Women can’t reclaim their agency from doctors by ceding it to midwives and lactation consultants

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How did the natural childbirth and breastfeeding industries go so wrong?

Why do I receive emails and Facebook messages from desperate women nearly every day detailing their guilt, self-abnegation and torment over “failing” to give birth vaginally or to breastfeed?

Why, when I talk about my writing with friends and acquaintances, do women years removed from childbearing burst into tears about their struggles?

Doctors shouldn’t pressure or shame you … and neither should midwives or lactation consultants.

The philosophies of both natural childbirth and lactivism were created as ways to re-domesticate women, so they would not seek legal and economic equality. Their retrograde beginnings were hidden when they reached the mainstream and their the goal of reclaiming women’s agency from paternalistic doctors resonated widely. Instead of doctors deciding that women should be asleep during birth, deprived of emotional support from partners and subject to unnecessary procedures like shaving and enemas, women insisted that it was their right to be conscious, to be accompanied by partners and to accept or reject procedures based on informed consent. Instead of being convinced to forgo breastfeeding or forced to give up breastfeeding due to lack of breastfeeding support, women insisted that it was their right to receive encouragement and support in nourishing their infants in the way they thought best.

What went wrong?

Both natural childbirth and lactivism went off the rails when they insisted that the only way women could reclaim their agency from paternalistic doctors was to hand it over to paternalistic midwives and lactation consultants.

What would childbirth and lactivism look like if women themselves were in charge of the decision making? It would look very different than it does today.

  • All possible choices would be represented because women have a broad spectrum of needs and desires.
  • Birth plans would just as readily include maternal request C-sections as unmedicated vaginal births.
  • Pain relief would have a prominent place in birth plans since most women find they need pain relief.
  • Women would choose how to feed their infants based on what worked for them, and they would NEVER be shamed for bottlefeeding.
  • Free formula gifts would be available to those who want them.

In other words, every safe childbirth or feeding decision made by mothers would be respected by professionals and by other mothers. Decision making would be bottom up: women would make the decisions and inform providers of their choices.

Instead, in the process of women reclaiming their agency from doctors, midwives and lactation consultants swooped in to steal it from them. Within natural childbirth and lactivism, decision making is top down. Midwives, doulas and childbirth educators decide what a “good” or “normal” birth should look like and they force that decision down women’s throats. How? By hectoring and shaming dressed up with the twin lies of being “better for baby” and “evidence based.” Lactation consultants decide how babies should be fed and force that decision down women’s throats. How? By hectoring and shaming dressed up with the twin lies of being “better for baby” and evidence based.”

The Baby Friendly Hospital Initiative (BFHI) is the paradigmatic example of how natural childbirth and lactivism reflect top down decision making and deprive women of their own agency.

The name itself — Baby Friendly Hospital Initiative — is a deliberate slap in the face to women, implying that women who can’t or don’t wish to breastfeed don’t care about their babies. It reflects the professional lactivists’ beliefs that they know better than women what is best for them and their babies, and it is the apogee of mother shaming.

It’s appalling that any hospital allows such an organization anywhere near emotionally fragile new mothers. The medical community has regrettably empowered a group of zealots — lactation professionals — with top down decision making authority over infant feeding. They’ve allowed these zealots to frame the issue of breastfeeding as “baby friendly” when it may be anything but. They’ve allowed them to ignore the needs of mothers. And they’ve allowed them to promote shaming woman as an acceptable tactic for manipulating them.

These zealots deprive women of agency. The assumptions behind the BFHI are that women cannot be trusted to make decisions for their infants, must be hectored into breastfeeding, any alternative must be made as inconvenient as possible, and that bottlefeeding or combo feeding mothers can and should be deprived of valuable infant formula gifts.

Similarly, national health systems that rely on midwives as gatekeepers to care have done the same thing. In the case of childbirth, it’s about saving money. Midwives cost less because they are less educated, less trained and provide less care. But many are zealots, promoting an ideology of “normal birth” above the needs and desires of women. In the UK, for example, these zealots have been empowered to deny desired pain relief, desired and (sometime necessary) C-sections and to shame women who won’t abide by their ideological dictates.

These midwifery zealots deprive women of agency. The assumptions behind contemporary midwifery ideology is that women can’t be trusted to make decisions about birth. They must be hectored or even tricked into giving birth the way that midwives prefer.

Lactivists rationalize their abysmal and disrespectful treatment of new mothers as “better” for babies, just as midwives justify their insistence on unmedicated birth as a standard by claiming that is is “better” for babies and mothers … just as doctors justified shaving and enemas as “better.”

But women can’t reclaim their agency from doctors by ceding it to midwives and lactation consultants.

It’s YOUR baby and YOUR body. You are entitled to YOUR choices in birth and infant feeding.

Doctors shouldn’t pressure you or shame you … and neither should midwives or lactation consultants.

  • Knittingbiddy

    A bit crude but lighthearted humor re LCs
    Recommend a lot of this guy’s stuff…especially Doc Vader and antivax parents

    https://youtu.be/K0C9BAH2G7c

    • MaineJen

      Crying!!

    • Russell Jones

      Epic.

    • The Bofa on the Sofa

      “Nips out for Harambe!”

    • mabelcruet

      Was it just me, or did anyone else think that the shark sounded just like D Trump??

    • mayonnaisejane

      All in Favor of trying to get Dr. T on to an Episode of Incident Report? I would love to see these two team up on birth quacks.

  • GeorgiaPeach23

    You know what pissed me off? We did 6 hours of baby care and feeding classes pre-birth at a well regarded hospital. Unfortunately it was taught by an LC so we didn’t cover bottle feeding or weaning AT ALL (despite my vocal request). So when my baby had a lip tie that was missed by multiple drs & LCs, we had to bottle feed and we had to figure everything out by trial and error. Indeed the lip tie was finally diagnosed because someone told us a six month old should be eating more each meal and not leaking formula out the sides of his mouth.

    The classes were completely useless for all the feeding problems we faced because we didn’t fit neatly into the BF paradigm. I want my money and my Saturday back.

  • Bee

    This is what I would want for the future. I had a natural birth and breast fed but the thing that makes me most annoyed is the risks of both of them are never talked about. Prior to giving birth and breast feeding nobody had told me what it would really be like, just that those things were the best thing to do and pain relief would have a negative effect. Now I try and support my friends as much as possible as they come to terms with not being able to have natural births or breast feed. It makes me so sad what other women put them through. If I had more resources I’d run antenatal classes with real facts and real life experiences, so new parents actually have some idea about the decisions they are making. The blanket natural approach is detrimental to mums and babies, even for some of those who succeed in it.

  • Mel

    I hated seeing a metal engraved list of BFHI goals prominently displayed in the area in front of the elevators of the Special Care OB unit.

    For anyone who is not familiar with Special Care – it’s a medical unit for women whose pregnancy is going or has gone horribly awry. It’s a mix of women trying to prevent a catastrophically early delivery, moms recovering while they have babies in the NICU for more than a few hours, and mothers whose babies were stillborn.

    Seeing a list of how my parenting of Spawn was failing miserably on the day he was born and everyday until I was discharged made me feel weepy, bitter or disgruntled – even though I straight-up knew the list was a crock of shit. (Seriously – why do patient lists include criteria 1 and 2? That’s a bunch of hospital management / administration work, not floor staff let alone patients!)

    It wasn’t until a baby died in the NICU that I realized that having that on a floor for moms whose baby died is sadistic.

    • alongpursuit

      Wow! How terribly insensitive, but not surprising given that mothers don’t really matter in the BFHI.

      The BFHI goals were posted in the room where I stayed after giving birth to my first. BFing was going horribly and I remember staring at the poster for 3 days thinking “must EBF for 6 months”. When my baby lost too much weight, had no wet diapers on day 4 and her jaundice was getting worse I thought (in my sleep deprived, indoctrinated mind) that I would be harming her if I gave her formula. I had completely missed the point! Thank goodness my boyfriend was clear headed and resolved to just feed the baby. This BFHI propaganda has to go! I will be removing or covering up any posters in my room the next time around.

      • PeggySue

        How awful, how dangerous. I’m so sorry this happened to you.

    • PeggySue

      It is indeed sadistic–really, having any of it on that floor is utterly inappropriate. How awful for you.

  • mabelcruet

    You could also mention midwife-on-midwife bullying. Remember the recent debacle over a student midwife blogging about Fed Is Best and being forced to undergo very public re-education by pressure from midwife ‘leaders’ to withdraw her support for FIB? That made me incredibly uneasy-if you’re a student, you are very vulnerable with regard to your tutors and supervisors and a student needs to be signed off-if you’ve created a public social media stir as a student, it could impact hugely on your career, and she ended up having to toe the party line and say what they demanded she say, at which point she was praised for not giving into formula propaganda. I thought it an appalling show of arrogance and bullying, and the people doing it should have been ashamed of themselves for pressuring a student like that.

    And also, don’t forget about inappropriate pressure being but on academic conferences: another recent story (with the same midwife leaders involved, unsurprisingly) was a national conference about birth where the organisers were pressured to drop one of the sponsors, a formula company. They were banned from having an exhibit at the show. The conference was geared towards student midwives and touted as educational for them. But if you are banning any discussion about formula feeding, and banning students having any contact with formula companies, how does that square with providing balanced and unbiased information for mothers? Midwives will be the first port of call for new mothers-if they aren’t allowed to learn about formula feeding, how can they possibly give new parents any information about it, and how does that square with midwife leaders proclaiming they support mothers in any decision they make-they absolutely cannot, not when students are only allowed to learn about one form of feeding.

    • nata

      I have missed that social media situation about a student midwife – where can I read about it? What strange with BFI is that they don’t allow any formula feeding education for parents until baby is born and parents made a firm decision/ there is an obvious need to bottle feed. As if knowing how to sterilise bottles and prepare a feed is not a good skill to have regardless of how you plan to feed your baby.

      I am also thinking how in general healthcare policies don’t seem to be flexible and accommodating for new parents: years ago we as parents in a small Eastern European state used to fight to room in with our babies, breastfeed on demand and avoid medical harassment when it was implied that majority of women would not have “enough milk” and breastfeeding support was minimal. BFI in our context implied making hospital policies better for babies and mothers – at least this is how we understood it. Here in UK pendulum seems to have moved far into the opposite direction – only rooming in, very strict control of hospital formula, unbalanced education. I don’t understand why healthcare policy makers cannot make it balanced in both directions and supportive of families’ choices

      • mabelcruet

        It was discussed in a post about 5 months ago:

        https://www.skepticalob.com/2019/02/fed-is-minimal-thats-what-all-the-mean-girls-say.html

        The student concerned removed her blog post and instead did one saying she’d now seen the light and she had been wrong. On Sheena Byrom’s twitterfeed there was a long discussion about it, and some people raised concerns that the original post should have been left up. It was back through 5 months but I’m sure its all still there.

        It really was like 1984 and groupthink and doubleplusbad. A student did a thoughtful post on her own blog and then a few influential midwife ‘leaders’ piled on and told her to think differently, and she caved (as most people would do when faced with a militant lactivist army led by people who potentially have control over your future career). A few non-midwife people raised this as a disturbing issue, but the attitude was one of ‘we are educating this wayward student who has fallen for Fed Is Best propaganda and been seduced by formula stooges, we’re helping her, not threatening her…’

        • nata

          I googled and found her “reflection” on all4maternity. This is sad. Interesting tho how said influential midwives turned it around and posted her reflection on their own self-promoting blog.

          • mabelcruet

            https://twitter.com/AlitheMidwife/status/1098328370553720833

            I couldn’t find the full twitter thread, but this will give you an idea of the way in which she was pressurized.

          • mabelcruet

            And as for Byrom’s comment that ‘NHS supports ALL women’s choices with infant feeding’, that’s a complete lie. She was the person directly responsible for getting a formula company banned from sponsoring a midwifery conference.

          • nata

            oh. really. breastfeed from armpits.. anyway, I have a sick day, so curious to read 🙂 anyone who knows how to use twitter – how to get to old posts without endless scrolling. These people are twitter monsters – they twit up to 10 a day, it takes 30 min just to scroll past July 🙂

          • mabelcruet

            Maddy the doula also claimed that you could use an SNS system alongside if you had had a mastectomy-she didn’t understand that a mastectomy often means the nipple is removed. If there’s no nipple to latch onto, how is SNS going to work? Basically you’re formula feeding down a tube while the baby is rooting desperately for a latch on a non existent nipple, so you may as well just formula feed from a normal bottle.

            If you go into the link on All Monaghan’s twitter feed (the one I posted), you should be able to see a selection of the posts about what happened-it was a couple of diametrically opposed camps. One was people who were concerned that there appeared to be pressure on the student and she wasn’t being allowed freedom of speech, or potentially being at risk of being penalized. Another group were concerned that by forcing her to change her blog they were showing contempt for formula feeders and attempting to demonize formula feeding as unhealthy. And others weighed in complaining of the language lactivists and midwives used in regard to women who chose to formula feed (the usual ‘all you needed was more support’, and faux sympathy about ‘such a shame that you’re having to formula feed’)-they were accused of belittling, judging and undermining women and telling them that they were substandard mothers for giving their baby substandard nutrition, at which point the lactivists all cried foul and were appalled that anyone would think they were deliberately trying to upset parents, and denied this entirely, even while they were in a real time conversation with women who were telling them that they had felt belittled, bullied, undermined and treated poorly by lactivists for their decision to formula feed. choice.

          • nata

            I looked through the thread, some of it has been cleaned up, so it looks like a little tidy discussion now :). It is interesting, how people can be entirely fixated on breastfeeding and forgetting that mothers and babies have other needs too. The woman after breast surgery with a newborn baby obviously has nothing else to do but work day and night to imitate breastfeeding (face palm).

          • mabelcruet

            In the original, there were some very unpleasant comments being made to the women who had asked why the student had felt it necessary to change her piece and what sort of pressure she had come under to do so-it got really rather vicious and personal. Sheena Byrom’s usual tactic is to demand to know who your editor is (if you’re a journalist), or to copy in your employer, as she routinely does with obstetricians and loss parents if they ever challenge her or dare to disagree. She’s even copied in the health minister at times when responding to clinicians. It’s her standard playground ‘I’m going to tell on you’ tactic.

          • nata

            I don’t see how it can be ethical, but it’s good to know that she does this, in case if I ever get a sick day again and get involved in what I think is a pure theoretical discussion that would ruin my career forever :).

            It often catches me off guard – when they encourage midwives to be independent practitioners, to exercise critical thinking, to advocate for women, but somehow all of this has to be along the party line. If you argue, you quickly become an unwelcomed outcast. It is even more strange that this transformation can happen over the internet, while discussing purely theoretical aspects of care.

            It seems to be, some midwives, when they speak about advocacy keep in mind only one kind of women – NCT trained, with unusual birth plans, planning to breastfeed. I don’t understand why it is difficult to see that women are so different and have different wishes/plans and they need as much support.

          • mabelcruet

            I’m sure you’re aware of this, but that issue was one of the central concerns in the Morecombe Bay (Barrow-in-Furness) enquiry. There were a group of midwives on the unit that had worked together for many years and were a team who resented outsiders. The Kirkup report described it as a ”them and us” culture, with poor interprofessional relationships and “strongly influenced by a small number of dominant
            individuals whose over-zealous pursuit of the natural childbirth approach” which led directly to deaths.

            There was no flexibility, no support unless you did it their way-their loyalty was to each other and to ‘natural birth’ rather than aimed towards patient care and health and safety. Information was left out of clinical handovers, observations weren’t recorded, other professionals weren’t communicated with, regardless of clinical need, simply because certain people considered themselves as the arbiter of what was acceptable and what wasn’t.

            But the RCM response to Morecombe Bay and the problems there was equally as appalling as the individual practices of those midwives directly involved. There was wholesale bullying of midwives on the unit, those who tried to do things differently, but there was also wholesale bullying at the level of the college as well. The mentality was absolutely shocking-totally tone deaf.

            Cathy Warwick, the former president of the RCM resigned in Jan 2017, having presided over the entire debacle of how badly the college had mishandled the whole Morecombe Bay disaster (multiple maternal and infant deaths, multiple episodes of bullying, belittling and undermining families,not responding to concerns raised, not responding to letters, ‘accidentally’ sending rude and offensive private emails about individuals to the individuals themselves, even setting lawyers on them to track of their social media statements).

            The day she resigned (which was shortly before the Government committee which had been set up to investigate the college’s behaviour released their hypercritical report), her twitterfeed, and that of other socially active senior midwives, was full of ‘oh you’re so wonderful, you’ve revolutionised midwife practice, you’re a star’ with not a single word about the babies and mothers who had died on her watch. She may not have been directly responsible for deaths, you could argue that, but the tone deafness of her departure speech, and the callous and tone deaf responses of other senior midwives was very obvious, and very upsetting to some of the parents directly involved. The RCM have a long way to go to get back public confidence.

          • Sarah

            She’s quite the piece of shit.

          • mabelcruet

            Absolutely. I admit she triggers me, but she is a dreadful person. She posts the most sickly sweet schoolgirl level gushing posts about how she loves everybody, and twinkly memes about birth, and humble-bragging posts endlessly and unceasingly. Meanwhile, she’s bullying students to change their reflection, bullying loss parents, ganging up against anyone who dares suggest natural birth is not always a perfect experience. She joins in with mobbing with a vengeance, usually with her pals Hannah Dahlen and Milli Hill. The ‘I’m telling on you’ behaviour is a long standing pattern. I’ve known certain staff in the NHS where ‘I’ll datix you’ is used as a threat and a form of bullying (Datix being the system we use to record errors, incidents and patient harm), and the impression I get is that she was one of them.

          • Anj Fabian

            She basically said “You win! You are right. I was wrong. The end.”.

      • Ozlsn

        “What strange with BFI is that they don’t allow any formula feeding education for parents until baby is born and parents made a firm decision/ there is an obvious need to bottle feed. As if knowing how to sterilise bottles and prepare a feed is not a good skill to have regardless of how you plan to feed your baby.”

        Yes!! I pumped milk for a fairly long time, women bottle feed for all sorts of reasons – and what is in the bottle may be formula, expressed breast milk or both. Knowing how to make up formula and how to sterilise equipment is really bloody useful, even if your plan going in is exclusive breasfeeding – things don’t always work out how you thought they were going to.

        Also what you describe about fighting for in the Eastern European state is what my mum fought for in a rural hospital in the 1970s – being able to see your baby outside strictly defined hours, even just closing the goddam curtains when doing examinations ffs. I know mum still utilised the baby nursery though (I remember looking through the window at my youngest sleeping siblings) – and her response to being told that they didn’t necessarily have those available was “but how do the women get any sleep?”

    • Ozlsn

      In one of my roles I have contact with various midwives, the majority of whom are sensible and reasonable people. A few though are absolutely convinced Big Formula is trying to “sneak in” formula wherever they can – something like sponsorship is “normalization of formula” and to be avoided at all costs (sponsorship by Medela etc though is fine). One of my midwife friends got seriously upset by the cartoon depicting the “Three Wise Women” at Christ’s birth – because they brought casseroles, diapers and…formula. (My response of “would have been useful if Mary’s milk was late coming in, and better than goats milk” was… unappreciated.) (Also to be consistent shouldn’t they be upset by the diapers and pushing for Huggies samples to be excluded?)

      • mabelcruet

        I find it very hard to reconcile what I know about midwives with the way their ‘leaders’ and their Royal College behave. I work very closely with midwives (NHS ones, not any homebirth or independent ones), and they are generally incredibly hard-working, dedicated, parent-centred and women-centred people. I know a lot of them give many extra hours to the NHS, working past their shift ending, and due to NHS underfunding, they are massively stretched and they still manage to deliver a great service.

        So when we have midwives like that, how come their leaders are so arrogant, dismissive, undermining, belittling and offensive? How come their royal college bullied loss parents to such an extent that it was remarked on in parliament, and no-one seems to have been made accountable? They brushed off concerns about bullying cultures developing and didn’t investigate until many, many years after events and only after huge public pressure to do so. What have these decent, hard working professionals done to deserve a college and midwife ‘leaders’ who behave so appallingly? When there is a government special committee set up specifically to investigate how the college responded to failures, how come they seem to get away with it, time after time? When a senior leader makes comments about obstetricians are a waste of money and shouldn’t be allowed anywhere near women, and should all be sacked, did the college come out and say that wasn’t appropriate? No-many individual midwives said that the comment (from Caroline Flint) was unwelcome, and that their unit worked in partnership with obstetricians, as it should be, but was she actually censured by the college?

        No, because secretly that’s what a lot of the ‘leaders’ genuinely believe. They want to get rid of obstetricians so that’s why they push the natural birth programme (sorry, the ‘physiological birth’ programme). They consider ‘protecting normal birth’ to be their core function-not protecting mothers and babies, protecting the process of non-medical birth itself. Any front line midwife I’ve ever worked with doesn’t talk or act like this, so where is all this coming from? How come all the activists get so high up in the college and are in control of where midwifery is going? I honestly think that any sensible normal NHS midwife who works in a multidisciplinary team in partnership with mutual professional respect for others doesn’t have a chance of ever getting voted on to the college council because she’s not toeing the party line.

        • nata

          I started to write a whole essay on how I understand midwifery leadership works here, but it’s too much for a post :). On a positive note, I attended a presentation on “future midwife” from our direct regulator, NMC and it is more focused around complex needs of the women and babies, inter-professional collaboration rather than promoting normality…
          https://www.nmc.org.uk/standards/midwifery/education/

          On the other side, a number of famous speakers, especially those known here and active on their social media accounts have no real power apart from being influential because famous. Some of them really seem to be a bit distant from actual hands on care. Then they tend to mix midwifery research with social sciences, for example social constructivism, etc and then turn childbirth into an area of power struggle between social and medical, personal and impersonal, technocratic and humanistic.

          • mabelcruet

            That’s promising at least. The whole natural birth agenda seems to be relentlessly pushed online and its not fair-women are being promised a perfect birth by these people, and that’s why women consider that they’ve failed if they had an epidural, or needed a section-because biased ‘leaders’ active on social media are telling them lies.

        • Anna

          I totally agree. The Australian midwifery “top brass” seems to be quite similar – though there are moderates and those more extreme. Its a lot easier to sit in an office and promote “physiological birth” than it is to actually work in the hospitals and potentially be held accountable. Unfortunately there are rank and file midwives that hang off those leaders words which is scary to me, but many of them become very jaded and bitter that the reality isn’t what they are sold and that most women actually listen to and follow the OBs and are more interested in a healthy baby than an unmedicated vaginal birth. I’ve noticed if becoming a homebirth midwife isnt possible the more extremist leaning students will go into academic (to change the system from the inside) or do stuff like hypnobirthing courses. I have seen comments inside the echo chambers were midwives say they want a system like the UK but also like NZ where, in some places now, women have little or no choice between midwifery led care or private OB. The comment sections on articles about NZ midwifery are always full of stories of women saying they had to beg to see a Dr. The more extremist Australian midwives want to be the “gatekeepers” that women have to go through if they want to see an OB which is horrifying to me. NZ outcomes reflect clearly what happens when women can’t access proper medical care when its needed.
          As for bullying of students I heard a story where a young nursing/mid student was in a lecture with one of the top “thought leaders” of Aust midwifery and the Professor was going on about freebirth and the student said she felt midwives shouldn’t support freebirth and the Professor reemed her out in front of the whole class saying she was anti-feminist and if she thinks like that she shouldn’t be a midwife. Another story, another uni – lecturer was praising LB and the student went to the department head to express her concerns and was told “well, everyones entitled to their opinion and some people had great experiences with her”. I know a couple of student mids who are questioning whether they should keep going as they feel they have to smile and nod along with a lot of bullshit and what they are being taught doesn’t line up with the reality in placement. They aren’t given enough on supporting women that don’t have simple straight forward vaginal births because the rhetoric is that everyone can and should.
          Saying that, I also know a good amount of really awesome young up and coming midwives who I think could really take midwifery in a great new direction. The midwives I had in the MFM unit were fantastic. Theres a few women that initially got into homebirth and the advocacy around “normal” birth and fighting against OBs that have now seen the light and are working towards more collaborative approaches and recognising the need to support diverse populations – many of which simply cannot have a low intervention pregnancy and birth.

  • Just came across this https://medicalxpress.com/news/2019-07-tongue-tie-surgery-breastfeeding.html and thought you might be interested.

    • moto_librarian

      I’m so glad that they’re studying this! It’s pretty clear that a lot of LCs are keen to come up with absolutely any reason other than low or non-existent supply to justify difficulties with breastfeeding. I hope that their colleagues will continue to push back against this nonsense.