The amount breastfeeding professionals don’t know about neonatal hypernatremic dehydration could fill a small coffin

The coffin with a baby which was found dead at bus stop on 15 October 2015 is carried by Pastor Steffen Paar from the church in Suelfeld, Germany, 20 October 2015. The municipality gave the girl the name Teresa. The child's mother has proven yet untrace

For people who claim to know so much about breastfeeding, many lactivists are profoundly ignorant on the topic. Indeed, the amount that they don’t know about breastfeeding dehydration is enough to fill a small coffin … and sadly sometimes does.

That’s one of the reasons why so much ire is directed toward the Fed Is Best Foundation. By highlighting the risks of breastfeeding as well as the benefits, they’ve forced lactivists to look long and hard at their cherished assumptions and they can’t bear what they see. Their need to soothe their own cognitive dissonance leads them to write nonsense like FED IS BEST: Twisting the facts to fit the agenda by IBCLC Valerie McClain. The tragic irony is that it is lactivists who have spent years twisting the facts to fit their agenda and babies have been injured and died as a result.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why is it so hard for lactivists to acknowledge that breastfeeding isn’t perfect?[/pullquote]

Watch McClain twist facts to suit HER agenda

Currently breastfeeding is under fire by an organization that twists the facts to fit their agenda. The Fed Is Best Foundation had the initial media appearance of being a “parent-led” organization that was using social media to invalidate exclusive breastfeeding. But the organization denies that they are a parent-led group. They list their credentials: physicians, scientists, IBCLCS, NICU nurses, attorneys, public health advocates.

But it’s not breastfeeding that’s under fire, it’s the fantasy that breastfeeding is perfect. No one is trying to “invalidate” breastfeeding; they’re demanding honesty about the true risks and benefits.

What’s truly hilarious is that nonsensical claim that Fed Is Best can’t possibly be parent led because of the credentials of its founders and leaders. Pro-tip: Women can be mothers AND have professional credentials and expertise, too.

McClain’s piece is a guide to the lies that lactivists tell themselves and new mothers.

Lie #1 Breastfeeding is natural so it must be perfect.

McClain starts with a classic quote from Ina May Gaskin:

We are the only species of mammal that doubts our ability to give birth. It’s profitable to scare women about birth. But let’s stop it.” Ina May Gaskin

Let us add to Ina May Gaskin’s comment that we are also the only species of mammal that doubts our ability to breastfeed.

I’m never sure whether the amazing thing is that Ina May believes women are stupid enough to fall for such nonsense or that many women are indeed stupid enough to fall for this nonsense.

We are also (so far as we know) the only species of mammal that doubts our ability to outrun a cheetah. That doesn’t mean that lots of mammals aren’t caught and eaten by cheetahs.

Just because other mammals don’t doubt their ability to give birth doesn’t mean their babies don’t die in childbirth; like humans, most higher mammals have HIGH rates of perinatal mortality. Just because other mammals don’t doubt their ability to nurse their young doesn’t mean that they make enough to do so. Primate infant mortality mortality is 20% is some species.

The sad fact is that dying in childbirth or in infancy is both natural and common. No amount of confidence can prevent it.

Lie #2 Neonatal hypernatremic dehydration is rare … but it is as common as SIDS and the incidence appears to be rising.

McClain writes:

The word, starvation, is a strong emotive word. Equating exclusive breastfeeding with starvation, is a propaganda technique (use of emotional words to persuade people) not a scientific fact. Card stacking or cherry picking evidence is another propaganda technique used to persuade people that your side is right. The use of evidence that only supports your “beliefs” is not science it is propaganda.

Here’s some science from Breastfeeding-Associated Hypernatremia: A Systematic Review of the Literature:

…[F]ollowing the seminal report by Clarke et al in 1979, there are increasing reports on hypernatremia in exclusively breastfed late preterm or term newborn infants…

Textbooks only marginally refer to breastfeeding-associated hypernatremia…


In a retrospective study in the United Kingdom, the frequency of breastfeeding-associated neonatal hypernatremia was found to be greater than all-causes combined of hypernatremia among late preterm and term newborns.81 In the mentioned report, the incidence of sodium level ≥ 160 was 71 per 100 000 breastfed infants (1 in 1400).

That’s more than double the UK risk of SIDS of 30/100,000 and slightly great than the US risk of SIDS of 54/100,000. We spend millions of dollars each year in public health campaigns to warn parents about the risk of SIDS, yet the World Health Organization has blithely admitted that warning parents about the risks of hypernatremic dehydration is “not a priority.”

The consequences of dehydration can be severe:

Neonatal hypernatremic dehydration secondary to lactation failure may result in brain damage owing to either dehydration or hypernatremia. Fluid volume depletion may cause, on one hand, circulatory shock and consequently hypoxic damage, and on the other hand, thrombosis, whereas hypernatremia may cause capillary dilatation that gives rise to rupture with cerebral hemorrhage.

Jaundice, which is common among infants with breast-feeding-associated hypernatremia, might also result, if severe, in brain damage…

Lie #3 Neonatal hypernatremic dehydration is easy to diagnose by the number of wet diapers … though hydration status is an unreliable marker of dehydration.

Though McClain doesn’t mention it in her piece, it’s commonly asserted my many lactivists.

But that’s not what the scientific literature shows. From the paper Hypernatremic dehydration in newborns:

Hypernatraemic dehydration is notoriously difficult to diagnose on clinical examination alone, as skin turgor is preserved; the anterior fontanelle can retain its normal fullness, and urine output, although reduced, is maintained even in the face of severe dehydration. The clinical features are a spectrum, from an alert and hungry child who appears relatively well to a child who is lethargic, irritable and even moribund…

Why is it so hard for lactivists to acknowledge the truth: breastfeeding isn’t perfect; dehydration from insufficient breastmilk is common; we should undertake science based interventions (regular infant weights, formula supplementation as necessary) to prevent it? Why are they so desperate to shoot the messenger, the Fed Is Best Foundation, for telling women the truth about the risks of breastfeeding?

Shooting the messenger calls both the knowledge and the credibility of breastfeeding into question. The truth is that the amount breastfeeding professionals don’t know about neonatal hypernatremia could fill a small coffin, and tragically has filled quite a few already.