The difference between natural and medical is “survival of the fittest” vs. “survival of the most”


The conventional wisdom among many laypeople is that natural is best.

Advertisers market it. Organic food purveyors rely on it. And it is obviously at the heart of natural childbirth advocacy and breastfeeding promotion. Women are supposedly designed to give birth vaginally and breastfeed. As a result, those who give birth vaginally and breastfeed are supposedly bestowing a gift of better health on their babies.

Survival of the fittest means a lot of babies naturally die.

But that, like nearly all of natural childbirth and breastfeeding advocacy, is nonsense that reflects a deep and abiding misunderstanding of evolution. In birth and breastfeeding the difference between natural and medical is NOT the difference between best and second best. It’s the difference between survival of the fittest and survival of the most.

Simply put, survival of the fittest means that by definition not everyone survives. Lots of people die. In the case of childbirth it means high levels of neonatal and maternal mortality. In the case of breastfeeding, it means high levels of insufficient breastmilk for mothers and dehydration, jaundice and failure to thrive by babies. And in contrast to the nattering of natural childbirth advocates and lactivists, high rates of offspring death are natural for the rest of the animal kingdom, too.

Modern medicine, in contrast, rests on the moral principle of survival of the most.

We don’t throw up our hands when a grown man breaks his leg; we don’t start planning the funeral for when he dies of starvation because he can’t hunt or is eaten by a predator because he can’t run away. Even in pre-history his group or tribe would have splinted the leg to promote proper healing and fed and protected him until he could once again hunt his food and protect himself. Moreover, we don’t pretend that a broken leg is a variation of normal that should be ignored or that, once healed, the man is somehow “lesser” than his peers.

Similarly, we shouldn’t throw up our hands when a baby is one of the 4% in the breech presentation and declare that such a baby is less fit and therefore not worthy of our concern. Even in prehistory, “wise women” trained each new generation to master special techniques to save babies from deadly breech complications. They didn’t pretend that breech was a variation of normal that should be ignored or that a baby delivered from the breech position was somehow “lesser” than her peers. Today was can improve further on the survival of breech babies by offering C-sections. We are always striving to save more babies.

Eyes are designed to see, but that doesn’t change the fact that 30% of the population will develop nearsightedness. Today, when a child or adult becomes nearsighted, we don’t throw up our hands and lament the fact that they aren’t the fittest and are henceforth less likely to survive. We provide vision correction in the form of glasses or contacts; we even the odds of survival; and we don’t deride the products and achievements of those wearing glasses as inferior to the products and achievements of those with 20/20 vision. We act to ensure excellent vision for the most, not acquiesce to it being the province of only the fittest.

Breasts are designed to breastfeed but that doesn’t change the fact that up to 15% of first time mothers will not produce sufficient breastmilk to fully nourish a baby, especially in the days immediately following birth. Contemporary lactivists have chosen to thrown up their hands in the face of insufficient breastmilk and declare that it doesn’t exist (“cluster feeding is a variation of normal”) and to fetishize exclusivity. They’d literally prefer to stick an IV in a baby’s head vein, or feed him dextrose gel for no better reason than to pretend that the baby was “exclusively” breastfed. There’s a much easier way to ensure survival of the most babies; supplement with formula.

The dirty little secret about breastfeeding is that formula saves more lives than breastfeeding ever could. Breastfeeding has a high failure rate (up to 15%) while formula has an exceedingly low failure rate. Yet lactivists still cling to their cherished belief that breastfeeding must be better than formula because natural is always best. Yet nature allows for survival of only the fittest while technological formula allows for survival of the most.

Is vaginal birth “best”? Is breastfeeding “best”? How can they be when they only ensure survival of the fittest? The best outcome is survival of the most.