I’m reading a fascinating book about the history of conservativism, The Reactionary Mind: Conservatism from Edmund Burke to Donald Trump by Corey Robin.

It’s offers an illuminating view of contemporary politics, but what has struck me most forcibly is something the author never intended. It’s an amazing explication of the political forces behind the contemporary natural mothering movement. And make no mistake, natural mothering is a political movement whose aim is to control women.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Submission is women’s primary duty, and natural mothering teaches them to submit to pain, exhaustion, and social isolation.[/perfectpullquote]

Natural mothering, though often touted by liberals, is a conservative movement and Robin describes conservativism as:

the felt experience of having power, seeing it threatened, and trying to win it back.

Men traditionally arrogated power over women to themselves; the legal and economic emancipation of white women in industrialized countries threatened men’s power, and the ideology of natural mothering is a subversive attempt to win that power back.

Robin writes:

Despite the very real differences between them, workers in a factory are like secretaries in an office, peasants on a manor, slaves on a plantation —even wives in a marriage— in that they live and labor in conditions of unequal power. They submit and obey, heeding the demands of their managers and masters, husbands and lords. They are disciplined and punished.

Sometimes they freely choose the relationship, as is often the case in modern marriages, but they don’t choose its entailment.

…[M]arriage contracts have been interpreted by judges, themselves friendly to the interests of … husbands, to contain all sorts of unwritten and unwanted provisions of servitude to which wives … tacitly consent, even when they have no knowledge of such provisions or wish to stipulate otherwise.

He offers the powerful example of marital rape:

Until 1980, for example, it was legal in every state in the union for a husband to rape his wife. The justification for this dates back to a 1736 treatise by English jurist Matthew Hale. When a woman marries, Hale argued, she implicitly agrees to give “up herself in this kind [sexually] unto her husband.” Hers is a tacit, if unknowing, consent “which she cannot retract” for the duration of their union. Having once said yes, she can never say no. As late as 1957—during the era of the Warren Court—a standard legal treatise could state, “A man does not commit rape by having sexual intercourse with his lawful wife, even if he does so by force and against her will.” … Implicit consent was a structural feature of the contract that neither party could alter.

In the 20th Century, women began to acquire rights traditionally reserved to men. That irritated and angered men whose power was threatened.

More than the reforms themselves, it is this assertion of agency by the subject class — the appearance of an insistent and independent voice of demand — that vexes their superiors.

To paraphrase Robin:

Natural (aka intensive) mothering is the theoretical voice of this animus against the agency of women. It provides the most consistent and profound argument as to why women should not be allowed to exercise their independent will, why they should not be allowed to govern themselves or the polity. Submission is their first duty, and agency the prerogative men.

On the political right, the backlash to women’s emancipation has been met with the rise of religious fundamentalism. According to this view, God wants women to stay home with children and give up other ambitions. That option was not available to the political left. They came up with natural mothering instead; according to this view, Nature wants women to stay home with children and give up other ambitions.

One of Robin’s central insights is that the private is political.

If women … are provided with the economic resources to make independent choices, they will be free not to obey their husbands …

So they must be prevented from obtaining independent economic resources. This is the private life of power:

Politicians and parties talk of constitution and amendment, natural rights and inherited privileges. But the real subject of their deliberations is the private life of power. “Here is the secret of the opposition to woman’s equality in the state,” Elizabeth Cady Stanton wrote. “Men are not ready to recognize it in the home.”

Behind the riot in the street or the debate in Congress is the wife refusing to submit to her husband.

When the conservative looks upon a democratic movement from below, this (and the exercise of agency) is what he sees: a terrible disturbance in the private life of power.

In the 1930’s and 1940’s, when Grantly Dick-Read looked upon white women of the “better classes,” he saw a terrible disturbance in the private life of power. Given the ability to exercise political and economic rights, women were “failing” in their primary duty to reproduce.

In the 1950’s, when the traditionalist Catholic women who founded La Leche League looked upon the small but growing phenomenon of mothers working, they saw a terrible disturbance in the private life of power. Allowed the ability to work, women were “failing” in their primary duty to nurture children. The founders reasoned that if they could convince women to breastfeed, they would be forced to abandon jobs and careers.

In the 1970’s, when Dr. Bill Sears, a fundamentalist Christian, looked upon the political and economic emancipation of women, he saw a terrible disturbance in the private life of power. He did not hide what he was trying to restore. As he wrote in the 1997 book, The Complete Book of Christian Parenting and Childcare:

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

What else does God purportedly expect from parents?

From husbands:

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

From wives:

Now as the church submits to Christ, so also wives should submit to their husbands in everything…

Robin quotes the French monarchist Louis de Bonald:

In order to keep the state out of the hands of the people, it is necessary to keep the family out of the hands of women and children

Natural mothering is fundamentally a conservative philosophy:

The priority of conservative political argument has been the maintenance of private regimes of power …

The philosophy of natural mothering — natural childbirth, lactivism, attachment parenting — is reactionary in the truest sense of the word. It is a reaction to the political and economic emancipation of women with the goal of returning to the private regime of male power.

It’s inexplicable on its face.

Tens of thousands of babies are readmitted to the hospital each year for breastfeeding complications at a cost of hundreds of millions of dollars. Exclusive breastfeeding is now the leading cause of newborn hospital readmission. Not a single lactivist organization or public health organization — not La Leche League, not the CDC, not the World Health Organization — denies this. Yet none of them are doing anything about it.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactation professionals hate formula more than they love babies.[/pullquote]

Why? Because injured babies are considered acceptable collateral damage in the lactivist war on formula companies.

Don’t believe me? Try to have a discussion with a lactivist, professional or lay, without the lactivist immediately mentioning formula companies, referencing the Nestle scandal of the 1970’s and accusing anyone who disagrees with them of being in the pay of the formula companies themselves.

I guarantee that when this blog post is discussed in the lactivist community, lactivists will reflexively — with no evidence — accuse me of shilling for formula manufacturers.

Wait, what? You thought breastfeeding is about what’s good for babies and mothers? That’s what lactation professionals and lactivists say, but watch what they do. They are engaged in a massive effort to erase from public awareness the tens of thousands of babies and countless mothers harmed by aggressive breastfeeding promotion.

Their calculus is simple — and ugly. They view themselves as generals in a war on formula; companies are the enemy and babies are the soldiers unwittingly drafted into their armies. Generals knowingly send soldiers to death and permanent injury “for the greater good.” Lactation professionals do the same thing with babies and mothers; they knowingly send them into harm “for the greater good” of depriving the formula industry of profit.

It certainly isn’t because breastfeeding is so obviously beneficial. Indeed, in industrialized countries the benefits of breastfeeding term babies are so trivial that they cannot be detected in large populations. Ask a lactation professional to show you how many lives have been saved by exclusively breastfeeding in the US — as I asked Melissa Bartick, MD several years ago — and you will get a response like I got.

Commenting on piece by Dr. Bartick’s on the Academy of Breastfeeding Medicine blog, I asked her directly:

Where is the evidence that term babies lives has been saved? Where is the evidence that the diseases you insist are decreased by breastfeeding are actually decreasing as a result of breastfeeding? Where are the billions of healthcare dollars you claimed would be saved as the breastfeeding rates rose?

Her response:

…To my knowledge, no one has actually dug it up yet. It’s not fair to say “it doesn’t exist.”

So Dr. Bartick acknowledges that the evidence for major benefits of breastfeeding DOESN’T exist.

What does exist is deep and abiding anti-corporatist bias against formula companies.

Make no mistake, Nestle and other formula companies DID engage in unethical behavior in Africa by luring women away from breastfeeding even though they lacked access to clean water with which to prepare formula. The result was the death of tens of thousands of babies.

But what got lost in the righteous anger toward Nestle’s behavior is that there was NEVER anything wrong with formula; the problem was the water used to prepare it. No matter; the goal was to punish Nestle and other formula companies and the best way to do that was demonize formula itself.

The Ten Steps of the Baby Friendly Hospital Initiative only make sense if their primary purpose is to punish formula companies:

There is no evidence that judicious formula supplementation is harmful to the breastfeeding relationship; the ban on formula supplementation only makes sense as punishment for formula companies.

There is no evidence that nipple confusion is real. The ban on artificial nipples only makes sense as a punishment for formula companies.

There is no evidence that insufficient breastmilk is rare; indeed the evidence shows that it is common. The insistence only makes sense as a punishment for formula companies.

There is no evidence that an occasional bottle of formula given to allow the mother to get a good night’s rest or to have some time to herself will harm an ongoing breastfeeding relationship. Insisting that it will only makes sense as a punishment for formula companies.

I have no love for formula companies, but they are hardly the most immoral businesses out there. Letting babies starve in order to punish formula companies makes as much sense as letting adults starve to punish cereal manufacturers for sugary cereals, farmers for E.coli tainted vegetables and meat packing companies for salmonella infected chicken.

The sad fact is that lactation professionals hate formula more than they love babies. As far as they are concerned (and they are best judged on their actions, not their words) babies are acceptable collateral damage in the lactivist war on formula.

But innocent people are never acceptable collateral damage in efforts to rein in unscrupulous companies. Lactation professionals have to make up their minds: do they truly hate formula companies more than they love babies?

The stories, tragic as they are, begin to run together in my mind.

I’m not talking about the part where the baby dies an easily preventable death (nearly all homebirth deaths are preventable) … and according to the most accurate data available, homebirth increases the risk of perinatal death 9-fold or more.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Unprofessional, abusive behavior from a homebirth midwife during labor? Ditch her and head to the hospital.[/pullquote]

And I’m not talking about the part where the homebirth midwife is utterly clueless that, although the labor is progressing, the baby has been dead for hours. Most American homebirth midwives have no clue what is going on during labor; they “trust” birth and usually nothing bad happens.

No, the most striking aspect to their sameness is how many involve the abuse of women at the hands of their homebirth midwives.

Midwife Cindy Morrow, CPM is currently in the spotlight for recent disasters. What’s most remarkable is how contemptuously she treated her patients.

In one case, the baby’s parents are seeking #JusticeforAsa.

You can read the entire story of Asa’s tragic — and totally preventable — death here.

Asa’s mother’s labor began on Wednesday evening.

On Thursday evening:

Later in the evening, I lost my mucus plug and had bloody show. We told Cindy to come on to the home and I have messages showing that we were expecting for our midwife to be coming around 9:45 pm … [A]bout three and half hours from that timing. Midwife had not arrived … Gabe called Cindy, letting her know my contractions were tough and she could hear me in the background. Cindy said, “Oh! It sounds like it may be go time.” …

Friday morning:

5:50 am I was going through tough contractions and my water broke. The water was tinged green. We told Cindy, she came in the room twenty minutes later. She wanted to get ready before coming in to check on me. Said everything was fine and she went back to bed for a bit because she was extremely tired. Cindy and the assistant Zoe, left to go have breakfast, somewhere.

Friday evening:

… The doula said she thought I must be progressing but she wished Cindy would’ve been there to actually take care of me and to be checking on me… Gabe then called the midwife and said she needed to be at the house. She came back around about 1.5 hours … That evening, Cindy was telling me that I was about 8 cm dilated and that probably by morning I should be pushing…

Cindy and Zoe then both left again to stay at THE HOTEL (my emphasis).

Saturday afternoon (approximately 60 hours after labor had begun):

Midwife and her assistant went outside and started talking. Gabe came outside and they immediately stopped talking and seemed bothered that he interrupted. They told him to go rest and that they were going to try and help me progress. They asked him to leave the room, three separate times… They were not letting Gabe come into the room and would not answer when he asked about my blood pressure and baby’s heartbeat…

Later:

During all that time, nothing is progressing and so Cindy came into our room to speak with us… She said that she thought we ought to head to the hospital to maybe get an epidural to help me better progress … She always kept telling me…. “This isn’t an emergency. Everything is fine.” She wanted me to travel to a hospital that was 2.5 hours away, in ATL traffic. The key to this hospital is that this is where Dr. Bootstaylor is. The doctor who is for midwives and home births…

Asa’s father insisted on a closer hospital:

On the way to the hospital, Cindy told us this exactly,” When we get to the hospital, I am going to tell the front desk I had called ahead to let them know we were coming. But I’m not actually going to call.”

And:

According to Cindy’s notes, which I have, Asa had a heartbeat of 120, an hour before we arrived to the hospital. We arrived around 8:45 pm.

But Asa had already been dead for many hours.

Asa had passed for over 15-24 hrs inside of me. She began deteriorating inside of me which led to a large infection. Her skin peeled completely off at the touch.

Asa’s parents will have to live with their grief for the rest of their lives.

Why did they tolerate such contemptuous treatment from the homebirth midwife? Why did it take them literally days to finally head to the hospital?

Homebirth midwives emotionally groom their patients and one of the keys to emotional grooming is isolation. They ensure emotional isolation of their clients by promoting distrust of real medical professionals and advising them to ignore friends and relatives.

When things start to go wrong — and Asa’s parents were suspicious things were going wrong DAYS before they went to the hospital — fear of opprobrium from medical professionals, relatives and friends, is enough to keep them from heading to the hospital until it’s too late.

Thinking about homebirth?

Think about protecting yourself from emotional grooming. Ditch any provider who speaks disparagingly of other medical professionals. Don’t let the midwife separate you from family and friends. Most importantly, if you experience unprofessional and abusive behavior from the midwife during labor, ignore her and head to the hospital.

Yes, you might have to deal with medical professionals who think your choices were irresponsible, but you can console yourself with your live baby … instead of keeping your pride intact while you bury your dead one.

Yesterday I wrote about the vicious treatment — the “Semmelweis treatment” — of the Fed Is Best Foundation. I explained that lactation professionals demonize Fed Is Best for the same reasons Semmelweis’ colleagues demonized him when he identified that doctors were spreading childbed fever. They can’t bear to acknowledge that they might be harming patients.

But why are lay lactivists often equally vicious in the way they interact with women who can’t or don’t wish to breastfeed? Instead of viewing all women as potential allies in the struggle to raise children, lactivists position women who make different choices as antagonists. They employ two primary rhetorical gambits: friend-enemy politics and “formula as poison.”

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists’ favorite rhetorical gambits: friend-enemy politics and “formula as poison.”[/pullquote]

Why?

Because the issue of breastfeeding vs. bottlefeeding isn’t about food and it isn’t about babies. It’s about womanhood. For lactivists, that is a battle worth fighting to the emotional death.

A new paper, Formula for Success: Dueling Discourses in the Breastfeeding Battle, from the International Conference on Gender Research explains that lactivism promotes a “culture of true womanhood.”

Lactivists:

… have essentialized womanhood to a degree that excludes the concept of maternal choice… [E]ssentializing womanhood in this manner reifies doctrines of motherhood as a dualistic construct formed by competing subjects of good and evil…

The cultural activism we analyze here continues to rely on an archetypal figurehead of natural motherhood— the True Woman … The breastfeeding mother emerges as the True Woman via hegemonic femininity … These Cult narratives employ the rhetorical strategy of definition by negation where the bottle feeding mother is portrayed as a “bad mother” who unnaturally puts herself before her children…

Both friend-enemy politics and “formula as poison” reflect the cultural and rhetorical touchstone of lactivism: the Nestle formula scandal. In the 1970’s and 1980’s, Nestle marketed formula in Africa and babies died as a result. Of course formula was NEVER harmful to babies; it was the contaminated water used to make the formula that was dangerous. No matter. Forty years have passed, but that tragedy shapes lactivist rhetoric today.

The authors use The Alpha Parent and KellyMom as paradigmatic examples. They also investigate Jack Newman, MD and Darcia Narvaez, PhD.

The Alpha Parent supports its heavily pro-breastfeeding stance with articles like “Is Formula Feeding Worse than Smoking?” and tweets depicting breastfeeding mothers and captions that read “Tbe, Skinny on Mommy Guilt (those of a nervous or butthurt disposition, look away now) #breastfeeding”. As a whole, The Alpha Parent uses aggressive, friend-enemy rhetoric that valorizes breastfeeding mothers and creates a strong sense of identification amongst them, while concomitantly blaming bottle feeding mothers for their children’s ailments …

Framing women who make different choices as enemies is key.

The Alpha Parent engages in a game of debasement with a strategy of shaming “other” women (women who are not breast feeding). It valorizes the true woman via heuristics of the natural (“If you feel guilty of your choice, that is your internal accountability system being triggered”)…

What about KellyMom?

Specifically addressing whether or not it is appropriate to make bottle feeding mothers feel guilty, Jack Newmann, a contributor to KellyMom writes:

“Let’s look at real life… If [a woman] went to the office with her one-week old baby and told the physician that she was feeding her baby homogenized milk, what would be the reaction of her physician? Most would practically collapse and have a fit. And they would have no problem at all making that mother feel guilty for feeding her baby cow’s milk, and then pressuring her to feed the baby formula. (Not pressuring her to breastfeed, it should be noted, because “you wouldn’t want to make a woman feel guilty for not breastfeeding”.)”

Newman mobilizes the rhetorical strategy of “formula as poison.”

Newmann’s article demonstrates how women are disciplined when operating outside of traditional gender boundaries. Newmann strips women of their choices in performing motherhood and places control of motherhood in the hands of medical professionals…

It would be more accurate to say that Newmann places control of motherhood in the hands of lactivist medical professionals. All others can be ignored.

Darcia Narvaez, PhD draws on anti-corporatist bias:

Narvaez’s … employed an interesting tactic of associating breastfeeding and health with the capitalist ideology:

“When your fellow citizens are not breastfed, it costs you. If you were not breastfed, it is costing you. It is costly for all members of society, whether or not you are a parent or grandparent… People who are breastfed are less likely to be a host of mental and physical diseases throughout life and are less likely to end up in prison”… [I]n denying her child the breast, predetermined her or him to a life of crime. In contrast, the breastfeeding mother, quite literally passed her virtue on to her children through her milk and breast.

But why make enemies of women who, though they make the choice to bottlefeed, are actually sympathetic to the struggles of ALL mothers?

For the same reason that radical conservative political outlets portray liberals as enemies and liberalism as moral and political poison: to build a following.

These websites and biogs promote a strong sense of identification amongst users and allow women to engage in a heuristic of the natural when addressing infant health. Through high levels of interactivity (posting, replying, commenting, etc.) followers foster strong group identifications which provides a rationale for their beliefs, to the detriment of holistic discussions that engage professional research and outside opinions.

And just as the conservative political culture constructs compromise as betrayal and support for the “other” as anathema, contemporary lactivist culture constructs compromise on aggressive breastfeeding promotion as betrayal and support to the formula feeding “other” as anathema.

It’s a great strategy for boosting followers, but a harmful response to everyone else.

It doesn’t have to be this way.

The authors don’t discuss the Fed Is Best movement, but the movement provides an antidote to toxic lactivist culture. Feeding safety advocates, myself included, promote CHOICE, not specific choices and try to support ALL women regardless of the way they choose to feed their babies. Because the truth is that formula is NOT poison and the benefits of breastfeeding term babies in industrialized countries are trivial. Babies don’t care whether they are breastfed or bottlefed so long as they are fed.

Breastfeeding and bottle feeding mothers could be allies in the struggle that is motherhood … but only if lactivists stop playing friend-enemy politics and drop the ugly rhetorical gambit of “formula as poison.”

It was a tragedy in every respect.

Dr. Ignác Semmelweis was an obstetric physician in 19th century Vienna. He … was appointed to Vienna General Hospital in 1846. There, he became aware of a puzzling disparity.

The hospital offered two free maternity clinics for economically disadvantaged women. First Clinic was run by all-male doctors and medical students. Second Clinic was operated by midwives and their students. The clinics admitted on alternating days…

… Between ten and twenty percent of women in First Clinic died of puerperal [childbed] fever, while Second Clinic’s percentage was only two to four percent.

Why was there such a vast disparity?

The death of a fellow doctor provided Semmelweis with his central insight:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If Semmelweis had created a slogan it would have been “Disinfected Is Best.”[/pullquote]

One of his colleagues pierced his skin on a scalpel while performing an autopsy and died from the infection. When Dr. Semmelweis examined the wound on his dead colleague, he found it showed the pathology as the bodies of women who died of puerperal fever.

Semmelweis realized that the cause of childbed fever was something in the cadavers and insisted that doctors wash their hands in chlorinated lime before seeing obstetric patients.

Immediately after this policy was instituted, mortality rates dropped 90%…

He broadened his theory to include infected but still-living women, not just corpses, and ordered doctors to wash between patients, too, and the numbers of infections fell even further. When Dr. Semmelweis included the medical instruments used on the women, the rate of infection dropped to around one percent.

If Semmelweis had created a slogan it would have been “Disinfected Is Best.”

What was the response to this astounding discovery? Nothing but abuse.

But Dr. Semmelweis’s discovery was not heralded as the life-saving breakthrough it was. Instead, doctors were offended by the implication that they were dirty and needed to wash more, or that doctors could be somehow at fault for their patients’ demise…

We could call this the “Semmelweis treatment.” His insight and the remarkable improvement in patient outcomes that resulted was rejected because it offended the people who were causing the deaths. As far as his detractors were concerned, “disinfected could never be best” because that would mean acknowledging their own role in the suffering they left in their wake.

Sadly, a similar scenario is playing out today. Christie del Castillo-Hegyi, MD and Jody Seagrave-Daly RN, IBCLC, founders of the Fed Is Best Foundation, are being subjected to the Semmelweis treatment.

Like Semmelweis, Dr. del Castillo-Hegyi came to her central insight because of a tragedy in her life, though in her case it happened not to a colleague, but to the doctor herself. Her own son sustained permanent brain injuries as a result of profound dehydration. She had been concerned that her son wasn’t getting enough breastmilk, but was repeatedly reassured by lactation professionals — incorrectly — that he was receiving all the breastmilk he needed.

Dr. Castillo-Hegyi’s central insight is that insufficient breastmilk and its complications are common, affecting up to 15% of first time mothers especially in the early days after birth. She has also identified a startlingly simple treatment that could prevent the tens of thousands of newborn hospital readmissions for breastfeeding complications each year: observing babies closely for weight loss and dehydration and having a low threshold for temporary formula supplementation. In other words, Fed Is Best.

What has she received for this critical discovery? Nothing but abuse!

Her insight and the improvement in neonatal outcomes that would result have been rejected for the exact same reason Semmelweis’ insight was rejected: it offends lactation professionals, the people who are causing the suffering of mothers and babies.

In contrast to Semmelweis, who couldn’t offer a scientific explanation for what he observed, Dr. del Castillo-Hegyi has provided reams of analysis, copiously referenced with contemporary scientific papers that have confirmed her central insight. No matter. She, Seagrave-Daly, and the Foundation have been subjected to an endless stream of abuse and invective.

Lactivist Prof. Amy Brown wrote an influential blog post entitled Why Fed Will Never Be Best:

‘[F]ed is best’ is simply putting a sticking plaster over the gaping wound that is our lack of support for breastfeeding and mothering in general.

She insists that lactation professionals — with their aggressive efforts to promote exclusive breastfeeding and avoid supplementation under almost all circumstances — are providing the best possible care. This despite the fact that exclusive breastfeeding is now the leading cause of newborn hospital readmission, responsible for tens of thousands of readmissions each year. Brown argues that what women and babies need is more of that care.

It’s the equivalent of Semmelweis’ medical colleagues who insisted they were providing the best possible care DESPITE the fact that they were actually causing patients’ deaths. It’s the equivalent of the colleagues arguing that what women needed was more of that (deadly) care.

Lactation professional Kimberly Seals Allers heaps abuse on the Fed Is Best Foundation:

… Is Fed is Best more interested in saving lives or stoking fear and anger among women? …

Perhaps FIB is only interested in speaking into their own echo chamber and putting out reports. And telling inflammatory stories designed to incite emotions but they are short on actions with others …

She’s and many of her sympathizers — particularly lactivists who run Facebook pages — are no different from the physicians who heaped abuse on Semmelweis.

There’s actually a Facebook group entitled “Fed Ain’t Best” whose administrators use a defaced version of the Fed Is Best logo as their own.

Semmelweis was nothing if not colorful in his own defense.

In an open letter to a medical editor he wrote:

I denounce you before God and the world as a murderer, and the History of Puerperal Fever will not do you an injustice when, for the service of having been the first to oppose my life-saving [treatment] …, it perpetuates your name as a medical Nero.

I wouldn’t go so far as to say Amy Brown, Kimberly Seals Allers and lactivist bloggers are medical Nero’s, but they are definitely on the wrong side of history. I have no doubt that, like Semmelweis, the Fed Is Best Foundation will ultimately be recognized as having been correct all along.

The only question is how many babies and mothers have to be harmed in the meantime by lactation professionals who —like Semmelweis’ detractors —have put their own egos above patient wellbeing.

You can’t make this stuff up!

If Lamaze International and Hannah Dahlen wanted to demonstrate their contempt for the wellbeing of mothers and babies, they couldn’t do better than to promote Robert Biter as a feature speaker at their Australian conference. Nothing illustrates contempt for women quite like featuring a doctor stripped of his license for harming women.

Biter initially had his license to practice medicine severely restricted because of 7 separate instances that the Medical Board of California described as:

“gross negligence in his care and treatment” of a patient”
“repeated negligent acts” performed on 6 additional patients”
“prescribing without an appropriate prior examination”
“acts of dishonesty with respect to the care and treatment of patients”
“failure to maintain adequate and accurate medical records”
“general unprofessional conduct”

Biter was suspended from the practice of medicine for 60 days, followed by 7 years of strict probation. However, AFTER he signed documents acknowledging the findings of the Board and the prescribed disciplinary action, but before the official start of the suspension, he presided over a homebirth death. In November of 2013 he surrendered his license to practice medicine. You can read the findings of the Board here.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Nothing illustrates contempt for women quite like featuring a doctor stripped of his license for harming women.[/pullquote]

According to the records of the San Diego Superior Court, at least 8 lawsuits have been filed against him. I recently learned that he is trying to resurrect his career by opening a birth center in Mexico. Perhaps the licensing standards there are less stringent or perhaps the Mexican authorities are unaware of his history of “gross negligence, repeated negligent acts and general unprofessional conduct.”

Biter has publicly complained that he was victimized because of his commitment to natural childbirth but the majority of accusations of negligence and harm were claimed by GYN patients and had nothing to do with birth.

So why is he a featured speaker at a Lamaze conference on “Creating a New Paradigm in Birth”? Why is Hannah Dahlen proudly appearing along side him? Because contemporary natural childbirth ideology has precious little to do with what is good for women (otherwise why invite someone who has allegedly caused so much harm to women?) and is really about increasing employment opportunities and market share for midwives, doulas and childbirth educators.

Indeed, irony of ironies, in 2013 Biter was a featured speaker at a Human Rights in Childbirth conference. Naïvely, you or I might think that human rights in childbirth refers to making sure that all women have access to competent medical care, without regard for ability to pay, that incarcerated women not be forced to labor in chains, and that women have access to birth control. Don’t be foolish. Who cares about those women? HRiC is about the “rights” of white, Western, relatively well off midwives, doulas and childbirth educators to do and say whatever they want and be paid for it.

What about the human rights of the women and babies injured and killed by negligent and unprofessional providers? They apparently have no rights at all. Lamaze and Dahlen should be ashamed of themselves for associating with Robert Biter, but we’ve known for a long time that they are beyond shame.

I suspect that Lucy Ruddle, IBCLC feels put upon by me.

First I took her to task for her meme that analogized formula to cake.

I created this:

Then she implied that anyone who recommends formula supplementation for starving babies is trying to “sabotage” breastfeeding mothers. I created this to express my incredulity that a lactation consultant could discuss breastfeeding problems without once mentioning the baby and his or her suffering:

Most recently Ruddle posted a meme questioning the existence of pressure to breastfeed:

It was a classic example of gaslighting and I called her on it.

She was angry. That’s the typical response of people who suffer from attribution bias, the tendency to assume that one’s own motives are pure while simultaneously insisting that anyone who disagrees has malicious motives.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The continuing insistence that “breast is best” is designed to create anger, anxiety, and to pitch us against one another.[/pullquote]

I don’t doubt that Ruddle’s motives are pure. I simply point out the harmful impact her claims have on women who can’t or don’t wish to breastfeed.

But finally there’s something on which we can agree, the Facebook post she wrote today:

The entire point of (“insert feeding method of choice) is best” is to create anger, anxiety, and to pitch us against one another. They aren’t about true support, because if they were, there would be no need to argue. X is best relies on divides… women beating each other up… it relies on our fears. Because while we’re arguing over who is best, we’re not focusing our attention on the real issue. Which is that mothers are not valued, heard, or encouraged to trust their instincts. That we are routinely silenced, are subject to abuse from professionals, and that we are not given access to the quality of respectful, kind support we all deserve…

I would modify that only slightly:

The ORIGINAL point of “breast is best” was to maximize the health of babies. At the time it came into widespread use many professionals believed that breastfeeding must be best because it is natural. There were also studies that suggested that breastfeeding had major health benefits.

But over the following years several things became clear:

• Breastfeeding in industrialized countries is socially patterned. Most benefits that were ascribed to breastfeeding are actually benefits of wealth.
• Breastfeeding, like most natural reproductive processes, has a high failure rate.
• Tens of thousands of babies are hospitalized each year for breastfeeding complications.
• Exclusive breastfeeding has become the leading risk factor for newborn hospital readmission.
• Women who can’t breastfeed successfully are suffering soul searing guilt.

Indeed, it’s been clear for MORE THAN A DECADE that breast ISN’T best for many babies and many mothers. The response of lactation professionals has been to ignore the evidence and dig in their heels. They keep shouting “breast is best” regardless of the fact that the claims of benefits have been largely debunked.

Why?

I agree with Ruddle’s assessment:

The continuing insistence that  “breast is best” is designed to create anger, anxiety, and to pitch us against one another.

Breastfeeding promotion in 2019 isn’t about what’s best for babies. It’s about what’s best for lactation consultants and there is no limit to the amount of anger and anxiety (not to mention harm to babies) that they are willing to provoke to pitch women against each other.

Ruddle’s point is the one I have been making repeatedly for years:

This isn’t about true support, because if it were, there would be no need to argue. BREAST is best relies on divides… women beating each other up… it relies on our fears. Because while we’re arguing over who is best, we’re not focusing our attention on the real issue. Which is that mothers are not valued, heard, or encouraged to trust their instincts. That we are routinely silenced, are subject to abuse from professionals, and that we are not given access to the quality of respectful, kind support we all deserve.

Fed is best is a REJECTION of that mentality. Fed is best doesn’t divide women; it doesn’t promote women fighting with each other; it soothes fears. The POINT of “fed is best” is to VALUE and HEAR women and to encourage them to trust their instincts about whether formula, breastfeeding or both is best for their babies or for them.

Breast is best is designed to silence women; there can be no argument. It serves to justify the abuse that lactivists heap on women who can’t or don’t wish to breastfeed; and it promotes a culture that insinuates that women who formula feed are “dupes” of the formula industry and lazy, selfish women who aren’t “baby friendly.”

Ruddle’s words are words to live by. She and other lactation consultants should try to live by them instead of merely paying them lip service.

My email inbox is filled with messages from women who hate themselves, blame themselves and are nearly incapacitated by guilt at being unable to breastfeed exclusively.

Why?

It’s certainly not because breastfeeding in industrialized countries is so beneficial for babies that it has a measurable impact on mortality rates, life expectancy or IQ. Walk into any kindergarten classroom and it is impossible to tell which children were breastfed and which were not.

It’s because in the past 30 years we have seen the rise and professionalization of a movement, lactivism, thats benefit from viewing new mothers the same way farmers view cows: as milk suppliers.

[pullquote align=”right”]Regardless of the difficulty, the lactivist prescription is always the same: “Breastfeed harder.”[/pullquote]

Consider:

The concept of choice doesn’t exist among lactation consultants. There is only one acceptable choice and that is to breastfeed. They will go to great lengths to help women who make that choice, but they will do nothing for women who bottlefeed.

A mother’s pain is irrelevant. For the breastfeeding industry, just because a mother has cracked and bleeding nipples is no excuse for her to avoid being a milked like a cow. It’s just another opportunity to sell her products that purportedly reduce the pain.

A baby’s hunger is irrelevant. For lactation professionals, just because a baby is screaming in hunger is no excuse for his mother to provide milk from any other source than herself or another mother breastmilk dispenser.

Breastfeeding difficulties are irrelevant. Regardless of the difficulty (poor latch, flat nipples, poor suck, insufficient breastmilk) and regardless of the severity of the difficulty the lactivist prescription is always the same: “Breastfeed harder.”

A mother’s need for sleep is irrelevant. She is supposed to dispense breastmilk 24/7/365. What else could be more important than being a breastmilk dispenser?

A mother’s need to control her own body is irrelevant. If breastfeeding makes her psychologically uncomfortable, she’s supposed to get over it. Her mental health receives as much attention from them as cows’ mental health receives from farmers.

A mother’s mental health is irrelevant. Lactation professionals are much more concerned with whether treatments for postpartum depression are compatible with breastfeeding than with whether they are the best possible treatment for the mother’s condition. The mother must continue dispensing breastmilk as she approaches and even endures psychological collapse.

The connection between breastfeeding and postpartum depression has been noted, but lactation professionals have chosen to spin it as evidence that successful breastfeeding prevents postpartum depression; the reality is that pressuring women to breastfeed when they can’t or don’t want to do so increases the risk of postpartum depression. That’s certainly what suffering women tell us, but lactation consultants don’t bother listening to them.

Treating women like cows has a corollary in pregnancy and childbirth and that corollary has been emphatically rejected by most women. The corollary is treating women as breeding stock, evaluating every decision they make by asking whether it is good for the baby. Ironically, many of the same people who would be horrified by reducing pregnant women to baby incubators, have no problem reducing new mothers to breastmilk dispensers.

In response to the never ending lobbying of lactation organizations, we have moralized breastfeeding far, far beyond any actual benefits. It has become a signifier of social status and an emblem of maternal superiority; indeed, it has become a requirement for being a “good” mother.

As a result we treat new mothers as if they were cows and there only reason for existence is to dispense breastmilk. Even if breastmilk were “the elixir of life” as some lactivists pretend, that would not justify this cavalier treatment of women. Since the benefits of breastmilk are in reality trivial, treating women like cows isn’t merely unjustified, it is gratuitously cruel.

Every women is capable of looking at the scientific evidence about breastfeeding term babies in industrialized countries (the real evidence, not the wildly exaggerated claims) and making her own considered decision how to feed her infant. Insisting that it is the lactation industry’s business deprives a woman of autonomy … and treats her as no better than a cow.

If our ancient foremothers could see Tracy Cassells, PhD, of Evolutionary Parenting (and other parenting “experts” like her) they wouldn’t know whether to laugh or cry.

We as humans have evolved in a particular manner, and the parent-child relationship is no different. Children, especially babies, expect certain behaviours from their caregivers and research is starting to understand both how deviations from these expectations affect child development and the bidirectional nature of the child-parent relationship. Of course, not all people can or want to parent our children based on their biology. In this realm, Evolutionary Parenting focuses on the idea that anytime we deviate from a known biological norm, we should have good reason and try to mimic biological processes as much as possible in order to minimize disruptions to later outcomes and child well-being.

The infant mortality rate in nature was astronomical, possibly as high as 1 in 3; babies died during childbirth, they died of dehydration before breastmilk came in, they died of infectious diseases, they died when minor injuries became infected, they died when they were attacked by predators, they died and their siblings died and if women didn’t give birth to the natural biological allotment of 8 infants of more, there was a chance they wouldn’t ever have an adult child.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Evolution never goes back to the past; that’s the surest way to extinction.[/pullquote]

Many mothers lived permanently bereft and forever in fear of the death of those their surviving children. This is what Cassells and her fellow natural mothering “experts” want to return to.

Why? Because they are remarkably ignorant about evolution and natural selection. Evolution always involves ADAPTATION, not the return to the past that Cassells recommends. Evolution is always about survival and WHATEVER maximizes survival is “evolutionary.”

The paradigmatic example of evolution in action was described by Charles Darwin. He noted the amazing variety of finches in the Galápagos Islands:

A few million years ago, one species of finch migrated to the rocky Galapagos from the mainland of Central or South America. From this one migrant species would come many — at least 13 species of finch evolving from the single ancestor.

… The ecological niches exert the selection pressures that push the populations in various directions. On various islands, finch species have become adapted for different diets: seeds, insects, flowers, the blood of seabirds, and leaves.

The ancestral finch was a ground-dwelling, seed-eating finch. After the burst of speciation in the Galapagos, a total of 14 species would exist: three species of ground-dwelling seed-eaters; three others living on cactuses and eating seeds; one living in trees and eating seeds; and 7 species of tree-dwelling insect-eaters.

Different species of finches evolved to exploit the environments of different islands. It was the CHANGES that ensured their survival, not the insistence on stubborning clinging to behavior that evolved thousands of years before.

Finches can teach us critical lessons about evolution.

1. Fitness is not static.

As conditions changes, fitness changes. And conditions always change, whether it is climate, pressure from other species, local events like volcanic eruptions, etc. There is no such thing as an animal that is “perfectly fit” because there is no such thing as a static environment.

2. Fitness is tied to the environment.

How successful do you think the seed eating finches were on islands that had very few seeds of the type they had been evolved to eat? Not very. That’s why they evolved characteristics like changes in beaks to allow them to eat different seeds and, in some cases, switched from seeds to insects.

3. The most successful animals are those who adapt, not those who remain unchanged.

If we anthropomorphize the finches, we can see just what is wrong with the philosophy of natural parenting, the philosophy of Cassells and her colleagues.

Imagine the finches who arrived in the Galapagos had surveyed the situation on each island and announced:

“We were evolved to live on the ground and eat seeds. Therefore, we will continue living on the ground and eating seeds and pretend we are still on the mainland.”

“Nature has rendered us perfectly evolved and all we have to do is live like we have always lived.”

The result would have been extinction from the islands. The finches destined to be most successful were those who abandoned the way they had evolved and sought out new food sources and new places to live.

It’s not hard to see the parallels with natural parenting.

Lactivists are equivalent to finches who insisted on eating seeds because they always ate seeds. In nature, many babies died due to insufficient breastmilk; those babies can now survive on formula. They are FITTEST for the current environment.

Parents who advocate co-sleeping are equivalent to finches who insisted on living on the ground even though there were new predators on the ground. The parents who will be evolutionarily MOST successful are those who let their offspring sleep in a separate bed, on a firm surface, with no bedding or soft toys because those children are most likely to survive and evolution is ALWAYS about maximizing survival.

Natural parenting advocates are evolutionary dinosaurs. Dinosaurs had been successful for millions of years. Yet when a massive asteroid impacted earth and the environment changed dramatically, they couldn’t adapt fast enough and died out.

Technology is the equivalent of a massive asteroid impact; it has changed everything. Those who can adapt to use it are evolutionarily successful while those who try to return to the past are less fit and their children are less likely to survive. Real evolutionary parenting means embracing the technology of the times, not rejecting.

Evolution NEVER goes back to the past; that’s the surest way to extinction.

I was lucky to do my internship and residency at the first hospital to have a Patient’s Bill of Rights, Harvard’s Beth Israel Hospital.

The Patient’s Bill of Rights was based on the belief that doctors and nurses owed patients MORE than merely excellent treatment; they owed them compassionate and ethical care. It reflected the change from a paternalistic mindset — doctor knows best — to one that recognized patients as individuals entitled to complete information and capable of making decisions for themselves.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Nothing about me without me![/pullquote]

It seems to me that we are now in need of a Birthing Person’s Bill of Rights. Those who provide maternity care owe patients more than just excellent medical treatment; we owe them compassionate care that meets their goals, not ours. We must give up the maternalistic mindset — natural childbirth advocates and lactation consultants know best — for one that recognizes patients as individuals whose priorities may be different from those of professionals.

Here’s a first attempt.

Nothing about me without me.

That should be the guiding principle of maternity care. The patient is the “decider” NOT the professionals. Sure professionals know more about the science, but we don’t know enough about the competing pressures in an individual’s life to tell her how she must give birth and feed her baby.

As the paper Shared decision is the only outcome that matters when it comes to evaluating evidence-based practice explains:

Population-level health outcomes rarely if ever take into account patient values and preferences and therefore by definition fly directly in the face of the fundamental goals and definition of EBP. Ignoring patient values and preferences or at least not placing them at the forefront of decision making legitimises the argument that the presence of effects at population levels is sufficient justification for recommending treatments even though the absolute magnitude of these changes clearly may not be important to all individual patients.

In other words, even if a treatment is shown to have population level benefits, that does NOT justify pressuring patients to make those choices. That’s because scientific evidence is a tool akin to a measuring tape to be used to evaluate various treatment options, not a stick to be used to beat patients into conformity.

VBAC activists may not know it, but they rely upon this insight in arguing for greater access to VBACs. Just because scientific evidence shows that elective repeat C-sections are safer overall for mothers and babies does not mean that all mothers should be pressured to have repeat C-sections. Individual women have different needs and priorities and those needs and priorities MUST be respected.

But the same principles tell us that even if vaginal births are safer overall, that does not mean that all birthing persons should be pressured into giving birth vaginally. Even if breastfeeding were safer overall (and that’s not clear), that does not meant that birthing persons should be pressured into breastfeeding.

We owe patients our recommendations, but we shouldn’t be forcing them to comply. Everything else follows from that principle.

Information about all birth risks not just C-section risks.

For the last 30+ years we’ve withheld vital information from birthing persons in order to convince them to do what some professionals want. We’ve eagerly offered information about the risks of C-sections, but we’ve withheld and even misrepresented information about the risks of vaginal birth. That has resulted in women grievously harmed by vaginal birth (prolapsed organs, incontinence, sexual dysfunction). Forceps deliveries dramatically increase the risks of these injuries yet we’ve represented instrumented vaginal deliveries as “better” than C-sections, thereby depriving women of the opportunity to make an informed choice between them.

Birthing persons are entitled to ALL relevant information about the risks of ALL possible choices.

The right to excellent pain relief.

Effective pain relief in labor is a human right, no different from the right to have effective pain relief for a broken bone.

Natural childbirth advocates often euphemize labor as “pain with a purpose,” but the pain from a broken bone is “pain with a purpose,” too. The purpose is to keep the limb or other body part immobilized. But just as casting has addressed evolutionary issue, access to medical assistance has addressed the evolutionary purpose of labor pain. There is NO benefit to pain itself and that’s why effective pain relief is a human right.

Of course some people need less pain relief than others. Some people need only ibuprofen for the pain of a broken bone while others might require something stronger. Some women need only support for labor pain, while others might require an epidural. NO ONE should ever deny or deliberately delay an epidural to a laboring woman.

Freedom from C-section & breastfeeding targets.

Targets exist for the benefit of institutions and insurers, NOT patients and, as such, should never determine the care of an individual.

Furthermore, according to Goodhart’s Law.

When a measure becomes a target, it ceases to be a good measure.

Campbell’s Law, a corollary of Goodhart’s Law, is equally instructive:

The more any quantitative social indicator is used for social decision-making, the more subject it will be to corruption pressures and the more apt it will be to distort and corrupt the social processes it is intended to monitor.

In other words, targets result in patients being pressured into choices that are best for institutions not best for patients. C-section targets are used to pressure women into vaginal births they might not want; induction targets are used to pressure women into longer pregnancies that have higher risks; breastfeeding targets are used to deprive women of choice in infant feeding.

The right to a well baby nursery.

No hospitalized patient should ever be forced to care for another hospitalized patient. If a person who has given birth needs to be in the hospital, BY DEFINITION that person is not healthy enough, strong enough or well rested enough to be fully responsible for a hospitalized baby. Therefore, there is a MEDICAL need for well baby nurseries in every hospital and a right of all birthing persons to send their babies to the nursery so they can rest and recover.

This is not rocket science, yet we have allowed lactivist organizations to do away with common sense for the purpose of promoting breastfeeding. Even worse, there is no evidence that pressuring women in this way increases breastfeeding rates.

The right to non-ideological care.

Ideologies of birth and infant feeding have no place in compassionate maternity care, just as they have no place in compassionate gynecological care. It is not up to a provider to decide whether or not a woman “needs” birth control or pregnancy termination; it is up to the individual patient. Similarly, it is not up to a provider to decide whether a birthing person “needs” an epidural, a C-section on maternal request, a pacifier to soothe a baby or formula to supplement; it is up to the individual patient.

The right to freely choose a baby’s feeding method.

It is not a providers job to determine how a baby should be fed; it is a parent’s job. We must give women accurate information — including information about the RISKS of breastfeeding — so they can make informed decisions. Support for breastfeeding should be provided ONLY on request; women are entitled to make feeding choices free from provider pressure.

The right to psychologically sensitive care.

Care that promotes provider objectives and targets ahead of patient preferences is not psychologically sensitive care. Indeed, it is often perceived by patients as pressure, shaming and humiliation. Instead of offering one-size-fits-all directives — reduce interventions, prevent C-sections, promote breastfeeding — providers are ethically obligated to determine an individual patient’s needs, desires and obligations and provide care responsive to that individual.

The sad reality is that we need a Birthing Person’s Bill of Rights now, more than ever. Ideology has been allowed to invade hospitals; scientific evidence that applies to populations has been used to justify treatment of individuals; and birthing persons have been denied accurate evidence and therefore been impeded from making informed decisions. That has got to stop.

Let The Birthing Person’s Bill of Rights be the first step toward more compassionate care!