Midwives and lactation consultants treat women like children

asian mother sitting on the sofa angry pointing

We treat children differently than we treat adults.

  • We presume we know better than they what they need.
  • We believe we have an obligation to guide them on the right path.
  • We know we understand risks better than they do.
  • To the extent they disagree, we ascribe it to immaturity and lack of knowledge.
  • We are sure that if they “understood” what was at stake, they would want what we want.
  • We accuse them of being inordinately swayed by outside pressures.
  • We feel obliged to force them to do things they don’t want to do “for their own good.”

All these reactions are perfectly appropriate if we are talking about a seven year old. They may even be appropriate if we are talking about a seventeen year old, although they may not. Surely, though, they are an inappropriate as a way to treat adult women.

It is unacceptable to treat women like children even for “their own good.”

Which begs the question:

Why do midwives and lactation consultants treat women like children?

Consider how midwives treat women who wish to have maternal request C-sections instead of vaginal births:

Most midwives assume that vaginal birth is better than C-section except in rare circumstances.

They imagine they have an obligation to guide women (“support them”) toward vaginal birth.

They believe they understand the risks better than women do even though they habitually ignore many of the risks that are most relevant to women like future incontinence and sexual dysfunction.

To the extent that women disagree, they ascribe this to lack of knowledge about the “real” (often rare, sometimes merely theoretical) risks.

They are sure (and they constantly reassure each other on social media) that women want what they wish to give even if the women themselves appear not to realize it.

To the extent that women disagree, they imagine that they are “socialized” to fear the pain of birth or swayed by obstetricians playing the “dead” baby card.

That’s how they justify their pressuring women to avoid C-sections, avoid interventions, and justify actively seeking to limit women’s access to epidurals.

But that’s nothing compared to lactation consultants:

Lactation consultants have codified treating women like children into the oxymoron of the Baby Friendly Hospital Initiative. It’s an oxymoron because it isn’t friendly to babies. It actually harms them by increasing hospital readmissions for dehydration and jaundice and by increasing infant deaths within the hospital from falls from or being smothered in maternal beds.

The baseline assumption of the BFHI is that women can’t be trusted to know what’s best for themselves and their babies. They must be subjected to a rigidly curated propaganda offensive.

Lactation consultants are sure (despite scientific evidence to the contrary) that breast is best for every mother and baby. They are so sure that they have enshrined their belief in the phrase “breast is best” and plastered it to the walls of midwives’ offices and hospital corridors. They endlessly harangue women about the “benefits” of breastfeeding, most of which have proven illusory.

Lactation consultants believe they understand the risks of formula feeding better than mothers do, but most of those presumed risks are based on poorly done epidemiological research riddled with confounders and have not occurred in real world experience.

To the extent that women wish to use formula, lactation consultants ascribe their desire to ignorance, lack of “support” and marketing by formula companies (despite the fact that they have banned marketing by formula companies).

Lactation consultants seek to restrain women who wish to use formula by placing stumbling blocks in their way: locking up formula in hospitals, forcing them to sign formula consent forms, limiting what health professionals are allowed to tell them on the topic.

Lactation consultants have gone so far as to fabricate risks that don’t even exist such as the “risk” of nipple confusion from a bottle and the “risk” of formula supplementation even though research shows that formula supplementation prevents hospital readmission and leads to increased rates of extended breastfeeding.

Lactation consultants are sure that their tactics are justified by an obligation to force women to breastfeed for “their own good” and their babies’ health.

But women are not children and it is completely inappropriate to imagine that they are. Women are adults capable of determining what is best for themselves and their children.

It follows therefore:

Women should not be pressured into avoiding interventions and epidurals or pressured into having a vaginal birth

Women who don’t find empowerment through their reproductive functions don’t need to be educated or “supported” into making choices that are different than the ones they articulate.

The arbiter of clinical practice MUST be scientific evidence, not intuition and certainly not providers seeking validation of their own choices by patients mirroring them back.

This applies equally to breastfeeding. As between breastfeeding and formula feeding there is no “best” way to feed a baby.

Midwives and lactation consultants need to hold themselves to a higher standard than what they currently embrace. It is completely unacceptable to treat women like children even “for their own good.”

  • Jane Strauss

    Actually it has been more my experience the physicians treat women like children. But what do I know? I’m only a woman in her 60s who has had 3 home and 2 hospital births, and got the hell out of the hospital (to avoid nosocomial infections) as soon as I could.

    • Daleth

      Can I ask, how long ago did you have your children? Things have changed a lot in the last 30 years.

      • Jane Strauss

        My eldest is 35 and my youngest 20. I have not found that physicians are any more respectful even today when I have to see one.

        • MaineJen

          What form of disrespect did you experience from physicians?

          • Jane Strauss

            Condescension, refusal to answer any questions, and pretty much how people describe lactation specialists on this page “There there little lady, I work magic and only by doing everything I say can you have a good outcome.” In point of fact, my eldest, born at home after the hospital had closed their midwifery unit when I was at 20 weeks, and while I was a med student, was “the most alert newborn I have ever seen” according to the clinic pediatrician who examined her at 10 hours old.
            I might also mention that I was raised in a household where my dad was the infection control officer in a large hospital, so I was privy to that many docs still did not take handwashing very seriously. My dad supported my decision to give birth at home.

          • Amy Tuteur, MD

            It’s hilarious that you imagine two years of medical school and a father who was an infection control makes you anything other than the average layperson. And your baby was the most alert newborn the ped had ever seen is also worth a good laugh. Classic natural parenting know-it-all. Sad that the medical profession doesn’t appreciate your genius!

        • Amy Tuteur, MD

          Are you respectful to them?

          • Jane Strauss

            I was, and they treated me as if I was at best mentally defective, refusing to answer any questions and pretty much saying “there there little lady, how dare you question me?”. Since I had completed 2 years of med school before deciding I could never comply with the condescending manner they were teaching and going into law instead, there was no call for this.

          • Amy Tuteur, MD

            You mean you treated doctors differently than the utterly contemptuous way you have treated us?

  • Shawna Mathieu

    Flat nipples, couldn’t get the damn nipple shield to stay on, and was visibly suffering post-partum depression but refusing meds b/c of the almighty breastmilk.

    What I needed to be told was, “Your son needs you home happy and healthy, even if he’s on formula, rather than you be suicidal and hospitalized, but grimly pumping.”

    What I got was “You just need to have confidence in your ability to make this work! “

  • RudyTooty

    I feel like we’ve been unfairly leaving lactation consultants out of this discussion.

    Another way to treat women like children:

    Tell them breast milk is MAGIC.

    https://www.mother.ly/child/breast-milk-is-basically-magical-science-says

    “…it sure is comforting to remember that not only are you helping your
    baby grow—but you’re also working some magic while doing it. ✨”

    Right up there with the tooth fairy and Santa Claus.

    • Jane Strauss

      No lactation consultant ever told me that. On the other hand, physicians told me that formula was excellent for my kid and so much easier, and virtually magic. I didn’t believe the doc.

      • RudyTooty

        Okay. You’ve had some experiences with people.

        Your saying that you have never had anyone tell you those things doesn’t mean there isn’t a lactation-promoting industry that based on this kind of ideology. It also doesn’t mean that all physicians promote formula.

        Someone told me at the grocery store today that she likes my shoes.

        ^ this is virtually meaningless and can be extrapolated to mean exactly nothing.

        • Jane Strauss

          All I can do is speak for my own experience. And I have never heard an LC or even a LLL leader call breast milk magic. I have however, as an attorney, had to defend a parent against a doc who reported her for neglect because she refused to stop nursing at 10 months. And the kid, who was supposed to be failing to thrive, was described by intake staff at the Children’s Hospital as a “well developed, well nourished, alert Native American female.” That doc was truly condescending and not even practicing good medicine at the time (which I believe was 1990). Can’t have it both ways.

          • RudyTooty

            “All I can do is speak for my own experience.”

            That is evident.

      • Amy Tuteur, MD

        A doctor told you formula was magic? Or are you just making that up?

        • Jane Strauss

          Nope. He did. And it was ever so much more convenient than nursing. And the modern way to feed. Honestly, I felt as if he was existing in the 50s, not the 80s.

          • Amy Tuteur, MD

            I can believe he said it was convenient but not that he said it was magic.

    • rational thinker

      Thanks for sharing that link, I had a good laugh. How do they get away with the science says title and have no scientific peer reviewed literature cited to support the title. Then again the target audience is most likely sanctimommies who want to emotionally abuse other people who formula feed.

  • Heidi

    OT Noticed an article from USA Today pop up on my feed regarding recreational marijuana use and breastfeeding. Evidently THC is found in breast milk up to six days after use. I didn’t read the article super closely but no one would even suggest using formula if you choose to use. Instead it was recommended you quit pot or cut down. And I’m not suggesting that’s bad advice but let’s be realistic! How about quit or formula feed? Not that I’m the least bit surprised since I’ve seen breast milk enthusiasts encourage breastfeeding for opiate users. But it’s ridiculous we won’t give a baby Tylenol until at least 2 months old but will not heavily discourage exposing them to substances that we know can impair brain development.

    • Heidi
    • PeggySue

      But but but… it’s nacheral.

    • rational thinker

      I have a friend on the breast is best formula is chemical food wagon and guess what that asshole was breastfeeding while on methadone and having hepatitis c. Eventually he was failing to thrive and had to be put on formula.

      • PeggySue

        Holy crap. That poor child. How did the withdrawal go, and does he have Hep C?

        • rational thinker

          He is doing fine now and i dont she plans on getting him tested for the hep c. He was in nicu for 6 weeks for the withdrawl but the nurses encouraged her to breastfeed anyway.Thank god to pediatric doctor put a stop to it.I just hope he didnt get the hep c. She told me her levels for the disease were low so it would be fine and it would be worth the risk to be able to breastfeed. I think she was grossly misinformed and she thinks breastmilk is magical too.

  • RudyTooty

    The ACNM seems to have abandoned their motto “Listen to Women.”

    https://www.ncbi.nlm.nih.gov/pubmed/8246085

    Women aren’t monolithic – but most want epidurals in labor, they’d rather not breastfeed at all costs, they’d like to have their newborn babies cared for in the nursery at night, they’d like reliable contraception, some want their labors induced, others want scheduled cesareans, the overwhelming majority want to give birth in a hospital and close to life-saving/preserving technology, and many would like to not be shamed for the choices that they make for themselves and their families.

    • fiftyfifty1

      Yeah, I am not too impressed with the Frontier Midwifery School (now renamed the Frontier Nursing University.) In my experience, their students/graduates spend a lot of time imagining that their decision to pursue a career as a nurse practitioner or midwife makes them some sort of hero like Mary Breckinridge. Since they are saving the downtrodden, they need not look too closely at their own motivations and biases.

      • RudyTooty

        Mary Breckinridge is an interesting character. There is a mythology that has been formed around her – but with only a little internet and literary research, we can see that Mary Breckinridge was a wealthy woman from the Southern US, and the descendant of prominent confederates. She states in her book _Wide Neighborhoods_ that she became interested in developing midwifery in Appalachia because the people who lived there were of “good stock.” She headed a midwifery organization, The American Association of Nurse Midwives, until her death in 1965 that apparently excluded African American nurse-midwives from membership.

        I’m not saying that Frontier alums are white supremacists, only that they demonstrate an ability to cling to myths, and ignore uncomfortable truths – in this case, depicting Mary Breckinridge as the heroic mother of midwifery and family nursing.

        It is true that her efforts decreased newborn and childhood deaths, and that the Frontier Nursing Service provided services to underserved populations in rural Kentucky. But was she really the illustrious and saintly hero that she is made out to be?

        • fiftyfifty1

          interesting.

      • There used to be a blog called “At Your Cervix”, written by a RN who went to the Frontier Midwifery School, and she listed the various required courses. She completed two years before she learned any “hard” science material associated with obstetrics or midwifery. It was all jargon and woo up to that point. It was a CNM program, and entire semesters were spent on “How to Establish a Midwifery Practice” and topics like “Identifying Situations Which Need Problem Solving”.

        • RudyTooty

          A week or two ago I searched the Frontier online bookstore to see if Henci Goer’s recent book was still required for one of the midwifery courses – it was.

          Today I looked, and I don’t see Goer’s book listed any longer, but the course now requires student nurse-midwives to sign up for the “Evidence-Based Birth ® Academy” online.

          Which, to me, is equivalent nonsense.

      • EmbraceYourInnerCrone

        So apparently the downtrodden don’t deserve adequate medical care, but someone who wants to play Lady Bountiful? /snark

        • fiftyfifty1

          Exactly. Incompetent Lady Bountiful types are the worst! In contrast, I have lots of respect for the medical professionals I know who are truly serious about providing care to people in low resource settings. They are constantly working to improve their skills: real skills like surgical techniques, intubation, vent management, sepsis management. Not bullshit woo classes like herbs or Henci Goer.

    • namaste

      but, but, but….if women just UNDERSTOOD the RISKS of all those things, they wouldn’t want them!!!!

      • RudyTooty

        If I’m busy telling women they don’t understand, then I’m not listening to them very well, am I?
        😉

        • namaste

          Pshaw, listening is overrated. The silly dears are too emotional and too easily swayed by marketing to know what they want! It’s up to those of us who know The Truth to protect them from themselves!

          • RudyTooty

            namaste,

            Did you happen to read the Whole Foods article from a few years back?
            Where everyone in the place was saying “namaste” to each other and the author was thinking maybe it didn’t mean what she thought it meant?

            I bet you’d like that one.

          • namaste

            Oh man, that was a crackup. I live in Northern California, pretty much the Ground Zero of food woo. And I come from a wealthy, white family who are steeped up to their eyeballs in it. The food at our family gatherings tastes like cardboard, and if I never see quinoa again, it will be too soon.

          • RudyTooty

            That article forever changed the meaning of NAMASTE for me. 😀

          • I’m in Israel and I never want to see quinoa again.

          • KQ Not Signed In

            *dons hipster glasses*

            Oh, I’m from Eugene, Oregon. We were into Woo before it was cool.

            *archly*

            Oh, haven’t you heard of Eugene? It’s like Portland, but more obscure and independent.

          • AnnaPDE

            The only useful function of quinoa is as a moron indicator: It ruthlessly embarrasses people who whinge about the evil chemical ingredients that they can’t pronounce and their grandmas wouldn’t have recognised as food, then try to promote it as a panacea and get its pronunciation wrong.

          • StephanieJR

            Kevin Bridges has a stand up bit about quinoa, and it’s all I ever think about it when it comes up now.

          • Merrie

            I gotta admit, I LOVE quinoa. I make quinoa salad a lot. I like the taste and texture better than rice. A former coworker used to tease me about the number of meals I brought to work that included quinoa. But I don’t buy that it’s a “superfood”. I just think it’s yummy.

          • BeatriceC

            Do you have a link? I’d like to read it and my google fu is failing me today.

          • RudyTooty
          • MaineJen

            Now that’s what I call a ‘feminist’ attitude! /snark

          • RudyTooty

            What’s worse? ‘Silly dears’ or ‘mamas’?

          • MaineJen

            Both make me cringe!

        • Jane Strauss

          Sounds like most doctors I have had the misfortune to meet.

          • RudyTooty

            I wasn’t talking about doctors, I was talking about midwives, specifically nurse-midwives, and the ACNM, the organization that represents them.

            They are doing a poor job of listening to women, which is ironic, because this was the ACNM’s motto. Too much medical influence? Or are they wrapped up in their natural childbirth ideology?

      • Jane Strauss

        And I did not, but that was my choice. When there was an emergency that was a real emergency, I agreed with the high tech options presented to me. When the same options were presented for convenience or defensive medicine, I said no. And in that case, the doc actually admitted my son would not have lived had I permitted an early delivery that he was advising.

    • Jane Strauss

      I understood the risks and did just fine without them.

      • MaineJen

        Here’s your cookie.

        You get another one if you recognize that not everyone has to do the same thing you did.

        • RudyTooty

          Can I have her cookie?

          • MaineJen

            Well, that depends. Did you “bravely” forego available medical care??

          • RudyTooty

            Wait! What are you handing out cookies for?
            I thought it was because I could recognize that not everyone has to do the same thing I did. Does it matter what I did? Maybe I’m not telling!

            And I can’t decide if it was brave or ignorant…. (probably ignorant.) 😛

          • MaineJen

            Oh! Yeah, that cookie you can have. 🙂

          • Jane Strauss

            I only deal with docs when absolutely necessary. I don’t believe they know everything. I have had too many relatives die of nosocomial infections, drug reactions, and unnecessary interventions of a variety of kinds.

      • RudyTooty

        You understood the risks of what? And did fine without what?
        Epidurals? Midwives? Risks?

        I was tempted to jump to the same conclusion that MaineJen did, but I’m not really sure what you’re talking about.

        I did a whole bunch of things during my pregnancies/labors/births/postpartum/contraceptive and reproductive life that worked well for me – but what I did or didn’t do isn’t the point. It’s never the point.

        If we think our experience and choices are inherently superior and should be mandated for everyone else then we’re just being self-centered and obtuse.

        • Jane Strauss

          Epidurals, hospital birth, episiotomies, formula feeding, all the things you are saying that most women want. I must hang out with a select group, as none of the women I know wanted those things.

          • RudyTooty

            Yes. You are probably hanging out with a select group of people.

            From this CDC report in 2011, 61% of women had epidurals during labor. I’m not sure what the rate is today, a more extensive google search would probably tell us.

            https://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf

            My group of friends did not have a 61% epidural rate – I’m pretty certain of that – but we aren’t EVERYONE.