A tremendous amount of ink has been spilled by doctors, scientists and public health officials pondering the bizarre beliefs of anti-vaccine parents. How can they promote such obvious nonsense? Why don’t they respond to efforts to improve their knowledge base? Why can’t we get them to understand the risks they pose to society in general and their own children in particular?

Sadly, we’ve been asking the wrong questions because we have assumed that anti-vax beliefs are the result of scientific ignorance. While ignorance of immunology, science and statistics are necessary concomitants of anti-vax beliefs, they are not sufficient. The missing piece we have failed to consider is the rise of performative mothering.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Anti-vax advocacy is perhaps the acme of performative mothering. It only acquires meaning by being performed under the gaze of other mothers.[/pullquote]

What is performative mothering? As I explained over the past two days, a mother used to be something you were; now it’s something you do, hence the term “mothering.” And you do it under the gaze of other mothers, micro-branding yourself by your choices, and disseminating a carefully curated portrayal through social media, artlessly seeking validation through the “likes” of strangers.

Anti-vax advocacy is perhaps the acme of performative mothering. It only acquires meaning by being performed under the gaze of other mothers, especially those on social media. Indeed, in a country where vaccination rates are high, it has almost no meaning unless it is observed. Until recently herd immunity meant that most unvaccinated children would never be exposed to most childhood infectious diseases. Therefore, there was no obvious difference between vaccinated and unvaccinated children. The only observable difference was the preening of anti-vax mothers.

Anti-vax advocacy acquires further meaning by being performed under the gaze of pediatricians and other healthcare providers. Behavior is not transgressive unless it is demonstrated to authority figures, eliciting the delicious disgust that gives meaning to the act.

As Pru Hobson-West explains in ‘Trusting blindly can be the biggest risk of all’: organised resistance to childhood vaccination in the UK:

Clear dichotomies are constructed between blind faith and active resistance and uncritical following and critical thinking. Non-vaccinators or those who question aspects of vaccination policy are not described in terms of class, gender, location or politics, but are ‘free thinkers’ who have escaped from the disempowerment that is seen to characterise vaccination…

…[Anti-vaxxers] construct trust in others as passive and the easy option. Rather than trust in experts, the alternative scenario is of a parent who becomes the expert themselves, through a difficult process of personal education and empowerment…

Ironically, despite the collective derision for experts, anti-vax advocates depend heavily on pseudo-experts like Dr. Bob Sears and similar anti-vax charlatans. What distinguishes Dr. Sears from other pediatricians? It isn’t merely his flexible ethics that allow him to pander to anti-vaxxers for profit. Bob Sears is fluent in the language of performative motherhood.

Consider how anthropologist and certified professional midwife Melissa Cheyney describes homebirth in Reinscribing the Birthing Body: Homebirth as Ritual Performance:

… As a socially performed act of differentiation, homebirths are constructed in opposition to dominant ways of giving birth, although just where the lines between consent and resistance lie are not always clear, shifting with each provider and each mother, over time and in the retellings.

Bob Sears understands that as a socially performed act of differentiation, anti-vax advocacy is constructed in opposition to dominant ways of protecting children.

Homebirth practices, thus, are not simply evidence based care strategies. They are intentionally manipulated rituals of technocratic subversion designed to reinscribe pregnant bodies and to reterritorialize childbirth spaces and authorities. For many, choosing to deliver at home is a ritualized act of “thick” resistance where participants actively appropriate, modify, and cocreate new meanings in childbirth.

Anti-vax, thus, is not an evidence based strategy to protect children. Bob Sears understands it is a ritual of technocratic subversion performed for the admiration and gratification of other mothers.

Bob Sears is fluent in the language of performative motherhood. To paraphrase Gallo and Cruz’s description of midwives:

Sears provides emotional support by sharing beliefs about the experience and by affirming the woman’s right to assign her own unique beliefs to vaccines. This seemingly simple service of association and presence is a critical social need in the context of anti-vax advocacy that depends on a shared cultural consensus for its significance.

As he notes in the final chapter of his book The Vaccine Book: Making the Right Decision for Your Child:

I’m sure you are trying to answer the question that is on every parent’s mind: What should I now do? How do you make the right choice for your child? I have offered you all the information you need to make this decision, but I have held back from actually telling you what to do. I want you to formulate your own decision without letting my opinion sway you one way or the other.

Whereupon he proceeds to give his opinion on an alternate vaccine schedule that has no basis in science but creates maximum scope for performative mothering. And he repeatedly panders to the pretentions of performative mothers.

Alternative vaccine schedules aren’t for everybody. It takes a lot of extra time, effort, and planning to follow them. In addition, some doctors will fight you if you try to “change the system.” …

You can’t walk into your appointment unprepared and ask your doctor to come up with an alternative schedule for you. There is only one standard schedule that doctors are trained to follow; working outside this schedule is foreign to most doctors. You must understand the diseases, feel comfortable with your knowledge of vaccines, and establish your own vaccine plan prior to seeing your doctor. The suggestions I offer in this chapter are a good place to start. If the doctor sees that you’ve thoroughly thought this through, he or she is much more likely to work with you.

Performative mothering is toxic for a host of reasons: it places women under tremendous pressure to perform for other mothers; it ignores the needs of the individual child in favor of the social approbation of the group, and — as in the case of anti-vax advocacy — it is dangerous, even deadly, for children.

Yesterday I wrote about the way that mothering has changed between fictional grandmother Myrna and her fictional granddaughter Mira.

Myrna assumed that her child would turn out fine without any special effort. Mira assumes her child will be a fat, unhappy, failure unless she interposes herself between him and the myriad risks she imagines he faces.

The ultimate irony is that while Mira imagines her grandmother as oblivious to high stakes of childrearing, Myrna managed to raise the happy successful adult that Mira dreams of creating with a massive amount of effort.

This difference reflects a fundamental change in the way that we view both risk and our reaction to it. Myrna was not unaware of the risks her child faced, but she didn’t believe that she could control them. Mira, on the other hand, is hyper-aware of the risks her child might face and believes that her primary purpose is to identify and manage those risks.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Mira is a stylist of motherhood, selecting from parenting identities and practices to present a meticulously crafted mothering persona designed for gaze of other mothers.[/pullquote]

For example, Myrna fed her son John canned vegetables while Mira prepares Jace’s food herself from organic produce that she sources at specialty markets. Myrna did not know or worry about toxins; Mira is obsessed with protecting her child from toxins, including toxins that are purely imaginary.

But there is another critical difference between Myrna’s experience and Mira’s. The intervening half century has witnessed the rise of performative mothering. A mother used to be something you were; now it’s something you do, hence the term “mothering.” And you do it under the gaze of other mothers, micro-branding yourself by your choices, and disseminating a carefully curated portrayal through social media, artlessly seeking validation through the “likes” of strangers.

When it came to raising John, Myrna might have feared the judgments of her mother and mother-in-law but she did not particularly fear the judgment of her peers since they were all doing the same thing. Everyone went to the hospital to have a baby; everyone was unconscious at the moment of birth; everyone bottle fed. For better or for worse, there was incredible uniformity in parenting practices.

Mira, in contrast, faces not merely the judgment of her peers, but she actively submits herself to the judgment of the larger world by engaging on Facebook. Mira is a stylist of motherhood, selecting from parenting identities and practices to present a meticulously crafted mothering persona designed for the gaze of other mothers.

In theory Mira carefully choreographed the experience of Jace’s birth because unmedicated vaginal birth is “better” for the baby; in truth she choreographed it to demonstrate to other mothers that she is a “natural” mother. That’s why she was so devastated when her birth did not go according to plan.

In theory Mira starved her baby because breastfeeding is “better” than formula feeding; in truth she let Jace suffer to preserve her natural mothering “cred” in the view of other mothers.

In theory Mira has created a alternative vaccine schedule because it is “better” for Jace; in truth she consulted other mothers extensively in order to “perform” natural mothering for the delectation of her peers.

Moreover, Mira hired other professionals, like a midwife and a doula, who understood — and therefore reinforced — the notion of mothering as a performance staged for the gaze of other mothers.

As Markella Rutherford and Selina Gallo-Cruz explain in Great Expectations: Emotion as Central to the Experiential Consumption of Birth:

… [T]he midwife’s role is critical … because she is fluent in the alternative symbolic orientations to and understandings of natural birth … [She] also provides her association and emotional support either by sharing beliefs about the experience or by affirming the woman’s right to assign her own unique beliefs to birthing. This seemingly simple service of association and presence is a critical social need in the context of extraordinary experiences and rites of passage that depend a shared cultural consensus for their significance.

While a midwife may have a medical function in addition to her role in confirming the performative nature of birth, a doula has no function beyond the permformative aspect of birth. Women hire doulas for the primary purpose of relentlessly reminding them of the image they wish to craft and bolstering the imperative to perform when pain or exhaustion threaten the mother’s commitment to the performance. Toward that end relieving pain with an epidural is framed as “giving in” and a C-section is framed as a failure.

While a lactation consultant has a medical function in addition to confirming the performative nature of exclusive breastfeeding, she also serves as a goad to ignoring the suffering of both baby and mother in an effort to continue the performance. Simply hiring her protects the mother from the judgment of her peers since a lactation consultant can give her “permission” to supplement with formula or stop breastfeeding altogether on medical grounds.

The rise of performative mothering explains the distrust engendered between natural mothering advocates on the one hand and obstetricians and pediatricians on the other hand. Most obstetricians and pediatricians are not fluent in the requirements of performative motherhood and are therefore not supportive of sacrificing the baby’s health and wellbeing for the express purpose of crafting an image designed for consumption by other mothers.

In contrast, quacks and charlatans like Ina May Gaskin and Dr. Bob Sears are successful precisely because they are fluent in the language of performative motherhood and are willing to countenance and even bless anything, no matter how dangerous, in the pursuit of micro-branding and image curation.

Finally, the performative nature of contemporary motherhood requires fabricating an endless series of threats to children that can only be ameliorated by mothers.

Perinatal mortality, infant mortality, and child mortality are at historic lows. Vaccine preventable diseases have been nearly vanquished. Rates of sudden infant death syndrome are falling. Congenital defects like heart disease can be treated. Malnutrition and vitamin deficiencies are rare. Foods and medications are safer than ever because of government oversight.

In other words, while Mira worries far more about her child than Myrna did, the actual threats to Mira’s child are smaller than those that Myrna’s child faced. But you’d never know that if you are part of the natural parenting culture, where motherhood is performed as the management of a never ending series of risks.

The piece in yesterday’s New York Times, The Relentlessness of Modern Parenting, has generated 1000 comments and counting.

Parenthood in the United States has become much more demanding than it used to be.

Over just a couple of generations, parents have greatly increased the amount of time, attention and money they put into raising children. Mothers who juggle jobs outside the home spend just as much time tending their children as stay-at-home mothers did in the 1970s.

Why?

Parent” as a verb gained widespread use in the 1970s, which is also when parenting books exploded. The 1980s brought helicopter parenting, a movement to keep children safe from physical harm, spurred by high-profile child assaults and abductions (despite the fact that they were, and are, exceedingly rare). Intensive parenting was first described in the 1990s and 2000s by social scientists including Sharon Hays and Annette Lareau. It grew from a major shift in how people saw children. They began to be considered vulnerable and moldable — shaped by their early childhood experiences — an idea bolstered by advances in child development research.

I would argue that our major shift in outlook was not in how we see children, but in how we see mothers. For most of human history we have viewed mothers as nurturers who raise children. Today we see mothers as risk managers who raise future competitors in the marketplace. It’s the difference between fictional grandmother Myrna and her fictional granddaughter Mira.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]We used to see mothers as nurturers; now we see them as risk managers.[/pullquote]

Myrna gave birth to her first child in the late 1950’s at the age of 22. Her granddaughter Mira gave birth to her first child in the late 2000’s at the age of 32.

Myrna had a baby because that is what one did within a year or so of marriage. She never thought to do otherwise and, in the absence of effective birth control, there wasn’t a great deal of choice about the matter. Mira worked hard at her career and delayed both marriage and childbearing to give priority to climbing the career ladder. Having used effective birth control for well over a decade, she deliberately chose to stop using it in order to conceive.

Myrna assumed that if she went to the doctor regularly throughout pregnancy and rigorously followed his advice, she could count on having a health baby. Her granddaughter Mira considers that attitude frighteningly blasé. Her grandmother had never worried about all the things that could go wrong and all the risks that must be managed. Mira controlled her food choices rigorously, avoided a myriad of foods that might harm her baby and possibly interfere with reaching his or her full intellectual potential. She had to be constantly on her guard.

When labor started, Myrna’s husband dropped her and her suitcase at the door of the maternity ward and reappeared after baby John had been born while Myrna was anesthetized and unaware of what was happening. Myrna may have worried about caring for a newborn, but she never worried for even a moment that her baby might not bond to her. Of course she was going to love her baby and her baby was going to love her.

Mira, in contrast, choreographed Jace’s birth with exquisite care with the help of her midwife and doula and then was devastated when it did not go according to plan. Had she harmed mother-child bonding by “giving in” to an epidural? Had she destroyed Jace’s microbiome by having a C-section thereby condemning him to be sickly? Only time would tell and Mira would have to be alert for the signs.

Myrna and baby John came home to a present from her in-laws: two weeks of a night nurse so she could rest and recover. She cracked open a can of formula powder, fed the baby as much as he wanted, and then put him to sleep in his crib. She didn’t do a single night feeding until the baby nurse left two weeks later by which point she was well on the road to recovering from the rigors of birth.

Mira, in contrast, could not sleep for more than 2 hours at a stretch until Jace was nearly 4 months old; even when she slept she didn’t sleep well since her baby was in her own bed beside her. At one point she was hallucinating from exhaustion, but what choice did she have? She had to breastfeed exclusively in order to protect Jace’s health and future intellectual potential. As a responsible mother she wasn’t going to let a drop of formula touch her infant’s lips.

Sadly she wasn’t producing enough milk to fully nourish her baby so she had to pump in between feedings to boost her supply. And because Jace remained hungry, he couldn’t settle and required hours of soothing each and every day.

Myrna never worried about any of that. Sure the relentless cycle of change diapers, feed, sleep was both boring and wearying, but she and her friends could commiserate. They were all doing exactly the same thing.

Every two months Myrna took her baby to the doctor so he could get his shots and his polio vaccine. She was so grateful to live in a time when infectious disease did not routinely kill babies. Mira, in contrast, spent countless hours researching vaccines by consulting with her mom friends on Facebook. There were so many decisions to be made about the choice and timing of vaccination. Obviously she wasn’t going to simply follow doctors’ recommendations. She presented her pediatrician with a modified vaccine schedule that the doctor was expected to follow.

Myrna’s doctor told her to start the baby on rice cereal at 4 months and that’s exactly what she did. Her son gradually progressed to eating little jars of Gerber puréed foods. Mira, in contrast, was determined to hold off on solid food until at least 6 months even though it became clear at 5 months that Jace was falling off his growth chart. When she did start him on solids she prepared everything herself from organic produce with no additives of any kind and served from bowls that were BPA free. There were so many toxins in the environment and she had to be on constant alert to protect her baby.

And so it went. John played outside in his backyard; Jace went to play groups. John watched television; Jace was only allowed screen time as a special treat. John had toy guns and cars; Jace started learning his alphabet and numbers at the age of 2.

John walked to and from elementary school and was allowed to play outside after school anywhere in the neighborhood; Jace’s mother drove him to school and then ferried him to various activities afterward. John built a model of the solar system by himself from styrofoam balls and coat hangers; Jace’s mom redid his first effort, deeming it unable to meet the high standards that might be required for future entry into a competitive private high school 5 years hence. John, Mira’s father, went to Harvard; it’s important to Mira that Jace go to Harvard, too and she will leave nothing to chance.

What’s the difference between Myrna and Mira?

Myrna assumed that her child would turn out fine without any special effort. Mira assumes her child will be a fat, unhappy, failure unless she interposes herself between him and the myriad risks she imagines he faces.

The ultimate irony is that while Mira imagines her grandmother as oblivious to high stakes of childrearing, Myrna managed to raise the happy successful adult that Mira dreams of creating with a massive amount of effort.

Children haven’t changed in the past 50 years, but mothers expectations of themselves have changed nearly beyond recognition.

Every war requires uniforms so that you can tell ally from enemy. The mommy wars are no exception.

Amber teething necklaces for infants are part of the crunchy mommy “look” that allows self-described natural mothers to signal their allied status to other crunchy moms and to set them apart from the mainstream. Too bad that amber teething necklaces are deadly, but babies must make sacrifices to promote their mother’s brand.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Amber teething necklaces not only AREN’T useful for treating teething pain, they COULDN’T be useful since the active ingredient isn’t released from the beads.[/pullquote]

The FDA has received reports of death and serious injuries to infants and children, including strangulation and choking, caused by necklaces and bracelets often marketed for relieving teething pain… The risks of using teething jewelry include choking, strangulation, injury to the mouth, and infection…

Strangulation can happen if a necklace is wrapped too tightly around the child’s neck or if the necklace catches on an object such as a crib. The FDA received a report of an 18-month old child who was strangled to death by his amber teething necklace during a nap…

This is not rocket science, people! The same babies who should have grapes cut up for them to prevent choking shouldn’t be adorned with small beads that will close off their airways if swallowed. The same babies who shouldn’t be allowed near drapery cords for fear of strangulation shouldn’t have cords draped around their necks.

Why would anyone with a modicum of common sense put an amber teething necklace on a baby?

According to The Natural Mama’s Guide to Amber Teething Necklaces:

Amber teething necklaces are designed to be worn by babies when they are teething. The common belief is that the child’s body heats the amber, causing it to release oils containing succinic acid. The succinic acid, in theory, gets absorbed into the bloodstream, helping to easy baby’s pain…

In theory, when placed around baby’s neck, Baltic amber warms up, causing it to release oils that contain succinic acid. The acid, in turn, gets absorbed through the skin and into the bloodstream.

There’s just two teeny, tiny problems with the theory: Succinic acid ISN’T an effective pain reliever and it ISN’T released from amber beads.

Anyone who isn’t living under a rock knows that there is a tremendous commercial market for pain relievers yet no pharmaceutical company is markets succinic acid as a pain reliever. It is sold for other reasons, however:

Succinic acid is used primarily as an acidity regulator in the food and beverage industry. It is also available as a flavoring agent, contributing a somewhat sour and astringent component to umami taste. As an excipient in pharmaceutical products, it is also used to control acidity or as a counter ion. Drugs involving succinate include metoprolol succinate, sumatriptan succinate, Doxylamine succinate or solifenacin succinate.

So crunchy moms are draping their babies in a choking hazard because it releases a substance used as a food and drug additive. Except that it doesn’t even do that.

According to a scientific abstract looking at release of succinic acid from amber beads.

Infrared spectroscopy was used to confirm that the teething necklaces were made of Baltic amber. The amount of succinic acid contained within the beads was quantified, and succinic acid release from intact beads was measured in phosphate buffered saline (PBS) pH 5.5 or octanol to simulate aqueous or oily skin environments.

RESULTS: Each necklace (33 beads in length) contained 19.17±4.89 mg of succinic acid (mean±se). Over a 6-month period, no succinic acid was detected in PBS, while 0.13±0.09 mg of succinic acid per necklace was released in octanol. Only one replicate of amber beads in octanol released succinic acid, and they had fragmented, with shards free-floating in the solvent.

DISCUSSION: It is likely succinic acid was only detected because the beads were breaking down in octanol, which does not occur when worn around the neck of a child. Furthermore, the hydrophilic properties of succinic acid would not favour its absorption across hydrophobic layers of the skin and into the bloodstream.

CONCLUSION: While the teething necklaces do contain small quantities of succinic acid, it is highly unlikely to be released from intact beads.

So amber teething necklaces not only AREN’T useful for treating teething pain, they COULDN’T be useful for treating teething pain since the active ingredient isn’t released from the beads.

What’s really going on here?

Amber teething necklaces are part of the maternal micro-branding culture. The necklaces offer mothers an opportunity to signal to their allies that they are crunchy and to signal to the mainstream that they are transgressive. They are part of what Alison Phipps calls the “politics of recognition.”

‘Natural’ birth and breastfeeding have become part of an identity package around organic or holistic parenting, while formula feeding and birth interventions (and in particular, caesarean sections) form aspects of a negative Other associated with other practices such as ‘cry-it-out’, vaccination and corporal punishment …

Crunchy mothers may be wrong about the pain relieving properties of deadly amber bead necklaces, but they are correct that such necklaces are a form of micro branding.

Sadly, they brand these mothers as anti-science, gullible and desperate for affirmation.

I received an email from Harry Orf, PhD, Senior Vice President for Research, and Research Integrity Officer Massachusetts General Hospital informing me that I disseminated incorrect information. Much to my regret I repeated false claims and mischaracterized the situation. For that I am deeply sorry and want to correct the record as soon as I can.

How could the original reporter have gotten it so wrong? Where did she come up with these accusations if not from the Harvard investigation?

Let’s look at whom she quotes: all three earn their money from the billion dollar breastfeeding industry. Another leading avatar of the breastfeeding industry, Melissa Bartick, MD, apparently filed the original complaint.

I want to offer a heartfelt apology to Dr. Kleinman for my original piece. I repeated misinformation and for that I am deeply sorry. I’ll be waiting for Bartick, Seals Allers, Sullivan and McEnroe to do the same.

*****

Kudos to Dr. Melissa Bartick for holding leading breastfeeding safety expert Ronald Kleinman, MD to account. He has failed to fully disclose payments from the formula industry.

Now if only she and other lactivists would only hold the Baby Friendly Hospital Initiative to account for iatrogenic brain injuries and deaths as a result of aggressive breastfeeding promotion.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Though Kleinman behaved unethically, there is no question that babies have been injured and died — and continue to be injured and die — on the altar of breastfeeding promotion.[/pullquote]

In 2016, Kleinman and two other physicians co-authored an article published in the highly-regarded peer-review journal, JAMA Journal of Pediatrics, which was viewed as critical of the Baby Friendly Hospital initiative, a global initiative designed to promote better breastfeeding practices in hospital maternity units. Specifically, the study entitled, Unintended Consequences of Current Breastfeeding Initiatives, reported the rooming-in practice, where a baby stays in the same hospital room as the mother at Baby Friendly Hospitals, could, as Time Magazine described, “lead to mothers’ accidentally smothering their children and possibly contribute to sudden unexpected postnatal collapse, a rare but often fatal respiratory failure.”

The revelations could hardly be worse:

At the time, Kleinman failed to disclose his deep financial ties to Mead Johnson, the parent company of Enfamil infant formula, which spanned eight years (2006 to 2014). He had also received an honorarium from Mead for chairing the Mead Johnson Iron Infant Nutrition Panel, funding for a hospital initiative (which he described as a “fruitful partnership”), and was the author of two Mead-funded studies…

Additionally, Kleinman has published at least six articles in the last three years, which some advocates claim are critical of breastfeeding initiatives…

In a more recent article published in the November issue of JAMA Pediatrics critiquing the skin-to-skin guidelines for the Baby Friendly Hospital Initiative, Kleinman disclosed his vast industry connections, including financial ties to the infant formula maker Mead Johnson, General Mills, Ocean Spray and the Alliance for Potato Research and Education (APRE), among others…

Kleinman’s explanation:

In an email response to Women’s eNews, Kleinman responded that his previous failures to disclose his industry connections were an “inadvertent omission.”

What was Dr. Bartick’s role in uncovering Kleinman’s unethical behavior?

I also filed a complaint about Kleinman’s conflicts of interest to the Harvard Medical School Office of Academic and Research Integrity in December 2017, which was never addressed.

Apparently Dr. Bartick was unaware of the investigation that she put in train.

I find Kleinman’s behavior inexcusable for two reasons. First, he deprived other doctors and researchers of relevant information needed to evaluate his papers. Second, by discrediting breastfeeding safety research he puts babies at continued risk of brain injuries and deaths from aggressive breastfeeding promotion.

Make no mistake: though Kleinman behaved unethically, there is no question that babies have been injured and died — and continue to be injured and die — on the altar of breastfeeding promotion.

In taking money from the formula industry, Dr. Kleinman is no different from leading lactivists who take money from the breastfeeding industry. The payments he received are no more or less likely to affect his research conclusions than the payments from the breastfeeding industry affect the conclusions of lactivist.

Moreover, financial conflicts of interest and not the only conflicts of interest that can affect breastfeeding research. White hat bias is equally if not more important. Indeed, breastfeeding research was identified as a paradigmatic example of white hat bias in the seminal commentary by Cope and Allison, White hat bias: examples of its presence in obesity research and a call for renewed commitment to faithfulness in research reporting.

‘White hat bias’ (WHB) [is] bias leading to distortion of information in the service of what may be perceived to be righteous ends… WHB bias may be conjectured to be fuelled by feelings of righteous zeal, indignation toward certain aspects of industry, or other factors. Readers should beware of WHB and … should seek methods to minimize it.

Cope and Allison note that researchers have been so anxious to establish a connection between formula feeding and obesity that they have ignored or misrepresented what the scientific evidence actually shows.

Certain postulated causes have come to be demonized (… formula feeding of infants) and certain postulated palliatives seem to have been sanctified…

Whether WHB is intentional or unintentional, stems from a bias toward anti-industry results, significant findings, feelings of righteous indignation, results that may justify public health actions, or yet other factors is unclear. Future research should study approaches to minimize such distortions in the research record…

I suspect that it is white hat bias — feeelings of righteous indignation toward the formula industry — that lead lactivists like Prof. Amy Brown to make irreponsible claims that she is subsequently forced to withdraw.

Earlier this week, Brown tweeted:

There is a misleading post circulating suggesting a newborn’s stomach is larger than medical textbooks say it is. It suggests that the volume at 40 weeks could be 33ml rather than approx 7ml. Based on this it incorrectly claims colostrum is not enough and top ups are needed.

It was repeatedly brought to her attention that the size of 7 ml comes from a 1920 paper that has been superceded by multiple recent papers that show a newborn stomach size of 20-30 ml. Brown refused to back down until she was shown this excerpt from a pediatric surgery text:

[Stomach] size increases rapidly from 30 ml in a term baby to 100 ml by the fourth week.

Brown responded:

Ranges seem to go from 5-30 which happy to accept. But again … stomach size is irrelevant…

But if it were irrelevant she wouldn’t have created a Twitter thread attempting to discredit the true size. The lactation profession has spent at least a decade attempting to normalize infant starvation by insisting that colostrum must be enough to assuage infant hunger because infant stomach size is too small to require larger amounts. That has always been a lie.

Why lie about newborn stomach size? It may be the result of the financial conflict of interest of lactation professionals who make their money by promoting breastfeeding. It almost certainly the result of white hat bias in the form of a near irrational hatred of the formula industry that has led to the irresponsible claim that formula supplementation destroys the breastfeeding relationship when the scientific evidence shows the exact opposite.

So thank you Dr. Bartick for doing the strenuous work required to hold another physician to account for his egregious failure to disclose his conflicts of interest. Now may I suggest that you perform a similar service by holding the breastfeeding industry to the same high standard. Because though Kleinman behaved unethically, there is no question that babies are being injured and are dying from aggressive breastfeeding promotion.

A new paper in Clinical Pediatrics, Umbilical Cord Nonseverance and Adverse Neonatal Outcomes, reports on babies harmed by the bizarre practice of lotus birth.

Lotus birth is the latest fad in the world of birth performance art.

It used to be that women got pregnant with the intention of having a baby. In 2018, among a certain segment of privileged, white natural childbirth advocates, the performance is the point. For example, freebirth, childbirth without medical assistance of any kind, is a stunt. As such, the baby is merely a prop and an expendable prop at that. According to freebirther Desirea Miller:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lotus birth is a bizarre practice with no medical benefit and considerable risk, particularly the risk of massive infection. [/pullquote]

A live baby is usually the goal. Not everybody has that same goal but if that’s your goal, there’s no shame in going [to the hospital] to get checked.

Lotus birth is another fringe stunt beloved of those who think bragging rights are more important than a healthy baby. It is the decision to leave the placenta attached to the baby for several days until it rots off. It’s an affectation with no medical benefit and considerable risk, particularly the risk of massive infection.

According to Lotus Fertility.com (“Serving your Inner Midwife”):

…[T]he placenta is placed in a special bowl or wrapped in a ceremonial cloth (it is helpful to rinse it first, and remove clots)… Sea salt is also applied generously on both sides to aid drying and minimize scent. This small pillow and its cord are easily kept with the baby, and some women even use the Lotus pillow as an elbow prop during nursing…

Why would anyone leave a dead chunk of meat attached to her baby?

The practice … [is] called “Lotus Birth”, connecting the esteem held in the east for the Lotus to the esteem held for the intact baby as a holy child … Ahimsa, (non-violence in action and thought within one’s self and towards others) … is from the writings and leadership by Gandhi … and Martin Luther King, Jr.’s civil rights inspired marches followed soon after. Approaching birth options with Ahimsa in mind is something that can create a tremendous liberation of creative energies, freeing the potential of birth & early parenting to be a peaceful experience for the human family at large…

In other words, lotus birth is New Age nonsense … but it is also potentially deadly to the baby. As the authors of the new scientific paper explain:

Because of the potential for decomposing placental tissue to become a nidus for infection, and in the absence of medical evidence describing a benefit of this practice, the United Kingdom’s Royal College of Obstetricians and Gynaecologists has issued a statement advising women about the lack of evidence to support UCNS as a safe procedure. The American College of Obstetricians and Gynecologist and the American Academy of Pediatrics do not recommend UCNS. One existing case report has linked UCNS with persistent neonatal hepatitis. Another has linked UCNS to a case of Staphylococcus epidermidis neonatal sepsis.

The authors describe a baby rendered critically ill by a heart infection apparently contracted from the decomposing placenta:

A 20-hour-old male infant with UCNS was brought to the emergency department by his parents for labored breathing. The parents reported that the infant was born at home via water birth with spontaneous, prolonged rupture of membranes (>18 hours). No resuscitation was required at birth…

He was admitted to the neonatal intensive care unit (NICU) due to concern for sepsis. Ampicillin and gentamicin were started empirically. At 30 hours after admission, the blood culture was positive for coagulase-negative Staphylococcus; the umbilical cord was then cut, and central lines were placed for continued antibiotic therapy… The second blood culture grew Staphylococcus lugdunensis…

The infection was so serious that the bacteria was growing in the baby’s blood. S. lugdunensis is a common skin bacteria that can gain access to the baby’s bloodstream through a skin infection (which this baby did not have) … or through direct communication of a rotting placenta with a baby’s circulation.

Even more ominous:

An echocardiogram (ECG) was ordered on hospital day 4 because of the association of S lugdunensis with endocarditis. The ECG revealed tricuspid valve leaflet thickening and presence of a vegetation [colony of bacteria] …

It took 6 weeks of hospitalization for IV antibiotics to cure the heart infection. Fortunately the baby appears to have escaped permanent damage to his heart valve and the associated disability.

In trying to recapitulate birth in nature, the mother had a homebirth. This “natural” birth led to the baby experiencing nearly every possible serious medical intervention in a 6 week hospital stay.

As the authors of the paper note:

Ironically, families seeking a more natural birth option may end up getting a more invasive experience than a family choosing standard delivery and newborn care.

The ultimate irony is that there is nothing natural about lotus birth. There are no primates, nor human cultures in which the placenta is left attached to a newborn. Lotus birth is a thoroughly modern affectation, one with potentially deadly consequences.

They created the surgical procedure with the best of intentions. They wanted to prevent serious problems and it seemed to them the best way to do it. Unfortunately they were wrong and a lot of unnecessary suffering was the result.

I’m talking about episiotomy, but I could be talking about painful newborn tongue-tie surgery.

How did good people get things so wrong?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If you wouldn’t willingly undergo a painful episiotomy because it “might” be helpful, don’t force your baby to undergo painful tongue-tie surgery because it “might” improve breastfeeding.[/pullquote]

Episiotomy was created to prevent both short term and long term complications of childbirth. Episiotomy was created on the theory that a controlled tear made by a scissors would create enough room at the vaginal opening so that the baby’s head would not tear it further down to the anal sphincter (3rd degree tear). The theory made sense.

It was also designed to prevent serious long term complications of childbirth like uterine prolapse and urinary incontinence. That theory made sense, too.

Unfortunately, both theories turned out to be wrong. Not only did episiotomy fail to prevent uterine prolapse and urinary incontinence (which are cause by weakening of muscles far above the vaginal opening) but — in an ugly irony — cutting an episiotomy actually made 3rd and 4th degree tears MORE likely.

Once routine, episiotomy is now recognized as only appropriate in some very specific situations such as the use of forceps.

Tongue-tie surgery was also created with the best of intentions.

What is tongue-tie?

If you look carefully at the photo above, you will see that underneath the infant’s tongue there is a small vertical membrane that connects the tongue to the floor of the mouth. Tongue tie occurs when the membrane (the frenulum) is abnormally shortened and or thickened, restricting the movement of the tongue itself. Since the motion of the infant tongue is critical in breastfeeding, it’s easy to see how tongue-tie can cause problems breastfeeding.

Signs and symptoms of tongue-tie include:

• Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side
• Trouble sticking out the tongue past the lower front teeth
• A tongue that appears notched or heart shaped when stuck out

The natural incidence of tongue-tie has been estimated as 1.7-4.8%.

There has been a recent dramatic surge in tongue-tie surgery. According to lactation consultant Nancy Mohrbacher:

What started as a problem for a small percentage of babies seems now to be an epidemic. Health-care providers report increasing numbers of breastfeeding mothers self-diagnosing tongue and lip ties in their babies, often based on online information, and asking for a tongue- or lip-tie revision …

The surgery can be very painful for babies, leading to a large open wound beneath the tongue as this photo shows:

Think about how painful biting your tongue it; now imagine a gaping wound like that. Some babies who have undergone tongue-tie surgery have developed oral aversion. Breastfeeding (and even bottle feeding) are associated with so much pain that the babies refuse to eat even after the wound has healed.

The worst part is that — like episiotomy — tongue-tie surgery doesn’t work as this 2017 paper in Breastfeeding Review explains.

A 2014 systematic review by Power and Murphy concluded that half of breastfeeding babies with tongue-tie will not have problems. If there were difficulties, mothers reported improvements after frenotomies or frenectomies. But the authors note that it is difficult to determine how much of this effect is placebo.

A 2015 systematic review by Francis, Krishnaswami and McPheeters concluded that a small body of low to insufficient quality evidence indicates that frenotomy is associated with mother-reported improvements in breastfeeding and nipple pain, noting that the studies are short-term and of inconsistent methodology.

Even worse, the surgery is now being recommended in the absence of classic tongue-tie for conditions known as “posterior tongue-tie” upper lip-tie. Supposedly, these ties cause reflux due to air swallowing. As physician/lactation consultant Pamela Douglas notes:

…[T]here is no reliable evidence that the diagnoses of posterior tongue-tie and upper lip-tie are meaningful or useful for breastfeeding pairs.

And:

…[T]he hypothesis that reflux is caused by excessive air swallowing in infants with poor latch due to posterior tongue-tie and upper lip-tie … lacks credible physiological mechanisms or supporting evidence… This article argues that our breastfeeding women and their babies deserve the most rigorous scientific methods available, and acknowledgment of the biases inherent in less rigorous research, if we are … to prevent unnecessary oral surgery.

Tongue-tie surgery — like episiotomy — is appropriate in certain specific situations such as classic anterior tie that prevents a baby from moving her tongue to her teeth (and may contribute to future speech impairment).

But tongue-tie surgery is big business and its practitioners promote it. The surgical fee for frenectomy/frenotomy is $850. I presume that $850 is what the doctor bills; what he or she is actually paid probably varies by insurance company. Those mothers who don’t have health insurance may be forced to pay the entire fee out of pocket.

Why has there been a dramatic increase in the diagnosis of tongue-tie and a dramatic increase in expensive surgery to correct it?

Dr. Bobby Ghaheri insists that Diagnosing Tongue-Tie In A Baby Is Not A Fad:

One of the most frequent things I hear is that primary care providers say something to the effect of “Oh, diagnosing tongue-tie is just a fad” or “This tongue-tie business is just something new that some people are doing”.

So if pediatricians and ENT specialists think most tongue-tie surgery is unnecessary, who’s making the diagnoses? Mothers and lactation consultants.

Is tongue-tie surgery the new episiotomy?

I’m afraid it it. It’s a painful procedure created with the best of intentions, useful in certain specific circumstances, but it has become widespread without solid evidence that it works.

So if you wouldn’t willingly undergo a painful episiotomy because it “might” be helpful, don’t force your baby to undergo painful tongue-tie surgery because it “might” improve breastfeeding.

Vision. It’s arguably the most important of our 5 senses.

It allows us to see a grain of salt, a mountain in the distance and everything in between. It is the key to game hunting, to precision manufacturing, to hitting a home run. It is 100% natural. All human beings are “designed” to see.

Curiously, despite the centrality of vision to our existence and despite the fact that it is natural, the incidence of poor vision is extraordinarily high. Approximately 30% of Americans are nearsighted; approximately 30% of Americans are farsighted; an equal proportion of Americans suffer from astigmatism. These impairments of vision can occur alone and in combination. Indeed, there are many people over age 40 who are both nearsighted, farsighted and have astigmatism.

[pullquote align=”right” color=””]If vision – a critical bodily function – could require technological assistance more than 50% of the time, why couldn’t lactation also require technological assistance? [/pullquote]

What does that tell us?

It tells us that even critical natural functions don’t work properly a large proportion of the time.

It tells us that lactivists like Prof. Amy Brown have literally no idea what they are talking about when they offer claims like this:

There’s a difference between dying from external causes and a part of the body simply not working across a species.

Over 60% of Americans use glasses for vision correction. Nearly 20% use contact lenses for vision correction. That sounds suspiciously like a part of the body — a vital part of the body —simply failing across a large proportion of the species.

If vision – arguably as important as breastfeeding — could require technological assistance more than half the time, why couldn’t lactation also require technological assistance?

We can take the analogy even further:

Are people who need glasses — who have eyes designed to see — not trying hard enough to see? Of course not.

Are they victims of relentless propaganda from Big Glasses and don’t really need vision correction at all? That’s absurd!

Are people who use glasses or contact lenses “giving in” to the inconvenience of not being able to see? How ridiculous!

What about the impact of “unnatural” glasses and contact lenses?

Does a book written by someone wearing reading glasses have less merit than one written by someone with 20/20 vision? No.

Is a touchdown pass drilled to the receiver by a quarterback wearing contact lenses not really a touchdown? No.

If a nearsighted climber summits Mount Everest wearing glasses, is it a lesser achievement than if she had done the same thing without glasses? Absolutely not.

Why not? Because we judge achievements by the outcome, not the process. It makes no difference if someone needs vision correction to complete their activities of daily living or to fulfill their wildest dreams. The achievement is not marred by the need for vision correction.

And, critically, not needing vision correction is not, in and of itself, an achievement.

The same arguments can be made about breastfeeding. Yes, it’s natural. Yes, women are “designed” to breastfeed. Nonetheless a substantial proportion of women and babies will have difficulty with breastfeeding.

Are women with insufficient breastmilk not trying hard enough? Of course not.

Are they victims of relentless propaganda from formula companies and don’t really need to supplement their babies at all? That’s absurd!

Are women who don’t breastfeed abnormal or unnatural? No.

Are woman who choose to formula feed “giving in”? Hardly.

Are babies nourished with formula any less intelligent, talented or valuable than babies nourished with breastmilk? Of course not.

Is raising that baby into a healthy happy child with formula any less of an achievement than doing the same with breastmilk? That’s absurd. The achievement is the healthy, happy baby, not the breastfeeding.

The bottom line is that a home run with vision correction is better than a strikeout without it. A healthy formula fed toddler is better than a stunted toddler who is breastfed.

I understand that there are women who want to view unmedicated breastfeeding as an achievement, but that says more about them and their fragile self-esteem than it says about childbirth or breastfeeding.

I also understand that lactivists like Dr. Amy Brown not only have limited understanding of human physiology, they appear to have no understanding of evolution.

It is the outcome that counts. A great outcome is infinitely more important than a natural process whether that process is vision or lactation. That’s why Fed Is Best!

One of the most distressing things about breastfeeding advocates is the cavalier way in which they dismiss the suffering of starving babies. It bears an uncomfortable resemblance to the way that drug companies cavalierly dismiss the suffering of patients when they learn of deadly side effects of medication. Both promote profits ahead of people.

For example, Vioxx is a non-narcotic medication that had dramatic benefits for a certain population of pain sufferers and, as a result, was a reliable money maker for Merck. But it also had serious side effects that Merck tried to hide in an effort to maintain market share. Merck lied and patients died.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The breastfeeding industry continues to lie and babies continue to suffer brain injuries and die.[/pullquote]

That’s how you can tell the difference between medical professionals and businesses. When real medical professionals learn about harm from their recommendations, they investigate and try to mitigate that harm. When businesses learn about harm from their recommendations, they issue denials that misrepresent or lie about the scientific evidence.

Breastfeeding is a biological process with small benefits for term babies, but because of exaggeration it has become a reliable money maker for the breastfeeding industry of lactation consultants, La Leche League and the Baby Friendly Hospital Initiative among others. But it also has serious side effects that the breastfeeding industry is trying to hide to maintain market share. The breastfeeding industry lies and babies die.

Consider the latest lie from lactivist Prof. Amy Brown, a psychologist by training who has no education in physiology:

#1 There is a misleading post circulating suggesting a newborn’s stomach is larger than medical textbooks say it is. It suggests that the volume at 40 weeks could be 33ml rather than approx 7ml. Based on this it incorrectly claims colostrum is not enough and top ups are needed.

#2 There are many things wrong with this. These figures are taken from 1 baby during an ultrasound. They measure an emptier stomach and then the stomach 15 mins later when the baby has swallowed amniotic fluid. Scientists do not make decisions based on 1 baby or 1 set of measures

Brown’s lie is chilling on a variety of levels.

1. A real medical professional would start by reviewing the scientific literature on neonatal gastric capacity. A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Here’s what the scientific evidence shows:

This chart comes from a literature review published in Acta Pediatrica in 2013. You can see that the average stomach size was found to be anywhere from double to nearly quintuple the size quoted by lactation consultants.

The lactivist claim is based on a study from 1920 by Scammon and Doyle that has clearly been discredited by seven studies done since then. The average size of the newborn stomach is NOT 5-7 cc but closer to 20 cc, rising dramatically over the first first days. And some babies need every one of those 20 cc per feeding and more.

2. A real medical professional would review the scientific literature for reports of breastfed babies being underfed (case reports). A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Even a cursory examination of the scientific literature reveals multiple case reports of babies suffering brain injuries and death from hypernatremic dehydration, hypoglycemia, hyperbilirubinemia, known manifestations of infant underfeeding. Brown either does not know or does not care.

3. A real medical professional would consult the scientific literature on the incidence of underfeeding among breastfed babies. A business person more concerned about profits than people would ignore the scientific literature as Brown has done.

Had Brown bothered to read the scientific literature, she would find quite a few papers on the risks of breastfeeding.

Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding by Flaherman et al. was published earlier this year. The results are startling.

We had data on inpatient feeding for 105,003 (96.6%) vaginally delivered newborns and 34,082 (97.0%) delivered by Cesarean. Among vaginally delivered newborns, readmission after discharge from the birth hospitalization occurred for 4.3% of those exclusively breastfed during their birth hospitalization and 2.1% of those exclusively formula fed during their birth hospitalization (p<0.001)… For Cesarean births, readmission occurred for 2.4% of those exclusively breastfed during the birth hospitalization and 1.5% of those exclusively formula fed during the birth hospitalization (p=0.025)…

In addition to the pain and suffering of the newborns and anguish of the parents, a tremendous amount of money was spent.

…[S]ince the cost of a neonatal readmission has been estimated at $4548.27 a potential savings of $7.8 million might be realized for a cohort similar to ours if the readmission rate of exclusively breastfed newborns approximated that of newborns exclusively formula fed.

To put that in perspective, with 4 million births each year and more than 75% hospital breastfeeding rates, that means we should expect 60,000 excess newborn hospital admissions at a cost of more than $240,000,000 each and every year — nearly a quarter of a billion dollars. And that doesn’t even count the downstream impact of brain injuries, a consequence that was beyond the purview of this study.

The study Efficacy of Subthreshold Newborn Phototherapy During the Birth Hospitalization in Preventing Readmission for Phototherapy was undertaken to determine whether prophylactive phototherapy could reduce the risk of hospital readmission for severe neonatal jaundice.

Phototherapy does work, but the authors serendipitously found a far simpler intervention that also dramatically reduces the risk of readmission: formula! Infants allowed unrestricted access to formula had a 76% reduction in risk of readmission.

So we have multiple scientific papers that show that newborn stomach capacity is far greater than what lactivists claim, multiple scientific case reports of babies harmed by underfeeding, and a variety of scientific papers that show that aggressive breastfeeding promotion accounts for tens of thousands of newborn hospital readmissions each year at a cost of hundreds of millions of dollars.

Who benefits by lying about that scientific evidence? It’s not babies since they are clearly harmed, sometimes even killed, by the insistence that newborn stomach size is so small that babies can’t possibly be underfed. It certainly isn’t mothers since they are clearly harmed by their babies screaming from hunger, readmitted to the hospital and sustaining brain injuries or even dying because they have been unwittingly underfed. The ONLY people who benefit from lying about newborn stomach size are those who make their money promoting breastfeeding … and that’s why they continue to lie.

The makers of Vioxx could have salvaged quite a bit had they been honest about the potentially deadly side effects of the drug. Alerting doctors and patients would have allowed them to consider the risk and the fact that the benefits might clearly outweigh the risk. But the drug company was afraid that the truth that Vioxx wasn’t perfect would lead to a tremendous fall off in market share so they lied. Eventually they were caught in those lies and they paid a massive financial price, but that didn’t bring back the patients who had already suffered and died.

Breastfeeding advocates could salvage quite a bit if they were honest about the potentially deadly risks of breastfeeding. Alerting providers and patients to the true newborn stomach size and counseling them to look for and treat underfeeding would allow them to consider the risks and the fact that for many women the benefits might outweigh the risk. But breastfeeding advocates are afraid that the truth that breastfeeding is not perfect would lead to a tremendous fall off in market share so they lie. They are already being caught in those lies, although I doubt they will pay any price for their lying. In the meantime babies and mothers continue to suffer and die … while breastfeeding advocates continue to profit.

Two articles on breast cancer risk were published this week and they provide a window on the politics of breastfeeding.

The first paper is Learning, Life, and Lactation: Knowledge of Breastfeeding’s Impact on Breast Cancer Risk Reduction and Its Influence on Breastfeeding Practices.

It received a fair amount of press, including articles like Study finds doctors aren’t telling moms about breastfeeding’s cancer protection:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Promoting breastfeeding as reducing breast cancer risk is yet another inappropriate attempt to pressure women.[/pullquote]

When it comes to reducing women’s risk of breast cancer, epidemiological studies connect breastfeeding beyond the baby’s first year with a lower chance of developing triple-negative breast cancer.

That news isn’t getting out enough, according to a survey of 724 women from the Ohio State University Comprehensive Cancer Center. It found that although almost 60 percent of breastfeeding mothers knew their risk of cancer was reduced, only 16 percent said they got the news from health care providers.

The lead author, Bhuvana Ramaswamy, apparently a rabid lactivist, had this to say:

“There’s so much effective marketing by Nestle about infant formula,” she added. Hospitals still don’t always support early breastfeeding efforts, she said.

“Often mothers are told, ‘We can room the baby in the nursery, so you can get a good night’s sleep,’” she said. “They’re bottle-grooming the baby at the start.”

Bottle-grooming? Seriously? Are lactivists analogizing bottle feeding to sexual predation now?

What is the magnitude of this reduction in breast cancer risk? According to the widely cited study by Horta et al.:

The largest individual-level analysis on this topic included about 50000 patients with cancer from 47 studies,30 which is about half those included in our meta-analysis. Each 12-month increase in lifetime breastfeeding was associated with a reduction of 4·3% (95% CI 2·9–6·8) in the incidence of invasive breast cancer.

So Dr. Ramaswamy believes that it is imperative to make women aware of a 4.3% decreased risk of breast cancer because it is yet another factor that will convince women to breastfeed.

The second paper that was recently published is Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies. The authors found:

Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99])…

Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women.

As a New York Times article explains:

…[I]n women between the ages of 41 and 50 who had given birth in the previous three to seven years, the study found that 2.2 percent developed breast cancer, while in those who had not had babies, the figure was 1.9 percent.

That’s an increased risk of 16%.

But don’t worry; that risk is still low.

[R]esearchers said that the findings should not influence women’s decisions about if or when to have children.

See the paradox?

Childbirth increases breast cancer risk by 16% in the short term, but that risk should not influence women’s decisions about if or when to have children.

Yet, breastfeeding decreases the risk of breast cancer by 4.3% and women should strongly consider that in making a decision about whether to breastfeed.

On the face of it, these opposing approaches make no sense. Even with a 33% increased short term risk of breast cancer, the actual number of breast cancer cases is so small that it should not be a factor for women in determining whether to have children. Obviously a 4.3% reduction in breast cancer risk as a result of breastfeeding is far smaller still. Therefore, it should not be a factor for women in determining whether or not to breastfeed.

In truth, a woman’s risk of breast cancer is complex and multifactorial and childbearing and breastfeeding are two relatively minor modifiers of risk. But in the world of breastfeeding promotion, any benefit no matter how small is exaggerated and celebrated as a reason to pressure women to breastfeed.

Taken together these studies illustrate how risk is emphasized or ignored based on researchers’ priorities, not based on reality. Promoting breastfeeding as reducing breast cancer risk is yet another inappropriate attempt to pressure women into breastfeeding. If anyone is engaged in grooming, it is lactation professionals who routinely mislead women about the benefits of breastfeeding, elide its risks and remain utterly dismissive of the harm that pressure to breastfeed causes both babies and mothers.