Breastfeeding advocacy and the culture of contempt

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Last week I wrote about conventional wisdom and used the example of stomach ulcers.

When I started medical school, the conventional wisdom was that stomach ulcers were caused by excess acid. The conventional wisdom was loud, pervasive and impossible to ignore. Whole careers in gastroenterology had been staked on maintaining its veracity. When that veracity was challenged, the challengers were silenced.

You can almost hear their eyes roll when a woman tells of her anguish at being unable to produce enough breastmilk.

At about the time I graduated from medical school researchers Robin Warren and Barry Marshall discovered H. pylori, the bacteria that actually causes gastric ulcers. Because of cognitive bias and the logical fallacy of argument from authority (all the prominent medical associations were in agreement that acid caused ulcers!), he was ignored.

But then:

To defend his thesis, in 1984 Marshall intentionally drank cultured H pylori and developed gastric symptoms, which were relieved with antibiotics. Another health professional who was similarly frustrated by the rejection of the theory of an association between H pylori and gastritis leading to peptic ulcer disease also consumed the putative agent. Multiple gastric biopsies before and after ingestion nicely demonstrated the resulting disease; however, Marshall’s colleague was less fortunate because antibiotics were unsuccessful in eradicating his disease, and he had debilitating symptoms for 3 years.

To my knowlege, although there was fierce professional disagreement during those years, those favoring the original acid theory never accused the researchers who claimed that bacteria caused ulcers of nefarious motives, shilling on behalf of a corporate entity, welcoming patients’ deaths or hatred of stomach acid.

Sadly, the same cannot be said about breastfeeding. Professional breastfeeding advocates have created a culture of contempt for anyone who dares challenge the conventional wisdom.

For example, on Saturday The New York Times published yet another piece about breastfeeding, Breast-Feeding or Formula? For Americans, It’s Complicated. Author Christina Caron noted:

But now a new movement called Fed is Best has arisen because of the pressure placed on women to exclusively breast-feed, sometimes to the detriment of their infants. The movement seeks to educate families about all of the safe feeding options available to them, and the complications that can arise when exclusively breast-fed newborns don’t receive enough breast milk.

In response, Lucy Martinez Sullivan, a lobbyist for the lactivist organization 1000 Days, reached out to the author with this Tweet:

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Ask who is behind the “Fed is Best” movement. Investigate. Do your homework @cdcaron. Ask who stands to benefit claiming women are harmed by the “pressure to breastfeed”

Followed by this one:

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@cdcaron The @nytimes should ask if Fed is Best is a fake grassroots movement / industry front group – pushing disinformation about the supposed dangers of #breastfeeding.

Does Martinez Sullivan have any evidence that Fed Is Best Founders Christie del Castillo-Hegyi, MD and Jody Seagrave-Daly, RN IBCLC are anything other than concerned health professionals who make no money from teaching others to recognize the signs of insufficient breastmilk? Of course not.

It’s easy to obtain tax records from non-profit foundations. The tax records from Fed Is Best reveal that both Christie and Jody receive $0 compensation. In contrast, Martinez Sullivan makes $168,968/yr to promote breastfeeding.

So why did Martinez Sullivan feel free to make such outrageous, unsubstantiated claims? I suspect it is because breastfeeding advocacy has created a culture of contempt for anyone who challenges their beliefs and claims. Under the influence of cognitive bias, which allows them to ignore the scientific evidence that breastfeeding has significant risks, the fallacy of argument from authority (the WHO, the AAP and every other medical organization promote breastfeeding as lifesaving!) and white hat bias (Nestlé!), they freely express their contempt for Fed Is Best.

That culture of contempt begins with the way that lactation professionals (and lay lactivists) view women who don’t breastfeed. They portray them as running the gamut from lazy (too selfish and self-absorbed!) through stupid (they are duped by formula companies!) up to the supposed moral high ground of helpless (they didn’t get enough support!). Lactation professionals view women who don’t breastfeed with such contempt that it never even occurs to them that women may have personal reasons for not breastfeeding or may have made an informed decision not to do so.

The result of their contempt is that babies become breastfeeding casualties. The single biggest risk of breastfeeding is dehydration and related complications from insufficient breastmilk. Up to 15% of first time mothers will not produce enough breastmilk to fully nourish a baby, especially in the early days after birth. Professional lactivists deliberately lie, insisting that insufficient breastmilk is vanishingly rare, despite the fact that the latest scientific evidence indicates that there are literally tens of thousands of newborn hospital readmissions each year for this complication. You can almost hear their eyes roll when a woman tells of her anguish at being unable to produce enough breastmilk. They hold women who don’t breastfeed in such profound contempt that they laugh at their distress and accuse them of faking it to selfishly avoid breastfeeding.

To say that lactation professionals lack insight into their own behavior is a profound understatement. Backpedaling frantically after being called out for her vicious accusations, Martinez Sullivan responded:

No mother should ever be shamed or stigmatized for how she feeds her child. Aside from being hurtful, this is “mommy war” nonsense that plays into the hands of the formula company giants, who pretty much invented the infant feeding mommy wars.

But implying that women who can’t or don’t want to breastfeed are dupes “in the hands of formula company giants” IS shaming. It’s yet another expression of contempt.

Breastfeeding professionals’ contempt toward other professionals who point out the risks of breastfeeding knows no bounds. Whether referring to Christie and Jody, myself, Courtney Jung or Joan Wolf, they don’t hesitate to imply that we are on the payroll of some nefarious organization or simply unconcerned with the health and wellbeing of babies. Those who earn their money promoting breastfeeding can’t imagine that feeding safety advocates might love babies more than they love money.

As I noted above, doctors favoring the original acid theory of stomach ulcers never accused researchers who claimed that bacteria caused ulcers of nefarious motives, shilling on behalf of a corporate entity, welcoming patients deaths or a hatred of stomach acid. In contrast, those who insist that breastfeeding is both lifesaving and almost perfect routinely accuse anyone who challenges them of shilling on behalf of formula companies, welcoming infant deaths and (my personal favorite!) hating breastfeeding.

Here’s a quote that breastfeeding professionals ought to keep in mind:

Science: If you don’t make mistakes, you’re doing it wrong. If you don’t correct those mistakes, you’re doing it really wrong. If can’t accept that you’re mistaken, you’re not doing it at all.

It is understandable that breastfeeding professionals have made mistakes in claiming that breastfeeding is perfect and complications are rare. But if they don’t correct those mistakes, they’re doing science wrong.

And if they can’t accept that they are mistaken — and treat everyone who disagrees with contempt — they aren’t doing science at all.

  • Alia

    Personal story here. My mother really wanted to breasfeed, even though it was the seventies and formula was so modern and all. But when she gave birth to her first, my older sister, it turned out she didn’t have enough milk. And since those days no doctor or nurse would let a newborn go hungry and thirsty, my sister was put on formula and that was it (pumping was not an option then).

    Fast forward a few years, I was born and my mother really wanted to breastfeed but she developed deep vein thrombosis and was put on medication that made breasfeeding impossible, so I was put on formula.
    And you know what is the saddest thing? When all those reports about the supposed benefits of breastfeeding started coming out, my mother felt terribly guilty – this despite the fact that both I and my sister grew up to be pretty healthy (well, I have a tendency to put on weight – but my sister has always been slim), intelligent and in general successful in life.

  • Madtowngirl

    Last week on Reddit, I dared challenge someone who claimed Fed Is Best was about “hurt feelings.” I explained that I never followed them because of hurt feelings, but actual danger that my baby was put in by the BFH she was delivered in. Surprise, surprise, I was downvoted like crazy and no one bothered to respond. It’s infuriating that they can’t conceive of the fact that mothers and babies are being hurt by aggressive breastfeeding promotion.

    Also: the concept of “professional breastfeeding advocate” gives me the heeby jeebies. Blarg.

    • NoLongerCrunching

      Care to post a link?

    • Gæst

      I was a big promotor of Fearless Formula Feeder, and now Fed Is Best (FFF doesn’t post much anymore). What hurt feelings did I have? I was never shamed – only praised for successfully breastfeeding twins. But when the time came that I switched to formula, I discovered all the lies and misinformation in the sources I read while breastfeeding. I follow them because I figured as someone who *wasn’t* personally affected, I could take some of the burden off the people who were.

      • demodocus

        I started reading FFF while i was still nursing my first.

  • space_upstairs

    I suspect it’s because infant feeding, unlike ulcers, is far from just a medical or scientific issue: it’s something roughly 80% of people will do at some point, and being so ubiquitous and for some other historical reasons, has become intertwined with class and politics. Matters of class and politics tend to invite contempt in a way that scientific issues without these politics and class links do not.

    • The Kids Aren’t AltRight

      Breastfeeding also ties into defining what women and mothers “should” be, and brings up a lot of ugly emotions that way, either from the type of feminists who need to believe the female body is magic, or from a conservative viewpoint where women are for making babies and having any limitations on or priorities besides babies becomes an existential threat. What if your mom doesn’t just exist for you!

      • space_upstairs

        I see that as part of the “politics” aspect, as essentialist feminism and conservatism are both political stances that would push mothers to breastfeed as part of a comprehensive view that motherhood (albeit for somewhat different reasons) should be the most important part of a woman’s identity. To the essentialist, it’s because only women can bear and nurse children, and thus doing so is key to fulfilling her nature; to the conservative, it’s because women supposedly better serve their God and country if they stay in their place. There also seems to be a third political stance, that ties in with class issues, and can explain why people can be pro-choice about abortion but not so much about breastfeeding: that we should be free to decide whether to become parents, but anyone who does decide to become a parent should give their children every single material advantage possible, as optimizing wealth and health is assumed to be the best or only way to optimize quality of life. People with this stance might also argue that maybe people who are poor should not so freely make the choice to become parents, because of their inability to provide their children with every single material advantage possible if they do.