Natural parenting is working.

No, not for children, silly! There’s no evidence that it has improved children’s lives. Rates of children’s psychiatric problems, including suicide, have never been worse.

It’s working on mothers just as it was designed to do. The holy trinity of natural child-rearing — natural childbirth, breastfeeding and attachment parenting — was designed explicitly to force women back into the home by problematizing infant safety, promoting maternal sacrifice as critical to child health and fetishizing physical proximity of mother to child. The result is that women who could work, who have been trained to work, are opting out of the workforce.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Those who feared women’s emancipation set out to make motherhood more demanding, intending to force women back into the home. It’s working.[/pullquote]

Finally others are taking note.

Claire Cain Miller, writing in the New York Times observes The Costs of Motherhood Are Rising, and Catching Women Off Guard.

An economic mystery of the last few decades has been why more women aren’t working…

The share of women in the United States labor force has leveled off since the 1990s, after steadily climbing for half a century…

The new analysis suggests something else also began happening during the 1990s: Motherhood became more demanding. Parents now spend more time and money on child care. They feel more pressure to breast-feed, to do enriching activities with their children and to provide close supervision.

A result is that women underestimate the costs of motherhood. The mismatch is biggest for those with college degrees, who invest in an education and expect to maintain a career …

But motherhood itself did not become more demanding. Children did not become more challenging or more needy. Socially constructed expectations of mothers became more demanding. Why? People who feared women’s political and economic emancipation set out to make them more demanding with the explicit intent of forcing women out of the workforce.

Think natural childbirth is about childbirth? Wrong. It’s about forcing women out of the workforce.

Grantly Dick-Read, the father of natural childbirth, wrote:

Woman fails when she ceases to desire the children for which she was primarily made. Her true emancipation lies in freedom to fulfil her biological purposes …

Think lactivism is about breastfeeding? Wrong. It’s about forcing women out of the workforce.

As psychologist Susan Franzblau has explained:

Out of concern that recently instituted bottle-feeding and drug-assisted births would break family bonds, these religious advocates of breastfeeding prescribed a regimen that included suckling on demand day and night with no pacifier substitute … Any work that competed with the infant’s need for continuity of maternal care was out of the question. One La La Leche League International group leader said that she was “pretty negative to people who just want to dump their kids of and go to work eight hours a day.”

Think attachment parenting is about children’s needs? Wrong. It’s about forcing women out of the workforce.

Bill and Martha Sears are explicit in their belief that God wants women to stay home and care for their children:

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.

These socially constructed expectations of motherhood were designed by privileged white people in order to control privileged white women and that’s precisely where they’ve achieve their greatest success.

As Miller notes:

For many women, the researchers show, stopping work was unplanned. Since about 1985, no more than 2 percent of female high school seniors said they planned to be “homemakers” at age 30, even though most planned to be mothers. The surveys also found no decline in overall job satisfaction post-baby. Yet consistently, between 15 percent and 18 percent of women have stayed home…

The people most surprised by the demands of motherhood were those the researchers least expected: women with college degrees, or those who had babies later, those who had working mothers and those who had assumed they would have careers. Even though highly educated mothers were less likely to quit working than less educated mothers, they were more likely to express anti-work beliefs, and to say that being a parent was harder than they expected.

It’s harder than the expected because the social constructed expectations of mothers have increased dramatically since they were children. They did not foresee the demands since those demands — natural childbirth, breastfeeding and attachment parenting — didn’t exist until recently. In each and every case, these demands have meant more work, more pain and more self-abnegation for mothers.

The cost of motherhood fell for most of the 20th century because of inventions like dishwashers, formula and the birth control pill. But that’s no longer the case, according to data cited in the paper. The cost of child care has increased by 65 percent since the early 1980s. Eighty percent of women breast-feed, up from about half. The number of hours that parents spend on child care has risen, especially for college-educated parents, for whom it has doubled.

And natural parenting advocates oppose virtually anything that decreases the cost of motherhood like epidurals, C-sections, formula, pacifiers, disposable diapers, commercially produced baby food, etc. That’s not a coincidence. Under the guise of what’s good for babies, they have ratcheted up the pressure on mothers. The worst part is that babies don’t truly need any of what’s touted to be good for them.

Miller quotes researchers:

“It is deeply puzzling that at a moment when women are more prepared than ever for long careers in the labor market, norms would change in a manner that encourages them to spend more time at home.”

It’s not deeply puzzling; it was intended all along.

Head over to the Academy of Breastfeeding Medicine blog and watch Melissa Bartick, MD put on a master class in motivated reasoning in her post Worldwide study on sudden infant death finds factors associated with poverty and racism are more important than bedsharing.

What is motivated reasoning?

Motivated reasoning is confirmation bias taken to the next level. Motivated reasoning leads people to confirm what they already believe, while ignoring contrary data. But it also drives people to develop elaborate rationalizations to justify holding beliefs that logic and evidence have shown to be wrong. Motivated reasoning responds defensively to contrary evidence, actively discrediting such evidence or its source without logical or evidentiary justification…

In this case, Dr. Bartick is desperately trying to rationalize her belief that bed sharing must be safe for babies in the face of copious evidence that it is in fact deadly.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Does the Academy of Breastfeeding Medicine have the will to promote infant health above breastfeeding?[/pullquote]

It’s hardly surprising that the Academy of Breastfeeding Medicine encourages motivated reasoning. They essentially announce it in their motto: “A Worldwide Organization Of Medical Doctors Dedicated To The Promotion, Protection and Support Of Breastfeeding.”

Call me old-fashioned, but I was taught that doctors are ethically obligated to promote the health and wellbeing of PATIENTS, not the protection and support of specific processes:

As a practicing obstetrician, I strove for safe pregnancy, but understood it was my obligation to provide contraception for women who didn’t want to be pregnant.

I strove for safe childbirth, but not when a woman requested a termination.

And although I strove for safe childbirth, I gave way, as I was legally obligated to do, when patients chose a more dangerous course such as Jehovah’s Witnesses refusing blood transfusions in the face of massive hemorrhage.

Why? Because it wasn’t my job to promote anything beyond a patient’s health and wishes.

The members of the Academy of Breastfeeding Medicine apparently don’t see it that way. They have committed themselves to promoting the process of breastfeeding regardless of whether it is what women want, what is safe for babies or what the scientific evidence shows. Like many doctors before them, they are up front about their paternalistic belief that they know what is good for patients better than patients themselves.

Dr. Bartick and her ABM colleagues have been stunned by the growing number of scientific papers highlighting the dangers of bed sharing. I was too … at first. When I initially saw the evidence about the deadly risks of bed sharing, I wrote posts to debunk them. I had bed shared with my own babies and it was difficult to contemplate that I might have put them at risk. Over the years, however the evidence has become overwhelming and I have accepted that bed sharing nearly triples the risk of sudden infant death syndrome.

Dr. Bartick has engaged in motivated reasoning instead.

Last year she published Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution, making the absurd claim that bed sharing must be safe because it is a product of human evolution.

Recommendations enforcing separate sleep are based on 20th century Euro‐American social norms for solitary infant sleep and scheduled feedings via bottles of cow’s milk‐based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia…

No, Dr. Bartick, recommendations for avoiding bed sharing are based on 21st Century scientific evidence that shows that it nearly triples the risk of SIDS!

That “argument” apparently didn’t persuade anyone beyond the ABM so Bartick now offers a new one, Sudden Infant Death and Social Justice: A Syndemics Approach.

It sounds fancy, but it is basically a plea to ignore the role of bed sharing in sudden infant death.

Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co‐occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation.

In other words, let’s ignore the role of bed sharing, which is easy to modify, and focus on structural inequality, which is extroardinarily difficult to modify.

That makes no sense … unless you are committed to promoting breastfeeding above preventing infant deaths.

In her ABM post, Dr. Bartick offers this deadly nonsense:

While the issue of improving overcoming the world’s worse SUID rates may seem daunting, some of these problems are low-hanging fruit. Bedsharing combined with smoking is extremely hazardous, and while it’s difficult to change bedsharing behavior as it’s a strong biological imperative, we can affect smoking by raising tobacco prices.

Do these folks ever listen to themselves? Smoking, despite being pharmacologically addictive, is “easier” to prevent than bed sharing? A strong biological imperative? Where’s the evidence for that claim? Oh, right; there isn’t any.

Dr. Bartick asks:

The question is, does the US have the political will to prevent its own infants from dying?

Yes, we have the political will to prevent infant deaths. That why we counsel women not to bed share since bed sharing KILLS!

The real question is: does the Academy of Breastfeeding Medicine have the will to promote infant health above breastfeeding? When you consider their sluggish to non-existent responses to scientific evidence showing aggressive breastfeeding promotion is injuring and killing infants through dehydration, kernicterus and smothering, the tragic answer is “no.”

I almost feel sorry for the older generation of UK midwives. They were taught by other midwives that midwifery hegemony was the key to safer outcomes, maternal satisfaction and tremendous cost savings. Faced with evidence of major failures on all three counts, they are struggling with serious cognitive dissonance.

There have been a myriad of midwifery scandals in the UK involving the preventable deaths of dozens of babies and many mothers. In nearly all cases babies and mothers died because midwives chose to arrogate their care to themselves and did not call obstetricians and pediatricians for assistance in high risk situations.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Babies and mothers have died and billions have been paid out in liability, but midwives feel sorriest for themselves.[/pullquote]

There has been an increasing outcry from women who resent the way that midwives have privileged their priority for so called “normal” birth over women’s personal priorities. Women resent that midwives promote their vision, discourage and interfere with obtaining epidurals, prevent women from accessing C-sections, and refuse to honestly inform women about the longterm risks of vaginal birth including prolapse, incontinence and sexual dysfunction.

To the horror of both government and population, maternity liability payments have exploded. They now stand at approximately £2 billion per year. Fully 20% of the annual budget for maternity care is spent on liability costs.

UK midwives have two choices:

1. They could apologize for their deadly mistakes and vow to learn from them.
or
2. They could insist they are being persecuted and feel sorry for themselves.

The older generation of midwives behind a new website, Birth Practice and Politics Forum, have chosen the second course.

Before analyzing what they have written, it is helpful to consider what an ethical childbirth ideology would look like. It’s relatively simple:

Her baby, her body, her birth, HER choice. Midwives’ preference are irrelevant.

Now, let’s look at the way that UK midwives ignore issues of safety, maternal satisfaction, and liability expenditures to focus on … their cherished beliefs.

Women are not being nurtured and cared for during pregnancy and birth in a way that supports and enhances their well-being or confidence in their abilities to give birth and become competent confident mothers. There is an on-going undermining of women’s rights and agency, and of the understanding that most women can give birth physiologically and without interference.

So what if mothers and babies are dying? So what if women are unsatisfied with midwifery care? So what if the government is paying billions each year to settle liability claims? In the view of these midwives the real issue is that they are being persecuted!

I kid you not.

Midwives and their support for normal birth are being unfairly attacked, if not demonised. This is preventing them from using their midwifery knowledge and skills to give women and families the kind of care they know is best and that has been repeatedly shown to provide excellent physical, emotional and psychological outcomes for mothers and babies. (my emphasis)

What about the dead babies and mothers?

The concept of risk is wheeled out at every turn. Risk and its avoidance have become so embedded in maternity care that decision-making has been all but removed from the mother and her midwife. Health practitioners’ fears of reprisal and fears of the birth process itself can and do lead to women being threatened either that their baby will die or be damaged, or with referral to social services if they do not follow medical advice.

It seems never to have crossed the midwives’ minds that the problem here is that risk and its avoidance have NOT become embedded in midwifery care and that the plethora of dead babies and dead mothers is the direct and predictable result.

Anyway there’s more to birth than a live baby and a live mother, right?

Although the rhetoric in maternity care focuses on safety and safe care, this is still largely restricted to short-term outcomes, often measuring only or mainly the survival of mother and baby…

If anyone has been ignoring the long-term outcomes of birth it’s the midwives themselves. Although they go into extraordinary detail with women about the purported long term risks of NOT having a vaginal birth, they don’t deign to mention the far more common long-term risks of HAVING a vaginal birth. For example, the absolute risk of urinary incontinence after vaginal birth is literally 10,000% higher than the absolute risk of placenta accreta after a C-section. You read that right, 10,000% higher, but midwives don’t seem to think that long-term outcome is worth talking about.

The midwives have the temerity to claim:

Maternity care is increasingly influenced by current ideological and financial considerations rather than rooted in what is best for women, babies and families.

Doing everything possible to avoid preventable deaths is not an ideology, it is an ethical requirement.
Doing everything possible to meet the stated preferences of mothers is not an ideology, it’s an ethical mandate.
Doing everything possible to reduce the liability payments for babies and mothers who are injured or die at the hands of midwives is not an ideology nor a financial consideration, it is basic medical ethics.

No matter!

We are concerned about a range of different but related influences on health care that are worsening maternity services for women, babies and families, for midwives and for other birth workers.

How could preventing perinatal and maternal deaths, improving maternal satisfaction and reducing liability payments “worsen” care for women, babies and families? It won’t; it will IMPROVE care. The real problem is that changes that improve safety and address women’s preferences will undercut the hegemony of UK midwives and therefore “worsen” their experience. But their experience is irrelevant.

Can you imagine if doctors had greeted the scientific evidence that routine episiotomy is harmful to women by insisting that the practice must be maintain to address the needs of obstetricians? Can you imagine if anesthesiologists rejected a woman’s preference to avoid medication and gave her an epidural anyway to improve the anesthesiologists’ experiences? There would be outrage and rightfully so. Patients don’t exist to meet providers’ needs; providers exist to meet patients’ needs.

As I said above, I almost feel sorry for these midwives. But I don’t for the simple reason that their happiness is not and should never be the goal of the maternity care system. The goal is patient safety and patient satisfaction, a point that seems to have utterly escaped midwives’ attention during their pity party for themselves.

Which came first, the chicken or the egg?

That question came to mind when I read an article in today’s Guardian, Growing childbirth terror disorder ‘fuelled by social media’.

Catriona Jones, a lecturer in midwifery at the University of Hull, who has studied tocophobia, believes social media is partly to blame for the phenomenon.

Speaking at the British science festival, taking place at the university, she said: “You just have to Google childbirth and you’re met with a tsunami of horror stories.

“If you go onto any of the Mumsnet forums, there are women telling their stories of childbirth – oh, it was terrible, it was a bloodbath, this and that happened. I think that can be quite frightening for women to engage with and read about.

Jones has adopted the position that the proverbial chicken came first. Fear of childbirth is implied to be a cultural construct that does not reflect the reality of nature. It arrives fully formed in response to socialization through frightening birth stories.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Midwives are employing the classic misogynist tactic of muzzling women who seek community and validation in sharing their experiences.[/pullquote]

Medieval philosophers also thought the chicken came first:

By the end of the 16th century, the well-known question seemed to have been regarded as settled in the Christian world, based on the origin story of the Bible. In describing the creation of animals, it allows for a first chicken that did not come from an egg.

They “knew” the chicken came first because their Bible told them so. Similarly, Ms. Jones “knows” that the chicken of fear of childbirth came first because her bible told her so. It is an article of faith among natural childbirth advocates that pain in labor comes from fear and fear comes from socialization.

But science tells us that it was the egg that came first:

…[A]n animal nearly identical to the modern chicken (i.e., a proto-chicken) laid a fertilized egg that had DNA identical to the modern chicken (due to mutations in the mother’s ovum, the father’s sperm, or the fertilised zygote). Put more simply by Neil deGrasse Tyson: “Which came first: the chicken or the egg? The egg — laid by a bird that was not a chicken.”

Science also tells that it the pain and the death toll of childbirth that led to fear, not socialization. The pain of childbirth is thought to have had the evolutionary purpose of promoting the purely human behavior of assistance in childbirth. Human childbirth is inherently dangerous and assistance can mitigate the risk by manipulating the baby out of a difficult position or by massaging the uterus to prevent hemorrhage after birth. A woman in pain sought out help; a woman who sought out help was more likely to survive; ultimately painful labor spread through the population because it was evolutionarily advantageous.

The death toll of childbirth speaks for itself. In every time, place and culture childbirth has always been a leading cause of death of young women. In countries where pre-technological conditions remain, the lifetime risk of maternal mortality has been as high as 1:10 as recently as 1990.

Even if science didn’t give us the answer, history tells us that the idea that labor pain is a construct of modern Western culture is nonsensical. The people who wrote the Bible were so impressed by the extreme agony of labor that they explained it as nothing less than a grievous punishment from God.

May midwives insist that the pain of labor is a cultural construct for a very simple reason: self-dealing. They have lost the care of a large proportion of women to obstetricians because OBs can abolish the pain of childbirth and midwives cannot. Living in our culture, where people are socialized to imagine that anything they like is natural and anything they dislike is a cultural construct, they have resorted to the foolish claim that painful childbirth is result of socialization, transmitted in this case by social media.

Midwives thus make stupifyingly ignorant claims like this:

Julie Jomeen, a professor of midwifery and the dean of the faculty of health sciences at the University of Hull, said: “Tocophobia is a modern-day phenomenon. Some of these women really think they are going to die.

“Two hundred years ago people accepted that they might die from childbirth. Today we expect childbirth to be safe.”

What? Does Jomeen think that women didn’t fear childbirth prior to the 20th Century? We have copious written evidence from women themselves that they viewed childbirth with unalloyed horror, dreaded the pain, feared the deaths of their children, and perhaps most anguishing of all, were terrified that they would leave their older childbirth motherless.

Is Jomeen trying to suggest that prior to the 20th Century women accepted the possibility of their own deaths with equanimity? Every bit of historical evidence we have shows that all people (men and women) have feared their own deaths throughout recorded history. Yes, they were surrounded by premature death; yes, their religious practice was designed to prepare them for death; but they still resisted death any and every way they knew how.

What’s going on here? The irony is that the midwives accuse women of being socialized to fear labor are oblivious to the fact that THEY are the ones who are blinded by a cultural construct. THEY are socialized to believe, despite massive evidence to the contrary, that labor is enjoyable, empowering and worthy of embrace.

As Suzanne Moore, also of The Guardian notes:

Women fear childbirth because pushing out another human being through a small opening in your body is to be split asunder…

The fear is rational. When women tell each other birth horror stories nowadays, this is not an exercise in fiction. They are telling the truth.

But there is another larger and more tragic irony here. Midwives who claim to be promoting a feminist ideal of birth are employing the classic misogynist tactic of muzzling women who seek community and validation in sharing their experiences.

If you feel mentally and physically traumatised, please do keep talking. You are not spreading fear. Because women sharing their truths, however bloody messy these are, is actually how we change things.

It is only through sharing the agony of postpartum depression that women have forced medical providers to take action. It is only through sharing maternal deaths (including sharing by journalists) that women have forced providers to take action. Similarly, it is only through sharing stories (especially sharing by the Fed Is Best Foundation) of babies harmed by aggressive breastfeeding promotion that women are gradually forcing medical providers to acknowledge the dangers and take action against unscientific programs like the Baby Friendly Hospital Initiative.

Social media has serious problems, but those problems concern empirical facts not personal experiences. Indeed, social media can serve as repository of and witness to raw human suffering and can elicit the best in human nature through campaigns, emotional and financial, to support those who are suffering. Moreover, social media is remarkably democratic, allowing anyone to communicate with the world, not merely those who satisfy a publishers’ prejudices.

Disparaging women who share their stories of childbirth agony, injuries and trauma on social media is a particularly chilling way to control discourse. Not only does it blame the victim but it also seeks to disempower women from preventing victimization. If you don’t know about the dangers of childbirth, you can’t protect yourself from them. If you don’t know about the agony of childbirth, you can’t mentally prepare yourself for it. And if you don’t know about the suffering that childbirth causes many women, you may needlessly, regrettably end up blaming yourself when it happens to you.

Bravo to Milli Hill for being willing (at least temporarily) to engage outside her comfort zone of UK midwives and natural childbirth advocates.

She unblocked a number of midwifery critics in an effort to convince them of the rightness of her convictions. But like an anti-vaxxer, Milli appears to be utterly flummoxed that we aren’t persuaded by the “facts” as she understands them. Similar to the typical anti-vaxxer, she doesn’t understand that she has been living in an alternative world of internal legitimacy.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]UK midwives never having to face dissent, respond to real scientific evidence or acknowledge that most of what they claim is factually false.[/pullquote]

That phrase was coined by the author of The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? by Anna Kirkland.

[They] have built an alternative world of internal legitimacy that mimics all the features of the mainstream research world — the journals, the conferences, the publications, the letters after the names — and some leaders have gained access to policy-making positions…

Consider:

Journals: There are a plethora of midwifery and natural childbirth journals. For example, Birth: Issues in Perinatal Care, published on behalf of Lamaze International, is technically a peer review journal. It is made up in large part of papers written by editorial board, which includes such luminaries of the natural childbirth world as Eugene Declercq, Marc J.N.C. Keirse, Michael Klein, and Marian F. MacDorman. Birth is where you send your paper if you can’t get it published in a real medical journal, and it carries little influence in the world of obstetrics. Every country has at least one peer reviewed midwifery journal and many non peer reviewed “journals” like the Journal of Perinatal Education, another Lamaze production, and Midwifery Today.

Conferences: Midwives and natural childbirth advocates love conferences like the Normal Birth Conference, the Trust Birth Conference and conferences of midwifery trade organizations. Unlike traditional scientific conferences where all viewpoints are heard on vigorous disagreements aired, midwifery conferences are heavily censored to remove dissenting views with the express purpose of creating an echo chamber for non-scientific claims. Sure, some doctors are allowed, like Michel Odent, Marsden Wagner and now Neel Shah, but only if they’ve been vetted for ideological purity beforehand.

Moreover, you won’t find midwifery academics and theorists on the speakers’ list at obstetric conferences, first because they aren’t respected within the greater obstetric and scientific communities, and second because they wouldn’t dare appear at a place where they would be laughed off the stage for their fanciful claims.

Libertarian individualist account of health: Midwives and natural childbirth advocates like to invoke all sorts of made up rights, like the “birth as a human right,” and the “right” to be attended by the provider of one’s choice in the place of one’s choice. They decry government regulation, yet, ironically, spend a great deal of time lobbying for government involvement in promoting and paying for favored birth choices and providers.

As Kirkland explains about anti-vaxxers:

[They] share an internally bounded world in which both individuals and ideas enjoy legitimacy, but undercut the groups’ external legitimacy …(emphasis in original)

But preserving internal legitimacy is considered far more important, hence Sheena Byrom and her UK midwifery clique block everyone who might possibly disagree with them. They insist that they are blocking trolls but the definition of “troll” belies that claim.

According to Wikipedia:

…[A] troll is a person who starts quarrels or upsets people on the Internet to distract and sow discord by posting inflammatory and digressive, extraneous, or off-topic messages … with the intent of provoking readers into displaying emotional responses and normalizing tangential discussion.

But I and like minded midwifery critics aren’t trying to distract, provoke midwives into displaying emotional responses or normalize tangential discussions. We are trying to engage on the issues, analyze scientific evidence, and subject claims to thorough analysis.

Kirkland asks a question about vaccine rejectionists that can also be asked about UK midwives:

Under what conditions could we imagine leaders reporting back at a later conference that the right study had finally been done and proved them wrong?

The answer, of course, is never.

UK midwives occupy an alternate world of internal legitimacy, which means never having to face dissent, never having to respond to real scientific evidence, and never having to acknowledge that most of what they claim is factually false.

It remains to be seen what Milli Hill will do about her cognitive dissonance. Will she be motivated to read the scientific literature, analyze it and seek out the papers of those who disagree with midwifery claims? Or will she take the easy route and subside back into the comforting community of like-minded believers inhabiting an alternate world of internal legitimacy?

Imagine that we set up our system of cardiology care like this:

Our bedrock assumption is that hearts are to be trusted.
We reduce screening measures since they only lead to more tests.
We deny that risks factors have any relevance.
We put initial cardiac care into the hands of nurses who have limited training in treating heart attacks.
We wait until people develop symptoms like chest pain and shortness of breath before we investigate.
We avoid high tech measures as long as possible.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Everyone who cares for pregnant women must have a high index of suspicion for complications and must treat early signs without delay.[/pullquote]

Would anyone be shocked if cardiac mortality rose as a result? I doubt it since we know that the key to cardiac care is prevention including routine blood pressure monitoring, routine treatment of asymptomatic high blood pressure, additional testing for people with risk factors and high tech investigation at the first sign of potential cardiac problems.

You don’t need to imagine how we’ve set up our maternity care system. We’ve eroded the technocratic model of obstetric care under pressure from the “holistic” midwifery model of care.

The bedrock assumption of midwives, doulas and natural childbirth advocates is that birth is to be trusted.
They deplore screening tests.
They minimize risk factors.
They insist that less professional training leads to better maternity care.
They wait until women develop life threatening symptoms before acting.
They avoid fetal monitoring and demonize C-sections.
They worry about the experience of birth because they assume the safety of birth is guaranteed.
They’ve created an adversarial relationship between women and their obstetricians that has led to decreasing vigilance.

Now everyone is shocked, shocked that maternal mortality has risen. We really have no excuse for our shock. We’ve allowed ourselves to forget that obstetric care ought to be preventive care, constantly assessing for risk factors and problems and aggressively treating early signs of potential complications before they become full blown disasters.

I have been writing about this issue for more than a decade and constantly emphasized four principles of preventing maternal mortality.

1. We cannot forget that pregnancy is inherently dangerous.
2. Certain groups of women are at high risk for complications
3. We must have a high index of suspicion for early signs of complications
4. We must treat those early signs aggressively

None of this is new information but we are in the midst of discovering it all over again and California is leading the way.

California’s maternal death rate fell from 13.1 deaths per 100,000 live births in 2005–09 to 7 per 100,000 in 2011–13, according to a new Health Affairs study…

They looked at why women are dying.

Two key lessons in reversing maternal mortality, [author] Main said, are denial and delay. “People want to deny that she’s as sick as she is. ‘It’s going to get better, the bleeding will stop, blood pressure will come down,'” Main said. “That invariably leads to delay in treatment.”

In other words, everyone who cares for pregnant women must have a high index of suspicion for complications and must treat early signs aggressively.

For example:

…[I]mplementing large-scale interventions by integrating providers with public health services, begins with a bundle, a quality improvement toolkit defining best practices and the creation of learning collaboratives. The largest of CMQCC’s learning collaboratives, which includes 99 hospitals that collectively report more than 250,000 annual births, reduced severe maternal morbidity among women with hemorrhage by 20% using an obstetric hemorrhage toolkit.

If we change the way we view and treat pregnant women, we can save their lives.

According to Becker’s Hospital Review:

1. Hospitals must implement and sustain a standardized approach to managing known obstetric complications and emergencies involved in pregnancy and childbirth.

2. Providers must recognize and modify care for pregnant women presenting with chronic conditions that contribute to pregnancy-related complications, including hypertension, diabetes and obesity.

3. Healthcare leaders and clinicians should have access to comprehensive clinical data on maternal health outcomes. Developing a maternal mortality review board lets providers gather data on known causes of maternal death and harm.

4. Patients, clinicians, nurses and the healthcare agencies that support them should participate in regular educational training sessions on preventing maternal harm and death, including reliable strategies and processes to mitigate unintended outcomes.

In other words, everyone who cares for pregnant women must have a high index of suspicion for complications and must treat early signs aggressively.

Why?

Because pregnancy is inherently DANGEROUS. When we forget that or choose to ignore it, women die.

But when we keep that reality front and center, train for deadly complications, drill for deadly complications, have a low index of suspicion for deadly complications and react aggressively to even the earliest signs of potentially deadly complications we can save women’s lives.

I’ve repeatedly noted that the evidence for the purported benefits of breastfeeding for babies is weak, conflicting and riddled with confounders. The actual benefits of breastfeeding are tiny, limited to 8% fewer colds and 8% fewer episodes of diarrheal illness across the entire population of infants in their first year.

The evidence for purported maternal benefits is even worse.

You’d never know it from the way that lactivists tout maternal benefits of breastfeeding. According to a recent article in Health, breastfeeding purportedly leads to these benefits for mothers:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Considering the disabling limitations of the data, there is NO basis for ANY claims of maternal benefit from breastfeeding.[/pullquote]

• Easier weight loss after birth
• Lower risk of breast cancer
• Lower risk of ovarian cancer
• Lower risk of endometrial cancer
• Lower risk of type II diabetes
• Lower risk of heart disease

But that’s not what the scientific evidence shows.

Consider this new review of the impact of breastfeeding on maternal health conducted by Alison Stuebe, MD and colleagues on behalf of the Agency for Healthcare Research and Quality (AHRQ).

I created this table to summarize their findings on a long list of diseases:

With the exception of ovarian cancer, there is insufficient evidence or only low quality evidence to support an association between breastfeeding and these diseases. And an association does not necessarily mean causation. For example, we know that the risk of ovarian cancer is related to the number of ovulatory cycles experienced by a woman. Breastfeeding can decrease lifetime ovulatory cycles and therefore may lead to a lower risk of ovarian cancer. But use of the birth control pill ALSO decreases lifetime ovulatory cycles and can provide the same benefit.

The key point is this: there is NO high quality evidence that even associates breastfeeding with the lower risk of these diseases, let alone evidence that breastfeeding causes a reduced incidence of these diseases.

But that doesn’t stop Stuebe and the other authors from making claims that are not supported by their own evidence:

Our conclusions related to the maternal benefits of breastfeeding suggest that breastfeeding is associated with lower rates of breast cancer, ovarian cancer, hypertension, and type 2 diabetes. The potential to improve maternal health could be highlighted as a rationale for improving rates of breastfeeding by health care and public health practitioners. For cardiometabolic outcomes, it has been hypothesized that lactation “resets” maternal metabolism after pregnancy, thereby reducing cardiovascular disease risk.

Wait, what? They JUST SHOWED that the evidence doesn’t support that claim and yet they are making it anyway?

This despite the fact that they acknowledge:

We concluded that low SOE supports the association between breastfeeding and reduced hypertension; however, primarily because of heterogeneity in outcome measures and study limitations, we concluded that evidence was insufficient to reach a conclusion about cardiovascular disease.

This is a perfect example of the way in which lactation professionals ignore the evidence in order to claim benefits for breastfeeding that don’t exist.

The authors admit that any claim of maternal benefits for breastfeeding is undermined by their inability to correct for confounding variables.

Several other factors may be at work. First, women in very high income countries who choose to and successfully breastfeed are typically better educated, wealthier, and more likely to engage in other beneficial health behaviors. Moreover, it is plausible that, rather than breastfeeding preventing poor maternal health, poor maternal health may prevent breastfeeding…

In their conclusion, the authors state:

The identified associations between breastfeeding and improved maternal health outcomes are supported by evidence from observational studies, which cannot determine cause and effect relationships.

Not really. The truth is that there is only insufficient and low quality evidence to support an association between maternal benefits and breastfeeding, with the exception of ovarian cancer. When corrected for confounding variables these associations may disappear entirely. In any case, an association is NOT causation. In light of these disabling limitations, there is NO basis for asserting ANY maternal benefit from breastfeeding.

Breast is NOT best.

Sure, all else being equal, fully fed with breastmilk by a well off, mentally healthy mother with access to high quality healthcare and high quality childcare who has freely chosen to breastfeed and has sufficient breastmilk has tiny benefits compared to formula feeding; but all else is rarely equal. Indeed, the scientific research shows that if the many factors in the previous statement are listed in order of importance to infant wellbeing from most important to least important, we get a list that looks like this:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women who have expended great effort to breastfeed need to believe that the benefits are large and are hypersensitive to any suggestion that they are not.[/pullquote]

1. Fully fed
2. Access to high quality healthcare
3. Mentally healthy mother who has freely chosen to breastfeed
4. Breastmilk

So if we REALLY cared about infant health, instead of merely pretending that we do, we’d work to ensure that every baby is fully fed, that every baby has high quality healthcare, that we do everything in our power to prevent and treat postpartum depression and only then promote breastfeding. Instead we do the opposite.

Why do we ignore the scientific evidence that the benefits of breastfeeding are tiny? Why do we ignore the growing body of scientific evidence that aggressive promotion of breastfeeding is leading to tens of thousands of neonatal hospital readmissions each year at a cost of hundreds of millions of dollars? Why do we ignore the minor epidemics of infant dehydration, severe jaundice, babies falling from and smothering in their mothers’ hospital beds leading to permanent brain injuries and even deaths? Why do we ignore the harms of aggressive breastfeeding promotion to mothers’ mental health?

The reason: effort justification.

According to Wikipedia:

Effort justification is a person’s tendency to attribute a value to an outcome, which they had to put effort into achieving, greater than the objective value of the outcome.

It’s an attempt to reduce cognitive dissonance:

[T]here is a dissonance between the amount of effort exerted into achieving a goal or completing a task (high effort equalling high “cost”) and the subjective reward for that effort (lower than was expected for such an effort). By adjusting and increasing one’s attitude or subjective value of the goal, this dissonance is resolved.

Simply put, women who have expended great effort to breastfeed — who have endured the screams of a starving baby, cracked and bleeding nipples, multiple episodes of mastitis, sleep deprivation and (in some cases) serious depression — need to believe that the benefits are large and are hypersensitive to any suggestion that they are not. That’s why the Fed Is Best Foundation is excoriated in the loudest possible terms with an endless repetition of lies.

For lactivists, the Fed Is Best Foundation is cognitive dissonance writ large. It’s very name is anathema because it suggests that breast is NOT best for every baby and it only gets worse from there. In order to protect future babies from being harmed by aggressive breastfeeding efforts, the Fed Is Best Foundation reports on existing babies who have been harmed, injured and even died from complications of breastfeeding. How dare they?

In order to protect babies, the Fed Is Best Foundation exposes the lies propounded by lactivists. Such lies include:

• The claim that insufficient breastmilk is rare (it’s common, affecting up to 15% of first time mothers)
• The lie that formula supplementation is harmful to breastfeeding (it’s not; judicious formula supplementation in the first few days INCREASES the likelihood of extended breastfeeding)
• The lie that pacifiers cause nipple confusion (they don’t; they prevent SIDS)
• The lie that a newborn’s stomach is the size of a marble (it’s not; it’s 4X larger)

In order to support mothers, the Fed Is Best Foundation provides accurate assessments of the tiny benefits and significant risks of breastfeeding. They support breastfeeding in every way they know how, but they aren’t willing to lie to do so. How dare they?

But perhaps most egregious is the fact that the Fed Is Best Foundation supports women who can’t or choose not to breastfeed. That produces unbearable cognitive dissonance for lactivists. If it’s okay not to breastfeed (and it is okay), then the effort that they expended to breastfeed was not heroic; it wasn’t even necessary. When lactivists insist against all evidence that the Fed Is Best Foundation doesn’t support breastfeeding what they mean is that the FIBF doesn’t support their view of themselves as superior mothers. How dare they?

Sadly, cognitive dissonance and effort justification affect breastfeeding professionals nearly as much as lay people. Consider this obnoxious lie tweeted by lactivist Prof. Rafael Perez-Escamilla:

Thank you Baby-Friendly USA for exposing the FIB Foundation which is an organization based on the principles of “Astroturfing” defined [by Wikipedia]

What is Astroturfing?

Astroturfing is the practice of masking the sponsors of a message or organization (e.g., political, advertising, religious or public relations) to make it appear as though it originates from and is supported by grassroots participants… The implication behind the use of the term is that instead of a “true” or “natural” grassroots effort behind the activity in question, there is a “fake” or “artificial” appearance of support.

We have a word for that kind of tweet. The word is libel.

To date, the Fed Is Best Foundation has not chosen to pursue legal action against liars like Dr. Perez-Escamilla, but that doesn’t mean they couldn’t. Like all charitable foundations, FIBF has publicly accessible tax documents. But you don’t even have to look them up; the Foundation has published those documents on the Web. They show that there is NO secret funding source, NO corporate sponsors, nothing but real, grassroots support. Perez-Escamilla and other lactivists who lie have reason to know that they are lying, yet they do it anyway.

Why? Effort justification.

These people have devoted their entire careers to the belief that breast is best for every baby. They’ve raised and spent millions of dollars putting unethical, aggressive breastfeeding promotion efforts like the Baby Friendly Hospital Initiative into practice. Ironically — unlike FIBF founders whom they accuse of profiting from their advocacy — these liars actually DO profit from their advocacy. Their professional raison d’etre is breastfeeding and they need to believe that the effort they have expended, the money they have spent and the money they currently earn are justified by the overwhelming superiority of breastfeeding.

The cognitive dissonance that results from acknowledging that the benefits of breastfeeding are tiny and the risks significant is simply unbearable. The need for effort justification compels otherwise responsible professionals to blatantly lie in order to protect their self-image.

Prof. Perez-Escamilla and the other professional lactivists who have lied about the Fed Is Best Foundation owe them a public apology and an acknowledgement that there is no evidence of corporate sponsorship beyond lactivists’ desperate efforts to avoid confronting the facts.

Breast is NOT best for every baby and I’d be happy to debate Prof. Perez-Escamilla in print or in public on that issue. But I suspect that he, like most professional lactivists, wouldn’t dare.

The single most important thing every prospective mother needs to know about breastfeeding is this: it has serious risks as well as benefits.

Baby Friendly USA is petrified that women will find out.

Sadly for the babies who have been injured and died and their grieving families, we found out the risks of breastfeeding hard way. The scientific literature is burgeoning with papers* detailing the high rate of insufficient breastmilk especially in the early days after birth (up to 15% of first time mothers) and the brain-threatening, life-threatening consequences. We are experiencing a dramatic increase in neonatal hypernatremic dehydration, hypoglycemia and kernicterus (severe jaundice). Exclusive breastfeeding is associated with tens of thousands of newborn hospital readmissions per year at a cost of hundreds of millions of dollars.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Ethical professionals ask, “What can we do to prevent this from happening again?” Baby Friendly USA asks, “What can we do to avoid blame?”
[/pullquote]

The press is bristling with reports of lawsuits over babies who died IN HOSPITALS. They fell out of or were smothered in their mothers’ beds in the wake of closure of well baby nurseries at the behest of breastfeeding professionals. Though we’ve spent millions on major public health campaigns to alert parents to the dangers of babies sleeping in an adult bed, babies sleeping with soft bedding and babies sleeping with anyone impaired by drugs, the Baby Friendly Hospital Initiative effectively ENCOURAGES all three.

Keep in mind that the hospitalizations, brain injuries and deaths are iatrogenic. They happen BECAUSE of aggressive breastfeeding promotion.

When a baby suffers iatrogenic harm, ethical healthcare professionals ask, “What can we do to prevent this from happening again?” Baby Friendly USA asks, “How can we discredit Fed Is Best for pointing it out?”

Their answer is to attack the whistle blower who is bringing the news of deadly harms to others. In this case the whistle blower is the Fed Is Best Foundation, a non-profit formed expressly to ensure that the brain injuries suffered by a founder’s son did not happen to any other babies.

Take a look at Baby Friendly USA’s latest attempt to retaliate against them for exposing injuries and deaths. It’s a 1200 word rant claiming that the Fed Is Best Foundation is misleading people on the issue of jaundice and breastfeeding. As you read it, ask yourself:

Is Baby Friendly USA trying to avoid infant brain injuries and deaths or are they trying to avoid blame and loss of market share?

The Baby Friendly USA rant appears to have lots of points but actually makes only two:

1. How dare the Fed Is Best Foundation show that breastfeeding professionals know that breastfeeding is implicated in 90% of cases of kernicterus in the US?

Pediatrician Lawrence Gartner acknowledged this in a slide used in a lecture to breastfeeding professionals, a slide that had been uploaded to a public website.

What does BF USA propose to do about kernicterus? NOTHING of course except offer blustering nonsense:

The slides from Dr. Gartner’s lecture were posted without his permission, a gross violation of accepted professional protocol.

But you DON’T need permission. Using a small piece of an article or presentation as a vehicle for a broader discussion is “fair use.” If anyone would know about that it’s me as I sued another blogger in Federal Court for accusing me of almost the exact same thing.

2. The Fed Is Best Foundation may have used numbers that overstate the incidence of jaundice and therefore the associated brain injuries.

What does BF USA propose to do about actual cases of jaundice and associated brain injuries? NOTHING beyond quibbling about the size of the increase.

BF USA insists on maintaining the status quo. They suggest doing nothing more, changing nothing, telling member hospitals nothing as if that isn’t what led to these cases of jaundice and kernicterus in the first place.

The Fed Is Best Foundation exists precisely because this has already been an ABJECT FAILURE. The whole point is that babies are suffering iatrogenic injuries as a result of aggressive breastfeeding promotion.
But BF USA fears reform will cut into their bottom line since their source of income IS aggressive breastfeeding promotion.

The rant concludes:

We would rather not spend our time “fact checking” this organization, but we will continue to do so if that’s what is necessary to ensure mothers and families get accurate information. We consider the constant drum-beat of these falsehoods to be reckless and negligent behavior and once again call on this organization to be more responsible in providing the public accurate and scientifically-grounded data.

It would be far more accurate to have acknowledged that they’d much rather spend their time “fact checking” Fed Is Best than protecting babies from harm. BF USA is right to be afraid of the Fed Is Best Foundation. No amount of suppressing the truth or attacking Fed Is Best for exposing it avert reform; it can only delay it at the cost of further infant hospital readmission, brain injuries and deaths.

When a baby suffers iatrogenic harm, ethical healthcare professionals ask, “What can we do to prevent this from happening again?” Baby Friendly USA ask, “What can we do to avoid blame?”

It’s an incredibly ugly look!

*Recent publications:

• United States Preventive Services Task Force (USPSTF) guidelines
• Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms
• Unintended Consequences of Current Breastfeeding Initiatives
• The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature
• Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding
• The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial