Everyone knew it was the gold standard for both health and sophistication.

Doctors recommended it and were sure to do it themselves. This despite the fact that for hundreds of years there had been obvious casualties.

It’s wasn’t until the Surgeon General’s Report of 1964, that the truth was finally presented for all to see. Tobacco wasn’t safe and had never been safe. It caused cancer, heart disease and lung disease. Thousands of people had been dying each year for decades, so why hadn’t anyone noticed?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Formula, not breastmilk, is the gold standard in infant nutrition.[/pullquote]

Marketing!

Breastfeeding is currently the gold standard for health and nutrition of infants.

Doctors recommend it and are sure to do it themselves. This despite the fact that for thousands of years there had been obvious casualties.

Aggressive breastfeeding promotion leads to tens of thousands of neonatal hospital readmissions each year in the US alone at a cost of hundreds of millions of dollars each year. Aggressive breastfeeding promotion causes neonatal brain injuries and deaths from dehydration, severe jaundice, low blood sugar and infants falling from or smothering in their mothers’ hospital beds. A single case of infant brain injury can cost millions in liability payments, not to mention the destruction of potential and the anguish of families.

So why hasn’t anyone noticed? Marketing!

As I explained yesterday, La Leche League, originally created by a group of traditionalist Catholic women in order to convince mothers of small children not to work, exploited the Nestle African tragedy to partner with the World Health Organization in promoting breastfeeding. Never mind that it was not infant formula that harmed babies, but the contaminated water used to make it. Never mind that children continued to die in their hundreds of thousands because they bathed in and ultimately drank that same contaminated water. This was the perfect opportunity to market breastfeeding and they took it.

They took it because it dovetailed neatly with their financial plans to profit from breastfeeding. At the same time that they partnered with the WHO to promote breastfeeding, they began to monetize it by creating the lactation consultant credential and lobbying heavily to install lactation consultants (themselves) in hospitals and doctors’ offices.

The heart of the marketing campaign was to convince everyone that “breast is best” and that breastmilk is “the perfect food.” Neither of those things were ever true (just as tobacco was never healthy) but after 30 years of marketing the average person “knows” that breastfeeding is the gold standard just like the average person in 1959 “knew” that smoking was healthy, or at a minimum, safe.

Don’t get me wrong: breastfeeding is not dangerous in the way that tobacco is dangerous. There is no safe way to use tobacco while millions of babies can be fully nourished with breastfeeding. But breastmilk is hardly the gold standard.

What would it take for something to be the perfect infant nutrition?

• It should contain all the nutrients and other factors that an infant needs.
• It must be available in sufficient quantity to promote vigorous growth of the infant.
• The infant must be able to access it easily.

Breastfeeding fails on all three counts. Breastmilk lacks sufficient iron and vitamin D; exclusively breastfed infants need vitamin supplements. As many as 15% of first time mothers cannot produce enough breastmilk to fully nourish an infant especially in the early days after birth. Moreover, a significant minority of infants cannot access milk from the breast. It has become fashionable to diagnose those babies as “broken” due to tongue tie and subject them to painful surgery though the scientific evidence provides no support for that treatment in the vast majority of cases.

You know what DOES meet the definition of the perfect infant nutrition? Formula!

It contains more nutrients than breastmilk. It is available in endless quantities. All infants can easily access it through bottles or feeding tubes.

In addition, it dramatically reduces the risk of neonatal hospital readmission, reduces the risk of dehydration, severe jaundice and low blood sugar, saving hundreds of millions of healthcare dollars and liability payments.

But, but, but breastfeeding is natural and formula is not. So what? Contaminated ground water is natural and filtered tap water is not. Living in caves is natural and central heating is not. Unvaccinated is natural and vaccines are not. In all three cases it is the “unnatural” that is far safer.

Wait, what? Formula doesn’t have maternal antibodies? That’s true, but the vast majority of antibodies a baby receives from its mother are transmitted across the placenta. Most antibodies in breastmilk can’t be absorbed through the infant gut; only the smallest antibodies, IgA, are biologically active within the infant. That accounts for the slight reduction in colds and diarrheal illnesses across the entire population of infants in the first year.

What about all those other benefits claimed for breastfeeding? Nearly all have been thoroughly debunked by careful studies that revealed that it is the higher maternal socio-economic status of breastfeeding mothers that accounts for benefits of breastfeeding, not breastfeeding itself.

I’m hardly the only person to point this out. Joan Wolf wrote in yesterday’s New York Daily News:

But, the WHO and myriad pro-breastfeeding groups will claim, the science on infant feeding is virtually unanimous. Breastfed babies are healthier, smarter and more socially successful than those who were formula fed throughout the life course, and formula feeding is dangerous. So they say.

The problem, as I have demonstrated in “Is Breast Best: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood,” is that this research is poorly designed, executed and interpreted — and then grossly misrepresented among scientists and between researchers and the public.

Courtney Jung pointed the same thing out in her book Lactivism and an her op-ed in The NYTimes Overselling Breastfeeding:

Oddly, the fervor of breast-feeding advocacy has ramped up even as medical research — published in The Journal of the American Medical Association, BMJ in Britain and The American Journal of Clinical Nutrition — has begun to report that the effects of breast-feeding are probably “modest.”

Some sobering results have come from Dr. Michael Kramer’s Probit trial, which has studied a wide range of outcomes among about 14,000 mother-infant pairs for 16 years… While Probit found that breast-feeding had some benefits, including for cognitive development, it did not reduce the risk of obesity, asthma, allergies, dental cavities or attention-deficit hyperactivity disorder.

The benefits associated with breast-feeding just don’t seem to warrant the scrutiny and interventions surrounding American infant feeding practices… [A] meta-analysis of the research on breast-feeding done by the United States Agency for Healthcare Research and Quality in 2007 concludes that much of that research is weak: Some studies are too small, or they fail to control for confounding variables. The findings themselves are often inconclusive. One study will find evidence of an effect and another won’t — so we just don’t know which results to trust.

So why do we believe that breast is best? For the exact same reason we believed that tobacco was safe: marketing!

A new Surgeon General’s report might finally convince people that they’ve been duped by excellent marketing and that breast is NOT best for every mother and every baby.

I don’t see that on the horizon since most doctors of the early 21st Century are as enthralled by breastfeeding as the doctors of the early 20th Century were by smoking. I suspect that it will be insurance companies that will lead the way on this issue. Health insurers will realize how much they are spending on infant hospital readmission and will stop paying for it; as a result hospitals will revert to common sense in formula supplementation instead of aiming for lactivist ideological purity. Furthermore, malpractice insurers will look at the millions they are spending on babies falling from and smothering in their mothers’ hospital beds and pressure hospitals to bring back well baby nurseries instead of knuckling under to lactivist insistence on mandatory rooming in.

No matter how desperately lactation professionals continue to exaggerate the benefits of breastfeeding (the microbiome! epigenetics!) it simply costs too much in infant illness and death, maternal anguish and money to maintain the fiction — breast is best — that has been created through marketing.

 

Don’t believe me? I’d be happy to publicly debate (in print or in person) any well known lactation professional on this issue. Don’t hold your breath waiting for that to happen, though. No lactation professionals would dare subject their claims to a public debate; they know they would lose.

Welcome to the thousands of new readers who have visited the blog over the past few days. You’ve been drawn by the posts on breastfeeding in which I’ve attempted to correct the massive amount of misinformation that passes for “education” on the topic.

On Sunday (New US breastfeeding policy, adopted for the wrong reasons, will almost certainly save lives) I wrote about the fact that Trump, though generally wrong about everything, is right to oppose the draconian WHO regulations around infant formula.

On Monday (What the breastfeeding literature REALLY shows) I provided a summary of major papers published in the breastfeeding literature in the past 2 years. Collectively they show that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS and extended skin to skin contact leads to babies falling from their mothers’ hospital beds or suffocating while in them. Most importantly, the myriad purported benefits of breastfeeding actually come from the higher socio-economic status of breastfeeding mothers, not breastfeeding itself.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivism, like anti-choice activism, isn’t about babies; it’s about controlling women’s bodies.[/pullquote]

On Tuesday (The conventional wisdom about breastfeeding is DEAD wrong!) I wrote about the ways in which the benefits of breastfeeding have become conventional wisdom and how conventional wisdom is often wrong.

Yesterday (Finally, data on lives saved each year by breastfeeding: only 8% of WHO claim!) I showed that the WHO’s central claim about breastfeeding, that it could save more than 800,000 lives each year is based on a faulty mathematical model and is thoroughly undercut by the actual evidence. At its peak, formula use in developing countries resulted in 65,000 deaths per year, ENTIRELY due to contaminated water, not formula itself. That peak occurred in 1981. Since then according to Paul Gertler whose research established the 65,000 peak death toll:

…[T]he annual death toll has dropped to about 25,000, driven by improved access to clean water in the Southern Hemisphere.

That’s only 3% of the total claimed by the WHO.

So why have professional lactivists, including those at the WHO, grossly exaggerated the benefits of breastfeeding, ignored the risks, massively inflated the number of lives that could be saved and clung to the conventional wisdom long after it had been disproven? Their tactics have a lot in common with those of anti-choice activists because neither breastfeeding nor abortion is about babies. This is about controlling women’s bodies.

Although La Leche League, the original and premier lactivist organization has carefully scrubbed their website of the fact, it was a religion inflected organization originally founded by seven traditionalist Catholic women designed to keep other women out of the workforce by convincing them to breastfeed.

In the book La Leche League: At the Crossroads of Medicine, Feminism, and Religion, Jule DeJager Ward explains that the La Leche League was:

…founded in 1956 by a group of Catholic mothers who sought to mediate in a comprehensive way between the family and the world of modern technological medicine…

[A] central characteristic of La Leche League’s ideology is that it was born of Catholic moral discourse on family life … The League has very strong convictions about the needs of families. These convictions are the normative heart of its narrative… The League’s presentations and literature carry a strong suggestion that breast feeding is obligatory. Their message is simple: Nature intended mothers to nurse their babies; therefore, mothers ought to nurse…

The idealization of motherhood reflects the place of Mary in Catholic popular devotion…

The League’s answer to the question “What should mothers do” is grounded in … the original faith community of its founders.

For those women, the contents of their Catholic faith and the existential question of motherhood are interdependent…

From its very inception lactivism has been about policing women through control of their bodies. The medical justifications were embroidered on later to conceal the religious goal.

From its founding in the late 1950’s through the 1970’s, LLL was an organization that depended entirely on volunteers for peer to peer teaching of breastfeeding. Two things happened in the early 1980’s to propel LLL to its current status as arbiter of and nexus for all things breastfeeding.

First, breastfeeding was monetized. LLL spun off a variety of organizations to create, educate and monitor an entirely new profession: lactation consultant. Though LLL continued to give away breastfeeding information for free, its daughter organizations worked aggressively to install lactation consultants in hospitals, doctors offices and public health organizations. The monetization of breastfeeding led inexorably to the moralization of breastfeeding. In an effort to create ever more employment opportunities for lactation consultants, ever more “benefits” were conjured for breastfeeding and ever more pressure was applied to women culminating in the Baby Friendly Hospital Initiative, a program to aggressively promote breastfeeding to new mothers while they were hospitalized after birth.

Second, these efforts dovetailed with moral outrage over Nestle’s behavior in Africa. In an effort to improve market share Nestle convinced women to abandon breastfeeding for the convenience of formula, deliberately ignoring the fact that many did not have access to clean water. LLL became an advisor to the WHO in creating a response which involved aggressive promotion of breastfeeding. It was at this point that lactivism devolved into a campaign against formula even though there was no evidence that it was formula itself that had caused the problem.

Nestle’s corporate malfeasance is so central to breastfeeding promotion that to this day, more than 30 years after the fact, outrage against Nestle remains front and center in every lactivist effort centered on demonizing formula, which is just about every lactivist effort.

But make no mistake, lactivist organizations have never dropped their original commitment to controlling women by policing their bodies.

Lactivism is not about babies since the benefits of breastfeeding are trivial in countries with access to clean water.

In truth, nearly all the claimed benefits of breastfeeding are based on studies that are weak, conflicting and riddled with confounding variables. When corrected for confounders like maternal education and socio-economic status, the only benefits that remain are an 8% decrease in the risk of colds and an 8% decrease in episodes of diarrheal illness across the entire population of infants in the first year. In other words, the vast majority of infants will experience no demonstrable benefit from breastfeeding.

Lactivism is not about saving babies lives since, with the small exception of extremely premature infants, breastfeeding DOESN’T save lives in industrialized countries.

Lactivism isn’t about following the scientific evidence since most efforts, like the Baby Friendly Hospital Initiative, IGNORE the scientific evidence about the benefits of formula supplementation and pacifiers and ignore the rising number of breastfeeding casualties: the tens of thousands of babies readmitted to the hospital each year for dehydration and other breastfeeding complications.

Lactivism isn’t about saving money since any potential healthcare savings are dwarfed by the hundreds of millions of dollars spent each year to hospitalize babies suffering breastfeeding complications and the hundreds of millions of dollars spent in liability payments for babies’ brain injuries and deaths as a result of those complications.

Lactivism is about controlling women through policing their bodies, imposing a restrictive view of motherhood on women in order force them back into the home. It’s about dictating to women how they should use their bodies, pressuring them to use their bodies in approved ways, and lying to them to convince them to knuckle under.

Is breastfeeding a good thing?

It can be. I breastfed four children (all adults now). They were fat, happy babies and I enjoyed it and was able to combine it with an extremely demanding job. But I have no illusions that it improved the health or intelligence of my children or my relationship to them.

In my view, given the facts about breastfeeding, our approach to breastfeeding ought to be the same as our approach to abortion:

HER baby, HER body, HER choice …

Anything else is an attempt to control women by controlling their bodies.

In 2016 The Lancet published a paper that made an extraordinary claim. According to Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect:

The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years …

It’s an extraordinary claim because it is belied by all existing real world data on the impact of formula around the world. Indeed countries with the lowest breastfeeding rates have the LOWEST infant mortality rates and countries with the highest infant mortality rates have the HIGHEST breastfeeding rates. And after 30 years of breastfeeding promotion that resulted in increased breastfeeding rates in a variety of countries, there’s no evidence that increasing the breastfeeding rate has any impact on infant mortality.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding doesn’t save lives; clean water saves lives.[/pullquote]

Since that claim was published I’ve searched incessantly for real world data to support that claim and was unable to find any. Neither could anyone else; I’ve challenged just about every major breastfeeding professional from every major breastfeeding organization to show me how many terms babies’ lives* are actually saved by breastfeeding. Thus far, no one could identify even a single one.

Now finally — finally! — a paper shows just how many lives are saved each year by breastfeeding: 65,000, a tiny fraction of the 800,000 claimed by The Lancet and the World Health Organization.

The paper is Mortality from Nestlé’s Marketing of Infant Formula in Low and Middle-Income Countries.

It’s an economics paper not a peer reviewed scientific paper. I wasn’t able to find it before because it was published only a few months ago in March 2018.

In contrast to The Lancet paper that relies on mathematical modeling, it it an attempt to find out exactly how many babies die when women who otherwise could breastfeed are pressured by companies to choose formula feeding instead.

The authors note what I have repeatedly emphasized: the WHO has staked out the claim that increasing breastfeeding rates could save more than 800,000 lives per year without ANY data to support it.

Intensive and controversial marketing of infant formula is believed to be responsible for millions of infant deaths in low and middle-income countries (LMICs), yet to date there have been no rigorous analyses that quantify these effects…

The authors attempt to rectify that problem. They start by explaining the “original sin” of Nestle:

The beginning of the public controversy over infant formula marketing practices in the developing world began in August 1973 when an article, The Baby Killer, was published in the New Industrialist. The article stressed the nutritional inadequacy of infant formula relative to breast milk, and provided examples of specific marketing abuses by Nestlé, the first major formula manufacturer to enter LMICs and the largest supplier worldwide. At the same time, public health researchers documented a large decline in breastfeeding contemporaneous with the introduction of infant formula, and published estimates of infant deaths resulting from the introduction of infant formula into LMICs ranging from annual figures of 1 million to 10 million …

The World Health Organization reacted:

In response, the World Health Organization and UNICEF organized a meeting of stakeholders out of which the International Code of Marketing of Breast-milk Substitutes (ICMBS) was created and later enacted in 1981.

The authors attempted to determine the impact of Nestle’s behavior on infant mortality over the past decades:

Nestlé’s phased entry over time into national infant formula markets provides plausibly exogenous variation in the market availability of formula conditional on location fixed effects. We exploit this variation to identify the causal effect of formula availability by estimating difference-in-differences models with location and year fixed effects. We interpret the results as Intent-to-Treat (ITT) estimates that capture the average mortality response to the availability of infant formula for purchase proxied by whether Nestlé is actively selling formula in the country. Our estimated treatment effects represent the intersection of adoption of infant formula by mothers within the exposed population and the impacts on infants from consuming the formula. The impact on infant mortality will also vary depending on whether formula is combined with clean water and whether it substitutes for breast milk or for some inferior nutritional supplementation such as water, diluted condensed milk, juice, rice water, or other low-quality substitute.

Looking at the data as a whole they found NO IMPACT of formula feeding on infant mortality:

The introduction of infant formula shows no statistically significant average impact on infant mortality for the population as a whole.

That’s why I and others have been unable to find any real world population data that shows that breastfeeding saves the lives of term babies.

The authors then drilled down into their data to find the impact of formula feeding among populations that lack access to clean water.

…[O]ur results show large and significant infant mortality deaths from formula introduction concentrated in vulnerable sub-populations. Specifically, infant formula availability had a significantly negative effect on mortality of infants born in households that used surface water. The availability of formula increased infant mortality by 12.9 per 1000 for households that used surface water relative to higher-quality water using households. The net effect of formula availability is an increase of 9.4 infant deaths per 1000 among mothers with poor-quality water.

What’s the magnitude of that effect? The authors looked at what happened in 1981, the year where Nestle’s market penetration was the highest:

We estimate the number of deaths for 1981, arguably the peak year of the controversy when media attention was the highest. We do this by multiplying the 47.8 million 1981 live births that occurred in Nestlé formula sales countries by the fraction of those households with surface water in those countries and by our estimate of the impact of formula on infants from households with only unclean surface water access, i.e. This yields an estimate of 65,676 infant deaths with a 95% confidence interval of [24,868, 106,485], lower than earlier estimates of one million or more, but unquestionably a substantial loss of human life.

It’s a substantial loss of life, but only a tiny fraction of the one to ten million lives claimed by lactation professionals and the WHO.

Since then the impact of formula on infant mortality has dropped both because of reductions in use of formula and increases in the availability of clean water. The claim that breastfeeding could save more than 800,000 lives per year is absolute nonsense. Indeed the real number is fewer than 65,000 lives per year, only 8% of the claimed impact.

Formula itself does NOT harm babies. Only contaminated water harms them. If we really wanted to save lives we would improve water quality since even breastfed babies have to bathe in that contaminated water and eventually drink it as they grow older. But it’s so much easier and cheap to hector mothers and pontificate about breastfeeding than it is to provide the very poor with clean water.

That doesn’t mean we should stop promoting breastfeeding; it’s still a valuable goal even if it only saves tens of thousands of lives each year instead of hundreds of thousands as claimed by the WHO. But it does mean that aggressive breastfeeding promotion through programs like the Baby Friendly Hospital Initiative has no place in societies with easy access to clean water. It means that draconian restrictions on formula advertising in industrialized countries are totally unwarranted. Most importantly, it means that the documented harms of aggressive breastfeeding promotion: brain injuries and deaths from dehydration, hypoglycemia, kernicterus, and babies falling from or being smothered in their mothers’ hospital beds, are inexcusable.

It also means that we cannot trust the WHO’s claims about breastfeeding being lifesaving. The claims were supported by real world data; now that we finally have that data, it appears that increasing breastfeeding rates can save less than 65,000 lives per year, a far cry from the 800,000 claimed by the WHO.

 

*There is real world data to show that breastmilk reduces the risk of necrotizing enterocolitis, a serious complication of extreme prematurity.

The reaction to the Trump administration’s decision to oppose the World Health Organization’s formula advertising restrictions has highlighted how conventional wisdom shapes thinking on a topic. The conventional wisdom about breastfeeding is that it is lifesaving, but the conventional wisdom is dead wrong.

Here is one of the best descriptions of conventional wisdom I’ve seen.

In most cases, CW is a lumbering beast: slow to move, but difficult to alter course once its big bullish head is set on moving in a certain direction… It’s loud, pervasive, and impossible to ignore – and avoid. Oftentimes, entire careers are staked on maintaining its veracity. When that veracity is challenged, either by critics or by experiment, the challenger is often silenced… [A] conforming chorus of assent can be mobilized to drown out even the most rigorously defended thesis, just as long as Conventional Wisdom is at stake.

For decades the conventional wisdom on stomach ulcers was wrong.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If breastfeeding saves lives why can’t the WHO find any term babies whose lives have been saved?[/pullquote]

When I started medical school, the conventional wisdom was that stomach ulcers were caused by excess acid. The conventional wisdom was loud, pervasive and impossible to ignore. Whole careers in gastroenterology had been staked on maintaining its veracity. When that veracity was challenged, the challengers were silenced.

At about the time I graduated from medical school researchers Robin Warren and Barry Marshall discovered H. pylori, the bacteria that actually causes ulcers.

The backlash was brutal. Dr. Larry Altman, medical correspondent for The New York Times, who reported these results, later wrote, “I have never seen the medical community more defensive or critical of a story.” I spoke with Dr. Altman about these events, and to this day, he recalls that “this was the review that got me the most heat for misleading the public” …

Warren and Marshall eventually broke through the conventional wisdom, and ultimately won the Nobel Prize in Medicine. But someone else had actually made the exact same discovery more than 40 years before they did.

As a young researcher at the Harvard-affiliated Beth Israel Hospital in Boston in 1940, Dr. [A. Stone] Freedberg became curious about stomach ulcers while studying the effects of fever on the heart and circulatory system when infections caused it to collapse. Scientific reports taught him that many such patients developed tiny bleeding ulcers in the stomach and small bowel…

He published his findings but was ignored. His superiors were convinced that he had made a mistake and counseled him to give up his claim and move on.

The conventional wisdom that ulcers were caused by acid was so strong that it suppressed the true cause for decades and people with ulcers, denied effective treatment, died as a result.

Today the conventional wisdom is that breastfeeding saves lives, that breastmilk is the “perfect” food and that women must be pressured into breastfeeding for the good of their infants. Whole careers (including careers at the World Health Organization) have been staked on maintaining the veracity of these claims. When that veracity is challenged, arbiters of the conventional wisdom attempt to silence the challengers.

The conventional wisdom on breastfeeding is DEAD wrong.

The evidence has been around for centuries. There once was a time when all babies were breastfed and 20-30% or more died in infancy. Indigenous cultures on nearly every continent practice pre-lacteal supplementation, giving babies teas, water or honey, in recognition that breastfeeding is often not enough to fully nourish a baby. Formula was invented in 1860’s specifically because some mothers could not produce enough breastmilk or because they died in childbirth. Indeed, as far as I can determine, there was NEVER a time or place where exclusive, extended breastfeeding was practiced in the way the World Health Organization now recommends.

The WHO insists that breastfeeding is lifesaving, quoting a variety of mathematical models that predict that when more women breastfeed fewer babies die. Yet the WHO can’t manage to find any term babies whose lives have been saved or any countries where increasing the breastfeeding rate has resulted in a decrease in infant mortality.

Nonetheless, everyone “knows” that breastfeeding saves lives.

The countries in the world with the lowest breastfeeding rates have the BEST infant mortality rates and the countries with the highest breastfeeding rates (approaching 100%) have some of the WORST infant mortality rates.

Nonetheless, everyone “knows” that breastfeeding saves lives.

In June 2017, NPR published Secrets Of Breast-Feeding From Global Moms In The Know:

It’s almost like in the U.S. we’ve lost the breast-feeding instinct. That Western society has somehow messed it up. [Evolutionary biologist Brooke] Scelza wanted to figure out why: What are we doing wrong?

So a few years ago, she traveled to a place with some of the best breast-feeders in the world.

In the desert of northern Namibia, there’s an ethnic group that lives largely isolated from modern cities. They’re called Himba, and they live in mud huts and survive off the land…

Moms still give birth in the home. And all moms breast-feed.

“I have yet to encounter a woman who could not breastfeed at all,” Scelza says. “There are women who have supply issues, who wind up supplementing with goat’s milk, which is not uncommon. But there’s basically no use of formula or bottles or anything like that.”

NPR neglected to mention that the infant mortality rate among the Himba is astronomical. According to USAID, the infant mortality rate in Namibia is 32.8/1000 (compared to 5.82/1000 in the US).

Nonetheless, everyone “knows” that breastfeeding saves lives.

During World Breastfeeding Week, Melinda Gates posted this on Twitter:

Between 2009 and 2014 breastfeeding rates tripled to 57% in Vietnam, soared to more than 80% in Bangladesh and increased to more than 80% in Ethiopia. But what happened to infant mortality rates in response? As far as I can determine, the change in breastfeeding rates had no impact on the trajectory of infant mortality rates.

Everyone “knows” that breastfeeding saves lives despite the fact that no one can find any term babies whose lives have been saved.

Meanwhile, as a result of aggressive breastfeeding promotion, we are literally breastfeeding babies to death.

The Baby Friendly Hospital Initiative was implemented around the globe without any evidence that it increases breastfeeding rates. The Ten Steps of the initiative directly violate both scientific evidence and medical ethics. There is no evidence that locking up formula improves breastfeeding rates; there is no evidence that banning supplementation improves breastfeeding rates (and there is evidence that supplementation increases breastfeeding rates); there’s no evidence to justify banning pacifiers and considerable evidence that pacifiers reduce the risk of sudden infant death syndrome (SIDS); and it is deeply unethical to restrict what providers can say when counseling patients about infant feeding.

Worst of all, there’s a growing body of evidence that aggressive breastfeeding promotion is leading to brain injuries and deaths of infants from hypoglycemia, jaundice, dehydration, starvation and infants falling from or being smothered in their mothers’ hospital beds because well baby nurseries have been closed.

But everyone “knows” that breastfeeding saves lives. That’s what the conventional wisdom about breastfeeding tells us but the conventional wisdom is wrong.

Don’t believe me? Ask those, including those at the WHO whose entire careers have been staked on the claim that breastfeeding save lives, to show you the term babies whose lives have been saved. Don’t allow yourself to be fobbed off by mathematical models; insist on real population data.

But don’t hold your breath while waiting for that data; because while everyone “knows” that breastfeeding saves lives, no one knows any term babies whose lives have been saved.

Yesterday I wrote about the Trump administration’s typically ham handed effort to oppose a World Health Organization breastfeeding resolution.

Make no mistake; Trump was only thinking about the welfare of formula manufacturers. But WHO breastfeeding recommendations are actually injuring and killing babies and they should have been changed long ago. How do I know? I read the scientific research.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Babies are dying because lactivists are lying.[/pullquote]

I hope you will read it, too so I’m citing and explaining the most important papers of the past 4 years. Collectively they show that that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS and extended skin to skin contact leads to babies falling from their mothers’ hospital beds or suffocating while in them. Most importantly, the myriad purported benefits of breastfeeding actually come from the higher socio-economic status of breastfeeding mothers, not breastfeeding itself.

The 2014 study, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons by Colen and Ramey, was a breakthrough study that showed that almost all the claimed benefits of breastfeeding don’t actually exist.

We have always known that breastfeeding varies among ethnic, cultural and economic groups and indeed, previous studies that corrected for these factors show that breastfeeding has only small advantages. This study looks at breastfeeding vs. bottlefeeding WITHIN families by comparing siblings who were fed differently.

The authors found that there were differences between breastfed and bottle fed children in 10 of the 11 measured variables when looking at the overall group. Those differences persisted when comparing families in which all the children were breastfed to families where all the children were bottlefed. But when the authors looked within families, there was NO SIGNIFICANT DIFFERENCE between breastfed and bottle fed children.

Previous research, in particular the PROBIT studies conducted over the past two decades by Michael Kramer in Belarus suggest a variety of benefits that have subsequently found to be illusory. At this point, the only confirmed benefits of breastfeeding for term babies are a slightly decreased risk of colds and episodes of diarrheal illness across the entire population of infants in the first year. The vast majority of infants will experience no measurable benefit from breastfeeding. The one exception to this is premature infants; breastmilk reduces the risk of necrotizing enterocolitis, a serious complication of extreme prematurity.

Don’t believe me? Listen to Michael Kramer himself.

Kramer is emphatic that breastfeeding does NOT prevent obesity, does NOT prevent allergies, and does NOT prevent asthma. When asked why lactivist organizations continue to insist on benefits that have been shown not to exist, he explains that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He is quite blunt that about the fact that lactivist organizations won’t accept scientific evidence that doesn’t comport with what they believe and he worries that their insistence of exaggerating benefits will undermine women’s trust in healthcare providers.

So most of the claimed benefits for breastfeeding don’t exist. But the real problem with aggressive breastfeeding promotion is that it HARMS babies.

That’s why in 2016 US public health officials changed the United States Preventive Services Task Force (USPSTF) guidelines reduce the relentless pressure on women to breastfeeding.

An accompanying editorial Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms noted that the vaunted Baby Friendly Hospital Iniative wasn’t merely a failure, it also exposed infants to danger.

The BFHI bans pacifiers in contradiction to the scientific evidence.

Counseling to avoid the use of pacifiers in the newborn period is an intervention commonly used to support breastfeeding. However, evidence has been building that infant use of a pacifier may be associated with a reduced risk of sudden infant death syndrome,7 the most common cause of postneonatal death in the United States. The evidence review showed that avoiding pacifiers was not associated with any breastfeeding outcomes assessed in the evidence review. A recent Cochrane systematic review reached the same conclusion. Thus, routine counseling to avoid pacifiers may very well be ethically problematic.

The BFHI bans formula supplementation in contradiction to the scientific evidence.

Counseling mothers to avoid giving infants any food or drink other than breast milk during the newborn period is step 6 of the BFHI and one of the primary care interventions most commonly used to support breastfeeding. Three randomized trials have specifically examined the effectiveness of counseling to avoid giving newborns any food or drink other than breast milk; none showed a beneficial effect of such counseling on breastfeeding duration.

Other harms were noted in the 2016 paper Unintended Consequences of Current Breastfeeding Initiatives:

Enforced prolonged skin to skin contact leads to deaths from Sudden Unexpected Postneonatal Collapse (SUPC).

Reports of SUPC include both severe apparent life-threatening events (recently referred to as brief resolved unexplained events) and sudden unexpected death in infancy occurring within the first postnatal week of life. A comprehensive review of this issue identified 400 case reports in the literature, mostly occurring during skin-to-skin care, with one-third of the events occurring in the first 2 hours after birth …

Infant injuries and deaths as a result of enforced 24 hours rooming in and closing well baby nurseries.

An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight … This may result in prone positioning and co-sleeping on a soft warm surface in direct contradiction to the Safe Sleep Recommendations of the National Institutes of Health. In addition, co-sleeping also poses a risk for a newborn falling out of the mother’s bed in the hospital, which can have serious consequences.

The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature confirmed many of the risks noted above as well of the lack of effectiveness of the BFHI itself.

How many babies are being harmed?

According to the 2018 paper Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding by Flaherman et al.:

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)…

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.

Lactivists have developed a cult-like fixation on exclusive breastfeeding and consider formula supplementation to be anathema, but the scientific evidence shows the opposite.

The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial

Current public health initiatives emphasize the importance of exclusive breastfeeding during the birth hospitalization, but our randomized trial of 164 newborns did not demonstrate improved outcomes for infants receiving exclusive breastfeeding compared with limited formula supplementation using the ELF strategy…

[T]hese results suggest that using ELF in a carefully structured, temporary manner may not interfere with breastfeeding or maternal experience in the first month or have a negative impact on intestinal microbiota. At the same time, our results suggest that further studies are needed to assess whether ELF reduces the risk of neonatal readmission, especially in the first week after birth. Using small volumes of formula on a temporary basis for newborns with pronounced weight loss may have the potential to help clinicians and mothers provide the nutritional volume needed by babies without interfering with duration of breastfeeding or with the health benefits achieved from longer breastfeeding duration.

Why is there such a disconnect between what lactivists claim about breastfeeding and what the scientific evidence actually shows?

Most papers cited in support of the benefits of breastfeeding are mathematical models based on extrapolation of small studies that are often riddled with confounders.

To my knowledge — please correct me if you have other data — there is NO CORRELATION (let alone evidence of causation) between breastfeeding rates and infant mortality rates. The countries with the lowest breastfeeding rates have the lowest rates of infant mortality and the countries with the highest infant mortality have breastfeeding rates approaching 100%. There is NO EVIDENCE that increasing breastfeeding rates within a country has any impact on the mortality rates of term babies.

Why have lactivists grossly exaggerated the benefits of breastfeeding and hidden the significant risks? That’s a philosophical problem; lactivists have claimed that breastfeeding — in contrast to all other natural processes — is perfect. But there is no biological process that is perfect. Just as 12% of women experience infertility, and 20% of pregnancies naturally end in miscarriage, breastfeeding has a failure rate, too, up to 15%.

Imagine what would happen if we told women struggling to get pregnant that infertility is rare and probably their fault. The result would be failure to have desired children and tremendous anguish. Imagine what would happen if we told women that miscarriage was rare and probably their fault. The result would be that millions of women would have their grief compounded by the sense that they were alone and could have prevented the miscarriage if they’d tried harder or had more support.

We don’t need to imagine what would happen if we told women that insufficient breastmilk was rare (though it is common) and that they could have breastfed successfully if only they’d tried harder or received more support. We know what happens: tens of thousands of newborn hospital readmissions; brain injuries and deaths from dehydration and other complications of insufficient breastmilk; injuries and deaths from babies smothering in or falling from their mothers hospital beds; an increase in SIDS from cosleeping and from depriving babies of pacifiers.

The sad truth is this: babies are dying because lactivists are lying.

Don’t take my word for it; read the scientific literature!

To my shock I find myself agreeing with something done by the Trump administration.

According to today’s New York Times:

A resolution to encourage breast-feeding was expected to be approved quickly and easily by the hundreds of government delegates who gathered this spring in Geneva for the United Nations-affiliated World Health Assembly…

Then the United States delegation, embracing the interests of infant formula manufacturers, upended the deliberations.

American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.

The lactivist community is outraged, but the new US policy — nakedly designed to benefit the formula industry — will almost certainly save the brain function and lives of newborns. Why? Three reasons:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Even had the purported benefits of breastfeeding appeared, they would not have justified the pressure on women; but those benefits never appeared. [/pullquote]

1. Most claims of lactation professionals have been thoroughly DEBUNKED by scientific evidence.
2. There is NO EVIDENCE that breastfeeding is correlated with infant health outcomes.
3. There is a significant and growing body of evidence that the pressure to exclusively breastfeed HARMS babies. It doubles the risk of newborn hospital readmission and increases the risk of neonatal brain injury and death from dehydration, severe jaundice, hypoglycemia, and smothering in or falling from maternal hospital beds.

Sadly, it is lactation professionals themselves who are responsible for this dismal state of affairs. By grossly over promising on the benefits of breastfeeding, by utterly ignoring the substantial risks, and by disingenuously and irresponsibly extrapolating from the impact of contaminated water used to make formula in underdeveloped countries to demonizing formula instead of contaminated water.

Lactation professionals have given the Trump administration moral cover for what is undoubtedly a business decision.

According to the spokesman for the US Department of Health and Human Services:

The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children,” an H.H.S. spokesman said in an email. “We recognize not all women are able to breast-feed for a variety of reasons. These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.”

That’s 100% correct because WHO breastfeeding resolutions since 1981 have been designed to benefit the lactation industry, not babies. The point of these resolutions has been to place unnecessary — and increasingly ugly — hurdles in front of women who wish to use formula: banning formula supplementation, locking up formula in hospitals, forcing women to sign formula “contracts,” banning formula advertising and banning the use of discount coupons to purchase formula.

These ugly hurdles violate mothers’ autonomy; women have the absolute right to decide whether or not they wish to use their breasts to feed their infants. Even had the purported benefits appeared, they would never have justified the inappropriate pressure on women. But those benefits never appeared:

There is no connection between country-wide breastfeeding rates and infant outcome. The countries with the lowest breastfeeding rates (like the UK which is the absolute lowest) have some of the best infant health outcomes and the countries with the worst rates of infant mortality and morbidity have the highest rates of breastfeeding.

To my knowledge — please correct me if you have other information — there is no evidence that increasing breastfeeding rates within a country has EVER had any impact in term babies or overall morbidity and mortality rates.

That’s hardly surprising since the campaign to promote breastfeeding is based on an empirical lie. In truth: Breast is NOT best for every mother and every baby since breastfeeding has a significant failure rate.

Up to 15% of first time mothers will be unable to produce enough breastmilk especially in the early days after birth. Breastfeeding — like fertility and pregnancy — is imperfect.

This was well known to our ancient foremothers. Contrary to the current pressure to breastfeed exclusively, indigenous people on nearly every continent practice prelacteal feeding and supplementation. The high rate of death from insufficient breastmilk led to the supplementation of breastfeeding with teas, water and honey. Sadly, those had their own drawbacks because of microbial contamination but the practice has been widespread for probably tens of thousands of years or more. The risk of death from insufficient breastmilk was greater than the risk of death from microbial contamination of supplements.

Lactation professionals have also promoted the empirical lie that formula is harmful. More than 40 years after the fact they continue to point to the moral horror perpetrated in Africa by Nestle. In order to increase profits, Nestle deliberately and knowingly encouraged African women who lacked access to clean water to replace breastmilk with powdered formula. Babies died needless, preventable deaths as a result. Lactational professionals use the moral debacle to demonize formula even though it was the water that was unsafe, not the formula. There is NO EVIDENCE that formula — properly prepared with clean water — is harmful in any way.

No matter. Try having a conversation with lactivists and you will immediately run into (the newly named by me) Tuteur’s Law of Breastfeeding Discussion. The well known Godwin’s Law asserts:

As an online discussion grows longer, the probability of a comparison involving Hitler approaches 1.

In other words, if any online discussion goes on long enough, someone will inevitably be compared to Hilter.

Tuteur’s Law of Breastfeeding Discussion asserts:

In any online (or print) lactivist discussion of formula, the probability of the invocation of Nestle’s abhorrent behavior approaches 1.

In other words, in any discussion of formula, those noting the inherent risks and limitations of breastfeeding will inevitably be compared to Nestle.

Just as the invocation of Hitler in Godwin’s law is designed to derail the discussion, the invocation of Nestle in Tuteur’s law is also designed to put an end to any discussion that might ultimately reveal the risks of exclusive breastfeeding.

In truth, Big Formula is no different from Big Pharma; both have behaved immorally in the past. But just as Big Pharma’s immoral behavior doesn’t invalidate the tremendous life saving powers of vaccines, statins, antihypertensives, anti-depressive and anti-psychotic medications, the immoral behavior of Big Formula doesn’t change the fact that formula has saved and continues to save the lives of more babies than breastfeeding ever could.

Once again the Trump administration is wrong, but this time they might save lives in spite of themselves. Even a broken clock is right twice a day.

I read your piece Dear Fed Is Best … and I am so sorry.

I am so sorry for your poor baby who suffered terribly as a result of your cult-like worship of breastfeeding.

My first few days with my baby were actually glorious in the moment…

Our bubble was violently burst on her fifth day of life. The midwife came to weigh my beautiful baby and she had lost 20% of her birth weight… I was asked to give my nipple a squeeze and when milk surfaced I was told ‘Oh. You’ve got loads’… Nevertheless, they thought it best to ring the hospital. Apparently, the paediatrician was not worried and decided that we should give her another 3 days to see what happened.

And so they left us. For another three days…

Why didn’t you just feed her formula??!!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]I am so sorry that being a breastfeeding apologist has robbed you and your fellow lactivists of simple human compassion.[/pullquote]

You were well aware that 20% weight loss is dangerous; that’s why you called the hospital, isn’t it? It’s as if you valued ideological purity above your daughter’s wellbeing as she was obviously failing to thrive.

Instead:

We ended up in hospital when she lost more weight. I watched the doctors tell me that they were deeply concerned about my baby, that they would need to transfer her to another unit for paediatric intensive care, that they would need to send a doctor and a nurse in the ambulance with her so we would need to make our own way as there wasn’t room for us. I watched the ambulance blaze past me on the motorway, blue lights flashing and siren blaring. Being separated from my precious girl was torturous.

There were moments of horrific trauma that week in intensive care. Like when they told us that they needed to re-hydrate her at a very specific speed and that if they got that wrong she could be left brain damaged. Or the time that her drip tissued and left blisters the size of her fist all along her arm, because somebody had given her a drip with potassium in. After that there were two hours of hell as the doctor tried desperately and repeatedly to replace her drip…

I am terribly sorry for her starvation and her traumatic hospitalization since you could have easily prevented it with formula but instead let her suffer until she was nearly dead.

But that’s not the only reason I am sorry.

You write:

I can only reason that for somebody to have launched a campaign such as yours they must have a story as harrowing as mine.

I am so sorry that you lack the insight to understand that the only reason your baby didn’t die or sustain permanent brain damage is LUCK; other mothers were not so lucky and now must live with empty arms.

There are stories that are MORE harrowing than yours and it baffles me that you don’t recognize the difference between a baby who recovers fully and one who never recovers or even dies.

You boast:

In a desperate attempt to ensure that this could never happen to us again, I learnt everything I could and sought support before having my next baby. And miraculously, this one thrived on breastfeeding alone from the very beginning. Nothing about my boobs changed between my first and second baby. My physiology remained exactly the same. And yet, I was able to feed my second baby totally and completely. The only thing that changed was the amount of knowledge and support that I had. Nothing more.

I am so sorry that you don’t understand that while your personal situation may have had a preventable cause, insufficient breastmilk is a very real biological phenomenon.

Breastfeeding, like fertility and pregnancy, has a significant failure rate as a result of known biological pathophysiology. No amount of support will reverse the effect of polycystic ovary disease or insufficient glandular tissue. It reflects remarkable ignorance or insensitivity or both to ignore that reality. It’s like claiming that because you had difficulty conceiving the first time and no difficulty the second, infertility doesn’t really exist.

You write:

Am I glad that in our time of crisis, there was substitute milk available to us that helped keep my baby alive . . . of course I am! But do I wish I’d formula fed her from the start and never put her to the breast? Absolutely not! …

I am so sorry that your daughter’s suffering turned you into an apologist for breastfeeding. Instead of recognizing that exclusive breastfeeding nearly killed your daughter, you continue to offer cult-like devotion.

I want to believe that your motivation in writing this piece is pure and that it is your desperatation to deny your own role in nearly killing your baby that makes you so insensitive to those who were not as lucky as you.

But then you write this:

I want to believe that your motivation is pure and that you are merely trying to spare other women from enduring what you have.

Advocates of Fed Is Best from the founders on down to individual women have given you NO REASON to question their motivation yet you do so anyway.

Why?

Because you can’t bear to acknowledge that breastfeeding isn’t perfect and that aggressive breastfeeding promotion doubles the rate of newborn hospital readmission, and leads to brain damage and death from dehydration, hypoglycemia, kernicterus and falling from or smothering in maternal hospital beds.

Ultimately, I am so sorry that being a breastfeeding apologist has robbed you and your fellow lactivists of simple human compassion.

Only someone who lack compassion could have written a piece like yours.

It’s almost as if lactivists can’t help themselves.

The mainstream media is suddenly full of mothers sharing the guilt of not being able to breastfeed and their anguish over nearly starving their babies. Over and over again new mothers have shared their stories about being wounded by the shaming language favored by lactation consultants: “artificial” baby milk, “risks” of formula feeding, comparisons of formula to tobacco.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Seals Allers and her colleagues appear to believe that everyone (millions of mothers, tens of thousands of doctors) is an ignorant dupe but themselves.[/pullquote]

I’ve learned that it is too much to expect lactation consultants to apologize as any healthcare professional would be ethically obligated to do, but is it really too much to expect them to stop using shaming language? Apparently it is.

Three days ago lactation consultant Kimberly Seals Allers posted this gem on Twitter:

No one would accept a nutritionist trained at a’McDonalds Health Institute’ but every day mamas face pediatricians only trained in breastfeeding by infant formula industry. The ones who financially benefit from failure of breastfeeding. We deserve better!

When called on it, Seals Allers resorted to that favorite lactivist tactic, gaslighting.

I speak facts. Shaming is your language not mine. My tweet is about where and how pediatricians receive training and who is best to do it. Commercial industry or non partisan medical authorities. All other assumptions about derision are made up and are your own.

So few words, so much lying and shaming.

1. The comparison of formula to McDonald’s is grossly irresponsible. Whereas certain McDonald’s products have lots of calories and little nutrition, infant formula is the PERFECT food for infants with the perfect amount of calories and the perfect amount of nutrients, indeed more nutrients than breastmilk.

2. It is meant to be vicious. The tweet not so subtly implies that women who choose to formula feed are knowingly and willfully choosing a nutritionally empty food for their babies.

3. It is a lie. Pediaticians are not trained by formula manufacturers. Indeed, I challenge Ms. Seals Allers to name 5 pediatrics residency programs where formula manufacturers are in charge of breastfeeding education.

4. It implies that pediatricians who value infant health over ideological purity are dupes of the formula industry. A growing body of research shows that the aggressive breastfeeding promotion campaigns favored by lactation consultants are injuring and even killing babies. Exclusive breastfeeding doubles the rate of neonatal hospital readmission, leading to tens of thousands of babies who are readmitted to the hospital and hundreds of millions of dollars of healthcare spending each year. Babies are being brain injured and are dying from dehydration, hypoglycemia, kernicterus and smothering in or falling from their mothers hospital beds because well baby nurseries have been closed.

5. It implies that women who don’t breastfeed are selfish idiots. This is not merely an insult to women who choose formula, but it is a denial of their moral agency. This is how lactivists justify ignoring the reasons women give for choosing formula since those women “didn’t choose” to use formula, they were tricked into it.

This is not the first time that Seals Allers has struck out aggressively and viciously against women who use formula to feed their babies and the health professionals who support them.

Why?

I suspect it reflects extreme frustration with the ongoing failure of lactivist efforts. While breastfeeding initiation rates have gone up dramatically, rates of extended breastfeeding have not followed suit. Lactation professionals could look at the situation and ask, “What are we doing wrong?,” but that involves introspection and taking responsibility, both apparently too uncomfortable to contemplate. Instead lactation professionals ask, “Who is doing this to us?,” and embrace the conspiracy theory that formula manufacturers are behind lactivist failures.

What are lactation professionals doing wrong?

• They value ideological purity (exclusive breastfeeding) over combination feeding.
• They demonize formula to a ridiculous extent, making themselves look foolish.
• They lie about the fact that insufficient breastmilk is common.
• They recommend barbaric regimens of feed/pump/supplement without any evidence of efficacy.
• They ignore the harms (sometimes deadly harms) to both babies and mothers.

Instead of acknowledging their own mistakes they prefer to blame the formula industry:

They claimed easy access to formula in hospitals the prevented breastfeeding so they banned formula; breastfeeding rates didn’t change appreciably.

They claimed formula gifts given to new mothers prevented breastfeeding so they banned gifts; breastfeeding rates didn’t change appreciably.

They decried lack of hospital based lactation support so they created the Baby Friendly Hospital Initiative; breastfeeding rates didn’t change appreciably but readmissions and injuries rose.

Now, as neonatologists and pediatricians scramble to save the brains and lives of babies harmed by aggressive breastfeeding promotion, Seals Allers has the unmitigated gall to float a monstrous lie, that pediatricians are trained by formula companies.

It’s almost as if Seals Allers and her colleagues believe that everyone (millions of mothers, tens of thousands of doctors) is an ignorant dupe but themselves.

Of course there’s an alternate possibility: mothers and doctors are caring individuals who have discovered through experience or scientific evidence that breast isn’t best for every baby or every mother and a few thousand lactation consultants are the ones who are dupes. They’ve been duped by a philosophy that values ideological purity over infant and maternal health.

But lactation professionals never, ever consider the possibility that THEY are the ones who are wrong. Far easier to lie and shame others than to take responsibility for their own misconceptions, misinterpretations and mistakes in promoting breastfeeding above all else.

In our obsession with lowering C-section rates, there has been much handwringing over the lost art of forceps deliveries. The dramatic rise in C-section rates has been caused in part by the fact that many deliveries that would have been accomplished by forceps have become C-sections because of our reluctance to use forceps. But there’s a good reason why forceps have gone out of fashion: they are much more likely to harm a baby than C-sections.

This hideous case is just one example: Mom blames newborns’ death on doctor’s use of forceps.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]We shouldn’t lament the passage of forceps into history  [/pullquote]

A Long Island obstetrician allegedly used forceps so aggressively during a delivery that he severed the infant’s head internally from his spine, according to court papers.

A devastated Megan Stirnweiss, 23, says her nightmare began when she went to Southampton Hospital in labor Dec. 30, in a last-minute decision after her home delivery became too painful.

What happened?

The doctor put forceps around the baby’s head and yanked, dragging Stirnweiss — who was holding onto the bars of her hospital bed — all the way down to the edge, court papers say.

Then “he pulled the forceps that he had around the fetus’s head, lifting [Stirnweiss] off the bed by the forceps around the fetus’s head, and shook her vigorously until the baby was delivered at 2:56 a.m.,’’ according to the lawsuit…

The baby — who “was internally decapitated” — was whisked away, the papers state.

As for Stirnweiss, she “suffered disruption, dislocation, tearing and lacerations of her internal organs and structures,’’ her suit says. She now “is in constant pain’’ and will “require reconstructive surgery,’’ the papers state.

The accompanying picture of the baby adds more detail for those who know where to look. While the doctor may or may not have used excessive traction, one thing appears indisputable; the doctor did not put the forceps on properly. Forceps are designed to rest over the baby’s cheeks. This baby has an obvious imprint of a forceps blade over his forehead, extending to his eye. The forceps application wasn’t even close.

This highlights a fundamental difference between forceps and C-sections. Forceps use requires far more skill than performing surgery.

As Atul Gawande wrote in a fabulous piece entitle The Score:

“Forceps deliveries are very difficult to teach—much more difficult than a C-section,” Bowes said. “With a C-section, you stand across from the learner. You can see exactly what the person is doing. You can say, ‘Not there. There.’ With the forceps, though, there is a feel that is very hard to teach.” Just putting the forceps on a baby’s head is tricky. You have to choose the right one for the shape of the mother’s pelvis and the size of the child’s head—and there are at least half a dozen types of forceps. You have to slide the blades symmetrically along the sides, travelling exactly in the space between the ears and the eyes and over the cheekbones. “For most residents, it took two or three years of training to get this consistently right,” he said. Then a doctor must apply forces of both traction and compression—pulling, his chapter explained, with an average of forty to seventy pounds of axial force and five pounds of fetal skull compression. “When you put tension on the forceps, you should have some sense that there is movement.” Too much force, and skin can tear, the skull can fracture, a fatal brain hemorrhage may result. “Some residents had a real feel for it,” Bowes said. “Others didn’t.”

Back when C-sections were considerably more dangerous than they are today, fetal injuries caused by forceps seemed like a reasonable trade-off for avoiding a procedure that might kill the mother. Once the C-section became as safe as it is today, harming a baby’s health and neurological function no longer seems like a reasonable risk.

It is important to note that there are different types of forceps deliveries. Outlet forceps, as the name implies, are used only when the head is extremely close to delivery. These forceps shorten the time to a birth that was going to happen anyway. They are often used to shorten labor when fetal distress is diagnosed and they rarely cause injuries.

Mid-forceps, in contrast, are used to deliver a baby that is stuck despite what appears to be a large enough maternal pelvis. They involve far more skill, far more traction, and far higher risk of injury. The most dangerous mid-forceps procedures are mid-forceps rotations. These are used to turn a baby in the unfavorable occiput posterior (OP or “sunny side up”) to the more favorable occiput anterior position and then traction is applied to deliver the baby. Not surprisingly, these procedures require the most skill of all and pose the most danger to both baby and mother.

The potential danger to the baby is obvious: fractured skull, neurological injury, and internal decapition (fracturing the top of the spine). The potential danger to mothers is also significant: far higher rates of anal sphincter injuries and subsequent problems with continence and sexual function.

Mid-forceps, and in particular mid-forceps rotations, are used to deliver babies that probably will not come out or will not come out alive if nature is left to take its course. If the baby cannot be delivered, the mother will die, too. So allowing a woman to push more than 3 or 4 hours in this situation won’t result in a vaginal delivery. The only choice is between forceps and Cesarean.

Most mothers and many obstetricians think it’s no choice at all. A C-section, which involves slightly more risk for the mother and virtually no risk to the baby, makes more sense than forceps, which involves very significant risks to the baby and risks to the pelvic floor of the mother.

Had this doctor opted for a C-section instead of forceps, both the baby and mother probably would have done fine.

Instead:

Stirnweiss, a cook for the US Coast Guard, said she and her husband kept their baby alive on machines for seven days so that his organs could be donated. A baby from Toronto, Canada, received Matthew’s lungs.

“He gave the ultimate gift of life,” she told The Post of her son.

Is this an indictment of all forceps?

Dr. Steven Goldstein, a professor of obstetrics and gynecology at NYU Langone Medical Center who is not involved in the suit, told The Post, “This is a terrible case.

“This is very sad, but this is not necessarily indicative of the way that forceps can and should be used,’’ he said. “Some forceps are still very safe.”

That’s true. Outlet forceps are very safe because the baby would have eventually come out vaginally in any case. But mid-forceps, the forceps procedures that have been replaced by C-sections, have major risks to both babies and mothers. No one should lament their passing into history or the higher C-sections rates that result.

Yesterday I wrote about the fact that midwifery philosophy has been notoriously unsuccessful. Despite tremendous rhetorical efforts to demonize inductions, epidurals and C-sections, the rate of all three has only increased. Breastfeeding professionals have been similarly unsuccessful. Despite aggressive promotion of exclusive, extended breastfeeding — involving both hospital and government backing — exclusive, extended breastfeeding rates are still quite low in many industrialized countries. More women try breastfeeding, it’s true, but most stop when they find it’s painful, inconvenient and, most importantly, doesn’t satisfying their babies’ hunger.

What’s going on? Despite relentless pressure on women to avoid childbirth interventions and infant formula, the vast majority of women have pushed back.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Campaigns to promote unmedicated vaginal birth and breastfeeding have largely failed except in one area: peer pressure exerted through social media. But those women are not your peers.[/pullquote]

Why?

Many women don’t believe the claimed “science” behind natural childbirth and lactivism since their own experience as well as that of their mothers, sisters and friends, contradicts it. Although epidurals, C-sections and formula are claimed to have “risks,” those purported risks are so rare that most people have never met anyone who experienced them.

Most women reject the sexist notion that their pain does not matter as much as the pain of men. If men aren’t empowered by the agony of passing a kidney stone, they reason, women aren’t empowered by the agony of childbirth.

Many women reject the traditional view, beloved of both religious fundamentalists and advocates of a “natural” lifestyle, that women are obligated to use their bodies to serve children regardless of the physical and psychic cost to themselves.

So the aggressive campaigns to promote unmedicated vaginal birth and exclusive, extended breastfeeding have largely failed except in one area: peer pressure, particularly pressure exerted through social media.

Many midwives and natural childbirth advocates routinely pathologize women who refuse to conform to their dictates. In Pushing Ecstasy: Neoliberalism, Childbirth, and the Making of Mama Economicus published in the journal Women’s Studies, Kate Rossiter explains:

…[W]hat on the surface may appear to be an ethic of care that empowers women in their choice-making ability is in fact a tactic that individuates and ultimately disempowers women …

Rossiter notes:

…[T]his discourse juxtaposes two images of the birthing mother: one wild, and one under technocratic gaze; one pure and authentic, and one living uncritically and irresponsibly within contemporary culture. Paradoxically, in order to access this wild self, the mother must work very hard to regulate herself and her surroundings in order to ensure that her ecstatic potential is realized… This is a mother who, through her diligent preparedness has optimized her natural capacity to birth … This is the mother who forgets herself in the face of her baby’s needs, and, crucially, enjoys this erasure of her non-maternal self…

It pathologizes women who refuse to go along, attempting to shame them into conforming:

This model holds no place for alternate reactions, such as ambivalence, grief, or anger. Rather, the implicit correlation is that deviation from the ideal of the ecstatic mother marks some kind of failure or pathology—suggesting that the birth circumstances were not optimal, or the mother’s hormonal system is somehow faulty, or that she herself is not a natural mother.

Women who can’t or don’t want to breastfeed are similarly pathologized.

Sunna Simmonardottir notes in Getting the Green Light: Experiences of Icelandic Mothers Struggling with Breastfeeding:

This idea that women have a ‘natural ability’ to breastfeed is culturally very strong but at the same time is counteracted with messages about the possible ‘faults’ that the women possess. They are discursively situated as both ‘natural’ and ‘unnatural’ at the same time, and in order to successfully breastfeed they have to rectify those unnatural faults often by going through quite technical processes, involving a range of breastfeeding aids such as breast pumps, artificial breasts and finger- or syringe feeding systems.

There is tremendous effort expended in shaming these women to force them to conform:

Should a mother exercise her own agency and decide for herself that the best thing for her would be to give up on trying to breastfeed, she runs the risk of being constructed as the villain, the selfish mother who didn’t want to inconvenience herself for the sake of her child. The biggest sin according to this cultural script of good mothering is not trying hard enough and giving up without a fight…

Social media like Facebook and Twitter can and do provide support for women who wish to pursue natural childbirth and/or exclusive, extended breastfeeding. But it often seems that they devote nearly as much effort to vicious criticism of women who don’t share their views. The tremendous number of likes, share, and approving comments may give these women the impression that they are part of the majority and may result in shame and guilt in those whom they attack.

But social media is not the real world. In the real world most women choose and enjoy epidurals, follow the advice of their obstetricians, and welcome any interventions that might assure the safety of their babies. In the real world most women use formula at least some of the time. In the real world, women who consider themselves more than the sum total of their reproductive performance are too busy working or caring for their families to waste time avidly liking and sharing posts that disparage women who make different choices.

People are swayed by what they think their peers are doing. Women who chose epidurals in labor, who requested C-sections, who couldn’t or wouldn’t breastfeed their babies often feel shame because they are the “only ones” who didn’t fulfill the script. But they aren’t the “only ones,” they are the majority and can find comfort in numbers.

Just about the only area in which natural childbirth and lactivism have been successful is in promoting peer pressure, particularly on social media. But the truth is that natural childbirth advocates and lactivists are not the peers of most women. Their peers are the majority of women who made the exact same choices they did.