The Fed Is Best Foundation gets the Semmelweis treatment


It was a tragedy in every respect.

Dr. Ignác Semmelweis was an obstetric physician in 19th century Vienna. He … was appointed to Vienna General Hospital in 1846. There, he became aware of a puzzling disparity.

The hospital offered two free maternity clinics for economically disadvantaged women. First Clinic was run by all-male doctors and medical students. Second Clinic was operated by midwives and their students. The clinics admitted on alternating days…

… Between ten and twenty percent of women in First Clinic died of puerperal [childbed] fever, while Second Clinic’s percentage was only two to four percent.

Why was there such a vast disparity?

The death of a fellow doctor provided Semmelweis with his central insight:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If Semmelweis had created a slogan it would have been “Disinfected Is Best.”[/pullquote]

One of his colleagues pierced his skin on a scalpel while performing an autopsy and died from the infection. When Dr. Semmelweis examined the wound on his dead colleague, he found it showed the pathology as the bodies of women who died of puerperal fever.

Semmelweis realized that the cause of childbed fever was something in the cadavers and insisted that doctors wash their hands in chlorinated lime before seeing obstetric patients.

Immediately after this policy was instituted, mortality rates dropped 90%…

He broadened his theory to include infected but still-living women, not just corpses, and ordered doctors to wash between patients, too, and the numbers of infections fell even further. When Dr. Semmelweis included the medical instruments used on the women, the rate of infection dropped to around one percent.

If Semmelweis had created a slogan it would have been “Disinfected Is Best.”

What was the response to this astounding discovery? Nothing but abuse.

But Dr. Semmelweis’s discovery was not heralded as the life-saving breakthrough it was. Instead, doctors were offended by the implication that they were dirty and needed to wash more, or that doctors could be somehow at fault for their patients’ demise…

We could call this the “Semmelweis treatment.” His insight and the remarkable improvement in patient outcomes that resulted was rejected because it offended the people who were causing the deaths. As far as his detractors were concerned, “disinfected could never be best” because that would mean acknowledging their own role in the suffering they left in their wake.

Sadly, a similar scenario is playing out today. Christie del Castillo-Hegyi, MD and Jody Seagrave-Daly RN, IBCLC, founders of the Fed Is Best Foundation, are being subjected to the Semmelweis treatment.

Like Semmelweis, Dr. del Castillo-Hegyi came to her central insight because of a tragedy in her life, though in her case it happened not to a colleague, but to the doctor herself. Her own son sustained permanent brain injuries as a result of profound dehydration. She had been concerned that her son wasn’t getting enough breastmilk, but was repeatedly reassured by lactation professionals — incorrectly — that he was receiving all the breastmilk he needed.

Dr. Castillo-Hegyi’s central insight is that insufficient breastmilk and its complications are common, affecting up to 15% of first time mothers especially in the early days after birth. She has also identified a startlingly simple treatment that could prevent the tens of thousands of newborn hospital readmissions for breastfeeding complications each year: observing babies closely for weight loss and dehydration and having a low threshold for temporary formula supplementation. In other words, Fed Is Best.

What has she received for this critical discovery? Nothing but abuse!

Her insight and the improvement in neonatal outcomes that would result have been rejected for the exact same reason Semmelweis’ insight was rejected: it offends lactation professionals, the people who are causing the suffering of mothers and babies.

In contrast to Semmelweis, who couldn’t offer a scientific explanation for what he observed, Dr. del Castillo-Hegyi has provided reams of analysis, copiously referenced with contemporary scientific papers that have confirmed her central insight. No matter. She, Seagrave-Daly, and the Foundation have been subjected to an endless stream of abuse and invective.

Lactivist Prof. Amy Brown wrote an influential blog post entitled Why Fed Will Never Be Best:

‘[F]ed is best’ is simply putting a sticking plaster over the gaping wound that is our lack of support for breastfeeding and mothering in general.

She insists that lactation professionals — with their aggressive efforts to promote exclusive breastfeeding and avoid supplementation under almost all circumstances — are providing the best possible care. This despite the fact that exclusive breastfeeding is now the leading cause of newborn hospital readmission, responsible for tens of thousands of readmissions each year. Brown argues that what women and babies need is more of that care.

It’s the equivalent of Semmelweis’ medical colleagues who insisted they were providing the best possible care DESPITE the fact that they were actually causing patients’ deaths. It’s the equivalent of the colleagues arguing that what women needed was more of that (deadly) care.

Lactation professional Kimberly Seals Allers heaps abuse on the Fed Is Best Foundation:

… Is Fed is Best more interested in saving lives or stoking fear and anger among women? …

Perhaps FIB is only interested in speaking into their own echo chamber and putting out reports. And telling inflammatory stories designed to incite emotions but they are short on actions with others …

She’s and many of her sympathizers — particularly lactivists who run Facebook pages — are no different from the physicians who heaped abuse on Semmelweis.

There’s actually a Facebook group entitled “Fed Ain’t Best” whose administrators use a defaced version of the Fed Is Best logo as their own.

Semmelweis was nothing if not colorful in his own defense.

In an open letter to a medical editor he wrote:

I denounce you before God and the world as a murderer, and the History of Puerperal Fever will not do you an injustice when, for the service of having been the first to oppose my life-saving [treatment] …, it perpetuates your name as a medical Nero.

I wouldn’t go so far as to say Amy Brown, Kimberly Seals Allers and lactivist bloggers are medical Nero’s, but they are definitely on the wrong side of history. I have no doubt that, like Semmelweis, the Fed Is Best Foundation will ultimately be recognized as having been correct all along.

The only question is how many babies and mothers have to be harmed in the meantime by lactation professionals who —like Semmelweis’ detractors —have put their own egos above patient wellbeing.