Melissa Bartick and the Academy of Breastfeeding Medicine give a master class in motivated reasoning.

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Head over to the Academy of Breastfeeding Medicine blog and watch Melissa Bartick, MD put on a master class in motivated reasoning in her post Worldwide study on sudden infant death finds factors associated with poverty and racism are more important than bedsharing.

What is motivated reasoning?

Motivated reasoning is confirmation bias taken to the next level. Motivated reasoning leads people to confirm what they already believe, while ignoring contrary data. But it also drives people to develop elaborate rationalizations to justify holding beliefs that logic and evidence have shown to be wrong. Motivated reasoning responds defensively to contrary evidence, actively discrediting such evidence or its source without logical or evidentiary justification…

In this case, Dr. Bartick is desperately trying to rationalize her belief that bed sharing must be safe for babies in the face of copious evidence that it is in fact deadly.

Does the Academy of Breastfeeding Medicine have the will to promote infant health above breastfeeding?

It’s hardly surprising that the Academy of Breastfeeding Medicine encourages motivated reasoning. They essentially announce it in their motto: “A Worldwide Organization Of Medical Doctors Dedicated To The Promotion, Protection and Support Of Breastfeeding.”

Call me old-fashioned, but I was taught that doctors are ethically obligated to promote the health and wellbeing of PATIENTS, not the protection and support of specific processes:

As a practicing obstetrician, I strove for safe pregnancy, but understood it was my obligation to provide contraception for women who didn’t want to be pregnant.

I strove for safe childbirth, but not when a woman requested a termination.

And although I strove for safe childbirth, I gave way, as I was legally obligated to do, when patients chose a more dangerous course such as Jehovah’s Witnesses refusing blood transfusions in the face of massive hemorrhage.

Why? Because it wasn’t my job to promote anything beyond a patient’s health and wishes.

The members of the Academy of Breastfeeding Medicine apparently don’t see it that way. They have committed themselves to promoting the process of breastfeeding regardless of whether it is what women want, what is safe for babies or what the scientific evidence shows. Like many doctors before them, they are up front about their paternalistic belief that they know what is good for patients better than patients themselves.

Dr. Bartick and her ABM colleagues have been stunned by the growing number of scientific papers highlighting the dangers of bed sharing. I was too … at first. When I initially saw the evidence about the deadly risks of bed sharing, I wrote posts to debunk them. I had bed shared with my own babies and it was difficult to contemplate that I might have put them at risk. Over the years, however the evidence has become overwhelming and I have accepted that bed sharing nearly triples the risk of sudden infant death syndrome.

Dr. Bartick has engaged in motivated reasoning instead.

Last year she published Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution, making the absurd claim that bed sharing must be safe because it is a product of human evolution.

Recommendations enforcing separate sleep are based on 20th century Euro‐American social norms for solitary infant sleep and scheduled feedings via bottles of cow’s milk‐based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia…

No, Dr. Bartick, recommendations for avoiding bed sharing are based on 21st Century scientific evidence that shows that it nearly triples the risk of SIDS!

That “argument” apparently didn’t persuade anyone beyond the ABM so Bartick now offers a new one, Sudden Infant Death and Social Justice: A Syndemics Approach.

It sounds fancy, but it is basically a plea to ignore the role of bed sharing in sudden infant death.

Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co‐occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation.

In other words, let’s ignore the role of bed sharing, which is easy to modify, and focus on structural inequality, which is extroardinarily difficult to modify.

That makes no sense … unless you are committed to promoting breastfeeding above preventing infant deaths.

In her ABM post, Dr. Bartick offers this deadly nonsense:

While the issue of improving overcoming the world’s worse SUID rates may seem daunting, some of these problems are low-hanging fruit. Bedsharing combined with smoking is extremely hazardous, and while it’s difficult to change bedsharing behavior as it’s a strong biological imperative, we can affect smoking by raising tobacco prices.

Do these folks ever listen to themselves? Smoking, despite being pharmacologically addictive, is “easier” to prevent than bed sharing? A strong biological imperative? Where’s the evidence for that claim? Oh, right; there isn’t any.

Dr. Bartick asks:

The question is, does the US have the political will to prevent its own infants from dying?

Yes, we have the political will to prevent infant deaths. That why we counsel women not to bed share since bed sharing KILLS!

The real question is: does the Academy of Breastfeeding Medicine have the will to promote infant health above breastfeeding? When you consider their sluggish to non-existent responses to scientific evidence showing aggressive breastfeeding promotion is injuring and killing infants through dehydration, kernicterus and smothering, the tragic answer is “no.”

  • rational thinker

    Absolutely correct. I used to counsel recovering drug addicts, mostly heroin users. In almost every case they told me it was easier to quit heroin than to quit smoking.

  • maidmarian555

    As someone who smoked for over 20yrs I can state categorically that I found it much easier to be woken numerous times by my small babies during the night than I did to quit smoking. An addiction honed and embedded over many years is not an easy thing to let go of. And smoking cessation services (certainly where I live) are often patchy and not necessarily very effective (one time I did use them, I had to attend clinic every week and be breathalysed in order to get my nicotine patches. I gained over a stone in under a month even though I wasn’t eating any more and the nurse told me I must be lying about my eating habits. Funnily enough, that attempt didn’t stick). Getting people to actually stop smoking for good is HARD. Especially if they are long-term addicts and it’s a regular part of their social habits (for example: I had never waited for a bus as an adult without smoking before I quit). Those daily habits are an absolute bitch to get out of your system and you can’t do it without effective support.

  • mabelcruet

    There is a bit of an issue between the UK and the USA in this, particularly using the term SIDS. Perinatal/paediatric pathologists in the UK and Europe (and Australia/New Zealand) almost exclusively use the term SUDI (sudden unexpected death in infancy). The criteria required to be met for a diagnosis of SIDS are very strict-age 1 month to 1 year, no pre existing history of illness, no concerns regarding the circumstances of death, the place of death etc and nothing found after a full autopsy examination. Found dead while co-sleeping immediately falls outside these criteria, so no co-sleeping death should be coded as a SIDS. There was a push a few years ago to sub divide into SIDS type 1 and type 2-SIDS type 1 is the classic, SIDS type 2 was supposed to be for those almost but not quite SIDS, like co-sleeping deaths. It’s absolute nonsense-I can sort of understand the reasoning, it is to destigmatise those deaths and stop parents feeling guilty about co sleeping, partly because we’re not entirely sure of the mechanism by which Co sleeping can result in death (some are obvious overlaying, asphyxiation by bedding, wedging deaths with baby stuck between the bed and the wall etc, but for others it’s a complex issue involving over heating, re-breathing, micro environmental issues perhaps triggering asphyxia in a baby with inherent vulnerablities dating from the antenatal period and so on). But we do nobody any favours by exaggerating either the benefits of breast feeding, or the dangers of co sleeping. There are infants at higher risk of death co sleeping (premature babies, underweight babies, babies with congenital anomalies, and particularly babies whose parents smoke), and ways in which to reduce risk (stop smoking during pregnancy and post natally would be the biggest). But claiming breast feeding is some sort of magical elixir that would protect every child from those risks is utter nonsense and dangerous advice.

  • rational thinker

    This is that magical thinking again. They will only admit bed sharing is dangerous if the baby is exclusively bottle fed. Somehow the breastfed baby wont be at as much risk because the magical breast milk will prevent mom from rolling over on it cause “good mothers” breastfeed so they couldnt possibly harm the baby even if they are sleeping.

    • yentavegan

      ..and when I bring into the discussion of bed sharing the dangers of over weight-obese adults sleeping with infants, and the dangers of co-sleeping with an unrelated adult/pets and marijuana alcohol use ,I am accused of being judgemental.

      • mabelcruet

        As far as I recall, the royal college of midwives used to have high BMI mothers as a risk factor in the advice sheet about co-sleeping, the argument for it was that they were less aware of their extremities, or had sleep issues like sleep apnoea which may affect their awareness, or were more likely to compress a baby accidentally (eg, a heavier arm over the baby might affect infant breathing more than a lighter arm), and there is a correlation between higher BMI mothers also being more likely to smoke. If the mum had been high BMI during pregnancy, gestational diabetes may have been present and thst might create inherent vulnerabilities in the post natal period too. I don’t think the royal college of children’s Heath and paediatrics had it in their advice though, and I’m not sure if the midwives still use it.

  • Merrie

    OT: Saw this crap on Facebook… sooo many statistical arguments to make. https://www.med.ubc.ca/midwifery-linked-to-better-birth-outcomes-in-state-by-state-report-card/

  • yentavegan

    I slept on a hard futon on the floor with baby #3 because he cried all night and my husband/older kids needed their sleep. He was a strappingly healthy 9.12 pounds at birth. I do not shy away from sharing how I managed to get my rest when mothering a high needs infant. But I gave up sleeping on a bed..is this bed sharing? I do not advocate/recommend bed sharing for my clients. I do support sleeping on separate surfaces within arms reach..if a mother wants to bed share I steer her away from it.

    • lawyer jane

      I think every person has to make their own decision; it’s highly contextual. If you’re so sleep deprived that you crash your car, that’s hardly safe either! Just like choosing not to rear-face your child until 5 years old. That said, the choices should be made with a full understanding of the risk-benefit trade-off. It should never be reduced to slogans. Very similar to breastfeeding itself!

  • Madtowngirl

    The very term, “breastsleeping,” betrays what their real motivation with this nonsense is. Sleeping with a breast. Not even trying to pretend it’s about “safe sleeping practices,” or that mom even is a human being. Ugggggh sorry, I really hate that term.

    I tend to sleep on my back, and putting a newborn to sleep in such a way that he/she could reach my breast while I slept would mean putting the child on their stomach to sleep……

    • Allie

      The thing that I can’t understand is why do they think bed-sharing and EBF have to go hand in hand? I exclusively breastfed after the first week, and we room-shared but didn’t bed-share. LO was in a bassinet beside the bed. I had an aversion to “side-lying” nursing, and LO didn’t like it either, so when she fussed, I picked her up, nursed her on my lap on a pillow, and put her back in the bassinet. Not that room-sharing is a necessary requirement either. I have a cousin who EBF for many months and her LO was in a crib in his own room pretty much from day 1. She had a baby monitor and would go to him as needed. It’s not that hard.

      • Chi

        But-but skin-to-skin, but booooonding!!!!

        How will you keep your supply up if you don’t allow unfettered access to the boobs AT ALL TIMES?!?!?!?!?!!?!?

        Don’t you know if your baby is in another room and starts to cry they won’t develop healthy attachments and if you take FOREVER to get there, the stress and cortisol will permanently destroy their brain!!!

        (Please note I am being extremely sarcastic here. These are but some of the bullshit excuses I have personally heard, although I may be exaggerating them…but only slightly).

      • Chi

        But-but skin-to-skin, but booooonding!!!!

        How will you keep your supply up if you don’t allow unfettered access to the boobs AT ALL TIMES?!?!?!?!?!!?!?

        Don’t you know if your baby is in another room and starts to cry they won’t develop healthy attachments and if you take FOREVER to get there, the stress and cortisol will permanently destroy their brain!!!

        (Please note I am being extremely sarcastic here. These are but some of the bullshit excuses I have personally heard, although I may be exaggerating them…but only slightly).

  • lawyer jane

    Give women the information and let them decide! It’s astonishingly paternalistic to suggest that women made vulnerable through STRUCTURAL issues out of their control, should not get information about factors they CAN control! It’s completely counter-intuitive to reduce emphasis on what they CAN control.

  • fiftyfifty1

    “Worldwide study on sudden infant death finds factors associated with poverty and racism are more important than bed sharing”

    Translation: White Mothers, do not fear bedsharing! Rolling over on a baby and inadvertently smothering it something that only happens to those nasty poor minorities. Erm, I mean is something that only happens to “people who have experienced historic trauma.” So carry on with your bedsharing excellent, lovely White Mothers.

    ..but then again I’m cynical.

  • fiftyfifty1

    “Worldwide study on sudden infant death finds factors associated with poverty and racism are more important than bed sharing”

    Translation: White Mothers, do not fear bedsharing! Rolling over on a baby and inadvertently smothering it something that only happens to those nasty poor minorities. Erm, I mean is something that only happens to “people who have experienced historic trauma.” So carry on with your bedsharing excellent, lovely White Mothers.

    ..but then again I’m cynical.

    • lawyer jane

      Worse, it means “bedshare, black mothers, because it increases breastfeeding rates; but don’t blame our bedsharing advice when your baby dies, blame racism.”

  • Mel

    I’d be hard pressed to defend the statement that all primates share sleeping space with their infants – but it might be possible. I am quite certain, though, that not all mammals share sleeping quarters exclusively with their infants. I’ve seen enough barn cats napping in the sun out of ear shot from their kittens to feel safe about that statement.

    • The Bofa on the Sofa

      And even if it is true that “all primates share sleeping space with their infants,” the question is, how many of those infants die as a result?

      When a sow has a litter of pigs, it is not uncommon for her to smother a couple by laying on them. How’s that “sharing sleeping space” working out for them?

      Tigers eat their young. I don’t think it is something worth emulating.

      • FormerPhysicist

        Yes, it bears repeating again and again and again. Evolution is a product of “good enough” or possibly just “not bad enough to fail”. It is NOT good design, or best practices, or wonderful efficiency.

        • Lilly de Lure

          Or a result of a trade off – I’m strictly a dabbler when it comes to evolutionary theory but it strikes me that for a primate in the wild sharing sleeping space with an infant may well be worth the increased risk that the mother may inadvertently hurt the baby if the alternative is leaving them alone and defenceless against any passing predators who fancy a snack during the night. Not ideal, but better than the alternative given the circumstances, is a standard outcome of natural selection – perfection (if such a thing could actually be measured) really isn’t.

    • Allie

      Ha! My cat was out whoring again when her kittens were only 4 weeks and not even weaned. I had to go to my neighbour’s house and drag her butt back home ‘cuz they were so hungry (note: she was pregnant when she came to me; had I gotten her as a kitten, I would have had her spayed before the first litter, and I had her spayed as soon as possible after).

  • Mel

    I’m skeptical that the effort put into reducing bed sharing directly affects the ability of organizations or people to change non-descript “structural interventions”, breastfeeding, prenatal care and tobacco cessation.

    Causing change at the “structural intervention” level requires a lot of macro-level work while bed sharing is mostly micro-level work. I doubt a social worker who helps a young mom get a crib and offers emotional support while the newborn pitches a fit is missing an opportunity to reform the legal processes surrounding illegal drugs that disproportionately affects people of color by helping that one mom. Not every person comes with the same skill sets; the people who are good at macro-level change are probably not as good at micro-level change.

    Since the reason the Academy of Breastfeeding Medicine is interested in promoting bed sharing is because they think bed sharing increases breastfeeding, including breastfeeding in the list of goals undermined by avoiding bed sharing is craven.

    Prenatal care – by definition – doesn’t overlap with ending bed sharing with an infant…unless pregnant women are supposed to put their unborn babies somewhere else to sleep. Prenatal care is a good place to offer education about the dangers of bed sharing – but it’s hardly taking away from any other form of prenatal care.

    And quitting tobacco is a lot harder than eliminating bed sharing. Crib manufacturers haven’t been designing cribs for increased addictive power over the last 50 years.