Regular readers know that I consider birth plans worse than useless, utterly ineffective at achieving their objectives and nothing more than a recipe for disappointment.

I’m offering this alternative plan in an effort to mitigate the guilt, disappointment and self-recrimination engendered by standard birth plans. What follows is NOT a plan to manage birth, but a plan to manage expectations around birth in order to ensure a safe, sane and satisfying experience.

This is NOT a plan to achieve the birth of your dreams. The birth of your dreams exists in one and only one place — in your dreams. Planning the birth of your dreams is the equivalent of planning to have an infant who sleeps through the night at 3 weeks of age. It could happen, but it’s not likely and expecting it to happen is a virtual guarantee of frustration, disappointment and anger.

This is NOT a plan to achieve bragging rights. In my view, birth is an intimate experience reserved for those closest to the baby and the medical professionals needed to ensure the health of the mother and baby. It is not an opportunity to feel superior to other women, any more than having painless periods or great oral sex is a reason to feel superior to other women. It is none of their business.

This is NOT a plan to empower you. You can’t be empowered by birth any more than you can be empowered by menstruation or digestion. It happens, regardless of what you think about it, or whether you think about it at all.

This IS a plan to ensure, as much as possible, a healthy baby, and a healthy, non-traumatized, happy, satisfied mother.

Here’s the plan:

1. Don’t plan. Planning your baby’s birth makes as much sense as planning the weather on your next wedding anniversary. It is a natural process, and, as such, you have no control over it. You have no idea what your labor will be like, no idea what position the baby will be in, no idea how much pain you will have or how you will tolerate that pain, and no idea how or if your baby will tolerate labor. You can plan what music is on your iPod and perhaps what color popsicles you’d like to suck on in labor. That’s about it.

2. Respect birth. Birth is a wild, powerful, potentially life threatening process. It’s like a hurricane or a tornado. You can’t control it; you just have to do what you can to stay safe and ride it out. Don’t trust birth. Birth is no more trustworthy than hurricanes or tornadoes. Only a fool trusts that her thoughts can prevent a tornado from hitting her house. Sensible people go to the basement and hope that the storm passes by.

3. Expect to experience the worst pain of your life. There is a reason why the writers of the Bible imagined that childbirth is a punishment from God. It is widely recognized among specialists in pain and pain management to be the worst pain you are likely to ever experience. It is absolutely essential to have realistic expectations about the pain of labor. In my experience, the single biggest source of disappointment for women is that they believed the lies about pain spoon-fed to them by the natural childbirth industry: that the contractions are not pain but “surges,” that there is a difference between “good” pain (childbirth) and “bad” pain (all other sources of pain), that the pain is beneficial, that birth is “orgasmic” or the racist, sexist fabrication of the originators of natural childbirth that it is fear that leads to pain. No, it a a baby being forced from your body that is the source of the pain. Do you find Super tampons uncomfortable? Extrapolate and you begin to get the idea.

I say this not to scare you, but to prepare you. I have contempt for healthcare professionals who tell you “this won’t hurt” in an effort to gain your cooperation when they know it will hurt a lot. Honesty is a bedrock value in medical care. Don’t trust people who lie to you about pain.

4. Don’t make any decisions about pain medication until you feel the pain. Deciding before labor begins to refuse an epidural is the equivalent of vowing not to use an umbrella next Tuesday. You don’t know what the weather will be next Tuesday so it would be the height of foolishness to make plans before you know. The ONLY people who encourage you to make decisions about pain management before you actually feel and assess the pain are people who benefit from your decision to refuse pain relief. Make decisions based on what is good for you, not what is good for them.

5. Trust yourself. Understand your own priorities and don’t get fooled into substituting someone else’s priorities for your own.

6. Trust preventive care. Obstetrics is, at heart, preventive care. It’s all about the tests and procedures that monitor for complications so they can be managed early, long before disaster strikes. Opposing obstetric tests and procedures is like opposing colonoscopies when you are over 50. Sure, most people who have a colonoscopy don’t have colon cancer, but that doesn’t mean that most colonoscopies are unnecessary. It is always better to prevent a complication then wait for it to happen.

7. Don’t keep secrets. Obstetricians and labor nurses are not mind readers. You are a unique individual with unique experiences and fears that can impact your experience of birth. Have you been a victim of sexual assault? Do you have a fear of needles? Let your healthcare providers know. Most are extremely sensitive to individual fears and will try to do what they can to mitigate those fears.

8. Don’t be confrontational. Natural childbirth advocate encourage women to be confrontational as an effective way to undermine the trust between women and their providers. It serves the interests of natural childbirth advocates to set up barriers between you and the people who are caring for you. It does not serve your interest at all.

9. Don’t pretend that your thoughts have the power to avert or cause disaster. Imagine if someone told you that you can cause skin cancer by wearing sunscreen and prevent it by planning not to get skin cancer. Utterly foolish, right? But that’s the thinking of natural childbirth advocates who claim that thinking about complications causes complications and that ignoring them and imagining that they won’t happen will prevent them.

10. Keep your eye on the ball. In this case, the “ball” is a healthy mother and a healthy baby. It is not a specific birth experience. You can recover from disappointment. You will never recover from the death of your baby.

The best way to have a safe, sane, satisfying birth is to have realistic expectations, plan on pain, decide about pain medication when you feel the pain, trust preventive care, keep your eye on the ball, and, above all RESPECT BIRTH. It is wild, powerful, unpredictable and unplannable, and anyone who tries to convince you otherwise is not being honest.

Anne, a long time reader, read my post about breastfeeding and bullying and felt compelled to share her story in the hope that it will help others.

Every mother wants the best for her baby. The minute they place that little burrito-wrapped bundle in your arms and your eyes meet, that’s it. From that day forward, you’re responsible for another human being who is totally dependent on you and one of the most basic needs is food.

For most of human history, babies were fed breast milk—whether their own mother’s or a wet-nurse. Only relatively recently has there been a safe, nutritionally balanced formula alternative to breast milk. And although it is safe and nutritionally balanced, there is a massive pushback against it and another type of pushing: that of lactivism, or breastfeeding activism. No one denies that breastfeeding is biologically appropriate food for human babies, but when we insist it is the ONLY appropriate choice, we do both babies and their mothers a disservice. How do I know this? I tried to breastfeed my baby. I succeeded, but at great personal cost. Now I wonder if that level of effort was really necessary or even beneficial.

My first child was born on a beautiful June day. There was only one issue; he had passed meconium when my water broke and he had to be deep-suctioned the moment he came out just in case any had been breathed in. None had, and he was pronounced healthy and handed over to me via his beaming father. Our son was absolutely perfect and as I looked at him I noticed his jaw trembling just a bit. It turned out the suctioning process had left his mouth sore. I was instructed to put him to the breast every hour during the day. The nurses left the room, the doctor said she’d check back the next day, and we were alone.

Suffice it to say that our first session was an absolute failure. He cried, I cried, my husband stood there helpless and saying things like “He’ll get it. It takes time.” He wasn’t getting it. The nurses told me “first time moms always think the baby’s not latched on.” He wasn’t latching on. He was frantic, rooting and crying and not getting anything. Exhausted, I agreed to give him sugar water. We were discharged 72 hours later with no luck at feeding; I was sobbing in the glider rocker at home when the lactation nurse arrived. “I want to breastfeed and it’s not working,” I told her. “Oh honey, it’s okay,” she said, “if you really want this we can make it work.” She set me up with a nipple shield and a sample bottle of formula. She explained that “normally, we don’t advise formula, but he’s lost over 10% of his birth weight and you must build that back up.” He drank it ravenously from the syringe and wanted more. Then he latched on the nipple shield and tried to nurse. There was no milk, so we gave more formula.

Next, the LC told me “you must pump every two hours to get your milk to come in, then mix it with the formula and feed that to him with a syringe. Put him to breast as well and he will get some from that.” So now I was pumping every two hours, nursing, caring for a newborn, attempting to care for myself, and, unfortunately, dealing with a severe case of hormonal postpartum depression, which only worsened with the sleep deprivation of the schedule we were on. I was miserable beyond belief. “Can I really do this?” I asked her. “Of course you can,” she said, “just focus on your baby and let the rest go.” “When do I sleep?” I asked. “Well, there isn’t going to be a lot of that,” she chuckled, “but it’s temporary.” I was fortunate to have my husband home for ten days, by the way. Most women don’t have that privilege.

The lactation nurse came to check on us every few days for a few weeks. She encouraged me and said I was doing so wonderfully! Wasn’t it great to give my baby breastmilk? It’s so good for them. He was nursing successfully after the first week or two with a nipple shield. I didn’t have to supplement anymore. I was a success! But I was still having severe panic attacks like tetanic contractions, one right after the other. I cried randomly and often. I could not shake the feeling of despair and I was so terribly tired. She told me “it’s unfortunate about the formula, but it couldn’t be helped. Don’t beat yourself up.” I did anyway. I was sure his colic and general fussiness was from his rough start and the formula. I read about gut flora and cried some more. On the Fourth of July we watched the fireworks as I pumped and the motor whooshing sounded like it was saying “help me, help me, help me.” Please, someone help me, I thought. I continued to try. The class we’d taken on breastfeeding at the hospital (prior to birth) had us say a mantra: “It’s always too early to quit.”

So we were two weeks in, my PPD was not improving despite additional medication and my stitches from delivery were infected because I hadn’t had two seconds to do the sitz baths that I was supposed to do. The pregnancy and birth forum I belonged to online, who had been so supportive and full of information while I was planning birth and postpartum, had suggestions like eating more fruits and vegetables, or counseling, or herbs. Considering I was on the verge of hospitalization for my PPD, these suggestions were useless. I knew I had to wait for the drugs to kick in fully—the only ones that were safe for nursing, apparently—I couldn’t have most of the medication that would be of immediate help because I was nursing. Despite struggling mightily, I never once considered quitting. I had seen the statistics my group pulled out on articles they discussed and people they discussed; namely, people who didn’t measure up to their standards. People who weren’t willing to make the sacrifice to breastfeed their babies and give it their all. I was not going to be that person. After all, I knew from reading online that breastfeeding has many benefits—immunity, intelligence, even bonding. Breastfed babies are statistically more likely to survive their first year! (I don’t know where this statistic comes from, but I suspect not first world countries). All this swirled around in my already-anxious brain like a toxic cocktail.

It was a hot summer and my son was three weeks old. I felt like I was going to die. I couldn’t possibly go on like this. He was sleeping two hours at a time maximum, and I wasn’t pumping anymore but I was being awakened by horrible nightmares. I was so tired I couldn’t function. My mother had to come stay because my husband had to return to work. I didn’t trust myself to care for the baby other than nurse him. I was literally afraid I would fall asleep nursing in the chair and drop him or squash him. He nursed constantly, until he was overfull and would vomit. I phoned the lactation nurse in desperation again. “Can I give a pacifier?” “Well,” she hedged, “it’s really not great if he’s still establishing nursing, but if he’ll eat until he vomits you can try it. But he might get nipple confusion and only want a plastic nipple.” After a maximum of two consecutive hours of sleep in a month, I was willing to take that bet. And it made absolutely no difference other than getting me three consecutive hours of sleep, which I welcomed.

Finally about six weeks in I felt okay. Not great, but okay. Things looked brighter. I wasn’t desperate and despondent all day. The nipple shield went in the trash, the baby nursing like a pro. But while I remember the awful, sinking into a black abyss, nearly indescribable feeling of PPD and the guilt of hearing my hungry baby screaming, I remember nothing other than that from his first six weeks. We have pictures and for most of them I pulled it together, but I still looked like I felt: terrified and exhausted. I breastfed my baby successfully no matter what.. in the end, did it actually matter? What were the real advantages to what I put us both through? The more I know now, the less convinced I am that there are many, if any. Would he really have been irreparably damaged if I had listened to the doctor who said “you know, breastfeeding is not a requirement,” and treated my own mental health so the baby could have a healthy mother? Would he not be the smart, healthy, amazing kid he is now if I had given him formula?

In so many ways, the breast vs. formula debate is no win. But it is especially so with conditions like PPD. Mothers are guaranteed to lose either way—neglect your own health and breastfeed the baby, or give formula and suffer the guilt from that. The conditional support of lactivists inherently involves guilt. Most of the people who supported me while I tried would have withdrawn that support if I had stopped. So when one of the women from our forum was struggling the same way I did, when she clearly had terrible PPD and needed medication, my advice to her was loud and clear: your needs matter. You cannot care for others unless your own basic needs are met. Take the medicine, give the baby formula, more importantly hold the baby, love the baby, meet its needs and accept no guilt. In the end, breastfeeding is not the yardstick by which your parenting will be measured.

The new Lamaze poster on epidurals raises some existential questions for me and perhaps my readers could help me out.

Which of the many ethical violations that Lamaze has committed within the poster are the worst?

Is it the lying about facts?

Is it the lying about judgment?

Or is it the way they treat their followers with utter contempt, imagining that they are stupid enough to swallow anything that the liars at Lamaze dish out?

Here’s my annotated version of the top of the poster to help you out:

Personally, I’m leaning toward the bald faced lies as the worst ethical violation.

It doesn’t matter to the folks at Lamaze what the scientific evidence shows. They are entirely evidence resistant. They are a business that depends on demonizing epidurals and they apparently see no problem with lying if that’s what promotes profits. Consider the plethora of lies above. In direct contrast to what Lamaze claims:

1. The fact that epidurals restrict movement has no impact on labor.

2. The “prolongation” of labor is measured in minutes and has no impact on anything.

3. There is NO DISRUPTION of hormones needed for labor. That is pure invention on the part of the liars at Lamaze.

4. There are no “dangerous” changes in blood pressure. Temporary drops in blood pressure are easily reversed and have no harmful effects.

5. There is NO EVIDENCE that epidurals cause trauma to the perineum.

6. There is NO EVIDENCE that epidurals cause difficulty breastfeeding.

The liars at Lamaze are batting 1000. Six claims and all six are lies. Way to go, Lamaze liars!

You know what the biggest risk of epidurals is? Epidurals decrease Lamaze profits!

That’s right. Lamaze is a business and it makes it money in two ways: it licenses infant toys (I kid you not) and it charges certification fees for Lamaze educators. Because Lamaze has chosen to indoctrinate its educators with bald faced lies about epidurals, epidurals themselves pose a tremendous economic threat. Who needs an educators to lie to women about epidurals if they find out that epidurals are SAFE, HIGHLY EFFECTIVE, have MINIMAL SIDE EFFECTS, TRIVIAL IMPACT ON LABOR, and NO EFFECT ON BREASTFEEDING? Apparently no one, hence the need for lying at Lamaze.

I must say that the Sanctimommy lie about no judgment is a nice touch. They are so not judging you even if you are benighted enough to believe that epidurals are the only way to relieve pain in labor (they are, of course, the only EFFECTIVE way to relieve pain in labor), even if you think epidurals relieve pain, and even if you are weak and lazy enough to pick the con side of the scale. Got to love that subliminal sanctimony of portraying the choice as the balancing scale, and weighing down the con side with lies.

Even so, I think you could make a good argument for the fact that the greatest ethical malfeasance of the liars at Lamaze is the absolute contempt with which they treat their followers. They figure that their followers are stupid enough to get their information about epidurals from people who only make money by demonizing epidurals. It’s like getting your information on renewable energy from oil companies. They believe their followers are gullible enough that they can lie with abandon and no one will either know or care. Not to mention that the liars at Lamaze apparently think any amount of women suffering any amount of agonizing pain is fine when balanced against the profits of the Lamaze itself.

Keeping that in mind, I’ve helpfully amended the Lamaze balance scale:

In conclusion, let me reassure the liars at Lamaze that I wrote this post about their lies with no judgment, exactly the same way that they designed their poster!

Wow, it happened again!

No sooner did I write a post about confident idiots than one of them stepped forward to offer a perfect example of why, despite their certainty, they cannot be trusted. Thank you Jennifer Margulis for your new post 45 Reasons NOT to Have a Home Birth. It is a delightful amalgamation of the mistruths, half truths and outright lies tossed back and forth between clueless homebirth advocates, who actually think it is knowledge.

As Dr. Dunning of the Dunning-Kruger effect has noted:

What’s curious is that, in many cases, incompetence does not leave people disoriented, perplexed, or cautious. Instead, the incompetent are often blessed with an inappropriate confidence, buoyed by something that feels to them like knowledge.

Jennifer Margulis has ZERO qualifications to offer medical information on homebirth. She’s not an obstetrician, not a midwife, not a medical professional of any kind. She hasn’t delivered any babies, cared for any pregnant women, or managed any pregnancy complications. Her degrees are in English Literature, so she lacks the fundamental knowledge of science and statistics needed to read and analyze scientific papers. She appears to have no idea what the scientific literature says about anything, and swallows every lie that the Midwives Alliance of North America chooses to spoon-feed her.

What’s curious is that her utter incompetence when it comes to the field of obstetrics does not leave her disoriented, perplexed, or cautious. Instead, she is blessed with entirely inappropriate confidence in her conclusions, buoyed by something that feels to her like knowledge, but is actually unbounded ignorance, with a heaping helping of arrogance. She, a travel journalist with a PhD in English literature, actually fantasizes that she has more knowledge about the risks of homebirth than the tens of thousands of obstetricians, pediatricians, and neonatalogists who have done the research that shows that homebirth dramatically increases the risk of perinatal death.

Of course, you can’t expect much from someone who offered what has to be the single stupidest excuse ever when presented with evidence that homebirth leads to preventable perinatal deaths. When I asked her about Judith Rooks, CNM MPH analysis of 2012 Oregon homebirth statistics that showed that planned homebirth with a licensed Oregon homebirth midwife has a death rate 800% HIGHER than comparable risk birth, Margulis responded:

Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…

Yes, she really wrote that.

I’m not going to bore you with the latest nonsense that Margulis recycles in her post; you are free to read it if you can stomach it. However, I will offer MY 5 reasons not to have a homebirth. It’s a much shorter list because it gets to the point immediately.

Dr. Amy’s 5 reasons NOT to choose homebirth:

1. A healthy live baby is your first priority.
2. You don’t want to take even the tiniest risk to your baby’s brain function.
3. You don’t need to impress other privileged Western white women with faux achievements.
4. You actually read the scientific literature.
5. You take medical advice from medical professionals, not confident idiots.

My 5 reasons are not particularly startling. They reflect the findings of ALL the scientific literature on homebirth, as well as state, national and international statistics. They reflect the mainstream views of ACOG and the AAP, as well as the overwhelming majority of obstetricians, pediatricians and neonatologists.

But, of course, Jennifer Margulis is confident, oh so very confident, that she knows better than tens of thousands of medical professionals. The only question for women contemplating homebirth is this:

Who are you going to trust for medical advice on childbirth, medical professionals or a travel writer who is inexplicably confident in her utter ignorance?

The trouble with ignorance is that it feels so much like expertise.

So says psychology professor Dr. David Dunning. He ought to know.

In 1999, in the Journal of Personality and Social Psychology, my then graduate student Justin Kruger and I published a paper that documented how, in many areas of life, incompetent people do not recognize — scratch that, cannot recognize — just how incompetent they are, a phenomenon that has come to be known as the Dunning-Kruger effect. Logic itself almost demands this lack of self-insight: For poor performers to recognize their ineptitude would require them to possess the very expertise they lack. To know how skilled or unskilled you are at using the rules of grammar, for instance, you must have a good working knowledge of those rules, an impossibility among the incompetent…

Or, for instance, to know how knowledgeable or ignorant you are about childbirth, you have to have a good working knowledge of modern obstetrics including both normal and abnormal childbirth. Paradoxically:

What’s curious is that, in many cases, incompetence does not leave people disoriented, perplexed, or cautious. Instead, the incompetent are often blessed with an inappropriate confidence, buoyed by something that feels to them like knowledge.

When it comes to childbirth, we call these people midwives, doulas and childbirth educators. Not all, fortunately, have an inappropriate level of confidence in their own incompetence, but a significant proportion of midwives (including 100% of homebirth midwives) and an astoundingly large proportion of doulas and childbirth educators suffer from the of delusion believing themselves “knowledgeable” after having done “their research.” The world of celebrity natural childbirth and homebirth advocates is filled with what Dunning calls “confident idiots.” These include, but are in no way limited to, Ina May Gaskin, Ricki Lake, Barbara Harper of Waterbirth International, Jan Tritten of Midwifery Today, Jennifer Margulis, Jen Kamel of VBACFacts, Milli Hill of Positive Birth, and doula Teri Shilling, former president of Lamaze International, of My OB Said What??!!

How do people become confident idiots?

Very young children … carry misbeliefs that they will harbor, to some degree, for the rest of their lives. Their thinking, for example, is marked by a strong tendency to falsely ascribe intentions, functions, and purposes to organisms. In a child’s mind, the most important biological aspect of a living thing is the role it plays in the realm of all life. Asked why tigers exist, children will emphasize that they were “made for being in a zoo.” Asked why trees produce oxygen, children say they do so to allow animals to breathe… This purpose-driven misconception wreaks particular havoc on attempts to teach one of the most important concepts in modern science: evolutionary theory. Even laypeople who endorse the theory often believe a false version of it. They ascribe a level of agency and organization to evolution that is just not there…

Hence natural childbirth and natural parenting advocates claim that women are “perfectly evolved” for childbirth or that women who are breastfeeding “always” have enough breastmilk.

This idea of evolution misses the essential role played by individual differences and competition between members of a species in response to environmental pressures: Individual cheetahs who can run faster catch more prey, live longer, and reproduce more successfully; slower cheetahs lose out, and die out—leaving the species to drift toward becoming faster overall. Evolution is the result of random differences and natural selection, not agency or choice.

Similarly, childbirth and breastfeeding have always been, and are still governed by random differences and natural selection. Some pregnancies are too short and the baby dies; some pregnancies are too long and the baby dies. The idea that “the baby knows when to be born” is paradigmatic example of the purpose driven misbelief; it’s just as foolish as imagining that a cheetah knows that if it runs faster it will catch more prey. These purpose driven misbeliefs are behind many of the most egregious claims of natural childbirth advocates, from “breech is just a variation of normal” to “you can’t grow a baby too big to birth vaginally.”

The confident idiots of the natural childbirth world also suffer from motivated reasoning.

Some of our most stubborn misbeliefs arise not from primitive childlike intuitions or careless category errors, but from the very values and philosophies that define who we are as individuals. Each of us possesses certain foundational beliefs — narratives about the self, ideas about the social order—that essentially cannot be violated: To contradict them would call into question our very self-worth. As such, these views demand fealty from other opinions. And any information that we glean from the world is amended, distorted, diminished, or forgotten in order to make sure that these sacrosanct beliefs remain whole and unharmed.

The foundational belief of natural childbirth, lactivism and natural parenting is: “My birth, feeding and parenting choices make me a better mother than everyone else.” Many natural childbirth advocates literally cannot tolerate any evidence that threatens this foundational belief. Hence the epidemic of deleting and banning that afflicts natural childbirth websites and message boards.

How can we combat the epidemic of misbeliefs promoted by natural childbirth advocates? Dunning advocates a general strategy that can be applied to natural childbirth advocacy:

For individuals, the trick is to be your own devil’s advocate: to think through how your favored conclusions might be misguided; to ask yourself how you might be wrong, or how things might turn out differently from what you expect. It helps to try practicing what the psychologist Charles Lord calls “considering the opposite.” To do this, I often imagine myself in a future in which I have turned out to be wrong in a decision, and then consider what the likeliest path was that led to my failure. And lastly: Seek advice. Other people may have their own misbeliefs, but a discussion can often be sufficient to rid a serious person of his or her most egregious misconceptions.

Of course natural childbirth advocates have already cleverly “immunized” their followers against such a strategy. According to them, you should never ask yourself how you might be wrong because questioning birth inevitably leads to poor outcomes. “Trust birth!” sounds better than “Don’t think!” but it means exactly the same thing.

How can you protect yourself against the confident idiots in the world of natural childbirth?

1. The first step is to recognize that those who know the least often think they know the most. That’s why professional qualifications are so important. The people who know the most about childbirth are obstetricians. That doesn’t mean that they know everything, or that they are always right, but it does mean that they have a strong foundation from which to assess claims about childbirth.

2. Be wary of anyone who claims that formal education is unnecessary, or that obstetricians don’t follow the scientific evidence. Be wary of anyone who tells you what birth is like in the hospital when they have never worked in a hospital.

3. Be wary of anyone who makes claims about what is or is not normal in pregnancy without having extensive experience in caring for women who have pregnancy complications.

4. Don’t “trust” any natural process.

5. Ignore anyone who cannot tolerate dissent and deletes comments that call their claims into question.

6. Resist the temptation to succumb to flattery. Choices about birth and breastfeeding do not have much, if any, impact on whether children will become healthy, happy and competent adults. Anyone who tells you that the “right” choices make you a better mother is a confident idiot. Don’t let the desire to feel superior to other mothers make you a confident idiot, too.

My new book!

For the last few months I’ve been working on a book proposal. I’m happy to say that it garnered a lot of interest among editors and publishing houses, and ultimately went to auction.

Guilt Trap: New Motherhood and the Natural Parenting Industry will be published next year by Dey Street Books, an imprint of Harper Collins.

From the proposal:

[I hope that] Guilt Trap will bring desperately needed comfort to millions of women and will stimulate discussions in the mainstream media and our society about the corrosive impact of the natural childbirth and breastfeeding industries on women’s wellbeing. … I will show readers who benefits from making women feel guilty about their choices, and why contemporary childbirth, breastfeeding, and attachment parenting movements are retrograde, sexist, and even dangerous – and in doing so, free women from guilt they have unnecessarily shouldered for far too long.

I’m thrilled that I’ll be working with an amazing editorial team and I can’t wait to get started.

All my life I dreamed of you … and then you came.

From the time that I was a small child I had imagined what it would be like to have a daughter. I envisioned a girly girl with a powerful sense of self, and you have wildly exceeded my every expectation.

Your personality was apparent from the day that you were born: you have your own ideas and you won’t settle for substitutions or diversions. I remember trying to give you a pacifier when you were fussy, just like I had given your 3 brothers. They took it happily; you, on the other hand, immediately spit it out and gave me a look like “you cannot possibly be serious; this is plastic and I don’t do plastic.”

You talked clearly and imperiously before you turned one (your first word was “ring” because you wanted to wear my engagement diamond) and you picked out your own outfits from the time you were 18 months old. I learned early on that disagreement was pointless, but that reasoning with you was highly successful. When you wanted to wear plaid with stripes I didn’t say no; I merely told you that most people felt that they clashed, but you were free to make your own choice. After careful consideration, you put the plaid back and picked something that matched better. Your fashion sense has been unerring since those early years.

As a preschooler you had 8 Barbies and two Magic Attic dolls, wore dresses every day and princess costumes for Halloween. I sewed for you and your dolls so you could have matching outfits for special occasions like your 2nd birthday above. Others cautioned me that dolls and frilly clothes would give you the wrong idea about about girls and ambition, but I’ve always felt that femininity and ambition are not incompatible. At six years old you asked me what you should do after you won the Nobel Prize.

When you were 11, you told me that your goal was to be a published author before you turned 16. I didn’t want to discourage you, but I thought that it was a goal much more difficult to achieve than you understood. Indeed, I pointed out for years I had written professionally (as a freelance medical writer) and for every 10 articles I sent out, 9 got rejected. “Well, yes, that’s you,” you replied, “but this is me.”

So we went to the bookstore and bought The Writer’s Guide to Children’s Literature, which listed all the magazines that accepted submissions of writing for children. That was on Saturday. When I came down on Monday morning, there was a neat stack of large, white envelopes on the kitchen table. Each contained a story and a cover letter, and each was addressed to a different publication. On top of the stack was a note asking me to mail them. Within several weeks you had an answer. You were going to be published. Your story, was published in Stone Soup, a national magazine for children. You had achieved your stated ambition, and you had achieved it ahead of schedule.

When you were 12, you asked me, “Why don’t you work?,” and more specifically, “Don’t you feel bad that you are not an important person?” We talked about it when you asked me, and I’ve thought a lot about over the years.

The third question you asked at the time was much easier to answer. “Don’t you feel bad that Daddy makes all the money, and you don’t have any?” No, I don’t, because, as I told you, Daddy may make all the money, but all of it is mine! “How does that work?”, you said. Marry the right guy, and it’ll work for you, too.

I understood that what you were asking about was not that mothers aren’t important; you were curious whether an ambitious person can be happy if she does not have professional success to point to, and if no one is paying her for the work that she does. The answer is yes. Because when it comes right down to it, it is the ordinary joys of life, the ones that are available to everyone and require no fancy skills that are the warp and weft of a happy life. Therefore, I recommend to you some ordinary joys:

Marry a good man. There is nothing better than being married to your best friend.

Pick interesting friends. Your friendships will be the backbone of your life. (Oh, be sure to have some friends who are doctors. That really comes in handy).

Do what you love, even if it’s hard. A satisfying career usually takes a lot of work to get started. Don’t let that stop you. Do the work, and you will be glad that you did.

Have professional colleagues whom you admire and respect. It’s even better if you can have professional colleagues who you admire, respect AND can call your friends.

Have children. There’s an upside and a downside to this. Children are extraordinary, but they are also a lot of work. They can bring joy and meaning to your life, and they can also point out that you are the dumbest person on earth, and the most embarrassing.

Read books. I cannot recommend that highly enough. I know that you love books as much as I do (we share a Kindle account and we are Amazon’s best customers) and they will always be a source of joy and comfort to you.

Have a hobby. I highly recommend sewing. Not only is it practical, but it is a way to shower attention on your children without actually being with them.

Finally, if you can manage it, have a daughter. It is every bit as fun, exciting, challenging and meaningful as I imagined it would be; you are the daughter of my dreams.

Wait, let me amend that, you are the daughter who has exceeded my fondest dreams!

Happy, Happy Birthday!

There are a lot of tips for differentiating peddlers of pseudoscience from real scientists. I’ve written about some of them myself (Six red flags you need to recognize to quack proof yourself).

But there’s a simple question you can ask that serves as a highly reliable shortcut. Does the website (or Facebook page) airbrush the owner’s mistruths and mistakes?

You can determine the answer to that question not by what you see, but by what you don’t see. Just like pictures of fashion models are airbrushed to remove any flaws and project an image of perfection, the websites of quacks are airbrushed to removed the author’s mistakes and to remove (and ban) anyone who questions the author’s claims.

Consider the recent incident with Aviva Romm, MD. In an episode of monumental hypocrisy, Romm issued a caution against shaming women who have C-sections in the midst of a 30 day Facebook rant on preventing unnecessary C-sections that only the day before had advised women to avoid associating with anyone who thought her C-section was acceptable. Romm piously declared:

Today I am making a departure from cesarean prevention to talk about SHAME prevention… Let’s talk about birth and shame. The fears of “failing” because of the pressures to go “au naturale” whether around birth, breastfeeding, or how we raise our kids. How we can better support each other to have the healthiest, safest, most empowering experiences possible?

She promptly got her head handed to her on a platter with a scathingly brilliant comment.

You’re taking a break from shaming women to talk about how we shouldn’t shame women. Wonderful! You want to prevent women from feeling like “failures”? How about stop vilifying a necessary and life-saving medical procedure. The easiest way to support women is to provide complete and accurate information without bias and allow them to make their own decisions about their health.

Your recent posts about not hearing “fearful things” about birth and trying to prevent cesareans with “traditional” birth practices not only encourages women to ignore valuable medical advice that can be vital in making a truly informed choice but also doesn’t disclose any actual information about these supposed traditional birthing means. In your anthropological study of “native” (how delightfully paternalistic) births did you not come across any statistics of maternal or perinatal mortality? Did you just not look for this information to avoid any uncomfortable cognitive dissonance? Or did you simply not want to disclose it?

You can prevent unnecessary medical procedures by education people at to their rights as a patient, the fact that the majority of healthcare workers come to work every day to do their absolute best, and that in the end there is no single correct way to birth or parent. Offer both sides and allow people to choose for themselves and leave it at that.

Romm should have offered an apology for her hypocrisy and henceforth vowed to scrutinize her own writing for subtle and not so subtle shaming strategies. Instead of acknowledging her mistake (and her insensitivity), however, Romm simply airbrushed it out of existence, erasing not merely the hypocritical post that counseled against shaming, but the entire 7 posts of the series thus far, and erasing any evidence that the series ever existed.

Just like Jan Tritten erased evidence of her involvement in the death of Gavin Michael.

Just like Jen Kamel erased the fact that she had boasted about the VBAC outcomes of her followers without realizing they were hideous.

Just like Hermine Hayes-Klein of Human Rights in Childbirth erased evidence questioning the organization’s response to their “forced episiotomy” video.

Quacks can never tolerate being shown to be wrong. That’s entirely different from tolerating being wrong. No sooner did she delete her post on shaming women who have C-sections, then Aviva Romm created a post suggesting that C-sections may raise autism risk, without bothering to include the authors’ caveat that their paper did NOT show that C-sections cause autism. I cannot believe that she is so innumerate that she did not recognize that the paper proved nothing, yet she posted it anyway. She is so not shaming you for having a C-section even if it did cause your child’s autism. Despicable!

Real scientists and doctors make mistakes and should acknowledge them and correct them when it is pointed out to them. Real scientists and doctors can and must tolerate public dissent, must allow their claims to be questioned and must respond to those questions. Natural childbirth and homebirth advocates, like quacks of all kinds, cannot tolerate dissent and create airbrushed websites and Facebook pages that make them seem omniscient and infallible. Quackery means never having to say your sorry.

When you encounter a natural childbirth or homebirth website gleaming with airbrushed perfection, all signs of dissent removed and anyone who could challenge the author banned, you can be certain that you are in the presence of quackery … and you should protect yourself accordingly.

Last month I wrote about a spate of infant deaths in so-called “Baby Friendly” hospitals and asked whether the Baby Friendly Hospital Initiative ought to be renamed the Baby Deadly Hospital Initiative.

The Initiative virtually mandates keeping babies in bed with exhausted new mothers even when multiple modifiable risk factors for infant suffocation are present, including maternal impairment due to sedating drugs or exhaustion and soft bedding. Why? To encourage breastfeeding, of course. The paper Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards (2014) reported on the results: 15 neonatal deaths and 2 near deaths.

Over the weekend, a reader alerted me that this phenomenon is far more common than I had realized. In fact, it is so common that it has a name, sudden unexpected postnatal collapse (SUPC), and multiple papers exist describing the phenomenon.

In Unexpected collapse of healthy newborn infants: risk factors, supervision and hypothermia treatment (2013), Pejovic and Herlenius describe the findings in just one city, Stockholm:

Twenty-six cases of SUPC were found among 68 364 live-born infants, an incidence of 38/100 000 live births. Sixteen of these cases of SUPC required resuscitation with ventilation >1 min, and 14 of these remained unexplained (21/100 000). Fifteen of the 26 children were found in a prone position, during skin-to-skin contact, 18 were primipara, and 13 occurred during unsupervised breastfeeding at

Conclusion

SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin-to-skin contact should be implemented.

Unexpected collapse in apparently healthy newborns – a prospective national study of a missing cohort of neonatal deaths and near-death events (2012) describes the British experience:

45 cases were reported, an incidence of 0.05/1000 live births of whom 12 infants died. In 15/45 infants, an underlying disease/abnormality was determined. In 30/45 cases (0.035/1000 live births), no such cause was found, but in 24, the clinical/pathological diagnosis was airway obstruction during breast feeding or in prone position. Mothers were commonly primiparous and unattended by clinical staff before collapse was recognised.

Not surprisingly, most cases occurred at times of low supervision and many cases involved known risk factors for sudden infant death syndrome (SIDS):

Collapse occurred between 21:00 and 08:59 h in 25 (56%) cases. Thirteen (29%) infants were presumed to be feeding at the time of collapse. Thirty (67%) women had received analgesia in the form of opiates or had had a regional or general (one case) anaesthetic in the 8 h preceding the collapse.

In 23 cases, the mother or both parents were unattended with their new baby at the time of collapse. When mothers were left alone with their baby, they recognised signs of collapse in around a third of instances. When another parent was present, they recognised the signs of collapse more often (75%)…

The long term outcomes were terrible:

Nineteen of the 24 infants with presumed accidental suffocation survived to discharge. At 1 year, five were noted to have neurological abnormalities (26%). Three have cerebral palsy, one has probable cerebral palsy with significant motor delay and the other has mild global delay and hypotonia…

Poets et al. reported in Sudden Deaths and Severe Apparent Life-Threatening Events in Term Infants Within 24 Hours of Birth (2011) on 17 cases of SUPC, defined as unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) that occurred within 24 hours of birth.

There were 7 deaths (ie, 1.1/100 000); 6 of the 10 S-ALTE infants were neurologically abnormal at discharge. Twelve infants were found lying on their mother’s chest or abdomen, or very close to and facing her. Nine events occurred in the first 2 hours after birth; 7, were only noticed by a health professional despite the mother being present and awake.

CONCLUSIONS: SID or S-ALTE may occur in the first 24 hours after birth, particularly within the first 2 hours. Events seem often related to a potentially asphyxiating position. Parents may be too fatigued or otherwise not able to assess their infant’s condition correctly. Closer observation during these earliest hours seems warranted.

An editorial in Archives of Diseases of the Child Fetal Neonatal Edition Unexpected collapse of apparently healthy newborn infants: the benefits and potential risks of skin-to-skin contact (2012) advises:

… it seems appropriate … to recommend that midwives check on the infant’s condition frequently during the first 2–3 h after birth, with particular emphasis on ensuring that when in skin-to-skin contact the infant’s position is safe and the nose and mouth are not occluded.

The ultimate irony, of course, is that there is no evidence that early breastfeeding or skin to skin contact has any impact on breastfeeding success. Correlation has been noted, but that is easily explained by the fact that women who entered labor committed to exclusive breastfeeding are more likely to initiate early breastfeeding and to value extended skin to skin contact than those who plan to bottlefeed. In other words, not only is one of the central tenets of the Baby Friendly Hospital Initiative unproven, but may actually lead to brain injury and death.

In a recent issue of The Journal of Perinatal and Neonatal Nursing, M. Terese Verklan, PhD, CCNS, RNC, FAAN points out that The Breast Can Be Lethal:

… I have recently heard of 2 incidences of newborns being suffocated when breast-feeding. One case involved a mother who was exhausted after feeding her newborn every 11/2 to 2 hours for the past 60 hours or so. It is believed that she fell asleep while the newborn was feeding and did not wake up until the morning. It was obvious that the baby did not survive the night. In the second case, the neonate was approximately 4 hours old when the parents excitedly summoned the postpartum nurse to check him because “he didn’t look right.” The nurse remembers seeing his legs looking mottled and dusky and that she had to lift the breast off his head and chest. He was in cardiopulmonary arrest and survived extensive resuscitation with major neurologic sequelae. Both mothers had had a lactation consultant spend some time instructing them on how to breastfeed, describing several positions to enhance latching for the baby and comfort for the mother. I believe both were being held in the football hold, but I am not 100% sure. I do know that both mothers were primiparas wanting to provide the best nutrition for these babies.

Verklan concludes:

… Given that we are using evidence-based practice interventions today as much as possible, perinatal researchers need to closely scrutinize the different practices taught to mothers and develop the science behind these “routine” interventions…

Mandated rooming in policies, encouragement of prolonged skin to skin contact, and pressure to breastfeed repeatedly and exclusively during the first postpartum days are interventions promoted by the Baby Friendly Hospital Initiative. Like all interventions, we need to examine whether there is scientific evidence to support them, and describe the harms that result from them.

Otherwise, the Baby Friendly Hospital Initiative will truly become the Baby Deadly Hospital Initiative.

You can’t make this stuff up.

Aviva Romm, MD has thoughtfully taken a break from her 30 day series on “Preventing Unnecessary Cesareans,” to inform us that she is shocked, shocked that some women are being shamed for their C-sections:

Day 7: Take Back Birth: Preventing Unnecessary Cesareans

Today I am making a departure from cesarean prevention to talk about SHAME prevention… Let’s talk about birth and shame. The fears of “failing” because of the pressures to go “au naturale” whether around birth, breastfeeding, or how we raise our kids. How we can better support each other to have the healthiest, safest, most empowering experiences possible?

How? Come closer, Aviva and I will whisper just one teensy, weensy little way that you might take the first step toward better support other women:

END YOUR NONSENSICAL, ANTI-SCIENTIFIC SERIES ON PREVENTING “UNNECESSARY” CESAREANS!

Romm’s series in a object lesson in the subtle cruelty of natural childbirth shaming.

Day 1: Start with self-serving hypocrisy:

My goal is not to make anyone who had a cesarean feel badly about it. We all do what we have to do in complex situations.

English to English translation: If only you had been smarter, you wouldn’t have had a C-section.

Day 2: Justify your own refusal to take responsibility by practicing obstetrics deciding which C-sections are necessary.

When applying to medical residencies, I considered becoming an OB-GYN, thinking this would be an extraordinarily subversive and effective way that I, as a midwife, could influence change in hospital birthing practices. Then I visited residency programs where I was confidently informed that I would get PLENTY of surgical training because there would be no shortage of cesareans!…

See, Aviva can’t take any personal responsibility for preventing unnecessary C-sections, because she might have had to perform a lot of C-sections in order to gain the qualifications to determine which C-sections are unnecessary, and she didn’t want to do that. Get it? Me, neither.

Day 3: Tell a whopper!

Your body should be your business not big business for someone else.

Thus saith Aviva Romm, whose entire career is a giant business, from midwifery, to books, to newsletters, to seminars, to bamboozling people by practicing “functional” medicine. 100% of Romm’s income depends on your body being a big business for her.

Day 4: Lie about the scientific evidence

Here’s a tip you might not have realized is ok and even beneficial: Eat during labor.

No, there is NO scientific evidence that eating in labor is beneficial. It’s not like the issue hasn’t been studied; it has been studied repeatedly. Each study has utterly failed to show any benefit to eating in labor, only risk. That risk being the risk of aspirating the food that you have eaten into your lungs.

But claiming that it is beneficial is delightfully subversive so Aviva indulges herself.

Day 5: Bash technology:

… [T]echnology and natural birth aren’t a great mix. So when I was pregnant I asked myself: How can I birth naturally? I studied how women birthed traditionally. I studied native birthing practices around the world through anthropology. Here’s what I learned and did: Walking, laboring with women friends and relatives there for support, eating when I was hungry, drinking when thirsty, staying upright for labor, pushing when the instinct overtook my body, squatting for birth. While you don’t have to do all of these, taking birth lying down and assuming technology knows our bodies better than we do are some of the ways we’ve gotten into this 34% cesarean rate!…

Me, me, me! Look at me! Follow me! Copy me! I’m awesome and if you try hard enough you can be like me, me, me!

Day 6: Today’s tip is tough but important. Be careful whose opinions and beliefs you “let in” to your personal emotional space while you are pregnant and in labor. Science shows us that who we surround ourself with affects our health. For example, if our friends are overweight, just by the social connections we have a 50% chance …

WE INTERRUPT THIS POST FOR AN IMPORTANT BULLETIN! AVIVA ROMM JUST RETRACTED HER 30 DAY SERIES ON PREVENTING UNNECESSARY C-SECTIONS! She removed each and every post from the series.

But I didn’t even get a chance to copy Aviva’s words on not socializing women who are overweight or women who have had C-sections, lest we become “infected” with obesity or Cesareans by them, before she deleted them.

As usual in the world of NCB, deletion is a sign of guilt. No sooner did Aviva notice that we were discussing her hypocrisy on the Fed Up Facebook page then she realized that we were right and moved quickly to erase the evidence … of course, without bothering to offer an apology for her smarmy tactics.

Looks like she took my advice even before I gave it, since I was going to say:

Aviva Romm, when it comes to preventing shame over C-sections, physician heal thyself!