Smug: how childbirth and breastfeeding professionals harm women

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There is a growing body of evidence that childbirth and breastfeeding professionals, ostensibly dedicated to helping women and babies, are harming them instead.

Over the years I’ve explored a variety of reasons for this — unthinking, ahistorical veneration for “nature”; desperation for professional autonomy; desire for profit — but there’s one that might be more important than all of the others. Childbirth and breastfeeding professionals are smug.

Smug is the moral equivalent of the Dunning Kruger effect.

According to Dictionary.com, smug means:

contentedly confident of one’s ability, superiority, or correctness

If there’s one thing that unites childbirth and breastfeeding professionals, from UK midwives to homebirth midwives, from doulas to lactation consultants, from Lamaze International to the Baby Friendly Hospital Initiative, it’s the fact that they are contentedly confident of their ability, superiority and correctness compared to other health professionals and compared to women themselves.

The thesaurus is rich with synonyms: complacent, egotistical, pompous, self-righteous, self-satisfied, conceited, holier than thou.

All can be applied to many childbirth and breastfeeding professionals, rendering them impervious not merely to criticism, but to reality.

Babies dying at the hands of homebirth midwives who are more concerned with promoting “normal birth” than live babies?

No problem. From Ina May Gaskin to Henci Goer to Melissa Cheyney, they are smug:complacent, egotistical, pompous, self-righteous, self-satisfied, conceited and holier than thou.

Women traumatized by UK midwives who are more concerned with promoting “normal birth” than promoting women’s autonomy, being denied epidurals, needed C-sections, and compassionate care?

No problem. From Soo Downe to Sheena Byrom to Cathy Warwick, they are smug: complacent, egotistical, pompous, self-righteous, self-satisfied, conceited and holier than thou.

Babies sustaining brain injuries and even dying because lactation professionals are more concerned with promoting breastfeeding that healthy babies?

No problem. From the Baby Friendly Hospital Inititative, to lactation consultants, to researchers who produce endless numbers of crappy papers hailing the “benefits” of breastfeeding, they are smug: complacent, egotistical, pompous, self-righteous, self-satisfied, conceited and holier than thou.

Smug is the moral equivalent of the Dunning Kruger effect.

According to Dr. Dunning:

What’s curious is that, in many cases, incompetence does not leave people disoriented, perplexed, or cautious. Instead, the incompetent are often blessed with an inappropriate confidence, buoyed by something that feels to them like knowledge.

What’s equally curious is that, in many cases, injured and dead babies do not leave childbirth and breastfeeding professionals disoriented, perplexed or cautious. Instead, impervious to the harm they cause, the smug are — say it with me now — complacent, egotistical, pompous, self-righteous, self-satisfied, conceited and holier than thou.

They “know” unmedicated, vaginal birth is best for every woman; they “know” that breastfeeding is best for every baby. The injured, traumatized and dead do not dent their overweening self regard and unwavering certainty that they are correct.

Those in the grip of the Dunning Kruger effect lack knowledge; they literally don’t know what they don’t know. Those in the grip of “smug” lack humility; they literally cannot imagine being wrong despite the injured, dead and traumatized who are screaming into their faces that they are hurting, not helping.

Doctors aren’t immune to smug. Indeed the history of medicine is a history of doctors feeling smug while injuring and killing patients by bleeding them, balancing their “humors” or feeding them arsenic and mercury to “cure” them. Those doctors “knew” the process was correct even though the outcome was dreadful. The operation was a success but the patient died; it must have been the patient’s fault because smug doctors would not admit it could be their fault.

Childbirth and breastfeeding professionals should learn from that embarrassing history. The birth can NEVER be a success if baby or mother are injured or die. Breastfeeding can NEVER be a success if a baby is brain injured or dies or if a mother suffers depression and guilt. Childbirth and breastfeeding professionals need to stop smugly asserting that it must be the patient’s fault — she was lazy, weak, didn’t trust birth and breastfeeding enough — because they cannot admit it is their fault.

When babies and mothers die in the pursuit of normal birth, midwives need to own it, investigate it and change their practices. When babies and mothers are harmed in the pursuit of exclusive breastfeeding, lactation professionals need to own it, investigate it and change their practices.

The last thing they should be doing is being complacent, egotistical, pompous, self-righteous, self-satisfied, conceited and holier than thou.

They shouldn’t be smug; they should be horrified.

  • Dusty Exner

    Can we see some stats here on # of births currently that result in injury or death to baby due to these kinds of practices?

    • The Bofa on the Sofa

      How many need to be harmed before you consider it unacceptable?

      • Dusty Exner

        I don’t know, I’m actually asking. I have no knowledge at all on the subject so I actually want to know – is death or injury to babies through midwife/homebirthing practice common? Occasional? Like stasticially is it 1 out if every 10 babies, 100 babies, 1000 babies? It probably matters to the people who don’t have that information and are trying to decide between the two systems.

        • Who?

          Have a look at the links Box of Salt posted.

          The numbers are tiny, which leads to the homebirth hobbyist’s cry of ‘what’s a few dead babies’. Yes, they say that.

          So how many babies is it okay to sacrifice so that mothers and homebirth hobbyists get the experience they crave?

        • The Bofa on the Sofa

          Like stasticially is it 1 out if every 10 babies, 100 babies, 1000 babies? It probably matters to the people who don’t have that information and are trying to decide between the two systems.

          Here’s the problem: people don’t have a good grasp on risk. Consider, what is the risk of drunk driving? How likely is someone who is drunk driving to die? Get in an accident? Get arrested for drunk driving, even?

          Do you consider drunk driving to be risky? (I hope so). However, the risk of dying in a car accident while drunk driving is somewhere on the order of 2/million drunken drives. So if you get drunk and drive, your chance of dying is about 2/million. Is that a large risk? Most people say yes, because they know drunk driving is wrong.

          Oh wait, maybe it’s not the risk of death, but the risk of getting in an accident? Or a DUI?

          According to the US DOT estimates, there are 27000 miles of drunk driving for every DUI. Assuming that the average length of a drunk drive is 8 miles, that means that only 1/3000 drunk drivers get arrested. That’s pretty small, right? Yet, I hope you won’t drink and drive. But why not?

          Because when it comes to risk in our lives, 1/3000 is NOT a small number. 1/3000 is generally too high of a risk for most of the population.

          So let’s keep that in mind as we discuss the risk of childbirth, alright?

          Second, it’s not just about the absolute risk, it’s about the relative risk. The bigger question with drunk driving is that it is a lot worse than sober driving (about 8 times more likely to result in death; a very large number times more likely to result in a DUI (but not infinite; there are people arrested for DUI without drinking due to erratic driving)

          is death or injury to babies through midwife/homebirthing practice common?

          Close to 1/1000. But more important, it is 3 times higher than hospital childbirth.

          So the short answer is, 2 out of 3 babies who die in a homebirth would not have died in the hospital.

          And the question is: is that acceptable? How many dead babies that would not be dead in the hospital are acceptable to you?

          Because “most babies turn out ok” is not much of a consolation to those mothers whose babies needlessly died during homebirth. Even “We did everything reasonably possible” doesn’t mean a hell of a lot, but at least there, you know it doesn’t do any good to second guess yourself.

    • Box of Salt

      Here you go, from 2014:
      http://www.skepticalob.com/2014/01/why-did-the-midwives-alliance-of-north-america-wait-5-years-to-publish-its-statistics.html (post on this website)
      and direct link to the paper that post discusses:
      http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full

      Both easy to find using the Search function on the blog.

      Sure, it’s not “current” as the data only goes through 2009, but it is published.

    • Roadstergal

      I think a lot of the numbers mentioned below underestimate the issue, because when a homebirth goes wrong and it turns into an emergency hospital transfer, that death becomes a ‘hospital birth death.’

      If you look at one of the very few studies of _planned_ place of delivery – a prospective study done by a homebirth-friendly midwife in Oregon, where you get a decent-sized pool of homebirthers and an unusually homogenous (for the US) group of hospital birthers to compare it to – planned homebirth resulted in a death rate to the babies of 4.5/1000 per 1000. That’s versus 0.6/1000 for planned hospital births. That is a _staggering_ increase in deaths.

      There’s a summary table at the end:

      https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585

      • Roadstergal

        To put it another way…

        The increased risk of OOH birth is 3.9/1000. Driving drunk with your baby in the car is _orders of magnitude_ safer than the risk of OOH birth vs hospital birth.

        To anyone planning a homebirth, I’d ask – is driving drunk with your baby in the car an acceptable risk?

        My mom would have been the perfect candidate for a homebirth. I was her fourth pregnancy, and my siblings had been easy, uncomplicated vaginal births. She went to a hospital for me anyway. Because if an easy, uncomplicated vaginal birth was going to happen, it would happen just the same at the hospital or at home (and it did). But on the off chance that something went wrong – why be far away from help??

  • rox123

    Hi everyone, a bit of an offtopic question:
    Does having a c section (the planned in advance kind) ruin my abdomen forever? Is is true that I’ll get an abdomen apron only by virtue of getting a c section – I mean having a vaginal birth won’t cause the same outcome?
    I am 1.67 m and 57kg pre-pregnancy weight (that’s 125.6 lbs at 5 feet and 5.74 inches) and I gained 6 kilos (13.23 lbs) so far at week 26. I anticipate gaining an additional 5 kilos, maybe 6 tops by the end of my pregnancy.

    • Empress of the Iguana People

      Honestly, I think pregnancy does that in general. My abdominal muscles were certainly less tight the 2nd time around. You can’t really tell with my round self, of course, but i felt the difference

    • Kerlyssa

      this is something you should ask the surgeon. the type of incision used for a planned caesarean is definitely something they can explain to you, and will be more helpful than asking about caesarians in general.

    • Heidi

      I think it has more to do with genetics than anything. I have a bit of flab from pregnancy but it’s tightening up nicely with time (and the stretch marks have faded) and as I’m losing weight. I didn’t have a C-section but most women I’ve seen just have a tiny scar.

    • Azuran

      All I can tell you is that for myself, Aside from my scar (which is very low) I don’t think my c-section caused anything particular.
      I still have a belly flap and 25lbs over my pre-pregnancy weight. However, my c-section scar is a good 2 inches lower than the ‘start’ of my belly flap. I feel no noticeable difference in my abdominal strength. So my belly flap is a mix of my pre-pregnancy belly flap, the additional 25lbs I still have to lose, and the stretching of my abdominal muscles because of pregnancy. I doubt it would be any different if I had a vaginal birth.
      One of my super thin colleague also had a c-section, she came back to work just as thin as she was before her pregnancy, without any belly flap. One of my aunt had vaginal births, but she had a massively floppy belly afterward. My MIL had surgery to remove her belly flaps after she was done having kids, she had 3 VB.

      I think it’s mostly genetic and pregnancy related.

    • Dr Kitty

      No.
      It depends on how heavy you were to start with, where you carry your fat and how strong your core is.

      I’ve had two CS, gained less than 12lbs total with each pregnancy (and what I did gain went on my hips, not my belly) do yoga/Pilates regularly (have done for years and continued it throughout pregnancy). Apart from the skin being a little looser, after a year there was no big difference in my tummy either time and I was back in my pre-pregnancy jeans by 8weeks both times, although it took a bit longer for my core to get back to 100%. My scar is low enough that even the most skimpy bikini will cover it.

      Obviously, if you gain a lot of weight, all on your belly and all in the last few months of pregnancy, you’re probably going to have a different outcome, but it’ll be the pregnancy, not the CS that does it.

      • rox123

        Wow, only 12 lbs! I still have some way to go but I am already past that!
        Thanks everybody for answering. I am mostly afraid of the dreaded overhang, pooch, pouch or however it’s called all over the internet these days. So all I can do is monitor my weight gain.

        • Roadstergal

          There are good reasons to pick VB or C/S, but I don’t think the tummy issues are going to come down to which mode…

          I will say that, although I have not had a C-section, I’ve had scheduled surgeries, and I would always prefer a scheduled surgery where the doc can take her time and do it as neatly as possible, vs an emergent one. 🙂

          • rox123

            My reason is to prevent pelvic floor disfunction.

        • Dr Kitty

          Yeah…my babies were only 6lbs and I managed to lose 12lbs in the first trimester with the first one and 6lbs with the second through hyperemesis, which is not a pregnancy weight management strategy I would recommend.

          When I was 9 weeks pregnant with my first I weighed under 39kg.
          Not something I would advise.

        • Bugsy

          FWIW, I totally have the dreaded overhang after two vaginal deliveries. I was 5′ 6″ and 122 prior to my first pregnancy – gained 30 lbs with that pregnancy, and ended up at a post-pregnancy weight of 130. A bit of an apron, but not much. It was my second pregnancy that killed me weight-wise. I was always starving, and didn’t have GD to help me keep sugars in check. I was up to 185 when I gave birth, and now hover around 153. (Never mind that I don’t have as much time nor energy to exercise regularly.). That being said, I’m not as disappointed with my body as I figured I would be…

        • adavis

          I might have missed this point so if it’s redundant I’m sorry. The skill of the surgeon is also a factor. My mother had a one C-section and has the apron or as we called it her flap.
          She was a tiny woman before pregnancy and was Tiny during. She liked to brag that she was 100 lb leaving the hospital with her new baby. It is worth noting that she was not athletic and probably did little strengthen her core afterwards. But she always blamed how she was stapled back together.

    • guest

      Honestly, pregnancy will do odd things to any person’s body, but what your abdomen looks like afterwards is dependent on a ton of different factors – genetics, elasticity of tissue, muscle tone, how scar tissue and fat deposits form in each individual patient. There is nothing about a C-section itself that makes an apron more likely to form.

      My mother was a competitive athlete and very active. She weighed 120 at 5’4″, pre-pregnancy. She also had two emergency C-sections, and gained an unusual amount of weight during all of her pregnancies (probably because she didn’t have much body fat at all to begin with and had to put on extra to prepare for lactation, etc).
      Within a year of each C-section, she had her flat belly and her impressive core strength back, but she also resumed her usual active lifestyle after recovering from surgery.

  • Empress of the Iguana People

    As I’ve noted before, the most arrogant and pompous health care professional I’ve met yet was that first LC I met when I had my first.

    • Heidi_storage

      The (male) neonatalogist who explained to me that I wouldn’t be able to pump exclusively for very long because I wouldn’t get the correct nipple stimulation was my favorite jackass. (This is after I’d told him I’d pumped for 9 months with my first kid, and after a night of my newborn biting my nipples bloody. I pumped for this kid 11 months.)