Dr. Alison Stuebe, better dead than not breastfed?

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Dead babies can’t breastfeed. I would have thought that even the most ardent lactivist understands that. Apparently not.

The editorial, Should Infants Be Separated from Mothers with COVID-19? First, Do No Harm, by Alison Stuebe, MD, the new president of the Academy of Breastfeeding Medicine is deeply troubling for its willingness to sacrifice the lives babies whose mothers are infected with COVID-19. Why sacrifice their lives? For no better reason than to promote breastfeeding.

Like gun rights activists, lactivists reject even the most common sense restrictions.

I guess I shouldn’t be surprised. We’ve already seen lactivists like Melissa Bartick, MD cheerfully do the same, promoting bedsharing despite the fact that it is the single biggest risk factor for SIDS.

But equally troubling to me is Dr. Stuebe’s willingness to use “arguments” typically associated with anti-vaxxers and gun rights activists.

Dr. Stuebe starts by acknowledging that separating newborns from COVID-19 infected mothers can save their lives:

The benefit of separation is that it minimizes the risk of transmission of SARS-CoV-2 from mother to infant during the hospital stay.

But then follows with this absurdity:

However, if the goal is the health and well-being of mother and child in the months following birth, there are additional considerations.

That makes her invocation of the phrase “first do no harm,” especially inappropriate. As Wikipedia explains:

Primum non nocere is a Latin phrase that means “first, do no harm.”…

It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

Immediate contact between a newborn and a mother infected with COVID-19 carries the obvious risk of the infant’s death. The chance of benefit of immediate contact is not merely less certain, but non-existent. The purported need for immediate skin-to-skin contact was invented less than 50 years ago and reflects religious and cultural beliefs, NOT medical evidence.

In other words, like gun rights activists who reflexively reject even the most common sense gun restrictions designed to save lives, breastfeeding activists reject even the most common sense restrictions designed to save babies lives. Why? For the exact same reason. Once people see that restrictions DO save lives and DON’T cause harm, they will no longer believe the expansive claims of activists. Better that some should die to preserve the “freedom” of others to claim what they want.

Let’s analyze the rest of Stuebe’s arguments.

1.“Separation may not prevent infection.”

This is a classic anti-vax argument: if it’s not 100% effective it’s not worth doing.

2.”Interruption of skin-to-skin care disrupts newborn physiology.”

That’s nonsense. Three generations of American babies were born to mothers who did not have contact with them for hours after birth. No one has ever documented even a single instance of harm to those millions of infants and mothers, let alone widespread harm.

3.“Separation stresses mothers.”

You know what stresses mothers far more? Their babies contracting a deadly illness and requiring painful interventions, NICU stays and possible death.

4.”Breastfeeding is a baby’s first vaccine.”

Breastfeeding is NOT a vaccine. Vaccines provide ACTIVE immunity; they teach the baby’s immune system to make antibodies to specific bacteria and viruses; babies make more of those antibodies whenever threatened, providing years or even lifetimes of protection. Breastfeeding provides PASSIVE immunity to a few bacteria and viruses; babies do not learn to produce their own antibodies. Therefore, the protection lasts weeks at most.

5.”Early separation disrupts breastfeeding, and not breastfeeding increases the risk of infant hospitalization for pneumonia.”

This is perhaps the most ridiculous of Dr. Stuebe’s ridiculous arguments. Early separation of babies from infected mothers is designed to prevent COVID-19 pneumonia. It is highly effective. Are we supposed to believe that letting babies get COVID-19 pneumonia is an effective strategy for preventing future pneumonia?

6.”Separate isolation doubles the burden on the health system.”

So? Is the fact that saving babies’ lives cost money supposed to be an argument for letting babies die?

The bottom line is that the risks of COVID-19 transmission from infected mothers to infants is real, documented and deadly. The “risks” of maternal newborn separation are purely theoretical and never seen over millions of babies born in the US over 50 years of experience.

Better dead than not breastfed immediately? Maybe to lactivists Dr. Stuebe, but not to mothers and certainly not to babies.

  • EmbraceYourInnerCrone

    OT but another reason for C-section being used when there is a possibility of problems during delivery, why the hell did the doctor not do a C-section for a baby weighing over 11 lbs(5 kilos)
    https://www.cnn.com/2020/04/15/entertainment/kara-keough-newborn-died-trnd/index.html

    This could have been my nephew who was a shoulder dystocia baby but survived.

    • mabelcruet

      Given the size of the father, surely a big baby could have been predicted? I don’t know what the standard monitoring for fetal growth is like in USA, but in the UK, most women are generally low risk midwife led care (ours are proper nurse qualified and degree level midwives). Estimated fetal weights tend to be done on fundal height measurements-low risk women have an anomaly scan at 20 weeks and rarely anything after that. I’ve a lot of misgivings about the accuracy of fundal height measurements-about 80% of my stillbirth cases are growth restricted or suboptimally grown, and there is frequently a marked discrepancy between the estimated fetal weight and what I measure at autopsy. I worry that we are missing a huge cohort of cases where fetal growth is maintained until the beginning of the 3rd trimester, and then when the baby is meant to be fattening up and putting on weight the placenta simply has no more reserve. The stillbirths in this group come to me at 35-37 weeks or so, and there is another group of intrapartum/peripartum deaths with babies dying because the placenta can’t cope with the increased stress of labour.

      Stillbirths and neonatal deaths in the large for gestational babies are more rare, but it’s a similar issue where either the size hasn’t been expected or monitored and the delivery unprepared. There’s a lot of data coming through that maternal glucose metabolism affects the development of the placenta. Microscopically, we see changes in the villous structure called distal villous maldevelopment. The villus, the structures where oxygen and glucose transfer takes place, are large and swollen and the fetal blood vessels within are in the wrong position, so there is a greater distance for oxygen and glucose to get across. This only happens in the third it’s old name was villous maturation defect or villous dysmaturity, which means that placental function tails off right at the time it’s most needed. Even those these babies are big, they are often hypoxic with oxygen deprivation brain damage. There is so much we don’t know yet about control of fetal growth, either big or small ones.

      • swbarnes2

        In America, I got a scan at about 35 weeks, but only because I asked for it. Being a little ‘elderly’, I was going to start twice a week monitoring in the last month, but baby was an air breather by then.

  • Pamela

    I’m 34 weeks right now, and honestly, being separated from my baby is one of my biggest fears. With my first baby, I still remember the fierce “mama bear” hormones that were surging and I think I would’ve attacked anyone who tried to separate us. However, I later figured out that I also had massive, untreated anxiety which probably contributed to that feeling. I’d like to think that if separation was necessary this time around, I would understand and act in the best interests of my child. Obviously protecting a newborn from a potentially deadly disease IS top priority, but it would NOT be easy and I know I’d need extra mental health support. I also know that eventually I’d bond with my baby as bonding is a process anyway, not something that magically happens with skin to skin (or at least it didn’t for me).

    I have to say, this is a tough time to be pregnant. I know rationally that the hospital is the safest place for me/us; at the same time I want to spend as little time there as possible. Normally I’d be completely fine if I needed a C section for example – but right now I’d prefer to avoid it just so I don’t have to spend any extra time in the hospital (and also so I don’t take up any valuable PPE!) I know L&D at my hospital is a completely separate building so some of these fears are irrational, but there’s just a whole new layer of uncertainty right now that makes things even harder. Fortunately I have good supports in place to help my mental health (including medication and planning to exclusively formula-feed) but that doesn’t completely take away the anxiety, you know?

    • Montserrat Blanco

      I do not have anxiety issues and obviously everybody is different and reacts in different ways. I wanted to have a normal vaginal birth at term and I ate great, exercised and took care of my health during the pregnancy of my son. Turns out my pregnancy ended at 28 weeks and my lovely son went directly to the NICU, so I was about the 20th person to hold him . The good news are 1) he is absolutely fine, in fact he has always been fine and 2) I had it so clear that it was the best thing to do for him that I was happy that he went to the NICU (thought I was a total pain asking for photos and updates after he was born). More good news: after the 37th weeks your baby will be a term baby, so your chances of ending up in the NICU are extremely low, you only have at the most 7 weeks to go in your pregnancy and that reduces the critical time for you to get the virus, if you practice social distancing it is much more unlikely you will get it, maternity wards are one of the safest places to be at the hospital right now and believe me, healthcare professionals do know how the virus is transmitted and will do anything within their powers to prevent you from getting it.
      Best wishes for a safe and nice end of pregnancy.

    • Mel

      Anxiety does heighten the maternal aggression instinct after birth – but increased maternal aggression is also a normal side effect of giving birth to a healthy term baby who needs protection.

      I say this as a mama to a 3 year old boy who was born at 26 weeks. He was 1 pound 12 oz and needed quite a few life support machines to stay alive – but I kept having this gut feeling that I should grab him, remove all the tubes and wires**, dive into an alcove next to his isolette and barricade the two of us in there where I could effectively fight off any things that tried to attack him.

      I settled for deep breathing and flagging that urge to talk to my therapist about. And sure enough, that urge passed about 3 weeks after he was born.

      I would recommend bringing a stuffed animal roughly the size of a newborn baby with you to the hospital just in case you do need to be separated. When I was fully awake, I felt ok enough with Spawn being separated from me since he was very tiny and I was very sick – but I would wake up at night and completely freak out because I was no longer pregnant and didn’t have Spawn within reach and I’d think he was either dead or had been stolen. Sleeping with a stuffed animal around the size of Spawn did a good enough job of bridging the gap between being half-awake and fully awake so I didn’t end up screaming hysterically at 3 am.

      *When I mentioned this to his nurses a month or two later, they assured me that the nurses would have tackled me long before I had gotten all of the tubes or wires out. This was the most comforting thing I ever heard…..

  • JT H

    I gave birth to four children and did not have immediate contact with them. They were immediately whisked off to a warmer and given oxygen for a few minutes and then handed to me cleaned up and wrapped. That’s just how it’s done where I live. It didn’t stop my feelings of intense joy and love overcoming me and I certainly couldn’t love them anymore than I have since then and still do. If people like Steube want to know what stress at separation is, how about this. It’s the death I’ve experienced since my abusive ex ran off with all of them over two years ago. It’s pain that can’t be described or imagined. It’s what’s kept me out of work and in the house and mostly in bed ever since. It’s what has me subsisting on Ensure shakes alone at the age of 43 ever since because I cannot keep a solid meal down. It’s a separation so frightening that every waking moment is a struggle. It’s stress that has caused a stroke, heart failure and the onset of ms. If people like her want to feel self righteous, it should be about something worth it. Like a zero tolerance policy for domestic abuse crimes. For child abuse crimes. For judges that can be bought and social workers who are charmed by psychopaths. For having exhausted mothers hold their clueless newborns, not so much.

    • Montserrat Blanco

      I am so sorry that you are going through such a difficult time. Lots of hugs and good wishes your way. I really hope you get your children back soon.

  • MaineJen

    Under #5, this sentence should read: “Early separation of babies from infected mothers is designed to *prevent* COVID-19 pneumonia.”

  • Alia

    Some people would say that it’s heartless and so on, but over here when the first covid-infected mother gave birth, the newborn was taken away quickly to protect him from infection. And everybody understands that’s the best solution for the child, even though it may be heartbreaking for the mother.

  • Cristina B

    I was separated from my newborn. I had a C-section and then they whisked him off to the NICU since he was born at 35 weeks. I was stressed out, but it was because he was having problems stabilizing his blood sugar (surprise gestational diabetes). It was hard seeing him hooked up to 2 IVs and being monitored on a screen, but that was necessary. He’s over 6 years old now and he’s my clingy, cuddly one, so being separated didn’t change anything.

    • swbarnes2

      I remember handing my two month old off to a stranger to hold at a Christmas party. When babies are that young, they do not care. If they feel warm, and fed and safe, they don’t worry at all about who is providing that. It’s the adults who care, but they can be adults and stifle their worry while knowing that separation is crucial for baby’s health for a short period.

  • Montserrat Blanco

    I understand it is deeply upsetting to be separated from your newborn. I understand there is a risk of infection. Having said that would there be any option? Could we protect the baby of the mother is infected taking other measures? Is there any alternative? I am a physician but work with adults and currently we do allow visits to very sick patients with covid 19 taking a lot of precautions and protections to minimize the risk of transmission to the visitor. I have no idea about how that would be possible for newborns, I do ask to find out. Please do not misunderstand me as an antivaxxer/lactivistatallcosts/hivdenialist. I am no expert in the field and would like to hear a more detailed opinión.

    • EmbraceYourInnerCrone

      I don’t understand. If I had a newborn yes it would be heartbreaking to be separated from them if I had COVID-19. But why would I want to risk them catching it if by staying away, I would not be chancing passing it on to them? Why would I risk exposing a vulnerable newborn to a novel virus? Not breastfeeding ever and Not doing skin to skin(she had breathing problems) did not prevent me from bonding just fine with my daughter.

      • Lurker

        There is a really strong, irrational, parenting belief in America that a parent’s presence is the only thing standing between children and certain death. How often do you read an article of a child involved in an accident where the comments all say, “Where were the parents????” (or more likely, “Where was the mother????”). Parents won’t let their kids walk around the block or play unattended because “what if something happened?” when the truth is that “something” can happen even if the parent is right there. It’s similar to parents who don’t trust anyone but family around their kids, despite the fact that kids are statistically most likely to be abused by someone in their family/household. Leaving a child alone in a car in a situation with no significant risks (e.g. cool day, keys out of the ignition, windows open, safe neighborhood, parents aware of the child’s presence and gone for a brief period, etc.) is treated as a reason to take someone’s kids away, but people can’t seem to assimilate the information that the most dangerous thing they do with their kids every day is driving with them in the car. Because they (the parents) are there. Kid with parent = safe, kid without parent = in danger.

        Who’s going to make sure the nurses are taking care of the baby, if there are no parents there to watch? Only parents can keep children safe. Most people don’t think (or wouldn’t ever say, especially now) that nurses don’t do their jobs well. But they absolutely don’t think their kids, especially their helpless babies, are safe without them, in any situation, anywhere, no matter what risk being *with them* actually poses.

        (And honestly, given the risk to doctors and nurses these days, I wouldn’t feel entirely sure that I wasn’t sending my baby out of the frying pan and into the fire – which is to say, off to be cared for by other people who also have or have been exposed to COVID-19, because essential healthcare workers are some of the highest risk people out there. In which case, if it’s 6 of one, half a dozen of the other, I’d rather be with my baby.)

        • Cristina B

          I’m curious if latchkey kids are going to make a come back.

      • Montserrat Blanco

        I had a 28 week preemie. I do understand there are a lot of great reasons to take a newborn away. I am just honestly asking if it is not possible to protect the newborn and let the mother have some time with the baby, probably not exactly at the time of birth, but eventually in the hours or days after and if it is being done somewhere else.

    • PeggySue

      One problem in many hospitals here is a shortage of personal protective equipment and since a Mom would have to be gowned, gloved, masked, maybe even a face shield to protect the baby, that may be a factor.

  • The Bofa on the Sofa

    3.“Separation stresses mothers.”

    One of the reason that separation stresses mothers is because people like Allison Stuebe beat it over their heads that an instant of separation is going to ruin your baby forever. If that is what they believe, then of course that separation would be stressful.

    OTOH, if the message were that separation is not going to harm your baby, then it is much less an issue. Sure, everyone wants to be with their baby when it is born, and I understand the disappointment that would result from being separated, but the situation is made much worse by the incorrect message of how it is essential and important.

    It’s just like the “I don’t want to have a c-section because my body is not a lemon” stuff. Who are the ones telling you your body is a lemon? It’s the ones who don’t want you to have a c-section. Doctors aren’t saying that a c-section means your body has failed or is broken. That’s the natural birth industry. Never trust anyone who makes up an affliction and then sells you the cure.