Midwives are so busy congratulating themselves and each other that they’ve failed to notice that their philosophy of birth is being rejected.

The latest example comes from a Stanford study. Despite decades of midwifery demonization of pain relief in labor, the US epidural rate has … risen.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Midwifery philosophy has had essentially no impact on childbirth metrics.[/pullquote]

“We were blown away,” said Alexander Butwick, MD, an associate professor of anesthesiology. “We were really surprised the rates were so high.”

Seventy-one percent of pregnant women get epidurals or other spinal anesthesia, according to the study, which appears online in Anesthesiology. That’s an increase of 10 percent from 2008, according to the researchers…

“There’s a lot of misinformation available online that is more likely to suggest epidurals may not be great,” Butwick told me. “And yet, here we are. The rates have gone up, for whatever reason.”

The sine qua non of contemporary midwifery philosophy is cult like obsession with unmedicated vaginal childbirth. There are two main reasons for this: the naturalistic fallacy and the promotion of midwifery itself.

The naturalistic fallacy is based on the erroneous belief that if something was a certain way in nature, that’s the way it ought to be. Couple that with basic ignorance of the inherent dangers of childbirth — astronomical rates of perinatal and maternal mortality — and you end up with the bizarre injunction to “trust” birth.

The promotion of midwifery has led to the demonization of anything that takes childbirth out of control of a midwife.

There is nothing natural about checking blood pressure, listening to the fetal heart with a Doppler or recommending chiropractic. Some midwives recommend herbs or over the counter medications like castor oil to stimulate labor and prevent a term pregnancy from extending into a higher risk postdates pregnancy. But as anthropologist Margaret MacDonald explained The cultural evolution of natural birth:

[If an intervention] can bring back the clinical normalcy of the labour pattern and keep it within the midwifery scope of practice, it is generally regarded as a good thing by midwives …

Toward these dual ends — glorifying nature and discouraging anything midwives cannot do — midwives have routinely demonized childbirth “interventions,” reserving particular opprobrium for epidurals and C-sections.

How’s that working out?

In addition to the epidural rate rising by 10% since 2008, there has been no change in the C-section rate, the induction rate reached an all time high in 2010 (23.8%) and has declined only slightly since then. Furthermore, mounting data indicates that labor induction at 39 weeks offers the best outcomes for babies and mothers and actually reduces the C-section rate.

Childbirth care in the US is a doctor led system, but the trend is similar in countries with midwife led care.

The Canadian C-section rate rose from 26.7% in 2007-2008 to 28.2% in 2016-2017.

In the United Kingdom induction rates increased from 20.3 per cent in 2006-07 to 29.4 per cent in 2016-17 and the cesarean rate rose to 27.8%. In addition, the Royal College of Midwives was forced to shutter its Campaign for Normal Birth as a result of multiple midwifery scandals involving high rates of death among babies and mothers and massive increases in maternity liability payments.

The Australian C-section rate at 33% is higher even than the US rate and has increased from 30.9% in 2007.

The one exception is the Netherlands. The low Dutch C-section rate decreased from 16.7% in 2010 to 15.9% in 2015.

Arguably the issue nearest and dearest to the hearts of midwives is homebirth since that is the setting that affords them the greatest autonomy. But despite efforts to promote homebirth, sometimes backed by the government, the results have been dismal.

In the US, the rate of planned homebirth has been rising but still represents less than 1% of planned births.

In the UK the homebirth rate dropped from 2.3% in 2012- 2015 to 2.1 in 2016.

Australia’s rate of planned homebirth is only 0.4%.

The homebirth rate in the Netherlands has continued to plummet falling from nearly 30% in 2006 to only 13% in 2015. The dramatic decline was attributed to more women wanting access to pain relief and to greater publicity of the relatively high Dutch perinatal death rates.

There appears to be only one area in which midwifery philosophy has been relatively successful and that’s its penetration into mainstream media and social media. There is a plethora of mainstream media articles bemoaning high C-section and intervention rates; there are countless books extolling midwifery philosophy, and the Twitterverse in particular is filled with midwifery advocates routinely exchanging tweets involving dozens of midwives congratulating themselves.

Midwifery conferences reinforce this sense of professional success. Midwifery has become an echo chamber; midwives rarely venture outside of it to engage with their colleagues in obstetrics or any childbearing women who don’t already share their high opinion of themselves.

But the numbers don’t lie. Midwifery philosophy has had essentially no impact on anything beyond paying lip service to it. Intervention rates continue to rise; scientific data and rising liability payments continue to demonstrate the deadly outcomes of trusting birth; and women ignore the injunctions closest to midwives’ hearts — continuing to choose epidurals in rising numbers and rejecting planned homebirth.

While it can be infuriating to watch midwives on social media congratulating each other for propounding a philosophy that harms mothers and babies the reality is that they are so busy patting themselves on the back that they’ve failed to notice that most people have stopped paying attention to them.

It is an article of faith within the breastfeeding industry that lactation consultants are good at what they do and are caring and considerate in how they do it. Many women beg to differ.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactation consultants are failing not merely at their chosen metric, exclusive breastfeeding rates, but at their fundamental task, providing breastfeeding support.[/pullquote]

I undertook a survey to determine just how effective lactation consultants are and whether they are indeed as caring as they believe. The results ought to be deeply concerning to lactation consultants.

Over 400 women participated in the survey, which was open to anyone who had initially wanted to breastfeed.

The first question was “Did you find the lactation consultants at your hospital helpful to your efforts to breastfeed?” and these were the results:

The good news for lactation consultants is that many women found them helpful in their efforts to breastfeeding. The bad news is that the majority did not. Over 46% of respondents rated their hospital based lactation consultants as somewhat helpful or very helpful. That’s far lower than I expected since lactation consultants have one and only one job, to promote breastfeeding. I would have thought that they would at least be effective in doing so.

The reality was that more than half of the respondents found lactation consultants to be ineffective or even harmful. That group was almost evenly divided between those who thought their lactation consultants made no difference, made them feel pressured or even made them feel inadequate. Considering the strenuous effort and millions of dollars expended to promote breastfeeding this is a disturbing finding.

Why are hospital based lactation consultants so ineffective? The survey cannot tell us but several possibilities come to mind.

I doubt that this reflects the competence of lactation consultants themselves. I suspect the overwhelming majority are well educated, well trained and deeply committed.

Is the training itself flawed? That’s certainly a possibility since a lot of what passes for “knowledge” among lactation consultants is actually false. Lactation consultants are taught that breastfeeding is nearly perfect, that insufficient breastmilk is rare, and that with proper “support” nearly any woman can exclusively breastfeed. But breastfeeding, like any other natural process, has a significant failure rate, insufficient breastmilk is common and that women stop breastfeeding for a host of reasons, not typically for lack of support.

The answers to the second question “Did you breastfeed?” bear that out:

Less than 28% of respondents were able to breastfeed exclusively for as long as they wanted. Slightly more than 16% of respondents found breastfeeding too painful, inconvenient or distressing. Over 26% felt that their babies were not getting enough to eat and more than 24% found that combo feeding (combining breastfeeding and formula) worked best. That amounts to a remarkably dismal failure rate for lactation consultants. Their goal is nearly 100% exclusive breastfeeding and their failure rate exceeds 66%.

This is similar to overall US breastfeeding rates. Over 79% of women try breastfeeding but only 20% are exclusively breastfeeding at 6 months.

Were lactation consultants willing to use a different, more realistic metric, they’d find themselves far more successful. Fully half of women were giving their babies some breastmilk for as long as they wanted. Sadly lactation consultants do not bother to consider women’s desires in their assessments.

That may explain why the majority of women found lactation consultants to be useless or harmful. Lactation consultants are obsessed with rates of exclusive breastfeeding. Women are concerned with happy babies, happy mothers and happy families. Breastfeeding might be a part of that but only to extent that it is satisfying for babies. Therefore, there is a tremendous mismatch between the support women want and the “support” that lactation consultants have been taught to give.

Lactation consultants would do well to keep these informal definitions in mind:

Support: Helping a women achieve HER goal.
Pressure: Helping a woman achieve YOUR goal.
Cruelty: Telling a mother that if she CARES about her baby, she’d replace HER goal with YOUR goal.

Nearly 18% of survey respondents felt pressured by the hospital based lactation consultants and nearly 17% reported that the lactation consultants were cruel enough to make them feel inadequate. In other words, more than 1/3 of respondents found hospital based lactation consultants to be harmful instead of helpful.

Obviously this is not a scientific survey, but it should give lactation consultants pause. Do the majority of women find their services unhelpful at best? Do a third of women experience them as harmful? I’d be interested to see the results of similar surveys undertaken by lactation consultants or the hospitals that employ them but I have been unable to find any such surveys or studies. It’s almost as if lactation consultants don’t wish to know how women experience their “support.”

Any way you want to look at it, lactation consultants are failing not merely at their chosen metric, exclusive breastfeeding rates, but at their fundamental task, providing breastfeeding support. They need to change what they are doing and how they are doing it because at the moment, the only task they are succeeding at is satisfying themselves.

In the ongoing effort to demonize C-sections, the association between C-sections and childhood obesity has received a lot of press. There have been numerous efforts to show that C-sections cause future obesity and a complex mechanism involving the gut microbiome has been proposed.

But there’s always been a serious problem with such research; the failure to adequately correct for confounding variables. We know that maternal obesity is a risk factor for C-section and we also know that maternal obesity is a risk factor for childhood obesity. Does the purported association between C-section and obesity mean that C-sections cause of obesity or that maternal obesity causes child obesity?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The risks of C-section have been overstated because of failure to fully correct for confounding variables.[/pullquote]

A new study in JAMA Pediatrics attempts to address that issue by looking at the impact of C-sections within families. Association of Cesarean Delivery With Body Mass Index z Score at Age 5 Years is an analysis conducted by researchers from Harvard and the NIH.

The authors explain the current state of research:

Two meta-analyses, summarizing data from 24 studies, have reported an increased risk of obesity for individuals with cesarean birth (pooled odds ratio [OR], 1.22 [95% CI, 1.05-1.42] and 1.33 [1.19-1.48]).1,2 Limitations of earlier studies include small sample size in several studies and lack of adjustment for maternal body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and sociocultural factors. Even after adjusting for these measured maternal characteristics, residual confounding is likely.

And propose a solution:

Within-family analysis is one way of controlling for such confounding. Because siblings grow up in similar social, economic, and cultural environments and share the same genetic predisposition to obesity, sibling studies minimize the variation in several of the noncausal factors that could explain why cesarean delivery could appear to be associated with a higher risk of obesity.

What did they find when they conducted within-family analysis?

Mean BMI z score was 0.45 among siblings who both had vaginal delivery, 0.51 among siblings with 1 cesarean and 1 vaginal delivery, and 0.63 among siblings who both had cesarean delivery.

What does that mean?

We found that, within families, cesarean delivery was not associated with higher BMI z score at 5 years of age. This null finding suggests that confounding by unmeasured variables, such as maternal BMI and sociocultural factors, accounts for observed associations between cesarean delivery and BMI z score in some earlier studies…

C-section does not increase the risk childhood obesity, but rather the maternal characteristics that lead to the need for C-section are responsible for the observed increased risk of childhood obesity.

That’s consistent with a variety of recent studies.

Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery found:

…[T]here was no discernable effect of the cesarean mode of delivery on the early microbiota beyond the immediate neonatal period (and never inclusive of that in the meconium or stool) …

A Critical Review of the Bacterial Baptism Hypothesis and the Impact of Cesarean Delivery on the Infant Microbiome showed:

Although most studies report no differences in the microbiome of VD and CSD neonates in the first days of life, evidence is compelling that differences begin to develop shortly thereafter and persist for weeks or months.

That suggests that it is not the mode of delivery that contributes to the difference.

Mother-to-child transmission of obesogenic microbes continues to disrupt microbiome patterns into early childhood. Galley et al. found that the gut microbiomes of toddlers born to obese mothers of high socioeconomic status (SES) clustered away from those of toddlers born from lean high SES mothers…

It’s not the C-section but rather the mother’s microbiome itself.

Sharp eyed readers will recall that it was a within-family study that put to rest the notion that breastfeeding has massive health benefits.

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, showed:

When we more fully account for unobserved heterogeneity between children who are breastfed and those who are not, we are forced to reconsider the notion that breastfeeding unequivocally results in improved childhood health and wellbeing. In fact, our findings provide preliminary evidence to the contrary. When comparing results from between- to within-family estimates, coefficients for 10 of the 11 outcomes are substantially attenuated toward zero and none reach statistical significance (p < 0.05). Moreover, the signs of some of the regression coefficients actually change direction suggesting that, for some outcomes, breastfed children may actually be worse off than children who were not breastfed.

In other words, the benefits of breastfeeding had been dramatically overstated because of failure to fully correct for confounding variables.

Similarly this new within-family analysis suggests that the benefits of vaginal birth have also been dramatically overstated because of failure to fully correct for confounding variables. C-section does not increase the risk of childhood obesity. The risk is increased because of the factors that led to the C-section, not the C-section itself.

Medical ethicist Susanne Brauer has written:

Obstetrics and midwifery are value-laden, value-producing and value-reproducing practices, values that constitute the social perception of what it means to be a ‘‘good’’ pregnant woman and to be a ‘‘good’’ (future) mother.

Similarly, professional lactation support is also value-laden, value-producing and value-reproducing.

There’s no better example of this behavior than their fraught relationship with maternal autonomy.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Midwives and lactation consultants sugar coat their paternalism by claiming that women who don’t follow their recommendations need more “support.”[/pullquote]

If there is one thing midwives are sure of, it’s that they are committed to maternal autonomy. They believe deeply that women are entitled to choose place of birth, birth attendant, birth support, vaginal birth, refusal of procedures, refusal of pain medication and refusal of hospital policies (e.g. separation of mother and child after birth) that do not serve their needs.

Yet there’s another thing they’re equally sure of: some maternal choices are better than others.

Similarly, lactation consultants are committed to maternal autonomy: women are entitled to choose where, when and for how long they breastfeed. They are entitled to choose public breastfeeding, breastfeeding in Parliament or locations otherwise restricted to professional behavior, breastfeeding on demand and breastfeeding toddlers or older children.

Yet there’s another thing they’re equally sure of: the choice to breastfeeding is better than the choice to formula feed.

How do midwives and lactation consultants square their ostensible commitment to maternal autonomy with promotion of specific maternal choices? Ironically, they rationalize it with paternalism, a practice thoroughly inconsistent with maternal autonomy.

What do we mean by autonomy in a pregnancy/early motherhood setting?

From a legal point of view every medical intervention, including therapeutic, palliative, diagnostic and preventive measures, is potentially an infringement on the bodily and psychological integrity of the patient—regardless of whe- ther the intervention is medically necessary. Each inter- vention is therefore in need of consent from the (competent) patient in order to be legitimate (special cases are emergency cases and medical decisions concerning incompetent or unconscious patients). This is especially true for routine prenatal care where the purpose of medical intervention is diagnostic and preventive in nature, and not the treatment or eradication of disease.

How can we tell if a mother’s autonomy is being respected?

1. She must receive accurate information.

2. She must receive complete information.

3. She must understand the information.

4. She must have a real choice between options.

5. While it is appropriate for a provider to convey what her choice would be in a similar situation, the provider must not exert pressure to produce that choice.

There is a massive professional and lay literature on the many ways in which obstetricians have failed to respect mothers’ autonomy. To their credit, there has been tremendous progress over the years — offering new options that privileged, primarily white women demand — but there is plenty of room for improvement. Obstetricians have replaced their paternalism, the belief that they know best, with greater respect for patient choices.

Midwives have often presented themselves as more respectful of patient autonomy than obstetricians. They spend more time eliciting patient preferences, discussing fears and making plans. They are quite comfortable, often encouraging, in promoting women’s right to refuse conventional medical tests and treatments and have offered novel options — continuous labor support, homebirth, placenta preservation, etc.

In both theory and practice midwives are actually less respectful of maternal autonomy than obstetricians because they feel no compunction about injecting their personal preferences into patient care. An obstetrician might prefer a maternal request C-section for herself, but she has no problem respecting patient preference for vaginal birth; an obstetrician might prefer an epidural for herself but she has no problem respecting patient preference for unmedicated birth; an obstetrician might prefer every possible prenatal test for her baby but she has no problem acknowledging that some women want as few as possible while still being compatible with safety.

Midwives, in contrast, prefer unmedicated vaginal birth for themselves and tout it to their patients. Indeed, they go so far as to label their preferences as “normal birth” and run campaigns to promote it. They argue vociferously against “interventions,” including effective pain relief in labor. For most midwives maternal request C-sections are anathema.

Lactation consultants don’t even pretend to respect patient autonomy. They have created the Baby Friendly Hospital Initiative and promoted public health campaigns, legislation and restrictions of formula, all explicitly designed to privilege exclusive, extended breastfeeding over any other possible choice (formula feeding, combo feeding).

How do midwives and lactation consultants defend their blatant violations of maternal autonomy? The exact same way that obstetricians always justified their violations of maternal autonomy: with paternalism. They believe unmedicated vaginal birth and breastfeeding are better for mothers and babies and that justifies pressuring women into approved choices.

When you point out to them that they are emulating the worst habits of patriarchal medicine, they double down. Instead of reflecting on the irony that they are promoting specific choices instead of maternal choice, they ignore the issue of autonomy altogether. In their account the problem with obstetricians is not that they failed to offer women choices; but that they offered a single choice that was inferior to the single choice that midwives offer.

For example, they applaud obstetricians offering women the choice of VBACs after multiple C-sections or breech vaginal births, because vaginal birth is better. They decry obstetricians offering women maternal request C-sections because C-sections are inferior.

Midwives and lactation consultants have offered one innovation to the practice of ignoring maternal autonomy, however. Obstetricians were quite forthright in asserting that their education and training justified their paternalism. Midwives and lactation consultants sugar coat their paternalism by claiming that women who don’t follow their recommendations need more “support.” But support means helping each mother to achieve HER goals, not the providers goals. We have another word for that: pressure. Midwives pressure women to have vaginal births; they pressure women to refuse epidurals or they sabotage their efforts to get epidurals. Lactation consultants privately and sometimes publicly deride women who can’t or don’t wish to breastfeeding as lazy, ignorant and manipulated by formula companies.

Obstetrics has a long history of paternalism; but to the credit of obstetricians most now recognize this and try to do better. Midwifery and professional lactation support rest firmly on paternalism, the belief that midwives and lactation consultants know best. Sadly they refuse to recognize their own paternalism and therefore continue to impose it.

Last week the Royal College of Midwives took the extraordinary step of reminding its members that every women has the right to bottle feed and that the choice should be suppported and respected. It was an implicit acknowledgement of just how harmful promotion efforts like the Baby Friendly Hospital Initiative have become. Babies’ physical health and women’s mental health are being compromised by the mantra that “breast is best” and, in particular, the risk based language (“artificial baby milk,” “risks of formula feeding”) and tactics (locking up formula, making women sign formula consents) often employed.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The Baby Friendly Hospital Initiatve, as well as the lactivists who promote it, are engaged in unethical violations of women’s autonomy.[/pullquote]

Literally tens of thousands of babies and women are suffering each and every year from these pernicious tactics and it could have been avoided if lactation professionals had considered the ethical dimensions of their language and policies. Indeed, this exact situation — suffering as a result of unethical promotion efforts — was predicted back in 2006 by Rebecca Kukla. Kukla is Professor of Philosophy at Georgetown University and Senior Research Scholar at the Kennedy Institute of Ethics.

In 2006 Kukla published a paper in Hypatia, a journal of feminist philosophy, entitled Ethics and Ideology in Breastfeeding Advocacy Campaigns.

Writing about breastfeeding promotion in 2006, she makes the following claim:

I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women’s actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets.

And that’s precisely what has happened.

Kukla’s thesis was that breastfeeding promotion efforts violated women’s autonomy and sense of agency while simultaneously ignoring women’s stated reasons for being unable to or choosing not to breastfeed.

She starts with the often unexamined belief that by controlling women we can control children’s health:

Accordingly, many of our public health initiatives specifically target mothers’ choices, as though these were morally and causally self-contained units of influence; if only we could talk women into making the right choices, these initiatives presume, then children would turn out healthy. However, even if we grant that, given our social division of labor and the natural facts of reproduction, mothers really do have special duties as caretakers of their children’s health, this does not justify the conclusion that mothers’ agential, independent, responsible choices exert primary control over child health outcomes, nor that these choices are straightforward and self-contained sites of moral accountability. We need a more sophisticated ethical analysis in order to avoid an easy individualist politics of blame and a single-minded public health strategy.

By 2006 lactivists had spent more than a decade pressuring to breastfeed yet breastfeeding rates were still considered low:

First, why isn’t the information that “breast is best” — now disseminated in every form, from the bare slogan to detailed scientific information, through hospitals, community health centers, media campaigns, advice books, prenatal classes, Web sites, and parenting magazines, in every language, in Braille and in large font — enough to make women choose to breastfeed? … Second, given that breastfeeding advocates imagine and promote breastfeeding as a joyous natural bonding experience, how can they explain the behavior of the majority of American women, who initiate breastfeeding (presumably with the intention of continuing) but quit early?

They concluded that women needed ever more “education” as well as increased pressure produced by employing risk based language and tactics.

This view is patronizing at best:

We need to think hard about the condescension and even the strategic imprudence involved in throwing our social resources into finding yet more ways of giving women information they already have. Even more fundamentally, we need to question our assumption that improper education is the cause of low breastfeeding rates.

It pathologizes women who can’t or don’t want to breastfeeding:

Rather than looking to the social and symbolic context that might make her feelings explicable and reveal her needs, we pathologize her, casting her as deviant and unmotherly… The emphasis here on personality lays the responsibility for a less-than-joyous breastfeeding experience directly upon the individual character of the mother, while invoking a litany of stereotypical images of gendered virtue.

Hence lactation professionals feel justified in using tactics — like the Baby Friendly Hospital Initiative — that deprive women of autonomy and agency.

I want to end by arguing that the current strategies and imagery used by American breastfeeding advocates … are not only inappropriate, but also constitute unethical assaults on new mothers’ autonomy and agency…

How?

Public health ethics often focuses on analyzing the extent to which restrictions of autonomy that curtail free choice (such as helmet laws, smoking bans, and, to a lesser extent, campaigns designed to change behavior) are justified by their welfare benefits. But I want to suggest that such limitations on negative liberty usually do not cut as deep into people’s intact agency as do violations that undercut our ability to make responsible, agential choices at all. If we have no morally livable options open to us, or if our moral judgments and risk judgments have been seriously distorted by the messages we receive from our culture, then our ability to exercise autonomous agency has been crippled … Autonomy, on any full-bodied account, involves the positive capacity for responsible action, and this capacity is compromised when we are offered only morally distorted representations of reality and self-damaging choices. Contemporary breastfeeding advocacy chips away at the autonomous agency of American mothers …

She concludes:

The breast vs. bottle debate is sometimes framed in terms of the competing interests of mothers and infants … but, overwhelmingly, these interests do not in fact compete. It is in a baby’s interest to have a competent, comfortable mother, and in a mother’s interest for her baby to be healthy and well nourished. Most mothers care deeply about their role as caretakers of their children’s health. Once we begin from this premise, rather than from the assumption that mothers are selfish or stupid until proven otherwise, we need to conclude that since most mothers also already know about the important health benefits of breastfeeding, they would do it if they realistically could.

With respect to breastfeeding, our public health goal should be to make breastfeeding a livable, comfortable, well-informed option for women, and not to cripple women’s ability to find a way of making caring choices for their children.

The Baby Friendly Hospital Initiatve, as well as the lactivists who promote it, are engaged in unethical violations of women’s autonomy in an explicit effort to deprive them of agency in choosing how to feed their children. The result has been injuries and deaths for babies and anguish for mothers. The Royal College of Midwives has acknowledged the harm; sadly, many lactation professionals still can’t bring themselves to do so and continue to write articles and make Facebook and Twitter comments that are both condescending and cruel.

Lactivist Prof. Amy Brown has a new piece on The Conversation this morning. It’s entitled Breastfeeding is not ‘easy’ – stop telling new mothers that it is and it’s a clumsy effort to deny that lactation professionals have spent the last decade pressuring, shaming and blaming women who can’t or don’t breastfeed.

It’s difficult to talk about breastfeeding in a productive way right now…

One of the traps public health promotion can fall into is being so keen to promote breastfeeding that any challenges get glossed over, through fear that it’ll put women off. Instead breastfeeding gets painted as some kind of idyllic, simple, miracle cure for all ills…

Sounds good, right?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s the difference between life and death.[/pullquote]

Until you get to this:

Breastfeeding is not easy. It requires women’s time and investment and can be a steep learning curve…

What in life worth doing is easy? We put ourselves through challenges all the time. We work hard for exams. We train for races. We do it because we think it’s worth it, not because it’s easy. And we expect others to support us. Imagine our outrage if we were training for a race and everyone suggested it wasn’t worth it.

Faux empathy with a helping heaping of more pressure, blame and shame. Talk about tone deaf!

It’s difficult for me to understand such a profound lack of empathy for the feeding struggles of new mothers but perhaps it comes from some fundamental differences between lactation professionals like Brown and a feeding safety expert like Christie del Castillo-Hegyi, MD of the Fed is Best Foundation.

1. It’s a difference in personal experience.

I don’t know it for a fact, but I suspect that Amy Brown did not have to watch one of her children struggle with the effects of dehydration induced brain injury.

In contrast, Dr. del Castillo-Hegyi’s eldest son sustained a breastfeeding related brain injury:

My son was born 8 pounds and 11 ounces after a healthy pregnancy and normal uneventful vaginal delivery. He was placed directly on my chest and was nursed immediately. He was nursed on demand for 20-30 minutes every 3 hours. Each day of our stay in the hospital, he was seen by the pediatrician as well as the lactation consultant who noted that he had a perfect latch. He produced the expected number of wet and dirty diapers. He was noted to be jaundiced by the second day of life and had a transcutaneous bilirubin of 8.9. We were discharged at 48 hours at 5% weight loss with next-day follow-up.

… We saw our pediatrician at around 68 hours of life (end of day 3). Despite producing the expected number of wet and dirty diapers, he had lost 1 pound 5 ounces, about 15% of his birth weight… Our pediatrician told us that we had the option of either feeding formula or waiting for my milk to come in …

Wanting badly to succeed in breastfeeding him, we went another day unsuccessfully breastfeeding and went to a lactation consultant the next day who weighed his feeding and discovered that he was getting absolutely no milk… We fed him formula after that visit and he finally fell asleep. Three hours later, we found him unresponsive. We forced milk into his mouth, which made him more alert, but then he seized. We rushed him to the emergency room. He had a barely normal glucose (50 mg/dL), a severe form of dehydration called hypernatremia (157 mEq/L) and severe jaundice (bilirubin 24 mg/dL)…

These numbers put her son at high risk of brain injury and indeed:

At 3 years and 8 months, our son was diagnosed with severe language impairment, autism, ADHD, sensory processing disorder, low IQ, fine and gross motor delays. He was later diagnosed with a seizure disorder associated with injury to the language area of the brain…

2. It’s a difference in professional training

Amy Brown is a professor of psychology. To my knowledge she has no medical training. Dr. del Castillo-Hegyi, in contrast, studied the effects of glucose on neonatal ischemic brain injury at Brown University and is a practicing, Board Certified Emergency Room physician.

It’s not really surprising then that Dr. del Castillo-Hegyi has much more experience with the medical aspects of breastfeeding and its complications.

3. It’s the difference between having no responsibility for patient care and having ethical and legal responsibility for the care of the vulnerable.

Amy Brown never has to see the results of her “advice.” She just gives it and assumes it works. Dr. del Castillo-Hegyi takes responsibility for providing medical advice and sees the effect of her recommendations every time she steps into the ER.

4. It’s the difference between “easy vs. easier” and “possible vs. impossible.”

Breastfeeding, like pregnancy, has a substantial failure rate. Current best estimates are that as many as 15% of first time mothers cannot produce enough breastmilk to fully nourish a baby, particularly in the early days. That’s significant but not as high as the natural miscarriage rate of 20%.

Imagine if lactation professionals like Prof. Brown treated women who miscarried like they treat women who can’t breastfeed because they don’t produce enough milk. Would insisting that pregnancies could be divided into easy or easier address their problems? Would efforts to make their pregnancies “easier” prevent miscarriage? Would refusing to acknowledge the biological basis of miscarriage reduce the suffering of these women? No, no and no.

The situation is the same when it comes to breastfeeding. For the 15% of women who are biologically unable to produce enough breastmilk particularly in the early days after birth, would making breastfeeding “easier” increase milk output? Would ignoring the consequences of infants screaming frantic from hunger and mothers weeping desperate to soothe their babies increase milk output? Would refusing to acknowledge the biological basis of insufficient lactation reduce the suffering of these women? Of course not, yet that is precisely what lactation professionals continue to offer instead of being honest about medical reality.

5. It’s the difference between process and outcome.

Prof. Brown promotes breastfeeding (a process); Dr. del Castillo-Hegyi promote healthy babies and healthy mothers (an outcome). That might involve exclusive breastfeeding, combo feeding or exclusive formula feeding. I suspect that Prof. Brown imagines that breastfeeding guarantees a healthy outcome, but that’s because she’s ignoring the latest scientific evidence and not listening to what struggling mothers are telling her. Breastfeeding has a high failure rate that leads to suffering, injury and death. That’s why breastfed babies are readmitted to the hospital at double the rate of bottle fed babies. That’s why there is a growing problem with infants presenting with profound dehydration. That’s why 95% of cases of kernicterus (jaundice induced brain damage) can be traced back to breastfeeding.

6. It’s the difference between an echo chamber and an uphill battle.

As we speak Prof. Brown is currently enjoying the atta-girls from dozens of lactivist colleagues on Twitter. She never appears in a setting where her ideas and claims can be subjected to probing questioning from other medical professionals. In contrast, Dr. del Castillo-Hegyi occupies the same place in the breastfeeding world that Ignaz Semmelweis purportedly occupied in the world of puerperal fever. Her knowledge, her integrity and her sanity are repeatedly called into question. Lactation professionals ignore the data she presents and the warnings she issues, demeaning and insulting her.

7. It’s the difference between life and death.

Dr. del Castillo-Hegyi is desperately trying to prevent agonizing infant hunger, prevent neonatal brain injuries and deaths and prevent the maternal suffering that results from all three. Prof. Brown ignores those outcomes, refuses to acknowledge the frequency with which they occur and refuses to listen to what women are telling her. Tragically, that can be the difference between life and death.

What’s the ethical response when a provider learns that a course of action she recommended has caused unintended harm?

Lactation consultants believe (because they teach and tell each other) that breastfeeding is best for every baby. As a result, they have harmed tens of thousands of babies and mothers for whom breastfeeding will never and can never be best. The Royal College of Midwives obliquely acknowledged that harm by reminding midwives that bottle feeding is a valid choice and that women who choose it merit respect and support.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Milli Hill, Amy Brown and Sheena Byrom among others are on Twittter right now engaged in this unethical behavior even as we speak.[/pullquote]

Midwives in general and UK/Australian midwives in particular believe (because they teach and tell each other) that unmedicated vaginal birth, so called normal birth, is best for nearly every mother and baby. As a result they have harmed untold numbers of mothers and babies who have sustained birth injuries, brain damage or even died when complications were ignored in the pursuit of vaginal birth. The Royal College of Midwives obliquely acknowledged that harm by shuttering their Campaign for Normal Birth.

Those are nice first steps, but sadly the RCM did not go far enough. As a result the bullying of mothers continues and many of the rank and file feel free to ignore the admonitions. Medical ethics requires more of providers who issue a recommendation that causes unintended harm than simply stopping the harmful recommendations. Ethics requires acknowledgement of the harm, support of those who have been harmed and reevaluation of the scientific evidence that undergird the harmful recommendation.

Instead, lactivists, like UK/Australian midwives before them have done the opposite.

• They’ve denied the harms.
• They’ve derided the parents of babies who have been harmed and called them liars.
• They’ve impugned the integrity of safety advocates.
• They’ve dismissed the scientific evidence of harm.
• And they’ve invoked their good intentions to absolve themselves of responsibility.

Milli Hill, Amy Brown and Sheena Byrom among others are on Twittter right now engaged in this unethical behavior even as we speak.

Imagine for a moment if the doctors who prescribed DES (diethylstilbestrol) had behaved like Hill, Brown and Bryom.

Diethylstilbestrol (DES) was first synthesized in 1938 and was the first orally active nonsteroidal estrogen that could be used for human therapy. At that time, endocrinology was in its infancy and this discovery was a unique and great advance. Recurrent pregnancy loss was a serious medical problem then as it is now. It was believed the problems were due to a faulty hormonal environment of the fetal-placental unit, rather than primarily to genetic causes, as we have subsequently learned.

The result was unforeseen disaster.

Then, in the late 1960s, eight extraordinarily rare cases of clear cell adenocarcinoma (CCA) of the vagina were diagnosed and treated in women in their teens and early 20s in the Boston area. No such cluster of cases in young patients had ever been seen previously. CCA of the vagina was known to be a cancer that rarely occurred even in older women. In an effort to understand the cause of this cluster, a case-control study was conducted at the Massachusetts General Hospital in 1971 that linked the appearance of these cancers to the patients’ mothers having been treated with DES …

Subsequently, DES use during pregnancy was associated with other adverse health effects in the exposed female offspring, including an increased frequency of anatomic problems in the female genital tract … all of which led to pregnancy complications including premature birth of offspring of the DES-exposed daughters…

How did the medical profession respond?

They acknowledged the harms, indeed they publicized the harms in an effort to inform any woman who might be affected.

They validated the harms that had befallen the affected women. They did not accuse them of lying about the harms; they did not impugn their integrity; they did not ignore the scientific evidence.

They did not invoke their unquestionably good intentions to avoid responsibility.

They reassessed the scientific evidence and the faulty conclusions they had drawn from it.

In contrast, lactivists and many midwives are still in deep denial despite both scientific evidence and testimonials of harm on both social and mainstream media.

Dr. Miriam Stoppard rightly takes them to task over their denial in regard to breastfeeding.

I don’t know which I feel more, anger or relief, at the announcement from the Royal College of Midwives (RCM) that mothers who choose to bottle feed their babies must be respected.

What took them so long to realise their rigid adherence to a policy of pressuring women to breastfeed was cruel and heartless?

Legions of bottle-feeding mothers have been humiliated and made to feel failures, guilt and shame by hard core midwives and health visitors who toed the party line and used “breast is best” as a whip to subjugate new mums.

I couldn’t have said it better myself!

The RCM is now all appeasement. “We know every woman wants the best for her baby and we want to be able to empower our members to support women to be the best they can be and enable them to make decisions that are right for themselves and their babies.”

But what about all those terrified mothers who were bullied and harassed by health care professionals making their lives a misery?

An apology would seem appropriate.

An apology would be nice, but a good first step would be to reprimand the Milli Hills, Amy Browns, and Sheena Byrons for their unethical behavior and publicly tell them to stop.

Lactivists are spluttering on Twitter.

They’ve been apprised over and over again about the harm that they’ve caused:

• The epidemic of neonatal hospital readmissions (tens of thousands per year) for dehydration, hypoglycemia and jaundice.
• The permanent brain injuries and deaths that result.
• The heartless closing of well baby nurseries to force women to undertake full care of their babies the moment the placenta has been delivered.
• The babies who’ve been injured and died because of smothering in or falling from their mothers hospital beds.
• The mental anguish of mothers who have been encouraged to let their babies scream in hunger because “breast is best.”
• The guilt and suffering of women who want to breastfeed but are physically unable to do so.
• The thousands of testimonials, Facebook posts and tweets from women who are angry that lactivists lied to them, pressured them, and shamed them.

How dare anyone mention the babies who have suffered as a result of their propaganda? How dare any mother share her own anguish at breastfeeding pressure? How dare anyone fail to recognize that lactation professionals are the “good guys”?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If lactation professionals acknowledge the suffering they’ve caused maybe they aren’t the good guys after all.[/pullquote]

It’s this last issue that’s most important.

As I written repeatedly over the years, breastfeeding activism is not about babies; it’s about mothers and how they wish to view themselves: as better, more loving, more educated, more committed to self-sacrifice than women who bottlefeed. And what goes for breastfeeding mothers goes double for lactation professionals since they “support” mothers into becoming better, more loving, more educated, more committed to self-sacrifice than the lazy, stupid, selfish women who bottle feed.

Lactivists can’t apologize for the harm they’ve caused because they can’t bear to acknowledge suffering they’ve caused. Because if they acknowledge the suffering they’ve caused maybe they aren’t the good guys after all and that is simply intolerable.

How intolerable?

They are incredible snowflakes. Most lactation professionals have blocked me on Twitter because they can’t bear to have their beliefs called into question.

They are furious at the charges I have leveled against them for the above mentioned suffering, as well as their sexist invocation of biological norms and their mind boggling hypocrisy, yet they can’t seem to respond in a measured way with facts and scientific citations.

They are so indignant at the possibility that they have harmed anyone that they have endlessly tried to smear the Fed Is Best Foundation and Christie del Castillo-Hegyi and Jody Segrave Daly who run it.

They prefer to tell each other that the formula industry is behind every woman who cries out in anguish rather believe their cries.

They have the temerity to insist that breastfeeding is not supported when there is an entire profession, an army of providers and government policy supporting it.

They cling fiercely to the notion that they are the victims, while assiduously ignoring the babies and women who are the real victims. They must be the victims when they are the good guys, right?

But here’s the problem, lactivists:

When someone shows you evidence that you’ve hurt them, you don’t get to decide you haven’t. If you want to hold yourself blameless you must provide evidence that those harms did not occur or that aggressive breastfeeding pressure wasn’t responsible for those harms.

When someone tells you that they felt anguished, pressured and shamed by lactation professionals, you don’t get to decide that they misunderstood or it’s all in their head.

When women whose babies have been harmed or have seen the harm that has befallen other women’s babies set up a Foundation to promote safety in infant feeding, you don’t get to impugn their motives, imply they are taking bribes from the formula industry, or declare that they hate breastfeeding.

When you have hurt as many infants and mothers as you have, you don’t get to claim that you are the good guys. It doesn’t matter how pure your motivations, if you hurt babies and women — and there is no doubt that you have done so — you aren’t the good guys.

I don’t expect apologies from the Amy Browns and Kimberly Seals Allers of the world, but is it too much to hope for personal reflection? The Fed Is Best Foundation currently has over 560,000 supporters on Facebook; that’s a lot of women and babies who have suffered and continued to suffer because of aggressive breastfeeding promotion. Are they all lying? Are they all misunderstanding? Are they all in the employ or under the sway of formula companies? Or is the real problem that lactation professionals have been lying to themselves about being the good guys?

When thousands of women tell you they are hurting because of your actions, you aren’t entitled to call yourselves the good guys.

The lactivist whining continues!

This week the Royal College of Midwives reminded its members that women have an absolute right to choose bottle feeding and are entitled to respect for that choice.

Why did they do that? I’d like to think it’s because they recognized that the benefits of breastfeeding in industrialized countries are trivial, that pressuring women to breastfeed is deeply sexist — violating a women’s right to bodily autonomy — and because they recognized the suffering and anguish they were causing.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists imagine themselves as motivated by love for babies and fealty to science and imagine women who don’t breastfeed as lazy, selfish, under the sway of formula companies or lacking support.[/pullquote]

But I’m a cynical person and I suspect that the real reason was that aggressive breastfeeding promotion is starting to cost the National Health Service serious money. Breastfed babies are readmitted at double the rate of bottle fed babies. Massive financial judgments are being paid out to compensate parents whose babies were brain injured or died. And that’s on top of the millions of dollars wasted to aggressively promote breastfeeding. Moreover, none of the promised benefits in lives or healthcare dollars saved has materialized.

It’s hardly a coincidence that the RCM was also forced to shutter their Campaign for Normal Birth. It, too, had become too costly in lives and money and failed to provide the promised benefits.

In response, lactivists have continued doing what they do best — lying, shaming, and asserting victimhood.

Consider this tweet from Kimberly Seals Allers:

As #breastfeeding is under attack, we need ALL WOMEN to see the right for women to choose & if so, be properly supported to use their bodies for their biological norm as a Women’s issue. Instead of falling prey to ways of dividing us.

As I noted on my Facebook page, claiming that respecting bottle feeding means breastfeeding is under attack is like claiming “black lives matter” means white people are under attack. Seals Allers dropped in to chastise me.

… Dear NonPracticing OB, I see that you are very consistent with your lack of context and rabble rowsing, while the rest of us are actually at work in the community. But I won’t address your collapsing methaphors and logic gaps — I am used to those but I will address the lack of facts: I never said supporting bottle feeding was attacking breastfeeding –YOU SAID THAT. I support bottle-feeding all the time. Have you been to where I work in Detroit???? And Philadelphia??? I have invited you and Christine on many occasions… Women must use bottles. Women also use formula!! And I support them!!! …. So please get your facts straight. When I say breastfeeding is under attack (And thank you asking instead of making blatant ASSumptions), I mean the commercial interests– the multi-million infant formula contracts, the multi-billion lobbying against WHO Code guidelines and the multi-billion dollar drug industry, the sensational headlines that pit mothers against mothers (your MO) and don’t get to the policy gaps that can save lives (including more training for physicians on lactation failures as I’ve also said many times) –so I don’t know who said I don’t respect bottle feeding because I do. PLEASE GET YOUR FACTS STRAIGHT!!! …

So many words, so little substance! And so much attribution bias.

In psychology, an attribution bias or attributional bias is a cognitive bias that refers to the systematic errors made when people evaluate or try to find reasons for their own and others’ behaviors. People constantly make attributions regarding the cause of their own and others’ behaviors; however, attributions do not always accurately reflect reality. Rather than operating as objective perceivers, people are prone to perceptual errors that lead to biased interpretations of their social world.

Simply put, attribution bias or error is the tendency to ascribe one’s own mistakes to lofty motives and other people’s behavior to malice.

Attribution error is fundamental to contemporary lactivist theory which imagines all lactation professionals motivated by love for babies and fealty to science and imagines all women who don’t breastfeed as lazy, selfish, under the sway of formula companies or lacking “support.”

Seals Allers demonstrates attribution bias by assuring us of her pristine motivations and attributing base motivations to me.

But the facts are indisputable: Babies are dying because lactivists are lying about the instrinsic failure rates of breastfeeding. Healthcare costs are rising because breastfed babies are being readmitted at twice the rate of formula fed babies, suffering from dehydration, hypoglycemia and jaundice. Liability payments are soaring as babies sustain permanent brain injuries or even die as a result of aggressive breastfeeding promotion. The promised saving from breastfeeding promotion have utterly failed to appear.

Seals Allers excuses herself and her colleagues for culpability in these injuries and deaths because their motives were pure.

She apparently can’t imagine that my motives are pure, too. I want to stop the neonatal brain injuries and maternal anguish at inability to breastfeed. And I have no connection to the evil formula industry, which in any case, has nothing to do with the intrinsic failure rate of breastfeeding.

I’m not so sure the motives of Seals Allers and other lactivists are entirely pure; they make money from lactivism and they feel superior for having breastfed. But that doesn’t really matter; if we want to stop these easily preventable injuries and deaths, and well as maternal anguish, lactivists must take responsibility for the fact that they lied and babies died as a result. Most importantly, they need to stop lying!

They may have had the best of motives, but that does not absolve them. Trying to deflect attention by questioning others’ motives doesn’t absolve them, either.

The road to hell is paved with good intentions.

Moral certainty can be used to justify the harm done by failing policies and actions. Those with good intentions believe their practices are good for the group; it is self-evident to them. They justify collateral damage in the belief they do a greater good.

I don’t doubt that your intentions were good, Ms. Seals Allers, despite the harm that has occurred as a result. Please give feeding safety advocates like me the credit for the same pure motivations you give to yourself.

Let the lactivist whining begin!

I wrote yesterday that the Royal College of Midwives issued a statement of what should have been obvious all along:

Bottle feeding is a woman’s right

New mothers ‘should not be shamed into breastfeeding’

Bottle feeding mothers’ ‘choice must be respected’ midwives advised

Prof. Amy Brown, like most professional lactivists, is upset that her unfettered ability to mentally torture new mothers by locking up formula, making women sign formula consents and refusing to provide information about bottle feeding has been curtailed.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Should women believe their own feelings of midwife induced pressure, shame and guilt, Amy Brown, or you?[/pullquote]

She expresses her frustration in a new piece What are women’s ‘rights’ when it comes to infant feeding? I notice that Prof. Brown puts the word rights in quotes implying from the start that women don’t really have any rights to control their own breasts.

But even worse, Prof. Brown appears to believe that women have no right to tell their own stories of mental torture to the press.

The right for the media to not sensationalise women’s experiences to make money.

…[W]omen do not deserve those headlines. Many a woman in my research has talked about how they hate and blame themselves, feeling like failures. Equally, many a woman has struggled on breastfeeding, through pain, confusion, exhaustion… because she couldn’t get the support she needs.

And the media thinks this is news? Heartbreak is not news. It is not there to sell papers. The only thing it is there for is to learn from and to move forward. And no one does that by stirring up layers and layers of deep hurt.

That would be hilarious if it weren’t so hypocritical. Brown has spent that last years using the media to publicly bewail the “lack of support” for breastfeeding, including:

Low UK breastfeeding rates down to social pressures over routine and sleep sensationalizing the selfishness of new mothers who want to get sleep to recover from childbirth.

Why Fed Will Never Be Best: The FIB Letting Our New Mothers Down sensationalizing the purported lack of support for breastfeeding and bitterly mocking women who have insufficient breastmilk by obnoxiously and falsely asserted that insufficient breastmilk is rare when it is quite common (up to 15% of first time mothers in the first few days after birth).

The breathtakingly hypocritical Don’t We Deserve Fairer Priced Formula Milks? arguing in direct opposition to basic economics that the Thewlis Bill, further restricting formula advertising in the UK, would lower the cost of formula. That’s like the anti-abortion crowd claiming that restrictive abortion laws are designed to improve the safety of pregnancy termination.

But when it comes to sensationalization, it’s hard to top Brown’s March 2018 piece Baby bottle propping isn’t just dangerous – it’s a sign of a broken society

Should women believe their own feelings of midwife induced pressure, shame and guilt, Amy Brown, or you?

Importantly, midwives do not deserve these headlines either. I have never met a midwife who has judged or criticised a woman for not breastfeeding. I have met plenty a midwife who has worked through breaks and past end of shifts to sit with a woman in pain and distress.

Brown is nothing if not an expert in gaslighting:

Those headlines are designed to do one thing – to turn women against each other, to cause arguments, to distract. They are designed to push women towards formula companies and away from each other. They are designed to divide and cause people to spend time debating a non-debate. They are designed to turn women against midwives, to turn midwives against their organisation. In other words, to cause havoc that privileges one group only – the formula industry.

Really? All those women who are telling their stories of mental distress over breastfeeding are attempting to turn women against each other and push women toward formula companies? You can’t be serious, Prof. Brown.

Gill Walton the head of the RCM wants only to turn women against midwives and to turn midwives against their organization? Are you for real, Prof. Brown?

Brown’s reveals her true obsession with this statement:

Every time we fight with each other. Every time we get distracted. Every time we fall into a trap of having to endlessly defend – they win.

While Brown may view everything through the prism of a battle to the death between lactivists and formula companies, the rest of us are concerned about BABIES.

That’s right, Prof. Brown, babies; you remember them? I can’t be sure since you didn’t bother to mention their needs at all. And that just proves the point I have been making for years: lactivism is not about babies and what they need; it’s about lactivists and how they wish to see themselves. They imagine themselves as superior mothers battling the forces of the formula industry and emerging victorious when the reality is that they are women who were lucky enough to face fewer breastfeeding problems than others and are battling for personal self-esteem, professional marketing share, and economic enrichment through greater employment opportunities.

Brown finishes with a flourish of lactivist sanctimony:

Enough of the stirring. There are no ‘sides’. We’re all fighting for the same things. More investment, more support, more value. Let’s stop the media from trying to pretend otherwise.

Sorry, Prof. Brown, there are sides and you’ve placed yourself squarely on the wrong one:

There are women on one side and lactation professionals who think they know better on the other.

There are hungry babies, babies suffering from hypoglycemia, kernicterus, and hypernatremic neonatal dehydration on one side and lactation professionals denying their suffering on the other.

There are mothers who want only to do what is best for their babies on one side and lactation professionals who refuse to listen to them, who lie about the natural failure rate of breastfeeding and who promote a process — breastfeeding — above the physical health of babies and the mental health of mothers on the other.

Fed Is Best. Fed Is Feminist. Offering lactivist “support” that women don’t want is neither.