Which came first, the homebirth or the narcissism?

 

[pullquote align=”right” color=”#E4A4B2″]Still in amazement that this lovely bonnie girl came out of my vagina! [/pullquote]

My HBAC this morning was at 42+1 and my little girl’s placenta was giant and healthy, zero calcifications or signs of age.

 

Too bad her baby was giant, but NOT healthy.

 

 

Please keep my little daughter … in your thoughts and prayers. Two hours after an amazing homebirth this morning @42+1, my very bonnie 9.8 lb little girl suddenly developed breasthing problems and MW had to call an ambulance and we raced to the city hospital. She’s being well looked after in NICU (and looking like the most enormous baby surrounded by tiny prems), but we still don’t know what’s causing her very laboured breathing 🙁

 

 

She’s doing OK, looks like she got fluid (may have been from her overly vigorous but slightly uncoordinated first breastfeed) on her lungs or possibly and infection. Just cuddled her and rocked her to sleep, and expressed her some colostrum…

Still in amazement that this lovely bonnie girl came out of my vagina! And I didn’t need stitches! It all worked so perfectly.

 

On what planet is a birth that ends with the baby in the NICU struggling to breathe and possibly suffering from pneumonia perfect?

Oh, right, on Planet Narcissist where the mother’s experience is more important than whether the baby can draw breath.

How perfect would the birth have been if the mother ended up in the ICU struggling to breathe? I’m going to go out on a limb and suggest that the mother would not have found it so perfect at all, despite marvelling about the fact that a baby transited her vagina. But what’s a little trouble getting oxygen to your brain when it merely happens to the baby? No need to feel bad about that; she was just a prop in her mother’s festival of narcissism known as high risk homebirth.

The homebirth went perfectly … for the mother, and apparently that’s the only thing that matters.

I have written before that birth plans are worse than useless and a new study lends credence to that view.

Birth plans engender hostility from the staff, are usually filled with outdated and irrelevant preferences, and create unrealistic expectations among expectant mothers. But the worst thing about birth plans is they don’t work. They don’t accomplish their purported purpose, make no difference in birth outcomes, and, ironically, predispose women to be less happy with the birth than women who didn’t have birth plans.

[pullquote align=”right” color=”#603b35″]The key to a safe, satisfying birth is to ditch the birth plan.[/pullquote]

For example, in Is the Childbirth Experience Improved by a Birth Plan?, Lundgren et al. were surprised to find:

… A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women’s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect.

The new study is Birth Experience Satisfaction Among Birth Plan Mothers. It was a prospective controlled trial comparing women with and without birth plans.

Three hundred two women met criteria -145 had a birth plan and 109 birth plans were collected. We established 23 common requests. The most common requests were: no intravenous medications (82%), exclusive breastfeeding (74%), and no epidural (73%). The requests most fulfilled were avoidance of episiotomy (100%), erythromycin (82%), and rupture of membranes (79%)… A greater number of requests correlated with meeting expectations less (P=.04) and feeling less in control (P=.04). Having a higher percentage of requests met correlated with having expectations met more (P=.03) and feeling more in control (P=.03).

The greater the number of requests by the mother, the greater the chance that she had a negative birth experience. In other words, it isn’t birth trauma that causes bad birth experiences, it is Birthzillas.

Who’s Birthzilla?

As I’ve written before:

We’ve all heard about bridezillas, the women who are so obsessed with having the perfect wedding that they become tyrants toward everyone else. There’s an argument to be made that many homebirth and natural childbirth advocates are “birthzillas” who justify their hypersensitivity, obsessive need for control, and rudeness to everyone else with the all purpose excuse “It’s my special day.”

Consider:

Obsessive need for control – It’s difficult to imagine anything more obsessive than birth plans. Birth plans, in addition to being useless for their stated purpose of improving the birth, are attempts to plan the unplannable. You might as well have a “weather plan” for the day of birth for all the good it’s going to do you. Birth plans, like obsessive wedding plans, have the added drawback of irritating everyone around you. The need to ruminate on every aspect of the day, and share those ruminations with everyone else is boring at best and narcissistic at worst.

Hyersensitivity – Homebirth and natural childbirth advocates spend a lot of time being angry. The birth is not going according to plan. The hospital staff are not taking their desires as seriously as they take them. The hospital staff are not behaving as instructed. Everything is a slight. Offered an epidural? Have a fit. Labor support not exactly as desired? Accuse the nurses of evil intentions. Baby needs something different than the pre-approved birth plan? Who does that baby think he is? After all, birth is not about the baby. It’s all about, exclusively concerned with, revolving only around Birthzilla.

Outsize feelings of disappointment – Birthzillas are psychologically very fragile and make no apologies for their fragility. Baby needs resuscitation before being placed skin to skin with Birthzilla? The birth is ruined. C-section needed to deliver a healthy baby? That no longer qualifies as a birth at all!

Birthzillas have an outsize view of their own importance, a hypersensitivity to slights, a feeling of being persecuted when the birth does not go as planned, and an imperiousness and insensitivity to others who work with or for them.

Instead of integrating the inevitable disappointments associated with a birth, they get psychologically “stuck.” They experience their disappointments as narcissistic injuries and respond with rage and accusations of persecution. They have no time for and no interest in the feelings of others, and feel entitled to use other people for their own ends.

The ultimate irony is that the behavior of birthzillas often fails to produce the perfect birth. Because of their psychological neediness and fragility, they are unable to appreciate that every change in plan is not the “fault” of someone, unable to accept that unwillingness of providers to follow commands is not a sign of persecution and, worst of all, unable to enjoy what they have.

The key to a safe, satisfying birth is to ditch the birth plan and concentrate on the baby, not the creation of the perfect experience.

In a tremendous victory for the mother and babies of Oregon, and a tremendous repudiation of homebirth midwives, Oregon has dramatically tightened the requirements for coverage of homebirth.

In many ways, homebirth midwives led by Melissa Cheyney, brought this on themselves. Their utter contempt for safety requirements of any kind led to their marginalization. Four years ago they were dragging their feet on even obtaining consent for homebirth, now it has been entirely removed from their hands.

Here is the document that sets out the new coverage regulations Health Evidence Review Commission (HERC) Coverage Guidance: Planned Out-of-Hospital Birth.

[pullquote align=”right” color=”#bfad74″]Oregon Medicaid won’t pay for homebirth of breech, twins, VBAC, prolonged rupture of membranes and other conditions that homebirth midwives pretend are “variations of normal.”[/pullquote]

It is a 100 page review that carefully documents the conclusion that homebirth is only appropriate in a restricted set of circumstances.

As a result, Oregon Medicaid will no longer pay for homebirth in the case of breech, twins, VBAC, prolonged rupture of membranes and a whole host of other conditions that homebirth midwives chose to pretend were “variations of normal.”

Why won’t Oregon Medicaid pay for homebirth in those circumstances? Because they dramatically increase the risk of perinatal death. Judith Rooks CNM MPH analyzed the 2012 Oregon homebirth statistics  and found that the death rate at planned homebirth with a licensed homebirth midwife was 800% higher than comparable risk hospital birth. Moreover, 6 of the 8 deaths in the homebirth group occurred in women that did not meet the criteria for low risk.

What is especially interesting about the HERC document is that it details an extensive review of the literature … a real review, not the cherry picking of papers and misrepresentation of findings that characterize homebirth advocates’ review of the literature.

The authors also call into question the validity of assessing homebirth safety in the US by citing studies from other countries. The note the differences in midwifery training:

The Netherlands

“The midwifery training is a four year fulltime direct entry education, which eventually leads to a Bachelor’s degree. The total study load is 240 ECTS and equals nearly 6,800 hours of education. Altogether, there are two years of theory, one year of primary care internships, and one year of secondary and tertiary care internships. The internships are spread equally over these four years… They have had an extensive assessment, which selects the best candidates. Around
three times more candidates apply for the course than places are available.”

Canada

British Columbia
“All current CMBC approved programs are Canadian four year direct‐entry education programs leading
to a university degree, or bridging programs leading to equivalency.”

Ontario
“1. The applicant must have at least one of the following:
A baccalaureate degree in health sciences (midwifery) from a university in Ontario.

2. The applicant must:
Have current clinical experience consisting of active practice for at least two years out of the
four years immediately before the date of the application, and
Have attended at least 60 births, of which at least:

• 40 were attended as primary midwife
• 30 were attended as part of the care provided to a woman in accordance with the
  principles of continuity of care
• 10 were attended in hospital, of which at least five were attended as primary midwife,
  and
• 10 were attended in a residence or remote clinic or remote birth centre, of which at
  least five were attended as primary midwife

3. The applicant must have successfully completed the qualifying examination that was set or approved
by the Registration Committee at the time the applicant took the examination.”

As compared to:

North American Registry of Midwives [CPM certification]

There are multiple routes to certification by the NARM, but in general they include a written test, a skills
assessment test, and the following experience requirements:

• Phase 1: Births as an Observer
  Ten births in any setting, in any capacity
• Phase 2: Clinicals as Assistant under Supervision
  Twenty births, 25 prenatal exams, 20 newborn exams, 10 postpartum visits
• Phase 3: Clinicals as Primary under Supervision
  Twenty births, 75 prenatal visits, 20 newborn exams, and 40 postpartum exams

There are other difference as well:

Good outcomes for planned out-of-hospital birth have been demonstrated in several countries. However, these settings have system characteristics that help to maximize safety. Chief among these is a robust system of consultation and referral/transfer that can assure seamless care for the woman and her newborn when transfer is needed. In addition, these systems include thorough education (informed consent) of women and families about the potential need for consultation/referral/transfer and the potential risks associated with having a delay to receipt of emergency obstetric and neonatal care.

Consideration of distance and time from a hospital able to provide emergency obstetric and neonatal services is important in managing intrapartum complications and in providing fully informed consent. Another characteristic is written agreements that cover consultation/referral/transfer and a welldefined and practiced system of transfer. Out-of-hospital birth attendants in these systems are appropriately trained and experienced in the identification and management of obstetric and neonatal emergencies, and are also licensed and certified. These providers should be capable of initiating appropriate newborn resuscitation, and be able to provide standard newborn care in addition to the routine postpartum care of women. Certification requirements for the practice of midwifery can vary significantly between the U.S. and other countries, with U.S. requirements for midwives, other than CNM/CMs, generally being less rigorous with regard to both years of formal education and experience.

These new restrictions are just the first shot across the bow. Even NARM and MANA can see the handwriting on the wall: the CPM certification is going to be phased out. As a result, they have created the Midwifery Bridge Certificate.

NARM is planning for the day when the CPM certification will no longer be enough:

Opposition to the licensure of CPMs has centered on the lack of a requirement for an accredited education. Work among the seven US MERA organizations in 2015 created a joint statement of support for licensure legislation on the condition that it include a requirement for a graduation from a MEAC accredited program or the Midwifery Bridge Certificate.

Both the HERC regulations and the NARM Bridge Certificate represent an extraordinary victory for homebirth safety and a tremendous vindication for those who have been arguing for years that American homebirth midwifery is both substandard and unsafe.

We have been heard!

Why do even sophisticated people fail to recognize that natural childbirth is an industry?

It’s probably because they equate “industry” with large amounts of money. True, individual natural childbirth professionals don’t make a lot of money, but for most, it represents 100% of their income. That’s why they have a tremendous financial incentive to convince you to buy their products and services.

[pullquote align=”right” cite=”” color=””]Midwives fought to wrest control of patients back by deriding what obstetricians offered and offering the exact opposite.[/pullquote]

The advent of modern obstetrics, and the dramatic drop in maternal and perinatal mortality that it brought, set the stage for the development of the natural childbirth industry. This created both a problem and an opportunity for midwives. The problem was that obstetricians could promise safer outcomes.

Midwifery succumbed to the success of obstetricians who were only too happy to supplant midwives. While midwives themselves make much of this economic competition, blaming deliberate action by obstetricians in an attempt to stifle competition, the fact is that women came to prefer hospital birth because of its safety and increased comfort. Previously doctors were called to childbirth in only the most dire circumstances. With the switch to routine hospitalization for birth and the routine presence of obstetricians, and, in particular the easy access to pain relief, midwifery went into decline.

The increased safety of childbirth also created an opportunity for midwives: the chance to emphasize the quality of the birth experience. Modern obstetrics made childbirth seem safe. Since safety was now a given, midwives fought to wrest control of patients back by deriding what obstetricians offered and offering the exact opposite.

• If obstetricians medicalized childbirth to make it safer, then midwives would de-medicalize it to make it more enjoyable, and, for added impact, would declare that childbirth was safe before obstetricians got involved.
• If obstetricians offered screening tests and measures to prevent complications then midwives would insist that “trusting birth” was all that was needed.
• If obstetricians offered pain relief, midwives would proclaim that feeling the pain improved the experience, tested one’s mettle and made childbirth safer.
• If obstetricians whisked babies off to pediatricians to make sure that they were healthy, midwives would claim that skin to skin contact between mother and infant in the first moments after birth was crucial to creating a lifelong bond.
• If obstetricians insisted that modern obstetrics was based on science, midwives would accuse them of ignoring science, and if that didn’t stick, they’d insist that scientific evidence was not the only form of knowledge.
• If obstetricians placed the highest value on a healthy mother and a healthy baby, midwives would place the highest value on a fulfilling birth experience.

In other words, no matter what obstetricians offered, midwives would insist that it was unnecessary, disempowering, harmful and contradicted by the scientific evidence. Midwives would wrest childbirth back from paternalistic doctors and give it to those to whom they believed it rightly belonged  …  the midwives themselves. And the entire project would be promoted as being in the best interests of women and babies.

The natural childbirth industry in general, and midwifery in particular, became unreflective (and completely reflexive) defiance of modern obstetrics.

That’s doesn’t mean that those who promote natural childbirth don’t believe in it. Its advocates believe fiercely in what they promote, and sell — normal birth as the holy grail of childbirth, midwives as the guardians of normal birth and distrust of obstetricians (whom they correctly identify as their chief competition) as the people who medicalized birth … and thereby made it safe.

Who could have seen that coming?

Remember Maura? She’s the woman whose in utero single footling breech daughter “told her” to go to Bali for her homebirth? Despite being counselled by everyone and their midwives that homebirth was not a safe option in her situation, Maura “knew” that it was the right choice. Of course it was the wrong choice and Maura nearly killed her daughter in the attempt. Ultimately she had an emergency C-section and Lila survived.

Cognitive dissonance is hard. That’s what happens when reality does not comport with your most cherished beliefs. You have two choices in that situation: you could change your beliefs or you could changed reality. Maura is currently attempting to change reality in a truly remarkable blog post, 42 Days and 42 Nights: The Joy and Grief of a Cesarean Birth. I urge you to read it in full. Nothing I write could truly capture the pretzel like contortions of logic that allow Maura to conclude that despite being wrong about every single thing she predicted for this birth, she was actually right.

But the internet never forgets even if Maura does.

Back in August, Maura wrote this:

[pullquote align=”right” color=”#67a7f1″]Her in utero single footling breech daughter “told her” to go to Bali for her homebirth.[/pullquote]

… Lila, our divine little one, things have taken a “turn”. As many of you know, we have long planned a water birth at home (actually outside) and we came to Asia to birth her because she literally asked us to. We sold our homes and cars and furniture and embarked on this journey for her sake. Doing so required an impossible amount of trust and openheartedness. Offering her a chance at natural birth at home here in Bali is something we feel incredibly strongly about … Lila, however, has decided she prefers to meditate sitting up, rather than relaxing on her head like most babies. This means she is breech. Now, I am all about having a breech home birth and have no qualms whatsoever about having her come through me butt first. I even created a new dance called the breech booty boogie to celebrate her choice on how she wants to enter the world 🙂

But others did have qualms including the Balinese midwives and doctors; every single one recommended an elective C-section at 38 weeks. No matter. Maura paid for a New Zealand midwife to spend a month in Bali and attend her in labor. Labor didn’t start until 43 weeks.

What happened?

It was just as Maura had envisioned … at first.

We had a beautiful 16 hour long outdoor labor under the palm trees and it was truly an ecstatic journey. Andrew was an epic labor partner! Our journey began at 4 am walking through the rice fields together under Lila’s birth stars and watching the sun rise over the ricefields as the first rushes came on. I labored in a warm pool sprinkled with rose petals under a sacred palm tree and sparkling blue skies and under a thatched roof looking out over the rice fields. I dilated to four centimeters quite quickly and baby was doing awesome throughout our wild day of laboring in the water and sun.

But then:

Sometime late in the day, Lila inserted one of her feet into my pelvis and my dilation reversed back to 1 cm. At that point after her waters had been broken for 18 hours, and she had switched from frank breech to footling breech, our midwife recommended that we go to the hospital for an emergency cesarean…

You might think that Maura would conclude that her vaunted intuition had failed her. You would be wrong. Maura believes her intuition saved Lila’s life:

She was still doing fine when we arrived at the hospital and no one was in a hurry to do anything. They took the monitor off. An hour after we arrived I had a bad feeling and asked the nurses to check her heart rate. It had plummeted! She was in severe distress and no one would have caught it if I had not asked them to check her… As they brought me into the operating room I was really worried that we were going to lose her. And Andrew didn’t even know where I was or what was happening. I was alone in a frantic operating room of people speaking foreign languages. Within 7 minutes of noticing the distress, I was cut open and Lila was born… There were no sounds, no cries for five minutes after I felt them pull her out. I did not know for the first five minutes after her birth whether she had survived. It was the longest five minutes of my life…

They determined that the cause of all of the abnormalities was a very short cord that didn’t allow her to turn and suspended her high in the uterus and eventually stretched to where it distressed her oxygen supply… Lila could never have been born by way of the birth canal and any further efforts to turn her or birth her would have killed her.

So did Maura make a mistake when she chose to believe that Lila could be born vaginally? Surely you jest!

If I had known Lila had a short cord and could not be born vaginally, I still would have chosen to wait until I went into labor and endure a trial of labor before having a c-section. There are so many benefits to going through some labor before a cesarean. For one, it indicates that the baby is ready to be born. Even at a bona fide 43 weeks, our baby was still quite small and she needed the extra time in the womb. Babies absolutely know when it is the right time to come out. Secondly, a trial of labor allows the baby to experience uterine contractions, which help their lungs and circulation prepare for entry into the world. If we had followed medical advice, Lila would have born five weeks earlier, would have weighed about 4 pounds. Not only would her lungs have been underdeveloped, but they would not have been primed by our labor together and she would have been very likely to have breathing problems.

Ummm, Maura, didn’t you tell us that “Lila is a very small baby estimated at only 4.8 pounds at 36 weeks.” Babies gain about a 1/2 pound per week at this point in pregnancy, so she would have been about 5 1/2 pounds, but what’s a little exaggeration when you are trying to make yourself the hero of your daughter’s birth story.

The truth is that Maura was wrong about nearly everything and Lila almost died as a result, but that’s not how Maura is spinning it:

When I first showed resistance to having a 38-week scheduled c-section just because our baby was breech, I got the line “how you birth doesn’t really matter, having a healthy baby in the end is all that really matters”. Something about that statement made me feel ill. After my experience, I say that yes, the most important thing is having a healthy baby at the end… But that doesn’t mean that that statement is true or that it isn’t dangerous. Statements like this are used to push cesarean on mothers with very insidious bits of guilt, shame, and an illusion of control. They imply that having a cesarean guarantees something. But scheduling a cesarean birth guarantees nothing. It does not guarantee that your baby will live.

Actually, Maura, it does guarantee that your baby will live; that’s the reason it’s done.

Despite having been wrong about nearly everything, Maura has learned nothing:

The other thing that I wish for you is a deep trust in your own intuition. Your perfect body and deep subconscious created your baby, and you and the baby can be trusted to finish the journey. It was my intuition that told me to insist on an internal exam when I did. It was my intuition that told me to go to the hospital when my midwife gave me the choice of hospital or trying to sleep for a few hours at home. And finally, it was my intuition that demanded that I insist for the baby’s heart rate to be checked when she went into distress. Each of these conspired to save Lila’s life. Our bodies know, and we can trust ourselves.

Maura’s intuition told her to go to Bali, told her that she should have a vaginal birth, told her not to alter her plans despite the baby’s breech position and told her to let Lila nearly die. Not to put too fine a point on it, but her intuition sucked! But not in Maura’s mind.

Maura isn’t the least bit chastened by her experience. She’s rewritten reality so that she can preen about being right all along.

If I would have listened to hospital staff over my own internal voice, my baby would be dead. It was not the hospital that made the choice that got her out alive. It was me. It was my body’s knowing. It was the same principle that could be trusted to keep a floating microscopic ball of cells safe for two weeks in my womb. It was the same principle that could be trusted to make 33 perfect vertebrae. My final words to you are that you can afford to trust yourself. You, yourself, are a miracle and a miracle maker and you can be trusted.

Trust birth like Maura? I hope not.

Jill Raleigh Fischer, a nurse, wrote about her experience with forceps and incontinence on The Skeptical OB Facebook page in response to my piece Incontinence: the traumatic result of vaginal birth that dare not speak its name. Jill gave me permission to share it on the blog. She was motivated to share her experience after reading a DONA international article “ACOG to OBs: Consider Operative Vaginal Delivery to Reduce Cesareans,” and notes that operative vaginal delivery has the highest risk of pelvic floor damage and subsequent incontinence.

I am a sample of one and my forceps baby is almost 41 years old… born in the heyday of forceps deliveries. Do I want any and all measures to be used to save the life of a mother and her baby ~ absolutely. Do I think “operative vaginal delivery” should be used to reduce cesareans ~ hell no!

That said, my son’s mid-forceps delivery was performed by a perfectly competent obstetrician in a perfectly fine hospital. No one has been sued.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Try asking some women how forceps delivery worked out for them.[/pullquote]

I went into labor at 40 weeks gestation with a SROM (spontaneous rupture of membranes) and progressed normally for a first labor. That is until the second stage of labor (pushing). After three hours of trying very hard to push an occiput posterior baby out, a forceps delivery was recommended. A spinal anesthetic was administered and forceps applied.

My entire body moved down the table with the pulling and tugging applied to my son’s tiny head and body. With gratitude from all that is within me, he arrived healthy and whole and suffered no more than a bruise to his beautiful face. He had no lingering problems from his traumatic entry into the world.

However, forceps delivery is an incredibly invasive procedure and can and does result in trauma to babies and to their mothers’ bodies. This consequence appears to be grossly under reported or even recognized. The above New Yorker article cites the historical lack of use of evidence based practices in obstetrics. Perhaps that has changed, but no one has asked how I have fared since my forceps encounter.

My first experience was intense perineal pain. Sitting for a month plus was very difficult. On the plus side, I was able to have 3 more children with natural, vaginal deliveries. Would I have traded being able to have fewer children had I undergone a cesarean section the first time and having 4 with the pelvic difficulties I have had? That is a loaded question I can’t answer since I adore all of my children.

I had complete urinary incontinence immediately following my son’s forceps delivery. I was horribly embarrassed. This improved but persisted as a problem. By the time my youngest child was 4 (and the first one was 10) I was experiencing pelvic prolapse. I underwent a hysterectomy and bladder suspension. 4 years after that I underwent an A & P repair. The damaged tissues between the vagina and the urinary tract and between the vagina and the end of the digestive system needed to be repaired to improve function of both systems and decrease urinary incontinence.

With the passage of time, aging and gravity, inherited quality of tissue, and the emerging thought that these procedures are not what should be done, I found myself needing a pelvic reconstruction at age 55. Seems old ~ so what? It’s not old when it is you this is happening to. Again, I was fortunate to work with an exceptional surgeon and had insurance to assist me in obtaining good care. But, there is no putting it back the way it was no matter what kind of deliveries you had. With my history, I had even less chance than that.

Still, the evidence seems to suggest that the kind of damage I have suffered is less common following cesarean section deliveries. Did anyone ask how it went for me? Did they ask anyone? Any real studies done that support using operative vaginal deliveries in lieu of cesarean section deliveries?

I am not writing about a few tugs on a vacuum, though this should be done with the utmost thought, skill, and care. I am writing about a violent procedure and to say that there is no reason any woman should again endure a forceps delivery merely done to avoid a c-section. It may look cost effective and that it reduces pain and suffering. I am telling you that from my experience, it costs plenty of money, plenty of suffering and it costs women world wide their dignity.

So, try asking some women how forceps delivery worked out for them. And, women… fight to retain control of your bodies, your healthcare and your birth process!

Way to go La Leche League! Thanks for proving Courtney Jung’s points for her.

In advance of the publication of her new book Lactivism, Jung wrote an op-ed in the NYTimes, Overselling Breast-Feeding.

The benefits associated with breast-feeding just don’t seem to warrant the scrutiny and interventions surrounding American infant feeding practices.

What are those benefits? In countries with clean water supplies, the benefits of breastfeeding for term infants amount to nothing more than a few less colds and episodes of diarrheal illnesses across the population in the first year of life.

[pullquote align=”right” color=”#cf4b93″]Total fail when it comes to refuting Jung, but, fear not. It is a masterpiece of bullying.[/pullquote]

Not surprisingly, La Leche League, the organization that has led the charge in overselling the benefits of breastfeeding and encouraging the moralization of infant feeding was angered by the piece and issued a press release in response.

They insist that the benefits of breastfeeding aren’t oversold.

Before we look at what they said, let’s think about what they’d need to show.

The claims on their website are remarkably expansive:

Breastfeeding has been shown to be protective against many illnesses, including painful ear infections, upper and lower respiratory ailments, allergies, intestinal disorders, colds, viruses, staph, strep and e coli infections, diabetes, juvenile rheumatoid arthritis, many childhood cancers, meningitis, pneumonia, urinary tract infections, salmonella, Sudden Infant Death Syndrome(SIDS) as well as lifetime protection from Crohn’s Disease, ulcerative colitis, some lymphomas, insulin dependent diabetes …

So the first thing LLL ought to show is the dramatic increase in breastfeeding initiation in the past 30 years has led to a commensurate decrease in all the illnesses that breastfeeding is supposed to prevent.

But LLL can’t show that, because with the exception of colds and mild diarrheal illness, breastfeeding has had no measurable effect on any of these ailments.

Furthermore, the increase in breastfeeding rates has had no impact on infant mortality, no impact on life expectancy and no impact on population IQ. And, contrary to the claims of lactivists that breastfeeding could save billions of dollars in healthcare costs, breastfeeding has had no discernible impact on healthcare costs.

What evidence did LLL offer for the benefits of breastfeeding? Their response can be summed up simply: because we said so.

[B]reastfeeding has been shown to have definite health risks and consequences…

This deepening understanding of the importance and value of human milk for human babies from an immunological, physiological, and psychological standpoint is a result of an ever-increasing, vast, and incontrovertible body of research.

What are those definite health risks? LLL doesn’t dare say.

What is this incontrovertible evidence? LLL doesn’t say.

Where is the proof that breastfeeding has any impact on infant mortality, life expectancy and healthcare savings? LLL doesn’t offer it because it doesn’t exist.

So the press release is a total fail when it comes to refuting Jung, but, fear not. It is a masterpiece of bullying and shaming:

Likening breastfeeding to tobacco smoking:

When our organization began nearly sixty years ago, most babies were not breastfed and a significant portion of the population smoked. Just as research has shown that smoking has a serious negative effect on health … not breastfeeding has been shown to have definite health risks and consequences …

Classy, huh?

Slamming women who bottle feed as abnormal:

…[B]reastfeeding is now clearly understood to be the normal way to feed a human baby.

Implying that women who don’t breastfeed are ignorant:

There isn’t any pressure in our society that could force intelligent women to do something that doesn’t make sense.

But no one is claiming that breastfeeding doesn’t make sense or that women are being forced to breastfeed. What Jung has claimed is that women have been tricked into breastfeeding by organizations like LLL that have dramatically oversold the benefits.

LLL ends with a flourish of nonsense:

We’re also hormonally driven and biologically hard-wired to breastfeed and be breastfed.

We’re also hormonally driven and biologically hard-wired to begin reproducing at age 16 or so, but we don’t, do we? We’re hormonally driven and biologically hard-wired to have no control over the number of children we have, but we ignore that, don’t we? We are not animals; we are people and our lives are much safer, healthier and more comfortable because we can and do exercise control over them.

And just in case they hadn’t shamed formula feeders enough:

We’re mammals. Lactation and breastfeeding is the normal behavior and food for human mothers and babies.

Eating raw meat on the hoof is also normal behavior and food for mammals. Should we do that, too?

The bottom line is that the La Leche League response to the claims that the benefits of breastfeeding have been oversold is pathetic, reflecting the complete dearth of evidence that breastfeeding term babies in first world countries has any major impact on health.

In the absence of evidence, LLL falls back on their favorite tactic: bullying mothers who don’t follow their prescription for motherhood.

That’s just nasty.

There has been considerable debate about whether attachment parenting is anti-feminist, placing as it does a tremendous burden on mothers to have an unmedicated childbirth, breastfeed exclusively for a year or years, carry a baby constantly, and let the baby sleep in the marital bed. So where did attachment parenting come from?

Bill and Martha Sears are widely credited as the originators of attachment parenting. They are generally reticent about its sexist, religious origins. They and others have promoted the idea that attachment parenting is the way children were raised in prehistoric times and that attachment parenting is supported by science. Neither claim is true.

The Sears deeply believe that attachment parenting is God’s plan for child rearing. As Martha Sears explains in her 1997 book, The Complete Book of Christian Parenting and Childcare:

[perfectpullquote align=”right” color=”#E10025″]”We have a deep personal conviction that this is the way God wants His children parented.”[/perfectpullquote]

The type of parenting we believe is God’s design for the father-mother-child relationship is a style we call “attachment parenting.” Our intent in recommending this style of parenting to you is so strong that we have spent more hours in prayerful thought on this topic than on any other topic in this book… We have a deep personal conviction that this is the way God wants His children parented.

What else does God purportedly expect from parents?

From husbands:

God has given the husband the prime responsibility for making the marriage relationship work, which is as it should be since he has been made the head…

From wives:

“Now as the church submits to Christ, so also wives should submit to their husbands in everything… and the wife must respect her husband.” The Greek word translated “submit” is derived from the same word meaning “to yield” in the sense of yielding to another’s authority…

What is attachment according to the Sears’?

Mother-infant attachment is a special bond of closeness between mother and baby. Mother’s care enables the young of each species to thrive and, for human babies, to reach their fullest potential. Babies come equipped with behaviors that help mothers deliver the right kind of care. God has placed within mothers both the chemistry and the sensitivity to respond to their babies appropriately. This maternal equipping is what is meant by the phrase “mother’s intuition.” It helps her get attached to her baby.

Elsewhere the Sears’ refer to the “science” behind attachment parenting, but the reality is that attachment parenting reflects the Sears’ fundamentalist Christian beliefs that traditional gender roles are part of God’s plan.

The similarity with the origins of both natural childbirth and lactivism is striking. In all cases, these represents the beliefs of traditionalists on the appropriate role of women in a modern society. Grantly Dick-Read believed that a woman’s natural role is as a mother; the women who started La Leche League believed that promoting breastfeeding was a way to keep mothers of small children out of the workforce and tied to the home; the Sears’ believe in hierarchical marriage and traditional gender roles as mandated by God.

Attachment parenting serves an important role in this cosmology. By tying women to the home and (literally through baby-wearing) to their children, attachment parenting emphasizes the subservient role of women, bars them from financial independence, and restricts them to their reproductive functions.

Attachment parenting has no basis in science and never did. It reflects a fundamentalist world view on the appropriate role of women, and as such, is deeply anti-feminist and retrograde. It’s religion smuggled into the mainstream in the guise of “science” and it has been remarkably sucessful at hiding its sexist, religious roots.

Trust birth?

You must be joking!

Jessa Duggar Seewald and Jill Duggar Dillard are two, young healthy women who planned homebirths. They were about as low risk as low risk can be, yet, in an object lesson for homebirth advocates, both had to be rescued by obstetricians.

Jill, in direct contrast to the prattling of homebirth advocates that “your body won’t grow a baby too big to birth” grew a baby too big to birth.

[pullquote align=”right” color=”#86273F”]They trusted birth and birth nearly killed them.[/pullquote]

Jessa apparently had an uncomplicated spontaneous vaginal delivery … and then began to bleed heavily, so heavily that she had to be transferred to the hospital.

What would have happened to the Duggar sisters had they lived 200 years ago instead of today?

Jill would have been one of the hundreds, perhaps thousands, of American women who died of obstructed labor each and every year.

What is obstructed labor? It’s the technical term for a baby too big or too poorly positioned to fit through the pelvis. Prior to the advent of safe cesareans Jill would have labored in agony for days, struggling to push the baby through her pelvis with no chance of success. The baby’s head would have molded and elongated, the plates of the his skull sliding over each other in a desperate effort to decrease the diameter of the his head so it could be forced through.

A uterine infection might have developed to which baby and mother would have succumbed. Alternatively, Jill’s uterus might have ruptured and they could have bled to death. If the situation became desperate, her providers might have attempted to save her life by passing instruments through the cervix and dismembering the baby.

Jessa, in contrast, might have bled to death after the successful birth of a healthy boy. Why did she bleed so much? There are a number of possible reasons:

• Uterine atony: the uterus was simply exhausted after pushing a very large baby and simply refused to contract. Since the only way uterine bleeding can be stopped is by the uterine muscles contracting around the blood vessels and closing them off, massive bleeding will occur if the uterus fails to contract.
• A retained remnant of placenta: The uterus can only contract completely if it is completely empty. Even a small piece that has torn away from the placenta can keep the uterus from contracting and heavy bleeding may be the result.
• A cervical laceration: These tears in the cervix can bleed profusely and can only be stopped by clamping and stitching them. Cervical lacerations are not common but they are more likely if the mother begins to push before she is fully dilated.
• Major vaginal lacerations: These tears can extend through the back of the vagina right through to the rectum. Although they need to be carefully repaired by an obstetrician they usually don’t bleed a great deal.
• Jessa could have developed pre-eclampsia with HELLP syndrome. HELLP stands for hemolysis, elevated liver enzymes and low platelets. It is a life threatening condition that, in the absence of treatment, can easily result in death.

What would have happened if Jessa had give birth at the hospital? That’s hard to say since we don’t know exactly what had happened. Uterine atony could be treated with a variety of medications. A piece of retained placenta could have been removed immediately. A cervical laceration or vaginal lacerations could have been repaired immediately. All of these things would have reduced or prevented heavy blood loss.

Instead, Jessa lost so much blood that she had to be admitted to the hospital, probably for blood transfusions at the least. The fact that she remains in the hospital suggests that there was a bigger problem than blood loss or lacerations alone.

Ironically, Jessa gave birth at home almost certainly so she could spend the first hour skin to skin and breastfeeding her newborn. Instead, she probably wasn’t even in the same zip code.

It’s hard not to feel sorry for Jessa. She was probably contractually bound to news outlets to provide pictures of the baby, but she wasn’t there to be in them. She was probably contractually bound to provide a family photo as soon as possible so her husband brought the baby to the hospital and it appears that they hung a sheet behind her hospital bed; she was probably sitting in the bed (too weak to stand?) and husband was standing beside her.

She’s given birth, she’s suffered a serious complication and she’s required to be on display in order to earn money. So much for the intimacy of homebirth.

So both Jill and Jessa trusted birth and birth nearly killed them. Obstetricians, in contrast, saved them. They’ve given us an object lesson in why homebirth can be dangerous and even deadly.

Thinking about homebirth? Think about Jessa and Jill and think again.

If there’s one thing that natural childbirth advocates are sure of, it’s that unhindered birth is best. Women and babies are “designed” for birth, and if they only trust birth, it will turn out fine. That’s why some natural childbirth advocates choose homebirth and a smaller group choose unassisted homebirth. They want to give birth “their way” and whatever way feels safest to them is safe. In other words, babies and mothers know how to handle birth; complications happen when we try to interfere with the process.

[pullquote align=”right” cite=”” link=”” color=””]Aren’t women and babies designed to bond spontaneously after birth?[/pullquote]

So why aren’t women and babies designed to bond spontaneously after birth?

Nearly all attachment parenting advocates are natural childbirth advocates, too. That makes the riddle at the heart of attachment parenting even more surprising. The same people who insist that birth happens naturally then turn around and claim that bonding does NOT happen naturally. It must be prodded and controlled in a series of ritualized behaviors (skin to skin at birth, breastfeeding only, baby wearing) otherwise children will presumably end up “detached.”

Why can childbirth be trusted to happen spontaneously, but bonding be considered an imminent disaster aveted only if you do exactly what the attachment parenting experts tell you to do?

Ironically, given that attachment parenting is promoted as “natural,” the idea that maternal-infant attachment occurs naturally, that mother and child might love each other simply because they belong to each other, is rejected out of hand, Instead, specific practices must be employed and mothers must be taught these practices by an army of experts including parenting gurus, midwives, doulas and lactation consultants, among others.

As Charlotte Faircloth notes in the essay The Problem of ‘Attachment’: the ‘Detached’ Parent in the book Parenting Culture Studies:

It hardly seems controversial to say that, today, we have a cultural concern with how ‘attached’ parents are to their children. Midwives encourage mothers to try ‘skin-to-skin’ contact with their babies to improve ‘bonding’ after childbirth, a wealth of experts advocate ‘natural’ parenting styles which encourage ‘attachment’ with infants…

Previously a mother’s love for her child had been romanticized and ascribed to inherent characteristics of women, mother love has now been medicalized, requiring participation in rituals prescribed by experts.

As I’ve noted before, attachment parenting is not based on attachment theory, which tells us that the “good enough” mother is all that any child needs. So where did it come from? It certainly did not come from an epidemic of “detached” children. Until recently it was accepted as obvious that children remained unattached only in the most severe cases of abuse and neglect.

It came not from the study of humans, but of non-primate animals. Animals like ducklings had been shown to “imprint” on whatever caretaker they saw first during an “attachment window.” Attachment parenting theorists simply extrapolated, theorizing that infants “bonded” to their mothers during an attachment window around birth.

Faircloth explains:

Initially, the focus was on the critical period immediately after birth, though this later expanded to the period around birth as a whole. The argument was that a child’s first hours, weeks, and months of life had a lasting impact on the entire course of the child’s development. Birth, in particular, was singled out as one of the ‘critical moments’ for bonding to take place. After birth, new mothers were told to look into the eyes of their infant, hold their naked child, preferably with skin-to-skin contact, and breastfeed for optimal bonding…

From the outset, successful bonding thus required both a set of behaviours that maintained proximity with one’s child and an emotional bond …

This belief is the result of the medicalizing and the pathologizing of bonding.

…[C]oncern with detachment as part of a broader trend in the twentieth century towards the medicalization of parenthood: in particular, the medicalization of maternal emotion and mother love itself. Where, for example, mothers’ love was promoted and idealized in the late eighteenth and nineteenth centuries as an extension of women’s inherent virtue, during the late nineteenth and early twentieth centuries, maternal emotion came under much greater scrutiny … Mothers’ own ‘instincts’ were increasingly considered inferior to the findings of experts, who based their guidance to mothers on a more rational account as to what promoted the emotional well-being of children.

It’s rather surprising considering that natural childbirth advocates rail again the medicalizing and pathologizing of birth.

But then natural parenting is, in large part, about looking at the medical evidence and then rejecting it. This defiance of authority is lauded as transgressive and empowering. So if obstetricians point out that childbirth is inherently dangerous, natural childbirth advocates insist that it is safe. If psychologists point out that maternal child bonding happens spontaneously as long as the mother is not abusive or neglectful, attachment parenting advocates insist that it is contingent. It will not occur unless women follow a formalized set of behaviors prescribed by attachment parenting advocates.

The truth is that bonding is not contingent and does happen spontaneously (as any father or adoptive parent could tell you). It does not depend on a formalized set of behaviors; indeed, it has NOTHING to do with those behaviors at all (as anyone who has adopted a child beyond infancy can tell you).

There’s nothing wrong or harmful about the behaviors prescribed by attachment parenting gurus if (and it’s a big “if’) that’s what works best for you, your child and your family. But they are not in any way required for bonding. As a general matter, bonding happens spontaneously when you put a mother and her child together. It does not depend on specific rituals; it arises from mutual love and need.

Vitually all children will bond to their mothers in the absence of abuse or neglect. Unfortunately, attachment parenting gurus have medicalized and pathologized bonding. They promote a fear based view of bonding, hinting at dire consequences if you don’t follow their advice. And that leads to a lot of unnecessary guilt on the part of mothers who did not or could not follow attachment parenting prescriptions.

Considering the close association between attachment parenting and natural childbirth, it’s ironic, isn’t it?