Last week I received a Facebook message from a reader who had reached out to her local La Leche League in Glendale, CA to find the safest local source for donor breastmilk.

I had breast cancer last year and am now pregnant. I have no breasts to breastfeed with, and am wondering if your organization provides donor milk.

The LLL leader explained that LLL does not provide donor milk and offered suggestions for accessing it elsewhere.

[pullquote align=”right” cite=”” link=”” color=”#EDC9C8″ class=”” size=””]It’s wrong for lactation consultants to treat every woman as a walking pair of breasts who must be browbeaten into breastfeeding.[/pullquote]

Then the leader, a certified lactation educator, offered this bit of unsolicited “advice”:

I’ve worked with a few mothers who still secrete milk… I would suggest seeking the services of an International Board Certified Lactation Consultant (IBCLC) to assist you. I have a list of referrals if you wish. It is sometimes suggested that you consult early so you are prepared … it never hurts.

Really? Really??!!

What’s next, selling shoes to bilateral leg amputees?

Had she bothered to ask, the LLL leader would have learned that my reader has NO NIPPLES. Has the LLL leader confused the prospective mother with a duck billed platypus? The platypus also has no nipples and secretes milk through its skin.

But that’s just the beginning of the LLL leader’s ignorance. A mastectomy involves the removal of ALL the breast tissue, every last bit, because the whole point of a mastectomy is that any remaining breast tissue is vulnerable to a recurrence of the cancer. A properly performed mastectomy will leave a woman without ANY breast tissue, and an improperly done mastectomy is not a reason to breastfeed, but a life threatening mistake. But who cares about the health of the mother? When it comes to the lactation industry, breastmilk is the only thing that counts.

I wish I could tell you that this is the first time I have heard such a story of mind boggling ignorance and cruelty at the hands of lactation educators, but it’s not. Journalist Emily Wax-Thibodeaux, also a breast cancer survivor post bilateral mastectomy, wrote in the Washington Post about her experience of feeding her newborn:

“Just try,” they advised. “Let’s hope you get some milk.”

“It may come out anyway, or through your armpits,” another advised later …

Such extraordinary ignorance and clueless cruelty has its origin in the mindless glorification of breastfeeding promoted by the lactation industry. The benefits of breastfeeding to term babies in first world countries are trivial, a few less colds and episodes of diarrhea across an entire population. The benefits of breastfeeding to lactation consultants are enormous. It represents literally 100% of their income. Unwittingly, they have become just like the formula manufacturers they vilify. Companies like Nestle promoted formula to women who didn’t have access to clean water with which to prepare it, simply to increase market share. Lactation consultants and the breastfeeding lobby promote breastmilk to women who don’t have access to BREASTS, simply to increase market share. It’s not coincidental that the “solution” to every infant feeding question is hiring a lactation consultant.

Just as ironic as their imitation of everything they hate about the formula industry is their imitation of the worst of patriarchal medical practice: stripping women of their humanity by reducing them to their organ systems. When I was in training I became inured to referring to people as “the gallbladder in 505” or “the hysterectomy in 767.” That was wrong. And it’s just as wrong when lactation consultants treat every woman as a walking pair of breasts who must be browbeaten into breastfeeding.

When no breasts is no longer an excuse not to breastfeed, the lactivist lobby has become everything it claimed to despise. The recommendation to breastfeed in the absence of breasts is ignorant; it’s unspeakably cruel; and it’s got to stop.

There’s a vile sanctimommy screed currently making the rounds. If You Don’t Breastfeed, I’m Judging the Hell Out of You by Alex Alexander is a perfect example of hatefulness masquerading as concern for babies.

But if you never even tried — if your baby’s mouth never met nipple, for reasons of personal choice that have nothing to do with health — I’m judging you. That’s right. You should’ve at least given breastfeeding a chance. And if you didn’t, you made a big parenting mistake and we all have the right to judge you for it.

There’s a dark part of the human psyche that glories in social sanctioned bullying. It’s ugly when religious fundamentalists do it; it’s ugly when sexual prudes do it; and it’s equally ugly when Sanctimommies do it.

Of course, the bullies have self-justification at the ready.

You’re a mammal. You’re built to lactate. When it fails, that’s sad. When it’s ignored, that’s a travesty defying nature and human biology. Why do you think your breasts became engorged? It wasn’t for kicks. Your doctor had to drug you to dry you up. That’s because you should be nursing your newborn.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Ms. Alexander, I’m judging YOU. For your monstrous ego, for your ugly sanctimony, and for your vicious sexism.[/pullquote]

That’s the battle cry of biological essentialists everywhere.

What are biological essentialists? They are people who believe that women should be defined by and restricted to their biological functions.

They hate and fear powerful women and say things like:

You’re a woman. You’re built to have babies. When you fail to do so, that’s sad. When you ignore your biological destiny to get an education, demand economic rights or political equality, that’s a travesty denying nature and human biology. Why do you think you menstruate? It isn’t for kicks. It’s because you are supposed to be pregnant, nursing or nurturing children.

Or:

You’re a woman. You’re built to get pregnant. When you fail to do so, that’s sad. When you circumvent your biological destiny by using birth control or terminating a pregnancy, that’s a travesty denying nature and human biology. Why do you think you have ovaries? It isn’t for kicks. It’s because you are supposed to get pregnant each and every month you have sex.

Homophobes are also biological essentialists. They hate lesbians and they say things like:

You’re a woman. You’re built to have penetrative intercourse with a man. When you have sex with another woman instead, that’s sad. When it’s ignored, that’s a travesty defying nature and human biology. Why do you think you have a vagina? It isn’t for kicks. It’s supposed to be for male sexual pleasure.

Ms. Alexander, you judge women who don’t breastfeed; you are a biological essentialist and therefore, I’m judging the hell out of YOU.

Who are you to declare that biology is destiny? Do you use birth control? If so, you’re a hypocrite.

According to Alexander:

You made a choice to carry a baby for nine months. You made a choice to birth a human infant. With choice come responsibility. Your responsibilities don’t end when you squirt out that watermelon-sized, wailing baby. You have an obligation to provide that baby with at least some breast milk.

An obligation? Why? It can’t be because breastfeeding provides extraordinary benefits. In countries with clean water supplies, like the US, the benefits of breastfeeding for term babies are trivial, a few less colds and episodes of diarrhea each year for the entire population of babies under 1 year of age.

Nursing involves more than just milk; it’s also about bonding and skin-to-skin contact and all those lovely hormones you release. You and your baby deserve those things.

Bullshit. There is no scientific evidence of any kind that breastfeeding or skin to skin contact is required for mother infant bonding.

When mom is exposed to a germ, she starts making antibodies against it. There’s evidence that a mother’s immunities to, for example, the flu, protect her baby for a certain amount of time.

Bullshit. Most antibodies are Immunoglobin G antibodies (IgG); they pass through the placenta, but DON’T pass through breastmilk. Only IgA passes through breastmilk; that’s what’s responsible for the fewer colds and episodes of diarrhea. It doesn’t protect against other illnesses.

Ms. Alexander, your “philosophy” is vile and the way you express it is repugnant:

But maybe you just think breastfeeding is icky. Maybe you don’t want a baby touching what you think is just for your partner. Maybe you think it’s primitive and disgusting.

In that case, you need to check your body image. Women’s breasts were made not as fun bags, but as baby-feeders. If you think breastfeeding is nasty, you’re denigrating an important function of your own body and turning your misaligned sense of female sexuality onto your own body. You need therapy, not baby formula.

No, Ms. Alexander. You need to check your self-righteousness. Women’s bodies were not made for others to control them. Women’s right to bodily autonomy does not get expelled with the placenta. If you think you have the right to impose your values on other women YOU are the one who needs help and education.

So yes, mom who never put her baby to her breast, I’m judging you. Sent your baby to the nursery instead of nursing? You made a poor parenting choice…

So, yes, Ms. Alexander, I’m judging YOU. For your monstrous ego, for your ugly sanctimony, and for your vicious sexism. You are no different from misogynists, religious extremists and homophobes who believe they have a right to control women’s bodies.

You’re just another judgmental, self-satisfied prig glorying in hatred of anyone who does live her life mirroring your own choices back to you.

You should be ashamed … but you appear to lack the insight to understand that in your desperation to glorify yourself you are trampling on other women and their rights.

Oh, the irony!

Yesterday I wrote about the fact that the Childbirth Connection is angered that estimated fetal weights are … gasp! … merely estimates. I cited a recent piece in the NYTimes, When a Big Baby Isn’t So Big. In the comment section, multiple people bewail the loss of trust in obstetricians, apparently without recognizing that it is articles such as the one they are commenting upon that are directly responsible for that loss of trust.

[pullquote align=”right” cite=”” link=”” color=”#540002″ class=”” size=””]Childbirth lobbying organizations like the Childbirth Connection are front and center in the effort to destroy trust between women and obstetricians.[/pullquote]

They fail to see that the premier marketing strategy of the natural childbirth industry (encompassing midwives, doulas, and lobbying organizations like the Childbirth Connection) is the tireless effort to undermine trust in obstetricians. Why? Because the natural childbirth industry is desperate to increase their market share and touting the “experience” of birth only gets them so far. The primary “product” of obstetricians is birth safety and most women want that more than anything else. It is absolutely essential to the natural childbirth industry to inculcate fear and distrust of obstetricians, especially around the issue of safety.

Craig Thompson, professor of marketing at University of Wisconsin wrote about this tactic in Consumer Risk Perceptions in a Community of Reflexive Doubt in the September 2005 Journal of Consumer Research. Thompson marveled at the ability of homebirth advocates to market a “product” by directly defying common sense:

Advocates of natural childbirth seek to inculcate reflexive doubt by countering two commonsense objections to their unorthodox construction of risk: (1) medicalized births would have never gained a cultural foothold if they were so risk laden and (2) the medical profession would not support obstetric practices that place laboring women at risk.

In other words, it is absolutely critical to the natural childbirth industry to convince women that doctors don’t know what they are doing, and willfully and cheerfully risk the lives of women and babies to promote a secret agenda.

It’s difficult to think of a single prominent natural childbirth advocate or organization that does not work assiduously to undermine trust in obstetricians.

Individual tactics may differ of course:

Ina May Gaskin resorts to new-agey nonsense, and animal birth, which she believes, in her absolute cluelessness, to be perfect. Whereas Henci Goer favors cherry picking data, selective interpretation of scientific papers and pandering to privileged Western, white women’s desire to see themselves as “educated.”

Feminist anti-rationalists like Robbie Davis-Floyd deride rationality and insist that women have “other ways of knowing.” Clowns like Jennifer Margulis point to diseases they don’t understand and pretend they are caused by “technology.”

Every homebirth and NCB book, blog and website is predicated on the belief that obstetricians are “surgeons” “untrained in normal birth” who make millions performing unnecessary C-sections in the few moments they have each day between endless rounds of golf. The tremendous successes of modern obstetrics and the fact that nearly 99% of women give birth in hospitals is dismissed as the result of an economic war perpetrated by obstetricians on midwives.

Childbirth lobbying organizations like the Childbirth Connection are front and center in the effort to destroy trust between women and obstetricians. How else to explain the endless iterations of the “Listening to Mothers Survey,” a giant push polling project that desperately seeks evidence that obstetricians are not “listening to mothers” and repeatedly finds that the vast majority of American mothers are very pleased with obstetric care?

The natural childbirth industry eagerly grabs on to new methods for demonizing obstetric care, such as the unproven claims that modern obstetrics causes “traumatic birth,” and the hope that C-section cause long term health problems which have heretofore escaped detection despite the fact that there are tens of millions of adults walking around who were born by C-section and appear no different than those born by vaginal delivery.

NCB and homebirth bloggers pile on with inane accusations like “every day 12 babies are given to the wrong mother.” That makes it sound like there’s an epidemic of women leaving the hospital with the wrong baby, when what it really means (if it is true at all), is that an attendant (and that includes midwives) may bring a baby into the room of the wrong mother and discover her mistake when she checks the ID tags on mother and baby.

What about the spectacular advances in modern obstetrics, dropping the neonatal mortality rate by 90% and the maternal mortality rate by nearly 99% in just 100 years?

That is simply dismissed out of hand, with claims that hospitals actually kill babies, or deliberately cause the medical disasters from which obstetricians thereby appear to rescue babies.

The natural childbirth industry has an “answer” for just about every objection you can name and those “answers” often involve misinformation, and always involve undermining women’s trust in obstetricians.

Of course, the irony of the natural childbirth industry bewailing the very loss of trust between women and obstetricians that they themselves promoted is exceeded by another irony. That irony is the reflexive and unstated reliance of the natural childbirth industry on obstetricians to save the lives of babies and mothers after they’ve taken the advice of the natural childbirth industry and made dangerous decisions.

The backup plan always involves the hospital with the expectation of immediate access to the care of …. you guessed it … obstetricians. Apparently those evil doctors, who should never be trusted, can always be trusted in an emergency.

The next time you read an article based on a press release from the natural childbirth industry, treat it with the same wariness that you would treat an article about solar power based on a press release from Big Oil. Just like it’s always possible that Big Oil is accurately relating derogatory claims about solar power because of a deep and abiding commitment to scientific accuracy, it’s always possible that the natural childbirth industry is accurately relating derogatory claims about obstetricians because of a similar commitment to scientific accuracy.

On the other hand, it could simply be a brazen effort to blacken the reputation of the competition in order to increase market share.

Adapted from a piece that first appeared in June 2013.

The Childbirth Connection is the leading lobbying organization for the natural childbirth industry. Their apparent goal is greater employment for the women they represent: midwives, doulas and childbirth educators. The heart of their marketing strategy is to promote distrust of modern obstetrics and obstetricians. As I noted almost exactly one year ago today, getting your information on birth from the Childbirth Connection is like getting your information on solar power from Big Oil. The conflict of interest is gargantuan.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Better maimed than Cesarean shamed.[/pullquote]

Their latest effort to promote distrust of obstetricians is embodied in two recent articles, When a Big Baby Isn’t So Big in the NYTimes, and, Are Women Being Tricked Into Having C-sections? by Beth Greenfield, who often serves as a conduit for the natural childbirth industry, in Yahoo Parenting.

From the Yahoo piece:

[R]esearchers … found that a significant number of women are being erroneously told that they would be having big babies. And the study, published in Maternal and Child Health Journal in December and based on the data of 1,900 women surveyed by Childbirth Connection, further showed that mothers who believed they were having big babies were nearly five times more likely schedule a C-section — even though the large majority of their babies wound up weighing less than 8 pounds 13 ounces …

“Estimating weight is still an imprecise science. But the study is really more about communication than anything else,” one of the researchers, Eugene R. Declercq, a professor at Boston University School of Public Health, tells Yahoo Parenting. Figuring that a baby will be big, rather than too small (and then at greater risk of problems), he notes, “should be conveyed as good news, with no question about it being able to be delivered vaginally.” But based on the study’s findings, that’s not what’s happening, as a doctor telling a mom-to-be that her baby will be big “has a profound effect, and contributes to undermining women’s confidence they can deliver the baby,” Declercq told the New York Times.”

See! See! It shows you that obstetricians don’t know what they are talking about. It shows you that they just want to trick women into C-sections. How dare obstetricians fail to inform the public that an estimated fetal weight is merely an estimate? How was anyone to know?

The articles make it sound like this is some sort of shocking discovery, but obstetricians are well aware of the fact that estimate fetal weights are … gasp … estimates. Moreover, we are also aware the the accuracy of estimated fetal weights declines as the baby gets bigger. In the third trimester, EFW is accurate only to within +/- 2 pounds. A baby with an EFW of 9 pounds may weigh as little as 7 pounds, but it is EQUALLY likely that it weighs as much as 11 pounds.

There’s a simple reason why EFW is an estimate. It’s the equivalent of weighing a child with a tape measure. If you were told a child’s age, height, head size and abdominal circumference, you could probably come up with a pretty good estimate of its weight. That’s essentially the same information that ultrasonographers use to calculate the EFW.

Why does fetal weight matter anyway?

Here’s why: the baby’s very life may depend on it.

In another recent study that examined the relationship between increasing birth weight and perinatal mortality among 5,049,104 liveborns in the United States between 1995-2000, a nadir was observed at approximately 3,900 g and a sharp rise occurred for newborns with higher weights (see the image below). Thus, depending on many factors, the optimal birth-weight range to minimize the risk of fetal and maternal morbidity and mortality is between 3000-4000 g.

We know that very large babies have a much greater risk of paralyzed arms (Erb’s palsy), brain damage and death. We know that our best methods of estimating fetal weight can be off by two pounds in EITHER direction. What’s the solution?

The obvious solution is to develop more accurate ways of estimating fetal weight. In the meantime, we have to make do with what we have in attempting to prevent injury and death.

But that’s not how the folks at the Childbirth Connection see it. What are they doing to develop new, more accurate methods of measure fetal weight? Absolutely nothing. They don’t want to improve existing technology because … never forget this … their goal is NOT to make childbirth safer; their goal is to make vaginal birth more common, and their go-to tactic is to demonize obstetrics and obstetricians.

Listening to the Childbirth Connection declaim on the risks of technology is like listening to Big Oil declaim on the risks of solar power. There is a massive conflict of interest. But in the case of the Childbirth Connection and obstetricians, there is also an extraordinary conflict of VALUES: the Childbirth Connection values process whereas obstetricians have a laser-like focus on outcome.

That’s why obstetricians are constantly working to improve the accuracy of their technology while the natural childbirth industry, represented by the Childbirth Connection, resorts to demonizing it. The Childbirth Connection want you to hire a midwife and a doula to preside over your unmedicated vaginal birth. If that means taking a chance that your baby will end up injured, brain damaged, or dead, so be it.

As far as the Childbirth Connection is concerned, better maimed than Cesarean shamed.

Ever notice how quacktivists often suffer from grandiosity?

According to Wikipedia:

Grandiosity refers to an unrealistic sense of superiority … as well as to a sense of uniqueness: the belief that few others have anything in common with oneself and that one can only be understood by a few or very special people …

Take Jennifer Margulis, for example.

I’ve written many times about Margulis and her wacky theories. My personal favorite is the stupidest excuse for homebirth deaths ever.

[pullquote align=”right” cite=”” link=”” color=”#fe8d23″ class=”” size=””]Margulis and Brogan come across as pitiable, but they are also dangerous.[/pullquote]

Margulis doesn’t do well with criticism. Her latest book received a scathing review in The New York Times Book Review. She couldn’t do anything about that, but she did try to manipulate the Amazon reviews of the book.

But she’s outdone herself this time. She’s actually written to Linda Birnbaum, the Director of the National Institute of Environmental Health Sciences offering to explain the purported rise in autism.

What are Margulis’ qualifications to opine on this topic?

I’m an award-winning science journalist and book author with an interest in children’s health and autism. I am also a Fulbright grantee — I lived and worked in Niger, West Africa in 2006 – 2007. I was also in Niger in the 1990s, working in part on a child survival campaign. I think it is important to have a global perspective on health.

I have a B.A. from Cornell University, an M.A. from the University of California at Berkeley, and a Ph.D. from Emory.

Her degrees are in English language and literature! As far as I can determine, she has no training in science, medicine or statistics. In her grandiosisty, she thinks she doesn’t need them.

My extensive research has a journalist has led me to suspect that two environmental factors may be directly contributing to the autism epidemic:

1) Over/ill-timed exposure to prenatal ultrasound…

2) The use of Acetaminophen, especially before or after infant vaccination.This may be the smoking gun…

No matter that the theories are incompatible with each other, let alone the fact that there is no proof for either one. Perhaps most pitiful is Margulis’ offer to educated Dr. Birnbaum,  a toxicologist with a PhD in microbiology whose dozens of publications focus on “the pharmacokinetic behavior of environmental chemicals; mechanisms of actions of toxicants, including endocrine disruption; and linking of real-world exposures to health effects.”

I imagine you are already familiar with these issues but I’d be delighted to send you more information or to talk on the phone, if that would be helpful.

While Margulis’ grandiosity is pathetic, that of “holistic psychiatrist” Kelly Brogan is frightening.

Consider her latest piece, ironically titled Sacred Activism: Moving Beyond the Ego, which is a paean to outsized self regard:

I was seemingly born with a fire in my belly and a sharp tongue. My mind stays sharp under pressure – maybe it even gets a touch sharper – and I’m notorious for saying what I mean. Just ask my family. These qualities made me a pretty righteous babe my entire young adulthood. Strong opinions, lots of critical thinking, a heaping portion of skepticism, and belligerent atheism, I took a vow of matrimony to science in my late teens.

But Brogan is just getting started:

I felt an ancient fire kindle inside me that churned and twisted with my own native force. I held my sword aloft. I began writing, speaking, lecturing. I changed my practice. And, of course, I was given the gift of my own health challenge to initiate me into the realm of self-healing and the power of food as information. Now I had proof – my recovery, and then the recovery of dozens of my patients as I began to arm them with what they intuitively knew to be the reason they had been stuck: our systems are making us sick and then profiting off of our ongoing illness.

The monstrous path of the righteousness

I was lionized. But I also felt alone. I felt awash in a sea of thinkers, doctors, and scientists, each with one pet interest they were willing to stick their neck out for. The anti-GMOer who would trust the same corrupt industry with their life if they got a cancer diagnosis. The anti-vaxxer who ate Twinkies for breakfast. The homeschooler having their babies at the hospital, just in case “something went wrong”. The green revolutionary screwing curly Q mercury-laced bulbs into every socket. The anti-fluoride campaigner turning a blind eye to escalating prescription of stimulants to toddlers. And the list went on.

Her thoughts are ugly:

… I would sit at my daughter’s birthday parties disgusted by parents handing out epi-pens and asthma inhalers to their pizza-eating, juice-box guzzling kids. I longed for the Schadenfreud [sic] of a prominent political figure struggling with vaccine injury. Somehow further news of catastrophe at the hands of industry would only validate my beliefs and intuition that everything was wrong.

And downright scary:

There were times the Truth felt so oppressive I wanted to be dead. I wanted not to have brought children into this corrupt, twisted world where everyone is self-sedated and complicit in evils beyond all imaging. Playing sports and watching TV while babies are being experimented on in the name of sound science and the greater good.

I won’t bore you with the rest of her logorrhea. The key point for Brogan is that she, in her monstrous grandiosity, seeks to spread the “Truth.”

I understand now, that I have a choice – a choice to put my energy toward that more beautiful world I do believe in, or to seek to feed my wounds and my ego by dwelling in the misery of how far off the golden brick road we have wandered. Both in my office with patients, in my teaching and writing, and with my daughters, I hope to offer an experience of the Truth. And a glimpse of what we all know is still possible.

Margulis and Brogan come across as pitiable, but they are also dangerous. As quacktivists, their grandiosity leads them to spew deadly health misinformation … and the children of those who believe their nonsense are the ones who pay the price.

Startling finding announced in prestigious journal
by Gull E. Bull

Scientists have made an astonishing discovery about the cause of pregnancy. According to the study, published in the widely read journal JCS (Journal of Crap Science), researchers have discovered a remarkable and powerful association between maternity clothes and pregnancy raising the possibility that maternity clothes cause pregnancy. Lead author Publish R. Parrish explains that this remarkable association was found in a variety of different investigations.

1. Nearly all women wearing maternity clothes are pregnant (correlation coefficient 0.95) indicating a near perfect relationship between maternity clothes and pregnancy.

2. There is a startling association between the number of stores selling maternity clothes and the overall fertility rate (p<0.01).

3. The odds ratio for pregnancy for a woman wearing maternity clothes as opposed to non-maternity clothes, is very high (RR 35.7). For non-pregnant women, the number wearing maternity clothes drops off in a linear fashion from the day after delivery to approximately 6 weeks postpartum.

According to Dr. Parrish:

“The findings in this study are even stronger than the study touting an association between induction and autism. We believe that our study deserves far more attention because the association is much clearer and even more robust.”

Asked if it were possible that the investigators had misinterpreted their findings, confusing the fact that pregnancy causes women to wear maternity clothes and not the other way around, Dr. Parrish acknowledged the need for further research. He admitted that correlation is not causation but pointed out that if the mainstream media could make such a fuss about crap research showing an association between induction and autism, his work should be able to get even more attention.

As Dr. Parrish noted:

“We aren’t really concerned with what is true, but rather what can be published and publicized. The more sensational the results, the better. Why wait to reproduce results when you can submit crap to any journal, get it published and get it publicized in the newspapers? It’s not like anyone is really checking the accuracy of our findings or the plausibility of our conclusions, right?”

Indeed, Dr. Parrish admits that he has no intention of further research in this area. He is eager to move on to his next project: C-sections for macrosomia cause babies to grow larger.

This piece, which previously appeared in August 2013, is satire.

I’ve been engaged in an online discussion with other healthcare providers about the NEJM Oregon study of out of hospital birth and it has crystallized for me something I’ve suspected for a long time:

Homebirth isn’t about women, babies or birth; it’s about midwives.

[pullquote align=”right” cite=”” link=”” color=”#C61210″ class=”” size=””]Homebirth is not popular among women. Most have no interest in anything that raises the perinatal death rate.[/pullquote]

Think about it: Except in the Netherlands, homebirth is (and has been for decades) a fringe practice. Anything that engages 2% of the population or less is almost by definition a fringe practice. So why does it receive so much attention? In part it’s because of the high death rate. The people who care for women and babies have a particular revulsion for preventable infant death and anything more likely to cause it. They pay attention to it because they are trying to prevent those deaths.

But I would argue that the real reason for so much attention is that the entire project is being driven by midwives. The proportion of midwives in the US, the UK, Canada and Australia who favor homebirth exceeds the proportion of women who favor homebirth by an extraordinary margin. Midwives are infatuated with homebirth for a number of reasons:

1. It is the natural end point of their obsession with promoting what they can do and demonizing what they cannot. They’ve gone from favoring the employment of midwives in maternity units, to midwife led units and birth centers. Homebirth is the logical next step, freeing them from any scrutiny by other health professionals.

2. It reflects the intellectually and moral bankrupt philosophy that the “best” birth is NOT the safest birth, but the birth with the least interventions.

3. It ensures that women cannot get effective pain relief.

4. It is a midwife full-employment plan. In contrast to a hospital based unit where one midwife can care for multiple women at a time, homebirth (in many countries) requires two midwives to care for one woman.

The truth is that homebirth is not popular and will never be popular among pregnant women. Most women have no interest in anything that raises the risk of perinatal death. Homebirth is deeply unpopular among obstetricians; most of us abhor anything that increases the risk of perinatal death. Homebirth is anathema among neonatologists for the same reason.

The provider discussion about homebirth crystallized that point. Among the participants, there was only one obstetrician on the record as favoring homebirth (though, to my knowledge, he doesn’t provide coverage for homebirth). There is not a single neonatologist who favors homebirth. Homebirth is relentlessly promoted by the midwives in the group. Sure, they dress it up with the usual nonsense that maternity care is in crisis, that we need to look at why women choose homebirth in the first place, etc.

But maternity care is not in crisis: neonatal mortality has never been lower. Women who in the past could not get pregnant, women who did not survive their serious medical illnesses to get pregnant or did not survive pregnancy are now having healthy babies. To the extent that there is a crisis it is reflected in maternal mortality and too LITTLE technology; some women with serious medical complications don’t have easy access to the technology that could save their lives.

The cries of “crisis” come from those who think that failure to privilege unmedicated vaginal birth is the crisis.

The pressure to support homebirth is not being driven by women. It is being driven by midwives and the rest of the natural childbirth industry (doulas, childbirth educators, natural childbirth lobbying organizations).Homebirth represents 100% of the income of American homebirth midwives, and it represents professional autonomy and a lack of professional scrutiny for others. The question we ought to be asking is not why some women choose homebirth; it’s why midwives promote homebirth as safe when it manifestly increases the risk of death.

The NEJM paper indicates the risk of homebirth death is underestimated, that at least in the US (and possibly in other countries as well), homebirth leads to preventable perinatal deaths. Yes, some women will choose it anyway despite the increased risk of death, but then some women will refuse to vaccinate. We don’t spend our time trying to make refusing vaccination safe; we educate our patients on the deadly consequences of their choice; that’s what we should do here, too.

Homebirth isn’t about women or babies or birth; it’s about midwives … and women contemplating homebirth need to understand both the risks of homebirth and the self-serving motivations of those who promote it.

I wouldn’t have believed it if I hadn’t read it with my own eyes.

Past and recent abuse is associated with early cessation of breast feeding: results from a large prospective cohort in Norway was recently published in BMJ Open. The authors made an important observation:

Nearly all women initiated breast feeding, but 12.1% ceased any breast feeding before 4 months and 38.9% ceased full breast feeding before 4 months, but continued partial breast feeding. Overall, 19% of the women reported any adult abuse and 18% reported any child abuse. The highest risk of any breast feeding cessation before 4 months was seen in women exposed to three types of adult abuse (emotional, sexual or physical), with adjusted OR being 1.47 (95% CI 1.23 to 1.76) compared with no abuse. Recent abuse and exposure from known perpetrator resulted in nearly 40% and 30% increased risk, respectively. The OR of any breast feeding cessation for women exposed to any child abuse was 1.41 (95% CI 1.32 to 1.50) compared with no abuse in childhood.

Cessation of breastfeeding appears to be associated with emotional, sexual or physical abuse of the mother.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women should NOT be treated as merely breastmilk dispensers.[/pullquote]

I don’t know how domestic abuse is handled in Norway, but here in the US, I was trained to looked for and ask about domestic abuse and if I suspected it, to offer comprehensive services to aid women in stopping, leaving and prosecuting the abuse. That approach reflects the belief that every woman deserves to live free of violence and abuse.

Astoundingly, that’s NOT what the authors recommend.

They understand what they observed:

The main finding in our study was that exposure to past and recent abuse was strongly associated with early cessation of any breast feeding. The strongest effect was seen for women exposed to three types of abuse (sexual, physical and emotional), with nearly 50% increased adjusted ORs of any breastfeeding cessation before 4 months compared to the non-exposed women. Recent abuse and exposure from known perpetrator resulted in nearly 40% and 30% increased risk of any breastfeeding cessation before 4 months, respectively. Women who reported a history of child abuse were more likely to stop breast feeding before 4 months than women who had not experienced child abuse…

But their utterly inappropriate conclusion is chilling in its disregard for women’s well being. The authors appear to view women like dairy cows, as sources of milk, but not as individuals worthy of physical and psychological support:

… Given the convincing evidence of the beneficial effects of breast feeding both for the mother and the infant, it is crucial to promote high breastfeeding rates. Mothers with a history of past or recent abuse comprise a key group to target for extra support and breastfeeding assistance.

Actually, the authors treat women worse than cows. If farmers found that their animals produced less milk when abused, they would move with alacrity to stop the abuse.

The idea that women who stop breastfeeding because of emotional, sexual or physical abuse should be treated with breastfeeding support is unspeakably ugly. The benefits of breastfeeding for term infants in Norway is trivial, perhaps a few less infants colds and episodes of diarrhea. The harms to women from emotional, sexual or physical abuse are monstrous. The authors’ conclusion that it is more important to support abused women to breastfeed longer rather than to support them in ending the abuse is both profoundly misogynistic and utterly grotesque.

It is an indication of just how far lactivists have strayed from human decency in promoting breastfeeding. Women are not cows. Their primary value to their children is NOT as milk dispensers. Their primary value to society is NOT as milk dispensers. They should not be treated worse than cows.

When women stop breastfeeding because of emotional, sexual or physical abuse, it is the ABUSE that should be targeted, NOT the breastfeeding!

I’m very cynical when it comes to the lactivism industry, but even I would have thought that lactivists would not need to be told that a woman’s right to live unabused is more important than a baby’s need for breastmilk. I was wrong. If anything, lactivism is even uglier than I had thought.

Many women are confused about the safety of homebirth. On the one hand, homebirth midwives insist that it is as safe (or safer!) that hospital birth. On the other hand, obstetricians insist that it increases the risk of perinatal death; that’s why most refuse to attend them.

The situation is further complicated by dueling scientific studies. The last few weeks alone have seen the release of a Canadian study that showed that homebirth did not increase the risk of infant death and an American study that showed that it did increase the risk of death,  with an increase that dwarfs death rates from SIDS or auto accidents.

There is no doubt in my mind that further research is going to corroborate the fact that homebirth in the US, particularly homebirth with a non-nurse midwife (CPM, LM), is deadly. The real difference between deaths in the hospital and deaths at homebirth with CPMs is probably in the range of 1000%!

But you don’t have to take my word for whether or not homebirth is safe; I could be wrong. You will know that homebirth is safe when this happens:

You’ll know homebirth is safe when neonatologists recommend it.

Neonatologists are doctors who care for critically ill newborns. They have no personal stake in the home vs. hospital debate. If anything, they are more likely to profit from homebirth, which leads to transfers of critically ill newborns whose problems could have been prevented by lower intensity care in the hospital.

Yet, to my knowledge, with rare exceptions, neonatologists recommend AGAINST homebirth. Babies are their only patients and babies’ wellbeing their overriding interest.  And they believe that homebirth puts babies at risk and leads to the deaths of babies who did not have to die.

Mothers are free to opt for homebirth regardless of the risk to their newborns. They may judge that avoiding the risk of a C-section or other interventions is more important than avoiding the smaller risk of perinatal death. But that doesn’t mean they’re choosing homebirth because it is safe. Until neonatologists recommend homebirth as safe for babies, you can be sure that it isn’t.

What if I told you that in an effort to promote weight loss a hospital refuses to provide food to obese patients? If they want to eat, they’ll have to purchase and bring their own.

Disgusting, right?

What if I told you that in an effort to promote contraceptive use a hospital refuses to provide sterile instruments for women desiring termination? If they want to have an abortion, they’ll have to purchase and bring their own.

[pullquote align=”right” cite=”” link=”” color=”#d32b2b” class=”” size=””]Lactimidation is both self-serving and unethical.[/pullquote]

An unconscionable violation of women’s autonomy, right?

Fortunately, those things haven’t happened.

But how about if I tell you than in an effort to promote breastfeeding the Countess of Chester Hospital in the UK refuses to provide formula to new mothers? If they want to feed their babies formula, they’ll have to purchase and bring their own.

It’s true!

The local newspaper report, Countess of Chester Hospital maternity shake-up means new mums will have to provide own formula milk explains:

Staff on the Countess maternity ward are advising expectant mums planning to bottle-feed their babies to include a pack of their own formula feed in their hospital bag, in keeping with other regional maternity units such as Liverpool Women’s Hospital.

Up until now the Countess has always provided ready-made bottles of the mother’s choice of formula, but this latest move is part of a drive to ‘encourage and support’ mums to breastfeed their babies…

Julie Fogarty, head of midwifery services at the Countess, said: “New parents either opt to breast feed or plan ahead and already bring formula feeds with them when coming into hospital.

It’s disgusting; it’s a violation of women’s autonomy; and it’s a prime example of “lactimidation,” the ongoing lactivist campaign to intimidate women into breastfeeding. It operates on the same principle as heckling outside abortion clinics. It’s meant to “encourage” women to breastfeed (or continue unwanted pregnancies) by shaming and browbeating them into making the choice that the intimidators approve.

Lactimidation is the latest battlefront in the lactivist campaign to oversell the benefits of breastfeeding. The truth is that in first world countries like the UK or the US, the benefits of breastfeeding for term infants are trivial, 8% less colds and 8% fewer episodes of diarrhea each year across a country’s entire population of infants. The other benefits claimed are based on research that is weak, conflicting and riddled with confounders.

But one thing is 100% certain, breastfeeding is a business, complete with salaries, products, marketing campaigns and lobbying groups. And the breastfeeding business is doing its damnedest to make sure it captures 100% of the potential market for its goods and services.

Moreover, it’s hardly a coincidence that the breastfeeding industry is dominated by Western, white women, well off women and that those most likely to choose formula feeding are women of color, young women, and poor women, those who have been traditionally underserved and discriminated against. The free formula in hospitals, which would be a trivial expense for most lactivists, represents a substantial expense for these women. That’s the point! It is so much easier to lactimidate poor women of color, and so much more satisfying to punish them for not emulating their “betters.”

Lactimidation is a central tenet of “baby friendly” initiatives to promote breastfeeding among new mothers. As a matter of principle, these initiatives seek to make accessing formula within hospitals as burdensome as possible. Whether that means locking up formula, subjecting women to lectures exaggerating the “benefits” of breastfeeding, banning formula gift bags, or making women buy and bring their own, lactivists intimidate women to enforce conformity with THEIR values about how women should use their own breasts.

Oh, but they’re doing it for the children! NOT!

As the article about the Countess of Chester hospital notes:

But staff strongly emphasise that they will not allow anyone to go without nutritional support and advice for their baby while under their care…

So the hospital is going to stock just as much formula as it ever did. The nurses are simply going to lactimidate women into not requesting it or shame them when they request it anyway.

That is both self-serving and unethical.

The Countess of Chester hospital may be leading the way with its new policy, but it is hardly alone in its efforts to lactimidate women into using their bodies in the lactivst approved way. So called “Baby Friendly” Hospitals in the US have made lactimidation a cornerstone of their policies in order to shame women into breastfeeding whether it is the right choice for them, the right choice for their babies, or even (in the case of women who don’t produce enough breastmilk) when it is an unsafe choice.

Lactimidation is an abomination and it MUST stop.

How can we put an end to lactimidation within hospitals? Suzie Barston, the Fearless Formula Feeder, is assembling lists of hospitals that do and don’t encourage lactimidation so women can make informed choices.

Ultimately, though, women will have to fight back against lactimidation by sharing their stories and exposing the unconscionable pressure applied to new mothers and the harmful results of starving, dehydrated babies, and shame and guilt wracked new mothers.

We need to name these policies for what they are: naked, ugly attempts to intimidate women into breastfeeding.

I’d be grateful to anyone who wishes to share their story with others. Just tag it with #lactimidation on Facebook or Twitter and we will be able to find it when we search.