illnesses, lack of medical care, the list goes on.
    When breastfeeding is a “do or die” situation in a country, you can be sure that the country is unsafe overall. Contaminated water that kills a baby can kill a child. Lack of infrastructure that makes access to formula difficult is the same lack of infrastructure that makes access to regular food and medical supplies etc. a problem.

    • Blue Chocobo

      Even the most “successful” breastfeeding doesn’t really even prevent malnutrition in impoverished areas. It just delays it. No matter what lactivists claim, you can’t just breastfeed forever, and the calories that go INTO breast milk have to come from somewhere.

      There’s no such thing as a free lunch.

  • AirPlant

    The thing that is making me a little crazy is the ovarian cancer lives that they are claiming. The best protection against ovarian cancer is reducing the number of times that a woman ovulates. Pregnancy and breastfeeding do that, but so does the pill. I am pretty willing to bet that a solid chunk of new mothers get on the birth control train before they manage to ovulate again. Can you really count those lives as saved by breastfeeding when they would not have been ovulating anyway breastfeeding or not?

    • demodocus

      on a population-wide basis, of course. My sister was 28 when she was first diagnosed. Amazingly, both she and the baby she was carrying are doing okay. He’s in 3rd grade.

      • AirPlant

        I am glad everybody is ok! That sounds like a terrible ordeal.

        • demodocus

          Thanks. Sib had a relapse when I was expecting my first, but she’s been upgraded to Stage III and her maintenence meds were halved last year, so she’s still beating odds. Appropriately, she works for one of the cancer research charities in a section that organizes fundraisers.

    • Azuran

      Reducing your risk of cancer is also such a good reason to have kids.

      • AirPlant

        I would guess that not having kids would ultimately reduce your risk of ovarian cancer. Staying on the pill for your entire fertile window would result in fewer ovulations than if you take two or three contraception breaks to conceive.

      • CSN0116

        There is no good reason to have kids. Not one. 😛

        • AirPlant

          It will make my mom stop texting me baby names and just start texting me parenting advice?

          • BeatriceC

            No, it won’t make her stop texting baby names, she’ll just add the parenting advise to the baby names. The pressure for baby #2 will start as soon as you announce the impending arrival of baby #1.

          • demodocus

            and the comments if you pick the “wrong” name like some people i could mention

        • BeatriceC

          If you consider added stress levels, premature grey hair, stretch marks and constant exhaustion positive things, then these are all good reasons to have kids.

          • Roadstergal

            I once sent my dad a father’s day card: “Nothing compares to the experience of being a father. Although shoveling money down a bottomless pit comes close.”

        • Dr Kitty

          The the only good reason to have kids is because you want to be a parent and feel that you have the skills and ability to be a good one.

    • Sarah

      Indeed, for some women breastfeeding would actually prevent them accessing their preferred type of ovarian cancer slaying contraceptive pill. After all, not everyone gets on with progesterone only.

    • nomofear

      I wondered about this! I’ve now been on the pill for nearly half my life, and both my maternal and paternal grandmothers, as well as my mother, had kids in their 40s. If the pill is keeping my eggs from dropping, am I further lengthing my potentially fertile years?

  • mostlyclueless

    OT: http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.4039.html
    Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer

    • demodocus

      Interesting, what I could see and understand of it, though it seems early to me to look for conclusions.

    • Roadstergal

      “Although the long-term health consequences of restoring the microbiota of C-section–delivered infants remain unclear”

      The long-term health consequences of the regular ‘C-section’ microbiota remains utterly goddam unclear! Come on, Nature.

      Also, check figure 1d. Dynamite plots are horrible things, especially when you’re dealing with few enough ns to just show the data (11 CS and 7 VB), and the reviewers should not have let those error bars pass. This paper is quite a shiteload of comparisons for so few ns.

      The message of figure 1c is ‘no difference.’ It really is.

      Supplementary figure 2 – the oral microbiota of non-inoculated C-section babies looks more like VB than inoculated. :p

      IMO, the conclusion of the study – wiping gauze on a vagina can result in bacteria getting on the gauze, and if you then wipe it on someone’s face and mouth, the bacteria will end up in their face and mouth for a while.

      Oh, and if you look at the basic table in the supplemental data – EBF and lack of maternal treatment with antibiotics was over-represented in the VB babies, especially problematic in a cohort so small. (All but one of the C-section babies were combo-fed). Oh, and D1 is the only day they have samples from all subjects.

      • Roadstergal

        Dammit, I need to do some crappy multi-comparison study on a tiny population and get a first-author Nature Med publication.

        • mostlyclueless

          word, it’s an interesting piece but with their staggering N of FOUR in the most important group I’m a little surprised nature med published.

          • demodocus

            they had 4 people/dyads in one of their groups?!?

          • mostlyclueless

            I think so. Supplementary Table 1. Characteristics of participating infants and mothers shows:

            7 babies born by normal c-section

            4 babies born by c-section + vaginal swab

            7 babies born vaginally

          • demodocus

            Missed that part. That is a freaking tiny sample.

          • BeatriceC

            *blinkblinkblinkblinkblink*

            When did Nature become a junk science journal?

          • mostlyclueless

            It’s Nature Medicine, which is part the Nature Publishing Group but not the actual flagship journal. That said it still has a high impact factor and I too am surprised they accepted the manuscript.

            Unfortunately it seems increasingly evident to me that journals will publish studies that drive traffic to them, as long as the studies can squeeze through peer review.

            That said, the article was very up front about the small sample size and acknowledged that this is a pilot study.

          • BeatriceC

            I do appreciate that they were upfront about the small sample sizes, and at least in the abstract, they were upfront about the fact that “different’ didn’t imply any sort of clinical significance, but those subtleties will be lost on most people reading it. I’m really getting very frustrated with some of these journals. With the way the media and anti-science crowd latch onto anything and twist things to their liking, I think the journals are abdicating in their responsibilities to make sure what they publish is solid. You know that the NCB crowd is going to latch onto this and make a much bigger deal over it than anything in the same ballpark of reasonable.

    • Charybdis

      About that term “restoration”. It implies that the baby has lost some of mom’s vaginal bacteria microbiome by being delivered by CS. So if they already have some of mom’s vaginal microbiota on board in utero, just being delivered by CS shouldn’t eliminate it. So their argument that vaginal is necessary because, microbiome, is sounding more and more ridiculous.

      To restore something means to return it to it’s original state. If the big argument is that babies need the trip through the vagina to get a life-changing, health-insuring dose of good bacteria and CS babies need to be dosed with mom’s vaginal swabs, then why are they using the word “restore”?

      Sorry, guys. It’s a pet peeve of mine when words are used incorrectly. Words have meanings and just because something is used commonly in everybody’s vernacular, does not mean it is used correctly. “Less” and “fewer” are NOT interchangeable, even though people use them that way. Vaccines are NOT injected “into the bloodstream”, “affect” and “effect” are not interchangeable either.. A CS baby *might* benefit from an initial dose of mom’s vaginal flora after birth, but it is not being partially restored. Because if it was, then that would mean that the baby already was colonized, and then where would their argument be?