Rafael Perez-Escamilla, PhD and colleagues owe women a profound apology for misogyny


Prof. Rafael Perez-Escamilla and his colleagues at the Yale School of Public Health have joined the cadre of medical misogynists by adding breastfeeding to a long list of medical issues where women’s self reports and suffering are dismissed out of hand.

Even I, a deeply cynical person, am stunned by the viciousness of their claim.

Some have hypothesized that SRIM (self-reported insufficient milk) is simply a socially accepted excuse that women give for explaining why they are not practicing what they know is recommended infant-feeding behavior.

Apparently, those lazy, selfish new mothers are faking it so they can get out of breastfeeding.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Every misogynist healthcare provider “knows” that women lie about their symptoms and suffering.[/pullquote]

It’s just like those “neurotic” women who self-report chest pain and are sent home from the ER having been told they are suffering from anxiety, when in truth they are in the midst of a heart attack.

Or just like those lazy women who complain of disabling menstrual pain just to get out of school or work, but in truth have severe endometriosis and are literally bleeding into their abdominal cavity every month.

Every misogynist healthcare provider “knows” that women lie about their symptoms and suffering. Don’t bother listening to them; they’re just making excuses.

However, others have postulated that SRIM may result from not understanding the lactation process, as women often report SRIM within the first 2 d after birth, a time when only small amounts of colostrum are being produced, and they introduce breast-milk substitutes in response to this (i.e., pre-lacteal feeding)… The precise proportion of women who cannot produce enough milk for satiating and meeting the nutritional needs of their infants for primary biological reasons remains unknown. However, it is likely that this proportion is low because the lactation process is mainly driven by a highly protected infant demand-maternal supply process.

Perez-Escamilla et al. seem to be afflicted with a lack of knowledge about both evolution and basic biology. First, evolution does not produce perfection. Second there are lots of critical bodily functions that are driven by highly protected demand-supply processes …. and those processes fail. These conditions include everything from irregular periods to type I diabetes. Are women with irregular periods making excuses? Are women with type I diabetes too lazy to metabolize sugar?

Here’s a radical thought: instead of postulating about whether women can be believed, let’s investigate.

Insufficient breastmilk is common, not rare.

In 2010, the Academy of Breastfeeding Medicine acknowledged:

It is important to recognize that not all breastfed infants will receive optimal milk intake during the first few days of life; as many as 10–18% of exclusively breastfed U.S. newborns lose more than 10% of birth weight.

There is a biomarker for insufficient breastmilk.

From a 2001 paper:

High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate.

Insufficient breastmilk is NOT a figment of women’s imagination.

This was confirmed in a 2017 paper that also showed that women who felt they had insufficient breastmilk were more likely to have the biomarker present.

…[E]levated day 7 breast milk Na:K occurred in 42% of mothers with a day 7 milk supply concern, compared with 21% of mothers without a day 7 milk supply concern (unadjusted relative risk, 2.0; P = .008) (Table II). The unadjusted odds of elevated Na:K were 2.7 greater (95% CI, 1.3-5.9) with maternal report of milk supply concern (refer- ence = no concern, P = .01) and further increased after ad- justment for maternal ethnicity (3.4; 95% CI, 1.5-7.9; P = .003).

The potential brain threatening and life threatening consequences include kernicterus, hypernatremic dehydration and severe hypoglycemia.

Kernicterus, thought to have nearly disappeared, is making a comeback.

Dr. Lawrence Gartner revealed to other lactation professionals in a 2013 lecture, 90% of cases of kernicterus (jaundice induced brain damage) are caused by insufficient breastmilk.

The Academy of Breastfeeding Medicine reported in a 2017 paper:

In the U.S. Kernicterus Registry, a database of 125 cases of kernicterus in infants discharged as healthy newborns, 98% of these infants were fully or partially breastfed …

Neonatal hypernatremic dehydration is more common than SIDS.

From 2016 paper :

In a retrospective study in the United Kingdom, the frequency of breastfeeding-associated neonatal hypernatremia was found to be greater than all-causes combined of hypernatremia among late preterm and term newborns.81 In the mentioned report, the incidence of sodium level ≥ 160 was 71 per 100 000 breastfed infants (1 in 1400).

The consequences include death and potentially devastating neurologic injury as this 2017 study explains:

In our study 7 out of 65 patients died as a result of complications of hypernatremia. There was a significant correlation between severity of hypernatremia and mortality (p = 0.001). All who died had serum sodium concentration >160 mmol/L…

All infants in the control group were developmentally normal at ages 6 and 12 months, but in the case group 25% and 21% had developmental delay at 6 and 12 months, respectively. At 18 months the incidence of developmental delay was 3% for the control group and 19% for case group, and at 24 months 12% of case infants had developmental delay versus none for the control group…

Hypoglycemia also injures and kills babies.

A 2017 paper reports that the UK has paid out $250 million dollars for brain injuries due to hypoglycemia, nearly all cases the result of insufficient breastmilk.

As far as I can determine Perez-Escamilla and colleagues simply IGNORED all of this research. Indeed the words “dehydration” and “jaundice,” together accounting for literally tens of thousands of newborn hospital readmissions each year, aren’t even MENTIONED in the paper.

This is not the first time that Perez-Escamilla has let his enthusiasm for promoting breastfeeding exceed his ethical obligation to tell the truth. Last fall he was forced to retract a libelous tweet about the Fed Is Best Foundation supposedly receiving industry funding. As far as I can determine, he had no evidence; he just made up the claim to suit his personal views.

Having staked entire careers (and possibly self-esteem) on the beliefs that breastfeeding has major benefits and every woman can breastfeed, Perez-Escamilla and colleagues cannot bear the cognitive dissonance of admitting that the scientific evidence shows the opposite and so they ignore that evidence.

That would be bad enough. What is truly reprehensible is that they substitute classic misogyny in its place: it’s okay to ignore women because they can’t be trusted to accurately report their own symptoms.

Perez-Escamilla and colleagues have let their prejudices and conflicts of interest blind them to the suffering of women and babies. They owe all women an apology.