Vaccination is one the greatest public health advances of all time.

It has saved, and continues to save, literally millions of lives each year, yet many well meaning parents have become convinced that vaccines are harmful and there is no amount of scientific evidence that can convince them otherwise.

As Rachel Burke reports in The Olympian, We’re hard-wired not to change our minds:

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Vaccine injuries are the demonic possession of our time.[/perfectpullquote]

The clearest example may be [the] work around the popularly held belief that the measles-mumps-rubella (MMR) vaccine is linked to autism, a claim made by a single, long-discredited study. Nyhan, Riefler, and their research partners surveyed over 2,000 parents; most received one of the following: (1) materials from the Centers for Disease Control (CDC) correcting the falsehood; (2) a pamphlet describing the dangers of measles, mumps, and rubella; (3) pictures of children who have these illnesses; or (4) a mother’s firsthand story about how her baby almost died from measles. A control group received no materials.

The results: None of these approaches made parents who were opposed to vaccines more likely to vaccinate their kids… (my emphasis)

Why are anti-vax parents evidence resistant?

Nyhan and Riefler speculate that “we’re even more inclined to hold on to a false belief if it threatens our sense of self.”

There’s no doubt that ego is a large part of anti-vax belief. As I’ve written before, anti-vaccine parents view themselves as smarter than others. They see their combination of self-education and defiance of authority as an empowering form of rugged individualism. Anti-vax supposedly marks out their superiority from those pathetic “sheeple” who aren’t self-educated and who follow authority. Psychologically, they cannot tolerate the reality that they are both ignorant and gullible.

But fear of vaccines is hardly new. It’s been around for 200 years, nearly as long as vaccines themselves. And Anti-vax advocates have a perfect record! They’ve never been right even once!!

Why, in the face of the scientific evidence of vaccines’ safety and efficacy and the historical evidence that anti-vaxxers have never been right about anything, do they cling so desperately to their beliefs?

It could be a form of mass hysteria.

According to Wikipedia:

… [M]ass hysteria … is a phenomenon that transmits collective delusions of threats, whether real or imaginary, through a population in society as a result of rumors and fear…

A common type of mass hysteria occurs when a group of people believe they are suffering from a similar disease or ailment, sometimes referred to as mass psychogenic illness or epidemic hysteria.

Fear of vaccines is a collective delusion transmitted through a population as a result of rumor and fear. Yet there’s no doubt that those in the grip of anti-vax hysteria  are completely convinced that children, including their children, have been harmed by vaccines.

But there was no doubt in the minds of the citizens of 1690’s Salem, Massachusetts that members of their communities were being harmed by demonic possession. Just like contemporary anti-vax parents who fervently believe in vaccine injuries, not merely in theory, but in practice in their own children, Salem resident believed passionately in demonic possession, not merely in theory, but in practice in their own neighbors.

Adolescent girls … began to have fits that were described by a minister as “beyond the power of Epileptic Fits or natural disease to effect.” The events resulted in the Salem witch trials, a series of hearings and executions of 25 citizens of Salem and nearby towns accused of witchcraft. The episode is one of America’s most notorious cases of mass hysteria, and has been used in political rhetoric and popular literature as a vivid cautionary tale about the dangers of isolationism, religious extremism, false accusations and lapses in due process.

There’s no such thing as demonic possession and there never was, so why were Salem residents so sure they were witnessing it?

1. Someone had a “fit.” That really happened.
2. It was interpreted in light of religious beliefs and irrational fears.
3. Other people also had “fits.” They and those around them were not making it up; they were certain it had happened.
4. The population was gripped by the collective delusion of a threat and transmitted that fear through rumor, aided and abetted by those who stood to benefit from convincing others that demonic possession was real.

Sound familiar? It should. It bears a striking resemblance to anti-vaccine advocacy.

1. Someone had a bad reaction after vaccination. That really happened.
2. It was interpreted in light of scientific ignorance and irrational fears about vaccines.
3. Other people also had “bad reactions.” They and those around them were not making it up; they are certain it happened.
4. The population was gripped by the collective delusion of a threat and transmitted that fear through rumor, aided and abetted by those who stand to benefit from convincing others that vaccines injuries are real.

The key point, which cannot be overemphasized, is that many anti-vaxxers honestly believe that they have witnessed the evidence with their own eyes and they’re not lying. They’re like the Salem residents who also believed they had witnessed the demonic possession with their own eyes and they weren’t lying, either.

That’s why anti-vaxxers are evidence resistant. It’s not merely that they can’t understand the evidence because they lack scientific knowledge; it’s not merely that view themselves as “educated,” “empowered” and transgressive. It’s that they are in the grip of mass hysteria.

Vaccine injuries are the demonic possession of our time. They are a collective delusion, fueled by fear and rumor, and fanned by those who stand to benefit from the fear.

Hi. It’s Ima Frawde, CPM. The initials after my name stand for “certified professional mammarist.” I am an expert in normal breasts.

I don’t know about you, but I am sick and tired of the hegemonic, patriarchal, male medical system constantly telling women that their breasts are “broken” and don’t make enough breastmilk. They try to undermine breastfeeding by destroying women’s trust in their own breasts.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]First trust breasts to make adequate milk and they will. Then trust them not to get cancer and they won’t.[/perfectpullquote]

Are we suppose to believe we’re inferior to squirrels, cows, rabbits and elephants? There are about 5000 species of mammals and we’re supposed to believe that we’re the only one that ever needs to supplement our young to ensure their survival. How did survive for thousands of years before formula? If insufficient breastmilk were really that dangerous, our species wouldn’t be here.

It’s not different from the hegemonic, patriarchal male medical system that insists that women of a certain age should have regular mammograms to detect breast cancer. Out of those 5000 species of mammals, we’re the only one that supposedly need routine scans. How did we managed to survive for thousands of years before mammography? If breast cancer were really that dangerous, our species wouldn’t be here.

It’s not a coincidence that my comments sound similar to those made by Ina May Gaskin on Feministing. Ina May is my hero. Everything she says goes double for me (heh, heh, heh, just a little breast humor).

Why should you listen to me? As a CPM (certified professional mammarist), I am an expert in normal breasts. In fact, certified professional mammarists are trained specifically to manage breast health. In order to obtain my certification, I had to meet rigorous standards; I was required to submit a portfolio of 20 breasts examined within the home (right and left breasts are each counted separately). Plus I had to observe examination of an additional 20 breasts done by my preceptor. That means I had contact with 20 separate women before I began practicing on my own!

That’s how I know that you should trust your breasts throughout your life. First trust them to make adequate breastmilk and they will. Then trust them not to get cancer and they won’t.

Insufficient breastmilk doesn’t exist. It’s fear that makes women “misperceive” adequate supply as insufficient. Baby screaming from hunger, losing weight and failing to thrive? It’s not insufficient breastmilk. It must be a defective baby tongue; cut it immediately. Trust breasts, but never trust baby tongues!

What? You don’t believe that lack of trust causes “perceived” insufficient milk supply? You mean you deny that there is a mind-body connection?

Once you understand that fear causes “perceived” insufficient supply, you can see why trusting breasts is the best way to ensure adequate breastmilk. Routinely weighing babies in unnecessary when you trust breasts. Weighing babies might reveal that the baby is losing weight and that lead to a cascade of unnecessary interventions like formula supplementation, not to mention undermining women’s faith in their own bodies.

But you shouldn’t think that certified professional mammarists reject technology. Far from it. We routinely recommend electronic and battery powered breast pumps. We routinely recommend off label use of dangerous medications to boost milk supply. And don’t forget our frequent recommendation to laser your baby’s tongue.

Are we always correct? Unfortunately, no, but some babies are just meant to die. They probably would have died eventually even if they were supplemented with formula anyway (it might have been 10 or 20 years later, but the principle holds true).

We’re also working on developing better methods for boosting milk supply. We are creating a new generation of breast pumps. Even as we speak, several groups of women are currently fabricating pumps to our own specifications, using no plastic of any kind; they are knitting them from steel wool! As soon as our breast pumps are fully knitted, we plan large qualitative studies comparing the experience of pumping with a knitted pump vs. a conventional machine.

You might be wondering why we are bothering with breast pumps at all. In answer, I will paraphrase anthropologist and midwife Melissa Cheyney:

The rituals of trusting breasts are not simply about assuring personal transformation via the transmission of counter hegemonic–empowering value —although many women certainly described their experiences this way. Breastfeeding rituals, are also self-consciously political in their intent. As the popular bumper sticker “Mammarists: Changing the World One Breast at a Time” suggests, trusting breasts is a performative medium for the promotion of social change.

That’s just a longer way of saying “trust breasts!”

Bitter grief is often an unselfish motivator:

Consider organizations like Mothers Against Drunk Driving, started by parents who suffered the ultimate loss, to ensure that other parents would not have to endure the death of a child. Consider the various laws named after children who were abducted and murdered, championed by parents who wanted to make sure that no other family’s life would be shattered by crushing grief…

Where is the organization to ensure that no other mother has to endure the preventable death of a child at homebirth or because the mother refused recommended obstetric or newborn care guidelines?

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The risk is not merely double or triple, but 81x higher for babies who don’t receive the vitamin K injection.[/perfectpullquote]

There is no such organization.

Why? Because the mothers who have a child who was injured or died as a result of homebirth or of refusal of routine interventions often collude with the providers who encouraged them.

Thankfully, that is not the case for Stefani Leavitt. She has unselfishly shared the story of the terrifying result of failing to give the recommended Vitamin K injection to her newborn daughter.

You can read the entire story across three blog posts:

The First 24 Hours
Getting Out of the Woods
Why It Happened: The Truth About Vitamin K Deficiency Bleeding

Leavitt has the inner strength to be brutally honest, even with herself:

This may be the hardest part of Olive’s story that I will write. The part where I admit that what happened to her was nearly 100% preventable. And yet it happened.

It happened because she didn’t receive her dose of Vitamin K when she was born.

I spent the first few days that she was in the hospital blaming myself. I ran through the situation in my mind, trying to understand why I would say “No” to something that would keep my daughter from being in this much pain. In Olive’s situation, unfortunately, it was largely accidental. That didn’t stop me from feeling guilty, however, and only recently did I accept that although this happened to Olive, it doesn’t have to happen to another person’s baby.

What happened to Olive?

It all started on Valentine’s Day.

Olive had struggled to eat the night before, so she and I had been up all night…

When we woke up [from a nap], Olive could barely open her eyes – the only word I could think of was “lethargic,” and since that never coincides with anything good, I immediately called the doctor… The doctor told us to go to the ER immediately …

At the hospital:

By this point, Olive was breathing and her heart was beating, but she was otherwise non-responsive…

The pediatric intensivist, Dr. M., came and asked me if we had given our daughter a Vitamin K shot at birth, and I just stared at him and said I had no idea. He said they needed to bring her in for a CT scan, but every time they tried to place an IV (which she needed before she went for the scan), the vein would blow. She was bleeding from every spot that she had gotten poked that night, including the LP point on her spine.

Finally they were able to perform the head CT.

The next thing I knew I was sitting in a room with Eric and our Bishop from church, and seeing the doctor wheel in a computer with pictures on the screen… Just by looking, you could tell it wasn’t good. Where the left side of her brain was supposed to be, there was a huge (16 mm, to be exact) mass of blood, pushing her entire brain off center.

Dr. M. explain that a clot had developed which was placing immense pressure on Olive’s brain. Not only that, but there was bleeding on the back of the right side of her brain as well. The water pockets that are within the brain were completely destroyed, and the tissue on the left side of the brain looked mostly damaged. He said that the lack of Vitamin K in Olive’s system resulted in her body’s inability to clot. Anything as small as putting her down in her bed could have caused this bleed. Since she couldn’t clot, the bleeding didn’t stop. There had been one other case of this that the doctor had seen – I asked what had happened then, and was told that the baby hadn’t lived.

The treatment? Correcting her clotting deficiency with Vitamin K and brain surgery to remove the blood clot.

After the brain surgery:

I walked into the hospital room to find Olive hooked up to a plethora of machines, with even more wires running from her. She had a gauze turban around her swollen head, and a breathing tube running from her throat. As hard as it was to see her like that, I was full of so much gratitude that she was alive and I was comforted by the sudden knowledge I had that she was going to be okay – I just didn’t know how.

The surgery had been successful:

Where there was once a huge mass of blood, her brain had moved back into place. The neurologist who spoke with us, Dr. R., explained that there had been a significant stroke on the left side of her brain, but it was on the surface, rather than in the central gray matter. On the right side, there was a pocket of blood in the cerebellum, but this was expected to absorb into the brain. Overall, Dr. R. said that he felt “cautiously optimistic.” ..

The next days were marked by milestones, which all seemed like little miracles.

Towards the end of the third day, Olive was taken off of sedation and opened her eyes for the first time in days.

Olive continued to improve.

Overall, Olive’s progress has been remarkable.

Olive is nothing short of a miracle. After seeing her condition the first night and seeing her now, only two weeks later, I am still in a state of disbelief. Countless doctors and nurses told me what amazing progress she was making. She took to nursing again like a champ. She is moving both sides of her body, with very little difference in strength. And since her surgery, we have all been able to see her beautiful smile.

There will still be struggles from here, I’m sure. We are uncertain of what Olive’s future will bring, or what challenges this brain injury will cause. But despite all of that, I am so grateful for the blessing that she has been to our life thus far …

But none of this had to happen at all. Stefani writes:

… [T]he Vitamin K shot should not be optional.

When a baby is born, they have a limited amount of Vitamin K in their system, and while some begin to produce it on their own, others struggle with a severe Vitamin K deficiency. If these babies receive a shot of Vitamin K at birth, this isn’t a problem and they will eventually begin to produce the Vitamin K on their own in order to avoid any deficiency bleeding. In a case like Olive’s, however, the severe lack of Vitamin K results in an inability to clot, which can cause deadly bleeds in a baby’s brain and gastrointestinal system.

In children that receive the Vitamin K shot at birth, the chance of developing this disease is relatively nonexistent. When the shot is not given, however, the risk of having late stage (from 2 weeks to 2 months old) deficiency bleeding is 81 times greater.

The sad thing is that while it is extremely rare, recent years have seen children suffering from VKBD more and more often. Four cases were reported at a hospital in Tennessee in 2013 – one resulted in severe gastrointestinal bleeding and the other three in severe intracranial bleeding. In the hospital where Olive was treated, there was one other recent, which resulted in the child’s death.

Stefani speaks from experience:

I can’t change what happened to Olive, but I can try to prevent it from happening to another baby.

Please share Olive’s story. Please tell the mothers you know about the importance of Vitamin K. Please let them know that the risks of rejecting the shot may not be as rare as they think.

Kudos to Stefani for turning her family’s pain into vital advice for other families. She will never know how many lives she may have saved.

It is perhaps the ultimate irony.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””] There has never been a randomized controlled trial that shows attachment parenting doesn’t cause autism![/perfectpullquote]

Advocates of attachment parenting, many of whom reject vaccination because of fear of autism, have failed to recognize that it is attachment parenting itself that causes autism.

Consider the ever growing body of evidence:

1. Both autism and attachment parenting have increased dramatically in the past two decades. The concept of attachment parenting is credited to Dr. William Sears, who first mentioned it in his book in 1988. Studies show that in the VERY SAME YEAR, the incidence of autism began to rise dramatically. (Environ. Sci. Technol., 2010, 44 (6), pp 2112–2118).

2. Regardless of who practices attachment parenting or how they define it, no one can deny that the practice of attachment parenting ALWAYS precedes the diagnosis. There are no known cases in which attachment parenting practices began after autism was diagnosed.

3. The purported mechanism is thought to be the sensory deprivation caused by baby wearing and extended breastfeeding. During the critical early months and years, when babies should be learning about the world and making millions of neuronal connections, babies exposed to AP are deprived of contact with the outside world (many are constantly carried in a position where they can see nothing but the surface of the mother’s clothing) and their exposure to other individuals such as fathers, grandparents and childcare workers is severely limited.

4. No one has EVER shown that attachment parenting does not cause autism.

5. Even those who strongly reject the notion that attachment parenting causes autism acknowledge that there are MANY children raised with attachment parenting who are subsequently diagnosed with autism.

6. Many of those who deny a link between attachment parenting and autism stand to lose money if attachment parenting is shown to be harmful. Authors, lactation consultants, and sling manufacturers, among others, have a strong economic motivation for discouraging investigation of this link.

It is time to launch a comprehensive investigation of the harmful side effects of attachment parenting in general, and the relationship between attachment parenting and autism in particular. It’s hardly coincidental that the same people who make money from attachment parenting have NEVER bothered to study these harmful effects. They insist that attachment parenting is beneficial, but there is no way they can know for sure.

****

Those who have read this far have probably figured out that this is a satire. I’m satirizing the “thinking” of anti-vaccine parents on the purported relationship between vaccines and autism. The purpose of the satire is to demonstrate that what seems to anti-vaxxers to be irrefutable “reasoning” is nothing more than nonsense and logical fallacies.

The above list highlights the major rhetorical gambits of anti-vaxxers. Number 1 is the claim that because both vaccination and autism have risen in recent decades, vaccines must cause autism. That claim is foolish as can be seen when the same observation is made about attachment parenting and autism. Just because the incidence of two phenomena rise at the same time does not mean that one caused the other. And that doesn’t even take into account the fact that rates of vaccination have actually been FALLING while rates of autism have been rising.

Number 2 is the temporal connection. Early childhood vaccination precedes the observation of autistic symptoms, but a lot of things precede the observation of autistic symptoms. That’s because those symptoms typically do not appear until the early toddler years and anything that takes place during infancy (like attachment parenting practices) will precede the observation of symptoms.

Number 3 invokes a spurious mechanism of action. It is certainly plausible, but no evidence is presented that it actually occurs. Anti-vaxxers play the same tricks with claims about the deleterious effects of “toxins” in vaccines.

Number 4 is the “argument from ignorance.” The argument from ignorance dares the opponent to prove a negative and when a negative cannot be proven (since that is a logical impossibility in most cases), the conclusion is proclaimed that this “shows” that vaccines cause autism.

Number 5 is the “fallacy of the lonely fact.” Since some children have developed autism after their parents practiced attachment parenting, the conclusion is drawn that large numbers of children will develop autism after their parents practice attachment parenting.

Number 6 is the conspiracy theory that undergirds almost every attempt to defend anti-vax. But when the same “reasoning” is applied to attachment parenting, it is easy to see that the conspiracy theory does not have much explanatory power. There is ALWAYS someone who stands to benefit from any recommendation or practice. That does not mean that those who benefit are actively hiding information on harms and risks from everyone else.

The concluding paragraph is the seemingly innocuous call for “more research.” But we cannot and should not waste time “researching” connections that have no basis in science. If we did, we could spend a lot of time “researching” whether the moon is made of green cheese or whether clouds are made of marshmallows. The call for “more research” is just away to add gravitas to what are often ridiculous claims. We do not need to “research” every wacky idea that anti-vaxxers devise and our refusal to “research” those ideas without basis in science or logic is not a sign that someone is hiding something.

The key point is that what passes for “reasoning” among anti-vaxxers is not reasoning at all. It is nothing more than wild accusations, logical fallacies and conspiracy theories. There is no more reason to take seriously the idea that vaccines cause autism than there is to take seriously the idea that attachment parenting causes autism.

Want to enrage a lactivist? Turn their tactics against them.

Lactivists insisting that corporations profit from formula? Point out that lactation professionals make 100% of their income from promoting breastfeeding.

Lactivists boasting breastfeeding saves lives? Ask them why they can’t show term babies whose lives have been saved.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]This is just the beginning![/pullquote]

Lactivists waxing rhapsodic over the purported benefits of breastfeeding? Mention that exclusive breastfeeding has become the LEADING risk factor for newborn re-hospitalization.

All are variants of culture jamming, the practice of forcing people to question the status quo, in this case the unreflective and unscientific insistence that breast is best. Lactivists get so mad when they are culture jammed!

In order to turn their tactics against them, it helps to understand exactly how those tactics work. The paper Embodied Online Activism: Breastfeeding Activism (Lactivism) on Facebook is very helpful in that regard.

The author starts with history of the movement:

Grass-roots breastfeeding support used to be understood and studied as face-to-face support groups based on formal and informal peer support. Over the last ten years, with a growing importance of mediatised sociability and the creation of ‘digital mundane’ practices of daily interactions and constant connectivity, a new form of grass-roots mobilisation has emerged.

She reports on her study of lactivist Facebook groups:

We share pictures of ourselves breastfeeding our children (‘brelfies’), experiencing the pleasure and navigating the exposure this kind of sharing can bring, including anger and fear of charges of ‘indecency’. We can also be ‘vicariously traumatised’ by the experiences of others: death of a fellow member’s child, reports of neglect, abuse, illness or stories of birth trauma. The complexities of ‘translations’ of self into social media spaces are also premised on presence – being ‘on’ for the night feeds, tapping away to fellow night-feeders with one hand, whilst nursing a child. Presence in a group is therefore experienced and performed on a personal, intimate level, but also ‘done’ in public ways.

The Fed Is Best Foundation support groups have copied lactivists. Women share pictures of their healthy breastfed, formula fed or tube fed babies. Group members are traumatized by the experiences of women whose babies have been harmed by breastfeeding. Women provide each other with support at any time of the day or night.

Facebook breastfeeding groups are primarily spaces of support, in which informational and instrumental support are inextricably linked with affirmation and emotional support parents receive. The ‘knowledge base’ on breastfeeding – research on human milk and lactation – is used to learn to live as a breastfeeding body and turned by group members into practical, actionable know-how. Biomedical knowledge on breastfeeding is also used by lactivist to justify and defend the practice, bolstered by technologically-facilitated knowledge dissemination, using pictorial content and mediated connectivity, which allows for breastfeeding knowledge to be circulated quickly and efficiently.

Fed Is Best support groups as well as groups created by me and other feeding safety advocates offer support in which scientific evidence is inextricably linked with affirmation and emotional support.

Lactivists love memes:

One example of this is the stomach size meme, which ranks amongst the most frequently shared lactivist images, using comparisons with fruit, marbles, or sweets to visualise the size of a newborn infant’s stomach. Its widespread use in online forms of breastfeeding activism – in groups, but also by pages and blogs – attests to a synergy between content (easy to read, pictorial information) and its digital format (easy to duplicate, copy, forward, and Typically posted as a comment or relayed in a ‘PM’ (private message), the swiftness of reply and the ease of re-posting are crucial, if the information is to reach a person pressurised to use formula to supplement… As digital artefacts ‘memes’ are also manipulable – easy to adapt, edit and (re)produce in different linguistic versions, another aspect of importance across different contexts of lactivism.

Sadly, this lactivist meme is a lie based on a paper from 1921. Copious, contemporary scientific evidence shows that infant stomach capacity is far larger. Feeding safety advocates counter it with memes of our own.

I use memes daily for the same reason that lactivists use them: they’re easy to understand, share and adapt to specific situations. My memes have the added advantage of accurately representing the scientific literature.

But the heart of lactivist activism is “electronic contention.”

For example, alterations to ‘walls’ have been made easier through the ‘report a correction’ feature. Using this function lactivists blocked from commenting and engaging in debate on a ‘bingo’ wall repeatedly corrected the erroneous claims made in its public posts.

Similarly, the function of ‘rating’ business pages facilitates ‘negrating’, or negative rating of pages representing businesses deemed to be discriminating against breastfeeding women or expressing negative views on breastfeeding. A coordinated mass action, negrating involves posting negative ratings and reviews on the offender’s wall and bringing its rating down using Facebook’s star system. Negrating aims to negatively impact the reputation of an organisation (reputational damage).

Both of these direct and disruptive forms of action are perceived from within the movement as ‘defence’ and as an ‘adjustment’ or ‘corrective’ measure, but may be interpreted by the affected entities (and their followers) as a (coordinated) ‘attack’…

Feeding safety advocates are able to react to lactivist attacks by using their tactics against them: reporting comments, negrating and descending en masse on “offending” Facebook pages.

The ways in which such individual interventions are then multiplied through specific technological means by lactivists whose mutual allegiance grows out of a sense of commonality predicated on engagement in an embodied practice of breastfeeding, is equally important for understanding the role of embodiment in online activism. Actions which use social media technologies in similar ways, like metadata tagging to raise awareness of an issue (hashtags) or documentation of transgressions and harassment (hollabacks), are not uniquely lactivist and have been used across social media.

That’s why feeding safety advocates use them, too.

The Fed Is Best Foundation has begun copying lactivists’ offline actions, too. They purchased their first billboard to alert women to the dangers of insufficient breastmilk and offer them an opportunity to connect with the organization. The billboard was purchased with money from — among others — parents whose babies have been harmed. Lactivists have responded with shock and anger. How dare feeding safety advocates use the exact same tactics that lactivists have mobilized against them?

I’ve got news for lactivists: this is just the beginning!

Feeding safety advocates are watching lactivists and learning from them. Most importantly we have realized that if a lactivist tactic is effective against us, it will be equally effective when deployed against lactivists.

There’s nothing wrong with breastfeeding. There’s a tremendous amount wrong with the lactation profession.

How can that be? Aren’t lactation professionals simply promoting breastfeeding?

That was probably how it started out, but they quickly became obsessed with exclusivity; that fetish is harming babies and mothers.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There’s one infant feeding goal that eclipses all others: the baby’s goal to be fully fed.[/pullquote]

I can’t tell you when the obsession started; it certainly didn’t exist when my children were born in the late 1980’s and early 1990’s. But I can tell you when it became codified: 1996 with the publication of Diane Weissinger’s seminal paper Watch Your Language.

Weissinger drew the battle lines:

When we … say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, “So what?” Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy and thus safety and adequacy-of artificial feeding…

That isn’t quite accurate — breastfeeding is a great, but not the best possible, way to feed babies — but it does highlight a central insight: lactation professionals recognized that when they tell the truth about breastfeeding, many women will choose not to do it.

Therefore, Weissinger encouraged lactation professionals to exaggerate the benefits of breastfeeding and massively exaggerate the “harms” from formula feeding. Her goal — and it became the goal of the profession as a whole — was to give women no choice but to breastfeed.

Why?

Weissinger was startlingly honest:

We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature.

And:

All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances.

Do you see anything there about what’s good for babies and mothers? I don’t. I see an effort to create full employment for lactation professionals.

Lactation professionals did more than merely exaggerate the benefits of breastfeeding and concoct “risks” of formula feeding; they became obsessed with exclusivity.

Prior to the 1990’s the thinking went that if some breastfeeding is good, more breastfeeding is probably better. But that practical position hardened into the fabricated claim that “even one bottle of formula” can harm an infant.

Where was the evidence for that position? There wasn’t any. There wasn’t even a theory; the claims about the microbiome came a generation later.

Indeed, to the extent that research had investigated the issue, it was difficult to find any dose-response relationship for breastfeeding. Some minimum amount of breastfeeding (two months, for example) appeared to convey many of the SAME benefits as longer duration of breastfeeding.

No matter. Exclusivity has been fetishized and that obsession is responsible for the harms of breastfeeding promotion we see to day.

Exclusive breastfeeding is the LEADING risk factor for newborn re-hospitalization. It results in approximately 40,000 preventable newborn hospitalizations a year at a cost of hundreds of millions of dollars. Breastfeeding isn’t the problem; exclusive breastfeeding is.

How can that be? Breastfeeding, like any natural process, has a significant failure rate. Up to 15% of mothers may be unable to produce enough breastmilk to fully nourish a baby, at least in the days immediately following birth. That might sound high until you consider that fully 20% of established pregnancies end in miscarriage. Nature doesn’t do perfection; it does “good enough.”

Imagine how different the experience of breastfeeding could be if lactation professionals didn’t fetishize exclusivity: the benefits — medical, psychological and economic — could be enormous.

No baby would be forced to experience agonizing hunger; any mother who felt her baby needed formula could offer it.

Once home, women could both reduce pressure on themselves and get more sleep by allowing partners and family to feed the baby one or more bottles per day.

Women could more easily return to jobs and careers knowing that they don’t have to pump every two or three hours because the baby sitter or daycare provider can give formula if there is not enough stored breastmilk.

It’s not breastfeeding that is causing dehydration, starvation, maternal exhaustion, maternal guilt and shame; it’s the fetish for exclusive breastfeeding.

But wait! Aren’t lactation professionals merely helping women meet their breastfeeding goals?

Prof. Amy Brown asks What Do Women Lose if They Are Prevented From Meeting Their Breastfeeding Goals?

Many women stop breastfeeding before they are ready, often leading to feelings of anxiety, guilt, and anger. Critics of breastfeeding promotion blame breastfeeding advocates for this impact, claiming that if the focus were merely on feeding the baby, with all methods equally valued and supported, maternal mental health would be protected. Established health impacts of infant feeding aside, this argument fails to account for the importance of maternal breastfeeding goals …

But who made exclusivity a goal? It wasn’t mothers. Prelacteal supplementation is common in cultures around the world. It is lactation professionals who fetishize exclusivity.

But that reality doesn’t stop Brown:

The purpose of this article is to highlight the importance of recognizing and valuing women’s individual breastfeeding goals, and not dismissing or invalidating their experience if they do not meet these by telling them that they do not matter.

Brown seems to have forgotten the most critical goal of all, the one that eclipses ALL other goals: the baby’s goal to be fully fed.

The bottom line is that the obsession with breastfeeding exclusivity is a fetish of lactation professionals. There is very little if any scientific support for it; it is harmful to babies and mothers; and the only ones who appear to benefit from it are lactation professionals themselves.

The term birthrape didn’t work out so well for the natural childbirth industry.

It was in vogue for several years, but generated not the outrage at obstetricians that midwives and doulas were hoping for, but rather revulsion at their appropriation of the suffering of rape victims to publicize their cause.

The new term is obstetric violence.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Campaigns against obstetric violence aren’t about protecting women; they’re about promoting midwives.[/pullquote]

But there’s a dirty little secret at the heart of campaigns against obstetric violence: they rarely mention midwives, a major group of perpetrators. How do I know that midwives are a significant source of obstetric violence? Because that’s what the scientific literature shows.

A new study in The Lancet, How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys, raises the alarm:

We prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment.

What did they find?

2016 labour observations and 2672 surveys were done. 838 (41·6%) of 2016 observed women and 945 (35·4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75·1%] of 253; survey: 295 [56·1%] of 526) or caesarean section (observation: 35 [13·4%] of 261; survey: 52 [10·8%] of 483), despite receiving these procedures. 133 (5·0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15–19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3·6, 95% CI 1·6–8·0) and younger women with some education (OR 1·6, 1·1–2·3) were more likely to experience verbal abuse, compared with older women (≥30 years), adjusting for marital status and parity.

The study itself has generated mainstream press and has been highlighted by midwives and their advocates. But here’s the kicker: there are very few obstetricians in these facilities; much of the violence was committed by midwives.

If those complaining loudest about obstetric violence actually cared about women, they’d acknowledge that midwives are perpetrators. Perhaps some of them do, but I haven’t seen it yet. That doesn’t surprise me because complaints about obstetric violence aren’t about improving birth for women; they’re about demonizing obstetricians, midwives’ chief economic competitors.

Ironically, midwives have institutionalized perhaps the largest category of obstetric violence: campaigns for “normal birth.” Denying women epidurals, trying to talk them out of them, delaying them or failing to call for the anesthesiologists who can perform them is emblematic of obstetric violence. There is not much that is more brutalizing in a healthcare setting than deny relief for excruciating pain.

That’s merely one aspect of abusive campaigns for “normal birth.”

Consider activist Amie Newman’s definition of obstetric violence:

It is an umbrella term that includes disrespectful attitudes, coercion, bullying, and discrimination from care providers, lack of consent for examinations or treatment, forced procedures like C-section by court order, and also physical abuse.

It’s hard to imagine anything more disrespectful than telling a woman how she ought to give birth and ignoring what she might want (pain relief, interventions, maternal request C-section), yet this is precisely what campaigns for normal birth do. By campaigning on behalf of a process instead of for patients themselves, proponents of unmedicated vaginal birth are explicitly ignoring the needs and wishes of those patients.

A good rule of thumb for respectful care is: “Nothing about me without me.”

Declaring that unmedicated vaginal birth is an institutionally supported goal instead of one choice among many possible choices, midwifery organizations are most definitely making policy and determining practice WITHOUT the input of women.

When will campaigns against obstetric violence take midwives to task for their role in perpetuating it? Not any time soon. Why? Because campaigns about obstetric violence aren’t about protecting women; they’re about promoting midwives.

A new paper confirms what we have known for several years: the Baby Friendly Hospital Initiative is a failure on its own terms.

I’m not talking about the fact that it harms babies with its dubious “achievement” of making exclusive breastfeeding the leading risk factor for newborn re-hospitalization leading to tens of thousands of re-hospitalizations per year at a cost of hundreds of millions of dollars.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Instead of putting lactation professionals in charge of doctors and nurses; put doctors and nurses in charge of lactation professionals.[/pullquote]

I’m not talking about the fact that its insistence on forcing 24 hour mother-infant rooming in has led to a small epidemic of newborns suffocating in their mother’s hospital beds or sustaining skull fractures from falling out of them.

And I’m not talking about the soul searing guilt that as many as 15% of mothers experience when they are biologically incapable of producing enough breastmilk to fully nourish an infant, especially in the early days after birth.

No, I’m talking about the fact that the Baby Friendly Hospital Initiative (BFHI) appears to have NO IMPACT on breastfeeding rates after hospital discharge.

A new paper, Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications, looked at breastfeeding data for all the nearly 4 million infants born in the US in 2015.

Breastfeeding outcome data from the 2018 Centers for Disease Control (CDC) Breastfeeding Report Card were used as a basis for determining outcomes from the corresponding 2015 birth cohort. Linear regression models were used to determine the strength of association of breastfeeding initiation and Baby-Friendly hospital penetrance and attainment of postdischarge breastfeeding rates. All hospital births from all 50 states, 3 territories, and the District of Columbia were included in the study.

They failed to find ANY ASSOCIATION (let alone causation) between the BFHI program and breastfeeding continuation rates.

Baby-Friendly designation did not demonstrate a significant association with any postdischarge breastfeeding outcome. There was no association between Baby-Friendly designation and breastfeeding initiation rates.

The results are starkly presented in two sets of graphs.

Any Breastfeeding at 6 and 12 months:

Exclusive Breastfeeding at 3 and 6 months:

The left side of each set shows a strong correlation — not surprisingly — between breastfeeding initiation rates and breastfeeding continuation rates. As breastfeeding initiation rates rise, breastfeeding rates at 6 and 12 months and exclusive breastfeeding rates at 3 and 6 months rise. The correlation is not surprising since only those women who start breastfeeding can continue breastfeeding.

The right side of each set shows NO correlation between births at BFHI facilities and breastfeeding continuation rates. Those who gave birth at BFHI facilities are NOT more likely to breastfeed at 6 and 12 months (or exclusively breastfeed at 3 and 6 months) than those who gave birth at non-BFHI facilities. The increasing adoption of BFHI certification has had NO IMPACT on breastfeeding rates.

My take away:

Instead of putting lactation professionals in charge of doctors and nurses in an effort to increase breastfeeding rates, we should be putting doctors and nurses in charge of lactation professionals.

The findings of this paper are neither new nor unexpected.

By the end of 2016, it had become clear that the BFHI failed to increase breastfeeding rates. The paper Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms noted:

…[O]nly individual-level interventions demonstrated effectiveness at improving breastfeeding, whereas system-level interventions, including the World Health Organization’s Baby-Friendly Hospital Initiative (BFHI), did not.

By November 2018, enough data had accumulated for the editor of the premier breastfeeding journal to call for a review of the Ten Steps on which the BFHI is based. He noted that A Critical Review of the Baby-Friendly Hospital Initiative Is in the Works.

The author’s use of scare quotes is particularly telling:

One cannot argue with the recent “success” of the Baby-Friendly Hospital Initiative (BFHI) that was established in 1992 in response to a call to action for support of breastfeeding by the 45th World Health Assembly…

In 2011, in only two states was there >20% BFHI penetration. In 20 states there were no Baby-Friendly facilities. Seven years later, in 2018, 40% of the birthing facilities in 12 states were certified as Baby-Friendly. Most striking, >1 million births (roughly 25%) of the annual US birth cohort were taking place in such facilities…

But there was no evidence that it was having any impact on breastfeeding rates. He concludes:

The measure of success of any initiative should not be the number of certified institutions per se but the actual breastfeeding rates that will meet our healthy people objectives.

The Baby Friendly Hospital Initiative chooses to incentivize hospitals, nurses and lactation consultants on certification rates and exclusive breastfeeding rates at discharge. There was NEVER any data that showed that either was correlated with breastfeeding continuation rates. Now there’s increasing evidence that they are definitively NOT correlated with breastfeeding continuation rates.

The BFHI is actually HARMING babies and mothers.

As the authors of the new paper note:

…concerns about associated neonatal sentinel events including sudden unexpected postnatal collapse (SUPC), newborn falls, and newborn dehydration and jaundice, which are recognized by the American Academy of Pediatrics, the WHO, The Joint Commission, and the CDC.

In addition, there has been increasing recognition of adverse perceptions of Baby-Friendly designation based on reports of the experiences of some mothers in Baby-Friendly designated hospitals. This is reflected in the new WHO Baby-Friendly Guideline statement on the need to respect maternal autonomy and avoid judgmental attitudes which could infringe on the mother’s dignity. The Breastfeeding Report Card outcomes also support the results of the recent US Preventive Services Task Force report, which demonstrated that Baby-Friendly designation was not a consistently effective intervention and that individual approaches were more successful.

The authors conclude:

Baby-Friendly designation penetrance did not demonstrate any positive postdischarge breastfeeding association.

In other words, putting a private organization of breastfeeding professionals in charge of breastfeeding in hospitals has been a terrible mistake and a failure on its own terms. If we want to increase breastfeeding rates and reduce breastfeeding complications, we should put hospitals, doctors and nurses in charge of lactation professionals.

The BFHI has become little more than a full employment program of, by and for lactation professionals. No doubt they are already penning their Letters to the Editor to defend the increasingly indefensible Baby Friendly Hospital Initiative. Let the excuses begin!

In the summer of 2000 I was diagnosed with a brain tumor.

I had developed double vision because a benign tumor, a meningioma, was pressing on the nerve that controlled the movement of one of my eyes. The tumor was small, but located deep in my brain. That meant that surgery to remove it would likely lead to significant nerve damage.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Under the guise of what’s best for women, midwives & lactation professionals recommend what’s best for themselves.[/pullquote]

Surgery was, up through the 1990’s, the only treatment. However, as a physician I had access to those who knew about the latest options. A dear friend, a neuro-radiologist, told me about stereotactic (“gamma knife”) radiosurgery, which is not surgery at all, but a one day course of radiation to kill the tumor.

I consulted a neurosurgeon, widely reputed to be one of the best in the US, to find out what he recommended. He recommended surgery.

I asked him:

Which treatment had the highest cure rate? He told me that surgery had a cure rate of 85% and radiation had a cure rate of 95%.

Which treatment had the highest complication rate? He told me that surgery would likely lead to loss of sensation on the left side of my face and deafness in my left ear. Radiation had no complications beyond local irritation.

If radiation treatment failed, would that make subsequent surgery more risky? He told me that it would have no effect.

So I asked him why he was recommending surgery if radiation had a higher cure rate and a lower complication rate. To his credit, he replied honestly:

“I don’t do the gamma knife.”

In other words, under the guise of recommending what was best for me, the surgeon recommended what was best for HIM. His financial and non-financial conflicts of interest led him to recommend the application of his personal skills.

But here’s the key point: I don’t doubt that he believed surgery was best.

Because of his personal experience, he believed implicitly in his surgical skills. Because of his lack of experience with the new form of radiation treatment he distrusted it. Because too much of medical practice is doing what you have been taught to do — in his case surgery — he recommended surgery.

That’s also the ethical problem at the heart of contemporary midwifery and lactivism. Under the guise of what’s best for women, they recommend what’s best for themselves.

And here’s the key point: I don’t doubt that they believe it.

Because of their personal experience, midwives and lactation consultants believe implicitly in their own skills. Because of lack of broader experience with complications, they are sure they don’t exist or are “variations of normal.” Because too much of midwifery and lactation medicine is recommending what they’ve been taught to do, they always recommend themselves and their limited skills.

Midwives like Sheena Byrom and Hannah Dahlen consistently recommend the application of midwifery to just about every situation. Byrom and Dahlen consistently demonize anything they can’t bill for — such as epidural anesthesia or C-section. If they can’t do it, they fervently believe, you don’t need it.

They are blind to the fact that their financial and non-financial conflicts of interest cause them to recommend what is best for midwives, NOT what is best for mothers and babies.

Lactation professionals like Amy Brown, Jack Newman or Natalie Shenker relentlessly recommend breastfeeding and greater financial support for lactation professionals. It doesn’t matter what the situation might be, the answer is ALWAYS more lactation support and more breastfeeding and pumping. They consistently demonize formula because they can’t bill for it and it undercuts their own economic wellbeing. As far as they’re concerned, if they can’t do it, you don’t need it.

They are blind to the fact that their financial and non-financial conflicts of interest cause them to recommend what is best for them, NOT what is best for mothers and babies.

Most women don’t have the luxury I had, not merely the ability to consult multiple providers, but the professional contacts to know whom to call. Ultimately, I chose to have the radiation treatment, a 9 hour marathon in a machine like an MRI, involved having a metal frame anchored into my skull. The results — as I had been counseled — were not immediate since it took time for the tumor to shrink and die. It was three months before I noticed any improvement and six months before the double vision completely resolved.

On the other hand, there was no surgical recovery. No drilling into my skull. No bleeding or infection. No hearing loss or loss of feeling in my face.

I do not begrudge the neurosurgeon for his recommendation to have a major surgical procedure that I didn’t need and could have harmed me. He was honest and I was aware that surgeons tend to recommend surgery even when there are other (sometime better) treatment options available. They know their own skills and trust them. They don’t trust technologies that are new and with which they are unfamiliar.

But a better surgeon, with greater awareness of his own financial and non-financial conflicts of interest, would have made it his business be thoroughly familiar with treatment options beyond those he could offer. He would have recommended the radiation treatment — or counseled me about it at the very least — since that was an option I deserved to have. It was also the option that was best for me, far better than what he could offer.

Ethical midwives, with greater awareness of their own financial and non-financial conflicts of interest, would counsel women about all options and not demonize the ones they can’t offer. I don’t doubt that they believe with every fiber of their being that midwifery care is almost always best. They can’t see the truth that just because it is best for them, doesn’t mean it is best for babies and mothers.

Ethical lactation professionals, confronted with the fact that they have single handedly made exclusive breastfeeding the leading cause of newborn re-hospitalization, would offer formula to any woman who wants it, not demonize formula and certainly not insist that what women need is more of the “support” that harmed their babies. I don’t doubt that they believe with every fiber of their being that breastfeeding is almost always best. They can’t see the truth that just because it is best for them, doesn’t mean that it is best for babies and mothers.

It was my brain tumor, in my head, and I deserved to know all the options for treatment so I could make MY choice.

When it comes to birth and breastfeeding: her body, her baby, HER choice … free from pressure by those who stand to benefit from offering only what they can do.

It’s truly amazing the lengths to which lactation professionals will go to avoid having to address the elephant in the room. They’ll even invite me to lunch!

What’s the elephant?

Exclusive breastfeeding has become the LEADING risk factor for newborn re-hospitalization.
As many as 1 in 71 exclusively breastfed babies will be re-hospitalized.
That means approximately 40,000 PREVENTABLE re-hospitalizations per year.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why wait until we’re in the same city, Leah? I’m happy to meet you on Facebook Live any time, including today![/pullquote]

No professional health or lactivist organization — not La Leche League, not the World Health Organization, not the American Academy of Pediatrics — denies it.

Indeed the problem has become so acute that at the forthcoming AAP Annual Meeting, they are devoting a “Controversies in Pediatrics” session to the Baby Friendly Hospital Initiative. You don’t do that if you think the program is safe and successful.

That’s the background against which I took issue with the flagrantly false claims of Yashed LC, Leah Drexler, who thought she was criticizing the Fed Is Best Foundation, but was actually illustrating her own appalling lack of knowledge on the critical topic of infant dehydration/starvation.

STARVING KIDS DON’T HAVE ENERGY TO CRY STRAIGHT FOR DAYS IN A ROW.
They stop crying by the second day and start sleeping way. Too. Much. That’s when the high bilirubin sets in.
There’s many thing that could make a child cry continuously after birth, but lack of calories to expend is not one of them.
Kids that truly aren’t getting any food by day 2-3, you can barely get them to open their eyes and it’s terrifying. I’ve caught a few with senseless old nurses who are just like “he’s so sleepy”…YEAH HE’S PROBABLY FORMING KERNITERUS [sic] GENIUS.

For some inexplicable reason, Drexler appears to think there is no middle ground between getting adequate calories and getting none. A baby will cry when he is hungry; if breastmilk is insufficient, he will continue to cry after eating and that crying will be powered by the calories that he did ingest.

Drexler’s nonsensical claim is hilarious, right? Not exactly. Fully 90% of cases of kernicterus (jaundice induced brain damage) occur in breastfed babies. The arrogant ignorance of lactation professionals like Drexler that is harming newborns each and every day.

I commented:

Why is Yashed LC trying to normalize infant starvation? Why is she gaslighting women who speak out about the harm to their babies and themselves?

Exclusive breastfeeding has become the LEADING risk factor for newborn hospital readmission. There are tens of thousands of preventable newborn hospitalizations per year at a cost of hundreds of millions of dollars.

What is Yashed LC doing about it besides pretending it isn’t happening? …

Drexler had no answer to that nor does she wish to discuss it. But she needs to fool her followers by changing the subject.

She posted a long — and entirely irrelevant — screed to the members of her private group, ending with this:

Lastly, because she is wholly incapable of matching the strength and receipts [sic] of the trees she keeps barking up: tell her to meet me and KSA for lunch. I hear she has no capacity to have a reasonable conversation in real life but Kimberly Seals Allers and I would love to give her the opportunity to prove everyone Wrong! Never too late to change. I mean … she could be the OB who discovers how to cure breast malfunction! …

Oh, and because I know you’re still in here, the answer is in my and Kimberly Seals Allers we do these things in person. Full legitimacy. You can email me at … Make sure you copy KSA, since you are suddenly so ready to talk.

I responded that I’m not going to email her (just like I didn’t email Maureen Minchin) because I don’t trust either of them to accurately report back to their followers. Drexler is already insisting that any discussion take place NEXT YEAR, apparently hoping her followers will forget that I already bested her.

Why wait until we’re in the same city, Leah? I’m happy to meet you on Facebook Live any time, including today!

Surely you want to set the record straight and explain why you ignored my substantive claims, right?

Or maybe you just want to hide. We’ll see.