Lactivism and the hallmarks of pseudoscience

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On the first day of medical school, they tell students that half of what they are about to learn will be overturned or changed in the next five years; the problem is that we don’t know which half. But the hallmark of science is that new information challenges old certainties and doctors must change their thinking and practice in response.

Pseudoscience, however, does not change as the facts and understanding change. It starts with a claim —for example, the claim that breastfeeding is best for every baby — and it sticks with that claim regardless of new facts that come to light.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactation professionals who resist changes to the Ten Steps are no different from obstetricians who continue doing routine episiotomies.[/pullquote]

The recent response of lactivists to the growing body of evidence that aggressive breastfeeding promotion is injuring and in some cases killing infants suggests that lactivism is a form of pseudoscience. While pediatricians, neonatologists and organizations like the Fed Is Best Foundation are begging the World Health Organization to revise the Ten Steps to Successful Breastfeeding to incorporate the new findings, lactivist organizations will not budge.

Contrast the response of the science of obstetrics to the pseudoscience of lactivism in the face of paradigm shifting scientific evidence.

I was taught to perform episiotomies very early in my training.

It was the rare delivery of a first time mother that was not accompanied by an episiotomy and the rationale was persuasive. The baby’s head often tore apart the lower vagina and tears might radiate out to the labia and clitoris and well as down to the rectum. It was thought that making a precise incision that was easier to repair would spare women from multiple, ragged lacerations. Most important, obstetricians believed that episiotomies made is less likely that the rectum would be damaged. Avoiding fecal incontinence was a high priority.

It made a lot of sense, but it was wrong. Paradigm shifting research done in the 1980’s and 1990’s demonstrated that a median episiotomy (straight up and down), by weakening the tissue of the lower vagina, made tears down to the rectum MORE likely, not less. Most obstetricians (including me) didn’t believe it at first, but the scientific evidence was clear and clinical practice changed on a dime. Within a few years the rate of routine episiotomies dropped precipitously and episiotomies are now almost solely reserved for forceps and vacuum delivery.

Lactation consultants are taught that breastfeeding is best for every baby, that formula supplementation and pacifiers harm the breastfeeding relationship, that insufficient breastmilk is rare, and that extended skin to skin contact and rooming in are safe and improve the likelihood of breastfeeding success. Paradigm shifting research done within the past decade has shown that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS and extended skin to skin contact lead to babies falling from their mothers’ hospital beds or suffocating while in them. The leading cause of jaundice induced brain damage (kernicterus) is breastfeeding and breastfeeding doubles the risk of neonatal hospital admission leading to literally tens of thousands of hospital admissions per year.

The evidence on the dangers of breastfeeding is actually far more compelling than the evidence on the dangers of episiotomies. In a feeble response, the WHO has made some minor, inadequate changes to the their recommendations. The response of lactation professionals has been to erect a wall of denial; they are vigorously protesting even the insufficient changes.

This letter from the International Baby Food Action Network, in partnership with the Baby-Friendly Hospital Initiative Network of Industrialized Nations (BFHI), International Lactation Consultant Association (ILCA), La Leche League International (LLLI), World Alliance for Breastfeeding Action (WABA) makes clear their insistence on clinging to old, discredited claims.

Global standards

The issues babies face in developing countries are very different than those in industrialized countries. Breastfeeding provides significant health benefits in developing countries as opposed to trivial benefits in industrialized countries. The WHO has proposed acknowledging these differences by allowing individual countries to develop national standards. Lactation professionals are opposed:

we still believe this approach will allow for wide variation of practices and inconsistent standards throughout the world, undermining global indicators. Global standards are the foundation of the BFHI and they are essential to monitoring the global effort to improve breastfeeding rates.

Yes, global standards might make things easier for the BFHI but they don’t make things better, healthier or safer for mothers or babies.


Given the paucity of evidence that the BFHI improves breastfeeding rates, the WHO has designated it as a “key” strategy, not the only strategy. Lactation professionals, sensing a threat to their employment prospects, vigorously disagree.

The Ten Steps

Many of the Ten Steps have been found to be harmful to babies and most have been found to be ineffective in promoting breastfeeding. No matter. Lactation professionals object to changes that incorporate the scientific evidence.

Consider the response to changing Step 9: Give no pacifiers or artificial nipples to breastfeeding infants. Pacifiers are lifesaving; indeed research shows that they are more likely to prevent SIDS than breastfeeding itself. Lactation professionals don’t care. They are affirmatively OPPOSED to making decisions based on the scientific evidence.

…[I]t was not the most appropriate method for examining the evidence related to the socio-cultural and ethical complexities of the BFHI. This method failed to portray the reality that those working and researching in this field have experienced over the past 30 years.

That’s the equivalent of obstetricians insisting that they are going to keep doing routine episiotomies because they believe in them despite the scientific evidence showing harm.

Lactation professionals have exerted tremendous pressure on the WHO to retain the outdated, dangerous Ten Steps. The WHO appears to be caving, but apparently not far enough.

WHO and UNICEF, based on an evaluation of the evidence and information submitted by the collaborative, appear to have made significant changes to the proposed initial draft, including the retention of the order, number and subject matter of each of the original Ten Steps. However, significant gaps in the alignment of our thinking with WHO and UNICEF remain.

They are encouraging their members to lobby the WHO to maintain the status quo even though the the status quo ignores the scientific evidence, is dangerous for babies leading to literally tens of thousands of newborn hospital readmissions in the US alone, and increases sudden infant deaths in hospitals.

Science necessitates change based on new information; pseudoscience resists change regardless of scientific evidence. By that metric, contemporary lactivism — cheered on by its lactation professional enablers — is pseudoscience.