Why does lactivist Prof. Amy Brown keep lying about breastfeeding physiology?

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One of the most distressing things about breastfeeding advocates is the cavalier way in which they dismiss the suffering of starving babies. It bears an uncomfortable resemblance to the way that drug companies cavalierly dismiss the suffering of patients when they learn of deadly side effects of medication. Both promote profits ahead of people.

For example, Vioxx is a non-narcotic medication that had dramatic benefits for a certain population of pain sufferers and, as a result, was a reliable money maker for Merck. But it also had serious side effects that Merck tried to hide in an effort to maintain market share. Merck lied and patients died.

The breastfeeding industry continues to lie and babies continue to suffer brain injuries and die.

That’s how you can tell the difference between medical professionals and businesses. When real medical professionals learn about harm from their recommendations, they investigate and try to mitigate that harm. When businesses learn about harm from their recommendations, they issue denials that misrepresent or lie about the scientific evidence.

Breastfeeding is a biological process with small benefits for term babies, but because of exaggeration it has become a reliable money maker for the breastfeeding industry of lactation consultants, La Leche League and the Baby Friendly Hospital Initiative among others. But it also has serious side effects that the breastfeeding industry is trying to hide to maintain market share. The breastfeeding industry lies and babies die.

Consider the latest lie from lactivist Prof. Amy Brown, a psychologist by training who has no education in physiology:

#1 There is a misleading post circulating suggesting a newborn’s stomach is larger than medical textbooks say it is. It suggests that the volume at 40 weeks could be 33ml rather than approx 7ml. Based on this it incorrectly claims colostrum is not enough and top ups are needed.

#2 There are many things wrong with this. These figures are taken from 1 baby during an ultrasound. They measure an emptier stomach and then the stomach 15 mins later when the baby has swallowed amniotic fluid. Scientists do not make decisions based on 1 baby or 1 set of measures

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Brown’s lie is chilling on a variety of levels.

1. A real medical professional would start by reviewing the scientific literature on neonatal gastric capacity. A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Here’s what the scientific evidence shows:

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This chart comes from a literature review published in Acta Pediatrica in 2013. You can see that the average stomach size was found to be anywhere from double to nearly quintuple the size quoted by lactation consultants.

The lactivist claim is based on a study from 1920 by Scammon and Doyle that has clearly been discredited by seven studies done since then. The average size of the newborn stomach is NOT 5-7 cc but closer to 20 cc, rising dramatically over the first first days. And some babies need every one of those 20 cc per feeding and more.

2. A real medical professional would review the scientific literature for reports of breastfed babies being underfed (case reports). A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Even a cursory examination of the scientific literature reveals multiple case reports of babies suffering brain injuries and death from hypernatremic dehydration, hypoglycemia, hyperbilirubinemia, known manifestations of infant underfeeding. Brown either does not know or does not care.

3. A real medical professional would consult the scientific literature on the incidence of underfeeding among breastfed babies. A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Had Brown bothered to read the scientific literature, she would find quite a few papers on the risks of breastfeeding.

Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding by Flaherman et al. was published earlier this year. The results are startling.

We had data on inpatient feeding for 105,003 (96.6%) vaginally delivered newborns and 34,082 (97.0%) delivered by Cesarean. Among vaginally delivered newborns, readmission after discharge from the birth hospitalization occurred for 4.3% of those exclusively breastfed during their birth hospitalization and 2.1% of those exclusively formula fed during their birth hospitalization (p<0.001)… For Cesarean births, readmission occurred for 2.4% of those exclusively breastfed during the birth hospitalization and 1.5% of those exclusively formula fed during the birth hospitalization (p=0.025)…

In addition to the pain and suffering of the newborns and anguish of the parents, a tremendous amount of money was spent.

…[S]ince the cost of a neonatal readmission has been estimated at $4548.27 a potential savings of $7.8 million might be realized for a cohort similar to ours if the readmission rate of exclusively breastfed newborns approximated that of newborns exclusively formula fed.

To put that in perspective, with 4 million births each year and more than 75% hospital breastfeeding rates, that means we should expect 60,000 excess newborn hospital admissions at a cost of more than $240,000,000 each and every year — nearly a quarter of a billion dollars. And that doesn’t even count the downstream impact of brain injuries, a consequence that was beyond the purview of this study.

The study Efficacy of Subthreshold Newborn Phototherapy During the Birth Hospitalization in Preventing Readmission for Phototherapy was undertaken to determine whether prophylactive phototherapy could reduce the risk of hospital readmission for severe neonatal jaundice.

Phototherapy does work, but the authors serendipitously found a far simpler intervention that also dramatically reduces the risk of readmission: formula! Infants allowed unrestricted access to formula had a 76% reduction in risk of readmission.

So we have multiple scientific papers that show that newborn stomach capacity is far greater than what lactivists claim, multiple scientific case reports of babies harmed by underfeeding, and a variety of scientific papers that show that aggressive breastfeeding promotion accounts for tens of thousands of newborn hospital readmissions each year at a cost of hundreds of millions of dollars.

Who benefits by lying about that scientific evidence? It’s not babies since they are clearly harmed, sometimes even killed, by the insistence that newborn stomach size is so small that babies can’t possibly be underfed. It certainly isn’t mothers since they are clearly harmed by their babies screaming from hunger, readmitted to the hospital and sustaining brain injuries or even dying because they have been unwittingly underfed. The ONLY people who benefit from lying about newborn stomach size are those who make their money promoting breastfeeding … and that’s why they continue to lie.

The makers of Vioxx could have salvaged quite a bit had they been honest about the potentially deadly side effects of the drug. Alerting doctors and patients would have allowed them to consider the risk and the fact that the benefits might clearly outweigh the risk. But the drug company was afraid that the truth that Vioxx wasn’t perfect would lead to a tremendous fall off in market share so they lied. Eventually they were caught in those lies and they paid a massive financial price, but that didn’t bring back the patients who had already suffered and died.

Breastfeeding advocates could salvage quite a bit if they were honest about the potentially deadly risks of breastfeeding. Alerting providers and patients to the true newborn stomach size and counseling them to look for and treat underfeeding would allow them to consider the risks and the fact that for many women the benefits might outweigh the risk. But breastfeeding advocates are afraid that the truth that breastfeeding is not perfect would lead to a tremendous fall off in market share so they lie. They are already being caught in those lies, although I doubt they will pay any price for their lying. In the meantime babies and mothers continue to suffer and die … while breastfeeding advocates continue to profit.

  • StephanieJR

    A newborn rabbit, at largest four or so ounces at birth, is fed 2.5 ml twice a day for the first week only. Now, a human newborn is different from a rabbit newborn; for starters, they are many times larger. Even premature babies need more than a teaspoon of milk on the first day. It’s utterly inhumane to deny your child food.

  • fiftyfifty1

    Stomachs stretch and expand whenever we eat or drink, that’s how they work. So it really doesn’t matter what size they are empty. Stating a newborn’s empty stomach is the size of a marble is as useless as stating that an adult’s empty stomach is the size of their fist. Shall we invite these lactivists over for dinner, serve each an apple, and then tell them that they must be full and send them home hungry?

    • The Bofa on the Sofa

      I’ve related this story before: When my oldest niece was born, we got to the hospital maybe an hour after (she was born by c-section, back in the days of full anesthesia). I remember explicitly when we got there my b-i-l saying that she had already drunk an ounce of fluid from a bottle (I don’t know if it was water or pedialyte or what; my sister was still coming out of anesthesia so it wasn’t breastmilk or colostrum; that’s all I know).

      Now, an ounce of fluid is 30 mL. Even if they rounded up, it still means that she had probably at least 20 mL. Amazing she could do that with a stomach size of 7 mL!

      I don’t know how old Prof. Amy Brown is, but I’m old enough to know what it was like when babies were born 35 years ago. And that experience makes it clear, a newborn baby’s stomach (btw, my niece was born at about 39w) holds more than 7 mL.

      • rational thinker

        My son drank almost 2 ounces a little over an hour after being born.

  • demodocus

    One of my worries that I can’t really express anywhere but here is that some how the 11% body weight my eldest lost in his first 3 days because I didn’t make enough colostrum is adding to his likely ADHD.

    • Who?

      Parenthood is so rough.

      The fact that you are noticing things going on with him, are open to finding out what that is, and get him the help he needs to make the most of where he’s at, is enough.

      None of us are perfect-and-our kids aren’t either. And thank goodness for that.

      • demodocus

        Aye, I know he can’t be perfect. He’s bright and goofy and I love my wiggle-worm to pieces, even when he is throwing apple cores about the living room.

        Teacher training reinforced what I already knew from my family’s experiences; there’s no need to make him wait and get more frustrated when we can help him today. My parents both thought they probably had undiagnosed learning disabilities. We’ve known my sister’s dyslexic since she was 6 at the latest, but although she had some trouble, she was never -that- far behind her classmates in spelling and math, because she was getting help from very early on.

    • Chi

      I feel you. I am also concerned that a similar weight loss in my daughter in her early days contributed to her autism. Yeah we also have some fun genetic stuff on my dad’s side of the family (Dyspraxia) but I can’t shake the niggling feeling that she suffered some mild brain damage as a result of being underfed.

      I’m relatively intelligent, with a university degree and I STILL fell for the ‘breast is best’ bullshit.

      • rational thinker

        My 14 yr old daughter has autism with dyspraxia and ocd. My husbands side has history of adhd, bipolar, ocd and autism. I never breastfed but she stayed on formula until she was about 18 months old. Normally I take bottle and formula away on babys first birthday but I could not do that with her cause she would not eat food. If I tried to feed her baby food she acted like she was being murdered and she would yell, cry, and hit if you tried to put food in her mouth so that’s why she stayed on formula. I often wonder if I should have tried harder to get her to eat (I always start baby food after three months) would it have made any difference. When you have a disabled child (especially in todays mommy martyr culture) you will always naturally feel like maybe if I had done something different she wouldn’t be this way or this bad. I used to think a lot about it and feel guilty at the possibility it may have made a difference. I did notice something wasn’t right with her when she was a week old so in my daughters case It probably wouldn’t have made any difference but I still carry the guilty feeling. Just keep reminding yourself if it can be genetically linked (in your childs case) it probably is genetically linked.

      • demodocus

        my history degree isn’t much help in this area. sigh. There’s a long history of known and likely learning issues in my family, so it probably comes honestly, but you know how crazy brains are

        • Chi

          Oh I know all too well how crazy scumbag brains can be. I’m constantly telling mine to stop imagining worst-case scenarios. Not that it listens to me.

          Thankfully therapy seems to be helping with a lot of underlying issues that likely contributed to my PPD.

    • moto_librarian

      If it makes you feel any better, my eldest did not have significant neonatal weight loss and he was diagnosed with ADHD 18 months ago. I spent some time worrying that his ADHD was the result of me staying on antidepressants during pregnancy, but research suggests that there is no correlation. Still, I get it.

    • Mel

      Personally, I’ve always thought AD(H)D is probably more about the fact that we expect kids and adults to sit quietly and work far more intensely at a single task than we’ve ever done in the history of humankind.

      Or the flip way of looking at it – hunting, gathering, subsistence farming and combining keeping children alive and fed with producing textiles actually works better with ADHD than without.

      When my son was in the NICU, the nurses were a bit fascinated by the fact my twin and I were TTTS 29 week preemie survivors that were doing fine. After the usual questions about intelligence and major sensory issues, one nurse asked “Did you have any behavior or attention issues?” I had to think about that for a second before responding, “Well, my twin and I are both diagnosed as ADD…but so is my Dad, my mom and our brother. Actually, most of our extended family on my dad’s side of the family is diagnosed ADD or ADHD. We share stories with our cousins about bringing romantic interests to family reunions and having them describe our family as loud, chaotic and overwhelming – which is funny because we separated the volleyball game from the spontaneous football game that year. So….maybe it’s genetic?”

      • demodocus

        LoL. Really, though, I’ve seen BoyBard in lots of situations with other kids and even younger kids are usually able to stay still-ish longer than he is.

        • DothethingZhuLi

          Behavior, like growth, is a spectrum. There will always be kids that are better at sitting, and kids better at running around. Our society is structured to view these behaviors through a moral lens, but it’s really not about “good” or “bad” it’s just difference.

          Some of it is also maturity, being able to control one’s impulses, but the rate we mature is also variable and normal.

          • demodocus

            Not so much “bad” as exasperating. Because really, child, running off when we need to get you to school/doctor’s/library/grocery store gets old really fast.

          • guest

            I’ve wondered the same about my oldest even though his dad also has ADHD. A rough birth and 4 days of no food couldn’t have been good for him. I’ve just come to realize worrying and wondering does him no good. I now try to focus on making his brain work for him, not against him, and teaching him to capitalize on all the ways it helps him. And I’ve just learned to live with the guilty feelings. I think they are probably inevitable with kids.
            I also medicate* him because even though he is smart enough to get by in school, I can see the impact from not medicating my child in my husband, who is equally as smart but unable to focus long enough to accomplish all the wonderful ideas in his head. And I look at it like his asthma, there is no way we would try to manage that without medication and hope for the best.
            *No judgment for others who make different choices for their kids. This is just my personal belief for my child.

          • lawyer jane

            My understanding is that ethical professionals won’t diagnose a 2 year old with ADHD UNLESS the behavior is so far at the end of the spectrum that it’s causing severe family stress or danger to the kid. As in, the kid is completely unable to be trusted not to run in the street, literally can’t sit and focus long enough to eat and is failure to thrive, stuff like that.

          • demodocus

            He’s 5 now. Girlbard is the 2yo

      • Cy Chase

        I’ve been lurking here a while, but first comment!

        This view of ADHD ignores the many subtler ways that the disease manifests, especially in girls. It is not always (in fact, probably not even most of the time) classic hyperactivity. I would never in a million years have been pegged with behavior problems in school, but my ADHD is just as real and potentially debilitating as a kid who can’t stay in their seat.

        Keeping a child alive and producing textiles and farming would be just as difficult for me. Ultimately my brain just works differently. It’s not good or bad, and it can be leveraged in many different situations, but it wouldn’t have been any more “adaptive” earlier in our evolutionary history than it is now.

    • lawyer jane

      I worry about this too wrt my son’s gross and fine motor delays (basically dyspraxia) and his early weight loss … but I see that his cousin is basically identical, so I strongly believe it’s genetic. Cousin also lost too much weight in the first few days of life. In retrospect, it’s clear that they were bad nursers due to their comparatively bad motor skills & coordination. I feel like this aspect of breastfeeding isn’t discussed enough … some babies just learn motor skills more slowly and are less coordinated.

  • Mel

    My son was 1 pound 12 oz and 12 inches long when he was born at 26 weeks gestation.

    A “full-feed” (e.g., the amount of breast milk given by OG tube based on his weight) was 10mL given 8 times a day when he was a snippet of a baby!

    By the time he was term-baby size, he was eating 60mL of breast milk per feed 8x a day.

    Either being born early caused some wonky stomach overgrowth (rolls eyes ) or babies are capable of filling their tummies when given unlimited access to breast milk or formula.

  • rational thinker

    I already posted this comment over a week ago but I think it would be more fitting for this post:

    What always bothered me most is how most lactation consultants tell you that all baby needs all day is a teaspoon of colostrum. Anyone with a little common sense should realize that cant be true. So the next lactivist I hear say that im going to tell them that when they get up in the morning all they have to do is take a really good multi vitamin and don’t eat or drink anything else all day. Then at the end of the day see if they have the balls to tell me they aren’t freaking hungry.

    • mabelcruet

      Remember Jan Hocking, the Australian midwife who got embroiled here about breast feeding. She was absolutely adamant that neonates didn’t experience hunger in the way that an adult does, and she refused to use the words ‘eating’, ‘feeding’ and ‘hungry’ in relation to newborns because she claimed their physiology was very different. Aye, right.

      • Cristina

        That’s…disturbing. By “othering” them, it makes it easier to ignore that they’re suffering.

      • Sarah

        I don’t recall that episode. Do you remember which post it was?

        • Daleth

          It was a discussion I was involved in a few weeks back. Someone posted that back in the day before modern medicine, she would’ve died painfully in childbirth. Some moron posted about how it wouldn’t have been painful because neonates don’t have fully-formed nerve endings. I responded, more or less, “Hey MORON, she’s talking about dying as a MOTHER giving birth, not as a baby being born.” The moron then further displayed his idiocy.

          • Cristina

            The paleo post, lol. Something about Paleo-Suckered.

        • mabelcruet

          It was about a year ago-long term neurodevelopmental outcome after neonatal dehydration. The comment section got rather heated.

      • MaineJen

        Reminds me of the recent poster who tried to tell us about the “not fully formed nerve endings” of a neonate, and how they probably didn’t feel pain during childbirth the way you or I would. And then tried to argue that they were shocked, SHOCKED, that I would think they had implied any such thing.

        • rational thinker

          I remember that one , then she called someone a “douche” and called me a troll for telling her it was rude to call someone douche

        • NfinitSovern

          People often make the same claim about infants not feeling pain the same way adults do in reference to routine infant circumcision

      • rational thinker

        I think I mildly remember it.

    • EmbraceYourInnerCrone

      Anyone who thinks all a baby needs is a teaspoon of liquid a day should not be anywhere near a baby….