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.

41 Responses to “The amount breastfeeding professionals don’t know about neonatal hypernatremic dehydration could fill a small coffin”

  1. fiftyfifty1
    October 30, 2017 at 12:01 pm #

    Semi OT: Today my organization sent out an email to us clinicians informing us we are withdrawing from the Baby-Friendly Hospital Initiative. Reason was the repeated concerns that we clinicians raised, combined with the recent media coverage of the downsides. Yay! The tide is turning!

    • Roadstergal
      October 30, 2017 at 12:14 pm #

      Congratulations! It’s great to hear that a: y’all are talking to the Powers That Be and b: that’s effecting change.

    • KeeperOfTheBooks
      October 30, 2017 at 3:34 pm #

      Three cheers for all of you! If I could, I’d buy whoever made that decision a round of whatever-they’d-have.

    • CSN0116
      October 30, 2017 at 5:35 pm #

      Omfg thank God. What country are you in?

      • fiftyfifty1
        October 30, 2017 at 6:36 pm #

        United States.

        • CSN0116
          October 30, 2017 at 6:58 pm #

          Yay! Do you think this will catch on around you? Good for you all and your hard work on behalf of your patients’ well-being.

    • PeggySue
      October 30, 2017 at 7:08 pm #


  2. Sue
    October 29, 2017 at 10:47 pm #

    Again, this reminds me why I prefer midwifery to be a specialty within nursing. Clinicians who have nursed babies with dehydration in the ED and the Pediatric Ward will be much more sensitive to the signs than ideologues who just want to push ‘natural’.

  3. Sarah
    October 28, 2017 at 12:47 pm #

    OT, but today is 5 years since Savita Halappanavar died, avoidably and pointlessly, because she was refused a medical termination. The 8th Amendment remains in place in the Republic of Ireland.

    Never forget.

    • Dr Kitty
      October 28, 2017 at 3:17 pm #

      I have actually heard people say “Savita died of sepsis, the treatment of sepsis is antibiotics, not abortion”.

      She died from overwhelming sepsis from chorioamnionitis.
      The treatment for chorioamnionitis is to remove the placenta and membranes ASAP- by delivery after viability and termination before viability. Due to the 8th amendment medical staff had to wait until her life was imminently endangered by infection or her foetus died before they could do that.

      Her death was an entirely preventable tragedy and it is shameful that Ireland has taken so long not only to endure it never happens again, but to listen to the will of the people who overwhelmingly want change.

      • Sarah
        October 28, 2017 at 3:19 pm #

        Yes, I’ve been reading a few claims of that ilk today. I’m not sure whether they’re deliberately or actually failing to understand that a timely termination and evacuation of the contents of the uterus would have prevented the sepsis in the first place. By the time she miscarried, it was too late.

        • Dr Kitty
          October 28, 2017 at 3:27 pm #

          If the pregnancy had been terminated the day she arrived in hospital it is likely she never would have developed sepsis.

          The eighth amendment literally prevents doctors intervening until a woman is dying in front of them. That’s not good enough.

          Repealing the Eighth is the only thing that makes any sense.

          No devout Catholic woman will have to have an abortion against her will, even if she will die without one.
          But women who don’t share those beliefs have died and been forced to continue pregnancies that risk their physical and mental health when they would rather not, which is something that needs to end.

          • LaMont
            October 28, 2017 at 7:47 pm #

            As an American, I was HELLA confused by this perverse definition of “eighth amendment”, holy f*ck.

          • Sarah
            October 30, 2017 at 6:11 am #

            There’s insufficient clarity. Something which is also exploited by anti-choicers to say it’s not the 8th that’s the problem, it’s clinicians failing to follow the law.

            Of course, if you effectively create a climate of fear, one which wouldn’t exist if the 8th didn’t and doesn’t exist in other countries where it doesn’t, clinicians not performing medical terminations because they’re worried about imprisonment is the inevitable consequence.

          • PeggySue
            October 30, 2017 at 7:11 pm #

            I think you’re right–hospitals operate on speed, not conversation, and ethics committees also want to be CERTAIN, so protocols and decision trees tend to be rigid as hell, and clinical expertise, that is, the eyes of a doctor who has seen this before and knows what likely lies down the road, is not taken into account.

          • swbarnes2
            October 30, 2017 at 7:47 pm #

            I imagine a rigid attitude of “If someone is at high risk for sepsis, do something to make that risk lower, do not sit around on your hands waiting for a life-threatening emergency to develop” had been followed, Savita would be alive. I bet they already have a rigid policy like that for all the male patients.

          • LaMont
            October 30, 2017 at 10:48 pm #

            Oh I understand the inanity of “life of the mother” exceptions and the cruelty of their application. I just boggle that the Irish Eight Amendment is pretty much the polar opposite of the American one. I’m imagining a first amendment that reads “shut up about your religion, burn that newspaper immediately and go home” and a second amendment that bans guns.

          • Amazed
            October 29, 2017 at 4:24 pm #

            I think doctors can be actually prosecuted if they perform an abortion when there is a heartbeat. Is this true? I know that some twenty years ago, teacher colleagues of my mum spent time in prison because on a trip abroad, a 16 year old student fell from too high and died, so it sounds plausible to me.

      • The Computer Ate My Nym
        October 30, 2017 at 12:34 pm #

        Actually, sepsis with a clear nidus of infection is completely untreatable unless you remove the nidus of infection. The lack of abortion killed her.

    • CSN0116
      October 28, 2017 at 8:30 pm #

      Isn’t this the same place that was performing symphysiotomies up to the 1980’s? Yikes this sounds like a scary place to be a woman.

      • ec
        October 29, 2017 at 3:04 pm #

        And where many women were kept in slavery in Magdalene Laundries until 1996.

  4. Who?
    October 27, 2017 at 7:31 pm #

    This narrative plays into the view that all you need to be able to do something is believe that you will.

    It’s the same mentality that natural healing shonks engage in-‘if you buy all my products, do all my routines, and believe you will be healed, you will be healed. You weren’t healed? You must have not believed enough, or not followed my instructions well enough, not bought enough of the right products, or missed telling me some apparently trivial but ultimately critical detail.’

    Believing you can fly does not trump gravity.

    • Steph858
      October 28, 2017 at 9:28 am #

      If I ever come across such a charlatan, I intend to ask them why one cannot avoid the side-effects of real medicine simply by not believing that such side-effects exist. Nor, for that matter, can one prevent real medicine from working by not believing it will work.

      For example, say you’re suffering from a bacterial infection. Alas, you currently reside in one of those primitive places where one must pay through the nose for healthcare so you cannot afford to seek treatment in the usual manner. But it’s your lucky day: a nearby Pharma company is conducting a trial of a new antibiotic they’ve developed; you won’t have to pay a penny to be treated!

      There is a catch, though; you might end up in the placebo arm. You can’t put your finger on why, but your sixth sense is telling you that this is exactly where Sod’s Law has seen fit to put you. So you don’t believe you’d been given real antibiotics; you believe you’ve just had sugar pills.

      Your sixth sense was wrong; you got the antibiotic. So, since you didn’t BELIEVE you would get better or have any side-effects, why is it that your infection has cleared right up but at the cost of being unable to stray too far from a toilet for a couple of days?

      • Who?
        October 28, 2017 at 6:32 pm #

        I ask anti-vaxxers calling for a double blind study on existing vaccines if they would be prepared to participate, or have their children participate.

        Of course they wouldn’t-and neither would I, because I want the vax, thanks.

        And re antibiotics, they believe in the negative side effects, no doubt, but would challenge the idea that getting over the infection would not have happened anyway. Mind you, if they are in the placebo arm, and get sicker to the point of needing hospital, pity help modern medicine if it can’t cure them on the spot.

        The thought process involved is not a rational one, unfortunately. And the more that is made clear, the more irrational the conversation becomes.

        • Steph858
          October 30, 2017 at 9:55 am #

          So in other words, they believe that real medicine only works when you DON’T want it to?

          If a woman who doesn’t want to get pregnant takes contraception, well, she’s bound to get pregnant anyway, because allopathy is a sham. If, on the other hand, she does want to get pregnant and is taking the contraception solely to treat painful/heavy/irregular periods, then she will never get pregnant because to her, infertility is an unwanted side-effect and will therefore be present in full force.

          So, to use the antibiotics example, all we have to do is convince ourselves that we’re constipated but are avoiding laxatives because they work a little TOO well. We’re also rather fond of those darling little bacteria who don’t mean to do us any harm; wouldn’t it be a shame if some horrible disaster were to befall the cute little mono-cells?

          As for the double-blind vaccine study; I’d be willing to enrol my son on such a study for the Chickenpox vaccine. They don’t offer it on the NHS so if he gets the vaccine under the study, great; if not, he’d be no worse off than if I couldn’t have afforded to get the vaccine done privately. Same goes for Hep B, until such time as the NHS rules change so that he’d be eligible for it. Or, if I couldn’t/wouldn’t enrol my son because of informed consent reasons, I’d be willing to volunteer
          myself for a flu vaccine study.

    • EmbraceYourInnerCrone
      October 31, 2017 at 3:56 pm #

      Ah yes the Peter Pan theory of medicine/health. Also known as “Just Clap harder!”

  5. The Kids Aren't AltRight
    October 27, 2017 at 5:18 pm #

    I don’t know if the women that buy in are stupid, just easily flattered. It must feel nice to believe your body is a magical quasi-deity. You get to be awesome and don’t even have to do anything. And I am sure that factually having your lack of magicallity pointed out feels like an attack.

    • Who?
      October 27, 2017 at 7:37 pm #

      When my kids were babies I knew nothing about babies. I was told by midwives who had cared for me throughout my incident free pregnancies and labours that all I needed to do was breastfeed. My second child was losing weight and very sleepy, and the midwives didn’t want her to have a bottle in case she got nipple confusion.

      My mother, who was going to be looking after her while I went to a wedding when she was two weeks old, adamantly insisted she be given bottles, so she could be fed while I wasn’t there. Daughterling sucked the bottle down and was combo fed after that.

      What would have happened if my friends weren’t getting married? I’d prefer to not think about it, with the benefit of better knowledge.

      I just wanted to do what was best for the baby. Trouble was, the information I had was not disinterested. There’s a broad spectrum of people who find themselves in this situation.

      • The Kids Aren't AltRight
        October 27, 2017 at 7:42 pm #

        I shave been more clear. I was thinking specifically of the women pushing the propaganda and attacking fed is best. Following the advise of medical professionals does not make you stupid, but it goes to show how dangerous the breast milk worshippers are. I am glad people are finally starting to push back.

    • KeeperOfTheBooks
      October 30, 2017 at 3:40 pm #

      It’s an especially attractive idea if you come from a background which, as mine did, emphasized a very negative body image for women. “My body is amazing and can do anything!” is, while still incorrect, somewhat more psychologically healthy than “My body is disgusting and shameful.”
      Of course, the ideal situation would be for women to be proud of achievements they actually worked for (see: education, a degree, learning an interesting/valuable skill, learning how to be a good parent no matter how a kid is fed or born, etc), but that’s just crazy talk…

  6. Zornorph
    October 27, 2017 at 3:51 pm #

    Unrelated, but a bit of good news. About a year ago, I met a woman who was in an abusive marriage. We struck up a bit of a friendship because of our kids – one of hers being quite autistic (basically non-verbal at age 7). Anyway, several months later, I was able to give her the confidence to leave her husband and file for divorce. The husband was not just abusive, but he believed in every conspiracy theory under the sun, so of course was a rabid anti-vaxer and he’d managed to convince her. I’ve been gently working on her, pointing out that since her unvaxed son was autistic, it seemed unlikely that the most common fear was at all valid. I could have ‘ordered’ her to do it – she’s quite religious and sees me as a male authority she would bow to, but I wanted her to get there on her own. It might sound paternalistic, but I’m trying to get her to be independent. I’ve no romantic interest in her as there’s enough baggage there to ground a 747.
    Anyway, the good news is that today she had her son vaccinated. She’s not ready to do the older girl yet, but it’s nice to see progress.

    • CSN0116
      October 27, 2017 at 4:07 pm #

      That’s a fabulous story! And I had to giggle at “enough baggage to land a 747.” Totally stealing.

    • yentavegan
      October 27, 2017 at 4:30 pm #

      Good for you for being a sane voice and being a catalyst for change. BUT ( sorry I’m going to say this anyway) Damsels in distress are wolves in sheeps’ clothing. Keep your good senses about you, and be aware.

      • Zornorph
        October 27, 2017 at 4:35 pm #

        Oh, she would love to be my significant other. I’m keeping her very safely in the friend zone. Also, as she was not ‘allowed’ to see her family when married to this creep, she’s now reconnected with them and they are giving her the financial help to get her back on her feet.

  7. October 27, 2017 at 2:11 pm #

    It’s profitable for Ina May to trumpet fear-free birthing. It gives her and her lackeys a constant stream of suggestible targets for her cult to profit from, then dump.

    Joey Feek would have had a much better chance of being alive today if her midwife had done a pap smear at some point during her pregnancy with her daughter. Stage 4 cervical cancer within a year of her daughter’s birth tells exactly what women need to know about how well The Farm takes care of mothers.

    I don’t know if her husband has ever figured out why the pediatrician who examined his daughter at 4 days old was terrified when he realized he had a 4-day-old baby with Down Syndrome who had received no prenatal screening for birth defects related to Down and had received no trained medical care after birth. I’m sure the pediatrician was afraid the baby would decompensate in his arms.

    If someone quotes Ina May, know that they are not on the side of the angels.

    • Heidi
      October 27, 2017 at 3:43 pm #

      I only knew of Joey Feel because of the cervical cancer thing but I didn’t know she sought care from Ina Mae. I know I did find it shocking for someone who had the means to seek medical care to die of cervical cancer. That’s just incredibly sad.

      • October 27, 2017 at 7:21 pm #

        I don’t know if she was under the care of Ina Mae herself – but she was under the care of either a Farm midwife or a Farm trained midwife.

        It breaks my heart to think of all the years that were taken away from Joey – and right after she had a baby who needed her.

  8. the skeptical OG
    October 27, 2017 at 12:48 pm #

    I always found it ironic that Gaskin and her husband named their commune “The Farm”

    For all that, they don’t seem to have much experience with livestock or farm animals. Animals struggle in birth, die in labor, deliver dead or severely damaged babies, and fail to produce milk all the time. It is part of the heartbreak of farming and living close to nature, to witness that.

    But Gaskin loves to push the narrative that somehow, animals live in a world without death or disease, fear or pain, risk or danger when it comes to birth and reproduction.

    She’s obviously never had to set an alarm every 2 hours to bottle-feed a sickly newborn calf or foal or kid, like a person who has lived on a farm without quotes around it.

    • October 27, 2017 at 2:03 pm #

      Nature can handle a lot of dead babies.
      *We lose a sizable minority of calves born to first calf heifers and a smaller percentage of calves to second or higher lactation mothers. Breech births often end with a brain-dead calf.

      *A surprising number of first-calf heifers run away from their newborn calf. We’ve also never seen a first-pregnancy farm cat show up with kittens – although we do find abandoned nests with dead kittens in the haymow.

      *Jersey calves are notorious for sudden calf collapse. Their calves are only born with 3% body fat so if the calf is weak at all, she can’t get up in time to nurse, burns through her tiny amount of available glucose, and will die if not tube-fed.

      *Human babies are really good at hiding signs of distress – until they are so sick that they collapse. Ask a NICU nurse for stories.

    • Tigger_the_Wing
      October 28, 2017 at 10:01 pm #

      I hate people who have such a flowery view of nature.

      Despite round-the-clock care, and veterinary attention, half our orphan and abandoned lambs died last year. Yes, sheep are those wonderful mammals who don’t have ‘doubts’ – and who will walk off and leave their premature lamb to die simply because it didn’t start suckling almost immediately.

      • EmbraceYourInnerCrone
        October 31, 2017 at 4:05 pm #

        OT but these are the people I love to explain about squirrels, specifically the fluffy grey squirrels in my neighborhood steal baby birds out of their nests and eats them. Mother Nature is trying to kill you and feed you to something else most days…(the something else may be a bacteria but still…)

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