Problematizing infant safety in the world of natural parenting

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There has never been a safer time or place to be an infant and small child than 2016 in industrialized countries. Ironically, there has never been greater anxiety about the physical, emotional and intellectual status of those same infants and small children.

Why is there an extraordinary disconnect between reality and anxiety? You can thank the cultural conceit of “natural parenting” for problematizing infant and child health … at the very same historical moment when infant and child health are extraordinarily good.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural parenting problematizes infant safety in order to pathologize women who don’t conform.[/pullquote]

Perinatal mortality, infant mortality, and child mortality are at historic lows. Vaccine preventable diseases have been nearly vanquished. Rates of sudden infant death syndrome are falling. Congenital defects like heart disease can be treated. Malnutrition and vitamin deficiencies are rare. Foods and medications are safer than ever because of government oversight.

But you’d never know that if you are part of the natural parenting culture, which justifies its intrusiveness into maternal choice by promoting fear in regard to infant and child health. Natural parenting advocates inflate risks of rare events to monstrous proportions or invent theoretical risks that have never been seen in real life.

For example, childbirth is inherently dangerous, but has been made dramatically safer by the liberal use of obstetric interventions. Yet to hear natural childbirth advocates tell it, childbirth is inherently safe and any dangers that exist are caused by technology.

Obstetricians are desperate to prevent brain injuries from lack of oxygen. Natural childbirth advocates pretend that the placenta is a miracle organ that never deviates from perfection and that “drugs” used to control labor pain threaten neonatal health.

Infant formula has never been safer or more nutritious. Yet to hear lactivists tell it, breastmilk is lifesaving and formula is deadly.

Vaccines have never been safer or more effective (as evidenced by the bottoming out of incidences of childhood diseases), but anti-vaxxers utterly ignore both medicine and history in denying the public health triumph of universal vaccination. Instead they obsess about rare or even fabricated vaccine injuries.

Food has never been safer. Natural parenting advocates have never been more afraid of food, wasting money on organic produce, blithering about GMOs, and dosing their children with unregulated supplements.

Pediatrics has never been safer or more effective at preventing disease and suffering. Natural parenting advocates have never been more sure that nonsense — homeopathy, cranio-sacral therapy, and herbal preparations — is the key to good health.

Why is there such a tremendous disconnect between reality and belief? Two reasons: privilege and problematizing.

The privilege issue is distressingly blatant. The only fears that count in the world of natural parenting are the fears of Western, white, well off parents.

Poor children and children of color face a plethora of truly life-threatening issues including hunger, lack of access to healthcare and gun violence. Poor children and children of color die each and every day because of these problems, but many privileged Western, white well off parents could care less. They oppose life saving free school meals, Obamacare and sensible gun regulations. Instead they are preoccupied by birth plans, brelfies and baby slings, though none of those do or could save lives.

What’s even more outrageous is that they are so insulated by privilege that they actually believe they are promoting safety by fetishizing birth, breastfeeding, organic food, vaccine opposition and homeopathy.

Using and misusing the language of science, natural parenting advocates problematize infant and child safety.

The natural childbirth industry of midwives, doulas and childbirth educators claim it is evidence based when the truth is that it is based on no evidence at all. They publish papers in industry trade papers disguised as scientific journals like the Lamaze International’s Birth: Issues in Perinatal Care.

Lactivists howl that low breastfeeding rates compromise infant health despite the fact that breastfeeding rates have no correlation at all with infant health. Infant mortality rates dropped precipitously through the 20th century despite the fact that for most of that time period breastfeeding rates dropped like a rock. Indeed, the countries with the highest infant mortality rates in the world have the highest breastfeeding rates.

Attachment parenting advocates have hijacked attachment theory (which postulates that children need only a “good enough” mother) in order to problematize infant attachment. The truth is that mother-infant attachment happens spontaneously, easily and is not contingent on any specific behaviors. In contrast, attachment parents obsess about promoting “bonding” through ritualized behaviors like baby wearing.

The philosophy of natural parenting is a “regime of truth” that has little to do with infants and children and a great deal to do with controlling women’s bodies and women’s lives.

As Sunna Simmonardottir writes in Constructing the attached mother in the “world’s most feminist country”:

…[T]he discourse on attachment has become another site for the medicalization of motherhood and maternal emotion… The role for women as mothers within attachment theory is considered to be narrow and conservative, promoting beliefs that are contrary to the interests of women. Cleary states that any feminist consideration of attachment theory should be mindful of the way it “not only describes but actively prescribes the nature of our psychological lives and ills”. This prescriptive nature of attachment theory has in turn led to the objectification and pathologization of women and presented women with the need to monitor themselves when it comes to their behavior toward their children.

By promoting fear about their children’s well-being, the philosophy of natural parenting causes women to tightly regulate their behavior so it conforms with the “rules” of natural parenting and to pathologize and blame themselves when they fail in conforming to those rules. Hence the outpouring of guilt and recrimination for epidurals, C-sections, formula feeding and other deviations from natural parenting diktat.

In other words, natural parenting problematizes infant safety in order to pathologize women who don’t conform.

  • Natural childbirth problematizes pain relief in childbirth in order to pathologize women who don’t accept that pain ought to be part of mothering.
  • Lactivism problematizes infant formula in order to pathologize women who don’t breastfeed.
  • Attachment parenting problematizes maternal independence in order to pathologize women who think there is more to life than mothering.

Why has natural parenting become popular despite the fact that it imagines threats to children that don’t exist?

Simmonardottir notes:

… According to Hays, the answer lies in the way the theory fits so neatly with our pre-existing cultural beliefs about the appropriate role of the mother and “operates so effectively as a means to keep women in their place”. Attachment theory “makes sense” for us as it taps into pre-existing ideas about the essential nature of men and women as well as the biological and evolutionary purpose of women’s reproductive abilities, where the relationship between mother and child is made to seem biologically determined but not socially constructed and historically specific…

And, of course, it reinforces the privilege of the privileged:

Additionally, it is important to acknowledge how middle-class, hetero-normative, and Anglo-centric norms of child rearing are assumed within the discourse of attachment theory, making it impossible for certain groups of women to discursively position themselves within the narrative of “good mothering”…

The bottom line is that children are not facing unprecedented threats to health that can only be ameliorated by natural parenting; they’ve never been healthier. Natural parenting problematizes infant/child health and safety in order to enforce a “regime of truth” regarding the appropriate role of women, robbing women of the opportunity to make the choices for themselves and their families that they deem best.

1,139 Responses to “Problematizing infant safety in the world of natural parenting”

  1. Amazed
    February 6, 2017 at 5:33 pm #

    Anecdote here: Amazing Niece was just diagnosed with yet another allergy. SIL would like to know just where these attested, confirmed, proven, etc. benefits of stellar health have gone. After all, the kid was EBF for many months. Only had her first lick of formula when she started trying to chew her mom’s nipples off. By then, she was already allergic.

    We’re pleased that at least SIL could pump so she didn’t need to stay with her baby 24/7 to make her the healthiest kid in town which didn’t work anyway. Somehow, I really doubt breastmilk was so much safer for her.

  2. myrewyn
    February 6, 2017 at 9:25 am #

    Hey Dr Kitty (or Dr Amy) — in one of your comments below I believe you mentioned that a woman over 40 shouldn’t go past 39 weeks of pregnancy and now I can’t find it back. I’m expecting my third and will be 43 by the time I deliver this one. I’m currently weighing TOL vs planned Caesarian. Can you elaborate on that comment?

    • Dr Kitty
      February 6, 2017 at 9:59 am #

      From RCOG guidance on Induction of labour at term in older mothers (https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_34.pdf)

      I quote from the final paragraph.

      “The incidence of stillbirth at term in women is low.
      It is higher in women of advanced maternal age.
      This at 39–40 weeks of gestation equates to 2 in 1000 for women ≥ 40 years of age compared to 1 in 1000
      for women < 35 years old.

      Women ≥ 40 years of age having a similar stillbirth risk at 39 weeks of gestation to women in their mid 20s at 41 weeks of gestation, at which stage the consensus is that
      induction of labour should be offered to prevent late stillbirth.

      There is therefore an argument for offering induction of labour at 39–40 weeks of gestation to women ≥ 40 years of age.

      The available evidence suggests this practice would reduce late antenatal stillbirths and maternal risks of an ongoing pregnancy such as pre–eclampsia. The argument is stronger where
      there are concurrent medical co–morbidities, nulliparity, or Afrocaribbean ethnicity; all are known to
      have higher stillbirth rates.

      However, at present there are insufficient data available on the effect such a policy would have on surgical deliveries and perinatal mortality specifically in older mothers. It is
      possible that any beneficial effect from prevention of late antepartum stillbirth is reversed by an increase in intrapartum stillbirths and neonatal deaths, although data on women of all ages shows an improvement in perinatal outcome.

      There is growing evidence that such a policy would not increase the number of operative vaginal deliveries or emergency caesarean sections. Such issues should be discussed
      with women who are older and pregnant."

      Basically- if you are 40, your risk of stillbirth at 39 weeks is the same as a younger woman's risk at 41 weeks, when induction is routinely recommended.

      As to TOL vs elective CS- that is very much your personal choice based on your own circumstances and past history and you should discuss it further with your care providers.

      Best of luck with everything and I hope that whatever you decide it goes smoothly!

      • myrewyn
        February 6, 2017 at 10:46 am #

        Thank you! We were just going to start talking about birth options at my next appointment when I will be ~28 weeks and I wanted to have already done some good thinking about it before I go in. So far everything has gone perfectly with this pregnancy and I don’t feel “old”… but I’m aware of my increased risks. Thanks again for the thorough response.

      • myrewyn
        February 13, 2017 at 4:29 pm #

        I just left my 28 week appointment and we are on for a 39 week induction! She brought it up first that with my age she would want to induce by my due date and so it was easy to segue into discussing that study, which she was familiar with. She said she usually starts with discussing a 40 week induction essentially because so many people want labor to start naturally but she agrees 39 weeks is better. I said, oh, as far as my “birth plan” goes just give me all the science! She laughed. Success!

  3. An Actual Attorney
    February 5, 2017 at 10:18 pm #

    A proposal: Stop replying to nikkilee. She’s a boring troll, and anyone who reads any bit of the comments can see she’s dishonest, an idiot, or both.

  4. Dr Kitty
    February 3, 2017 at 8:01 pm #

    https://www.google.co.uk/amp/www.bbc.co.uk/news/amp/38831313?client=safari

    Finally!
    We might see an end to the “mama” nonsense!

    The politically correct terms are “pregnant people”, “parents to be” or “expectant parents”, in case you are interested.

    Because not all pregnant people identify as women.

    Personally, I’m fine with this because I never liked the “mama” stuff, and being addressed in inclusive terms doesn’t bother me.

    I await the “mama- wombyn power” contingent tying themselves into knots trying to claim labour and birth as sacred wombyn empowerment while attempting to be trans- inclusive.

    • nikkilee
      February 4, 2017 at 8:05 am #

      That attitude is has been a barrier to transgender women participating in cis-gender womens activities.

  5. nikkilee
    January 20, 2017 at 9:53 am #

    The infant formula industry has made China, with its high birth rate, a target for marketing. The rates of childhood obesity are rising; lack of breastfeeding is cited as one of the major factors. https://www.ncbi.nlm.nih.gov/pubmed/23823460

    • Heidi
      January 20, 2017 at 10:11 am #

      “However, no association was found between paternal employment, breast-feeding practice in the first 4 to 6 months, or maternal age at the time of giving birth and the prevalence of overweight and obesity in our study sample.”

      Oh Nikki Lee. Can you read?

      • Roadstergal
        January 30, 2017 at 2:05 pm #

        You know, I think she’s so used to telling her echo chamber what the studies say that she really has no idea what to do when people actually read them.

        So she just ignores that part.

        • Heidi
          January 30, 2017 at 2:43 pm #

          I’m glad she’s ignoring it! I guess a true believer won’t be swayed, but her lack of response I think speaks volumes.

      • swbarnes2
        January 30, 2017 at 3:05 pm #

        She can read. She’s just a fundamentally dishonest person.

      • nikkilee
        February 5, 2017 at 6:59 pm #

        “However, we found the prevalence of overweight and obesity to be significantly associated with maternal employment status. Our study showed that the prevalence of overweight and obesity increased when mothers were employed.”

        How are the babies of employed mothers fed? Formula?

        • MaineJen
          February 5, 2017 at 7:52 pm #

          OMFG lady. That’s a horrible thing to say. Do you realize that?

          • Empress of the Iguana People
            February 5, 2017 at 8:16 pm #

            Not to mention she acts like medieval women didn’t work. *everyone* but the baby had to work. Hard.

        • Heidi
          February 5, 2017 at 8:17 pm #

          You are still a horrible, dense person, I see. The abstract spelled it out for you. Formula didn’t cause obesity.

          I know you want women back in the home. We got it. Just be honest.

        • Azuran
          February 5, 2017 at 8:44 pm #

          Wait, so the study said they found no link between formula and obesity, but found a link between working mothers and obesity.
          And what you decide to derive from this is that even though there was no direct link between formula and obesity, it’s STILL formula because you decided (without any proof, might I add) that working mother formula fed more?
          And you say that we are the one who are not having an honest discussion here.

          • Roadstergal
            February 6, 2017 at 11:22 am #

            Our workplace has a dedicated mothers’ room for pumping with a fridge for storing. Also, generous maternity and paternity leave. So any working woman here who wants to feed their kids breastmilk and is biologically able to, will.

        • momofone
          February 5, 2017 at 11:07 pm #

          My baby of an employed mother was fed breast milk. And it wasn’t worth it. (And with that, I’m out.)

    • Azuran
      January 20, 2017 at 10:22 am #

      seriously, did you even read that? It says exactly the opposite of what you say it does.

      • Heidi
        January 20, 2017 at 10:30 am #

        I think she’s so convinced that formula does all the worst things ever, she just saw breastfeeding and obesity and presumed it agreed with her little fantasies.

        • nikkilee
          January 30, 2017 at 9:24 pm #

          CDC agrees that breastfeeding and obesity are connected.

          • Heidi Fritz
            January 30, 2017 at 9:56 pm #

            Stick to the damn crapola you posted. You don’t give a crap about what the CDC has to say about vaccines so I take it you don’t even believe the CDC is a credible source. Quit the platitudes for once and respond to the crud you post or what any of us are actually saying.

          • nikkilee
            January 31, 2017 at 8:39 am #

            The CDC has done fabulous work with breastfeeding. I disagree about what they say about new vaccines.

          • Heidi
            January 31, 2017 at 9:35 am #

            I think we are all very aware of what you think. No need to reiterate. None of us thought you wouldn’t think yourself more knowledgeable about vaccines than the sum of people who have gone to school for years studying them and dedicated their lives to them.

          • Empress of the Iguana People
            January 31, 2017 at 9:55 am #

            It’s like there are dramatic, observable effects of vaccines like the lack of polio in most of the world after the introduction of polio vaccine or how rinderpest is eliminated, or something. And how there *aren’t* dramatic between the high formula use among boomers and much higher rates of bf’ing among earlier and later generations.

          • Madtowngirl
            January 31, 2017 at 10:09 am #

            Lactivist logic 101: The CDC, WHO, etc, are all totally credible sources when it supports our ideaology, but not when it doesn’t.

          • fiftyfifty1
            January 31, 2017 at 11:25 am #

            What does the study YOU posted say Nikkilee?

          • swbarnes2
            January 31, 2017 at 12:11 pm #

            NIkki, you aren’t fit to judge what is and is good research work. You lie when you claim otherwise. You don’t even read the papers. And you are so fundamentally dishonest you don’t even understand why that’s a problem.

          • momofone
            January 30, 2017 at 10:26 pm #

            What does the study YOU posted say?

    • Aine
      January 30, 2017 at 6:17 pm #

      High birth rate in China? Have you heard of the one-child policy? Recently relaxed to allow couples in specific circumstances choose to have two children. Not exactly a high birth rate by any standards. This is basic general knowledg.

      • nikkilee
        January 30, 2017 at 7:45 pm #

        The population of China is about 1.5 billion people. Enough babies that the formula industry is making China the focus of new marketing strategies and construction of factories.

        • momofone
          January 30, 2017 at 7:46 pm #

          Waiting for your response to the comments about what this study actually shows. If you had a shred of credibility you would have responded days ago.

          • The Bofa on the Sofa
            January 31, 2017 at 11:05 am #

            Yeah, I agree with momofone. All this other discussion is distraction from the fact that the study said exactly opposite of what nikki claimed.

            She is either a liar or a buffoon. Or both.

        • Nick Sanders
          January 30, 2017 at 8:13 pm #

          Companies responding to the presence of an untapped consumer base? The cheek of it!

        • Azuran
          January 30, 2017 at 8:48 pm #

          So?
          You sure don’t offer your own advice for free. You don’t see CPMs going around in poor neighbourhood to sell their services either, they go where people have money. Lactation consultants charge for their consultations as well.

        • momofone
          January 30, 2017 at 9:21 pm #

          Kind of like the way you market your wares to hospitals?

        • Dr Kitty
          January 31, 2017 at 5:34 am #

          A population of 1.5 billion people who generally can’t eat unfermented dairy products after childhood due to lactose intolerance.
          There is very little in the way of a dairy industry in China.

          With milk being a deeply unprofitable business (bottled water costs more per litre than milk in my local supermarket) dairy farmers are trying to diversify and get as much bang for their buck as possible.

          Turning unprofitable milk into profitable infant formula is a good business strategy- exporting to large foreign markets makes sound business sense.

          If you want to change that, maybe the solution involves not just promoting breast feeding, but paying dairy farmers a fair price for milk, which means spending less energy protesting formula and more energy protesting your big supermarket chains who continue to drive milk prices down.

          Dairy farmers aren’t choosing to sell milk to formula companies for any other reason than because it makes them good money. If they could make better money selling milk to Ben& Jerry for ice-cream, or to make butter or cheese or just selling milk to local supermarkets, they would do that.

          • nikkilee
            January 31, 2017 at 8:37 am #

            Interesting comments. Another reason foreign companies are importing to China is the melamine scandal of 2008. Some say the source of the problem is farmers caught between rising costs and a government cap on prices. The farmers, these critics say, added the melamine to boost the tested protein level of watered-down milk.

        • Aine
          January 31, 2017 at 9:37 am #

          Population size has nothing to do with birth rate. You are using words without knowing what they mean.

        • MaineJen
          February 1, 2017 at 10:01 am #

          “High birth rate” bwahahaha

          This word…I do not think it means what you think it means.

    • Roadstergal
      February 1, 2017 at 11:01 am #

      You still haven’t addressed the fact that this study says the exact opposite of what you claim, I see. Does this ‘lying’ stuff fly with the people you sell your services to? Whiffs of fraud, there.

    • nikkilee
      February 4, 2017 at 9:24 am #

      http://www.bbc.com/news/business-38851056

      • Heidi
        February 4, 2017 at 10:44 am #

        Point? Two children per couple isn’t high birthrate – that’s replacement rate. U.S. and European formula companies make a product that is at least perceived safer and is making money. Is this financial advice? Hey, maybe I’ll invest some money in Mead-Johnson and Abbott!

        • nikkilee
          February 5, 2017 at 6:56 pm #

          In 2010, nearly 16 million babies had been born in China. The annual number of births in China has increased continuously since 2010. In 2014, the number of births in China had reached 16.87 million. A replacement birth rate in a country of 1.3 billion is a lot of babies. . . or consumers, depending on who is looking.

          • MaineJen
            February 5, 2017 at 7:47 pm #

            Well…naturally, some of those mothers are going to want formula, no? Not all of them will be able or willing to breastfeed, I would think for the same reasons that American women are not always able or willing to breastfeed.

          • Heidi
            February 5, 2017 at 8:31 pm #

            So what?

            Are you anti-capitalist? Do you think all of us should be growing and raising our own food? We don’t have enough land for that and most of us don’t want to be farmers. If you’re so anti-consumerist, communes still exist.

            The only evidence you’ve provided is formula companies provide a product people want and need. Women want to work and they don’t want to stay at home all day. Their baby needs appropriate food to eat and people are willing to provide money for it. Big whoop.

  6. Dr Kitty
    January 15, 2017 at 7:53 pm #

    Had a lady in the other day who is EBF her colicky baby.
    We discussed a 2-4 week trial of a diet which excluded all
    Cows milk.
    She felt that wasn’t an option (she liked milk in her tea and on her cereal, apparently quite a lot).

    So we talked about 2 weeks of pumping and dumping with a hypo-allergenic formula, going back to EBF if baby didn’t improve.
    She felt that was too much hard work, but really wanted to continue to BF:

    So we decided that in the absence of any clear indicators of cows milk protein allergy that she would just continue to breast feed and we could re-visit the options down the line.

    The baby is thriving -no rashes, nothing to suggest CMPA, as far as I’m concerned she can knock herself out.

    Either it will grow out of the colic or we’ll end up discussing exclusion diets and hypoallergenic formulas again.

    Needless to say, if there had been evidence that baby had CMPI and needed a specialist diet, the outcome would have been different.

  7. Dr Kitty
    January 14, 2017 at 2:22 pm #

    For nikkilee
    http://ukscblog.com/case-comment-montgomery-v-lanarkshire-health-board-2015-uksc-11/

    This is the UK Supreme Court ruling about consent, specifically as applied to CS versus VB in the case of a diabetic woman whose baby suffered brain damage after shoulder dystocia.

    The Court has ruled that risks don’t come down to percentages, but to the importance the patient ascribes to them. Therefore a patient may rightly choose a treatment which avoids a rare but serious risk, even if it confers a higher chance of a risk the patient considers less serious. It is up to clinic and to advise on ALL risks, but the patient to ascribe their own weighting to them.

    From everything you have written here you seem to have a problem with this interpretation of patient autonomy and informed consent, in particular how it applies to more and timing of delivery.

    • Dr Kitty
      January 14, 2017 at 2:27 pm #

      Sorry- so many typos!!

      “Clinic and” should be “clinicians” and “more and timing” should be “mode and timing”.

      • Dr Kitty
        January 14, 2017 at 5:19 pm #

        Psst-
        Nikkilee- up here!

        I’d love to hear your thoughts on this.
        It’s been up for 3 hours now, while you responded to other comments downthread, you’ve been silent on this.

        Any comment?

        *hint- this is another character test and you’re not exactly winning the audience over so far.

        • nikkilee
          January 15, 2017 at 10:34 am #

          I am not here to win over the audience. Thanks for the link. US system is different. I like these comments:

          “The Court noted that “the “informed choice” qualification rests on a fundamentally different premise: it is predicated on the view that the patient is entitled to be told of risks where that is necessary for her to make an informed decision whether to incur them”

          “The Court also noted how “unreal” [5] it was to place the responsibility on patients to ask about potential risks. This leads to the “the drawing of excessively fine distinctions between questioning, on the one hand, and expressions of concern falling short of questioning, on the other hand” [6], the disregard of “the social and psychological realities of the relationship between a patient and her doctor”[7] and the odd finding that “the ignorance which such patients seek to have dispelled disqualifies them from obtaining the information they desire” [8].”

    • sdsures
      January 20, 2017 at 10:51 am #

      In general, most people are TERRIBLE about risk assessment.

    • ForeverMe
      January 20, 2017 at 6:16 pm #

      Re: the UK case posted by Dr. Kitty, but OT
      http://ukscblog.com/case-comment-montgomery-v-lanarkshire-health-board-2015-uksc-11/

      “An exception to the duty is if the doctor reasonably considers that the disclosure of the risk would “be seriously detrimental to the patient’s health” [12], or in circumstances of necessity. However, the Court made it clear that this exception should not be abused.”

      As an American, I am curious- in what scenario(s) would the above exception apply, esp. the “seriously detrimental…” part? (Not just in OB, but in UK medical care generally). Anyone know of any examples?

      • Dr Kitty
        January 20, 2017 at 6:43 pm #

        This is basically where you have someone who has a phobia of something which is a million to one chance of happening, but would decide to forego the treatment because of the risk.
        Say someone with a needle phobia who is told a procedure had a 1 in 1 million risk of causing diabetes, but the procedure would cure their current condition without problems 99/100 times.

        In reality, it is actually very hard to find a real life scenario where withholding information from your patient against their wishes is in their best interest.

        Even in extremis, where it is life or death, your patient still has a right to know the risks and weigh them up for him or herself.

        I run into difficulties where families don’t want their elderly relatives told their dire prognosis, lest they give up hope.

        I can ask the person if they want me to tell them their diagnosis and how much time the have left, but if the person wants to know and they have capacity, I can’t lie to them even if their family wants me to.

        Sometimes that causes issues.

        • ForeverMe
          January 21, 2017 at 2:51 pm #

          Dr. Kitty, Thank you for answering.

  8. Amazed
    January 14, 2017 at 11:15 am #

    OK, boys and girls. Pro-tip from your helpful Amazed: while it might make some sense tp argue with natural and anti-vaxxer loons in hopes that they might see the light and it does make sense to exchange thoughts and arguments with fence-sitters, it’s an exercise in futility to do so with someone who makes living off advertizing naturalness. That’s why you’ll never have a meaningful discussion with nikkilee, as interesting as it was for me to watch your exchanges.

    Just thought you might need a reminder. This isn’t your average “researching” mommiest mommy. That’s a professional natural-exploiter.

    • Nick Sanders
      January 14, 2017 at 11:19 am #

      I’m bored, and it’s a bit of a diversion that doesn’t take too much time.

      • Amazed
        January 14, 2017 at 11:27 am #

        I know that about you but I thought it might be helpful to remind people what she is. In discussions, people sometimes forget who they are arguing with.

        • Dr Kitty
          January 14, 2017 at 2:06 pm #

          Oh I’m not arguing with *her*, I just don’t like leaving some of her more egregious stuff sit there unrebutted for any lurkers who might be reading.

          I’m pretty sure she thinks I made terribly unfortunate choices and feels sad for me, but she doesn’t have the guts to actually say so, knowing that it will just make her look like the blinkered ideologue she is.

          • Dr Kitty
            January 14, 2017 at 5:48 pm #

            Correction- horrible thing happened to my friend and nikkilee’s insensitive comment might have been a little to much to take.
            So I’m being deliberately annoying.

            #sorrynotsorry.

          • Box of Salt
            January 15, 2017 at 12:30 am #

            Dr Kitty “I made terribly unfortunate choices and feels sad for me” Right with you on that one. And she can’t cope with how we don’t fit into her narrative.

          • nikkilee
            January 15, 2017 at 12:51 pm #

            No judgements; not taking things personally. I have control over only my own choices. I come here for different reasons, and you have all taught me a lot.

          • Dr Kitty
            January 15, 2017 at 12:53 pm #

            Really?
            Like what, for example?

          • nikkilee
            January 15, 2017 at 3:23 pm #

            That evidence doesn’t change beliefs.

          • Dr Kitty
            January 15, 2017 at 3:45 pm #

            What convincing evidence have you, personally, presented?
            What was meant to change our minds?

            You cited nausea and vomiting as risks of CS, for example, and then happily acknowledged that it is a risk of VB also.
            You can’t reason your way out of a paper bag.

            What I think you mean to say is that poor quality evidence doesn’t convince well educated people.

            You’re right, NOTHING you have posted has in any way changed my belief that your knowledge of up to date research and practice in obstetrics surpasses mine.

          • Empress of the Iguana People
            January 15, 2017 at 3:59 pm #

            i’m unconvinced her knowledge surpasses -mine,- and i’m a history teacher. I know damn little.

          • Amazed
            January 15, 2017 at 4:05 pm #

            Makes two of us. No, not two history teachers. Two non-medical professionals whose knowledge has moved past the 80s.

            Really, with her boasting of her 40 years of experience, I am bound to think of Antigonos. She has about this much but seems to keep her knowledge updated whike nikkilee’s seems anchored in the years I was still playing with dolls.

          • Heidi
            January 15, 2017 at 4:09 pm #

            Nikki Lee is very self-centered. It’s not that she’s even stuck in the 80s. Nikki Lee wanted to stay at home with her children when she gave birth, Nikki Lee wanted to breastfeed, Nikki Lee wanted a homebirth so what Nikki Lee wants is what is best and thus what everyone wants. And she’ll go scouring for “evidence” that her way is the best way to boost her self-esteem and to make a little money.

          • maidmarian555
            January 15, 2017 at 4:38 pm #

            You don’t even need to have any level of medical or historical knowledge. It’s about empathy. If you care about women and babies that benefit from medicalised care, you can see the hatefulness in many of her statements. All you need is to be a half-decent human being to see that what she’s saying isn’t quite right.

          • BeatriceC
            January 15, 2017 at 6:49 pm #

            I’m another non medical person who’s knowledge has moved past the 80’s. Wanna know how I evaluate research? I zero in on the statistical analysis, since that *is* my area of expertise. Once I’m convinced there’s no shenanigans in the analysis (like data torture, poor study design, etc), then I’ll read the study. It’s amazing how much time I save just tossing out anything with bad statistical analysis. (Now granted, there might be some good info in some studies where the data was tortured, but more than likely not).

          • Empress of the Iguana People
            January 15, 2017 at 9:07 pm #

            The studies are mostly outside my skill set, such as they are, but I read history books and journal articles well enough to know not to trust Mother Nature!

          • nikkilee
            January 15, 2017 at 4:41 pm #

            This is a unique forum, full of conundrums. For example, there is no evidence to identifying health benefits of feeding formula (and some here have acknowledged that), and every piece of evidence that supports what governments and health agencies’ from around the world recommend about breastfeeding is rejected. For healthy, low-risk women, birth in a free-standing birth center attended by midwives is at least as safe as birthing in a hospital, and in some case, offers better outcomes. That is not accepted here. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1208-1

          • maidmarian555
            January 15, 2017 at 5:02 pm #

            Because that is not the case in many, many individual cases. I have a big health benefit from formula feeding- the baby gets to eat and doesn’t starve to death. You don’t need to produce a study to show me my healthy, thriving son for that. Formula doesn’t hurt babies. It’s just another way of feeding those for whom breastfeeding doesn’t work. Want to respond to your completely incorrect list of formula ingredients that you invented and then a bunch of us went out of our way to repudiate? No? Didn’t think so. Also, I had a healthy, low risk pregnancy. As I’ve said many times, if I’d have waited for labour to start in a birthing centre, both my son and I would be dead. There is no one-size-fits-all solution for birth. Many things can go wrong. Women should be allowed to choose what’s right/safe for them without people like you trying to make them feel shitty for doing the best for them and their babies. Natural didn’t work for me. Doesn’t work for many women. Who are you, to criticise us for feeling thankful that medical solutions existed so that we are alive today? I refuse to feel bad that me and my son are alive today. Sorry.

          • Who?
            January 15, 2017 at 5:03 pm #

            One of the health benefits of formula is a fed baby, where mum can’t/won’t breastfeed.

            The trouble with ‘in most cases’ at the freestanding birth centre is that there’s not always a crystal ball available to allow people to know which labours are going to go wrong.

          • The Bofa on the Sofa
            January 15, 2017 at 5:09 pm #

            I have explained the benefits of formula feeding for our family. A happy mom and $15k. You don’t think that leads to better health?

          • nikkilee
            January 15, 2017 at 8:08 pm #

            Evidence versus personal experience are two different things.

          • Heidi
            January 15, 2017 at 8:28 pm #

            Try answering the actual question asked.

            Nikki Lee’s personal experience is evidence but everyone else’s personal experiences don’t count. (See her spiel about EDD not being accurate cuz her baby had vernix.)

          • nikkilee
            January 15, 2017 at 11:11 pm #

            Try reading what I wrote.

          • Heidi
            January 16, 2017 at 7:32 am #

            I read what bofa wrote. He asked a very specific question and you totally didn’t answer him. You had three options basically: yes, no, maybe/don’t know. The platitudes about populations, not individuals and every variation on that are wearing thin, especially when they don’t seem to apply to you. Individuals absolutely do matter. I don’t know why answering in a straight forward manner is so hard for you.

          • The Bofa on the Sofa
            January 16, 2017 at 8:22 am #

            No, her answer was pretty clear. She just couldn’t bring herself to say, “you are right. Formula was better for you.”

            The irony, of course, is that she notes how our individual situation doesn’t apply in terms of the population level evidence, but then fails to recognize that in the exact same way, “the evidence” does not apply to individuals.

          • nikkilee
            January 16, 2017 at 8:49 am #

            “Depends what evidence you are talking about. If you are talking populations, then my personal experience is only one part of a large picture.” Case studies are lower in the hierarchy of evidence; meta-analysis is the highest.

            Individuals do what is best for them. Research outcomes look at populations.

          • Heidi
            January 16, 2017 at 8:52 am #

            You replied to the wrong person.

          • Azuran
            January 16, 2017 at 9:30 am #

            Indeed, individuals should be allowed to do that they feel is best for them. However, that requires that they receive proper information and education. Which you do not provide.

          • The Bofa on the Sofa
            January 16, 2017 at 10:56 am #

            Individuals do what is best for them. Research outcomes look at populations.

            How can what individuals doing what is best for them lead to worse results overall?

          • nikkilee
            January 16, 2017 at 6:18 pm #

            Best choices and best outcomes don’t go together.

          • The Bofa on the Sofa
            January 16, 2017 at 6:48 pm #

            Um, yes they do. Kind of by definition. The best choices are the ones that give the best outcomes. That’s what makes them the best choices.

            Your problem is still that you are trying to apply population results to individuals.

            If we had breastfed, that would have been a worse outcome for us, and therefore would have been worse for the entire population.

          • Azuran
            January 16, 2017 at 7:22 pm #

            Yea, they kinda do. The best choice is the choice that gives the best chance of the desired outcome to a specific individual.
            And what is best also depends on the individual. Not everyone has the same goals and what is considered the best outcome for one isn’t the best outcome for another.

          • momofone
            January 18, 2017 at 10:29 am #

            So, question:

            My son was born at 38w3days due to placental degradation. His dad and I made the choice to deliver then because though we are not medical professionals, we had the impressions that placentas are fairly important. (It was also the recommendation of my clearly trying-to-get-to-the-golf-course OB.) He lived! In what way would you consider that a less-than-best outcome?

          • nikkilee
            January 18, 2017 at 12:46 pm #

            Technology being used for the right reasons is appropriate. Technology used routinely is not appropriate.

          • momofone
            January 18, 2017 at 12:48 pm #

            That is not what I asked.

          • Empress of the Iguana People
            January 18, 2017 at 1:40 pm #

            That’s the silliest statement I’ve read yet. And I read one sentence that said “You might have to tickle-tackle your dragon to get his socks on.” So, do you prefer to cut umbilical cords with your teeth or let your pet wolf eat it?

          • momofone
            January 18, 2017 at 9:09 pm #

            I see that you’ve responded to other posts since I posted earlier asking for a clear, direct answer to my question. Should I take this as confirmation that you cannot or will not respond?

          • Azuran
            January 18, 2017 at 9:49 pm #

            What does that even mean? Does that mean that you oppose the use or routine screening tests? How are you supposed to know there is something wrong if you don’t use technology to do routine testing and screenings?

          • swbarnes2
            January 19, 2017 at 1:06 am #

            It means she is anti-hatting.

          • Juana
            January 19, 2017 at 1:35 am #

            I guess it’s the same notion as with unnecesareans (sp?) – every CS where both mother and baby end up unharmed (or the baby gets out undistressed/alive) was unnecessary.

          • nikkilee
            January 19, 2017 at 7:52 am #

            Routine screening tests, when used appropriately, are clearly useful. Like using an occult stool screening to see if a colonoscopy is warranted. When a pregnancy went nearly a month past the due date, using regular testing enabled me to make my own best choices. However, giving every single woman in labor an IV with pitocin in it, is not appropriate. What used to be done in an as-needed event has now become routine practice. Having seen physicians do dangerous things, such as wanting a multiparous woman having minute-long contractions every 3 to 5 minutes to be given an IV with pitocin in it is one example. Having working in the maternity care system for over 40 years, and teaching in it, and reading, is a foundation to make choices.The technology isn’t always helpful: there is just as much cerebral palsy now as there was before EFM became routine practice.

          • momofone
            January 19, 2017 at 8:12 am #

            But it all comes down to risk and context, doesn’t it? With my family history, if my physician had stopped with the false-negative results of my occult stool test, I would be dead. Fortunately he knew to pursue more comprehensive testing based on both my report and my risk factors. I wonder how many things you have missed because of your aversion to the use of technology and your blind trust of nature. It’s frightening to think about.

            By the way, you still haven’t answered my question. 🙂

          • Daleth
            January 19, 2017 at 9:13 am #

            You are aware, aren’t you, that pitocin is given not just to assist or trigger labor, but to prevent PPH by helping an exhausted uterus contract sufficiently to stop bleeding? Or would you post somewhere about how terrible it was that I was given pitocin right after my c-section, when obviously with the babies out I had no need for a labor drug?

          • nikkilee
            January 20, 2017 at 9:27 am #

            My comment was about the use of pitocin in labor.

          • Azuran
            January 19, 2017 at 9:18 am #

            So I see that once again, you are just complaining against medicine in general. Despite not having any kind of proof that anyone is doing anything wrong.
            No one is giving every single woman in labour an IV of pitocin. As for your claim of a doctor pushing pit on that woman: Probably there was a reason that you do not understand, as you have proven time and time again that you stick your nose in things without having the full picture
            So I wouldn’t trust your ’40 years experience’ since you apparently still think today that it’s ok to tell total stranger that they shouldn’t follow medical advice even though you know nothing about them. That you say stupid stuff like ‘babies know when to be born’ and that you didn’t know induction reduces the risks of c-section until last week.
            And apparently you think that cerebral palsy is the ONLY thing that EFM is supposed to prevent.

          • nikkilee
            January 20, 2017 at 9:50 am #

            In my community, it is rare for a woman in labor not to receive pitocin. I know this because I teach hundreds of nurses from all the area hospitals every year and I ask them. In Mississippi, pitocin is not used routinely in labor, at least in the Hattiesburg region.

            It is difficult to find what is the national rate of pitocin use in labor.

            Induction of labor is underreported: http://www.nationalpartnership.org/research-library/maternal-health/quick-facts-about-labor-induction.pdf

            http://www.nationalpartnership.org/research-library/maternal-health/quick-facts-about-labor-induction.pdf

            ACOG has discovered that pitocin has adverse effects on babies. http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Study-Finds-Adverse-Effects-of-Pitocin-in-Newborns

          • Azuran
            January 20, 2017 at 10:29 am #

            And you think that asking people how often pitocin is used is a proper way of measuring this? Especially asking nurses who are not the one making the decision, and probably don’t know why a specific case gets a specific treatment.

            Clearly, you present yourself as someone who is against the use of modern medicine, you obviously have something against pitocin for example.
            Your classes are not mandatory, People go to your class because THEY are interested in what YOU have to say. If they are interested in your class, it’s probably because they share some of your views. Meaning that they probably align more with your anti-medicine view than the average nurse. And it’s obvious that if someone thinks that pitocin is bad, they are WAY more likely to take notice of every single case that uses it and remember them more and dismiss and forget cases where it’s not used.

          • nikkilee
            January 20, 2017 at 3:54 pm #

            I ask the audience how often do they see spontaneous, unmedicated labors. My classes are mandatory for some facilities. Pitocin per se is neither good nor bad. Physiologically, it is different to natural oxytocin. It is how it is used that makes the difference, whether it is used routinely or not.

          • Azuran
            January 20, 2017 at 4:26 pm #

            I would expect that not many people get to see ‘spontaneous’ labour because women typically get to the hospital AFTER their labour started.
            So yea, if you go to the hospital without actually being in labour, you either get sent back home, or you probably had an appointment for an induction/c-section.
            You are again just being an hypocrite. You would be crying bloody murder if Doctors where deciding how to best treat patients by ‘asking the audience’. Why do you think it’s appropriate for you to do this?
            and again: asking people their own experience, even if they are nurses, is in no way an adequate way to measure something.

            But then again, if pitocin is neither good nor bad, why does it matter if it’s used routinely or not? You really make no logical sence

          • momofone
            January 20, 2017 at 9:15 pm #

            Is it your job to determine when it’s needed, or to order it for a patient?

          • momofone
            January 20, 2017 at 11:16 am #

            I live in Mississippi, and could not be more dismayed to hear that you are “teaching” anyone here. We have enough problems without your adding woo to the mix.

          • nikkilee
            January 20, 2017 at 1:05 pm #

            Public health agencies in Mississippi feel differently.

          • momofone
            January 20, 2017 at 6:00 pm #

            Do they? Please provide documentation of that. Because the people I know who teach healthcare professionals are not fans of the Baby Friendly Initiative.

          • nikkilee
            January 20, 2017 at 8:00 pm #

            I was brought there to teach; hospital staff from at least 4 hospitals were there. I was part of an initiative that seeks to do something about Mississippi being at the bottom of most public health outcomes.

          • momofone
            January 20, 2017 at 8:40 pm #

            I fully support an initiative that does something about that. I do not support woo in the service of accomplishing improvement.

          • Daleth
            January 19, 2017 at 9:22 am #

            The technology isn’t always helpful: there is just as much cerebral palsy now as there was before EFM became routine practice.

            The reason cerebral palsy rates haven’t plummeted since EFM was introduced has NOTHING to do with EFM. It’s because extremely premature infants are surviving now who would have died before. Babies who would have died in the 1960s/70s/80s/even 90s are now surviving, albeit with CP and other neurodevelopmental disorders, because neonatal care has vastly improved since then.

            If you stratify the CP rates by gestational age, or by birthweight (a good proxy for gestational age), you’ll see less CP in term and near-term infants, and far more in preterm and extremely preterm infants.

            So actually the technology IS helpful. EFM helps prevent CP in term and near-term babies, and other technologies help preterm babies survive instead of dying.

          • nikkilee
            January 20, 2017 at 9:36 am #

            According to the United Cerebral Palsy Research and Educational Foundation, 70% of brain damage that causes Cerebral Palsy occurs prior to birth, mostly in the second and third pregnancy trimesters. Twenty percent occurs during the birthing period while 10% occurs during the first two years of life while the brain is still forming. The industry has identified four key terms to help discern “when” the brain damage occurs.

            Causes of congenital Cerebral Palsy include oxygen deprivation, complex pregnancies, medical malpractice, preterm birth, low birth weight, growth restriction, sexually transmitted disease, birth positioning, placental complications, fetal strokes, bleeding in the brain, poorly treated health conditions, trauma to the developing fetus and exposure to toxins during critical stages of development. Infections and fevers also contribute to the occurrence of congenital Cerebral Palsy.

          • Daleth
            January 20, 2017 at 10:26 am #

            Thank you for agreeing with me. Nice to know that you are retracting your initial claim that because rates of cerebral palsy haven’t dropped since EFM was introduced, routine EFM is bad.

            I mean, after all, here you are admitting that 80% of cerebral palsy cases occur at a time other than labor (i.e., a time when EFM cannot possibly help), so rates of CP are pretty much irrelevant when it comes to telling us whether EFM is a good thing.

          • sdsures
            January 20, 2017 at 10:48 am #

            You act like cerebral palsy is just one type – the worst imaginable. It’s not your fault, though – unless you have it or have a child who has it, all you know comes from the media, which tends to trot out the worst cases of CP that are confined to a mechanical wheelchair, can’t feed themselves, and have severe speech problems that are easily mistaken for developmental delay.

            In reality, it’s a very wide spectrum, and some patients can have mild to moderate CP and still lead normal lives.

          • Empress of the Iguana People
            January 19, 2017 at 9:35 am #

            Not screening until a month past due date? Are you nuts?

          • nikkilee
            January 20, 2017 at 9:29 am #

            I didn’t write that clearly. I was screened several times a week each of the nearly 4 weeks after the EDC; NST and several biophysical profiles.

          • moto_librarian
            January 19, 2017 at 11:28 am #

            But EFM has lowered the stillbirth rate. And I want to see proof that every laboring woman in the hospital is given pitocin during labor. I had none during my first labor – hell, I didn’t even have an IV.

          • nikkilee
            January 20, 2017 at 9:15 am #

            Every year, I teach hundreds of hospital nurses from all the hospitals in my region. I ask them about spontaneous undisturbed labor, and labors without pitocin. They laugh and say, “Well if she comes to the hospital pushing, she won’t get pit.” There is regional variation in this practice; when I taught i Mississippi, the nurses there said that pitocin is not routinely given to laboring women.

          • Daleth
            January 20, 2017 at 9:52 am #

            A handful of comments from your classroom every year, and you conclude that *in general* hospitals give pitocin to all laboring women? Seriously, if I posted a study with that methodology, you yourself would laugh at me, and rightly so.

          • nikkilee
            January 20, 2017 at 9:55 am #

            It is far more than a handful, when 20 or 30 nurses in a class agree, and when these nurses are coming from every hospital in the region. Speaking to people who are doing the work, right now, has value.

          • Daleth
            January 20, 2017 at 10:24 am #

            You said your classes contain hundreds of nurses. If 20-30 out of, say, 200-300 nurses all say that in their experience X is true, what in god’s name permits you to assume that it is true for the roughly, what, 80% of nurses who did not agree?

          • momofone
            January 20, 2017 at 11:14 am #

            How, again, are your classes populated? Largely self-selection if I recall correctly.

          • nikkilee
            January 20, 2017 at 1:08 pm #

            Hospitals involved in changing policy and practice (encouraged by the CDC, the Surgeon-General, ACOG, AAP, and APHA) mandate their staff to receive trainings. All healthcare professionals should have received 20 hours of breastfeeding education; the course I teach is just that, using an outline from BabyFriendly USA. Others choose to take my class. I have a mix of community and hospital workers.

          • momofone
            January 20, 2017 at 5:59 pm #

            So, again, largely self-selected.

          • Azuran
            January 20, 2017 at 1:45 pm #

            And all vets have this ‘joke’ about how orange cats are more likely than other cats to have urethral obstruction than other cats, and that they are more likely to have complication. Where did this come from? I have no idea. And I have never found any shred of evidence for this. But I’ve heard it being said at school, and by basically every vet I know agrees with this. Yet it’s based on 0 scientific evidence (and more than probably is not true)
            It’s probably just a case of selection and recollection bias.
            80% of orange cats are males. Urethral obstruction happens almost exclusively in males. Orange cats are rare, so you remember them more.

            Speaking to people who are doing the work has 0 scientific value in how to make medical decisions.

            And BTW, 20-30 nurses IS a handful. That is not in any way a statistically significant portion of nurses working in birthing ward. Even if we limit it to only your region.

          • MayonnaiseJane
            January 20, 2017 at 2:17 pm #

            OTish: How do I know if my ginger boy has an obstruction? Will he make a fuss? I think I’d notice genital irritation on my tuxy… he’s a shorthair and likes to clean his privates in the middle of the livingroom while holding eye contact (weird cat) but the ginger is longhair.

          • Azuran
            January 20, 2017 at 5:10 pm #

            Generally, cats with an obstruction will strain a lot. They keep going to the litter, stay there very long period of time, complain, strain and either don’t urinate or only urinate a few drops. (many owners actually mistake this for constipation.) They are also generally very uncomfortable, they will be moody or aggressive, hide, avoid contact etc. Grabbing them by the belly will result in very obvious pain.
            Some times you can find little drops of urine (with or without blood) on the floor.
            Some cats will lick their genitals more, but not all of them, and it’s generally not irritated or really visible.

            Any male cat with any kind of urinary problem (blood, pain, light straining, urinating outside the litter) should be seen by a vet, as any untreated urinary problem can lead to an obstruction. If the cat is visibly straining, it should be seen ASAP as an obstructed cat can degrade very rapidly and die within 48 hours.

          • MayonnaiseJane
            January 20, 2017 at 5:19 pm #

            Gotcha… so as long as he’s still supper huggable, all is well. 🙂 Wait… does this mean that the chronicly wee-wee licking tuxy might be trying to tell me something? I mean he’s cuddly too… but… he does pay an AWFUL lot of attention to his little-pink-tick-tack.

          • Azuran
            January 20, 2017 at 6:42 pm #

            I don’t think I’d be worried if there is no visible irritation, he doesn’t have any urinary problem and it’s a behaviour that he had for a long time.
            He’s probably just a little pervy 😉

          • MayonnaiseJane
            January 20, 2017 at 6:51 pm #

            That’s what my husband says. Lol. He doesn’t like the cat licking himself while staring at me. He’s all “Hey! That’s MY wife!!!” I kinda hope he’s not into me like that though… because last I checked he thought I was his mother, and that’d be really weird if he was into his mom. (I’m aware cat’s generally don’t think that. The ginger sure doesn’t but the tuxy brat was abandoned in the city park waaaay small and does that “suckling” on shirts thing…)

          • moto_librarian
            January 20, 2017 at 10:07 am #

            You have no business teaching nurses anything.

          • fiftyfifty1
            January 19, 2017 at 10:27 am #

            ” Technology used routinely is not appropriate”
            …types the woman on her computer …

          • nikkilee
            January 20, 2017 at 9:30 am #

            Birth technology used routinely is not appropriate.

          • Azuran
            January 20, 2017 at 9:41 am #

            You should be more specific. What birth technology? All of them? Some of them? What makes you an expert in deciding when they are appropriate? As far as I know, you aren’t a doctor.

          • The Bofa on the Sofa
            January 20, 2017 at 9:59 am #

            Don’t you know? If a midwife can do it, then it is acceptable technology. If a midwife can’t do it, it is in appropriate.

          • Charybdis
            January 20, 2017 at 10:18 am #

            Why is that, exactly? Does it somehow interfere with the Ancient Birth Mysticism BS the NCB/EBF folks espouse?

          • momofone
            January 20, 2017 at 11:06 am #

            Who do you think should make that decision–patient, doctor, nurse, you?

            Edited to add, just for the record, that I want ALL the birth technology if I’m the one having the baby.

          • nikkilee
            January 20, 2017 at 3:56 pm #

            In an emergency, the licensed health care provider. In normal circumstances, the mother and provider.

          • maidmarian555
            January 20, 2017 at 4:19 pm #

            So if you think it’s the mother and her provider’s choice whether to take advantage of ‘routine’ birth technology, maybe you should stop sticking your nose in and saying it’s “not appropriate” when used routinely. Also, define “emergency” when applied to appropriate use of a hormone drip. Because here it’s used for induction (only after every other method has been tried and failed) and failure to progress if a labour is going on way too long. How many hours should a woman be experiencing (SUFFERING) contractions (which may be erratic) and not dilating before a drip is administered? As I’ve said before, you can’t keep denigrating the ‘routine’ use of interventions and then dodge specific questions about what would constitute a ‘genuine’ need.

          • Azuran
            January 20, 2017 at 4:28 pm #

            And generally, the primary health care provider is the Doctor.

          • momofone
            January 20, 2017 at 6:33 pm #

            So essentially, you believe the person/people who should be making these decisions are the people who actually already ARE making them. Your problem is that they’re making different ones than you support.

          • fiftyfifty1
            January 20, 2017 at 6:01 pm #

            “Birth technology used routinely is not appropriate.”

            Got it. If nikkilee wants to use a technology, it’s appropriate for routine use. If nikkilee doesn’t want to use a technology, it’s not appropriate for routine use. Doesn’t matter what the evidence shows or what other women may want or choose.

          • EmbraceYourInnerCrone
            January 20, 2017 at 10:16 am #

            Humans especially in first world countries use technology for everything to improve their lives. Technology makes life easier and safer in everything from loading and unloading and tracking shipping containers, to improved methods for insulating and heating homes, to recycling, to testing and clinical trials for new medications and treatments. We live in homes that are cooled and heated and were built with technology. Technology is helping feed the 7 billion humans on earth(and technology is in large part how we ended up with 7 billion people) Technology helps find people after disasters and keeps them alive. Technology prints our books and transmits our data, and allows us to communicate with colleagues thousands of miles away.

            All of us use “technology” all day every day unless we are living in a cave and eating only what we can catch ourselves.

            Why should only pregnant women be forced to have technology rationed? Sorry I want the access to Rhogam, ultrasounds, tests for gestational diabetes, prophylactic treatment for Group B strep, C-sections for macrosomia, and breech and placenta previa and maybe twins. I want the monitoring of BP and quick treatment of pre-e and post-e. All the lovely advances in obstetrics means my daughters children maybe won’t die of the things that killed my mother and grandmothers siblings, mothers or sisters.

          • fiftyfifty1
            January 16, 2017 at 7:37 pm #

            “Case studies are lower in the hierarchy of evidence; meta-analysis is the highest.”

            LOL, you have no idea what you are talking about. What evidence is “best” depends greatly. A single case study may be perfectly sufficient for some things (the classic Statistics 101 example is jumping out of an airplane without a parachute.) And of course where meta-analyses are concerned “garbage in, garbage out”.

          • sdsures
            January 16, 2017 at 9:42 pm #

            “Research outcomes look at populations.”

            No, they don’t. Research outcomes look at samples. Statistics 101.

          • momofone
            January 16, 2017 at 11:12 am #

            Or you could try reading what other people have written. Many people here have given you firsthand examples of exceptions to your claims, which you discount with your populations vs individuals comments. You are so invested in breastfeeding being the supreme method of feeding no matter what that you are deaf to anything that contradicts that.

          • Azuran
            January 15, 2017 at 9:48 pm #

            Not in any kind of medical practice. Being a health care professional means being able to look at the data, then at the patient, and decide, between all the possible options, which ones are best suited to a specific patient.
            There is NEVER a once size fits all in medicine. There is NEVER any option that is best for everyone.
            You don’t push the ‘statistically’ best treatment. You tailor your care to every single patient in front of you, based on ALL the evidence

          • The Bofa on the Sofa
            January 16, 2017 at 8:01 am #

            Depends what evidence you are talking about. If you are talking populations, then my personal experience is only one part of a large picture.

            But if you are talking individuals, then my experience demonstrates unequivocally that formula feeding can be more beneficial than breastfeeding.

            This is your problem. We ARE talking about individuals, and what is best for them. Just as in your “babies are born when they are ready” crap, you make generalities when we are talking about individuals. You could say, “in general, babies are born when they are ready.” But that means nothing to a woman who has a prime, or to the mother of a stillborn. Regardless of what happens in general, each pregnancy must be considered individually. As does each baby in feeding.

            You would be wise to learn this guideline: all else equal, breast is better. But all else is never equal.

            These are individual decisions made at an individual level. Population statistics mean squat.

          • nikkilee
            January 16, 2017 at 8:50 am #

            “These are individual decisions made at an individual level. Population statistics mean squat” to the individual. The theme of this forum. Thanks.

          • Heidi
            January 16, 2017 at 9:30 am #

            Breastfeeding studies really don’t look at the whole population and they never will! Breastfeeding is very self-selecting. In the developed world, it’s always going to be the privileged-in-so-many-ways population that does breastfeed. In the developing world, we have issues of water contamination. Breastfeeding, if possible is better than feeding a baby contaminated water in those situations, and literally no one said it isn’t. But that still leaves moms who aren’t able to breastfeed (and those do exist and they are a sizable chunk of the population!) having to feed a baby with contaminated water and it still leaves women having to prepare food after 6 months with contaminated water. Babies still have poor outcomes in the developing world despite being breastfed. We’d do best by these people by providing them infrastructure. However, I didn’t notice you rah-rahing clean water. It’d save more children than breastfeeding.

            There’s nothing in breast milk and the way it is consumed that makes it that much better than formula. It has antibodies, sure, but very few antibodies consumed orally do any good. That’s why most vaccines aren’t taken orally. The kind of antibodies that can be consumed orally are for GI illness and colds. But the nature of those kind illnesses is they mutate so quickly they don’t provide that much protection. A measly 8% reduction, which means multiple women have to breastfeed to reduce *ONE* cold among multiple babies, not to prevent one baby from ever getting sick. My antibodies for a cold I had in 1989 is unlikely to do much for a cold strain in 2017 or that diarrhea I had in 1992 probably didn’t produce antibodies that do much for a 2017 strain of random tummy bug.

            And to say formula doesn’t offer health benefits is beyond dumb. You know it does. Would you seriously feed a baby with galactosemia breast milk? Would you seriously starve a child who didn’t have access to breast milk?

          • nikkilee
            January 16, 2017 at 10:34 am #

            There are no studies showing that babies receive health benefits from formula feeding. Industry can’t do that. Classical galactosemia does require that a baby be fed formula; depending on which study you read, this happens in 1: 30,00 to 85,000 births. Duarte’s galactosemia would allow for some breastfeeding, along with regular clinical monitoring. Formula was designed as emergency replacement feeding when it was invented in the 1860s; a combination of factors (the rise of industrialization, two world wars, the rise of science and corporate influence) lead to its spread). The impact on the environment is another problem with the globalization of formula. Formula manufacturing, packaging, transportation, and trash are environmentally costly. Breastfeeding itself is a sustainable process, leaving no carbon footprints. Pumps are environmentally costly. Another conundrum to be solved.

          • The Bofa on the Sofa
            January 16, 2017 at 10:54 am #

            There are no studies showing that babies receive health benefits from formula feeding.

            Yeah, because all else equal, breastfeeding is better.

            But that does not tell us much when all else is not equal. As in, always.

            These are decisions made by individuals according to their individual situations. They are not basing it on what is better for everyone else, but on what is best for them.

            You have a problem with that.

          • Heidi
            January 16, 2017 at 10:56 am #

            Because moms don’t eat right? And when they do eat their *extra* calories, you can guarantee it’s in a highly sustainable way? Surely, they wouldn’t be relying on convenience foods, like maybe UHT milk cartons or prepackaged yogurts or nuts, or anything like that on a nearly daily basis, especially if they lead busy lives? Requiring more calories, and likely a prenatal vitamin and/or a vitamin D supplement, is going to have a negative impact on the environment. Don’t try to deny thermodynamics or do if you want to further make a fool of yourself. And do you ever recommend supplements to aid in lactation, such as fenugreek or whatever? I saw you gladly gave an interview/shout out for yourself on Motherlove, a company that peddles supplements that most likely do not work at all. Are you concerned about the impact that producing those have? Get back to me when you’ve actually done all the analysis for this.

            And the fact you’d even suggest breastfeeding with Duarte’s galactosemia shows how unreasonable you are. We aren’t going to do a study on infants who we know shouldn’t consume breast milk to prove to you formula has health benefits. It would highly, highly unethical to breastfeed a baby who can’t metabolize lactose. It should never happen!

          • nikkilee
            January 16, 2017 at 6:21 pm #

            https://www.ncbi.nlm.nih.gov/books/NBK258640/

            As for herbs, I don’t recommend them as I don’t know about them, and there are associated risks. When moms want them, I refer to the licensed herbalists who practice in my state.

          • Heidi
            January 16, 2017 at 6:27 pm #

            “Because available data about the neurodevelopmental outcomes of children with Duarte variant galactosemia are conflicting, further studies are warranted to determine what long-term outcomes are and whether the dietary intake of galactose in the first year of life influences outcome.”

            If it was me, I’d much rather play it safe than sorry.

          • fiftyfifty1
            January 16, 2017 at 7:33 pm #

            “As for herbs, I don’t recommend them as I don’t know about them, and there are associated risks. When moms want them, I refer to the licensed herbalists who practice in my state.”

            And let me guess, the herbalists refer to you when a client “needs” crianial sacral therapy!

          • Heidi
            January 19, 2017 at 10:53 am #

            At least if she “prescribed” herbs, she could be a one-stop shop for all your quackery needs and would reduce vehicle carbon emissions. Obviously, she’s not that committed to environmental causes.

          • swbarnes2
            January 18, 2017 at 1:09 pm #

            If you are referring people to non-evidenced based practitioners, encouraging them to spend money on unregulated shit that does not work, that reflects on your honesty Badly.

          • nikkilee
            January 18, 2017 at 7:58 pm #

            Folks that are licensed by the state have passed an exam validating a basic level of safety.

          • Azuran
            January 18, 2017 at 8:44 pm #

            ohhhh basic level of safety. That’s SO reassuring. Let’s not forget, some CPM are also licensed at a state level…..and we can see what that’s worth.

          • nikkilee
            January 19, 2017 at 8:01 am #

            In most countries with better maternal survival rates than ours, most of the births are attended by midwives, and a physician isn’t in the room. But then, those countries have socialized medicine, so that is another helpful factor.

            Yes, some states license CPMs. Their state licensing boards have deemed this safe.

          • The Bofa on the Sofa
            January 19, 2017 at 9:09 am #

            Yes, some states license CPMs. Their state licensing boards have deemed this safe.

            But it isn’t. Ask Oregon, where, IIRC, CPMs are licensed, and their outcomes are poor.

            Your “basic level of safety” is nonsense. Then again, we know that because “basic levels of safety” are not “validated” by stupid exams.

            An exam would be considered a _minimal_ level of safety, but nowhere near sufficient for any practice.

          • nikkilee
            January 20, 2017 at 9:24 am #

            Physicians are licensed by the state. Licensing attests to the person being educated enough to be able to practice their profession safely.

          • The Bofa on the Sofa
            January 20, 2017 at 9:43 am #

            Licensing attests to MINIMAL competency.

            Doctors aren’t capable and good because they are licensed.

          • Azuran
            January 20, 2017 at 10:03 am #

            Indeed they are. But not all state license are equal.

            In order to be a vet, I had to go to university for 5 years (no other option, no internet class, no correspondence class, no ‘following a vet’ for a month or two, we have only 5-6 vet school in my entire country, it was one of those or nothing) And most teachers in those school where actually board certified specialists.
            Then I had to pass a certification exam. And we are not talking a ‘state’ level exam. It’s a North American exam. Every one in both canada and the USA has that same exam, can’t pass it, can’t be a vet.
            And then I have to register to the professional order. I am then required by law to attend a minimum number of approved continued education programs every single year. And the professional order does regular inspection of my work and my clinic. Any disciplinary action against me or any other vet is public. Anyone can call the order and as if I’ve ever been found guilty of anything. If I’m banned from practice, I can’t go to another place and just start over again, the order won’t allow it.

            Next to that, CPM do what? Internet classes, correspondence classes. Follow another midwife for 10 births. And the people who give those classes are other CPM. And if things go south, they move next state.

            CPM licensing is a joke. I wouldn’t trust them with a pet rock.

          • nikkilee
            January 20, 2017 at 1:11 pm #

            I don’t know of any licensed practitioners that don’t have to take some form of continuing education. CPMs have to have education, practical experience and a licensing examination: the same as any licensed worker.

          • Azuran
            January 20, 2017 at 1:33 pm #

            Maybe they do, but since their base education is shit, so is their ‘CE’
            To be honest, medical professional are licensed on a state level for administration purposes. What tells you much more about what their licensing is worth, you have to look at the recognition outside of the state.
            I’m licensed in my province. BUT, if I decide to, I can more to any other province, any state in the USA, and even some other countries in the whole, and my certification is still recognized and I can practice there.
            The same goes for doctors. They can practice anywhere in the country, they can practice and are recognized for their skills in many other countries as well.

            As for CPM? Their accreditation is so worthless that it’s not even recognized between states of the same country. It has 0 recognition anywhere else in the world. If a CPM tried to come to Canada, we would laugh in her face. Even third world countries don’t want them.

          • Daleth
            January 20, 2017 at 10:18 am #

            CPMs are licensed, in the states where they are licensed (about half of US states), because they lobbied the hell out of those states’ legislatures. That’s how laws get passed. I speak as a lawyer from a very politically active family.

            Legality does not equal safety any more than illegality equals lack of safety. Or tell me, did recreational marijuana suddenly stop being dangerous in Colorado and Washington, while remaining dangerous everywhere else? Or for that matter, are CPMs safe in Oregon but unsafe in Pennsylvania?

          • momofone
            January 20, 2017 at 6:49 pm #

            So then when licensed physicians use technology in providing prenatal care and assessing fetal and maternal health, they’re (to use your words) “educated enough to be able to practice their profession safely.” I’m sure that must be a huge relief for you!

          • Azuran
            January 19, 2017 at 9:33 am #

            And yet, their own stats show that their CPM have a death rate much higher than hospital birth. Their accreditation isn’t worth shit.
            Oh, so, you just decided that it was because of the midwives that in SOME other countries, the maternal death rate is lower. Do you have some kind of actual study for that? Because between socialized medicine, better healthcare, probably lower rates of risks factor such as obesity, diabetes etc etc, midwife care is probably not the lifesaver you think it is.
            Especially when anyone with half a brain can understand that midwives in those places only take care of low risk women, and will bump anyone with any kind of complication to an OB. So of course, any death that will happen will happen under the care of an OB.

          • nikkilee
            January 20, 2017 at 9:33 am #

            I am quoting Marsden Wagner OB, technical consultant to the UN. Midwives in the US take care of only low risk women; the majority of women that receive OB care are also low risk. https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/pages/risk.aspx

          • Daleth
            January 20, 2017 at 10:07 am #

            Midwives in the US take care of only low risk women

            What about when they illegally assist at the home birth VBAC of post-term triplets, as this midwife did?
            http://www.drbrewerpregnancydiet.com/id21.html

            Or how about when a midwife agrees to assist at the home birth VBAC of post-term twins where one twin is breech?!?!?!
            http://birthwithoutfearblog.com/2011/12/21/home-birth-of-twins-born-past-41-weeks-one-footling-breech/

            Or how about when you call your home birth midwife to tell her you’re in premature labor, only 35 weeks and a few days into your pregnancy, and instead of telling you to go to the hospital she comes over and encourages you to deliver at home?
            http://www.mamabirth.com/2011/01/early-home-birth-baby-birth-story.html

            And how about when a home birth midwife not only accepts a patient with a history of preterm labor, a cerclage, and thyroid problems, but encourages her to deliver a premature baby at home, and refuses to take her to the hospital when she asks? And the baby dies as a result?
            http://hurtbyhomebirth.blogspot.com/2011/03/thomas-story.html

            Those are just a few examples I found in less than 5 minutes on google.

            Please tell me you now understand that in fact NO, in the US, home birth midwives do NOT “take care of only low risk women.”

            Handy list: Let’s count the risk factors there:
            1. Multiple pregnancy
            2. Post-dates (41 weeks is VERY post-dates for triplets, which is quite dangerous since placentas tend to fail earlier in multiple pregnancies)
            3. For the triplet mom, no prenatal care–they didn’t even know she was carrying triplets, they thought it was twins!!!!
            4. VBAC holy shit excuse my language but HOLY SHIT, these midwives agreed to assist in a post-term HBAC of a multiple pregnancy! Even an uncomplicated full- or slightly pre-term VBAC of a singleton baby carries an approximately 1/200 risk of death to the baby. Make it twins and the risk more than doubles (each baby has 1/200 risk, so with two babies the total risk is 1/100, and having more than one baby in the womb increases the stress on the womb and thus the chance of uterine rupture–which is what kills babies in VBACs).

          • Azuran
            January 20, 2017 at 10:51 am #

            You know, majority means 50%+1. It really means nothing
            Did you even read those stats?
            2-10% of mothers have GD.
            6-8% have high blood pressure
            3-5% have preeclampsia
            1% is over 40.
            So, from those numbers alone, it’s pretty safe to estimate that 10-15% of pregnant women will have at least one of the condition listed above.
            And that doesn’t include breech or women with previous c-section. It also doesn’t include women with preexisting condition like hearth problems, obesity, non gestational diabetes.
            Sure, the ‘majority’ of women (as in, more than 50%) followed by OB are low risks. But a very significant portion (at least 1/10, more than big enough to be statistically relevant) are higher risks.

            I could just look at the pregnancies in my clinic since I’ve started working.
            In the last 3 years we had 13 pregnancy. Of those 13 pregnancy, 5 were high risk for a variety of reasons. So yea, you could say that the majority of the pregnancies at my clinic are low risks, it’s true. But that’s a little hypocrite when 38% of them where high risks. But hey, thanks to medicine, 100% of those babies where born healthy.

          • moto_librarian
            January 19, 2017 at 11:27 am #

            Try doing some research on the demographics of the birthing population in the U.S. We are as a whole heavier, older, and more prone to preexisting health conditions that used to preclude pregnancy. One of the leading causes of maternal death in this country is cardiac problems.

            CPMs are a joke. Their boards are more interested in promoting the “sisterhood” than actually ensuring safe practice. The credential should be abolished. If you want to be a midwife, put your big girl panties on and become a CNM. If that’s too hard, you don’t deserve to be in the profession.

          • nikkilee
            January 20, 2017 at 9:20 am #

            Here’s the top 10 percentages of maternal death, from the CDC 2011-2013.

            Cardiovascular diseases, 15.5%.
            Non-cardiovascular diseases, 14.5%.
            Infection or sepsis, 12.7%.
            Hemorrhage, 11.4%.
            Cardiomyopathy, 11.0%.
            Thrombotic pulmonary embolism, 9.2%.
            Hypertensive disorders of pregnancy, 7.4%.
            Cerebrovascular accidents, 6.6%.
            Amniotic fluid embolism, 5.5%.
            Anesthesia complications, 0.1%.

            Hemorrhage, pregnancy-related hypertensive disorders and infection are among the top causes of death in both the United States and the developing world.

            The vast majority of these women are dying after hospital care given by physicians.

            CPMs reflect a different philosophy of education, and an equally valid education. We disagree.

          • moto_librarian
            January 20, 2017 at 10:07 am #

            You are willfully ignorant. 30% of deaths are related to cardiovascular or non-cardiovascular diseases. Midwifery care would not save these women, and it’s fair to say that more would die as a result. The same can be said for AFE, pre-eclampsia, HELLP, and cardiomyopathy. Women in the developing world die of pph because they do not have access to anti-hemorrhagics and blood transfusions. Infections occur after vaginal birth as well as CS.

            CPMs are an insult to the expertise, education, and training of midwives everywhere. It’s unfortunate that you are too blinded by your own ideology to see that.

          • momofone
            January 20, 2017 at 11:00 am #

            Specifically what “equally valid education” are you referring to?

          • nikkilee
            January 20, 2017 at 3:58 pm #

            What experts at state licensing boards decide.

          • Azuran
            January 20, 2017 at 4:40 pm #

            I doubt they think that CPM education is ‘equally’ valid as that of CNM or OB.

          • momofone
            January 20, 2017 at 5:58 pm #

            No, that’s not the question. What education, specifically, do you mean? High school diploma, bachelor’s level, master’s level, doctoral level, other?

          • Dr Kitty
            January 20, 2017 at 6:26 pm #

            When it comes to CPMs and we’re talking about someone who may or may not have a high school diploma, “expert” is a stretch.

          • Azuran
            January 20, 2017 at 4:38 pm #

            ‘The vast majority of these women are dying after hospital care given by physicians.’
            Well DUH. of course they are. It would be insane if anyone BUT an OB was following there women. That’s why they are risked out of midwife care you idiot.
            That’s like saying that ICU have one of the highest rate of deaths of the hospital department. DUH it’s the ICU, basically everyone who is at risks of imminent death goes there.

            Guess what, the more time I spend personally giving care and monitoring my patients, the more likely they are to die. Now an idiot like you might think that I’m killing my patient. But an intelligent person would understand that I’m going to trust my technicians with most of the care needed by my stable, not dying patients. While I’m going to personally take care of the unstable ones who have a very real risks of dying very soon.

          • nikkilee
            January 20, 2017 at 4:48 pm #

            The majority of women seen by OBs in hospitals are healthy low-risk women.

          • Azuran
            January 20, 2017 at 4:54 pm #

            And the low risks women are generally not the ones dying. Do you have any kind of proof that CPM care have LOWER death rate for low risks women than OBs caring for low risks women? Of course you don’t, because it’s actually HIGHER.
            But we’ve already talked about how ‘majority’ really means nothing. As I pointed out, the majority of the women at my clinic had low risks pregnancy, despite the fact that 38% where high risks. But once again, you decided not to answer, as you generally do when someone points out your false argument.
            Care to also comment on that study about obesity in Chinese babies and how the study actually said the exact opposite of what you said it did?

          • Azuran
            January 20, 2017 at 4:55 pm #

            Again: Define ‘majority’
            As I pointed out twice already. The ‘majority’ of women at my clinic where low risks. But 38% where sill high risk.
            Majority is 50%+1

          • corblimeybot
            January 20, 2017 at 4:59 pm #

            You’re really bad at calculating percentages and ratios and all that. Just abysmal. I thought I was crappy at math, but at least my shitty math skills aren’t incorporated into the healthcare of others.

          • kilda
            January 20, 2017 at 5:03 pm #

            yes, and in those countries the midwives have a much higher level of training that a CPM in the US has. US direct entry CPMs would not be considered qualified to practice midwifery in ANY of those countries.

          • swbarnes2
            January 19, 2017 at 12:23 pm #

            Your dishonesty shines through again. Selling sugar pills and water is “safe”. But not medicinally effective.

            Do you tell your patients that you know you are sending them to practitioners who are going to charge them for things that don’t work better than sugar pills?

            No, because you are dishonest.

          • sdsures
            January 16, 2017 at 9:40 pm #

            What’s wrong with UHT milk? My husband and I keep it around for emergencies when we’re unable to go grocery shopping because of low energy levels.

          • Nick Sanders
            January 16, 2017 at 9:59 pm #

            It comes in a box. That’s just wrong.

          • sdsures
            January 17, 2017 at 8:48 pm #

            In Toronto, milk comes in bags. The horror!

          • Azuran
            January 17, 2017 at 9:08 pm #

            XD I’ve never understood why people are so freaked out by our milk bags

          • Nick Sanders
            January 17, 2017 at 10:14 pm #

            Because it looks like a recipe for milk getting spilled everywhere all the time.

          • Azuran
            January 18, 2017 at 8:31 am #

            It really isn’t. Bags are super sturdy, I’ve never broken one. And we have pots to put the bag in to serve the milk.

          • MaineJen
            January 18, 2017 at 10:57 am #

            ….”milk bags” *giggle*

          • sdsures
            January 20, 2017 at 11:29 am #

            Dunno. Guess I’m just a weird Winnipegger.

          • Nick Sanders
            January 17, 2017 at 9:35 pm #

            And not just any milk, homo milk! Won’t someone please think of the children?!

          • Heidi
            January 19, 2017 at 8:58 am #

            I want my milk to separate within seconds of shaking it while I’m trying to drink a glass personally, or while I’m trying to eat a bowl of cereal, it’d be fun for the fat to be floating to the top.

          • sdsures
            January 20, 2017 at 11:29 am #

            That made my British husband chortle when he saw that.

          • Heidi
            January 16, 2017 at 10:01 pm #

            Nothing is wrong with it! I keep it because you don’t have to heat up milk to make yogurt. But it can’t be recycled in the US and Nikki is pretending she cares about that kind of thing.

          • corblimeybot
            January 18, 2017 at 10:01 am #

            I am still very annoyed with a lactation consultant who convinced me to take megadoses of fenugreek. It’s not just that it doesn’t work. It’s also that she didn’t check my OWN health situation at all before she told me to take huge doses of unregulated supplements.

            Ex: I have asthma, and fenugreek can worsen asthma. i had also had severe preeclampsia with organ involvement just a week or two before this LC appointment. Yet she wanted me to take some gigantic amount of unregulated herbs, despite that I was recovering from systemic damage to my entire body.

          • Heidi
            January 18, 2017 at 10:06 am #

            All fenugreek did for me was make my armpits smell like vomit pancakes! I took it entirely on my own, even figuring that it probably doesn’t work and knowing supplements aren’t regulated. I just had to see for myself.

          • corblimeybot
            January 18, 2017 at 10:07 am #

            You’re right about the awful pancake stench. It was NOT pleasant!

          • Heidi
            January 18, 2017 at 10:09 am #

            Nothing to do with lactation, I’ve noticed the new fad with deodorant lately is food scents, like macaroons. I seriously don’t get it!

          • corblimeybot
            January 18, 2017 at 10:21 am #

            Ewwwwwww!

          • nikkilee
            January 18, 2017 at 12:47 pm #

            An unsafe practice. . . .fenugreek can interfere with the absorption of prescription medication.

          • moto_librarian
            January 18, 2017 at 1:06 pm #

            No shit. My LC told me to use it too, and I’m a severe asthmatic. Your whole profession is a joke.

          • MaineJen
            January 17, 2017 at 5:06 am #

            Babies definitely receive benefits from not starving when their moms (can’t/aren’t able to/don’t want to/none of your business) breastfeed. I would think that would be self-evident.

          • Daleth
            January 18, 2017 at 9:35 am #

            There are no studies showing that babies receive health benefits from formula feeding.

            Actually that’s not true. The discordant siblings study found only one health difference between breastfed kids and their formula-fed siblings: the breastfed ones were slightly MORE likely to have asthma.

            a combination of factors (the rise of industrialization, two world wars, the rise of science and corporate influence) lead to its spread

            FYI the past tense of “to lead” is not “lead,” it’s “led.”

          • nikkilee
            January 18, 2017 at 12:49 pm #

            The discordant siblings study had a detailed analysis of everything except the definition of breastfeeding, which was “Yes or no”. . . .no analysis of duration or exclusivity. Big flaw. Too bad, because if the authors had done that, it would have been a landmark study.

          • swbarnes2
            January 18, 2017 at 1:07 pm #

            “Table 5 presents findings from a set of analyses that are identical to those presented in Table 4 except the independent variable is breastfeeding duration (in weeks) as opposed to breastfeeding status (yes/no). Taken as a whole, these results reveal the same patterning as was evident in Table 4, whereby estimates of the effect of breastfeeding on a diverse set of childhood outcomes are substantially attenuated toward zero when we rely on sibling comparisons.”

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077166/

            You are a liar. Fundamentally dishonest.

          • nikkilee
            January 18, 2017 at 8:13 pm #

            “Table 4. Unstandardized Coefficients and Corresponding Standard Errors for Breastfeeding Initiation (Yes/No) from Regression Models Predicting Select Outcomes among NLSY Children Aged 4–14, 1986–2010”

            “Table 5
            Unstandardized Coefficients and Corresponding Standard Errors for Breastfeeding Duration (in Weeks) from Regression Models Predicting Select Outcomes among NLSY Children Aged 4–14, 1986–2010”

            No where in this study is there a chart or table of how many kids breastfed, how many were breastfed exclusively, and what was the breastfeeding duration. There are only these two tables reporting on those data, and conclusions based on those tables. A big question about breastfeeding data is unanswered. Very interesting that this is left out.

            Here’s some examples of what that sibling study should have included in their paper:

            Main outcome measures of the original PROBIT study were: “Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life”.

            A study from Greece in 2014 stated this: If women initiated breast feeding, further information on breastfeeding intensity and duration was asked, as well as information regarding the first time they breast fed their infant and the duration of breast
            feeding. Duration of breast feeding was categorised as ‘never’ breast fed, breast fed for ‘1–6 months’ (according to WHO recommendations) and breast fed for ‘>6 months’. Breast feeding was also categorised according to the WHO breastfeeding
            definitions as exclusive, predominant and complementary breast feeding.”

            One of the studies based on the Harvard Nurses” study (Steube 2009) described breastfeeding this way:

            In 1997, participants completed a detailed questionnaire on breastfeeding and use of medication to suppress lactation for
            each of their first 4 children. Women with more than 4 children reported total months of breastfeeding across all additional pregnancies. All durations were reported as categorical variables. For assessment of total duration, women were asked, “If you breastfed, at what month did you stop breastfeeding altogether?” For assessment of exclusive duration, women were asked, “At what month did you start giving formula or purchased milk at least once daily?” and “At what month did you start giving solid food at least once daily (baby food, cereal, table
            food, etc)?” Exclusive duration was defined as the earlier of these 2 time points.”

            There is a big hole in the sibling study.

          • swbarnes2
            January 19, 2017 at 12:20 pm #

            You said they didn’t study duration of breastfeeding. That was a lie, end of story. You lied because you are dishonest. You can’t get around that.

            The cold truth is that at best, the benefits of breastfeeding are utterly dwarfed by benefits from better socioeconomic status. You are too dishonest to accept this.

          • Daleth
            January 20, 2017 at 9:33 am #

            I agree that better definition would be ideal. However, by definition in the discordant siblings study all kids who were exclusively or primarily breastfed fell into the “yes” group, and the only ones in the “no” group were the exclusively formula-fed kids. Don’t you find it interesting that thousands of exclusively formula-fed children were indistinguishable, healthwise, from ones who got anything from “any amount of breastmilk sufficient for mom to remember it 4 years later” to “exclusive breastmilk”?

            Or I should say, indistinguishable except that they actually had lower rates of asthma.

          • Sue
            January 30, 2017 at 6:33 pm #

            “Formula was designed as emergency replacement feeding when it was invented in the 1860s; a combination of factors (the rise of industrialization, two world wars, the rise of science and corporate influence) lead to its spread). ”

            Nope – wrong again.

            Breast milk substitutes have always been known. “Formula” just means “recipe”. It included everything from goats’ or cows’ milk with sugar added, to tinned condensed milk, to rice porridge.

            Sure, mass manufactured baby formula came with industrialisation, as did mass manufacture and supply of a huge number of products.

          • Sue
            January 30, 2017 at 6:36 pm #

            “There are no studies showing that babies receive health benefits from formula feeding.”

            Nonsense.

            There is a huge natural experiment – historically – babies who could not be breast fed just starved. Those who were fed a breast milk substitute didn’t starve.

            It’s hard to imagine doing a prospective trial – would you advocate intentionally allowing babies to starve to show that the fomula-fed did better? What a bizarre idea?

          • sdsures
            January 16, 2017 at 9:39 pm #

            Populations in any research cannot be studied as a whole; it’s impossible because a population is defined as every single participant in existence. That’s why we work with samples.

          • The Bofa on the Sofa
            January 16, 2017 at 10:52 am #

            “These are individual decisions made at an individual level. Population statistics mean squat” to the individual. The theme of this forum. Thanks.

            You disagree?

          • fiftyfifty1
            January 16, 2017 at 7:30 pm #

            “”These are individual decisions made at an individual level. Population statistics mean squat” to the individual. The theme of this forum. Thanks.”

            You have a problem with that? What can population statistics do anyway beyond give a person a hint about what *might* be more likely to turn out well for them?

            Studies show that MOST people do best with ~7.5-8 hours of sleep. But I need closer to 9. Should I choose what is healthiest for the average person and walk around chronically sleep deprived?

            Studies show that in general children do best when they are given books at grade level. Should gifted students be made to read books too easy for them because they match what grade they are in? Should students who are struggling to read be made to choose books they have no chance of decoding?

            Studies show a glass of wine a day prevents heart attacks. Should alcoholics and Mormons be berated into drinking?

            Come on nikkilee, you said you were all about individualized care.

          • Dr Kitty
            January 15, 2017 at 6:02 pm #

            Nikkilee if formula feeding leads to money in the
            bank, sleep for the parents and a baby who thrives, it beats breast feeding.

            And you mean this:
            https://pathways.nice.org.uk/pathways/antenatal-care-for-uncomplicated-pregnancies/antenatal-care-for-uncomplicated-pregnancies-planning-place-of-birth#content=view-node%3Anodes-low-risk-multiparous-woman

            Which is the outcome for healthy, low risk, PAROUS women and is only applicable because composite outcomes which make TTN equivalent to intrapartum stillbirth were used (both coded as “serious adverse events”).

            Forgive me, but 3 days in NICU without long term adverse effects aren’t equivalent in the real world to the death of your baby during labour.

            Like I said- the people who comment here know how to evaluate research.

            Frankly, I don’t expect much from someone who has to be prompted to seek evidence updating SIDS information she got 30-odd years ago…

          • nikkilee
            January 15, 2017 at 8:07 pm #

            The links from 2011 and 2016 (AAP) didn’t count.

          • Heidi
            January 15, 2017 at 6:29 pm #

            Galactosemia is one glaringly obvious situation where formula offers a lifesaving health benefit. There are also other situations where formula is better for a baby than breast milk. Some babies with soy and milk allergies cannot even drink breast milk without suffering. Even if mom eliminates them from her diet, the baby must eat formula for a few weeks until soy and dairy has left mom’s system.

          • maidmarian555
            January 15, 2017 at 7:00 pm #

            I have a friend who’s baby was allergic to eggs, dairy and soy (amongst have other things). She managed to follow a restrictive diet and breastfeed. You know what she called it? (Keeping in mind she was also vegetarian at the time). Hell. She called it hell. Said she’d never recommend in a million years that any other woman do what she did.

          • Heidi
            January 15, 2017 at 7:14 pm #

            That sounds like hell! I can’t imagine having the time or energy to read every label for offenders and having to prepare everything from nearly scratch when life is already so hectic with a baby. Then I’m sure you still worry that you accidentally ate something bad for baby.

          • maidmarian555
            January 15, 2017 at 7:20 pm #

            Poor little thing was in and out of hospital for his allergies continuously for his first year. He shook off the soy allergy eventually (thank Christ) but if that’d been me I couldn’t have done what she did. She wouldn’t recommend it either. There are special formulas designed for what she went through. I’d have been all over that.

          • Heidi
            January 15, 2017 at 7:52 pm #

            I wonder if my younger sister had some sort of allergy or could have benefited from some kind of specialized formula. My mom breastfed her, she latched just fine and my mom felt like she made plenty with her.my mom thinks she made “skim milk.” I don’t know if making too low fat of milk is a common problem. Anyway, she kept losing weight so my mom switched to formula. The pediatrician was relieved since she was a failure to thrive. But then with formula she would spit up entire bottles. She looked so pitiful for months. This was 1995 so I’m not totally sure what the formula choices were but soy was also tried to no avail. Things did get better with time but they were considering surgery for reflux but I feel like I’ve read that option has fallen out of favor. I was only 10/11 years old but even I remember being so worried about her.

          • maidmarian555
            January 15, 2017 at 8:12 pm #

            Yeah nowadays there are way more options. And things to examine if a baby isn’t thriving. I’m not particularly convinced by the ‘crap milk’ theory, often peddled by lactivists so that women will blame themselves rather then look into allergies. I’ve had issues with dairy causing eczema for years. Apparently I rejected cows milk and other dairy products as a baby for a number of years. Idk how well I trust my mother’s assessment but it makes some sense that I wouldn’t drink milk as a child when I know it gives me rashes now. There are other children in my family with quite severe lactose intolerance so it does make sense.

          • Heidi
            January 15, 2017 at 8:45 pm #

            The choice of formulas is a great thing. My husband’s cousin’s son needed hypoallergenic, hydrolyzed protein formula. She was not able to breastfeed. He went from being inconsolable after eating to perfectly fine with nutrimigen and zantac. I am not sure how nikkilee can claim that isn’t a tremendous health benefit.

          • fiftyfifty1
            January 15, 2017 at 8:49 pm #

            Your link is ridiculous and you know it. It’s a study in Denmark where they compared freestanding birth centers to hospitals, and found that the birth centers were indeed safe for strictly risked out women. But it just so happens that these “freestanding” birth centers were actually located *immediately adjacent* to hospitals with full anesthesia and ICU services. And of course they were staffed by real, hospital trained, midwives (the equivalent of CNMs in the US).

            When you use this paper to convince your clients that out of hospital birth is “safe” do you reveal to them that this situation bears absolutely no resemblance to OOH birth in the US where you practice?

          • Amazed
            January 15, 2017 at 8:56 pm #

            Now, she’s going to tell you that everyone has to make a living. Clearly, it’s totally fine for her to lie to her clients, as long as she gets to make money from it.

          • nikkilee
            January 15, 2017 at 11:12 pm #

            There are 2 free standing birth centers in my region, staffed by CNMs.

          • fiftyfifty1
            January 16, 2017 at 8:37 am #

            “There are 2 free standing birth centers in my region, staffed by CNMs.”

            And if they are staffed by CNMs and nothing but CNMs, and they are located immediately adjacent to a hospital staffed 24/7 with ICU and anesthesia, and the CNMs have privileges at that hospital, and the records are integrated, and the women are rigorously risked out, then you can tell your clients that the Danish study applies to them. Otherwise you aren’t giving them the info they need to make an informed choice.

          • Roadstergal
            February 1, 2017 at 8:04 pm #

            You’re shockingly good at missing the point. It’s a rare skill to do it so smoothly and consistently.

          • momofone
            February 3, 2017 at 2:43 pm #

            I think it comes from lots of practice.

          • yentavegan
            February 1, 2017 at 9:31 pm #

            But do those Free standing Birth centers have seamless transfer of care procedures? Do those free standing birth centers employ CNM with hospital privilege?

          • yentavegan
            February 1, 2017 at 9:33 pm #

            Vylette Moon’s mother thought she was getting the best of both worlds when she chose a Free standing Birth Center staffed by CNM’s. Read her story on Justice for Vylette Moon facebook page….

          • Azuran
            January 15, 2017 at 9:44 pm #

            And no one is saying that birth centres with properly trained midwives shouldn’t be handling low risk women.
            However, first of all, the woman has to WANT to use midwive. (Which is a minority of women, you might not like it, but that’s the truth)
            Knowing who is low risk enough also requires medical knowledge that you obviously lack.
            Lying to women about their risks factors is malpractice.

          • Empress of the Iguana People
            January 15, 2017 at 10:08 pm #

            I’m kind of glad to be old, fat, and with a history of scarlet fever (though apparently it didn’t hurt anything by my ear) Only the Sooper Sertifyed MidWives would have not risked me out. My BP was perfectly fine until 4 hours into my first labor.

          • MaineJen
            January 16, 2017 at 6:48 pm #

            Yawn. Midwives have better outcomes *because* they treat low-risk women only. As soon as they start not running tests for fear of risking their potential patients out (I’m looking at you, American CPMs), their bad outcomes skyrocket. Look at Oregon.

          • sdsures
            January 20, 2017 at 10:54 am #

            Selection bias, right?

          • Daleth
            January 20, 2017 at 9:56 am #

            For healthy, low-risk women, birth in a free-standing birth center attended by midwives is at least as safe as birthing in a hospital

            Actually no, birth in a free-standing birth center is twice as likely to kill your baby as birth with hospital midwives. That is better than home birth, though, which is about four times more likely to kill your baby.

            Or did you not read the study out of Cornell that looked at ALL births of low-risk babies in the United States over a 3-year period (over 10 million babies)?

            Here’s the study itself (there’s a handy chart at the bottom comparing the relative likelihood that your baby will die in each different birth setting):
            http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext

            And here’s a handy overview by Dr. Tuteur:
            http://www.skepticalob.com/2014/02/new-cornell-study-shows-homebirth-has-4x-higher-death-rate-than-comparable-risk-hospital-birth.html

          • nikkilee
            January 20, 2017 at 10:09 am #

            Dr. Michael Klein, emeritus professor of family practice and pediatrics at the University of British Columbia, and co-author of a study used in the report has already written a response to the journal saying that the data was misconstrued—and that this “is a politically motivated study.”

            The neonatal mortality rate for full-term birth is very low (a few per thousand at the most). It’s difficult to calculate rare events unless there are massive numbers because even one event in a small group will artificially raise the rate. A meta-analysis allows a researcher to combine many studies in order to get a larger data pool, but meta-analyses are prone to error when the groups are too small or are too dissimilar.

            A good analysis uses data sets that are consistent for what they are supposed to represent. In this case, a homebirth vs. hospital study should only contain the single variable of location. Other parameters should be consistent for each study included in the meta-analysis. The births should be considered low-risk. The births should be planned to occur with an attendant. The attendants should have similar training or emergency equipment. The locations should have similar travel times to similarly equipped hospitals. And the studies should take place during similar time periods.

            A good meta-analysis comparing low-risk homebirth to low-risk hospital births would not include unattended births, unplanned homebirths or high-risk homebirths. And it would compare rural homebirths to rural hospital births, not to urban hospital births.

          • Daleth
            January 20, 2017 at 10:22 am #

            Thank you for your views on meta-analyses. Not sure why you went to the trouble of writing all that down, though, since the Cornell study WAS NOT A META-ANALYSIS.

            Also, thank you for your views on studies in which sample sizes are too small to draw accurate conclusions. But again, not sure why you shared those views, since in a study that seeks to compare the relative safety of home birth vs. hospital birth in a given country, it is literally impossible to have a LARGER sample size than “every single baby born in the entire goddamn country, except we left out the high-risk ones so that we could be sure we were comparing apples to apples.”

            And that of course was the sample size used in the Cornell study.

            Why are you wasting your breath by criticizing unidentified other studies that used different methods, instead of talking about the study that we’re supposed to be talking about?

          • swbarnes2
            January 29, 2017 at 11:58 pm #

            Did you guys catch that the reason Nikkilee is talking about meta analysis is that she didn’t write any of that herself? She plagiarized it from Midwifery Today about another study. Nikkilee is fundamentally dishonest. Lying is like breathing to her.

          • Daleth
            January 30, 2017 at 5:52 am #

            Or she’s just not interested in thinking for herself or questioning any aspect of her quasi-religious faith in home birth, midwifery etc. She’d rather just spout the party line. Oh well.

          • Roadstergal
            January 30, 2017 at 1:38 pm #

            OMG, that’s the perfect parallel. This is like the Nicene Creed to her. “Breast is always best, formula is poison, unmedicated vaginal birth is our lord and savior.”

          • Empliau
            January 30, 2017 at 10:53 am #

            I don’t care about a mortality rate of a few per thousand if my baby is one of the few. And by the way, what is the rate of morbidity? If at a free-standing birthing center that is not part of a hospital complex I or my baby should have a complication that needs an OB, a c-section, or some other intervention (transfusions in case of severe hemorrhage, for example) and it’s not available, the rate is 100%. I consider that utterly and completely unacceptable. To lose a child or to have a child with disabilities that could have been avoided by skilled medical care could never be worth it to me. To bring up a child without me could never be worth it to my husband.

            You are very dismissive of the dangers, but in this community there are many women who were low risk until something went south. It happens, and the doctors and CNMs here have made it clear that it isn’t rare. Luckily most of the women who post here who have needed skilled or emergency interventions were at hospitals with competent medical professionals.

            My professional field is the ancient world. Archaeological finds and historical evidence are unequivocal: childbirth is bloody goddamn dangerous for both parties. Yes, things have improved. They have improved because of medical science. Why people with access to these lifesaving techniques would deliberately gamble that nothing will go wrong with their and their child’s health, brain, and very life is simply beyond me.

          • nikkilee
            January 30, 2017 at 4:13 pm #

            Trouble is that skilled medical care also carries risks. This is how medical malpractice attorneys make a living. Life is risky; there is no way to guarantee the outcome that we want. We can do only our best.

          • swbarnes2
            January 30, 2017 at 4:35 pm #

            So you have nothing to say about how dishonest, not to mention stupid, it is to plagiarize a response that isn’t even relevant to the discussion? Is it because you sincerely do not understand why lying is wrong?

          • Who?
            January 30, 2017 at 4:57 pm #

            Maybe nikkilee is all about alternative facts?

          • Heidi
            January 30, 2017 at 4:39 pm #

            Trouble is that riding in a car with a seat belt also carries risks. This is how car wreck attorneys make a living. Life is risky; there no way to guarantee the outcome we want. We can only do our best. And best is not wearing a seat belt, right?

          • Who?
            January 30, 2017 at 4:44 pm #

            So what, just choose nothing because then it can never be your fault? Stumble through life sighing about bad luck and crowing about good luck? And quietly burying the bad luck stories which would be bad for business.

          • Nick Sanders
            January 30, 2017 at 4:51 pm #

            That’s what comparative risk assessment is for.

          • MaineJen
            January 30, 2017 at 5:12 pm #

            Doing our best doesn’t mean throwing caution to the wind. Doing our best means availing ourselves of every possible opportunity to make the experience safer.

            I’m very short, and I have to pull my seat close to the steering wheel when I drive. If I’m in an accident, there’s a chance I’ll be injured by either the air bag or the seat belt (if I can’t adjust it low enough). Does that mean I drive without a seat belt, in a car without an air bag? Of course not. I don’t obsess about how unsafe my airbag is; it’s there to save my life if I’m in a catastrophic accident.

            Skilled medical care is there to save your life, too. I consider myself very fortunate to live in an era of air bags and seatbelts, AND pitocin and continuous fetal monitoring.

          • Sue
            January 30, 2017 at 6:23 pm #

            “Skilled medical care also carries risks”? Of course, but much smaller risks than the absence of skilled medical care. Clearly.

            Wearing seat belts also carries risks – but tiny risks in comparison to those it mitigates.

          • Azuran
            January 30, 2017 at 6:31 pm #

            Except that the risk from skilled medical intervention is much lower than the risk of CPM care, which is basically: can’t do anything but look and transfer if anything is wrong.
            The reason why malpractice attorneys aren’t making a living out of CPMs is because CPMs do not carry medical insurance and therefore cannot pay up when they are sued. So it’s a waste of time.

          • Empliau
            January 30, 2017 at 6:38 pm #

            Good. Exactly. Now, what are you risking? In a hospital, the biggest “risk” seems to be an unwanted CS and hurt feelings. (I except people like Erin, who have suffered genuine trauma. Erin, I’m so sorry they treated you that way.)

            I am in the U.S., and when things go south in the hospital and a medical professional was negligent or otherwise at fault, insurance will compensate a family for loss and subsequent necessary care. CPMs in freestanding birth centers don’t have such insurance – so, if your baby suffers HIE or other damage, well, they wash their hands of you with blather such as you just said above.

            Finally, some of the hospital malpractice claims come from home birth/birth center births that they shoved off on the hospital when things went sideways. Thanks loads! Way to take responsibility for the risk!

            Sorry about the sarcasm. Pious platitudes like Nikkilee’s above set my hackles on stun.

          • nikkilee
            January 30, 2017 at 7:43 pm #

            Risk depends on your point of view. To me, iatrogenic prematurity, risk of MRSA and C. diff, and a host of practices that should be done as necessary and instead are done routinely. Women chose home birth; how about looking at why? http://www.cnn.com/2016/01/18/opinions/declercq-home-births/

          • momofone
            January 30, 2017 at 7:44 pm #

            How about you pay attention to what people are telling you about why they DON’T choose home birth?

          • Azuran
            January 30, 2017 at 7:57 pm #

            How about looking at why >99% of people DON’T chose homebirth.
            Risk itself doesn’t depend on your point of view. The risks of something doesn’t change. What change is whether or not you’d prefer to face risk X or risk Y.
            If you’d rather face the much higher risks of homebirth than hospital birth, that is your right. But it doesn’t make home birth safer. You just preferred which which you’d rather take.

            And define ‘iatrogenic prematurity’ because the only time a baby is induced prematurely, it’s because of health reason. Those don’t happen because anyone felt like it.

          • nikkilee
            February 1, 2017 at 5:58 pm #

            http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.180570

            Conclusions. Obstetrical interventions were related to the increase in the US preterm birth rate between 1991 and 2006. The public health community can play a central role in reducing medically unnecessary interventions

            Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.180570

          • nikkilee
            February 1, 2017 at 6:00 pm #

            Before the latest ACOG recommendation and the March of Dimes campaign to stay pregnant for 39 weeks, women were induced because doctors told them “you’ve been pregnant long enough” or because it was hot out and the mother was uncomfortable, or because her mother was available to help for only a particular week. I heard these stories from the women I cared for as a maternity nurse..

          • Azuran
            February 1, 2017 at 6:47 pm #

            And what you linked does not provide any information about the reason for the induction­ or c-section. So it doesn’t mean anything.
            And you also might want to look at the outcome.
            Who cares if mothers want to be induced for whatever reason if there is no negative outcome (or if the woman CHOOSES to take that risks?)

          • momofone
            February 1, 2017 at 10:05 pm #

            If your doctor wants to induce you because “it’s hot out” (which, by the way, is BS, but I’ll play along), and you don’t want to be induced, guess what you can do–you can say no. If your mother’s availability is not a consideration for you in being induced or scheduling a c-section, you don’t have to consider it. What you don’t get to do is to say no for the people for whom it may be a consideration.

            You have still failed to address any issue of substance on this post. Your attempts to divert attention and move goalposts constantly do not fool anyone. Your hypocrisy is exceeded only by your complete lack of integrity.

          • Amazed
            February 7, 2017 at 1:34 pm #

            Of course you did. I’ve noticed that likes are drawn to likes. Narcissists who whine about their discomfort against their babies’ lives and brain function potentially saved WOULD find you. And I bet the women who wanted to give birth at a time when they could get help had no idea that they were talking to a sanctimommy judging them. They likely believed they were talking to a professional and not a hardcore natural (when it was beneficial for her bank account) advocate.

          • swbarnes2
            February 1, 2017 at 7:31 pm #

            SIgh. As we’ve gone over and over…if pre-term increases were matched in decreases in neonatal deaths and stillbirths, that’s a good thing.

            Also, see this much more recent citation(emphasis mine):

            https://www.ncbi.nlm.nih.gov/pubmed/27824748

            “CONCLUSIONS:
            Oregon’s statewide policy to limit elective early-term delivery was associated with a reduction in elective early-term deliveries, but no improvement in maternal or neonatal outcomes.”

          • MaineJen
            February 1, 2017 at 10:08 am #

            FYI, most cases of MRSA are community-acquired, not hospital-acquired. Nice try, though.

          • Heidi
            February 1, 2017 at 10:38 am #

            Same with C. diff. I have my doubts that on a well baby/well mother labor and delivery floor, C. diff is even close to common at all.

          • Roadstergal
            February 1, 2017 at 11:10 am #

            “Women chose home birth; how about looking at why?”

            Let’s start with people like you lying to them about relative risks. That seems to be a substantial factor.

          • Amazed
            February 7, 2017 at 1:30 pm #

            Skilled medical intervention definitely carries risks! Mom can’t stuff her face to her heart’s content. Mom’s little accessory can’t choose their birthday after 3 days of agonizing labour. Mom doesn’t get bragging rights of most mommiest natural mommy ever. Mom doesn’t get an orgasm during birth.

            Mom, mom, mom. What’s a dramatically lowered risk of a dead or damaged baby compared to the horror of THIS? You feed the narcisism of mothers who think this way because it gets you nice sums.

          • Azuran
            February 7, 2017 at 2:58 pm #

            I think those women are just wilfully ignorant. Obviously, if you care so much about your birth experience, you clearly never actually faced the fear of losing your child. (or you are a psychopath)
            I spent half the day at the hospital yesterday because my baby wasn’t moving. I called the hospital in tears after spending hours trying to get her to move. I don’t think I’ve ever been this scared or distressed in my entire life. Hearing her heartbeat once I got to the hospital was the most beautiful and reassuring sound ever. They kept me on constant monitoring for 1h30. Thankfully everything is fine (though just thinking about it is still making me cry).
            But if at any time the doctor told me I needed an emergency c-section/induction or whatever, I would have done it.
            I would have stayed hooked to that monitor all week if that’s what the Doctor recommended. Heck, if I could I’d rent it and wear it 24/7 until I give birth.
            I’d drink nothing but juice and ate nothing until I gave birth if the doctor told me it was better for my baby.

            And people are complaining that they can’t eat for their own safety? That the belt for the foetal monitoring is annoying? That they can’t walk around the hospital? Honestly, if that qualifies as a negative pregnancy/labour experience, then you had a pretty damn good time and you should be freaking grateful.

          • Empress of the Iguana People
            February 7, 2017 at 3:33 pm #

            Damn how I hated that blood pressure cuff. But it’s annoying, not horrendous. Truly terrible would have been my pre-e progressing and killing one or both of us.

          • momofone
            February 9, 2017 at 12:57 pm #

            I’m so glad everything was ok.

          • Sue
            January 30, 2017 at 6:39 pm #

            There are several very large, well-structured trials of home birth vs hospital birth, with good attempts to risk-match.

            They consistently find that for first time mothers, neonatal mortality is at least three times higher at home than in hospital.

            Examples include the UK Birthplace Study and the Australian Publicly-FUnded Homebirth study, published in the MJA.

            These studies don’t even report – or even measure – the injuries or disabilities short of death. That would be very useful information, don’t you think?

          • nikkilee
            January 30, 2017 at 7:36 pm #

            http://www.cmaj.ca/content/181/6-7/377.short

            The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).

          • nikkilee
            January 30, 2017 at 7:37 pm #

            This study is from Holland, where about 1/3 of the births are at home. With support services and a good transportation system, home birth is safe.

            http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02175.x/full

            I planned a home birth, and ended up transferring to hospital; an example of how a system can work. We lived 5 minutes away.

          • nikkilee
            January 30, 2017 at 7:39 pm #

            http://www.bmj.com/content/330/7505/1416?ehomPaper=

            Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United State

            Looks like there is evidence for both sides of this debate.

          • Amazed
            February 7, 2017 at 10:57 am #

            Thank you, nikkilee! I am so happy to see you showing a real study! Now, would you please highlight the Netherlands study (Holland isn’t a country, JFYI) comparing low-risk and high-risk births? Because high risk over there leads to better mortality rates. The difference between low and high risk? High risk is followed and delivered with obstetricians.

            IOW, the study you trotted out only shows that Dutch midwives suck mightily. Do you include this bit when singing praises to the Dutch homebirth?

          • Azuran
            February 7, 2017 at 11:34 am #

            And yet, I expect that transferring you took more than 5 minutes.
            When you recommend homebirth. Do you specifically talk about a maximum safe distance? For example, I’m 20 minutes away from the hospital. Not counting however long it’s going to take me to get to the car and get processed once we arrive at the hospital. Is that too far? What if there is a snow storm? A car accident? A blocked road? And do you tell them to make sure their provider is actually working with the hospital and has a transfer agreement or hospital priviledge? Or is she just going to dump you in the emergency room?
            And seriously, how freaking horrible must it be to have to transfer while in active labour?

            As for your study. As Amazed explain. Dont you find it weird that home birth has the same death rate as hospital birth? That means that Doctors, who deal with ALL the high risk births, somehow manage to have the exact same birth rate as midwives who care only for the healthiest women with the lowest risks.
            Now there are only two way this is possible. Either Doctors are so freaking good that they reduce the risk of all high risk birth down to the risk of low risk women (highly unlikely)
            OR, Doctors actually have a LOWER death rate for low risk women then homebirth midwives. Which is then compensated by the higher rate of death of their high risk patient.

            That, or course, is also without taking into account the fact that those midwives are actually nurse midwives. Not CPM, which, for some stupid reason, you are still suporting.

          • Amazed
            February 7, 2017 at 12:33 pm #

            It’s worse, Azuran. Have a look at this.

            http://www.bmj.com/content/341/bmj.c5639.full

            “Infants of low risk pregnant women who started labour in primary care had
            a higher risk of delivery related perinatal death than did infants of
            high risk pregnant women who started labour in secondary care”

            The comparison is straight: low risk – high risk. Midwives – obstetricians. Higher mortality rate – lower mortality rate.

            Dutch midwives suck and I could never understand the praising of them as good providers. I guess it’s because we don’t want to sound radical, lest we push expectant mothers to think we’re extremists. But it’s very clear indeed: they suck. They might be better compared to the joke that is a CPM but they suck anyway. And we aren’t saying this as loud as it should, instead praising the Netherlands homebirth system as a safer one. To me, we should always add, “But less safe than hospital birth anyway.”

          • Roadstergal
            February 7, 2017 at 12:43 pm #

            Yes, yes, yes, and yes.

            If you want your baby to live and you’re in the Netherlands, your best bet is to be just barely in the high-risk group and under OB care. You’re better off that way than with the most textbook low-risk pregnancy!

            That’s some crazy Kafka-esque stuff, there.

          • Empress of the Iguana People
            January 29, 2017 at 8:08 pm #

            For my daughter, there is not specific benefit to her formula use, except that her mom’s PPD is exacerbated by breastfeeding. She’s better off on formula with a less suicidal mother.

          • momofone
            January 29, 2017 at 9:41 pm #

            I’d call that a very specific benefit.

          • Roadstergal
            January 30, 2017 at 1:36 pm #

            But nikkilee wouldn’t.

          • nikkilee
            January 27, 2017 at 6:44 am #

            I thought that you all would like to see the latest for ACOG, experts on obstetrics, suggesting that interventions be limited in low-risk situations.

            http://www.acog.org/About-ACOG/News-Room/News-Releases/2017/Approaches-for-Obgyns-Limit-Intervention-During-Labor-and-Birth-in-Low-Risk-Pregnancies

          • Erin
            January 27, 2017 at 7:19 am #

            And no one here is suggesting anything different

            A friend of mine had her third baby at home recently. The Baby pretty much delivered herself. There was zero need for interventions.

            In fact I imagine that’s why they’re called “interventions” because something has already happened to make intervening seem like a good idea.

            Also any healthcare professional offering me a “massage” in labour would swiftly need to see a Doctor themselves.

          • nikkilee
            January 27, 2017 at 8:51 am #

            Many women can’t bear to be touched in labor. Others enjoy it.

          • MaineJen
            January 27, 2017 at 9:20 am #

            You seem to only believe in “personalized care” when the woman wants what you want. When the woman wants to follow her doctor’s recommendations and be augmented in labor (say, for prolonged ruptured membranes), or when the woman wants an epidural, or when the woman actually doesn’t mind not being able to eat because a) labor is excruciating and b) she feels like she’s going to puke, it’s all “she just doesn’t have the right information.”

            How about you just butt out, and let the decision be made by the woman and her health care provider? (Does this rhetoric sound familiar? It should.)

          • momofone
            January 27, 2017 at 7:20 am #

            I haven’t seen anyone advocating for interventions in low-risk situations. Unless you mean issues of maternal choice (c-section specifically) I doubt you’d find much disagreement.

            I’d really like to see your answers to the questions you haven’t answered.

          • nikkilee
            January 27, 2017 at 8:46 am #

            My protest is about interventions used routinely. As when a woman in labor is routinely given an IV with pitocin in it, and confined to bed, and denied food and drink, and told to hold still because moving influences the monitor tracing. I chose not to answer questions about individual situations because I can’t. I wasn’t there.

          • Daleth
            January 27, 2017 at 9:05 am #

            Being denied food and drink is not an intervention. It is a precaution so that if she does need an emergency c-section, she won’t be at any risk of choking to death on the snack you loving NCB types gave her earlier. Food and surgery are not a good mix.

            While many women have no urge to eat during labor, for those who need energy, try giving them spoonfuls of honey. I used to eat honey by the spoon before my law school exams because honey, unlike every other sugar I’ve ever heard of, contains both short- and long-chain sugars, so there is no “sugar crash” after eating it. In other words like all sugars it gives you immediate energy, but with honey the energy lasts longer and only fades gradually. And it’s impossible for a few spoonfuls of honey to cause perioperative choking like food can.

          • The Bofa on the Sofa
            January 27, 2017 at 10:09 am #

            Being denied food and drink is not an intervention.

            What does the ACOG say about denying food or drink?

            Nikki brought up the ACOG recommendation to limit intervention, so I want to know, does the ACOG consider denying food or drink an “intervention” that should be limited? Or is Nikki just making that up?

            (it’s called “bait and switch”, I think)

          • Daleth
            February 1, 2017 at 7:14 am #

            Here’s what ACOG says:

            “Adherence to a predetermined fasting period before nonelective surgical
            procedures (ie, cesarean delivery) is not possible. Therefore, solid
            foods should be avoided in laboring patients
            .”
            http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Oral-Intake-During-Labor

            What has relaxed is the old-school prohibition on drinking liquids during labor:

            “The oral intake of modest amounts of clear liquids may be allowed for
            patients with uncomplicated labor.
            The patient without complications
            undergoing elective cesarean delivery may have modest amounts of clear
            liquids up to 2 hours before induction of anesthesia. Examples of clear
            liquids include, but are not limited to, water, fruit juices without
            pulp, carbonated beverages, clear tea, black coffee, and sports drinks.
            Particulate containing fluids should be avoided. Patients with risk
            factors for aspiration (eg, morbid obesity, diabetes, and difficult
            airway), or patients at increased risk for operative delivery may
            require further restrictions of oral intake, determined on a
            case-by-case basis.” (Same link).

          • nikkilee
            January 28, 2017 at 5:15 pm #

            Honey is fabulous, I agree.

            Denying a health person food and drink is an intervention. The stomach is never empty; it’s always full of digestive juices. The prohibition about eating came from the 20th century days when anesthesia was more crude, and general or twilight sleep were the norms. ACOG has relaxed about women being able, if they want, to eat in labor.

          • Azuran
            January 28, 2017 at 6:32 pm #

            There is still a HUGE difference between a stomach with digestive juices and a stomach full of food.
            Indeed, since general anaesthesia is rare in birth, most places allow women to drink a little and eat some light snacks.
            So why are you complaining? Because the woman trying a VBAC, with risks of rupture and crash c-section isn’t allowed to eat?
            Fasting is still recommended for general anaesthesia.

          • January 28, 2017 at 8:07 pm #

            No.

            The stomach is not “always full” of digestive juices . The presence of food or liquids in the stomach stretches the stomach slightly which triggers nerves within the stomach to produce more gastric juices and acid.

            The ACOG allows women with uncomplicated deliveries to drink clear liquids but abstain from non-clear liquids and food. Complicated deliveries should consult an ob – or more likely the anesthesiologist.

            http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Oral-Intake-During-Labor

            While this opinion was written in 2009, it was reaffirmed the last time it was reviewed by the committee in 2015.

          • Sue
            January 30, 2017 at 6:20 pm #

            “ACOG has relaxed about women being able, if they want, to eat in labor.”

            So, it’s not a “routine intervention”, then, is it?

            Another false assertion knocked over.

          • Daleth
            February 1, 2017 at 7:18 am #

            The false assertion was actually that ACOG says it’s ok for women to eat during labor.
            http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Oral-Intake-During-Labor

          • Daleth
            February 1, 2017 at 7:12 am #

            The prohibition about eating came from the 20th century days when
            anesthesia was more crude, and general or twilight sleep were the norms.

            What’s more important to you: that, say, 1 million women are more
            comfortable in labor because they’re allowed to eat, but 10 women die
            from aspirating that food? Or 1 million women are less comfortable, but
            none of them die? Does your answer change if you personally know one of the 10 dead women? It shouldn’t.

            Eating within 6 hours of going under general anesthetic is dangerous. The fact that it’s now the 21st century hasn’t changed that, and the rigid NPO (no food or drink) policy used in most western hospitals in the 20th century was too rigid, but it did reduce the number of women who died from inhaling semi-digested food into their lungs. That’s why this article suggests that the rule be applied less rigidly (let laboring women drink isotonic drinks to keep their energy up, but still prohibit solid food so they can’t choke to death):
            https://www.ncbi.nlm.nih.gov/pubmed/12698834

            There was also a study of first-time moms in Australia–done in the 21st century, in case you care–that found that labor takes 3.5 hours longer when women ate during early and established labor, and 2.16 hours longer when they ate only during early labor. Do you tell your patients that?
            https://www.ncbi.nlm.nih.gov/pubmed/17011681

          • Roadstergal
            February 1, 2017 at 11:03 am #

            That delay is longer than the ‘delay’ (confounders, obviously) introduced by an epidural, isn’t it?

          • nikkilee
            February 1, 2017 at 6:02 pm #

            And why is that a problem? Shorter labors aren’t necessarily better labors.

          • Azuran
            February 1, 2017 at 6:42 pm #

            Oh but when epidurals might make labour longer, then it’s unacceptable.

          • Roadstergal
            February 1, 2017 at 8:02 pm #

            Is that also your response when the NCB-ers bleat that epidurals are bad because they delay labor? Go ye and enlighten the midwives! Shorter isn’t necessarily better!

            (I don’t care that eating might affect the duration of labor, as long as it’s not to a point that endangers the child. I care because of the risk of choking and death. The thing you’re steadfastly ignoring in your comments.)

          • momofone
            February 1, 2017 at 10:37 pm #

            It’s interesting that of all the comments you could have replied to (but have avoided), this is what you chose.

          • Roadstergal
            February 2, 2017 at 11:21 am #

            100% ignoring the risk to the mother. Ignoring serious risks to mothers is kind of her thing.

          • Daleth
            February 2, 2017 at 9:23 am #

            Take a poll among your patients. Ask them, “Who would rather spend 10 hours in labor than 20?” Or to be honest, “Who would rather spend 10 hours in excruciating pain than 20?”

          • Empress of the Iguana People
            February 2, 2017 at 9:51 am #

            Nonsense, we don’t have pain during labor, we have *surges*. *eyeroll*

          • MaineJen
            February 3, 2017 at 9:38 am #

            I will laugh in the $%^& face of anyone who says labor isn’t painful.

          • The Bofa on the Sofa
            February 3, 2017 at 10:10 am #

            We should think about having a “commenter FAQ” for this blog, so that we didn’t have to repeat ourselves over and over again. For example, I would include my comment on pain in childbirth:

            “Pain in childbirth was recognized 3000 years ago as being so severe that it was attributed to being punishment from God.”

            I am a guy and have never experienced that pain, but I don’t need to to know that claims that it isn’t in general painful are bullshit. As are the claims that pain is a modern concept and that ancient natives did not have it.

          • Roadstergal
            February 3, 2017 at 1:43 pm #

            I have never gone through labor, despite having the parts. And I’ve had some really painful experiences – a compound fracture, various broken bones and lacerations, etc., so I thought I could at least guess. Then I had my cervix dilated just a little bit to put in my IUD, and OMFG. It’s not just the pain, which is pretty intense; it’s also how _deep_ the pain was. It engaged my lizard brain like I’ve never had it engaged before; it was serious fight-or-flight, and I had to grab the table to restrain myself from hitting the OBGYN and running out of the office. I can put pain aside if necessary; I dunno how you can put that kind of pain (what I had + a jillion) aside and think rationally.

          • myrewyn
            February 3, 2017 at 2:08 pm #

            Haha yep labor is indescribably painful and I have broken bones, torn my groin, and on a couple occasions been literally kicked airborne by a horse. Interestingly I didn’t find my IUD insertion to be painful but maybe that’s the benefit of having a cervix that’s already dilated in childbirth a couple of times?

          • Roadstergal
            February 3, 2017 at 2:31 pm #

            My OBGYN did say it’s generally easier when it’s not a dusty old unused cervix like mine. 😀

          • myrewyn
            February 3, 2017 at 4:58 pm #

            Oh and I don’t mean to diminish your pain from having an IUD inserted in any way. I just found it interesting how intensely painful you found it. I had no idea. Maybe that’s why the literature I got from my doc said it was mostly recommended for women who have had children.

          • Heidi
            February 3, 2017 at 2:38 pm #

            Probably. I know I used to have HORRIBLE menstrual cramps. Some months it’d be just really bad but every few months I’d have the kind that made me throw up and want to die. Labor felt just like that. Once I had the baby, though, I have no menstrual cramps at all. I’m guessing the big chunk of the pain was caused from my cervix dilating. I’ve also read that labor kills some of the uterine prostaglandin receptor sites.

          • myrewyn
            February 3, 2017 at 5:02 pm #

            That makes a lot of sense, actually. I had a similar experience with terrible adolescent cramps that went away after my first baby. I used to predictably miss one day of school per month for cramps that kept me in bed curled into a miserable ball and my mom had the same when she was young. A woman I know was ridiculing girls for missing sports practice over cramps and I wanted to punch her hard, probably in the cervix. Apparently she never had cramps like ours.

          • Roadstergal
            February 6, 2017 at 1:31 pm #

            Interesting – I had similar experiences to you and myrewyn, with horribly debilitating period pain that would immobilize me about one day a week. My poor dad (my mom died when I was 13) had to help me through it, and he mentioned that my mom had similar horrific period pain that went away after her first baby…

            Mine went away when I went on BC. :p

          • Heidi
            February 6, 2017 at 2:18 pm #

            The fear of my period returning is one reason I tried so hard to make breastfeeding work and pumped around the clock. Then when it came back a little less than 3 months postpartum despite all my efforts, I was pleasantly surprised the cramps were non-existent.

          • Dr Kitty
            February 6, 2017 at 3:04 pm #

            Primary dysmenorrhoea is the fancy name for bad period pain that starts from the first period you ever have, tends to run in families (so mum, aunties, sisters, granny all had horrible periods) and it is historically known to be improved after pregnancy and birth.

            The usual pattern is that pain starts with bleeding and is worse for the first day or two, easing up as the flow decreases.

            There are lots of old studies that show that women with this kind of period pain not only have higher levels of circulating prostaglandins but also have more frequent and stronger uterine contractions during their periods.

            This type of period pain also tends to come with fainting, vomiting and diarrhoea- which is super fun. Birth control to create anovulatory cycles or less frequent cycles also helps if a baby seems a bit drastic.

            Endometriosis tends to cause painful periods that get worse as you get older, the pain starts days before the bleeding and lasts for the entire period, even if the blood loss is minimal. There is sometimes associated blood in the urine or stool and often painful intercourse. Anything that stops the bleeding (pregnancy, breastfeeding, menopause, ovarian suppression drugs) helps.

            Some of us are super lucky to have both endometriosis and primary dysmenorrhoea!

            Without birth control only opioid painkillers enable me to function. Unfortunately neither pregnancy nor having my cervix repeatedly dilated for surgical procedures improved my pain much. Laser to burn away the endometriosis deposits and anything that stops me bleeding helps.

            Our local formulary suggests GPs prescribe Ibuprofen and Paracetamol for period pain. I laughed, bitterly.
            In my experience if women have severe enough pain to bother seeing a doctor about their period, the over the counter stuff isn’t working, so I skip straight to the heavy stuff and the hormones.

          • Who?
            February 6, 2017 at 4:04 pm #

            Oh yes. Horrible periods here, from the very beginning. Mine was endometriosis, much better but not ‘normal’ on the pill.

            Now on HRT, and having bad pain or heavy bleeding but not usually both, so back to the doc I go. Part of me wants to have my uterus out, which would leave me with one ovary and no bleeding, but not sure if that is even an option.

          • Dr Kitty
            February 3, 2017 at 2:36 pm #

            Interestingly, with Mirena #2 I had local anaesthetic in my cervix and so I experienced only mild cramping, but my cervix would not play ball and dilate.

            Apparently my cervix has some stenosis and scarring from endometriosis and only dilates when I’m unconscious. Who knows what it would have done in labour.

          • MaineJen
            February 3, 2017 at 2:40 pm #

            I had mine put in 6 weeks postpartum, and all I felt was a slight pinch at one point. I think it makes a huge difference if your cervix has ever dilated before or not; I’ve heard another woman who’s never experienced labor describe IUD insertion as excruciating, too.

            Although it wasn’t painful, I did get lightheaded for about 10 minutes afterward. Probably from my body going “What the #$% is that thing?”

          • Heidi
            February 3, 2017 at 2:40 pm #

            I had a similar experience when my cervix was chemically cauterized during my pregnancy. I could barely stand for a few hours.

          • Heidi_storage
            February 3, 2017 at 2:33 pm #

            Don’t forget the many instances when labor is used as a figure to describe the horror of an upcoming day of judgment, and the utter powerlessness of the people.

          • nikkilee
            February 2, 2017 at 10:37 am #

            Labor takes about 24 hours. The study you quoted talked about making early labor a few hours longer. Early labor is manageable; it is the longest phase of labor, and the easiest. If a mother is encouraged and supported (eating, drinking, walking around) this is doable. She has to see the value in it before labor starts; this is where education comes in. This is a different attitude than others have on this forum. There is room for all of us. No, I didn’t like labor. And I was committed to letting it happen on its own timetable, because I knew the chances of complications were diminished. Worked well twice.

          • Roadstergal
            February 2, 2017 at 11:16 am #

            Oh, hey, you’re here! I know you’re really good at avoiding questions, so there’s so many to direct you towards, so let’s start with that study you posted at the very tip-top of the page – easy to get to! – that said the opposite of what you said it said. Were you actively lying, or did you just not read it and got the link second-hand? Have you learned anything from the experience? Or is lying to clients just good business for you with no downsides?

          • rosewater1
            February 2, 2017 at 11:34 am #

            And for you, that’s great. Good for you. But why are you so convinced that everyone can be like you? Or should be like you?

            One of the head scratching things about the NCB movement for me is how they advocate for mothers to choose, to be listened to, to have their rights respected. BUT when that means “I want an epidural! I want a c-section!”-oh, THAT’S not acceptable. Pretty clear contradiction. And it’s insulting. Why can’t a woman choose to have pain relief? Why can’t she choose her delivery method? How she feeds her baby? What is gained by so many people being judge jury and executioner?

            It’s really ironic that you would say “There’s room for all of us.” There doesn’t seem to be a whole lot of room for others in your views.

          • nikkilee
            February 2, 2017 at 5:36 pm #

            She can. . .and she does. My concern is that folks have enough education to make the best choice. After working in labor and delivery for years, I saw what happened and had the advantage of being able to choose to avoid that system. Most people don’t have that advantage. One mother I worked with who had 2 children with serious ear infections (with one that ended up with severe hearing loss) was furious that no one had suggested she breastfeed. She did breastfeed her 3rd baby; I worked with her during that time and she was still very angry that no one had given her the information that could just have possibly made a difference in her children’s lives.

          • maidmarian555
            February 2, 2017 at 6:08 pm #

            I call bullshit. Just go away with your judgemental nonsense. You’ve answered precisely zero question when it comes to individual cases and failed to provide exact answers when we’ve asked what you consider to be ‘legitimate’ interventions. Take your judgemental, lying, organismic birth-pretending shit elsewhere. I’m sick of your lies. You’re a liar that makes money out of fearful pregnant women and I’m tired of being polite about that. You lie and risk lives to make a profit. Whilst you may be totally fine with making a living that way, I’m not ok with the fact that people like you shame women on a daily basis just for a dollar. You’re disgusting.

          • Heidi
            February 2, 2017 at 7:00 pm #

            You are the worst. You are a horrible person.

          • nikkilee
            February 3, 2017 at 7:01 am #

            Bless you.

          • Heidi
            February 3, 2017 at 8:34 am #

            No, save it for the women who you’ve lied to, who you have convinced all their children’s problems and issues were from not breastfeeding so you could sell them the solution. It’s horrible enough to have a child with a health issue and even worse to have a child succumb to SIDS but you are there to rub salt in the wound.

          • momofone
            February 3, 2017 at 9:37 am #

            So, nikkilee, planning to address any of the multitude of substantive questions you’ve evaded, or just sticking with the condescending responses?

          • MaineJen
            February 3, 2017 at 9:05 am #

            What the hell does breastfeeding have to do with ear infections?

          • MaineJen
            February 5, 2017 at 8:01 pm #

            Someone should tell that to my kids. They got it all wrong. My son “only” breastfed for 9 months, give or take, and he’s never had a single ear infection. My daughter breastfed until she was 2, and she had multiple ear infections.

            It’s almost like…there are OTHER factors at play here, besides breastfeeding.

          • Amazed
            February 7, 2017 at 10:45 am #

            Routine interventions reduces the risk of mother/ child dying and/or being permanently damaged. Somehow, I don’t see that as mattering to you. You sell your crap because you have to make a living and if it goes over the dead bodies of moms and babies – well, that’s bad. At least mom got to eat at home to her heart’s content. Right before the tragedy hit. But at least she was better equipped now to handle it because she was fed, aka strong. Far better than being hungry and exhausted in them evil hospitals holding a healthy baby.

            You’re all for reducing risks but only certain risks. The ones whose reduction leads to filling your purse.

            Please.

          • Azuran
            February 7, 2017 at 11:41 am #

            Oh geez. Ear infection. The deadliest of all childhood illnesses.
            Seriously, considering the rate of ear infection and the complication rate of ear infection. Please, do calculate how many babies need to be breastfeed in order to prevent any kind of permanent injury.

            And please. How does that risk of ear infection compares to all the babies who end up dehydrated, jaundiced or brain damages because of inadequate milk supplies in the first few day?

          • Empress of the Iguana People
            February 7, 2017 at 11:54 am #

            Knock on wood, there’s only been 1 ear infection in my house in 4 years, and that one in an adult.

          • The Bofa on the Sofa
            February 7, 2017 at 11:55 am #

            My older son was EBF for about 3 months and then combo fed until 9 months where he gave up nursing altogether. And he never had an ear infection that whole time – heck, he only had one cold the whole time.

            Then at about 14 months, he went on a streak of getting sick like every other week. What was the difference?

            He went to daycare.

          • Roadstergal
            February 3, 2017 at 12:06 pm #

            Oh, hey, you’re here! I know you’re really good at avoiding questions, so there’s so many to direct you towards, so let’s start with that study you posted at the very tip-top of the page – easy to get to! – that said the opposite of what you said it said. Were you actively lying, or did you just not read it and got the link second-hand? Have you learned anything from the experience? Or is lying to clients just good business for you with no downsides?

          • rosewater1
            February 3, 2017 at 12:23 pm #

            Um, what? No one suggested breast feeding to her? Not just once but twice?

            And I’m not getting the hearing loss thing as it relates to breastfeeding. Really? If you don’t breastfeed your children they are doomed? Really?

            If you REALLY want to do something about what you see as “injustices”-get off this page and do something constructive to change matters. Clearly what you are selling no one is buying here.

          • Empress of the Iguana People
            February 3, 2017 at 1:03 pm #

            Apparently, chewing’s motion helps prevent ear infections, or so my health teacher said many moons ago (refering to chewing gum). Not that sucking is the same as chewing.
            But what are the chances that no one mentioned breast feeding? Damned small, I’d say. Not to mention that bf’ing is no guarantee of anything! Neither of my kids have yet had an ear infection. (One’s bf’d, the other’s ff’d) I was bf’d and I did get the occasional infection.

          • Roadstergal
            February 3, 2017 at 1:33 pm #

            If it’s the sucking motion, wouldn’t bottles and pacifiers have the same effect?

          • Azuran
            February 3, 2017 at 12:41 pm #

            And my brother was breastfed, he had ear infection all the freaking time. We spent Christmas in the emergency room every single year because of him.
            I wasn’t breastfed, had 0 ear infection as a baby.

            Breastfeeding wouldn’t have stopped her 2 other kids from having ear infection, or at best, they would have had 1-2 too less. You are far over blowing the benefits of breastfeeding and making this poor woman feel guilt for something that isn’t true.

          • Linden
            February 4, 2017 at 5:45 pm #

            If someone told her the ear infections could be completely avoided with bf, they lied to her. If she had another kid after the third, she’ll probably be mad about that bs.

          • Who?
            February 4, 2017 at 6:15 pm #

            I breastfed my son and he had loads of ear infections.

            Do tell me how I must have done it wrong, somehow.

          • Daleth
            February 3, 2017 at 11:51 am #

            The study you quoted talked about making early labor a few hours longer. Early labor is manageable; it is the longest phase of labor, and the easiest. If a mother is encouraged and supported (eating, drinking,
            walking around) this is doable.

            That’s not your call to make. It’s hers–the woman in labor. If you’re talking to women about eating during labor, you should tell them it could add 2-3 hours to the length of labor and let them decide. Why not tell them that, offer isotonic drinks or spoonfuls of honey as an option for keeping their energy up without the risk of lengthening labor or hugely unpleasant vomiting at transition, and LET THEM CHOOSE?

            If you genuinely respected women, that’s what you would do.

          • Roadstergal
            February 3, 2017 at 12:04 pm #

            While I agree, I think her telling women it could add 2-3 hours to their labor is not the totality of her responsibility. She needs to tell them they risk _choking and dying_ if an emergency surgery is required, and note that fluids in the ACOG guidance do not. That’s what respecting women looks like.

          • Daleth
            February 6, 2017 at 9:20 am #

            Yes, absolutely. Here are the risks; here are the benefits; here’s what ACOG recommends; now you choose, since it’s YOUR life, YOUR body, YOUR baby.

          • Daleth
            February 3, 2017 at 11:51 am #

            No, I didn’t like labor. And I was committed to letting it happen on its
            own timetable, because I knew the chances of complications were
            diminished.

            That’s actually not true. Letting labor proceed “on its own timetable” doesn’t lower your risk of complications:

            Prolonged second stages and prolonged pushing phases are associated with increased adverse neonatal outcomes. This study included 42,539 first-time moms with singleton, full-term, head-down babies–in other words it was a large study of low-risk babies, which adds strength to their conclusion.
            https://www.ncbi.nlm.nih.gov/pubmed/27929527

            A prolonged pushing phase is associated with an increased risk of c-section for the mom and adverse outcomes for the baby. This study included 53,285 women, both nulliparous and parous, all with singleton, full-term, head-down babies and no prior c-sections. So again, strong support for the findings.
            https://www.ncbi.nlm.nih.gov/pubmed/26959213

            And you’re not even right to claim labor normally takes 24 hours. In this study, done in Scandinavia where the rate of interventions is much lower, the “total median duration from onset of labor until the birth of the baby was approximately 14 hours for primiparas and 7.25 hours for multiparas”–and again, a longer pushing phase was bad news for the mom: “blood loss more than 1,000 mL and perineal ruptures that needed suturing were associated with a longer pushing phase.”
            https://www.ncbi.nlm.nih.gov/pubmed/26467758

          • Dr Kitty
            February 3, 2017 at 1:15 pm #

            Labour takes about 24 hrs?
            It really shouldn’t… and if it does, someone should be intervening, and intervention leads to reduced CS rate and improved outcomes.

            From this very old but still relevant WHO publication about the Partograph:

            Before partograph introduction in Zimbabwe:
            13% of labours lasted over 24 hrs.
            Perinatal mortality was 5.8%
            CSection was 9.9%

            After partograph introduction in Zimbabe:
            0.6% of labours lasted more than 24hrs
            Perinatal mortality was 0.6%
            Csection rate was 2.6%

            For Malawi the figures showed less marked improvements, but still improvements:

            Prolong labour before14%/ after 3.0%
            Perinatal mortality before 5.3% / after 3.8%
            CS rate before12.5% / after 9.5%

            http://apps.who.int/iris/bitstream/10665/58903/1/WHO_FHE_MSM_93.8.pdf

          • Dr Kitty
            February 3, 2017 at 2:04 pm #

            Oh, and my mother was one of the many medical students in Zimbabwe back in the day who put the partograph data into what passed for a computer, and she said that it literally changed things overnight in the big teaching hospital in Harare.

            But sure nikkilee, you keep believing most labours last 24hrs and are safer left to proceed unhindered by modern evidence based practice.

          • The Bofa on the Sofa
            February 3, 2017 at 2:40 pm #

            I think the word nikkilee is looking for is “schooled”

          • The Bofa on the Sofa
            February 3, 2017 at 10:16 am #

            I have to say, this is about the funniest thing I have ever heard.

            Let’s see….long painful labors are ok if you get some food. However, give you pain relief, and now long labors are horrible things to be avoided.

            Why do you hate women so much?

          • momofone
            February 3, 2017 at 10:52 am #

            Exactly.

            Withholding food, resulting in the discomfort of hunger = abominable and irresponsible

            Withholding pain relief, resulting in agonizing pain (not to mention potentially ignoring issues of patient autonomy) = responsible care

          • Heidi
            February 3, 2017 at 11:21 am #

            Well, it’s not okay to withhold from laboring women for safety reasons (and I doubt that many are hankering to eat actual solid foods anyway) but it is a-okay to withhold food from your newborn infant if your supply hasn’t come in (or like me, possibly never comes in).

          • rosewater1
            February 3, 2017 at 12:24 pm #

            But, but, infant stomach size is tiny! But but magical breastmilk!

          • nikkilee
            February 4, 2017 at 8:18 am #

            Have you ever worked with a woman who is both angry and depressed because her labor went so fast she didn’t have time to get an epidural? Have you ever worked with a mother or a baby who are in shock because labor went so fast?

          • Heidi
            February 6, 2017 at 12:28 pm #

            Have you been one of those women who experienced a very quick labor? Nope (I’ve read your little birth biography)! Food isn’t going to slow down those of us who labor quickly. I bet most of us, and I speak from personal experience, have no desire to eat in the middle of a painful, quick labor.

          • nikkilee
            February 6, 2017 at 4:43 pm #

            Agreed. Women should be able to drink and eat if they want. . . not routinely denied food and drink because they are in labor.

          • Azuran
            February 6, 2017 at 5:25 pm #

            I don’t think Heidi’s point was that women should eat in labour.
            Why are NCB advocate freaking so much about this eating stuff anyway? Most women don’t even want to eat. I sure as hell have never heard even 1 mother complain or even mention that she was hungry while she was giving birth. And even then, many places actually allows you to eat lightly until we start active labour.
            People have to fast for tests, medical procedures or surgery all the freaking time and they don’t whine about it. Sure, it sucks, but no one is freaking dying from it. Jesus, you can handle pushing out a baby without an epidural but you can’t handle not eating?

          • momofone
            February 6, 2017 at 7:00 pm #

            Well, sure. Going without an epidural makes her a warrior. Not eating during labor? That’s just oppression, man.

          • nikkilee
            February 7, 2017 at 12:59 am #

            If you want to eat, you should be able to eat. I’ve seen a few women in labor who were hungry; more are thirsty. People riding in bike races or running marathons can drink and eat; some view labor as a similar endurance event and want the choice.

          • Who?
            February 7, 2017 at 2:31 am #

            Of course you can eat-the question is whether doing so is a wise choice in all the circumstances. Is a snack worth dying for?

          • nikkilee
            February 7, 2017 at 8:09 am #

            No risk of death if a woman eats in labor. Some women have huge meals, then go into labor.

            “Eating and drinking in labor is a controversial subject with practice varying widely by practitioners, within facilities, and around the world. The risk of aspiration pneumonitis and anesthesia-related deaths at cesarean section has resulted in adherence to historical practices of starving women in labor. Studies have shown that the risk of this anesthetic-related complication is low. It is the fear of the birth-attendant to bear full responsibility if a patient inhales gastric contents when giving in to demands for liberal fluid and food regimes during labor that governs practice. While the bulk of evidence supports fluid intake in labor, there are insufficient published studies to draw conclusions about the relationship between fasting times and the risk of pulmonary aspiration during labor.”

            I did a PubMed search for deaths due to aspiration in labor and didn’t find any.
            https://www.ncbi.nlm.nih.gov/pubmed/19428169

          • Azuran
            February 7, 2017 at 8:56 am #

            Once again, did you even read that? It says: Whether or not allowing food and fluid throughout labor is beneficial or harmful can only be determined by further research.
            Meaning: We don’t know, so we are taking the safe approach.
            And the problem isn’t aspiration during labour. It’s aspiration during anaesthesia.
            And as much as you are pretending that there is a huge Doctor conspiracy to make women suffer. I do have the right to eat lightly up until I’m in active labour and I have the right to drink basically anything during the entire labour.

            And the ‘if you want to eat, you should be able to eat’ it’s just stupid. That’s not how it works you dumbass. I wanted to eat the two times I had to do the GD test, or the two times I had surgery and the time I had an abdominal US. So according to you, screw the test, just eat? When my mom had brain surgery, should she just have eaten because she was hungry? Should my dad have eaten food on the morning he got his stents for his infarcts?

            People in marathons and labour are too different things. Comparing the two is just stupid. Those who think they are the same are just as stupid.

          • Daleth
            February 7, 2017 at 9:56 am #

            The risk of dying during a minor outpatient surgical procedure is low too, but it killed Joan Rivers among many other people, and because the risk exists, doctors have to warn us about it so we can make up our own minds.

            Why are you so gung-ho about eating during labor? Why aren’t you interested in just letting women know what the risks are so that they can decide for themselves?

            Perhaps it’s because most women, if informed that eating solid food during labor has a small but real chance of KILLING THEM, would decide to keep their energy up with juice, honey and protein shakes instead of food. In other words, most women wouldn’t make the decision you think they should make.

            Would you mind BACKING OFF and respecting women’s ability to make informed decisions, even when they’re not the decisions you personally prefer?

          • Empress of the Iguana People
            February 7, 2017 at 11:30 am #

            She sounds like she thinks every woman actually wants to eat during labor. I did for the first few hours with #2 because I went in just before i was supposed to make dinner and had only a cucumber sandwich for lunch, but i wasn’t *starving*, just peckish. Then the pitocin really kicked in and I stopped caring. (I was induced for bp)

          • Daleth
            February 8, 2017 at 9:30 am #

            She does sound like she thinks that. Which is an absurd thing to think–perhaps try LISTENING TO EACH INDIVIDUAL WOMAN instead of reaching sweeping conclusions as to what all of them supposedly want?!

          • momofone
            February 7, 2017 at 1:35 pm #

            I’m consistently astounded by the lack of wisdom in nikkilee’s choices/sales pitches.

          • Azuran
            February 7, 2017 at 2:02 pm #

            Oh it’s actually quite simple.
            -Any risk or consequences of something done by a doctor/medicine is horrible.
            -Anything positive done by a doctor/medicine is irrelevant.
            -Anything positive done my breastfeeding or midwives is absolute gold and should be the standard for anyone
            -Any risk or consequences of breastfeeding or midwives is irrelevant.
            And yes, this remains true even when the risk is the same in both situation. It’s good when it’s done by a midwife, but evil if it’s done by a doctor.

            Which is why, being hungry in labour is evil. But a newborn starving for days is ok.
            Or a longer labour because of an epidural is evil, but a longer labour caused by eating is good.

          • momofone
            February 7, 2017 at 1:32 pm #

            You know, as a grown person, you can take any food and drink with you that you want. You can eat it when you want it. You can drink what you want, when you want. No one’s going to physically remove it from your hungry little hands. Now whether that’s smart or not is another thing altogether, but you can rail against The Man all you want. You’ll show them!

          • Roadstergal
            February 7, 2017 at 12:31 pm #

            You have yet to acknowledge the true reason for the recommendation, which has nothing to do with labor duration and everything to do with THE RISK OF THE WOMAN DYING.

            Again, is this what you do with your clients? Conceal the risk of death? Sweep it under the rug and if it happens, note that not all mamas were meant to live – or better yet, that it was somehow due to those awful interventions?

          • swbarnes2
            February 6, 2017 at 5:39 pm #

            You really aren’t going to address the fact that you are a plagiarizer and liar? Do you even understand what is wrong behaving like that? I wonder if deep down, you really don’t understand what you did wrong.

          • The Bofa on the Sofa
            February 7, 2017 at 10:57 am #

            Wait a minute.

            Are you suggesting that a woman who is experiencing a precipitous labor should try eating something to slow it down?

          • Roadstergal
            February 7, 2017 at 12:28 pm #

            That’s today’s twist and turn to get her out of the corner she painted herself into. She still has yet to acknowledge, BTW, the true risk of eating in labor – the risk of choking or dying. Like any good NCBer, she’s beating the ‘slowing down labor isn’t a bad thing!’ drum to distract from the real risk.

          • Daleth
            February 1, 2017 at 7:17 am #

            PS: your statement that “ACOG has relaxed about women being able, if they want, to eat in labor” is wrong.

            What they’ve relaxed about is this: low-risk women with uncomplicated (so far) labors can drink “modest amounts of clear liquids,” but “solid foods should be avoided.”

            http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Oral-Intake-During-Labor

          • EmbraceYourInnerCrone
            February 1, 2017 at 10:00 am #

            SOrt of OT but I remember my Lamaze class nurse saying that once labor started it was a good idea to stick to ice chips and water. She said that many of her patients in labor vomited when they hit transition (and that it didn’t matter if they were going all natural or got an edidural. Well dopey me figured I’d be in labor for hours and had a 7-Up and a baked potato. Which I got to see again when I hit transition…blergh

          • Heidi
            February 1, 2017 at 10:41 am #

            I threw up during labor, too, before and after the epidural. I hadn’t eaten in hours and I had already been throwing up breakfast for a few days.

          • Daleth
            February 2, 2017 at 9:23 am #

            Oh argh. How unpleasant, you poor thing!

          • MaineJen
            January 27, 2017 at 9:34 am #

            Have you been listening to anything we’ve been saying the past few weeks? There are good reasons for these things being done. We’ve given you specific examples. We can’t keep making the same arguments over and over.

          • Heidi
            January 27, 2017 at 11:31 am #

            Have you been listening to anything we’ve been saying the past few weeks?

            No, she hasn’t.

          • Azuran
            January 27, 2017 at 10:53 am #

            Didn’t stop you from telling that random woman you didn’t know that she should tell her pregnant daughter to not listen to her OB.

          • momofone
            January 27, 2017 at 11:47 am #

            Yet you also say that doesn’t necessarily happen routinely. Which is it?

            Regarding your not being there, you seem quite comfortable sharing your opinions broadly, but don’t have much to say when people offer experiences that contradict your opinions. Your lack of response comes off (to me) as avoiding the question.

          • rosewater1
            February 3, 2017 at 12:19 pm #

            I’m still not clear why these things are bad. Hospitals aren’t dungeons. Women aren’t tied down against their will. In the interest of full disclosure: I work in a hospital, in OB. I’m not a doctor or nurse. I’ve never seen interventions for just their sake. And I’ve been full time for TEN YEARS.

            Consent is major. EVERYTHING is explained and consented prior to it happening. The consent for an epidural is 1 page-front and back with ALL the complications.

            When you go to a hospital, you go with the understanding that the professionals know some things more than you do.

            If you don’t understand something…ASK THEM.

            I’ve also seen nurses advocate-firecely-for their patients.

            I’m really not sure what you gain by this broad brush painting. Aside from perhaps pushing your own agenda?

          • Azuran
            January 27, 2017 at 11:01 am #

            And I see nothing in this that is proving your point. Everything in this documents are things that are already being done.
            Hey, guess what, If I’m low risk, I even have the right to drink lightly and eat a few soft things during labour. I also have the option of a pool, I have the right to a support person with me all the time. No one’s membranes are ruptured for no reason. No one is put on pitocin routinely ‘just because’. No one is induced ‘just because’. No one has c-section because the doctor had enough.
            You have no proof of anything that you are trying to say. All you do is take the random comments of other biased people to confirm your own biases.

          • Visitor
            January 15, 2017 at 6:01 pm #

            Irony alert.

          • sdsures
            January 20, 2017 at 10:53 am #

            I can’t believe you actually wrote that.

          • nikkilee
            February 4, 2017 at 9:25 am #

            A participant in class asked about the “Breast is best” slogan, wondering if it should be used. I said no, because it doesn’t help anybody.

          • momofone
            February 4, 2017 at 4:09 pm #

            And did you go on to say that the most important thing is that babies are fed?

          • swbarnes2
            February 4, 2017 at 4:26 pm #

            Right, like how you have control over what you post, and you decided to plagiarize and lie. Fundamental dishonesty leads you to choices like that.

    • Heidi
      January 14, 2017 at 1:07 pm #

      I have no hopes of changing her mind! My thoughts if someone is thinking of using her services (or fencesitters or moms who might be feeling guilt about having to formula feed), they’ll read our stuff and notice her little game of cricket when she knows she’s wrong.

      • maidmarian555
        January 14, 2017 at 3:02 pm #

        Yeah this. I remember when I found this site. It was the first time I’d really seen the NCB movement properly challenged online. I have so many friends who’ve been hurt by it (whether it’s via chronic unnecessary guilt for c-sections and formula feeding or indeed those who’ve had unmedicalised natural births who were shocked and traumatised by the pain and brutality of it). It’s pretty rare to find somewhere where their rhetoric and ‘facts’ are properly challenged, debunked and criticised. I thought I was going to be a sensible, rational mother and have never really been even vaguely crunchy. I still (mostly) am but in my post-partum fug I was really damaged emotionally after accidentally stumbling on NCB sites. It felt like such a weight was lifted when I came here and read the BTL commentary and saw people like Nikki Lee and her ideology torn to shreds. It made me realise that actually, the way I felt wasn’t ‘wrong’. I wasn’t a ‘failure’. Their movement is and their bullshit and cruelty should be called out for what it is.

    • The Bofa on the Sofa
      January 14, 2017 at 1:21 pm #

      Well, it’s kind of the on-line version of running her panties up the flag pole for everyone to laugh at. But instead of stealing them, she hands them to us.

    • Sarah
      January 14, 2017 at 5:27 pm #

      It’s always worth correcting her because you never know who’s reading. If it stops one person from being influenced by her pernicious shit, it’s worth it.

    • sdsures
      January 20, 2017 at 10:52 am #

      Resistance is futile; we are the Borg.

  9. Christy
    December 30, 2016 at 9:05 pm #

    So sorry this is off topic, but I have to vent. In a parenting group that has nothing to do with health, a mom mentions a woman in her community who lost a baby to SIDS. By the 3rd response the anti-vax vultures were already speculating that the baby died of vaccines. Because package inserts. I don’t do Facebook drama but I am so angry right now!

  10. nikkilee
    December 30, 2016 at 11:26 am #

    Oh are you quick and smart, Dr. Amy. The facts are still true. There is no labor drug FDA-approved for infant safety. Human milk, a cousin to human blood, will always be best for human infants. Maternal mortality in the US is rising to the highest of any developed nation; as far as infant mortality goes, currently the US is ranked 28th, in a country where over 1/3 of women have their babies surgically delivered, whereas the WHO suggests that surgical birth rates are best at 10-15%; less than that, and not enough are being done; more than that is too many. However your points about the privilege factor in childbirth and breastfeeding are interesting and reflect your desire to keep learning. I appreciate that. A goal of teaching is to inform, never to make anyone feel bad; this is an ideal, and, unfortunately, not always real. But still a goal. The most important thing about infant feeding is that the mother loves her baby.

    • StephanieJR
      December 30, 2016 at 12:09 pm #

      The most important thing about infant feeding is that the infant is FED. If you love your child, you feed them what is best for them, and formula is a perfectly good substitute for breastmilk. Breast is not always best. Fed is.

    • Azuran
      December 30, 2016 at 12:17 pm #

      Actually, human milk is a cousin of human sweat, not blood.
      It is no more magical than any other liquid your body produces.

      And funny, how to you explain that despite our relatively similar use of medical intervention, Canada has better outcomes? Perhaps free health care helps a lot.

      • nikkilee
        December 30, 2016 at 6:31 pm #

        You bet, about the free health care. As for blood versus sweat, seems that sweat glands and mammary glands diverged about 100 million years ago. Human milk contains much that sweat doesn’t: stem cells, lots of different white blood cells, bioavailable iron bound to a protein.

        • Azuran
          December 30, 2016 at 9:51 pm #

          Try injecting Breastmilk Intra-veinously, then tell me how you feel.
          There is no such thing as breastmilk being like a cousin of blood. It doesn’t even mean anything. It’s just gibberish peddled by idiots who want to believe that they have magical powers.

          • sdsures
            December 31, 2016 at 3:05 pm #

            It’s a bodily fluid, like urine – that is its only similarity to blood.

          • Gæst
            January 1, 2017 at 1:34 am #

            I don’t understand how bodily fluids can have cousins at all. Do they also have mothers and fathers? What or who is the mother of my blood? If I have a blood transfusion, is that like having a blood step-sister? Or maybe this whole metaphor is just asinine.

          • Sarah
            January 1, 2017 at 6:43 am #

            Your doula.

        • Azuran
          December 30, 2016 at 10:08 pm #

          Also, so you agree that better health care leads to better outcome, not lower c-section rates.

        • Heidi
          December 30, 2016 at 10:10 pm #

          Guess what contains “antiseptic enzymes (such as lysozymes), immunoglobulins, inorganic salts, proteins such as lactoferrin, and glycoproteins known as mucins that are produced by goblet cells in the mucous membranes and submucosal glands”? Snot! Let’s feed babies snot then! Sounds pretty magical and awesome, too!

          Now, I’m all for breastfeeding if mom wants to breastfeed, there’s enough to sustain baby, and it isn’t contributing to any mental or physical anguish, but it ain’t magical.

          • Azuran
            December 30, 2016 at 10:53 pm #

            Even better, let’s feed the babies blood!!!!

            (for the glory of Satan)

          • sdsures
            December 31, 2016 at 3:04 pm #

            Side note: in a documentary about the “Blood Countess” Elizabeth (Erzabet) Bathory, it’s theorized that she may have been anemic, and been treating it unknowingly by drinking the blood of her victims. https://en.wikipedia.org/wiki/Elizabeth_B%C3%A1thory

          • nikkilee
            December 31, 2016 at 10:38 am #

            Certainly children eat enough snot; nice to learn that it is good for them. As for breastfeeding, it isn’t magical. It is amazing, as amazing as any other body process such as brain function or immune function. But it isn’t magic fairy dust. It does give babies a better chance for a healthy life, just as seat belts don’t guarantee survival in a car crash.

          • Heidi
            December 31, 2016 at 3:05 pm #

            “It does give babies a better chance for a healthy life”

            Nope! Getting enough of an appropriate substance does and formula fits that bill. Babies died all the time when breast was almost the only option. Where the breastfeeding rates are the highest so are the infant mortality rates. Thanks to quality tap water and high quality formula, my son does have a healthy life that does not involve dying of dehydration nor starvation. It also did not involve accidental suffocation. Nikkilee, I remember being so sleep deprived when my son was first born that I would nod off sitting straight up. Fortunately when I just couldn’t do it, I handed the baby and a bottle off to someone more rested than me.

          • nikkilee
            December 31, 2016 at 7:19 pm #

            There are so many factors to infant survival; breastfeeding is only one of them. Talking about babies in general is not talking about you and your baby specifically.

          • The Bofa on the Sofa
            January 1, 2017 at 11:57 am #

            There are so many factors to infant survival; breastfeeding is only one of them.

            And a trivial one at that. You aren’t the first lactivist to admit that when it comes to healthy babies, there are a lot of things that are far more important than breastfeeding.

          • Azuran
            January 1, 2017 at 12:32 pm #

            Yesterday my SIL described her night feedings of her baby as: Getting up, sitting on the chair, putting him on the breast, falling asleep, waking up when he’s done, putting him on the other breast, falling asleep, waking up when he’s done, putting him back to bed then going back to sleep.
            Somehow that doesn’t sound very safe.

    • Elizabeth A
      December 30, 2016 at 12:26 pm #

      Infant mortality (deaths up to age 1) is a measure of pediatric care and social services, not of obstetrical outcomes. The WHO admitted that it basically pulled that 10-15% number out of thin air – it is not applicable to all populations. The important statistic about c-sections is that every mother who needs one gets one.

      The most important thing about infant feeding is that the infant is fed. Who feeds the infant, and that person’s feelings about the infant, are far lesser concerns.

    • MI Dawn
      December 30, 2016 at 12:29 pm #

      nikkilee: the WHO does NOT suggest surgical rates of 10-15%. That’s a very old number and one not supported by actual research. Try updating your tropes.

      The most important thing about infant feeding is that a mother FEEDS her baby. It does not matter how she does it (breast or bottle, breastmilk or formula) provided the food is supplied and appropriate for the child’s age and health needs.

      • nikkilee
        December 30, 2016 at 6:33 pm #

        As of 2015, WHO stands behind 10%. http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/

        • Young CC Prof
          December 30, 2016 at 7:07 pm #

          Uh, yeah, that might work for countries where women don’t have access to birth control and the surgical technology is so poor that c-section complications can turn fatal. In other words, not here.

        • Nick Sanders
          December 30, 2016 at 7:10 pm #

          “These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research. “They also illustrate how important it is to ensure a caesarean section is provided to the women in need – and to not just focus on achieving any specific rate.”

          So, no, WHO does not “stand behind” 10%.

          • Box of Salt
            December 30, 2016 at 7:55 pm #

            In the WHO’s FAQ: “In addition, in some societies, delivery by caesarean section is
            perceived to preserve better the pelvic floor resulting in less urinary incontinence in the future or sooner and more satisfactory return to
            sexual life.”

            Put a fork in my own eyeball moment: since when is desiring less future urinary incontinence a bad thing?

        • Sue
          December 31, 2016 at 12:41 am #

          What most people seem to miss is that the WHO was trying to define a MINIMUM standard of access to Cesarean section, not a maximum.

          WHO is concerned with WORLD health – in a world where mothers and babies die for lack of access to effective care and necessary
          interventions.

        • Sarah
          January 1, 2017 at 6:40 am #

          You haven’t even bothered to read what you’ve posted! The sidebar of the link contains a link to FAQ. The VERY FIRST one of the questions is whether the WHO have a recommended section rate at country level. The VERY FIRST word of the answer is ‘No’.

          http://www.who.int/reproductivehealth/topics/maternal_perinatal/faq-cs-section/en/

    • RudyTooty
      December 30, 2016 at 3:06 pm #

      Struggling to understand your point with this one:

      “There is no labor drug FDA-approved for infant safety.”

      Maternal-fetal medicine is a complicated field because risks and benefits need to be continuously measured and evaluated. Infants only exist after a pregnancy has ended (ie after birth). And there are plenty of circumstances during pregnancy that pose significant risks to fetal health, well-being and survival. So we make use of medications utilizing a risk-benefit approach. What, exactly, is your point and/or position? That no drug is to be used on a pregnant woman ever?

      • Empress of the Iguana People
        December 30, 2016 at 3:39 pm #

        probably

      • nikkilee
        December 30, 2016 at 6:30 pm #

        No point. Merely a statement of fact. What happens is, as you say, a matter of benefit/risk analysis. That women get what they need in labor, and are treated as individuals, and that each labor is treated for the unique event that it is, and that interventions are used as needed, instead of as routine.

        • Who?
          December 30, 2016 at 7:09 pm #

          You jump from ‘safe for baby’ to ‘mother’s needs’ pretty fast there.

          Who decides what mother needs?

          Surely diversity of treatment is more likely to be a sign of individual care than not. Yet in birth centres, diversity of care can’t be provided-it’s either what they can do, or off to hospital.

          Surely the hospital is the best place to ensure women get what they need, as opposed to what a birth hobbyist thinks they should want.

          • Sarah
            January 1, 2017 at 6:38 am #

            Lactivists decide what mother needs. Come on, you know this!

        • sdsures
          December 31, 2016 at 3:01 pm #

          “There is no labor drug FDA-approved for infant safety.”

          Nikkilee, when you show me proof of your medical degree with a subspecialty in MFM, I’ll listen to you. Otherwise, there’s no proof to your claims, and you don’t have the education to back them up.

          • nikkilee
            December 31, 2016 at 7:29 pm #

            Name one drug that is FDA approved. I’ve worked in maternity for over 40 years, including 4 different hospitals. Here’s an area of cognitive dissonance, where women are cautioned against taking an aspirin or a beer in pregnancy, yet are given narcotics in labor.

          • sdsures
            January 1, 2017 at 10:59 am #

            Answer my question.

          • sdsures
            January 3, 2017 at 3:10 pm #

            Narcotics during labour are given under CONTROLLED CONDITIONS IN A MEDICAL SETTING. Stop being stupid. Beer and aspirin during pregnancy are not, unless you are prescribed aspirin by your GP and your OB signs off on it, and you do not spend the entire pregnancy on bedrest in hospital.

          • nikkilee
            January 3, 2017 at 4:16 pm #

            That doesn’t mean they are good for babies.

          • Heidi
            January 3, 2017 at 4:42 pm #

            There you go with your shamey shame shamin’ again. “Oh, you should be able to make your own decision, but just be aware, it’s probably HORRIBLE for your baby! But it’s all your choice, you know, you’ll probably just kill your baby, but I totes support you.” So the argument goes that there’s no safe drug to take during pregnancy. This coming from a person who published a book embracing homeopathy and adjusting babies who won’t breastfeed.

          • sdsures
            January 4, 2017 at 5:40 pm #

            They’re for the mother’s pain.

          • sdsures
            January 6, 2017 at 7:11 pm #

            They’re good for the mother’s pain.

    • Amy Tuteur, MD
      December 30, 2016 at 6:57 pm #

      You seem to have utterly missed the point, nikkilee.

    • fiftyfifty1
      December 30, 2016 at 7:09 pm #

      “Human milk, a cousin to human blood”

      No, not really. Milk is actually a cousin of sweat. Apocrine (armpit and groin) sweat, not eccrine sweat, to be exact.

      • Sue
        December 31, 2016 at 12:37 am #

        Yep. And urine is (filtered) blood, without the red cells, proteins or pus.

        • Empress of the Iguana People
          January 1, 2017 at 11:22 am #

          …hopefully…

    • CSN0116
      December 30, 2016 at 7:46 pm #

      nikkilee! Hi! Can I have your ear for a moment?

      Can you please explain to me why, I’ll call them breast feeding advocates, continuously harp on the fact that breast milk is unlike any other substance and that formula will never compare? I understand that those things are true, of course. But where I come from, something that is superior has to produce superior OUTCOMES in order to be worth its claim. So, the fact that breast milk has stem cells, and loads of white blood cells, or even magical unicorns in it is kind of all lost in glory when we get to outcomes assessment, no?

      Aside of the whole “you can’t pick out a non breast fed person from a breast fed one,” there are the facts that no health questionnaire anywhere asks how long I was breast fed for. It will ask me a whole ton of other personal and family-related health questions, but why not something so vital? My lack of being breast fed should put be at increased risk for several diseases and even cancer. Wouldn’t my doctor need to know this to tailor my care?!

      Why do my children’s school registration forms ask in what gestational week they were born and their birth weights (both highly correlated to academic achievement), but not how long they were breast fed? Surely they would want to know if they were totally deprived of this substance, so that they can be promptly placed in remediated tutoring or something, bringing them up to par with their breast fed classmates, reducing disparity, and ultimately saving the school district money?

      Surely these things are not practiced because all of us here know (including you) that whatever breast feeding benefits exist are beyond trivial and in no way clinically significant, which is why no health care provider cares to know about how we were fed as infants. I don’t think you can argue your way out of the damning evidence that the obesity, asthma, cancer, allergies, colds, GI illness, bonding “benefits” …have all gone to shit. They’re not real.

      So explain to me why you continue to point out how “speshul” this substance, that is incapable of producing any discernable positive OUTCOMES, is? Why not play it up in some other fashion? Using fancy terms for what breast milk contains is just so futile in my opinion, because nobody’s buying it. Shit, kale and spinach are inherently different too, and will never be equal… but I think you get the point.

      Please elaborate.

      • Who?
        December 30, 2016 at 7:52 pm #

        It’s a feelings thing.

        That’s all.

        • CSN0116
          December 30, 2016 at 8:24 pm #

          Sigh. It’s just so stupid. Like claiming and bragging that my kid comes from a royal blood line, has perfect body proportions, and is ambidextrous with a photographic memory… BUT she is dead middle in class rankings, average looking, and mediocre at sports. WHY would I continue to play up these attributes? I’d look like an irrelevant moron.

          • Who?
            December 30, 2016 at 9:10 pm #

            It just flashes me right back to early teens/high school. All those mean, bitchy competitive girls competing over trivial crap and being horrible to anyone who didn’t fit their template.

            In retrospect, and having watched teen girls in action from a parent’s perspective, it’s just insecurity and anxiety. Really annoying to be on the receiving end though.

      • Azuran
        December 30, 2016 at 10:04 pm #

        And especially: Life and medical Insurance companies.
        They didn’t ask me how long I was breastfed. Yet if ANYONE is going to care about every little thing that might make you less healthy, it’s freaking insurance companies.
        How could they not care how much magical breastmilk I got?

        • CSN0116
          December 30, 2016 at 10:18 pm #

          This is an amazing point!

        • nikkilee
          December 31, 2016 at 10:34 am #

          That’s been a mystery to me also. I’ve been working on that for years. Insurance CEOs would make way more money if more babies were breastfed, as healthcare costs for mothers and babies would be lower in both acute and chronic situations.
          Could it be that in a corporate nation, industry dominates, and that the billions of dollars made by the formula industry speak loudest? In Japan, how long a baby breastfed was part of a school entrance history; I don’t know if that is still true.

          • CSN0116
            December 31, 2016 at 1:09 pm #

            Could it be that statisticians working for insurance companies are quite fabulous at what they do and bias-free when it comes to infant feeding? They just analyze what they need to analyze and interpret it. Could it be that they have all figured out that the statistics do NOT support lower health care costs related to breast feeding? Do you really think that the profit-seeking scumbags at the leading insurance companies would let the infant formula market step in front of “billions of dollars” in their pockets and the pockets of their shareholders?! LOL You’re incredibly disillusioned regarding the “power” of Enfamil and Similac.

            For Christ’s sake, some 1 in 20 EBF newborns are readmitted to special care for starvation-related issues like hyperbilirubinemia and dehydration. One day in special care utterly dwarfs the costs of an extra two colds and one gastro illness (neither of which require medication or even an office visit, and so long as a fever isn’t present, that kid can still go to daycare and my ass to work) that my formula fed baby “supposedly” contracts in its first year. And you know that adult chronic illness related to not breast feeding are all riddled with socio-economic confounders.

          • sdsures
            December 31, 2016 at 2:59 pm #

            My premature birth t 28 weeks, and the cerebral palsy and hydrocephalus caused by it – leading to severe chronic migraines in adulthood – all occurred before I was fed a single drop of breastmilk or formula. I was fed breastmilk because my mom was a lucky woman who had enough to not just feed me, but the ENTIRE NICU.

            So, the argument that FF babies have more chronic illnesses is, at least in my example, shown to have no correlation.

          • Mariana
            December 31, 2016 at 10:40 pm #

            My husband, who was fed whatever milk was available (he was even breastfed by a family friend) because my mother-in-law had no milk, had his first round of antibiotics at age 30! And an allergic reaction to them 2 days after that. But come on! You can’t say he wasn’t a healthy kid!

          • sdsures
            January 1, 2017 at 10:57 am #

            Needing antibiotics is only one measure of when a person gets sick. For instance, nobody gets antibiotics for the flu or a cold.

          • nikkilee
            December 31, 2016 at 7:39 pm #

            In one study, the incidence of hypernatremic dehydration overall was 0.04% for hospitalizations of babies over 2 weeks old. In another, it was 1.9% Where does this 5% figure come from? Hypernatremic dehydration also occurs in formula-fed babies, when caregivers use it incorrectly. Sometimes they mix it incorrectly out of ignorance, or error, or hoping to resolve constipation. True it does occur more often in the exclusively breastfed baby; to blame breastfeeding per se for that is an incomplete view, and points out the complexity of our deficient health care system, community skills and social support.

          • CSN0116
            December 31, 2016 at 8:48 pm #

            Well, let’s talk about that. Our health care system and much of the community and social support networks promoting breast feeding, like WIC and Le Leche League, all seem pretty preoccupied with the recommendations set forth in BFHI. And regarding the health care system, in particular, BFHI is completely institutionalized and runs the show.

            The unfortunate bit with all of this, is that the BFHI tenants are horribly dangerous. Their “rules” on formula feeding, exclusive or supplemental (#6.1 in the US version), are demeaning and patronizing, and set babies up to be starved and readmitted. And the 2-4% EBF readmission rate was referring to USPSTF’s updated recommendations.

            But let’s sort this all out. If I BF, my breast pump will be paid for (~$200). My employer will have to give me time to pump and I will either cost my company money, or my family my time with them. My baby will need additional weigh-ins in the early days. I will most likely need lactation consultations. I will need to give certain vitamin supplements to account for what breast milk is deficient in. My baby is at higher risk for readmission, hyperbilirubinemia , dehydration, and long-term neurological damage that can be caused by these things, the effects of which can be seen and quantified all the way through elementary school on standardized testing. My baby is at *higher* risk for allergies. And I risk diagnoses of my own, like mastitis and thrush, that will require office visits and meds.

            HOW…HOW can all of this be cost saving? You’d be lucky to break even on the “increased acute and chronic illness” front, but it seems perfectly plausible that because it is natural and nature is so prone to failure that needs fixing, breast feeding COSTS the health care system, individual families, and the school system loads of money.

            What are the complex deficiencies in the health care system, community and social supports, in your opinion?

          • nikkilee
            January 1, 2017 at 3:15 am #

            1) Lack of support for mothers. 23% of mothers are returning to work at 2 weeks or less. I got the figure from an administrator of AWHONN, and have validated it. No paid maternity leave as a national policy; if one is lucky enough to work for certain companies (Johnson and Johnson come to mind first), then paid maternity leave is available, but for the majority of mothers, there is none. In the US today, Most healthcare professionals are poorly educated, if educated at all, about breastfeeding. At one medical school where I teach, students get 2 hours of education about breastfeeding in 4 years. This is more than many schools offer, and far from what is necessary.

            2) An overworked and underfunded hospital system, where nurses and lactation professionals are caring for more than they should be. When a nurse has to care for more than 3 couplets, i.e. 6 people in one shift, care suffers. (3 couplets is the AWHONN recommendation, and this was quoted in the recent AAP updated SIDS and Safe Sleep Policy). When a lactation professional is expected to see 20 or 30 or more breastfeeding mothers in one shift, care will not be good. It can’t be; not a fault of the nurse or lactation professional, this is a systems issue. The rules and regulations and requirements placed on maternity staff plus the fact that charting on the computer (originally promoted as saving time) actually does the opposite; staff can spend twice as long charting (many hospitals have one charting system for mothers and another for babies, and the systems don’t communicate with each other), means less time with the patients.

            3) Unrealistic expectations about change. The healthcare system in the US never integrated breastfeeding into its care. For 3 generations, hospitals promoted formula use, and separated mothers and babies. 3-5 years, which is the length of time it takes to achieve designation, is far too short a time to integrate changes in attitudes, policies, and practice. Resistance then develops; folks can feel battered or forced.

            Look at Dr. Melissa Bartick’s latest article for the costs of not breastfeeding; the costs to our world, not only the US, of cancer, diabetes, and obesity. A reminder, these are data about populations, not individuals.

            I would like to see evidence, case-control studies or retrospective reports that describe the health benefits of formula.

          • CSN0116
            January 1, 2017 at 8:33 am #

            Nikki, you won’t address any of the things I present, you just hop to different things. Clearly, we each think that what’s wrong with hospitals, community and social supports, as they relate to bf, is very different. You’re all more support, more education, more normalization, all of which is so exhausted at this point. LCs are overworked in hospitals? Well every wic office and nearly every ped office has one. Too much info at once? Women are bombarded for 9 months with posters, pamphlets, lectures, and classes on how to breast feed.

            And Bartick? She’s a fucking loon who used a simulated model of cherry picked, flawed ideals to come up with her “savings”. That study is shit and has bee ripped apart by many. I work at the same institution with one of her co authors… nobody is much impressed.

            TALK TO ME ABOUT THE COSTS TO BREAST FEED. TALK to me about how the female body, and all body systems, fuck up constantly but breasts can’t. TALK to me about the cost when they do fuck up. Talk to me about the cost of perpetuating that breast feeding is “amazing” instead of inherently flawed.

            You want controlled studies of formula’s benefits… for starters, look at the breast feeding studies already out there.

          • CSN0116
            January 1, 2017 at 10:21 am #

            http://pediatrics.aappublications.org/content/131/5/e1538#ref-10

            To my knowledge, upwards of 80% of newborns are EBF at 1-2 weeks of age. Soooo these are some pretty unfortunate findings.

          • KeeperOfTheBooks
            December 31, 2016 at 11:21 pm #

            Well, yes.
            If parents are denied any sort of information on safe formula preparation, then it’s not entirely shocking that they, especially first-time parents, might *possibly* not prepare it correctly. (She says sarcastically.) Take me: I’m college-educated, and I’ve cooked a LOT over my lifetime. What’s just about the number one rule of baking? You add liquids to solids, right? Well, that’s how I prepared DD’s formula until I happened across a warning about that a few weeks into her life. No one told me how to mix a bottle or prepare formula, even though we were supplementing as a condition to leave the hospital due to DD’s dehydration and weight loss.
            However, the BFHI solution to this isn’t “if mom/dad/whoever is caring for baby decides to formula feed, give them appropriate education on how to do so safely.” The BFHI solution, from what I’ve seen at my local BFHI hospital, is to pretend that everyone will breastfeed no matter what and not give any information whatsoever about formula, even if mom states from the start that she’ll be formula feeding. No doubt some bureaucrat somewhere can explain to me how that prevents issues with formula prep, but damned if I can see it. Hell, as I stated in another thread recently, the required educational video we had to see prior to discharge in lieu of actually talking to a nurse didn’t even mention how to bottle feed, or pump, or thaw breastmilk, or whatever: all it talked about was a) how breastfeeding is always easy and painless, and if it isn’t You’re Doing It Wrong, and b) a brief how-to on breastfeeding. Not even any mention, IIRC, of mastitis or plugged duct or abscess symptoms or treatment–no doubt they didn’t want to infringe on the breastfeeding is always easy and painless party line, or something. Frankly, if I were a nursing mom, I’d have been angered by the lack of rather vital information in that video about my chosen method of feeding. As it was, I couldn’t see why I had to sit through that drivel rather than sleep.

          • nikkilee
            January 1, 2017 at 3:20 am #

            BabyFriendly guidelines require that families be taught the safe preparation of the formula they will use. Hospitals in my region are using flip charts to teach about the safe preparation of powdered infant formula, as hospitals don’t carry powdered infant formula because of its risks, despite it being the one most given by WIC as it is cheapest.

          • CSN0116
            January 1, 2017 at 10:03 am #

            BFHI patronizes and requires that staffers:

            1. Ask a woman why she wants to EFF or supplement

            2. “Address these concerns” i.e. try to talk her out of it

            3. Explain to her the dangers of formula and what her baby will be missing

            4. If the woman persists, THEN she receives formula and proper preparation instruction.

          • nikkilee
            January 1, 2017 at 10:38 am #

            Here is the exact wording:

            “6.1 Guideline: When a mother specifically states that she has no plans to breastfeed or requests
            that her breastfeeding infant be given a breast milk substitute, the health care staff should first
            explore the reasons for this request, address the concerns raised, and educate her about the
            possible consequences to the health of her infant and the success of breastfeeding. If the
            mother still requests a breast milk substitute, her request should be granted and the process
            and the informed decision should be documented. Any other decisions to give breastfeeding
            infants food or drink other than breast milk should be for acceptable medical reasons and
            require a written order documenting when and why the supplement is indicated. ”

            There are reasons and evidence behind these guidelines. One is that corporations don’t want the truth about their product to be common knowledge. If you are interested, explore the patents behind formula ingredients, and what the companies who are applying for those patents say about them.

            This is true about all corporations, tobacco being a major example. The truth about tobacco causing harm was known for decades and suppressed. GM had information about its airbags for years; it wasn’t enough enough people died or were injured that the litigation started.

            It is possible to do this kindly and respectfully. I have done so. In my experience, and It is important to do it only once during her hospital stay, not every single shift!! Unfortunately, in some facilities, it happens every single shift. This is awful and disrespectful and rude, and creates backlash.

            There will always be formula in hospitals with BFHI designation.

          • CSN0116
            January 1, 2017 at 10:41 am #

            Like I said, patronizing.

            “There are reasons and evidence behind these guidelines. One is that corporations don’t want the truth about their product to be common knowledge.”

            Surely the risks of EBF are discussed as well? Otherwise it sounds like the breast feeding industry is much like the formula one you describe. Seems they don’t want the truth exposed either.

            1. the ingredients in formula are safe.
            2. comparing formula ingredients to a tobacco or air bag level conspiracy is ridiculous…

          • nikkilee
            January 1, 2017 at 9:02 pm #

            The ingredients in formula are not all safe; many are not listed on the label, MSG, for one. Hypoallergenic formulas are the highest in MSG content. Many adults choose not to eat MSG because it gives them headaches.

            https://www.google.com/patents/US6270827

            https://www.dsm.com/content/dam/dsm/cworld/en_US/documents/2014-09-04-presentation-us-fieldtrip-ethan-leonard.pdf

            The formula industry uses human milk as a model, and aims to produce human milk in a laboratory. . . .they know it is the best thing for human infants.

          • CSN0116
            January 1, 2017 at 9:36 pm #

            Sigh…You refuse to engage in any discussion worth a damn. I’m out.

          • nikkilee
            January 2, 2017 at 9:01 am #

            Thanks for the comments about Dr. Bartick. No matter what evidence is presented in this forum, it is guaranteed to be rejected, both here and out in the world.

            Thank you too for the comment about the lack of studies about the health benefits of infant formula. There will never be any.

          • CSN0116
            January 2, 2017 at 9:16 am #

            I said there will never be controlled, prospective studies, for the typical ethical reasons.

            There are benefits to formula.

            If every newborn worldwide were eff with access to clean water for preparation, morbidity and mortality would plummet… even in the US.

          • nikkilee
            January 3, 2017 at 8:02 am #

            No way. EFF babies have more physician visits, more hospitalizations, and use more prescription medications in the first year of life than do EBF babies. While this study is from 1999, the results are still true. https://www.ncbi.nlm.nih.gov/pubmed/10103324

          • momofone
            January 3, 2017 at 8:24 am #

            You state that as an inevitability. Anecdote: My breastfed son had one illness requiring a doctor’s visit in his first year of life. My breastfed nephew (same age) had 40, and multiple prescription medications. It’s almost as if feeding method isn’t the only factor that affects these things.

          • nikkilee
            January 3, 2017 at 4:17 pm #

            Yes. you are correct.

          • momofone
            January 3, 2017 at 4:48 pm #

            I think what was far more relevant than how they were fed is that my son is an only child whose dad stayed home with him, vs my nephew, who had an older sibling and who went to daycare so was exposed to lots of other kids. Your statement seems to neglect other possible factors.

          • The Bofa on the Sofa
            January 3, 2017 at 5:02 pm #

            My first son got one cold when he was 1 month old, at baptism, but other than that, he wasn’t sick at all for the first 14 months. He was EBF for about 3 months and then combo fed until he was weaned at 9 months.

            Our second, who is 20 mos younger than the first, got his first cold at about 1 mo and was sick pretty much for his first two years. Also EBF for 3 months, combo fed for 10 mos, and then weaned.

            The difference? Well, what happened with my oldest at 14 mos is that he started daycare.

            And with the younger, he started daycare at 4 mos. However, his brother was in daycare the whole time.

            A BF study that does not account for daycare attendance either by the child or by siblings is ultimately not going to be worth much.

          • Box of Salt
            January 3, 2017 at 11:58 pm #

            “A BF study that does not account for daycare attendance either by the
            child or by siblings is ultimately not going to be worth much.”

            I chose not to be employed for the full first year of both children’s lives, because my family could afford it.

            Munchkin#1 was exposed to babies the same age a few times a week (play group, Gymboree or the YMCA, and cousins), used shopping car handles for teething, drooled endlessly, got the sniffles a bit, but has been seriously ill all of twice in over 12 years.

            Kiddo#2 had a serious cold at all of 3 weeks old, leading us to figure out how to raise the head end of the basinette to allow for snot drainage (how are folks going to do that once they stop delivering phone books to doorsteps?), ended up needing antibiotics before starting solids, and has had antibiotic resistant ear infections more than once.

            What’s the difference between the two? Munchkin started preschool when Kiddo was not quite one year old (yeah, I know that doesn’t explain all of the illnesses mentioned above. Bear with me). Munchkin had a few more URI-type sick days during preschool years than Kiddo, because Kiddo got those colds when Munchkin did. Munchkin’s only sick day since starting kindergarten happened at the start of Middle School – more kids, from different elementary schools, new germs. I’m keeping my fingers crossed that if the next school year starts off with a Middle School Plague striking the new students again, Kiddo already had it last year. But with Kiddo’s luck, I’m not counting on it. Guess which one of them had H1N1 just before the vaccine became available?

            And no, nikkilee, no drop of formula ever crossed either kid’s lip.

            It’s not the breastfeeding. There are other factors involved.

            Sure, looking at population level data is great. But as you yourself (nikkilee) have noted, nothing in life is guaranteed. Using that data – which, for crying out loud, is still confounded! – to bludgeon women into making the same choices you made is unethical.

          • Azuran
            January 3, 2017 at 8:55 am #

            You think that way just because you are refusing to look at the risks of breastfeeding.
            The ‘protection’ from breastfeeding is far from perfect and generally minimal.
            As such, my breastfed brother was sick all the time, with emergency visits multiple time per year. I’m formula fed and I wasn’t sick. My mother was breastfed, she’s obese, another one of my breastfed brother was also obese in childhood. I wasn’t
            And without formula, I might have died, I couldn’t drink breastmilk. I was hospitalised twice because of breastmilk.
            Bad outcomes with breastfeeding are something you have to take into consideration if you want to compare the 2.

          • Heidi
            January 3, 2017 at 9:25 am #

            As far as I can see, the only thing it even factored in was maternal smoking and education status. It didn’t factor in income or daycare, anyone else in the household who smoked or even if other caregivers smoked (why the eff not?!), what kind of environment they were living in generally. Those are huge things not to consider. My formula fed baby has been sick never. But you know what? I’m a stay at home parent and he’s never had to go to daycare. In 1999, pumping wasn’t big nor was breastfeeding in public. I would think in 1999 breastfeeding moms were even less likely to work outside the home and were much more likely to be affluent. It was less feasible than it is to day to work and breastfeed.

            I did have a lot of ear infections as a kid that “magically” quit once I was old enough not to go to my grandmother’s. I also got croup as a toddler. She was a 2 pack a day smoker who smoked indoors and in her car. My mom didn’t smoke, though, and she was college-educated. But what difference does that make if I spent a third of my day in bad air quality?

          • CSN0116
            January 3, 2017 at 10:10 am #

            Are you serious with this shit? I don’t care that it’s from 1999, I care that they don’t control for socio-economic status, number of older siblings in the home, or daycare usage. This is a very poorly done study and proves nothing, which is why, 18 years later, no insurance company care about EBF.

          • Box of Salt
            January 3, 2017 at 5:19 pm #

            From nikkilee’s link “Children were classified as never breastfed, partially breastfed, or
            exclusively breastfed, based on their feeding status during the first 3
            months of life.”

            Anecdata:
            How do you explain my younger kid’s ear infections? Was formula somehow coming out of my breasts the second time around? Two kids, same parents, same feeding method, different experiences. It’s almost as there are other factors involved!

          • nikkilee
            January 3, 2017 at 7:50 pm #

            Research data comes from populations. You can do everything right and still have things go wrong. No guarantees in life. Non-smokers can lung cancer, and smokers have a much better chance.

          • swbarnes2
            January 3, 2017 at 5:42 pm #

            So your study did NOT correct for whether the kids went to day care or not? And you sincerely think that’s not the slightest bit relevant? Sincerely? You sincerely think that going to day care, or having siblings that go to day care or school is not at all relevant to how often a child gets sick?

            Do you understand that everyone is laughing at you for thinking that day care is irrelevant here?

          • CSN0116
            January 2, 2017 at 9:22 am #

            We discuss well-done breastfeeding studies here all the time, and compliment them. Unfortunately, the ones with good designs and proper controls return the most lackluster “benefits” findings. Gee, wonder why?

            Bartick’s study was shit because it was shit.

          • momofone
            January 2, 2017 at 11:51 am #

            “No matter what evidence is presented in this forum, it is guaranteed to be rejected, both here and out in the world.”

            Does it occur to you that if your “evidence” is soundly rejected everywhere you present it, the common denominator may be the “evidence” itself?

          • nikkilee
            January 3, 2017 at 7:53 am #

            Every single healthcare organization policy and public health organization recommends breastfeeding as the first option for infant feeding.

          • momofone
            January 3, 2017 at 8:18 am #

            Regardless, parents are still free to make that decision, and don’t have to offer explanation or justification for it.

          • The Bofa on the Sofa
            January 3, 2017 at 9:58 am #

            Absolutely. All else equal, breastfeeding is better. But all else is never equal, and in those situations, there can be other better options.

          • Sarah
            January 2, 2017 at 2:04 pm #

            Studies or benefits? If the former, I concur, at least in the current climate, but that tells us more about the prevailing orthodoxies and the unwillingness to consider anything that might challenge them than anything else. If the latter, prove it.

          • Box of Salt
            January 2, 2017 at 4:33 pm #

            nikkilee “There will never be any.”

            Nor will there be a placebo controlled trial of parachutes to treat falling out of airplanes.

            The “health benefits” of formula are like the “health benefits” of c-section: the baby is not dead.

          • nikkilee
            January 3, 2017 at 7:51 am #

            Formula feeding has been shown to increase the risk of SIDS.

          • Heidi
            January 3, 2017 at 9:38 am #

            And you are probably doing a fair share of exacerbating PPD and anxiety in women with your unfounded breastfeeding “facts.” Even if we could definitely prove it does, telling that to a woman who can’t breastfeed can be so hurtful, but you blather on anyway.

          • The Bofa on the Sofa
            January 3, 2017 at 9:57 am #

            So give the kid a pacifier at night. That’s more effective than breastfeeding in reducing SIDS anyway.

            Oh, and vaccinate.

          • Heidi
            January 3, 2017 at 10:31 am #

            But if you give the baby a pacifier at night, where is Nikki Lee’s money?! She can’t sell you her book about “alternative medicine in breastfeeding therapy” or her services as a baby twister. She’s nothing but a greedy fear-monger.

          • CSN0116
            January 3, 2017 at 10:32 am #

            This woman authors this garbage?! I thought she was just here harassing.

          • Heidi
            January 3, 2017 at 11:09 am #

            I guess she believes any publicity is good publicity? I have a hard time, though, believing she’s gaining any future customers posting here. As someone who experienced an inability to lactate enough, I have no interest in her services. If some LC started shaming me about how I was increasing the chance of SIDS, setting my baby up for frequent hospitalizations and obesity, telling me formula was poison, and the cherry on top of the sundae, I was going to get breast cancer before menopause and started throwing poorly controlled studies at me to justify their abusive behavior (and I, a mere English major, can even spot the flaws a mile away), I’d tell him or her to go f*** themselves!

          • PrudentPlanner
            January 3, 2017 at 11:43 am #

            Do you enjoy coming here and making yourself look foolish? Does it fill you with righteous rage? If so, you may have an addiction to anger….

            “”Usually, if a person causes a fight deliberately it’s because there is
            resentment, jealousy, or anger that has not been resolved. Sometimes it
            is a guilt reaction, often seen among those who feel they have not been
            kind”

            http://www.nydailynews.com/life-style/health/person-addicted-anger-strong-emotions-bring-chemical-reactions-article-1.960715
            http://www.angermanagementresource.com/dealing-with-anger.html

            Perhaps making silly comments on SOB not the most well-rounded way to conduct your life.

          • nikkilee
            January 5, 2017 a