On Mother’s Day let’s apologize to mothers for harming them with ideology while calling it science


Whether it’s childbirth, breastfeeding or postpartum depression and anxiety, for the past three decades we have been harming mothers grievously by pretending that ideology is science.

For three decades we’ve obsessing over C-section rates, induction rates and interventions rates.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural childbirth and breastfeeding advocates have demonstrated a curious lack of concern for the impact of their ideologies on women themselves.[/pullquote]

Meanwhile C-sections weren’t harming women and actually cost less than vaginal births. Routine induction at 39 weeks saves lives. But most importantly, women have been dying for LACK of interventions.

For three decades we’ve been obsessing over breastfeeding rates claiming that breastfeeding could save hundreds of thousands of lives.

Meanwhile, no one could ever show that any health parameter for term babies was improved by increased breastfeeding rates, tens of thousands of babies were being readmitted to the hospital each year for dehydration and jaundice, and many babies were deprived of the lower risk of SDIS (as well as the soothing) associated with pacifiers.

For three decades we have been prattling about birth “experiences” and “normalizing” breastfeeding.

Meanwhile countless women were suffering postpartum experiences blighted by depression and anxiety and others were suffering the horror of having starved their own babies in an effort to breastfeed.

We have no indication that mothers are doing better today than they were before we embarked on our well-meaning efforts and some reason to believe that they are doing worse.

What went wrong?

We embraced natural childbirth and lactivist ideology and pretended it was science.

We owe mothers an apology and there’s plenty of blame to go around. Ideologues should be first in line to apologize.

And as epidemiologist and founding member of the Cochrane Collaborative Hilda Bastian wrote recently:

…[T]he main thing I learned – very painfully – in 20 years as a health consumer advocate, is that zealots always, always end up hurting patients. Because whatever it is that they are against, is not the same as being for patients, and it will, inevitably, betray us.

Midwives (particularly in the UK and Australia), doulas and childbirth educators are often zealots who value ideological purity above the well being of women. They oppose technological birth, doctors and insitutions that curtail their autonomy … but that’s NOT the same as being for women.

Like most zealots, they believe one size fits all: unmedicated vaginal birth is best in all but “rare” cases.

For the past three decades, while midwives, doulas and childbirth educators have blithered endlessly about promoting “physiological birth” as well as the evils of C-sections, inductions and other inventions, not a single parameter of women’s health has been improved as a result. Women have continued suffer severe morbidity and to die in and around childbirth because of lack of access to the same high tech care that natural childbirth advocates are bewailing. Worse, they may have begun to die in higher numbers in the US because providers have been bewitched by the lie that childbirth is inherently safe when in truth it is inherently dangerous.

Lactivists and most lactation professionals are zealots. They have an almost visceral hatred of formula companies and are opposed to formula … but that’s NOT the same as being for babies or women.

Like most zealots, they believe one size fits all: breastfeeding is best in all but “rare” cases. They make the bizarre claim that breastfeeding is perfect when there is NO bodily function that is perfect.

They’ve insisted that aggressive breastfeeding promotion is based on science, while forgetting that they instituted the Ten Steps of the Baby Friendly Hospital Initiative without ANY scientific evidence at all. It was ten years before they even began doing the necessary research and at that point they were trying to justify what they had already mandated.

As a result, they grasped at any data that seemed to show breastfeeding as beneficial, but didn’t bother to correct for the confounding socio-economic and educational variables that are known to be associated with breastfeeding. As a result, tens of thousands of babies and mothers are harmed each and every year by policies that never had any basis in science even though they were being touted as supported by science.

The toll of lactivist ideology is only just being appreciated because pediatricians became horrified by its harmful effects. The highest quality studies — studies that DO correct for confounding variables — have found that most of the purported benefits of breastfeeding are illusory.

The 2018 paper Is the “breast is best” mantra an oversimplification? summarizes the evidence that the benefits have been overstated and the risks ignored.

The evidence for infant breastfeeding status and its association with health outcomes faces significant limitations; the great majority of those limitations tend to overestimate the benefits of breastfeeding. Nearly all evidence is based on observational studies, in which causality cannot be determined and self-selection bias, recall bias, and residual confounding limit the value or strength of the findings.

And aggressive breastfeeding promotion has very real harms:

…[E]xclusive breastfeeding at discharge from the hospital is likely the single greatest risk factor for hospital readmission in newborns. Term infants who are exclusively breastfed are more likely to be hospitalized compared to formula-fed or mixed-fed infants, due to hyperbilirubinemia, dehydration, hyper- natremia, and weight loss (number needed to harm (NNH)=71). For weight loss >10% of birth weight with or without hospitalization, the NNH for breastfed infants is 13.

Throughout the relentless promotion of natural childbirth and breastfeeding ideologies as science, its advocates have demonstrated a curious lack of concern for the impact of these ideologies on women themselves. We are in the midst of what feels like an epidemic of postpartum depression and anxiety and not only do childbirth and breastfeeding ideologues fail to question their own role in promoting women’s distress, they insist on doubling down on the very tactics that women often identify as the source of their distress — shame and humiliation at not having an unmedicated vaginal birth and struggles to breastfeed.

All providers have an ethical obligation to provide women with informed consent and informed consent can only be given when women have access to ACCURATE scientific evidence, risks as well as benefits; ideology is not a substitute.

All providers have an ethical obligation to RESPECT the choices of informed mothers; it is paternalism to imagine that providers know better than women what is best for themselves. Claims — beloved of natural childbirth and breastfeeding ideologues — that women need more “education” and “support” to make the decisions that providers favor is just another form of paternalism.

Most importantly, natural childbirth and breastfeeding advocates must start taking women’s MENTAL HEALTH into account in their calculations about risks and benefits.

Natural childbirth and breastfeeding advocates have been proven wrong over and over and over again. Countless women have been harmed as a result. On this Mother’s Day, ideologues owe them an apology.